Nursing Theory Development

• Systematic accumulation of knowledge is essential for professional progress, especially in nursing
• Theory informs practice and practice informs theory
• Nursing theorists' work became a prominent theme in the 20th century's latter half
• There is a great focus towards nursing theorists and their work developing

Nursing Theory Development

• Professional growth and quality improvement initiatives stimulated nursing theory development
• Developing nursing knowledge guides practice and differentiates it as a profession
• Nursing education expansion beyond vocational training furthered nursing theory

Understanding Nursing Theory

• Nursing theory offers insight into the meaning of nursing and its healthcare contributions
• Nursing theory has also had a historical development as a profession
• It also helps us understand the significance of nursing theory for the academic discipline and profession of nursing

History of Nursing Theory

• Professional nursing's history begins with Florence Nightingale stressing organized and public health nursing
• Her writings guided nursing school establishment and practice improvement.
• Early theory development (mid-1800s to 1950s) focused on defining nursing's unique focus and knowledge separate from medical knowledge
• Patient care was emphasized in their environment
• The curriculum era aimed to standardize nursing education
• The research emphasis era (mid-20th century) increased focus on research to develop a scientific base for nursing practice
• Recognition of the need for conceptual frameworks and theoretical underpinnings for nursing research was recognised in the mid 20th century
• Graduate education era (1950s-1970s) involved developing master's degree programs in nursing
• Nursing theories and concepts were introduced into graduate curricula.
• Debates arose regarding the proper discipline base for nursing (profession-based vs. science-based).
• Theory era (1980s-1990s) saw significant developments in major nursing theories and conceptual models
• Efforts focused on organizing existing nursing concepts into meaningful frameworks
• Research increased on theory testing and development.
• The theory Utilization era (21st century) emphasized applying nursing theory in practice, education, research, and administration
• Guiding thinking and action in nursing practice with nursing theory was further recognised
• There was also more scholarship examining the relevance of nursing theories in contemporary healthcare

Significance of Nursing Theory

• Nursing theory is significant for both the academic discipline and the profession of nursing
• As a discipline, nursing is academic with knowledge focused on theoretical understanding
• As a profession, nursing is specialized and based on scientific knowledge with focus on practice and service
• As an academic discipline, nursing requires a defined body of knowledge that theory helps organize
• Nursing as a profession benefits from theory by: providing a framework for practice, education, and research
• Theory helps define the scope of nursing practice, and establishes criteria for professional status
• Enhances the scientific basis of nursing practice and improves care quality and consistency
• Promotes autonomy and accountability in nursing, generating further knowledge through theory-guided research
• Nursing theory's development mirrored the progress of nursing as a profession, showing growing recognition
• Early theorists work laid the groundwork for formalizing nursing knowledge

Science

• Science is important for describing, explaining, and predicting causes or outcomes of nursing care interventions
• Science aims to guide nursing care delivery and increase life longevity
• Since the 1960s, nursing scholars aimed to solidify nursing as a scientific discipline
• Being a scientific discipline means identifying nursing's unique knowledge for patient, family, and community care
• Nursing seeks to establish the scientific basis for clinical and basic nursing research
• Recent research focuses on increasing preoperative mobility training and reducing anxiety in total knee arthroplasty patients

Nature of Science

• Science aimed to formalize nursing science by addressing questions on knowledge, truth, and the relationship between knowledge and practice
• A philosophical perspective guides how researchers conduct research, interpret outcomes, and define science
• The 2 competing philosophical perspectives on what defines science are rationalism and empiricism
• Each offers a theory of knowledge (epistemology) for understanding how knowledge is acquired
• Each also implies a different view of reality (ontology) or a theory of what is knowable

Rationalism

• Rationalism emphasizes a-priori reasoning as the method for advancing knowledge
• A priori reasoning is knowledge gained without actual experience
• It uses deductive logic from cause to effect or generalization to a particular instance
• Lacking causal support in hospital readmission challenges traditional a priori reasoning
• Theory-then-research strategy is used in rationalism, where research findings not aligning with theory lead to modifications
• Rationalists believe the most evident work in science to involve developing extensive mathematical equations to describe progress
• Rationalism highlights continuous interplay between theory construction and testing

