introduction to theoretical nursing knowledge

Transcription

nes & Bartlett Learning, LLC
FOR SALE OR DISTRIBUTION
© Jones & Bartlett Learning, LLC
NOT FOR SALE OR DISTRIBUTION
onal Association of Long Term Care Administrator Boards
1
© Jones & Bartlett Learnin
NOT FOR SALE OR DISTR
INTRODUCTION
TO
National Association of Long Term Care Administrator Boards
THEORETICAL NURSING
NOT FOR KNOWLEDGE
SALE OR DISTRIBUTION
L e a r n i ng O b je c t i v e s NOT FOR SALE OR DISTRIBUTION
onal Association ofAfter
Long
Term this
Care
Administrator
Boards
completing
chapter
the student should
be able to
1. Identify and define terminology related to theoretical thinking
2.NOT
Identify
and SALE
describe OR
several
types of theoretical works in nursing
FOR
DISTRIBUTION
3.National
Identify and
explain the fourof
metaparadigm
concepts
nursing
Association
Long Term
CareofAdministrator
© Jones &KBartlett
LLC
e y T e rLearning,
ms
Assumptions
Clarity
Concept
Boards
Health
Human being (person)
Metaparadigm
nes & Bartlett Learning,
LLCmodel
Conceptual
Derivable consequences
onal Association
Nursing
NOT FOR
Philosophies
of nursing
precision
Proposition
of Empirical
Long Term
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Environment
Simplicity
Generality
Theory
1
© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION.
72376_TEXT_Masters.indd 1
onal Association
of Long Term Care Administrator Boards
10/18/10 12:27 PM
2
N ursing T heories : A F ramework for P rofessional P ractice
A
lthough the beginning of nursing the-
oryTerm
development
can be traced to Florence
National Association of Long
Care Administrator
Boards
Nightingale, it was not until the second half
of the twentieth century that nursing theory caught the
© Jones &BACKGROUND
Bartlett Learning, LLC
attention of nursing as a discipline. During the decades
NOT FORAND
SALEOVERVIEW
OR DISTRIBUTION
of the 1960s and 1970s, theory development was a
topic
of discussion andBoards
publication. During the
National Association of Long Termmajor
Care
Administrator
1970s, much of this discussion related to the development of a single global theory for nursing. However,
Jones
& Bartlett
Learning,
in the©
1980s,
attention
turned away
from the LLC
developFOR SALE OR DISTRIBUTION
NOT
FOR
SALE
OR
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ment of a global theory for nursing, as scholars began to recognize the
validity
of Administrator
multiple approachesBoards
to theory development in nursing.
onal Association of Long Term
Care
Because of the plurality in nursing theory, this information must be
organized to be meaningful for practice, research, and further knowledge
© Jonesdevelopment.
& BartlettThe
Learning,
© Jones
& Bartlett Learnin
goal of this LLC
chapter is to present an organized
and pracNOT
FOR
NOT FOR
SALE
OR
DISTRIBUTION
tical overview of the major concepts that are essential to understandingSALE OR DISTR
perspective in professional nursing practice. Definitions of key
Nationaltheoretical
Association
terms are included throughout the discussion.
T
NOTtheory
FOR SALE
OR DISTRIBUTION
o apply nursing
in practice,
the
nurse must have some knowledge of the theoretical works of the nursing profession. Theoretical
STRUCTURE
works in nursing are generally categorized either as
philosophies,
conceptual
models,
theories, orLLC
middlenes & Bartlett Learning,
LLC
© Jones
& Bartlett
Learning,
OF NURSING
range NOT
theories,
depending
theDISTRIBUTION
level of abstraction.
FOR
SALEon
OR
KNOWLEDGE
The most abstract of these theoretical works are the
onal Association of Long Term Care Administrator
philosophiesBoards
of nursing, followed by the conceptual
models, theories, and middle-range theories. However,
the metaparadigm
© Jones & Bartlett Learning,
LLC of the discipline is considered
© Jonesthe
&
highest level of abstraction.
