1.
ARBA MINCH UNIVERSITY
COLLEGE OF MEDICIN AND HEALTH SCIENCES DEPARTMENT
OF NURSING
Nursing theory and Ethico-legal basis of
Nursing for PG Maternal and RH
Nursing
By Dinkalem G(BSc,MSN)
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Nursing theory and Ethico-legal basis of
Nursing
Course Description:
The aim of this course:
to deepen your knowledge of developing a
theory,
learn to analyze and critically evaluate the
existing nursing theories.
Learn how to apply different nursing theories
into nursing practice.
Acquire detail Ethicolegal foundations to the
profession
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Course objectives:
At the end of the course, the learner will be able to:
1. Describe the central concept related to the
development of nursing theory
2. Describe the strategies of development of the nursing
theory.
3. Analyze the central and other concepts of the field
4. Describe, analyze, and critically evaluate nursing
theories.
5. Describe the development trends of nursing theory.
6. Apply ethical theories in nursing.
7. Evaluate bioethical issues.
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Course contents:
Unit I: Introduction:
Definition, Terminologies, The nature of nursing
Unit II: Exploration of theory of nursing
Historical development of theory in nursing
Theory development strategies
Types and characteristics of theories
Uses of theory
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Unit II: Exploration of theory of nursing cont..
Nursing theories
Orem's Self Care Deficit Theory of
Nursing
Roger’s Science of Unitary Human Being
Newman’s Health Systems theory
Watson’s theory of caring
Course contents cont…
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Unit III: Concept development
Concept development strategies
Concept analysis
Unit IV: Evaluation of nursing theory
Evaluation criteria of a theory
Description, analysis, critique, testing and support
of a theory
Unit V: Application of knowledge of nursing theory in
nursing practice and research.
Unit VI: Ethics and law
Course contents cont..
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Brain storming
• Who are nurses? Definition of nursing
• What do nurses do? Role of nursing
• Is nursing a vocation or a profession?
• What is a science of nursing? Nurses’ Body of
knowledge
• Why is nursing theory important? Evaluation and
Application
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Unit I: Introduction:
• Definitions of Nursing:
“The goal of nursing is to put the patient in the best
condition for nature to act upon him.” (Florence
Nightingale, 1858)
“Nursing is the diagnosis and treatment of human
responses to health and illness.” (ANA, 2003)
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Ways of defining nursing
• The easy first approach to developing a definition is
to describe what nurses do.
• however, this approach leaves out important aspects
and essentially reduces nursing to tasks.
• More consideration needs to be given to
(1) what drives nurses to do what they do,
(2) why they do what they do (rationales, evidence-
based practice [EBP]), and
(3) what is achieved by what they do (outcomes) (Diers,
2001).
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Professions Vs occupations:
• Professions are valued by society because the services
professionals provide are beneficial for members of the
society.
• Characteristics of a profession include
(1) a defined knowledge base,
(2) power and authority over training and education,
(3) registration,
(4) altruistic service(for interest of others),
(5) a code of ethics,
(6) lengthy socialization
(7) autonomy (Rutty, 1998)
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Is nursing a profession or occupation
• Until recently, nursing was viewed as an occupation rather
than a profession.
• Nursing has had difficulty being deemed a profession because
– the services provided by nurses have been perceived as an
extension of those offered by wives and mothers.
– historically nursing has been seen as subservient to
medicine.
– Nurses have delayed in identifying and organizing
professional knowledge.
– Furthermore, the education for nurses is not yet
standardized.
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• On the other hand, many of the characteristics of
a profession can be observed in nursing.
– Indeed, nursing has a social mandate to provide
health care for clients at different points in the
health–illness continuum.
– There is a growing knowledge base, authority over
education, altruistic service, a code of ethics, and
registration requirements for practice.
• Although the debate is ongoing, it can be
successfully argued that nursing is an aspiring,
evolving profession(Logan et al., 2004)
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TERMINOLOGIES: Components Of The
Theoretical Foundation
• The basic elements that structure a nursing theory
are concepts and propositions.
• In a theory, propositions represent how concepts
affect each other.
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What Is a Concept?
• A concept is the basic building block of a theory.
• A concept is a vehicle of thought.
• The term concept refers to a “complex mental formulation of .
. . [our] perceptions of the world.” (Chinn and Kramer, 1995)
• A concept labels or names a phenomenon, an observable fact
that can be perceived through the senses and explained.
• A concept assists us in formulating a mental image about an
object or situation.
• Eg. Independence, self-care, and caring are just a few
examples of concepts frequently encountered in health care.
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What Is a Proposition?
• A proposition: is a statement that proposes a
relationship between concepts.
Eg: “people seem to be happier in the springtime.”
“multiple and rapid losses predispose one to feelings of
helplessness.”
• Propositional statements in a theory
represent the theorist’s particular view of which
concepts fit together and,
establish how concepts affect one another.
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• What Is a Theory?
• A theory is a set of concepts and propositions that
provide an orderly way to view phenomena.
• A theory not only helps us to organize our thoughts
and idea, but it may also help direct us in what to do
and when and how to do it.
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• What is a paradigm?
• A model that explains the linkages of science,
philosophy, and theory accepted and applied
by the discipline (Alligood and Marriner –
Tomey, 2002)
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What is a domain?
• The view or perspective of the discipline.
• It contains the subject, central concepts,
values and beliefs, phenomena of interest,
and the central problems of the discipline.
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• How does domain relate to nursing theory?
Nursing has identified its domain in a paradigm
that includes four linkages:
1) person/client
2) health
3) environment
4) nursing
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Unit II Exploration of theory of nursing
Historical development of theory in nursing
The discipline of Nursing
Theory development strategies
Types and characteristics of theories
Uses of theory
Relevance of theory
Nursing theories
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Historical development of theory in nursing
• The historical achievements by nursing leaders are
