What is the relationship between theory, research, and evidenced based care? 

peer reviewed articles from 4 sources within 5 years 

Several terms related to the creation of theory are found in the nursing literature. Theory construction, theory development, theory building, and theory generation are sometimes used synonymously or interchangeably. In other cases, authors have differentiated the concepts or subsumed one term as a component or process within another. These modules discuss theory development as the global term to refer to the processes and methods used to create, modify, or refine a theory. These next few modules will also describe theory construction as the final steps in theory development, in which the components of the theory are organized and linkages specified.

Theory development is a complex, time-consuming process that covers a number of stages or phases from inception of concepts to testing of theoretical propositions through research. In general, the process of theory development begins with one or more concepts that are derived from within a discipline’s philosophy. These concepts are further refined and related to one another in proposition or statements that can be submitted for empirical testing.

Therefore, the purpose of these modules is to define terminology related to theory development and discuss the purpose and process of theory development in an effort to assist in understanding practice in a more complete and insightful manner.

Module 3 provides the background needed to understand what theory is, and how it is used in nursing. These modules outline tools and techniques used to develop, analyze, and evaluate theory for utilization in nursing practice, research, administration, and education.

Conceptual themes in nursing theories

In nursing, theories are systemic explanations of events in which constructs and concepts are identified, relationships are proposed, and predictions are made to describe, explain, predict, or prescribe practice and research. Without nursing theory, nursing activities and interventions are guided by rote, tradition, outside authority such as JACHO, hunches, or they may simply be random.

Theories are not discovered, rather, they are invented to describe, explain, or understand phenomena or solve problems. In the past, nursing leaders saw theory development as a means of clearly establishing nursing as a profession, and throughout the last 50 years, many nursing scholars developed models and theories to guide nursing practice, nursing research, nursing administration, and nursing education. Theory development seeks to help the nurse understand practice in a more complete and insightful way and provides a method of identifying and expressing key ideas about the essence of practice. Theories help organize existing knowledge and aid in making new and important discoveries to advance practice.

The most abstract and general component of the structural hierarchy of nursing knowledge is called a metaparadigm. A metaparadigm is the global perspective of a discipline that identifies the primary phenomena that are of interest to that discipline and explains how the discipline deals with those phenomena in a unique manner. The metaparadigm includes worldviews of a discipline, the conceptual models and theories that guide research, and other scholarly activities. In the 1970s, a number or nursing scholars identified the consensus that the dominant phenomena within nursing science revolved around the concepts of person, health, environment, and nursing. Dr. Jacqueline Fawcett was the first nursing theorist to write on the central concepts of nursing, and formalized them as the metaparadigm of nursing in 1984. Each theorist describes the metaparadigm as reflected in their work.

  The following is a summary of each metaparadigm:

  • Nursing – This metaparadigm concept refers to the definition of nursing, the actions taken by nurses on behalf of or in conjunction with human beings, and the goals or outcomes of nursing actions.
  • Person – This metaparadigm refers to individuals, which may be recognized in a culture, as well as to the families, communities, or other groups who participate in nursing.
  • Society and Environment- This typically refers to the external elements that affect the person, significant others, and physical surroundings, as well as to the settings in which nursing occurs.
  • Health – This is the ability to function independently, successful adaptation to life’s stressors, achievement of one’s full life potential, and/or unity of body, mind, and spirit. Nursing literature indicates great diversity in the explication of health and quality of life.

Process of Theory Development

Theory is defined as “a creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena” (Chinn & Kramer, 2018, 190). The process of theory development is described in some detail by several nursing scholars. Despite slight variations related to terminology and sequencing, the sources are similar in explaining the processes used to develop theory.

The basic steps in theory development are:

  1. Concept development
  2. Statement/proposition development
  3. Theory construction (systematic organization of the linkages)
  4. Empirical testing (testing theoretical relationships)
  5. Application of theory to practice

The first step of theory development, concept development, involves creating conceptual meaning. This process provides the foundation for theory development and includes specifying, defining, and clarifying the concepts used to describe the phenomenon of interest.

Concepts are terms that refer to phenomena that occur in nature or in thought. Creating conceptual meaning uses mental processes to create mental structures or ideas to be used to represent the experience. This produces a tentative definition of the concept or concepts and a set of criteria for determining if the concept(s) exists in a particular situation. Methods of concept development are described in detail under Topic 3.

The second step in theory development is statement/proposition development. Rational statements are skeletons of theory and the means by which the theory comes together. The process of formulation and validation of relational statements involves the development of relational statements and the determination of empirical referents that can validate them. Statement analysis is a process described by Walker and Avant to thoroughly examine relational statements. Statement analysis classifies statements and examines the relationships between concepts, as well as assist in directing theoretical construction. There are seven steps in the process of statement analysis:

  1. Select the statement to be analyzed.
  2. Simplify the statement.
  3. Classify the statement.
  4. Examine concepts within the statement for definition and validity.
  5. Specify relationships between concepts.
  6. Examine the logic.
  7. Determine stability.

Following the process of statement analysis, the statements are refined and may be operationalized.

The third step of theory development is theory construction – systematic organization of the linkages, which involves the structuring and contextualization of the theory components. This includes formulating systematic linkages between and among concepts, which results in a formal, coherent theoretical structure. The format used depends on what is known or assumed to be true about the phenomena of interest. Aspects of theory construction include identifying and defining the concepts, identifying assumptions, clarifying the context within which the theory is placed, designing relationship statements, and delineating the organization or relationship among the components.

Theory synthesis is a theory construction strategy developed by Walker and Avant. In theory synthesis, concepts and statements are organized into a network or whole. The purposes are representing the phenomenon through an interrelated set of concepts and statements, describing the factors that influence the particular phenomenon, predicting effects that occur after some event, or putting discrete scientific information into a more theoretically organized form.

Theory synthesis involves three steps:

  1. Select a topic of interest and specify focal concepts.
  2. Conduct a review of the literature to identify related factors and note their relationships.
  3. Organize concepts and relational statements into an integrated representation of the phenomena of interest. Diagrams may be used to express the relationships among the concepts.

The fourth step in theory development is testing theoretical relationships. Chinn and Kramer are the only nursing scholars that include the process of replicating and validating theoretical relationships as a component of theory development. Validating theoretical relationships involves empirically grounding emerging relationships, naming empirical indicators, and testing relationships through empirical methods. In this step, the focus is on correlating the theory with demonstrated experiences. Alternative explanations are considered, based on the empirical evidence.

The fifth and final step in theory development, identified by Chinn and Kramer is applying the theory in practice – theory application. In this step, research methods are employed to assess how the theory can be applied in practice. The theoretical relationships are examined in the practice setting and results are recorded to determine how well the theory achieves the desired outcomes. The research design should provide evidence of the effect of the interventions on the well-being of recipients of care.

This process has three components. The first is selecting the clinical setting which may be a practice site, where the theoretical relationship may be observed. A second component is determining outcome variables or practice goals for application of the theory. The third component of application is implementing a method of study to examine the theory. The research should provide evidence to evaluate the theory’s usefulness.

The following is an example of theory development in which Smith (1994) developed the “Caregiving Effectiveness Model” to be applied to home care situations in which the patient requires “technologically based treatment.” The purpose of the theory is “to explain and predict outcomes of technology-based home caregiving provided by family members”

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