1
The National Yang-Ming University
College of Nursing
N43001 Theoretical Basis for Nursing
Fall 2002
Credits: 3 semester hours
Class Time: Monday 9-12 noon
Place:護理館 RM602
Faculty: F-C Ma, RN, PhD; Zxy-yann Jane Lu, RN, PhD
Course description
The nature and purpose of theory in nursing are introduced. Paradigmatic progress
in nursing is also introduced. Nursing’s patterns of knowing are discussed. The
methods of concept development are compared and contrasted. The components of
theory and the process of theory development are described. Several schemes for
evaluating theory are presented. The relationship of theory, practice and research is
discussed.
Course Objectives
Upon completion of the course, the student will be able to:
1.
2.
3.
4.
5.
6.
Analyze four patterns of knowing in Nursing
Identify the components of a model or theory
Ascertain the relationship between knowledge synthesis and concept
development
Evaluate selected theories and conceptual frameworks using a variety of
schemes
Apply selected theories and conceptual frameworks to clinical nursing
situations
Identify the implications of selected theories and conceptual frameworks for
various areas of nursing research.
Required Textbooks
Chinn, P. L., & Kramer, M. K. (1999). Theory and nursing : integrated
knowledge development. (5th ed.). St Louis: Mosby.
Fawcett, J. (2000). Analysis and evaluation of contemporary nursing
knowledge: Nursing models and theories. Philadelphia: F. A. Davis.
Recommended textbooks
Benner, P. (1984). From novice to expert: Excellence and power in clinical
nursing practice. Menlo Park, CA: Addison-Wesley Pub. Co.
Kenney, J. W. (ed.). (1999). Philosophical and theoretical perspectives for
advanced nursing practice.(2nd.ed.). Boston: Jones and Bartlett.
Kikuchi, J. F. & Simmons, H. (eds.). (1992). Philosophic inquiry in nursing.
Newbury Park, CA: Sage Pub.
Marriner-Tomey, A. & Alligood, M. R. (2002). Nursing theorists and
their work (5th ed.). St Louis: Mosby.
Meleis, A. I. (1997). Theoretical nursing : Development & progress (3rd ed.).
2
Philadelphia: Lippincott.
Neuman, B. & Fawcett, J. (ed.). (2001). The Neuman systems model
th
(4 ed.). East Norwalk, CT: Prentice Hall.
Newman, M. A. (1994). Health as expanding consciousness. (2nd.ed.).
National League for Nursing.
Orem, D. E. (1991). Nursing: Concepts of practice (4th ed.). St Louis:C. V.
Mosby.
Parse, R. R. (1998). The human becoming school of thought: A perspective for
nurses and other health professionals. Newbury Park, CA: Sage Pub.
Parse, R. R. (1999). Illuminations: The human becoming theory in practice and
research. National League for Nursing.
Rogers, B. & Knafl, K. A. (eds.). (2000). Concept development in nursing:
foundations, techniques, and applications. (2nd.ed.). Philadelphia: W. B. Saunders
Co.
Rogers, M. E. (1987). An introduction to the theoretical basis of nursing.
Philadelphia:F. A. Davis.
Walker, L. O., & Avant, K. C. (1999). Strategies for theory construction in
nursing. (3rd. ed.). East Norwalk, CT:Appleton & Lange.
Watson, J. (1994). Applying the art and science of human caring. NY: National
League for Nursing.
Course Evaluation
1. Class participation
20
Demonstrate your participation in discussion, Raise critical questions, and preparation
prior to the class by reading class materials. The successful session will be the
responsibility of each student.
a. Reading assignments
10
b. Discussion participation
10
2. Theory debate
25
Select a phenomenon (i.e. women’s menstruation) with various approaches (at least
two) in research endeavor. (Papers in menstruation phenomenon with various
theoretical perspectives will be provided) Each group of students will take up a
theoretical approach and identify the major concepts in the theoretical model.
Theoretical definitions and operational definitions of the concepts will be discussed.
Strengths and weaknesses of philosophical foundations of concepts are evaluated.
Interrelationships among concepts are analyzed and reviewed. The class debate
focuses on the presentation of the strengths and weaknesses of philosophical
foundations of concepts as well as their antecedents and consequences.
Major concepts identified
Attributes, antecedents and consequences are reviewed
Strengths and weaknesses of philosophical foundations of concepts
Analysis of interrelationships among concepts
Organization, Closely comply with time frame
Total
4
6
6
6
3
25
3. Prepared presentation in a selected conceptual model
25
Conduct discussions in the class by selecting a theory of interest. Discuss with
3
instructor the outline of the materials at least one month prior to the presentation.
