Purpose
As the nursing profession continually evolves, practice knowledge is increasing and closing the theory-practice gap. The purpose of this discussion is to explore how nursing theory is used as a framework in nursing research, building the body of professional nursing knowledge.
- Using one of the articles provided (BELOW #2) in this week’s course announcement, identify the nursing theory used to frame the nursing research.
- Analyze the selected nursing theory and describe how the theory applies to nursing’s metaparadigm, including each of the following:
- Person
- Health
- Environment
- Nursing
Week 2 Discussion question asks you to evaluate a research article with a nursing theory as the underpinning. Use one of the following links to a recent research article in your discussion question this week.
Comfort and fluid retention in adult patients receiving hemodialysis.Links to an external site.
Estridge, K.M., Morris, D.L., Kolcaba, K., & Winkelman, C. (2018). Comfort and fluid retention in adult patients receiving hemodialysis. Nephrology Nursing Journal, 45(1), 25-33, 60.
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Barutcu, C.D. & Mert, H. (2016). Effect of support group intervention applied to the caregivers of individuals with heart failure on caregiver outcomes. Holistic Nursing Practice, 30, 272-282. https://doi.org/10.1097/HNP.0000000000000164
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Breastfeeding support guided by Swanson’s theory of caringLinks to an external site.
Miller Westmoreland C., & Wojnar, D. (2019). Breastfeeding support guided by Swanson’s theory of caring. MCN, American Journal of Maternal Child Nursing, 44, 351-356. https://doi.org/10.1097/NMC.0000000000000570
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Turan Kavradim, S., & Canli Ozer, Z. (2020). The effect of education and telephone follow-up intervention based on the Roy Adaptation Model after myocardial infarction: randomised controlled trial. Scandinavian Journal of Caring Science, 34, 247–260. https://doi.org/10.1111/scs.12793
REQUIRED TEXBOOK:
Zaccagnini, M. E. & Perchacek, J. (2021). The Doctor of Nursing Practice essentials: A new model for advanced practice (4th ed.). Jones & Bartlett Publishers.
- Read Chapter 1
REQUIRED ARTICLE:
Rosa, W. E., Dossey, B. M., Koithan, M., Kreitzer, M. J., Manjrekar, P., Meleis, A. I., Mukamana, D., Ray, M. A., & Watson, J. (2020). Nursing theory in the quest for sustainable development goals.Links to an external site. Nursing Science Quarterly, 33(2), 178-182. https//:10.1177/0894318420903495
ADDITIONAL RESOURCES:
Review the following additional resources for further exploration of the weekly topics/concepts:
American Association of Colleges of Nursing. (2004). AACN position statement on the practice doctorate in nursing.Links to an external site. https://www.aacnnursing.org/Portals/42/News/Position-Statements/DNP.pdf
American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice.Links to an external site. https://www.aacnnursing.org/DNP/DNP-Essentials
Best, D., Day, E., McCarthy, T., Darlington, I., & Pinchbeck, K. (2008). The hierarchy of needs and care planning in addiction services: What Maslow can tell us about addressing competing priorities?Links to an external site. Addiction Research and Theory, 16(4), 305–307. https://doi.org/10.1080/16066350701875185
Roy, C. (2018). Key Issues in nursing theory developments, challenges, and future directions.Links to an external site. Nursing Research, 67, 81-92. https://doi.org/10.1097/NNR.0000000000000266
Tobbell, D. A. (2018). Nursing’s boundary work: Theory development and the making of nursing science ca 1950-1980.Links to an external site. Nursing Research, 67(2), 63-73. https://doi.org/10.1097/NNR.0000000000000251
Younas, A. (2017). A foundational analysis of Dorothea Orem’s self-care theory and evaluation of its significance for nursing practice and research.Links to an external site. Creative Nursing, 23(1), 13-23. https://doi.org/10.1891/1078-4535.23.1.13
LESSON:
CHECK IN: Welcome to the second week of our journey together! Last week we learned that the DNP-prepared nurse possesses a unique skill set to apply evidence to address patient care problems and improve outcomes. This expertise is guided by nursing science and theory—the scientific underpinning of nursing practice.
This week, we will introduce nursing theory development, linking it to nursing science. Also, we will explore how nursing science differs from medical science, and the philosophical foundations that underlie nursing’s knowledge development.
Understanding the philosophical foundation of nursing science, the values, beliefs, and ideas informing the decisions and actions of the DNP-prepared nurse, is essential to effective advanced nursing practice. Let’s examine how you will use these scientific foundations differently than other healthcare providers.