reviewed in successive eras toward the challenge of
developing a body of substantive knowledge to
guide nursing practice.
• Early in the twentieth century nurses recognized the
need to establish nursing as a profession and began
the transition from vocation to profession.
• This movement toward professionalism provides a
context to understand the eras as nursing’s march
toward achievement of a body of nursing knowledge.
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Historical development of theory in
nursing
• Despite different emphases in each era, one criterion
became a constant force— the one specifying that
nursing practice be guided by a body of specialized
knowledge:
– the criterion for specialized nursing knowledge and
transition from vocation to profession.
• Reviewing some of the efforts that were made to
address the criterion helps us understand the
struggles of these eras and demonstrates how events
led us back to practice as nursing’s central concern.
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Eras of Nursing Knowledge
• As the beginning of the twentieth century drew near,
nurses began to express the need for communication
with other nurses to improve their practice.
• Signs of a national consciousness for nursing may be
seen in the first national gathering of nurses at the
World’s Fair in Chicago in 1893 and
– in the publication of the first edition of the American
Journal of Nursing (AJN), the first national organ of
communication for nurses, in October 1900 (Kalisch &
Kalisch, 2004).
• These initial efforts by nurses began the transition
toward a profession.
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Eras of Nursing Knowledge cont..
• At this early time the focus was clearly on practice
and on teaching the practice of nursing to students.
• There was recognition of the need for specialized
knowledge to guide the practice of nursing from the
beginning.
• With the boom of the industrial age, hospital training
schools flourished as America grew, and the
curriculum era of the 1900s to the 1940s followed
(Judd, et al., 2010; Kalisch & Kalisch, 2004).
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Curriculum Era: The 1900s to the 1940s
• In the curriculum era, evidence of efforts to understand what
knowledge was needed for the practice of nursing led to
– an emphasis on curricular content and
– progression toward standardizing curricula.
• The focus of this era was evident in state activities such as
the 1933 curriculum survey of New York training schools
(Kalisch & Kalisch, 2004).
• This emphasis on what nurses needed to know to practice
nursing led to
– an expansion of curricula beyond physiological and patho-
physiological knowledge
– to include social sciences, pharmacology, and formal classes
on nursing procedures (Judd, et al., 2010).
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• It is interesting to note that courses to teach content
were called fundamentals,
– a term that means “basic essentials,” and that the term is
still used in nursing education today.
• This early appreciation of
– essential content specific to nursing action and
– beyond knowledge of the illness of the patient is an observation
that is pertinent to the progress of this era.
• The differences between the medical view of the patient
and those of the nurse were obvious in these
developments, as had been emphasized by Nightingale
(1946).
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• It is also interesting to note that nursing procedures
were taught in class and practiced in large wardlike
rooms called “nursing arts” laboratories.
• In later decades, with the research and science emphasis
in nursing curricula, these rooms came to be referred to
as “skills or simulation labs.”
• The change in terminology may be related to
– nursing’s movement into colleges and universities and
– the transition from vocational nurse training to professional
nursing education with emphasis on science.
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• Nursing curricula taught mostly in diploma programs
in this era became standardized.
• And some nurses began to seek higher education
courses related to nursing in colleges and
universities.
• The idea of developing nursing programs in colleges
and universities soon followed.
• The transition of nursing into schools of higher
learning brought with it a significant change in the
search for a substantive body of knowledge.
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• Those nurses introduced to research process
– began to recognize and write about its value as an
essential process
– for the progression toward a body of substantive
knowledge (Kalisch & Kalisch, 2004), leading to
the research era.
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Research Era: The 1950s and the 1970s
• In the 1950s, research emerged as a beginning force.
• Nurses were encouraged to learn how to conduct
research, developing the role for nurses for that
specialized body of knowledge.
• Learning to conduct research led to an emphasis on
statistics and research methods introduced as new
curriculum areas in baccalaureate programs.
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Research Era: The 1950s and the 1970s
• This era saw the development of scholarship and the
dissemination of early research findings.
• Nursing Research, the first nursing research journal, was
established for this purpose in 1952.
• In addition, two programs funded by the federal
government were instituted in 1955
– to prepare nurses as researchers and teachers of
research—the U.S.
1. Public Health Service predoctoral research
fellowships and the
2. Nurse Scientist Training Program (Schlotfeldt, 1992).
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• This development began a major shift that affected
all levels of nursing.
• Nurses had to consider what that change in nursing
education meant with regard to their:
 level of nursing preparation, and
the question of the nature of the knowledge needed for
nursing practice persisted.
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• Selection of nursing education programs for potential
students was difficult at this time.
• Although the transition of nursing education into
schools of higher learning was a key development for
the nursing profession,
– the effects of that transition are still felt today in
debates about multiple levels of nursing education
and the failure to establish differentiated practice.
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• The developments in research influenced
nursing education, emphasizing graduate
education with nursing research courses.
• Master’s programs were being introduced in
universities across the country and
– nursing knowledge or concept development
courses were being taught and emphasized in
most programs,
– along with introductory courses in the research
process by the late 1950s and early 1970s.
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Graduate Education Era: The 1950s and the
1970s
• During the graduate education era, curricula for master’s-
level preparation were becoming standardized through
accreditation that most schools were seeking by the
National League for Nursing (NLN).
• By the end of the 1970s, most accredited master’s
programs included
Courses in nursing research,
 clinical specialty practice, leadership, and concept
development or nursing theory in a core curriculum
organized with a nursing philosophy and conceptual
framework. 36