Emphases are on raising issues and generating critical discussion.
Discuss outline with instructor
3
Overview of the theory
4
Concepts and their relationships in the theory
4
Evaluation of the theory
4
Raise critical questions for discussion
4
Organization, Closely comply with time frame 3
Audiovisual aids preparation
3
Total
25
4. Final written papers
Due on 1/17/92 (maximum 20 pages)
30
Select the theory you have presented and carefully discuss its application for advanced
nursing practice.
Overview of the theory
3
Concepts and their relationships in the theory
4
Evaluation of the theory
4
Advance nursing practice applications
8
Appropriate literature support for the paper
4
Content comprehension
4
APA Style
3
Total
30
Assignments must be submitted on the due date unless prior arrangements are made
with the instructors. One point per hour will be deducted for late assignments.
Papers should be typed written, and double-spaced with fond size 12. (Double-sided
print is encouraged to save trees in the world!!)
1
The National Yang-Ming University
College of Nursing
N43001 Theoretical Basis for Nursing
Fall 2002
Class Schedule
Date
Topic and assignments
Wk 1
9/16
馬
Course overview
The historical development of nursing theory
Assignments:
Meleis, A. I. (1997). Theoretical nursing : Development &
progress (3rd ed.). Philadelphia: Lippincott. Pp.25-69.
Study questions:
1. What are the dominant themes in different stages of
development of nursing theories?
2. What are the forces and barriers confronted in our
endeavor of theory development?
Wk 2
9/23
盧
Patterns of knowing in nursing
Assignment:
Chinn, P. L. & Kramer, M. K. (1999). Theory and nursing :
integrated knowledge development. (5th ed.). St Louis: Mosby. Chap.
1,2.
Study questions:
1. What kinds of knowledge are the most valuable in the
discipline of Nursing?
2. How nursing knowledge is developed?
3. How the unique processes and expressions of each
pattern contribute to the whole of knowing?
4. Why do we need to develop substantive theory
(midrange practice theory)?
Wk3
9/30
馬
Nature and purpose of theory ( in Nursing);Components of a
theory
Assignment:
Fawcett, J. (2000). Analysis and evaluation of
contemporary nursing knowledge: Nursing models and
theories. Philadelphia: F. A. Davis. Chap. 1, 2.
Chinn, P. L., & Kramer, M. K. (1999). Theory and
nursing : integrated knowledge development. (5th ed.). St
Louis: Mosby. Chap. 2,3.
Recommended readings:
2
Dickoff, J. & James, P. (1968). A theory of theories: A
position paper. Nursing Research, 17, 197-203.
Meleis, A. I. (1997).
Theoretical nursing:
Development & progress (3rd ed.).
Philadelphia:
Lippincott. Pp. 250-254.
Walker, L. O., & Avant, K. C. (1999). Strategies for
theory construction in nursing.(3rd. ed.) East Norwalk,
CT:Appleton & Lange. Chap. 1.
Study questions:
1. Compare and contrast three concepts: theory, conceptual
framework, conceptual model
2. What are the characteristics of a theory (conceptual
framework)?
3. Analyze the levels of theory
4. What are the major themes in nursing theoretical
conceptualization?
5. What are the components of a theory?
6. Discuss the relationship of assumptions, concepts and
propositions in a theory.
Wk4
10/7
盧
Wk5
10/14
盧
Concept development (I)
Assignments:
Rogers, B. L. (1989). Concepts, analysis, and the
development of nursing knowledge: The evolutionary cycle.
Journal of Advanced Nursing, 14, 330-335.
Rogers, B. & Knafl, K. A.(eds.). (2000). Concept
development in nursing: foundations, techniques, and
applications.(2nd.ed.). Philadelphia: W. B. Saunders Co.
pp.1-37.
Study questions:
1. Discuss
philosophical
foundations
of
concept
development
2. Determine the characteristics of concepts
3. Identify methods for concept development
Concept development (II)
Assignments:
Rogers, B. & Knafl, K. A.(eds.). (2000). Concept
development in nursing: foundations, techniques, and
applications. (2nd.ed.). Philadelphia: W. B. Saunders Co.
Chap. 4
Walker, L. O., & Avant, K. C. (1999). Strategies for
theory construction in nursing. (3rd. ed.). East Norwalk,
CT:Appleton & Lange. Pp. 35-54.
Recommended readings:
3
Henson, R. H. (1997). Analysis of the concept of
mutuality. Image: Journal of Nursing Scholarship, 29(1),
77-81.