Empiricism

• Empiricism states that scientific knowledge comes primarily from sensory experience (seeing, feeling, hearing)
• The Inductive method is central to empiricism, moving from specific observations of facts to devising general principles
• The research-then-theory strategy involves formulating logic after data collection and analysis.
• Empiricists believe scientific inquiry should focus on collecting empirical data
• Some advised caution against premature inferences and overarching theories before sufficient data collection
• The research-then-theory approach may miss important observations if the focus is too narrow or observations stop prematurely

Science and Theory

• Early 20th-century philosophers focused on empirical research and nature of scientific discovery
• Positivism emerged as a dominant view, emphasizing empirical/logical analysis for valid knowledge
• Positivists sought objective truth through observation, experimentation
• Logical positivists sought to develop a unified scientific method applicable across all sciences
• Late 20th century analyses challenged the positivist view of science
• Human sciences' epistemology (theory of knowledge) was increasingly scrutinized
• Brown (1977) urged a revolution in philosophy, stating scientific understanding evolves with changing perspectives, not just accumulating objective facts
• Empiricists propose theory should be inductively derived from observations
• Theory-ladenness of facts means a scientist's observations are influenced by existing theories and presuppositions
• Scientists actively interpret the world not passively observe
• Observable data does not interpret itself but are given meaning within a theoretical context
• Traditionally, theory building and research have been viewed as distinctly independent
• Theory provides a framework for understanding and explaining phenomena, also guiding research questions
• Research tests are used to refine existing theories or contributes in the development of novel ideas
• A theory must be judged on its logical consistency, clarity, parsimony, testability, empirical adequacy, and usefulness.
• Scientific consensus is crucial for theory acceptance within a scientific discipline
• Consensus needs agreement on the theory's boundaries, it's elements' clarity, and fit with collected data
• Achieving consensus is often a social process within the scientific community
• Achieving universal consensus is harder for nursing science due to human experiences' complexity and worldviews differences

Science as a Social Enterprise

• Scientific inquiry is influenced by social factors
• Social, political, and economic contexts impact the funding and the direction of scientific research
• The nursing profession's values, beliefs, and priorities and also the broader healthcare system shape development of scientific knowledge

Nursing Theory

• Nursing theories aim to describe understanding of nursing phenomena, guiding practice and research
• Proposed to address a phenomenon of interest and considering completeness, logic, internal consistency,
• In addition it needs to show consistency with empirical findings, and be operationally defined for testing
• Nursing theory development is a scholarly endeavor through rigorous research that either supports or refutes assertions of theory
• It also guides modifications or the extensions of current theory

Theory Components

• Theory requires understanding terms, definitions, assumptions that demonstrate how scholarly analysis may occur
• Concepts classify phenomena of interest and are the building blocks of theories whose meanings are part of the theoretical system
• Abstract concepts are mentally constructed and can be be separate from time or place.
• Concrete concepts relate to a particular time or place.
• Table 4.2 provides abstract and concrete examples of the differences.
• Continuous concepts permit classification of dimensions or phenomena on a continuum, indicating degree.
• Meanings are provided to concepts through using definitions
• Theoretical definitions provide a general understanding of each concept
• Operational definitions specify how a concept will be measured or seen - examples can be seen in Table 4.5
• Relationships are specified between 2 or more concepts and are outlined in relational statements
• How that theory is organized is an interrelated, logical system with definitions, concepts, and relational statements

Theory Building

• Exploring issues emerging in science's philosophy can help nurses expand conceptual tools
• Nurses' practice patterns create protocols or decision trees focused on client care, and defining the phenomena of interest
• A conceptual model or framework helps understand and define phenomena of interest
• Relationships/linkages between related concepts are the second step
• Relationship statements or propositions are then developed
• Specifying linkages/ordering is vital for proper theory development
• Statements must assert connections betweens concepts, which need to be presented clearly as well
• Operational linkages provide explanation as to why variables are connected

Types of Nursing Theories

• Middle-range theory is common and addresses specific phenomena with 2+ concepts, narrower than grand theories
• Middle-range theories are developed quantitatively from nursing conceptual models or practice observations
• Table 4.4 are examples of selected concepts analyzed in middle-range theories
• Table 4.8 presents middle-range theory of forensic nursing care
• Lenz identified 6 approaches for devising middle-range theories in 1996: inductive research; deductive grand theories
• Other approaches included using integration through nursing theories and other theories. And either Derivative (retroductive) in approach, theories derived from guidelines or even clinical practice. With finally also a synthesis approach from using multiple research findings.
• Grand theories provide a general frameworks for nursing practice
• Practice-level theories guide day-to-day nursing practices