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• Only three nursing doctoral programs existed at the
beginning of this era,
• And the federally funded programs established in
the 1950s as a result of the post– World War II
shortage of nurses were still in place.
• Nurses were being prepared for research and
teaching roles in nursing with doctorates in
education and a range of related science disciplines.
• The American Nurses Association (ANA) set forth the
need for nursing theory development in 1965
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• During this era
– a series of national conferences united nurses to
exchange ideas and
– evaluate knowledge obtained from non-nursing
doctoral programs that could address nursing’s
knowledge-building needs.
• Those conferences centered on nursing science and
theory development and facilitated discussion of the
application of knowledge from the various disciplines
in nursing.
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• The Nurse Scientist Training Program is noteworthy in
this history because that program addressed the
question of the nature of the body of nursing
knowledge.
• That is, will nursing be based on applied knowledge
from other disciplines or nursing science?
• Dealing with this question was a major turning point in
nursing history regarding graduate nursing education
because
– it led to the realization that the nature of knowledge
needed for nursing practice was nursing knowledge.
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• Doctoral education in nursing began to flourish,
• And by the late 1970s, 21 nursing doctoral programs existed
and several more universities indicated intent to develop
programs.
• A driving force in this era was the need for nursing
knowledge and an awareness that the knowledge should
be developed by nurses prepared in the discipline of
nursing.
• It is not surprising that recognition of the difference
between nursing knowledge and borrowed knowledge
surfaced in the nursing literature at this time (Johnson,
1968).
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• This differentiation emerged from recognition that
theory from other disciplines was specific to that
discipline and not specific to nursing (Johnson, 1968;
Rogers, 1970).
• Rogers (1970) reasoned that nurses needed to clarify
the phenomenon of concern for the discipline and
use frameworks that addressed nursing’s
phenomenon of concern to frame their research and
develop nursing knowledge.
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• It was during this era that early versions of nursing
frameworks began to be published.
• The works by Johnson (1974, 1980), King (1971), Levine
(1967), Neuman (1972), Orem (1971), Rogers (1970), and
Roy (1970) are evidence of the general recognition that
nursing theoretical approaches were needed.
• Research continued to develop during this era of
graduate education; however,
– nurse scholars soon noted that much of the research
being published lacked form and direction.
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• In fact, Nursing Research celebrated its twenty-fifth anniversary in
1977 (volume 26, number 3) with published reviews of progress in
its first 25 years.
• These reviews presented recommendations for development in
five practice areas of nursing: medical-surgical, community,
maternal-child, psychiatric, and gerontological.
– Lack of conceptual or theoretical direction or
conceptual connections in the research was identified
as a weakness of the studies.
– It was also noted that the research focused on nurses or
student nurses rather than patients.
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• Indications of the theory emphasis in nursing
education at the national level were with the Nurse
Educator conferences in Chicago (1977) and New
York (1978).
• This conference brought nurse theorists onto the
same stage for the first time in history.
• It was the New York conference that underscored a
growing awareness that the nature of knowledge
needed for nursing practice was theoretical
knowledge.
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• This was an exciting time in nursing as scholarly
works of nurse scholars from across the country
began to be recognized as theoretical frameworks for
research and practice.
• In this era, nursing publications began to proliferate
and time has shown three publications of this era to
be particularly important to this history:
– Carper’s (1978) patterns of knowing,
– Fawcett’s (1978) description of the helical
relationship between theory and research, and
– the first edition of Advances in Nursing Science
(1978) where Carper and Fawcett’s seminal
articles were published.
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Theory Era: The 1980s and 1990s
• The theory era began with a strong emphasis on
knowledge development.
• The theory era, coupled with the research and
graduate education eras, led to understanding of the
scientific process beyond production of a scientific
product (Kuhn, 1970).
• First editions of several nursing theory texts in this
era included contemporary nursing theorists, some
with chapters written by students in master’s
programs.
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• Proliferation of nursing literature; new nursing
journals; regional, national, and international nursing
conferences;
• and new nursing doctoral programs were evidence of
exponential growth in this era.
• Fawcett (1984, 1989) contributed significantly to our
understanding of the nature of nursing knowledge.
• She proposed a metaparadigm of nursing knowledge
for nursing, specifying discipline boundaries of
person, environment, health, and nursing.
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Theory Utilization Era: The Twenty-First
Century
• Nursing is now in the era of theory utilization—
nurses using philosophies, models, and theories for
theory-based nursing practice.
• Soon after we entered the twentyfirst century
sufficient evidence of theory-based practice existed
to declare a theory utilization era (Alligood, 2010).
• Bond and colleagues (2011) recently researched
– “who uses nursing theory?” (p. 404), and
– reported…“increasing numbers, both in quantity and in
the use of nursing theory”.
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• Continued theory development is essential for our
progress as a profession, and as a discipline this is
especially important.
• Theory development with analysis and critique of
syntax and the structure of theory is how knowledge
development is learned in nursing doctoral
programs, especially PhD, which are vital to the
discipline.
• Theory courses in practice-focused master’s and
doctor of nursing practice (DNP) programs focus on
the application of theory in nursing practice.
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Thanks!
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51.
Nursing as an Academic Discipline
• A discipline is “a branch of knowledge ordered
through the theories and methods evolving from
more than one worldview of the phenomenon of
concern” (Parse, 1997)
• It has also been termed a field of inquiry
characterized by a unique perspective and a distinct
way of viewing phenomena (Holzemer, 2007; Parse,
1999).
• Knowledge development within a discipline proceeds
from several philosophical and scientific perspectives
or worldviews (Newman, Sime, & Corcoran-Perry,
1991;
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Characteristics of disciplines include
(1) a distinct perspective and syntax,
(2) determination of what phenomena are of interest,
(3) determination of the context in which the
phenomena are viewed,
(4) determination of what questions to ask,
(5) determination of what methods of study are used,
and
(6) determination of what evidence is proof (Donaldson
& Crowley, 1978).
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Nursing as an Academic Discipline cont…
• Several ways of classifying academic disciplines have
been proposed.
• For instance, they may be divided into
– the basic sciences (physics, biology, chemistry, sociology,
anthropology) and
– the humanities (philosophy, ethics, history, fine arts).
• In this classification scheme, it is arguable that
nursing has characteristics of both.
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Academic Vs Professional disciplines
• The academic disciplines aim to “know,” and their
theories are descriptive in nature.
• Research in academic disciplines is both basic and
applied.
– e.g., physics, physiology, sociology, mathematics, history,
philosophy.
• The professional disciplines are practical in nature,
and their research tends to be more prescriptive and
descriptive (Donaldson & Crowley, 1978).
– e.g., medicine, law, nursing, social work
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Academic Vs Professional disciplines
• Nursing’s knowledge base draws from many
disciplines.
• In the past, nursing has depended heavily on
physiology, sociology, psychology, and medicine to
provide academic standing and to inform practice.
• In recent years, however, nursing has been seeking
what is unique to nursing and developing those
aspects into an academic discipline.
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Academic Vs Professional disciplines
• Areas that identify nursing as a distinct discipline are
as follows:
■ An identifiable philosophy.
■ At least one conceptual framework (perspective)
for delineation of what can be defined as nursing.
■ Acceptable methodologic approaches for the
pursuit and development of knowledge (Oldnall,
1995).
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58.
• To begin the quest to validate nursing as both
a profession and an academic discipline, this
chapter provides
– an overview of the concepts of science and
philosophy.
– It examines the schools of philosophical thought
that have influenced nursing.
– explores the epistemology of nursing to explain
why recognizing the multiple “ways of knowing” is
an important concept in the quest for
development and application of theory in nursing.
– Exploration of theory of nursing
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Introduction to Science and Philosophy
• Science is concerned with causality (cause and effect).
– The scientific approach to understanding reality is
characterized by observation, verifiability, and experience;
hypothesis testing and experimentation are considered
scientific methods.
“Science is theoretical explanation of the subject of inquiry and
the methodological process of sustaining knowledge in a
discipline”(Parse, 1997)
• In contrast, philosophy is concerned with the purpose of
human life, the nature of being and reality, and the theory
and limits of knowledge.
– Intuition, introspection, and reasoning are examples of
philosophical methodologies.
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NURSING PHILOSOPHY:
• Nursing philosophy has been described as
“a statement of foundational and universal assumptions,
beliefs and principles
– about the nature of knowledge and thought
(epistemology) and
– about the nature of the entities represented in the
metaparadigm (i.e., nursing practice and human health
processes [ontology])” (Reed, 1995)
• Nursing philosophy, then, refers to the belief system
of the profession and provides perspectives for
practice, scholarship, and research (Gortner, 1990).
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NURSING SCIENCE:
• Barrett (2002) defined nursing science as “the
substantive, discipline-specific knowledge that
focuses on the human-universe-health process
articulated in the nursing frameworks and theories.”
• In general, nursing science refers to the system of
relationships of human responses in health and
illness addressing biologic, behavioral, social, and
cultural domains (Gortner & Schultz, 1988).
• The goal of nursing science is to represent the nature
of nursing—to understand it, to explain it, and to use
it for the benefit of humankind.
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Knowledge Development and Nursing Science
• Development of nursing knowledge reflects the
interface between nursing science and research.
• The ultimate purpose of knowledge development is
to improve nursing practice.
• Approaches to knowledge development have three
facets:
Ontology= study of being: what is or what exists.
Epistemology=study of knowledge or ways of knowing
Methodology=means of acquiring knowledge
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Ways of Knowing
• In epistemology, there are several basic types of
knowledge. These include the following:
• Empirics—the scientific form of knowing.
– Empirical knowledge comes from observation, testing, and
replication.
• Personal knowledge—a priori knowledge.
– Personal knowledge pertains to knowledge gained from
thought alone.
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64.
Ways of Knowing cont…
• Somatic knowledge—knowing of the body in
relation to physical movement.
– Somatic knowledge includes experiential use of
muscles and balance to perform a physical task.
• Metaphysical (spiritual) knowledge—seeking
the presence of a higher power.
– Aspects of spiritual knowing include magic,
miracles, psychokinesis, extrasensory perception,
and near-death experiences.
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65.
• Esthetics—knowledge related to beauty,
harmony, and expression.
– Esthetic knowledge incorporates art, creativity,
and values.
• Moral or ethical knowledge—knowledge of
what is right and wrong.
– Values and social and cultural norms of behavior
are components of ethical knowledge.
65
Ways of Knowing cont…