Lackey, N. R. (1993). Concept clarification: Using
Norris method in clinical research. In Rogers, B. & Knafl, K.
A.
Concept development in nursing: foundations,
techniques, and applications. Philadelphia: W. B. Saunders
Co. pp. 159-174.
Morse, J. M. (1995). Exploring the theoretical basis of
nursing using advanced techniques of concept analysis.
Advanced Nursing in Science. 17, 31-? .
Rogers, B. & Knafl, K. A.(eds.). (2000). Concept
development in nursing: foundations, techniques, and
applications.(2nd.ed.). Philadelphia: W. B. Saunders Co.
Chap.5. pp.77-102.
Schumacher, K. L., Stewart, B. J. & Archbold, P. G.
(1998). Conceptualization and measurement of doing family
caregiving well. Image: Journal of Nursing Scholarship,
30(1), 63-69
Study questions:
1. Discuss the steps of concept analysis (Wilson method
and Walker and Avant method)
2. Application of concept analysis to a specific nursing
phenomenon
Wk 6
10/21
盧
Midterm exam: Preparation for theory debate
Wk 7
10/28
馬
Evaluation and analysis of theories; Theory, Research, and
practice
Assignments:
Fawcett, J. (2000). Analysis and evaluation of
contemporary nursing knowledge: Nursing models and
theories. Philadelphia: F. A. Davis. Chap.3.
Hardy, M. E. (1974). Theories: Components,
development, and evaluation. Nursing Research. 23(2),
100-107.
Recommended readings:
Kenney, J. W.(ed.). (1999). Philosophical and
theoretical perspectives for advanced nursing practice.
(2nd.ed.). Boston: Jones and Bartlett. Chap.31,33,34,35.
Meleis, A. I. (1997).
Theoretical nursing :
Development & progress (3rd ed.).
Philadelphia:
Lippincott. Chap. 11.
Study questions:
4
1.
2.
3.
4.
Wk8
11/4
馬盧
What are the steps involved in the evaluation of a
theory?
Compare and contrast various models for evaluating a
theory
What are the units of analysis included in the structural
components of a theory?
What are the units of analysis included in the
functional components of a theory?
Theory debate
Divide the class into two groups. Apply the forum of
debate
to discuss the pros and cons of two different theoretical
perspectives of a phenomenon.
Wk9
11/11
馬
Parse’s theory of human becoming (4)
Wk10
11/18
盧
Benner’s from Novice to expert
Wk11
11/25
盧
Watson’s Human Caring theory
Wk12
12/2
盧
General Systems Theory
Wk13
12/9
馬
Roy’s adaptation model
Wk14
12/16
馬
Orem’s Self –care Framework
Wk15
12/23
盧
Health Promotion Model
Wk16
12/30
Betty Neuman’s systems model
5
馬
Wk17
1/6
馬盧
Course summary and Course evaluation
1
Course overview
Historical development of nursing theory
9/15
Study questions
1. What are the dominant themes in different stages of development of
nursing theories?
2. What are the forces and barriers confronted in our endeavor of theory
development?
Why does nursing need theories?
Nurses attempt to conceptualizing their actions and facilitate better care
through theory-based policies and theory-driven practice.
Use of theoretical thinking:
1. identifying phenomenon within the domain of nursing: i.e. loss
2. guide the process of research: i.e. see how the concept related to other
nursing phenomenon. Loss, grief, social support.
3. theory testing：to evaluate if theory is applicable to practice
4. refine, modifying, or expand theory
Nursing theory attempts to answer questions such as:
1. What is the essence of nursing?
2. What are the goals of nursing?
3. What are the domains of nursing?
4. What are the nursing interventions (action)?
5. What are the desired outcomes of nursing intervention?
According to Meleis (1997), serious labeling and systematic communication
of concepts and theories in nursing occurred between 1950 to 1980.
Stages in nursing progress:
1. Stage of practice: defined as providing care (care goals and processes);
2. Stage of Education and administration: development of functional roles
for nurses. Through development of curricula, nurse educators ask the
question about domains of nursing
3. Stage of Research: Questions of how to teach, learning strategies, how
to lead direct educators to research; Nursing Research publishes in
1952. Establish universal criteria to evaluate ; sharing ideas of
communality; Objectivity and detached scrutiny; Focus of syntax (vs.
Content of research)
4. Stage of theory: essence of nursing; use theory to guide teaching;
research; practice
5. Stage of philosophy: focus on philosophical inquiry. defining domain
of nursing, the nature of nursing knowledge (four paradigm of nursing);
appropriate methods for knowledge development, the consistency
between nursing knowledge and research methodologies;
2
Epistemological issues; Focus on structure of knowledge, nature of
theory, criteria for analysis, justification of particular methodologies for
knowledge development; also ontological issues.