Bartlett Learnin
National
Association ofofLong
Term Care Administrator Boards
Metaparadigm
Nursing
Before discussing the metaparadigm concepts that are important to nurs© JonesA&concept
Bartlett
define the term “concept.”
is aLearning,
term
LLC to
ing, it is important
LLC
onal Association
10/18/10 12:27 PM
chapter 1 Introduction to Theoretical Nursing Knowledge
3
or label that describes a phenomenon or group of phenomena (Meleis,
2007). National
The label may
be a word or phrase
that Term
summarizes
obserAssociation
of Long
Careideas,
Administrator
Boards
vations, and experiences so as to provide a mental image for the purpose
of facilitating communication and understanding about the phenomenon
(Fawcett, 2005). The phenomenon described by a concept may be either
NOT FOR
SALE
OR
DISTRIBUTION
empirical or abstract. An empirical concept is one that can be either
or experienced
through
the Care
senses.Administrator
An abstract concept
is one
Nationalobserved
Association
of Long
Term
Boards
that is not observable, such as hope or caring (Hickman, 2002).
A metaparadigm is the most global perspective of a discipline. A
LLC
© Jones
Learning,
Most LLC
disciplines
metaparadigm
is defined by Fawcett (2005,
p. 4) “as &
theBartlett
global concepts
have a single
NOT
FOR
SALE
OR
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that identify the phenomenon of central interest to a discipline, the global
metaparadigm
that describe
concepts, and the
global propositions that but multiple
onal Associationpropositions
of Long Term
Carethe
Administrator
Boards
state the relations between or among the concepts.” Each discipline sin- conceptual
gles out phenomena of interest that it will deal with in a unique manner. models. Multiple
© Jones
Bartlett Learning,
LLCinterrelate these phe- conceptual
The concepts
and &
propositions
that identify and
models
FORtheSALE OR DISTR
NOT
FOR
SALE
OR
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nomena are even more abstract in the metaparadigm than those found in NOT allow
members of the
the conceptual models, yet identification of these metaparadigm concepts
National Association of Long Term Care Administrator
Boards
discipline
to view
allows members of the discipline to identify and communicate the bound- the phenomena
aries of the subject matter specific to the discipline (Kim, 2000). Most of interest in
© Jonesdisciplines
& Bartlett
LLC
© Jones
& Bartlett
Learning, LLC
different ways.
haveLearning,
a single metaparadigm
but multiple conceptual
models.
NOT FOR
SALE
OR DISTRIBUTION
NOT FOR
Multiple
conceptual
models allow the members of the discipline
to viewSALE OR DISTRIBUTION
the phenomena of interest in different ways (Fawcett, 2005).
While several proposals have sought to define what should be
included as the metaparadigm concepts for the discipline of nursing, most
scholars accept
the central concepts of the©discipline
as person
LLC
Jones of&nursing
Bartlett
Learning, LLC
(human
being),
environment,
health,
and
nursing:
❖❖ Human being or person: individuals, families, communities, and
other groups who are participants in nursing
❖❖ Environment: human beings’ significant others and physical sur©
Jonesas&well
Bartlett
LLC and worldwide
roundings
as local,Learning,
regional, national,
NOT
FOR
SALE
ORand
DISTRIBUTION
cultural,
social,
political,
economic conditions that are associated with human beings’ health
❖❖ Health: human processes of living and dying
❖❖ Nursing: the definition of nursing, the actions taken by nurses on
behalf of or in conjunction with human beings, and the goals or
onal Association
10/18/10 12:27 PM
4
National
outcomes of nursing actions; the process of which encompasses
activities that
referred
to asCare
assessment,
diagnosis (labeling),
Association
ofare
Long
Term
Administrator
Boards
planning, intervention, and evaluation (Fawcett, 2005, p. 6)
BecauseLLC
concepts are so abstract at ©
theJones
metaparadigm
level, many
& Bartlett
Learning, LLC
models have developed from NOT
the metaparadigm
of OR
nursing.
