Nursing Research

Melanie McEwen

Matt Ng has been an emergency room nurse for almost 6 years and recently decided to enroll in a master’s degree program to become an acute care nurse practitioner. As he read over the degree requirements, Matt was somewhat bewildered. One of the first courses required by his program was entitled Application of Theory in Nursing. He was interested in the courses in advanced pharmacology, advanced physical assessment, and pathophysiology and was excited about the advanced practice clinical courses, but a course that focused on nursing theory did not appear congruent with his goals.

Looking over the syllabus for the theory application course did little to reassure Matt, but he was determined to make the best of the situation and went to the first class with an open mind. The first few class periods were increasingly interesting as the students and instructor discussed the historical evolution of the discipline of nursing and the stages of nursing theory development. As the course progressed, the topics became more relevant to Matt. He learned ways to analyze and evaluate theories, examined a number of different types of theories used by nurses, and completed several assignments, including a concept analysis, an analysis of a middle range nursing theory, and a synthesis paper that examined the use of non-nursing theories in nursing research.

By the end of the semester, Matt was able to recognize the importance of the study of theory. He understood how theoretical principles and concepts affected his current practice and how they would be essential to consider as he continued his studies to become an advanced practice nurse.

When asked about theory, many nurses and nursing students, and often even nursing faculty will respond with a furrowed brow, a pained expression, and a resounding “ugh.” When questioned about their negative response, most will admit that the idea of studying theory is confusing, that they see no practical value, and that theory is, in essence, too theoretical.

Likewise, some nursing scholars believe that nursing theory is practically nonexistent, whereas others recognize that many practitioners have not heard of nursing theory. Some nurses lament that nurse researchers use theories and frameworks from other disciplines, whereas others believe the notion of nursing theory is outdated and ask why they should bother with theory. Questions and debates about “theory” in nursing abound in the nursing literature.

Myra Levine, one of the pioneer nursing theorists, wrote that “the introduction of the idea of theory in nursing was sadly inept” (Levine, 1995, p. 11). She stated,

In traditional nursing fashion, early efforts were directed at creating a procedure—a recipe book for prospective theorists—which then could be used to decide what was and was not a theory. And there was always the thread of expectation that the great, grand, global theory would appear and end all speculation. Most of the early theorists really believed they were achieving that.

Levine went on to explain that every new theory posited new central concepts, definitions, relational statements, and goals for nursing, and then attracted a chorus of critics. This resulted in nurses finding themselves confused about the substance and intention of the theories. Indeed, “in early days, theory was expected to be obscure. If it was clearly understandable, it wasn’t considered a very good theory” (Levine, 1995, p. 11).

The drive to develop nursing theory has been marked by nursing theory conferences, the proliferation of theoretical and conceptual frameworks for nursing, and the formal teaching of theory development in graduate nursing education. It has resulted in the development of many systems, techniques or processes for theory analysis and evaluation, a fascination with the philosophy of science, and confusion about theory development strategies and division of choice of research methodologies.

There is debate over the types of theories that should be used by nurses. Should they be only nursing theories or can nurses use theories “borrowed” from other disciplines? There is debate over terminology such as  conceptual framework ,  conceptual model , and theory. There have been heated discussions concerning the appropriate level of theory for nurses to develop, as well as how, why, where, and when to test, measure, analyze, and evaluate these theories/models/conceptual frameworks. The question has been repeatedly asked: Should nurses adopt a single theory, or do multiple theories serve them best? It is no wonder, then, that nursing students display consternation, bewilderment, and even anxiety when presented with the prospect of studying theory. One premise, however, can be agreed upon: To be useful, a theory must be meaningful and relevant, but above all, it must be understandable. This chapter discusses many of the issues described previously. It presents the rationale for studying and using theory in nursing practice, research, management/administration, and education; gives definitions of key terms; provides an overview of the history of development of theory utilization in nursing; describes the scope of theory and levels of theory; and, finally, introduces the widely accepted nursing metaparadigm.

Overview of Theory

Most scholars agree that it is the unique theories and perspectives used by a discipline that distinguish it from other disciplines. The theories used by members of a profession clarify basic assumptions and values shared by its members and define the nature, outcome, and purpose of practice (Alligood, 2010; Butts, Rich, & Fawcett, 2012; Rutty, 1998).

Definitions of the term  theory  abound in the nursing literature. At a basic level, theory has been described as a systematic explanation of an event in which constructs and concepts are identified and relationships are proposed and predictions made (Streubert & Carpenter, 2011). Theory has also been defined as a “creative and rigorous structuring of ideas that project a tentative, purposeful and systematic view of phenomena” (Chinn & Kramer, 2011, p. 257). Finally, theory has been called a set of interpretative assumptions, principles, or propositions that help explain or guide action (Young, Taylor, & Renpenning, 2001).

In their classic work, Dickoff and James (1968) state that theory is invented, rather than found in or discovered from reality. Furthermore, theories vary according to the number of elements, the characteristics and complexity of the elements, and the kind of relationships between or among the elements.

The Importance of Theory in Nursing

Before the advent of development of nursing theories, nursing was largely subsumed under medicine. Nursing practice was generally prescribed by others and highlighted by traditional, ritualistic tasks with little regard to rationale. The initial work of nursing theorists was aimed at clarifying the complex intellectual and interactional domains that distinguish expert nursing practice from the mere doing of tasks (Omrey, Kasper, & Page, 1995). It was believed that conceptual models and theories could create mechanisms by which nurses would communicate their professional convictions, provide a moral/ethical structure to guide actions, and foster a means of systematic thinking about nursing and its practice (Chinn & Kramer, 2011; Peterson, 2013; Sitzman & Eichelberger, 2011; Ziegler, 2005). The idea that a single, unified model of nursing—a worldview of the discipline—might emerge was encouraged by some (Levine, 1995; Tierney, 1998).

It is widely believed that use of theory offers structure and organization to nursing knowledge and provides a systematic means of collecting data to describe, explain, and predict nursing practice. Use of theory also promotes rational and systematic practice by challenging and validating intuition. Theories make nursing practice more overtly purposeful by stating not only the focus of practice but also specific goals and outcomes. Theories define and clarify nursing and the purpose of nursing practice to distinguish it from other caring professions by setting professional boundaries. Finally, use of a theory in nursing leads to coordinated and less fragmented care (Alligood, 2010; Chinn & Kramer, 2011; Ziegler, 2005).