6. Stage of integration: 6 characteristics
a. identify coherent structures of the discipline of nursing ：
development of middle-range and situation-specific theories
focused on an aspect of nursing. i.e. middle-range theory of
chronic sorrow published in Image 1998 30(2).
b. substantive areas through integration of theory, research, and
practice
c. evaluation of different aspects of theoretical nursing
d. Whether strategies of knowledge development appropriate to
nursing assumptions
e. specialty field of nursing theory development：community health
nursing theories
f. systematic appraisal of philosophical and theoretical underpinning
of central concepts of the domain of nursing：i.e. health, person,
environment
1
Pattern of knowing
Study questions:
1. What kinds of knowledge are the most valuable in the discipline of
Nursing?
2. How nursing knowledge is developed?
3. How the unique processes and expressions of each pattern contribute to
the whole of knowing?
4. Why do we need to develop substantive theory (midrange practice
theory)?
4 Patterns of knowing in nursing (Carper, B, 1978)
Knowledge is a representation of knowing that is collectively judged by
standards and criteria shared within the nursing community.
Each of the patterns of knowing has nondiscursive forms of expression that
give nursing its distinctive character as a healing practice and that can be
recognized as arising from a particular pattern of knowing.
4 Patterns of knowing:
Empirics (science of nursing)： nursing process of caring a DM patient.
Blood sugar level measurement, symptoms and signs, interventions,
evaluation.
ethics (moral knowledge)：
aesthetics (the art of nursing)：Using artistic expression to articulate
experiences in caring for patients.
personal knowing in Nursing：inner experience of becoming a whole,
aware, genuine self. Personal knowing encompasses knowing one’s own
self and the self of others. Essence of writing Logs.
Exercise
1. Using a picture to depict your experiences in caring for patients.
2. making a statement about your own growth and perceptions in this
caring events.
The methods for developing knowledge are unique to each of the patterns of
knowing.
However, challenging ontologic-epistemologic paradox exists.
The
experience of knowing always draws the knower into the whole, where one
aspect cannot be comprehend without immediate grasp of the whole
knowing. I.e. in the actual experience of scientific inquiry, the scientist’s
personal, ethical, and aesthetic knowing shapes and influences how the
inquiry unfolds.
4 Patterns of knowing in nursing (Carper, B, 1978)
Knowledge is a representation of knowing that is collectively judged by
standards and criteria shared within the nursing community.
2
Each of the patterns of knowing has nondiscursive forms of expression that
give nursing its distinctive character as a healing practice and that can be
recognized as arising from a particular pattern of knowing.
4 Patterns of knowing:
Empirics (science of nursing)： nursing process of caring a DM patient.
Blood sugar level measurement, symptoms and signs, interventions,
evaluation.
ethics (moral knowledge)：
aesthetics (the art of nursing)：Using artistic expression to articulate
experiences in caring for patients.
personal knowing in Nursing：inner experience of becoming a whole,
aware, genuine self. Personal knowing encompasses knowing one’s own
self and the self of others. Essence of writing Logs.
The methods for developing knowledge are unique to each of the patterns of
knowing.
However, challenging ontologic-epistemologic paradox exists.
The
experience of knowing always draws the knower into the whole, where one
aspect cannot be comprehend without immediate grasp of the whole
knowing. I.e. in the actual experience of scientific inquiry, the scientist’s
personal, ethical, and aesthetic knowing shapes and influences how the
inquiry unfolds.
Using the example in p.13 (Chinn & Kramer, 1999) "Patterns gone wild"
and conduct discussions
Group I: discuss what nursing diagnosis you'll make after assessement and
then what are the nursing interventions you need to solve the problem?
Group II: You are a new nurse in the setting and you know most of the
nurses in this nursing home want to confine her in bed. What are the
ethical issues you are facing? Are there any conflicts in your judgment?
How you solve your ethical conflicts?
Group III: You are a very experienced clinical nurse specialist. A new
nurse come to you for help to solve the problem she is facing because she
does not know what to do with this old lady. What are your strategies to
help her?
Personal knowing: knowing one's own self and the self of others.
Knowing one self through interaction.
Full awareness of the self, the moment, and the context of interaction makes
possible meaningful, shared human experience.
Personal stories and autobiographies describe certain things about the
self.
3
Personal knowing emerges more fully "throughout life", the unique self
can be more fully expressed and becomes accessible as a means by which
deliberate action and interaction take form.