NOT FOR SALE OR conceptual
DISTRIBUTION
FOR SALE
DISTRIBUTION
Subsequently, multiple theories have been developed from each concepphenomena
within the model. These conceptual models and theories of nursing reprefrom the
metaparadigm
of the discipline
nes & Bartlett Learning, LLCsent various paradigms derived
© Jones
& Bartlett
Learning,
LLC of
nursing. Therefore, although
of the
conceptual
models and nursing
NOTeach
FOR
SALE
OR DISTRIBUTION
theories may link and define the four metaparadigm concepts somewhat
Care Administrator
Boards
differently,
the four metaparadigm
concepts are generally pres
ent and
defined either implicitly or explicitly in each of the models and theories.
National Associationtual
of model
LonginTerm
Care
Administrator
an effort
to describe,
explain, andBoards
predict the
NOT FOR
Philosophies
of Nursing
of nursing
set forth
theCare
general
meaning of nursing
and
NationalPhilosophies
Association
of Long
Term
Administrator
Boards
nursing phenomena through reasoning and the logical presentation of
ideas. Philosophies are broad and address general ideas about nursing.
LLCbreadth, nursing philosophies
© Jones
& Bartlett
Learning, LLC
Because of their
contribute
to the discipline
NOT
FOR
SALE
OR
by providing direction, clarifying values, and forming a foundationDISTRIBUTION
for
theory development (Alligood, 2006). Four theoretical works that have
been categorized as philosophies of nursing will be presented in Chapters
3 through 6 of this book.
Conceptual Models ofNOT
Nursing
Conceptual
models are composed
of abstract and general concepts and
Care Administrator
Boards
propositions that provide a frame of reference for members of a discipline.
This frame of reference determines how the world is viewed by members
© Jonesof &a discipline
Bartlett and
Learning,
© Jonesand
& Bartlett Learnin
guides theLLC
members as they propose questions
NOT
FOR SALE OR DISTR
NOT FOR
SALE
OR DISTRIBUTION
make
observations
relevant to the discipline (Fawcett, 1994).
A conceptual model is specifically defined as a set of concepts and statements
National
Association of Long Term Care Administrator Boards
that integrate the concepts into a meaningful configuration (Lippitt,
1973; as cited in Fawcett, 1994). Assumptions are accepted as truth and
Bartlett Learning,
LLC
© Jones
& Bartlett
Learning, LLC
represent the
values and beliefs of the theory
or conceptual
framework.
© Jones &
onal Association
10/18/10 12:27 PM
5
Assumptions form the basis for defining concepts and framing propositions (Meleis,
2007).
A proposition of
is aLong
statement
about
a concept
or a
National
Association
Term
Care
Administrator
Boards
statement of the relation between two or more concepts (Fawcett, 2005).
Conceptual models of nursing are models containing abstract con© Jones & Bartlett Learning, LLC
cepts that are not directly observable and that are not limited to a parNOT FOR
SALE
OR
DISTRIBUTION
ticular type of patient, situation, or event (Fawcett, 2005, p. 16). At the
of the conceptual
model,Term
each metaparadigm
concept is defined
and
Nationallevel
Association
of Long
Care Administrator
Boards
described in a manner unique to the model, with the model providing an
alternative way to view the concepts considered important to the discines & Bartlett Learning,
LLC
© Jones
& Bartlett
Learning, LLC
pline. The definitions
and overall framework
presented
in a conceptual
NOT
FOR
SALE
OR
DISTRIBUTION
model are formal and explicit. Thus they identify the purpose and scope
nurses,
for other
healthcare providers,
and for the public.
onal Associationofofnursing
LongforTerm
Care
Administrator
Boards
In addition, they provide a framework for recording the effects of nursing.
Using a conceptual model or framework also helps to provide consistency
© Jones
LLC
in nursing
practice&
byBartlett
facilitatingLearning,
communication
and provides a mecha- © Jones & Bartlett Learnin
NOT
FOR
SALE
OR
DISTRIBUTION
nism for engaging in a systematic approach to nursing research, educa- NOT FOR SALE OR DISTR
tion, and practice (Fawcett, 2005, p. 17–18).
