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  1. 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) 1
  2. 2. 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 2
  3. 3. 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. 3
  4. 4. 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 4
  5. 5. 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… 5
  6. 6. 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.. 6
  7. 7. 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 7
  8. 8. 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) 8
  9. 9. 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). 9
  10. 10. 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) 10
  11. 11. 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. 11
  12. 12. • 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) 12
  13. 13. 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. 13
  14. 14. 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. 14
  15. 15. 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. 15
  16. 16. • 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. 16
  17. 17. • 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) 17
  18. 18. 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. 18
  19. 19. • 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 19
  20. 20. 20
  21. 21. 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 21
  22. 22. 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. 22
  23. 23. 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. 23
  24. 24. 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. 24
  25. 25. 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). 25
  26. 26. 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). 26
  27. 27. • 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). 27
  28. 28. • 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. 28
  29. 29. • 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. 29
  30. 30. • 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. 30
  31. 31. 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. 31
  32. 32. 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). 32
  33. 33. • 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. 33
  34. 34. • 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. 34
  35. 35. • 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. 35
  36. 36. 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
  37. 37. • 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 37
  38. 38. • 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. 38
  39. 39. • 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. 39
  40. 40. • 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). 40
  41. 41. • 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. 41
  42. 42. • 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. 42
  43. 43. • 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. 43
  44. 44. • 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. 44
  45. 45. • 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. 45
  46. 46. 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. 46
  47. 47. • 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. 47
  48. 48. 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”. 48
  49. 49. • 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. 49
  50. 50. Thanks! 50
  51. 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; 51
  52. 52. 52
  53. 53. 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). 53
  54. 54. 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. 54
  55. 55. 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 55
  56. 56. 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. 56
  57. 57. 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). 57
  58. 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 58
  59. 59. 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. 59
  60. 60. 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). 60
  61. 61. 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. 61
  62. 62. 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 62
  63. 63. 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. 63
  64. 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. 64
  65. 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. 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). 66
  67. 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. 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. 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. 69
  70. 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. 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. 71
  72. 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. 72
  73. 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. 73
  74. 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. 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 75
  76. 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 76
  77. 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) 77
  78. 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= 78
  79. 79.  Benner’s philosophy in nursing(Melkam) The Gorden’s approach of Nursing process(Rediet) 79
  80. 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 80
  81. 81. Assignment 6. Parse’s Theory of Human Being in nursing practice 81
  82. 82. Thanks! 82
  83. 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 83
  84. 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. 84
  85. 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. 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 86
  87. 87. • Examples of middle range theories used in nursing include:  social support, Quality of life, and health promotion 87
  88. 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. 88
  89. 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. 89
  90. 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. 90
  91. 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. 91
  92. 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. 92
  93. 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) 93
  94. 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 94
  95. 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). 95
  96. 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. 96
  97. 97. Requirements for a Metaparadigm 97
  98. 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. 98
  99. 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. 99
  100. 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. 100
  101. 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. 101
  102. 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. 102
  103. 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. 103
  104. 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). 104
  105. 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. 106. Assignments 1(2011 Batch) 106
  107. 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. 107
  108. 108. 108
  109. 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). 109
  110. 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) 110
  111. 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 111
  112. 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. 112
  113. 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. 113
  114. 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 114
  115. 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 115
  116. 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 116
  117. 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 117
  118. 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?’ 118
  119. 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. 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 120
  121. 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. 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. 122
  123. 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. 123
  124. 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 124
  125. 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. 125
  126. 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. 126
  127. 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. 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. 128
  129. 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. 129
  130. 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 130
  131. 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 131
  132. 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. 132
  133. 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 133
  134. 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 134
  135. 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 135
  136. 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. 136
  137. 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. 137
  138. 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. 138
  139. 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. 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 140
  141. 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. 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. 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. 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. 144
  145. 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. 146. Contrary case This case represents what is not the concept being analyzed. 146
  147. 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. 147
  148. 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. 148
  149. 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. 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. 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. 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. 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. 153
  154. 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. 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. 156. Assignment 3 1. Consider a phenomena from nursing practice or a nursing theory and come up with a concept development(20 points). 156
  157. 157. Stepping points The nature of knowledge needed for nursing practice was theoretical knowledge. 157
  158. 158. 158
  159. 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. 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. 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. 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. 162
  163. 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. 163
  164. 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. 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. 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. 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. 168. THEORY OF CHRONIC SORROW by EAKES, BURKE, AND HAINSWORTH(1998) (Theoretical basis of nursing, p 238) 168 THEORY EVALUATION EXEMPLAR
  169. 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. 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. 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. 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. 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. 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. 175
  176. 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. 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. 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. 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. 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. 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. 182. Class end…. Thank you!! 182

Notes de l'éditeur

  • world fair is an international exhibition of the industrial, scientific, technological, and artistic achievements of the participating nations.