Foundations for Learning
Since the groundbreaking work of Florence Nightingale, nurses have sought to understand the art and science of nursing. Nursing gained a structured process enveloping philosophy, conceptual models, theories, and knowledge that developed with the intent of improving nursing practice and positively impacting patient outcomes. Nursing continues to build nursing knowledge with these underpinnings. The following article provides recent thoughts of one of our nursing leaders, Dr. Jacqueline Faucett:
Faucett, J. (2020) Thoughts about nursing science and nursing sciencing revisited.Links to an external site. Nursing Science Quarterly 33(1), 97-99. https://doi.org/10.1177%2F0894318419882029
Scientific Underpinnings for Practice—Nursing Theory
Philosophical Foundations of Nursing
Nursing’s knowledge development is relatively new, underpinned by theory and nursing research that developed around the 1940s after World War II. Since the groundbreaking work of Florence Nightingale, nurses have sought to understand the art and science of nursing. Before a structured process enveloping philosophy, conceptual models, and theory evolved, knowledge was gained through tradition and authority. Knowledge creation happened via a trial-and-error clinical experience and learning through apprenticeship. Nursing knowledge began with the systematic development of the first theories and conceptual models in response to a need for a dedicated body of nursing science and knowledge unique to the nursing profession. It is crucial that the practice of nursing remain rooted in theory and nursing science.
The Science of Nursing
What is nursing science and how does it differ from medical science? Nursing’s conceptual models and theory have had a profound effect on the ongoing development of nursing knowledge. Nursing theory is foundational to nursing research producing new knowledge unique to the profession. Consider that nursing science differs from medical science. Nursing science focuses on the diagnosis and treatment of the human response to health and disease. Medical science takes an alternative view with a focus on the diagnosis, treatment, and prevention of disease.
The path to the development of nursing science began with Florence Nightingale and her early contributions to research with her coxcomb diagram where she proved a positive cause and effect result of her nursing interventions. The recognition of nursing as a unique and separate profession began in the 1950s. Following was the curriculum era where educational content was developed, followed by the research era and graduate nursing era. In the 1970s, Dr. Barbara Carper identified and quantified the ways of knowing in which we gained an understanding of how nurses gain knowledge unique to the profession. Carper (1978) identified four fundamental patterns of knowing, and she went on to describe nursing knowledge and categorized knowing as empirics, aesthetics, ethics, and personal knowing. Since that time, nursing knowledge has evolved considerably through research and nursing theory development.
Major developments in nursing theory occurred during the 1970s and 1980s. A plethora of nursing conceptual models, grand theories, and middle-range theories have emerged along with new nursing science.
The Metaparadigm of Nursing
Collectively, the four phenomena of interest form nursing’s metaparadigm. The nursing metaparadigm is a conceptual framework encompassing these interrelated phenomena that are relevant to patient care:
- Nursing
- Person (Patient)
- Environment
- Health
The continuum of nursing knowledge ranges from the metaparadigm or conceptual aspects of nursing care to situation-specific or specialized theory as the most concrete form of nursing knowledge.
Metaparadigm
The metaparadigm identifies the foundational and broad conceptual boundaries of the discipline of nursing: Nursing-Environment-Health-Person.
Philosophy
Nursing philosophy provides a broad understanding of the discipline of nursing to explain the enduring beliefs nursing holds. Nursing philosophy, having been developed prior to the theory era, gives meaning to nursing philosophy and a basis for new theory.
Conceptual Models
Conceptual models address the metaparadigm providing meaning and perspectives for critical thinking specific to the nursing discipline. The conceptual models provide the lens for ongoing theory development and care of persons, family, and community.
Grand Theory
Grand theory is the broadest in scope of nursing theory consisting of a general conceptual framework, broad perspectives, and ways of viewing nursing phenomena. Grand theory provides insight to nursing practice and contains concepts that may be empirically tested.
Nursing Theory
Nursing theory isYAA an organized framework that includes a set of definitions, relationships, and assumptions that explain and guide nursing practice.
Middle-Range Theory
Middle-range theories offer a targeted link between grand theories and nursing practice. Middle-range theories are narrower and less abstract than grand theories. A middle-range theory lends support to empirical testing of specific phenomena such as pain, stress, and comfort.
Metaparadigm Interactive Transcript
Nursing Theory Development
Theory guides nursing practice and provides an organized way to view phenomena and clarify the domain of nursing. It underpins the development of nursing interventions to improve patient health and provides a framework to evaluate the effectiveness of these interventions. Just as nursing science and theory guide practice, nursing practice informs science and theory. In a complex healthcare setting, nursing practice expands and changes, and, in response, nursing theory continues to evolve.
View the following video to explore theory development as it relates to nursing practice.
