Nursing Theory

• Empirics
• Personal knowledge
• Intuitive knowledge
• Somatic knowledge
• Metaphysical (spiritual) knowledge
• Esthetics
• Moral or ethical knowledge

• Scientific form of knowing.
• Comes from observation, testing, and replication.

What I have learned from books based on scientific knowledge.

Knowledge gained from thought alone.

What I know from my collective education and experiences.

• Feelings and hunches.
• Not guessing, but relying on unconscious pattern recognition and experience.

gut feelings from "signs"

• Knowing of the body in relation to physical movement.
• Includes experiential use of muscles and balance to perform a physical task.

how to walk, balance while walking on ice, playing the piano, starting an IV

• Spiritual knowledge.
• Seeking the presence of a higher power.
• Include magic, miracles, psychokinesis, ESP, and near-death experiences.

Religion, believing in ghosts.

• Knowledge related to beauty, harmony, and expression.
• Incorporates art, creativity, and values.

Arranging a room to be comfortable and appealing, music.

• Knowledge of what is right and wrong.
• Values and social/cultural norms.

• "Do the right thing".
• Values taught to us by our parents, religion, school, etc.

• Origin - How did the theory come to be? What are its origins? Inductive or deductive? Come from practice? Empirical support in literature & research? What is already known?
• Meaning - How do the concepts relate to each other? What kinds of concepts are in the theory (concrete, abstract)? What kinds of definitions (theoretical, operational)? What kinds of statements (descriptive, relational, causal)?
• Logical Adequacy - Is the structure logical? Free of fallacies? Accuracy in predictions? Premises accurate & correctly drawn? Format accurate? Content make sense to experts in the field?
• Usefulness - Provide new insights? Explain phenomena better than previous theories? Allow better prescriptions? Potential to benefit nursing practice?
• Generalizability - the extent generalization can be made; the wider the usage = more generalizable. Where can this info be used?
• Parsimony - simplicity; simply stated. Statements do not overlap.
• Testability - Hypotheses can be generated; definitions are operational or observable level. If already tested, then testable.

• Systematic examination of theory
• Determines theory's strength and weaknesses
• Determine if there's need for further theory development

• Follows theory analysis
• Considered a higher level of analysis
• Evaluator makes judgments about worth of theory for making decisions and taking action

• Theory analysis - puts aside personal biases and values; concentrates on exploring the theorist's values
• Theory evaluation - evaluator's personal values and biases are considered during evaluation

• Existence - something "is"
• Correlational / associational - one concept does NOT cause the other; they occur together; positive or negative
• Probabilistic - "this" + "that" will probably result in "the other"
• Deterministic / sufficient - cause and effect; most POWERFUL type

• Identify concepts to put together in the theory (building blocks, nouns)
• Identify assumptions - statements we accept as true without systematically studying them or collecting data. Implicit = implied, NOT stated. Explicit = stated
• Develop definitions - Descriptive = describe attributes. Operational = how the concept will be measured. Theoretical = gives meaning to the terms in the context of the theory (the story of the theory)
• Develop relational statements
• Order or Systematize relational statements in a logical way that makes sense
• Test
• Revise
• Test again

• Study of science and scientific practice
• Seeks to describe and understand how science works within a wide range of sciences

• Rationalism - received view
• Empiricism - received view
• Human science / phenomenology - perceived view

• Descriptions derived from collectively lived experiences, interrelatedness, human interpretation, & learned reality
• Subjective
• Inductive reasoning
• Multiple truths
• Constructivism - theory of knowledge that argues that humans generate knowledge and meaning from their experience
• Qualitative research

• Individuals learn by being told or receiving knowledge
• Objective
• Empiricism - scientific knowledge R/T evidence; discovered in experiments
• Positivism - belief that knowledge is based on sensory experience and positive verification
• Deductive reasoning
• Validation and replication
• Quantitative research

Accepts subjective nature of inquiry but still supports rigor and objective study through quantitative research methods.

Belief that human knowledge is not based on unchallengeable, rock-solid foundations, but is conjectural.

Believe there are real grounds, or warrants, for asserting these beliefs or conjectures, but these warrants can be modified or withdrawn in light of further investigation.