66.
Nursing Epistemology
• Nursing epistemology has been defined as “the study
of the origins of nursing knowledge, its structure and
methods, the patterns of knowing of its members,
and the criteria for validating its knowledge claims”
(Schultz & Meleis)
• Like most disciplines, nursing has both scientific
knowledge and knowledge that can be termed
conventional wisdom (knowledge that has not been
empirically tested).
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67.
Nursing Epistemology cont..
• Traditionally, only what stands the test of
repeated measures constitutes truth or
knowledge.
• Classical scientific processes (i.e.,
experimentation), however, are not suitable for
creating and describing all types of knowledge.
• Social sciences, behavioral sciences, and the arts
rely on other methods to establish knowledge.
• Because it has characteristics of social and
behavioral sciences, as well as biologic sciences,
nursing must rely on multiple ways of knowing.
67

68.
• In a classic work, Carper (1978) identified four
fundamental patterns for nursing knowledge:
Empirics—the science of nursing,
Esthetics—the art of nursing,
Personal knowledge in nursing, and
Ethics—moral knowledge in nursing.
Empirical knowledge tends to be the most
emphasized way of knowing in nursing, because
• there is a need to know how knowledge can be
organized into laws and theories for the purpose of
describing, explaining, and predicting phenomena of
concern to nurses.
68
Nursing Epistemology cont..

69.
Esthetic knowledge is expressive, subjective, unique,
and experiential rather than formal or descriptive.
– Esthetics includes sensing the meaning of a moment.
– It is evident through actions, conduct, attitudes, and
interactions of the nurse in response to another.
– It is not expressed in language (Carper, 1978).
 Esthetic knowledge relies on perception.
 It is creative and incorporates empathy and
understanding.
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70.
Personal knowledge refers to the way in which nurses
view themselves and the client.
• Personal knowledge is subjective and promotes
wholeness and integrity in personal encounters.
• Personal maturity and freedom are components of
personal knowledge, which may include spiritual and
metaphysical forms of knowing.
• It is largely expressed in personality
70

71.
• Ethics refers to the moral code for nursing and is
based on obligation to service and respect for human
life.
• Ethical knowledge occurs as moral dilemmas arise in
situations of ambiguity and uncertainty, and when
consequences are difficult to predict.
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72.
Other Views of Patterns of Knowledge in
Nursing
• Schultz and Meleis (1988) observed that
Carper’s work did not incorporate practical
knowledge into the ways of knowing in
nursing.
• Because of this and other concerns, they
described three patterns of knowledge in
nursing: clinical, conceptual, and empirical.
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73.
• Clinical knowledge refers to the individual nurse’s
personal knowledge.
• It results from using multiple ways of knowing while
solving problems during client care provision.
• Clinical knowledge is manifested in the acts of
practicing nurses and results from combining
personal knowledge and empirical knowledge.
• It may also involve intuitive and subjective knowing.
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74.
• Conceptual knowledge is abstracted and generalized
beyond personal experience.
• It explicates patterns revealed in multiple client
experiences, which occur in multiple situations,
and articulates them as models or theories.
• In conceptual knowledge, concepts are drafted and
relational statements are formulated.
• Propositional statements are supported by empirical or
anecdotal evidence or defended by logical reasoning.
• Conceptual knowledge uses knowledge from nursing and other
disciplines. 74

75.
• For decades, the importance of the multiple ways of
knowing has been recognized in the discipline of
nursing.
1. Encourage the use of different types of knowledge in
practice, education, theory development and research
2. Encourage the use of different methodologies in
practice and research
3. Make nursing education more relevant for nurses with
different educational backgrounds
4. Accommodate nurses at different levels of clinical
competence
5. Ultimately promote high-quality client care and client
satisfaction
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76.
Assignment
• Read on the following Theories and Models
individually and present:
1. The nature of the theory(Description, critics
and achievements)
2. Associations found based on respective
theory or model, if any
3. the application of the theories in nursing
practice
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77.
Read on the following Philosophies, Theories and(or)
Models individually and present to your class:
1. Orlando’s Nursing process theory in nursing
practice(Teklu)
2. Modeling and Role modeling theory in nursing
practice(Abdi).
3. Mercer’s Becoming a Mother theory in Nursing
practice(Wondu).
4. Leininger’s Theory of culture care Diversity and
Universality in nursing practice(Desalagn)
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78.
Reading assignment
1. Watson’s Philosophy of Nursing= Rediet
2. Nightingale’s Philosophy of Nursing= Desalegn
3. Orem’s Conceptual Model= Melkam
4. Rogers’ Science of Unitary Human Beings= Abdi
5. Levine’s Conservation Model= Wondu
6. Johnson’s Behavioral System Model= Teklu
7. King’s Conceptual System= Zerihun
8. Neuman’s Systems Model=
9. Roy’s Adaptation Model=
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79.
 Benner’s philosophy in nursing(Melkam)
The Gorden’s approach of Nursing process(Rediet)
79

80.
References
• Melanie Mc Ewen , The theoretical basis for
nursing
• Jones & Bartlett Learning, LLC. The Essence of
Nursing: Knowledge and Caring,
• Martha Raile Alligood, Nursing Theory
UTILIZATION & APPLICATION
• Fundamentals of Nursing
• Medical Surgical Nursing
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81.
Assignment
6. Parse’s Theory of Human Being in nursing
practice
81

82.
Thanks!
82

83.
Theory development stages
Five stages in the development of nursing theory and
philosophy:
(1) Silent knowledge: blind obedience to medical
authority.
(2) Received knowledge: Borrowed theories
(3) Subjective knowledge: authority internalized and
negative attitude toward borrowed theories
(4) Procedural knowledge: theory development
approaches, methodology, statistical analysis
(5) Constructed knowledge: integration of different
types of knowledge
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84.
Types and characteristics of theories
Grand Theories:
• Grand theories are the most complex and broadest in
scope.
• Grand theories are nonspecific and comprised of
relatively abstract concepts that lack operational
definitions.
• Their propositions are also abstract and are not
generally amenable to testing.
• Grand theories are developed through thoughtful and
insightful appraisal of existing ideas as opposed to
empirical research (Fawcett, 2000).
• The majority of the nursing conceptual frameworks
(i.e., Orem, Roy, Rogers) are considered to be grand
theories.
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85.
Middle Range Theories
• Middle range theory lies between the nursing
models and more circumscribed, concrete idea
(practice theories).
• Middle range theories are substantively specific and
encompass a limited number of concepts and a
limited aspect of the real world.
• They are comprised of relatively concrete concepts
that are operationally defined and relatively concrete
propositions that may be empirically tested (Higgins
& Moore, 2000; Peterson, 2008; Whall, 2005).
85