Importance of theory in practice / research

• Theories provide a conceptual framework to understand and define phenomena of interest in patient care
• Theory development is essential for scientific progress in nursing.
• Theory-testing research explains nursing phenomena more adequately

Principles of Theory Development

• Scientific laws describe an action or a set of actions in a statement
• The process of creating theory involves developing a hupothesis (educated guess based on observation)
• And verifying said hypothesis multiple times, building a theory
• Examples include critically thinking, analysing photographs to identify underlying theories and models or examining an observed practice to identify definitions.

Nursing Knowledge

• Nurse scholars tried to define the boundaries of nursing and establish the unique knowledge body
• Developing specialized nursing knowledge was crucial for nursing recognition as a profession in the 20th century
• Establishing criteria for a guided process of development for guided process

Structure of Nursing Knowledge

• The levels relevant to nursing are analysed in this chapter
• Theoretical works are presented in Chapters 6-36
• Table 5.1 illustrates each level's nature/theorists' abstraction level and preference
• Effort was made to show abstraction level/theoretical preferences of theorists

Levels of Theoretical Works in Nursing

• Nursing philosophies address nursing's meaning through analysis, reasoning, and logical argument
• Nursing philosophy provides a broad understanding and direction for the discipline
• Examples of philosophers: Nightingale, Watson, Ray, Benner Martinsen, Eriksson
• Nursing conceptual models provide perspectives on concepts providing a framework for understanding phenomena
• Nursing conceptual models are more abstract than theories but less so than philosophies
• Example of Conceptual System pioneers: Neuman, Rogers, Orem, King, Neuman, Roy, Johnson
• Nursing theories and Grand theories propose relationships through global concepts or explain/describe data
• Grand theories are broad in scope, but may not be testable
• Examples of Grand View leaders: Pender, Newman, Parse, Erickson, Leininger
• Middle-range nursing theories concentrate on specific situations or patient populations
• They offer applicable propositions/address specific nursing practice
• Mercer's Maternal Role Attainment-Becoming a Mother is an example
• Swanson is also an example

Analysis and Critical Thinking

• How clear the concepts/relationships are in the theory needs to be assessed
• Whether the assumptions stated are clear or not also needs to be assessed in that theory
• If the theory is straightforward but comprehensive, or contains a manageable amount of concepts needs analysing too
• Also the scope for generality. Whether it has broadness and if application is possible in several situations and/or populations
• This also extends to assess the concepts for accessibility. And if what it is conveying is applicable for measuring/in day to day life
• Additionally, whether that theory is able to contribute significantly for improved delivery in healthcare
• These are all factors

Overview of Nightingales Theory

• Her principles and work are foundational to modern nursing, remaining relevant today.
• Her focus is about the environment as a critical factor for patient health and recovery
• Nursing can help manipulate a patients environment to support healing

Key Environmental Components

• Pure air, pure water, and efficient drainage are significant
• Cleanliness and light particularly direct sunlight are significant
• Keeping things quiet, warm, and providing proper ventilation and diet are significant. Warmth.

Theoretical Assertions

• Nature will cure injuries on its own at any opportunity, and it is nursings duties in that situation to provide a proper means for those benefits to take place
• Disease comes from poor conditions of environment and its management
• As such that means nurses need to understand how to implement practical skills and obtain adequate training for the improvement of any patient

Analysis of Nightengale's Theory

• The clarity of the environment was designed for environment focused settings. Nurse and patient interaction.
• The concepts that are used are straight forward meaning they are easy to use and can be set in the real world fairly easily as a means of practice. A descriptive format.
• In its generality, it is broad from differing aspects such as settings, geography, different levels of education or health, and even while based in an older time period it is still applicable
• Environmental advice given is generally directly applicable to practice, while data collected is to help set a foundation that is used to set further research into the area. It can be seen as a contribution to the shaping of best healthcare and nursing practices.
• By having these statistics it shows that observations set to promote a means of evidence and is considered in evidence based practice