Nursing Theories
A nursing theory is more specific than
NOT FOR
a conceptual model (Alligood,
2010). A “theory is an organized, coherent, and systematic articulation
NationalofAssociation
of related
Long to
Term
Carequestions
Administrator
Boards
a set of statements
significant
in a discipline
that
are communicated in a meaningful whole . . . discovered or invented
for describing, predicting, or prescribing events, situations, conditions, or
LLC
relationships” (Meleis, 2007, p. 37). More specifically, nursing theory is
NOT FOR
SALE
DISTRIBUTION
defined by Meleis (p. 41) as “a conceptualization
of some
aspectOR
of reality
or Term
discovered)
pertains to nursing.
The conceptualization
onal Association(invented
of Long
Carethat
Administrator
Boards
is articulated for the purpose of describing, explaining, predicting, or prescribing nursing care.” According to Fawcett (1994), “The primary distinc© Jones
& Bartlett
© Jones
primary & Bartlett Learnin
tion between
a conceptual
modelLearning,
and a theoryLLC
is the level of abstraction. The
distinction
NOT FOR
ORabstract
DISTRIBUTION
A conceptual
model SALE
is a highly
system of global concepts and NOT FOR SALE OR DISTR
between a
linking statements. A theory, in contrast, deals with one or more specific,
conceptual
model
Boards
concrete concepts and propositions.”
and a theory
Theories vary in their scope and level of abstraction. The theory that is the level of
© Jonesis&broad
Bartlett
Learning,
LLC
Learning, LLC
abstraction.
in scope
and highly
abstract conceptually may ©
beJones
referred &
to Bartlett
onal Association
10/18/10 12:27 PM
6
as a grand theory, whereas the theory that has a narrow scope and is
concrete or practical
may
be referred
as a middle-rangeBoards
theory
Nationalmore
Association
of Long
Term
CaretoAdministrator
(Fawcett, 2005, p. 19). Middle-range theories also generally include fewer
concepts and propositions (Fawcett, 2005), represent a limited or partial
view of nursing reality and are more appropriate for empirical testing
NOT FOR SALE OR (Liehr
DISTRIBUTION
& Smith, 1999), and are more applicable to practice (Smith, 2008).
theoriesCare
may be
derived from existing
conceptual models
National Association ofNursing
Long Term
Administrator
Boards
of nursing. Such theories evolve from nursing reality as perceived by the
theorist. Nurse theorists, like other nurses, are affected by both historical
nes & Bartlett Learning, LLCevents and philosophical©influences
Jones &
LLCmay
in Bartlett
their lives.Learning,
Nursing theories
NOT
FOR
SALE
OR
DISTRIBUTION
also evolve from a perception of ideal nursing practice. As a consequence,
various
nursing
theories represent
different realities and address different
Care
Administrator
Boards
aspects of nursing (Meleis, 2007). For this reason, the multiplicity of nursing theories presented in the following chapters should not be viewed as
© Jonescompeting
& Bartlett
Learning,
& Bartlett Learnin
theories,
but ratherLLC
as complementary theories ©
thatJones
may proNOT
FOR
NOT FOR
SALE
OR
DISTRIBUTION
vide insight into different ways to describe, explain, and predict nursingSALE OR DISTR
and/or prescribe nursing care.
Nationalconcepts
Association
Curley (2007, p. 3) describes this understanding in an interesting way
by comparing the multiplicity of nursing theories to a collection of maps
© Jones
& Bartlett
Learning,
LLC
of the sameLLC
region. Each map may display
a different
characteristic
of
NOT
FOR SALE
ORallDISTRIBUTION
the region, such as rainfall, topography, or
air currents.
Although
of
the maps are accurate, the best map for use depends on the information
needed or the question being asked. This is precisely the case with the
nurse’s choice of nursing theories for practice.