86.
• A middle range theory may be
A description of a particular phenomenon,
An explanation of the relationship between phenomena,
or
A prediction of the effects of one phenomenon or another.
• Many investigators favor working with propositions
and theories characterized as middle range rather than
with conceptual frameworks because
– they provide the basis for generating testable hypotheses
related to particular nursing phenomena and
– to particular client populations
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87.
• Examples of middle range theories used in nursing
include:
 social support,
Quality of life, and
health promotion
87

88.
Practice Theories
• Practice theories are also called microtheories,
prescriptive theories, or situation specific theories and
are the least complex.
• Practice theories are more specific than middle range
theories and produce specific directions for practice.
• They contain the fewest concepts and refer to specific,
easily defined phenomena.
• They are narrow in scope, explain a small aspect of
reality, and tend to be prescriptive.
• Examples of practice theories developed and used by
nurses are theories of infant bonding and oncology pain
management.
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89.
Partial Theories
• Partial theories are those in the development stage.
• In a partial theory some concepts have been
identified and some relationships between them
have been identified, but the theory is not complete.
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90.
Theory Development in Nursing
• A number of issues related to use of theory in
nursing have received significant attention in
the literature.
– The first is the issue of borrowed versus unique
theory in nursing.
– A second issue is nursing’s metaparadigm, and
– a third is the importance of the concept of caring
in nursing.
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91.
BORROWED VERSUS UNIQUE THEORY IN
NURSING
• Since the 1960s, the question of borrowing theory
from other disciplines has been raised in the
discussion of nursing theory.
• The debate over borrowed theory centers in the
perceived need for theory unique to nursing
discussed by many nursing theorists.
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92.
• Concerns of opponents:
– Only theories that are grounded in nursing should
guide the actions of the discipline.
– believe that nursing knowledge should not be
tainted by using theory from physiology,
psychology, sociology, and education.
– Furthermore, they believe borrowing requires
returning, and that the theory is not in essence
nursing if concepts are borrowed.
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93.
• Arguments of Proponents
– knowledge belongs to the scientific community and to
society at large, and it is not the property of
individuals or disciplines.
– the use of knowledge generated by any discipline is
not borrowed, but shared.
– Further, shared theory does not lessen nursing
scholarship, but enhances it.
– like other applied sciences, nursing depends on the
theories from other disciplines for its theoretical
foundations. Eg.
• General system theory (nursing, biology, sociology, and
engineering.)
• Theories of stress and adaptation (nurses, psychologists,
and physicians)
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94.
Conclusion on the arguments:
• In reality, all nursing theories incorporate concepts
and theories shared with other disciplines to guide
theory development, research, and practice.
• However, simply adopting concepts or theories from
another discipline does not convert them into
nursing concepts or theories.
• Emphasis should be placed on redefining and
synthesizing the concepts and theories according to
a nursing perspective
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95.
NURSING’S METAPARADIGM
• The most abstract and general component of the
structural hierarchy of nursing knowledge is what
Kuhn (1977) called the metaparadigm.
• A metaparadigm is the global perspective of a
discipline that:
– identifies the primary phenomena of interest to
that discipline and
– explains how the discipline deals with those
phenomena in a unique manner (Fawcett, 2000).
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96.
• The metaparadigm includes:
– major philosophical orientations or worldviews of
a discipline,
– the conceptual models and theories that guide
research and other scholarly activities, and
– the empirical indicators that operationalize
theoretical concepts.
• The purpose or function of the metaparadigm is to
summarize the intellectual and social missions of the
discipline and place boundaries on the subject
matter of that discipline.
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97.
Requirements for a Metaparadigm
97

98.
• According to Fawcett and Malinski (1996), in the
1970s and early 1980s,
– A number of nursing scholars identified a growing
consensus that the dominant phenomena within
the science of nursing revolved around the
concepts of
Man(person),
 Health,
Environment, and
Nursing
• Fawcett first wrote on the central concepts of nursing in
1978 and formalized them as the metaparadigm of
nursing in 1984.
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99.
A summary of Fawcett’s definitions for each
term is in metaparadigm of nursing theory
• Person refers to
– a being composed of physical, intellectual,
biochemical, and psychosocial needs;
– a human energy field;
– a holistic being in the world;
– an open system; an integrated whole; an adaptive
system; and a being who is greater than the sum
of his parts.
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100.
• Health is
– the ability to function independently;
– successful adaptation to life’s stressors;
– achievement of one’s full life potential; and
– unity of mind, body, and soul.
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101.
• Environment typically refers to
– the external elements that affect the person
– internal and external conditions that influence the
organism;
– significant others with whom the person interacts;
– and an open system with boundaries that permit
the exchange of matter, energy, and information
with human beings.
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102.
• Nursing is
– a science, an art, and a practice discipline, and
– involves caring
– Goals of nursing include care of the well, care of
the sick, assisting with self-care activities,
– helping individuals attain their human potential,
and discovering and using nature’s laws of health.
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103.
Relationships Among the Metaparadigm Concepts
(Donaldson, Crowley and Gortner)
1. Person and health: Nursing is concerned with the
principles and laws that govern the life-process,
well-being, and optimal functioning of human
beings, sick or well.
2. Person and environment: Nursing is concerned with
the patterning of human behavior in interaction
with the environment in normal life events and
critical life situations.
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104.
3. Health and nursing: Nursing is concerned with the
nursing action or processes by which positive
changes in health status are effected.
4. Person, environment, and health: Nursing is
concerned with the wholeness or health of human
beings, recognizing that they are in continuous
interaction with their environments (Fawcett &
Malinski, 1996).
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105.
• In addressing how the four concepts meet the
requirements for a metaparadigm, Fawcett and
Malinski (1996) state that:
– The first three propositions represent recurrent
themes identified in the writings of Nightingale
and other nursing scholars.
– Furthermore, the four concepts and propositions
identify the unique focus of the discipline of
nursing and encompass all relevant phenomena in
a parsimonious manner.
105

106.
Assignments 1(2011 Batch)
106

107.
Reading assignments
• What are Other Viewpoints on Nursing’s
Metaparadigm, if any.
• Illustrate how the four domains of nursing are
described in the nursing theories you have taken for
your assignment 1.
• Discuss how the concept of “Caring” is explained in
Nursing.
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108.
108