Benners Model of Skill Aquisition Overview

• Patricia Benners is known descriptive theory for nursing and how the process of nurses becoming skilled goes from novice to a type of specialist in their respective field
• The findings by Benner puts an emphasis on knowledge can gained first hand and through practices
• The thinking for Benner was mainly from knowledge and Dreyfus having influence.
• Her model consists mainly on her own experience
• Benner heavily builds around her own knowledge having a influence from the works of Dreyfus and the work with skilled knowledge, and skill learning which includes lived experiences
• Benner builds qualitatively based research into nursing and narratives

Application of the Theory By Benner

• Its use is based from qualitative studies including narratives and descriptions
• Having been the director for clinical studies it helped aim to discribe and find ways towards the level of skill for nurses during her years. Having analysed not only interviews, but having to evaluate and watch nurses has given Benner many details.
• Her goal and finding was to help highlight the 7 core elements regarding skills
• The major definition as stated by Dreyus
• Novice: Limited and reliant information, making it hard to properly figure out if the knowledge they are receiving it is to proper
• Advanced: having some experience allowing them to focus on the main concepts and information they are working around, being able to recognise details
• competent: 2-3 years with an improved sense of planning, being able to manage multiple challenges
• Proficient: Being able to have a larger understanding rather than small parts, having learned and has some amount of understanding to have actions set straight
• Expert: Well versed with great fluid intelligence allowing high focus.
• The most important concepts are about situation, attributes, understanding ability, domain, narrative. paradigms. Understanding overall and how what you know applies to the overall picture.
• Main assumption that the practice for nursing is built in each context
• Clinical knowledge is distinct
• and skills

Work from Benner and Impact

• It is meant to better articulate the experience that one receives from the field.
• Due to its highly influential factor, greatly impacted and increased education, it puts a framework down the level of nursing development
• Critics stated it was long and complex leading too lack of use that could exist .
• By being hard to obtain numbers it caused it hard to replicate the data by having it set in the field.
• By revolutioning skill it helped improve areas in both development clinically and overall education

Overview of Roy's Adaptation Model

• It views that people often tend to evolve or find adaptive change allowing them to cope with the world
• By evolving patients go through a series of regulators in cognitive or physical manner that help then make them adapt internally
• Environment: All conditions involved, those that impact development considering resource.
• Heath: A consistent and ongoing integration that allows you maintain overall ability. That is also reflected from a success and how to impact a environment. This involves an inability to lack to integrate.
• Nursing: A means of assessing the stimuli behaviour having diagnosis
• Adaptation: Understanding thinking, emotion, which has humans integrating to the current envionment

Adaptive Modes to keep in mind

• Physiological physical mode: Needs necessary of survival with various processes taken place with all levels of functions, nervous or endocrine too.
• Self concept: Including mental spiritual for group based or personal.
• Role based function: Concerns society with various level based roles.
• Interdependence mode: Giving respect and building connections with loved ones

Stimuli and sub system to see for the adaptive system to adapt

• In total a model is needed for adaptations to take place such as a cognator for understanding various levels of perception.

Sources for Sister Callista Roy's Model

• Development comes from Harry Helon being sited
• Rapoport being seen as being an individual with input, throughput or an output
• Understanding stimulus

Acceptance and Review with Roy's Model

• Is is widley accepted and highly know both nationally
• The framework is great too ensure people can handle health levels and build interventions

Other Key Concepts

• Leiningers goal with patients is to build what is seen as cultur acceptance.
• Building trust is a great way in order to have health and long term ability.
• Culture needs to be able to support as there are issues with the approach

Key Parts for Madeleine's Work

• Leiningers worked around patients with culture being a factor.
• Seeing that existing solutions where bad she built around the ability to have cultural understanding with anthropology as a great solution for patients

Main Points

• By having understanding for their values and beliefs she built around the solutions which is to help grasp their cultural side and be able to understand and show care
• This care promotes acceptance and cultural solution

Solution Model

• The core idea Is to have care be implemented as a means of unifiying to best apply care and service
• By unifying that helps apply congruently with patient care from clients , groups or even various communities
• By having values, customs or what the patient thinks that would help the decisions and action

Influencial Culture

• By following those that helps best give patients a means of best helping or solving in any case