Consider, for a moment, a stairway of theory development ranging from the lowest level of abstraction to the highest. At the lowest level are the general assumptions regarding the phenomena of interest to nursing that extend from nursing’s metaparadigm. Upon these assumptions exist the first landing, or philosophical discourse of nursing. The philosophical level of discourse is the most foundational level of understanding. From there, the building blocks of theory emerge at the theoretical level of discourse. The theoretical level of discourse is a higher level of understanding and examines the elements of theory, such as concepts, constructs, and frameworks. An example concept might be that of studying. As the concept is examined, one must consider the antecedent that contributes to the notion of studying. For studying to occur, additional antecedents might be necessary. Such as a desk, an open book, an engaged mind, and the like. In addition, consequences of studying must be examined. Such consequences might include increased understanding. Once a concept is thoroughly analyzed and its legitimate use and illegitimate use understood, the concept emerges as a construct. What makes a theory a nursing theory? Nurses use knowledge from many disciplines to frame nursing research. And the knowledge gained, although shared with others, is important to nursing and is used by nursing in distinctive ways. A theory that organizes nursing knowledge and offers a systematic way to explain or describe nursing practice is a nursing theory. Nursing theories clarify what we do and help establish the parameters of our profession. From relational statements, a conceptual or theoretical model emerges. From this level of development, propositional statements can be identified for testing. Such if then statements form the basis for empirical discourse and testing. Leading to theoretical validation or further refinement. Thus, the highest level of understanding would be the empirical level of discourse, in which proposed knowledge theory has been validated or refuted. [MUSIC]
Further your exploration by viewing the activity below to investigate the value and importance of nursing grand theories, middle-range theories, and borrowed theories in nursing.
As we know, grand theory is complex and is broad in scope. To exist at a level of theoretical discourse, the unique concepts of a given model must additionally specify relationships among the concepts that are central to nursing. The grand theory level derives from the conceptual model and proposes an abstract although testable theory. Once the relationships among the applicable concepts are explicated, a conceptual or theoretical model emerges at the theoretical level of discourse.
Some grand theories you may recognize are Dorthea Orems’s Self Care Deficit Theory and Dorothy Johnsons’s Behavioral System Model.
Next, we recognize that the middle-range theory can develop from grand theory, research, or practice. Middle-range practice theories offer a specific perspective regarding a practice situation and provide the framework for the clinical question (population, intervention, comparison, and outcome). Because these mid-range theories offer a very concrete and narrow exploration of phenomena of interest to nursing practice, they are typically limited to a specific practice situation under which assumptions apply. For the DNP-prepared nurse, one of the most exciting aspects of theory development is the opportunity to generate middle-range practice theory.
Some common middle-range theories you may recognize are Pender’s Health Promotion Model and Kolcaba’s Comfort Theory. Many nurses find these middle range and practice theories less abstract and subsequently can utilize them within their own nursing practice.
We must not forget the collaborative spirit of nursing. Nursing as a practice-based profession was challenged in the early 1900s to respond to the call for nursing to develop as a discipline. As nursing evolved and strides were made to develop unique nursing theory, the use of borrowed theory helped to form the underpinnings for the new theory. In addition, the contribution of the social and behavioral sciences is recognized as key to the building and creation of the first conceptual models and grand nursing theory. As the discipline grew in knowledge, theory became a natural progression following the influx of nursing research and advancing nursing education. Utilization of borrowed theories to base nursing research allows for additional nursing knowledge through a borrowed lens. The use of borrowed theory continues today.
Some popular theories you will recognize are Bandura’s Social Cognitive Theory, and Maslow’s Hierarchy of Needs.
Nursing Theory and the Theory-Practice Gap
Nursing theory has explained and validated what nurses define as nursing practice. Ongoing research will continue to validate the grand theory, middle range, and practice theories providing solutions to improve patient outcomes. Simply stated, these nursing theories provide the mechanism of testing nursing interventions through quantitative and qualitative research, producing new knowledge to apply to practice problems. Nursing theory and research are intertwined as nursing research reveals the evolving science of the discipline of nursing theory-guided practice (Younas, 2019). Ongoing nursing theory development continues with relevant concepts applicable to the growing body of nursing knowledge and produces precise practice-relevant outcomes to bridge the theory-practice gap (Reed, 2020).
COACH WRAP UP
Let’s reflect on what we learned this week regarding the scientific foundation of advanced nursing practice. You are gaining understanding about where nursing knowledge was discovered, from the patterns of knowing to theory-guided practice. The fundamental patterns of knowing were instrumental as nursing knowledge grew distinct from medical knowledge. The DNP-prepared nurse must be knowledgeable about theories. Nursing theories provide a way to define nursing as a unique discipline that is separate from other disciplines.