S
everal authors have devised criteria for
onal Association of Long Term Care Administrator
Boards
the analysis
and evaluation of nursing concep-
ANALYSIS AND
tual models and theories. In general, the criteria that areLLC
used for analysis include examination
EVALUATION
OF
© Jones & Bartlett
Learning,
© Jones of
& Bartlett Learnin
the origins of the model relative to logic and reasoning
THEORETICAL
as well as the work of other scholars who have influKNOWLEDGE
IN
National Association
of Long
Term ofCare
Administrator
Boards
enced
the thinking
the theorist,
the unique focus
of
NURSING
the model, and the definitions of the metaparadigm
concepts (Fawcett, 2005, p. 52–53). Other authors sug-
gest that the criteria for analysis should include clarity,
onal Association
10/18/10 12:27 PM
7
NOT FOR
SALE OR DISTR
C R I T I C A L
simplicity, generality, empirical precision, and derivable consequences
T H I N K I N G
(ChinnNational
& Kramer, 2008,
p. 237). Clarity
refers to
consistency
terms of
Association
of Long
Term
Care in
Administrator
Boards
terminology and structure—or put simply, “How clear is the theory?” (p.
237). Simplicity is highly valued in nursing model and theory develop© Jones & Bartlett Learning, LLC
© Jones & Bartlett
Can you Learning, LLC
ment: “How simple is this theory?” (p. 237). Generality refers to the scope
think of
anyDISTRIBUTION
NOT FOR
SALE
OR
DISTRIBUTION
NOT
FOR
SALE
OR
of the concepts and the purpose of the theory (Alligood, 2010, p. 12)
additional
is reflected in of
theLong
question,
“How
general
is this theory?” (Chinn
&
Nationaland
Association
Term
Care
Administrator
Boards
criteria that
Kramer, 2008, p. 237). The fourth criterion in analytic schema is empiri- should be
cal precision, which is linked to the testability and usability of the theory added to the
LLCp. 13). Chinn and Kramer
© Jones
Bartlett
Learning,
(Alligood, 2010,
(2008, p.&237)
express
this list forLLC
analysis
NOT
FOR
SALE
OR
DISTRIBUTION
notion by asking, “How accessible is this theory?” Finally, the last cri- and evaluation
is “How
important
this theory?” (p.237)—that
onal Associationterion
of Long
Term
CareisAdministrator
Boardsis, the derivable of models and
theories? If so,
consequences of the theory.
Suggested evaluation criteria include an explanation of the origins of what are they?
your & Bartlett Learnin
© Jones
Bartlett of
Learning,
© Jones
the model
and an &
examination
statements LLC
of values and philosophi- Share
rationale
for SALE OR DISTR
NOT
FOR
NOT
FOR
SALE
OR
DISTRIBUTION
cal claims of the theorist. This step is followed by an exploration of the
adding these
comprehensiveness of the content of the model, which entails looking at
criteria.Boards
the depth and the breadth of the model to ascertain, for example, if definitions of the metaparadigm concepts of the discipline are included. The
© Jonesthird
& Bartlett
Learning,
step considers
whether LLC
the structure of the model is logical.
NOT FOR SALE
OR DISTRIBUTION
NOT
FOR
Step 4 considers
whether the model will lead to further
theory
gen-SALE OR DISTRIBUTION
eration, and step 5 of the evaluative process focuses on the credibility
of the model for use in practice. As a part of the criterion for step 5,
attention is also paid to the factors of social utility, social congruence,
and social significance.
The criterion of social
utility&considers
whether
LLC
© Jones
Bartlett
Learning, LLC
special
education
is
required
to
use
the
model
in
practice.
The
criterion
of social congruence considers whether the model will lead to nursing
onal Associationactivities
of Long
Care
Administrator
Boards
thatTerm
meet the
expectations
of the public.
The criterion of social
significance considers whether the model makes differences in the health
conditions
of the public.
© Jones
& Bartlett Learning, LLC
Finally, in step 6 of the evaluation process, a determination is made
as to the contributions of the model to the discipline of nursing. This
National
Association
Long
TermofCare
Administrator
Boards
determination
is reflects
the findingsoffrom
a review
literature,
where
the expectation is that the model will enhance understanding of the pheof interest rather than being based up any type of comparison of
© Jonesnomena
& Bartlett
Learning, LLC
one model to another (Fawcett, 2005, p. 54–57).
onal Association
10/18/10 12:27 PM
8
A combination of these criteria will be used in the brief analysis of
nursing modelof
and
theoryTerm
in theCare
chapters
that follow in this
book.