109.
Chapter three: Concept Development
• Concepts are terms that refer to phenomena that occur
in nature or in thought.
• Concepts may be:
– abstract (e.g., hope, love, desire) or relatively
– concrete(e.g., airplane, body temperature, pain)
• Concepts are:
– formulated in words that enable people to
communicate their meanings about realities in the
world and
– give meaning to phenomena that can directly or
indirectly be seen, heard, tasted, smelled, or touched
(Fawcett, 1999).
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110.
• With regard to labeling, concept may be:
– a word (e.g., grief, empathy, power, pain),
– two words (e.g., job satisfaction, need fulfilment,
role strain), or
– a phrase (eg postmastectomy grief)
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111.
Categories of concepts in nursing
• In nursing literature, concepts have been categorized
in several ways. For example, they have been
described as
– concrete or abstract,
– variable or non variable and
– operationally or theoretically defined
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112.
PURPOSES OF CONCEPT DEVELOPMENT
• Clarifying, recognizing, and defining concepts that
describe phenomena.
• To provide basis for development of conceptual
frameworks and research studies.
• Reexamination of concepts adopted from other
disciplines for relevance and fit in nursing context.
• To introduce new concepts as knowledge is
continually developing.
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113.
Importance of concept analysis
■ Identifying gaps in nursing knowledge
■ Determining the need to refine or clarify a
concept when it appears to have multiple
meanings
■ Evaluating the adequacy of competing concepts
in their relation to other phenomena
■ Examining the congruence between the definition
of the concept and the way it has been
operationalized.
■ Determining the fit between the definition of the
concept and its clinical application.
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114.
Strategies for Concept Analysis and Concept
Development
• Three different processes were described by
Walker and Avant (2005):
– Concept analysis/Concept clarification
– Concept synthesis/ Concept exploration
– Concept derivation
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115.
Concept Analysis
• Concept analysis is an approach to clarify the
meanings of terms and to define terms (concepts) so
that writers and readers share a common language.
• Concept analysis should be conducted when
concepts require clarification or further development
to define them for a nurse scholar’s purposes,
whether that is research, theory development, or
practice.
• This method for concept analysis requires an nine-
step approach
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116.
The Steps of concept analysis by Walker and
Avant
1. Select a concept.
2. Determine the aims or purposes of analysis.
3. Identify all the uses of the concept possible.
4. Determine the defining attributes.
5. Identify model case.
6. Identify borderline, related, contrary, invented,
and illegitimate cases.
7. Identify antecedents and consequences.
8. Defining the context
9. Define empirical referents
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117.
Step 1: select the concept of interest
A concept may be selected which originates from an
intuitive feeling or an area of concern.
The best concept analyses tend to have their roots in
clinical phenomena
 This helps to bridge the theory– practice gap in that the
end result has more credibility and relevance for
practice.
 The developed theory can be more easily used and
tested in practice
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118.
Step 1 cont’d…
While giving care a practitioner’s attention may be
attracted to a particular phenomenon
 Attention grabbing
Then attention giving
Example of attention giving question: ‘what are the
properties of pre-operative anxiety?, why do pts get
angry with their spouse during visiting time?’
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119.
Step 1 cont’d…
To ensure that the nursing focus is not ignored,
nurses persistent with probing questions such as:
How is the phenomenon related to nursing’s
body of knowledge?
Would understanding the phenomenon
contribute to better understanding of a patient
care issue?
How would questions relating to the
phenomenon be significant for nursing? 119

120.
Step 1 cont’d…
Once these questions have been answered, label
the phenomenon with a word or a short phrase.
Contain one cardinal idea and be fundamental to
the definition/description of the phenomenon;
 This label is a concept
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121.
Step 1 cont’d…
Example: intuition, caring, compassion, spirituality,
loneliness, loss…
It may be helpful to categorize the concept requiring
analysis within the metaparadigm.
E.g.
 ‘well-being’ may be subsumed under health
 ‘identity’ or ‘body image’ under person
 ‘caring’ or ‘empathy’ under nursing
 ‘energy field’ under environment
121

122.
Step 1 cont’d…
For the first analysis we undertake it may also be
a good idea to avoid broad concepts: e.g.
communication
A range of concepts can be selected analysis:
sorrow, hope, intuition, caring, grief, restlessness,
trust, quality of life, dignity, comfort, feeling,
burnout, etc.
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123.
Step 2: Define the aims of the analysis
This Step should provide a good rationale as to
why we are undertaking the process at all.
Research-based justification for selecting a
particular concept may be provided.
The prime purpose for undertaking an analysis is
to clarify and to create conceptual meaning for a
clinical phenomenon.
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124.
Step 2 cont’d…
Among many reasons to undertake concept analysis
To reduce a complex concept to its component parts
for examination of its internal structure to increase its
explanatory power
To examine and clarify confusing or unclear concepts
in an existing theory and provide the basis for
operational definitions
For refining and generating research questions and
hypotheses
Allow the operationalization of variables for testing a
theory or hypothesis through a research study
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125.
Step 2 cont’d…
 Clarifies overused concepts
 Differentiates a concept from other similar yet
different concepts
 Lays the foundation for theory development
 The outcome of a successful concept analysis is
the identification of empirical indicators to
reliably inform the presence or absence of the
concept.
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126.
Step 2 cont’d…
This step will also set the parameters for later
steps in the process
If the purpose was to investigate fear or
hopelessness among coronary care patients,
 then this will guide us towards those indicators and
attributes identified as an aid to recognizing and
investigating these concepts.
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127.
Step 3: Identify meanings of the concept
Involves trawling (searching) the literature to find
as many pertinent meanings of the concept as
possible.
127