• Guides interventions
• Helps determine desired outcomes
• Provide evidence of effectiveness of interventions

• Logically interpret and organize collected data
• Focus on what's important to make purposeful decisions
• Predicts outcomes
• Allows planning of nursing care

• Describe
• Explain
• Predict
• Control

• Inquiry
• Experimentation
• Collecting information

• Process - systematic inquiry based on empirical observations
• Product - empirical knowledge; results of investigation
• Focus on cause and effect
• Validates theory
• Result of relationship between theory and research

Cycle with entry @ any point, but most likely at practice

• From specific to general
• Make a generalization from many specific observations
• All premises must be validated
• If all premises true, conclusion probably true
• Conclusion provides new information

• Format: All A are B. All B are C. Therefore, all A are C.
• From general to specific
• Clarify information
• Provide no new information
• Must answer following questions:
• Are premises sound? (criteria 2)
• Does argument follow logical format? (criteria 1)
• Does conclusion make sense?

• Choose a concept.
• Determine aims/purposes of analysis.
• Identify uses of concept.
• Determine defining attributes.
• Identify model cases.
• Identify borderline, related, contrary, invented, and illegitimate cases.
• Identify antecedents and consequences.
• Define empirical referents.

• Primitive - cannot be explained; defined by example. Ex. colors, soft or hard
• Concrete - simple; directly observable; seen, felt, heard; limited by time and space. Ex. tree, chair, bird chirping
• Abstract - not observable directly or indirectly; defined in terms of observable concepts. Ex. love, hope, desire, fear
• Variable (continuous) - describe phenomena based on dimensions of the phenomena. Ex. BP, pain; measurement on scale
• Non-variable (discrete) - categories or characteristics; can be single-variable categories. Ex. gender, ethnicity, religion, marital status, can require yes or no answers

• Cannot be explained
• Defined only by example
• Ex.: colors, concepts like soft or hard

• Simple, directly observable
• Can be seen, felt, heard
• Limited by time and space
• Ex.: tree, chair, bird chirping

• Not observable directly or indirectly
• Defined in terms of observable concepts
• Independent of time and space
• Ex.: love, hope, fear, desire

• Concepts that describe phenomena based on dimensions of that phenomena
• Classification of dimension or graduation of phenomena on a continuum
• Ex.: BP, pain; measured on a scale

• Categories of characteristics
• Can be single-variable categories
• Ex.: gender, ethnicity, religion, marital status; may require yes-or-no answer

• To understand what we observe
• Use concepts to develop theories, frameworks, research studies
• Breaking down concepts makes it easier to understand and convey to others

• Organize data in systematic way
• Provide insight - guide interventions
• Describe / explain significant phenomena
• Predict outcomes

• Defined knowledge base
• Power and authority over training and education
• Registration
• Altruistic service
• Code of ethics
• Lengthy socialization
• Autonomy
• Institutionalized goal or social mission
• Group of scholars, investigators, researchers who work continually to advance knowledge with goal of improving practice
• Responsible and accountable to public for their work

• Person - that which makes one human; the holistic being; physical, intellectual, biochemical, and psychosocial needs
• Health - being able to function to fullest capacity, independently; unity of body, mind, and soul
• Nursing - science, art, and practice discipline involving caring
• Environment - external and internal forces influencing the individual; patient's support system

• Knowledge developed and used by nurses should be separate and distinct from medical knowledge
• Insisted nurses control and staff nursing schools and manage nursing practice in homes and hospitals

• Role of the nurse = put client in best condition possible for nature to act upon him
• Formal training - necessary to teach what to do and HOW to do it
• Teaching symptoms and what they mean
• Importance of rationale for actions
• Significance of trained powers of observation and reflection
• Proposed basic premises for nursing practice
• Nurses make astute observations of the sick and their environment
• Nurses should record observations and develop knowledge about factors that promote healing
• Nursing framework emphasized utilization of empiric knowledge

To "nurse" is to be in charge of the personal health of another.