Nationaleach
Association
Long
Administrator
Boards
While some of the theories will fare better than others based on the way
they satisfy these criteria, in the final analysis all of the theorists whose
work is included in the subsequent chapters of this book have made subNOT FOR SALE OR stantial
DISTRIBUTION
contributions to the discipline of nursing.
onal Association
10/18/10 12:27 PM
9
C l as s r o o m A c t i v i t y 1 - 1
Select one nursing model or theory for review. Review the chapter
in this book that pertains to this model or theory, and conduct an
© Jones &analysis
Bartlett
Jones &
andLearning,
evaluation ofLLC
the theory, using the criteria©presented
in Bartlett Learning, LLC
NOT FOR SALE
OR
DISTRIBUTION
NOT
FOR
this chapter, based on the information in the model- or theory-specificSALE OR DISTRIBUTION
chapter. Compare your evaluation with the evaluations made by your
fellow students, and discuss areas of agreement and disagreement.
onal Association
10/18/10 12:27 PM
10
REFERENCES
Alligood, M. R. (2006). Philosophies, models, and theories: Critical thinking structures. In M. R. Alligood & A. M. Tomey (Eds.), Nursing
LLC
theory: Utilization and application (3rd ed., pp. 43–65). St. Louis:
Mosby.
M. R.
(2010).
Introduction
to nursing theory:
Its history, signifiNational AssociationAlligood,
of Long
Term
Care
Administrator
Boards
cance, and analysis. In M. R. Alligood & A. M. Tomey (Eds.), Nursing
theorists and their work (7th ed., pp. 3–15). Maryland Heights, MO:
Mosby.
Chinn, P. L., & Kramer, M. K. (2008). Integrated knowledge development
in nursing
(7th ed.). St. Louis,
MO: Elsevier-Mosby.
onal Association of Long Term Care
Administrator
Boards
Curley, M. A. Q. (2007). Synergy: The unique relationship between nursing
and patients. Indianapolis, IN: Sigma Theta Tau International.
© JonesFawcett,
& Bartlett
Learning, LLC
J. (1994). Analysis and evaluation conceptual models of nursing.
NOT FOR SALE
OR
DISTRIBUTION
Philadelphia: F. A. Davis.
J. (2005). Contemporary
nursing
knowledge:
Analysis andBoards
evaluNationalFawcett,
Association
of Long Term
Care
Administrator
ation nursing models and theories (2nd ed.). Philadelphia: F. A. Davis.
Hickman, J. S. (2002). An introduction to nursing theory. In J. B. George
LLC theories: A base for professional
© Jonesnursing
& Bartlett
LLC
(Ed.), Nursing
practiceLearning,
(5th
NOT
FOR
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OR
DISTRIBUTION
ed., pp. 1–20). Upper Saddle River, NJ: Prentice Hall.
S. (2000).
TheCare
natureAdministrator
of theoretical thinking
in nursing (2nd ed.).
National AssociationKim,
of H.
Long
Term
Boards
New York: Springer.
Liehr, P., & Smith, M. J. (1999). Middle range theory: Spinning research
the new Learning,
millennium. Advances
nes & Bartlett Learning, LLC and practice to create
© knowledge
Jones &for
Bartlett
LLC
FOR SALE OR DISTRIBUTION in Nursing Science, 21(4),
NOT81–91.
Lippitt, G. L. (1973). Visualizing change: Model building and the change
process. Fairfax, VA: NTL Learning Resources.
Meleis, A. I. (2007). Theoretical nursing: Development and progress (4th
Philadelphia:
J. B. Lippincott.
© Jones & ed.).
Bartlett
Learning,
LLC
Smith,
M.
C.
(2008).
Disciplinary
perspectives
linked
to
middleFOR
range SALE OR DISTR
NOT
theory. In M. J. Smith & P. R. Liehr (Eds.), Middle range theory for
ofpp.
Long
Term
CareSpringer.
Administrator Boards
nursing (2nd ed.,
1–11).
New York:
onal Association
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introduction to theoretical nursing knowledge

Transcription

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