128.
Step 3 – meaning cont’d…
If the concept was ‘caring’, note that it could be
perceived as a noun or an adjective, whereas ‘care’
could be a verb
‘Care’ could also mean caution or attention or
protection.
It is a good idea to keep searching until you reach
the stage of ‘diminishing returns’, where no new
meanings are being uncovered.
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129.
Step 3 – meaning cont’d…
Definitions are often unclear and ambiguous, so
simply providing a list of definitions of a concept
should not be interpreted as undertaking an analysis.
It is also recommended to examine what theorists or
researchers have said about the concept.
Do not confine the search to nursing, but include all
those who have attempted to use the concept within
their theory or study.
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130.
Step 3 – meaning cont’d…
Sources that may give you an insight into the use
of the concept:
Professional, popular, classical and
philosophical literature
Poetry
Books of quotations
Music
Paintings
Photographs
Dictionary
Colleagues
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131.
Step 4: Determine the defining attributes
 The meanings of the concept identified in Step 3
explicate (clarify) the particular characteristics of the
concept that occur again and again.
 These refer to as the ‘defining attributes’ of the
concept.
 The defining attributes distinguish the concept from
similar or related concepts.
 For each concept there may be a list of several
defining attributes
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132.
Step 4: Defining attribute cont’d…
 It is better to have 3 or 4 defining attributes that really
characterize the concept well
 E.g. Of a defining attribute:
Caring - providing for another
Empathy - demonstrating concern
Attachment - visual contact
 Ensure that the defining attributes are examined for their
degree of consistency with nursing’s perspective.
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133.
Step 4: Defining attribute cont’d…
Defining attributes helps to differentiate the
concept being analyzed from dissimilar ones
Test for necessity – checking the ability of the
attributes to differentiate the concept from
dissimilar concepts
Test of sufficiency - the entire list of defining
attributes is considered
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134.
Step 4: Defining attribute cont’d…
 When undertook a concept analysis of ‘caring’. It
identified the following defining attributes of
caring:
Serious attention
Concern
Providing for
Regard and respect
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135.
Step 5: Identify a model case
A model case is a pure example of the concept being used
and should include all the defining attributes.
Extract from the literature illustrating a real-life event or a
clinical example that accurately describes the concept
Model case enhances the degree of clarification and
credibility of the concept
There must be no contradictions between the model case
and the defining attributes
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136.
Model case for ‘self-care’
A 30 year old woman has just been diagnosed with Type I
diabetes.
She returns from her health clinic armed with data she received
after educational sessions with the diabetes nurse educator and
dietician.
Included in this data is a phone number that she may call for
additional support, and questions.
She also has a follow-up appointment to reinforce the new
knowledge she received at today's’ session.
Over the next several days and weeks, she begins to make lifestyle
changes.
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137.
Model case cont’d…
Her eating habits are changing based on self-selected
choices. She begins an exercise program. With the
assistance of her diabetes nurse educator she becomes
adept at giving herself insulin injections. Four times a day
she checks her blood sugar. When she returns to the clinic
one month later for one of her follow up visits she feels
confident that she is able to manage this disease. Her lab
results reflect this also. This individual has been
empowered to successfully implement self-care.
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138.
Model case cont’d…
The above model case illustrates the defining
characteristics of self-care through the inclusion of
specific behaviors such as:
Dietary changes
Blood glucose monitoring and
Exercise
Additional defining characteristic of self-care is the
inclusion of a nurse or other health care professional
to facilitate the process.
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139.
Step 6: Identify alternative cases
Provide examples of what is not the concept
Alternative cases include
Related cases
Borderline cases
Contrary cases
139

140.
Related case
In a related case all the defining critical attributes
are missing but the concept is still seen as similar
in meaning to the concept
Related cases may represent concepts that are
often confused with the concept under study
E.g. the concept stress with burnout
Fear with anxiety
Adaptation with coping
Comfort with care
Innovation with change
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141.
Related case cont’d…
 E.g. of related case ‘self-care’
 An individual with chronic fatigue syndrome
attends a self-help group meeting with the intent
to learn how to cope with his illness and receive
support from fellow chronic fatigue patients. By
attending this meeting the individual will gain
knowledge into his disease process and be
empowered to do more to help himself.
141

142.
Related case cont’d…
 However, there is no evidence of any actual self-
care behaviors or activities occurring,
 Although there is similarity in the two concepts of
self-help and self-care.
142

143.
Borderline case
This example is very similar to a model case but
some of the defining attributes are missing
Identifying borderline cases helps to clarify the
attributes which are an essential prerequisite of
the model case and helps to reduce the blurring
of the boundaries between cases.
143

144.
Borderline case cont’d…
E. g. of border line case ‘self-care’
At the end of a weekend, a college student packs
to return to his campus dorm. As he prepares to
leave in his car, his parents call out “take care of
yourself”. He responds with “I will”.
This demonstrates the parents concern for their
child’s welfare and safety.
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145.
Borderline case cont’d…
The parents are implicitly suggesting to their son
to utilize self-care measures like
Use of seat belts
Driving within the speed limit and
Getting adequate sleep and exercise
However, there is no evidence of whether the son
is actually performing these behaviors
145

146.
Contrary case
This case represents what is not the concept being
analyzed.
146

147.
Contrary case cont’d…
 E.g. of contrary case of ‘self-care’
 A 35 year old woman who has felt an enlarging breast lump
for over a year.
 It has now enlarged to the size of an egg. She consumes 3-4 alcohol
drinks daily, smokes 2 packages of cigarettes daily, doesn’t exercise,
and her last visit for a physical examination was after the birth of
her last child 10 years ago.
 She doesn’t trust the news media and therefore pays no attention
to health news reported in newspapers and on television.
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148.
Step 7: identify antecedents and
consequences
Antecedents
 Events that precede/contribute the occurrence of the
concept.
 The predisposing factors certain concept
 It gives an indication of the purpose of the analysis and
the clinical arena
 Consider that something cannot be an antecedent and a
defining attribute at the same time.
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149.
Step 7: Antecedents cont’d…
E.g. of antecedents of ‘self-care”
Need to maintain health and prevent disability
Patient with chronic illness
Need to alleviate the symptoms of a disease
process
149

150.
Step 7: Consequences
Consequences are those events or outcomes that
happen after the occurrence of the concept.
Example for ‘self-care’ positive/negative
Pregnant women may practice negative self-care
behaviors. Examples include using alcohol or
drugs and smoking during pregnancy (Negative)
150

151.
Step 7: Consequences cont’d…
 Self-care activities modify and improve on
achievements made during the course of
rehabilitation for patients following stroke disease.
 Self-care is viewed as enabling these individuals to
maintain and comply with treatments consistently
(positive)
151

152.
Step 8: consider context and values
Concepts have different meanings depending on
the context in which they are used.
E.g. Caring in an ICU may be perceived differently
from caring in an elderly rehabilitation unit or in
Africa compared to Japan.
Contextually, language and culture play a major
role in how concepts are viewed.
152

153.
Step 8: Contexts and value cont’d…
Values and beliefs are also important
considerations
Dependency may be seen as a normal social need
in some communities but as a burden on society in
others
Clients’ self-care may be seen as important and
valuable by some nurses but as upsetting to the
ward routine by others.
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154.
Step 9: identify empirical indicators
 These are clear referents for measuring or
appraising the existence of the concept.
 Referred to as the operationalization of a concept
 In some cases, the empirical indicators will be the
same as the defining attributes identified in step 4
above.
154

155.
Step 9: Empirical indicators cont’d…
 Such indicators are useful in research and practice
 Because they can provide criteria by which a
concept can be measured
155

156.
Assignment 3
1. Consider a phenomena from nursing practice or
a nursing theory and come up with a concept
development(20 points).
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157.
Stepping points
The nature of knowledge needed for nursing
practice was theoretical knowledge.
157

158.
158

159.
Importance of concept analysis
■ Identifying gaps in nursing knowledge
■ Determining the need to refine or clarify a
concept when it appears to have multiple
meanings.
■ Examining the congruence between the
definition of the concept and the way it has
been operationalized.
■ Determining the fit between the definition of
the concept and its clinical application.
159

160.
Chapter 4: Theory Analysis and Evaluation
• Theory evaluation has been defined as the process of
systematically examining a theory.
• Criteria for this process are variable, but they generally
include examination of the theory’s origins, meaning,
logical adequacy, usefulness, generalizability, and
testability.
• Theory evaluation identifies a theory’s degree of
usefulness to guide practice, research, education, and
administration.
• Uses to identify the need for additional theory
development or refinement.
160