• Formal nurse training - Kaiserwerth, Germany
• Served British Army in the Crimean War
• After Crimean War, established first nursing school in London
• In 1859, published Notes on Nursing
• Distinguished statistician

• To "nurse" = being in charge of the personal health of another
• Role of the nurse = put client in best condition for nature to act upon him

• Nurses were to:
• Make astute observation of the sick and their environment
• Record these data
• Develop knowledge about factors that promote healing

• Education - provided by MDs in evenings after nursing students worked hard all day
• Curricula - little theory, some A&P, occasional lecture on special disease, few nursing books
• Practice - performance-focus, emphasis on carrying out MD orders, submissive and obedient, fulfilling duties without question, apprenticeship model, students learn from more advanced students
• Exploited as cheap labor - all patient care done by student nurses; may have only been one graduate nurse in the hospital; most hospitals had nursing programs = cheap labor
• Adherence to medical model - focus on cure and treatment; view mind and body separately

• 1920s - two landmark reports reveal deplorable state of nursing and physician education --> development of nursing curriculum
• 1924 - Yale University began first school of nursing
• Nursing shortage after WWII - Esther Brown, PhD blamed nursing education model as central to problems in profession; recommended formal nursing education - in universities, NOT hospital-based
• Hill-Burton Act - dramatic increase in # of hospitals
• Professional organizations for nurses
• By 1949 - 41 states required licensing and registration for nursing
• 1956 - Health Amendment Act - provided financial aid to promote graduate nursing education
• 1954 - first nursing doctoral program at University of Pittsburgh

• Nurse scholars began to debate ideas, viewpoints, and research methods used in nursing literature
• Nurses began to question ideas previously taken for granted in nursing

• Silent knowledge
• Received knowledge
• Subjective knowledge
• Procedural knowledge
• Constructed knowledge

• 1st stage
• Non-questioning obedience to MDs - carrying out orders, performing tasks
• Limited research
• Minimal theory development

• 2nd stage
• Learning through listening to others
• Nurse licensing and registration
• Nursing shortage
• Borrowed theories
• Non-nursing doctoral degrees
• Research - educational, sociological

• 3rd stage
• Revolution in nursing - beginning attempts to define nature of nursing practice and theory development
• Nursing models - developed from experience and perceptions of ideal nursing practice
• Theories - define distinct relationship between nurse role and health

• 4th stage
• Nursing viewed as scientific discipline
• Nursing curriculum = conceptual frameworks
• Consensus = common elements of nursing
• Theory in practice = under-emphasized; emphasis on procedures to acquire knowledge

• 5th stage
• Recognition of different types of knowledge - intuition, reason, self-knowledge
• Nursing theory based on:
• empirical studies
• literature
• patient reports of clinical experience and feelings
• nurse intuition
• related knowledge
• Theory-development based on:
• evidence-based research
• application of nursing process

• Branch of educational instruction
• Department of learning or knowledge
• Field of study; branch of knowledge

• Aim to know
• Descriptive theories
• Research - applied and basic
• Examples: basic sciences - chemistry, physics, biology, sociology, anthropology

• Practical
• Research - prescriptive and descriptive
• Examples - medicine, law, nursing, social work

• Process - systematic inquiry; empirical observations; procedures/methods to acquire knowledge
• Product - empirical knowledge grounded in testing and experience; result of investigation; knowledge
• Focus on cause and effect
• Validates theory

• Branches of learning that investigate human constructs and concerns as opposed to natural processes and social relations
• Deal with various aspects of humans and human interactions
• Ex.: philosophy, arts, languages vs. physics, chemistry, anthropology, economics

• Tentative suggestions that specific relationship exists between 2 concepts or propositions
• Educated guess to be proven

• Proposition about relationship between concepts in theory that has been repeatedly validated
• Usually observable and measurable

• Broad view of a discipline
• Most global perspective

• Interrelated concepts that convey mental image of phenomenon
• Symbolic representation of concept
• Allows visualization of concept in images

• Attempt to explain broad areas of a discipline
• May incorporate numerous theories
• Non-specific
• Relatively abstract concepts lacking operational definitions - not easily tested
• Majority of nursing conceptual frameworks
• Ex.: theories of Orem, Rogers, Roy

• Encompass limited # of concepts and limited aspect of real world
• Relatively concrete concepts; measurable and testable
• Ex.:
• description of phenomena - discomfort, grief
• explanation of relationship between phenomena - end-of-life issues, novice-to-expert
• prediction of effects of phenomena - adopting healthy behaviors

Skillful and responsible thinking in which you study the problem from all angles, and then exercise your best judgment to draw conclusions

• Science of correct reasoning
• Valid induction or deduction