161.
A three-phase process of theory work out by
Meleis and Moody
1. THEORY DESCRIPTION:
• In theory description,
– the works of a theorist are reviewed with a focus on the
historical context of the theory
– related works by others are examined to gain a clear
understanding of the structural and functional
components of the theory.
• The structural components include assumptions,
concepts, and propositions.
• The functional components consist of the concepts of
the theory and how they are used to describe, explain,
predict, or control a phenomena.
161

162.
2. THEORY ANALYSIS
• Theory analysis is the second phase of the evaluation
process.
• It refers to a systematic process of objectively
examining the content, structure, and function of a
theory.
• Theory analysis is conducted if the theory or
framework has potential for being useful in practice,
research, administration, or education.
• Non judgmental but a detailed effort of
understanding the theory.
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163.
3. THEORY EVALUATION
• Theory evaluation, or theory critique, is the final step of
the process.
• Evaluation follows analysis and assesses the theory’s
potential contribution to the discipline’s knowledge base.
• Involves reflection of ascertaining how well a theory
serves its purpose, with the process of evaluation
resulting in a decision or action about use of the theory.
• This involves evaluation of how the theory is used to
direct nursing practice and interventions.
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164.
Synthesized Method for Theory Evaluation
1. THEORY DESCRIPTION
What is the purpose of the theory? (describe,
explain, predict, prescribe)
What is the scope or level of the theory? (grand,
middle range, practice)
What are the origins of the theory?
What are the major concepts?
What are the major theoretical propositions?
What are the major assumptions?
Is the context for use described? 164

165.
Synthesized Method for Theory Evaluation cont..
2. THEORY ANALYSIS
• Are concepts theoretically and operationally defined?
• Are statements theoretically and operationally
defined?
• Are linkages explicit?
• Is the theory logically organized?
• Is there a model/diagram?
• Does the model contribute to clarifying the theory?
• Are the concepts, statements, and assumptions used
consistently.
• Are outcomes or consequences stated or predicted?
165

166.
Synthesized Method for Theory Evaluation cont..
3. THEORY EVALUATION
• Is the theory congruent with current nursing
standards?
• Is the theory congruent with current nursing
interventions or therapeutics?
• Has the theory been tested empirically? Is it
supported by research?
• Does it appear to be accurate/valid?
166

167.
Synthesized Method for Theory Evaluation cont..
• Is there evidence that the theory has been used
by nursing educators, nursing researchers, or
nursing administrators?
• Is the theory socially relevant?
• Is the theory relevant cross-culturally?
• Does the theory contribute to the discipline of
nursing?
• What are implications for nursing related to
implementation of the theory?
167

168.
THEORY OF CHRONIC SORROW
by
EAKES, BURKE, AND HAINSWORTH(1998)
(Theoretical basis of nursing, p 238)
168
THEORY EVALUATION EXEMPLAR

169.
Theory Description
 Scope of theory : Middle range
 Purpose of theory : Explanatory theory—
“to explain the experiences of people across the
lifespan who encounter ongoing disparity because of
significant loss”.
 Origins of theory : “Chronic sorrow” appeared in the
literature in 1962.
It was used to describe recurrent grief experienced by
parents of children with disabilities.
169

170.
Theory Description cont…
• Major concepts:-
– Chronic sorrow,
– Loss experience,
– Disparity,
– Trigger events (milestones),
– External management methods,
– Internal management methods.
All are defined and explained.
170

171.
Major theoretical propositions(only few):
1. Disparity between current reality and desired reality
is created by loss experiences.
2. For individuals with life-threatening illnesses,
chronic sorrow is triggered when the individual
experiences disparity with accepted norms.
3. For bereaved individuals, disparity from the ideal is
created by the absence of a person who was central
in the life of the bereaved.
171
Theory Description cont…

172.
 Major assumptions: Not stated
 Context for use:
“Experienced by individuals across the lifespan”;
imply that it may be used in multiple settings
and nursing situations.
172
Theory Description cont…

173.
Theory Analysis
Theoretical definitions for major concepts:
 Disparity—a gap between the current reality and the
desired as a result of a loss experience.
 Loss experience—a significant loss that may be
ongoing, with no predictable end.
 Chronic sorrow--grief-related feelings associated with
ongoing disparity resulting from a loss experience.
 Internal management methods—positive personal
coping strategies used to deal with the periodic
episodes of chronic sorrow.
173

174.
 Operational definitions for major concepts: No
 Statements theoretically defined: Theoretical
propositions are stated.
 Statements operationally defined: not operationally
defined.
 Linkages explicit: Linkages are described.
 Logical organization: Theory is logically organized.
 Model/diagram: A model is provided and assists in
explaining linkages of the concepts
174
Theory Analysis cont..

175.
175

176.
 Consistent use of concepts, statements, and
assumptions: Concepts and propositions are used
consistently.
 Assumptions are not explicitly addressed.
 Predicted or stated outcomes or consequences:
Outcomes are stated.
176
Theory Analysis cont..

177.
Theory Evaluation
• Congruence with nursing standards and
interventions : The theory appears congruent with
nursing standards(a number of articles refer it).
• Evidence of empirical testing support/validity : The
theory was derived from multiple research studies
and a review of the literature. Ex.
– The Burke Chronic Sorrow Questionnaire is an interview
guide comprising 10 open-ended questions that
explore the theory’s concepts.
177

178.
• Use by nursing educators, nursing researchers, or
nursing administrators:
– Studies have cited the work of Eakes, Burke, and
Hainsworth related to chronic sorrow (e.g.,
Northington, 2000).
178
Theory Evaluation cont…

179.
 Social relevance: Theory is relevant to individuals,
families, and groups, irrespective of age or
socioeconomic status.
 Transcultural relevance: Theory is potentially relevant
across cultures.
 Contribution to nursing: Authors note that the
theory is applicable to different groups.
But more study is needed to test the theory and to identify
strategies to reduce disparity created by loss.
179
Theory Evaluation cont…

180.
Conclusions and implications:
 The theory is useful and appropriate for nurses
practicing in a variety of settings.
 Implications for research were described and
implications for education can be inferred.
Further development of the theory is warranted
to better explicate relationships and
operationalize the concepts and propositions to
allow testing.
180
Theory Evaluation cont…

181.
Assignment
Conduct a theory evaluation on the following theories
using synthesized method discussed in this course(20%).
• KOLCABA’S THEORY OF COMFORT(Adult Nursing)
• BECK’S POSTPARTUM DEPRESSION THEORY(Maternity)
• MERCER’S CONCEPTUALIZATION OF MATERNAL ROLE
ATTAINMENT/BECOMING A MOTHER(Pedi).
• PENDER’S HEALTH PROMOTION MODEL
• CRITICAL SOCIAL THEORY
181

182.
Class end….
Thank
you!!
182