In a sense, all knowing is personal. Each individual can know only
through their personal senses and sensibilities.
Reflective practice:
Practical syllogism:
Reflection on action
Reflection in action(Schon, 1983; Benner, 1984)
Critical incident technique (a form of “Reflection on action)
Identify a single
situation which was an important event in clinical works
Examine key elements and issues
In relation to own attitudes and actions
reveal insight into the workplace cultures
Reflection in action
•Know how (experiential knowing): the characteristics that expert nurses have
•On-the-spot experimenting
Constructing informal theory
ReferencesBenner, P.（1984）. From novice to expert: Excellence and power in clinical
nursing practice. Menlo Park, CA: Addison- Wesley Pub. Co.
Benner, P.,Tanner, C. A.（1987）.How expert nurses use intuition. American Journal of
Nursing, 87(1), 23-31.
Benner, P., Hooper-Kyriakidis, P, Stannard,D. (1999) . Clinical wisdom and
interventions in critical care. Philadelphia, PA : W.B.Saunders.
Carper,B.A.（1978）.Fundamental pattern of knowing in nursing. Advances in Nursing
Science,1（13）,13-23.
Chinn, P.L. & Kramer, M. K. (1999). Theory and nursing:A systematic approach (5th
ed.). St Louis: Mosby.
Kim,H.S.（1999）.Critical reflective inquiry for knowledge development in nursing
practice. Journal of Advanced Nursing, 29(5), 1205-1212.
Kim, H. S. (2000 Nov.). Critical perspective for nursing knowledge development.
Paper presented at the Conference, New Paradigm approach for nursing knowledge
development in the 21th Century held at Seoul, Korea.
Koning,K.& Martin,M.（1996）.Participatory research in health in health: setting the
context. In K. Koning & M. Martin（Eds.）,Participatory Research In Health : Issues
and Experiences（p.1-18）.London & New Jersey:Zed Books Ltd.
Lauder,W.（1994）.Beyond reflection: Practical wisdom and the practical syllogism.
Nurse Education Today.14,91-98.
4
Perry,L.（1997）.Critical incidents, crucial issues: insights into the working lives of
registered nurses. Journal of Clinical Nursing,6（2）,131-127.
Radwin, L. E.（1996）. ‘Knowing the patient’︰a review of research on an emerging
concept. Journal of Advanced Nursing, 27,1142-1146.
Radwin, L. E.（1998）. Empirically generated attributes of experience in nursing.
Journal of Advanced Nursing, 27,590-595 Schon, D.（1991）.The reflective
practitioner （2nd ed.）.San Francisco:Jossey-Bass.
Sheilds, L.E., Lindsey, A.E.（1998）.Community Health Promotion Nursing Practice.
Advances in Nursing Science, 20(4), 23-36.
Smith,A.（1998）.Learning about reflection. Journal of Advanced Nursing, 28(4),
891-898.
SmithBattle, L., Drake, M. A. & Diekemper, M.（1997）. The responsive use of self in
community health nursing practice. Advances in Nursing Science, 20(2), 75-89.
1
NATURE AND PURPOSE OF THEORY
What are the purposes of theory?
Compare and contrast three concepts: theory, conceptual framework,
conceptual model?
p.27 in Fawcett, 1995.
Conceptual model
What are the characteristics of theory?
Why midrange theory in nursing?
Caring
Philosophies: a statement of beliefs and values; statements about what
people assume to be true in relation to the phenomena of interest to a
discipline and what they believe regarding the development of knowledge
about those phenomena.
There are three worldviews:
reaction,
reciprocal interaction,
simultaneous action.
Categories of nursing knowledge comes with world views
Conceptual model: a set of abstract and general concepts and the
propositions that integrates those concepts into meaningful configuration
Theory:deals with one or more relatively specific and concrete concepts and
propositions.
Empirical indicators:very specific and concrete real world proxies for
actual instruments, experimental conditions and procedures that are used to
observe and measure the concepts of a middle range theory.
1
Components of a theory
Study questions:
1. What are the components of a theory?
2. Compare and contrast three concepts: theory, conceptual framework,
conceptual model
3. what are the characteristics of a theory (conceptual framework)?
4. Analyze the levels of theory
5. What are the major themes in nursing theoretical conceptualization?
The definition of theory (Chinn & Kramer, 1999, p.51)
1. Logically interconnected set of confirmed hypothese: a specific form of
expression based on rules of logic
2. A conceptual system invented to some purposed: Theory is created
3. An imaginative grouping of knowledge, ideas and experience that are
represented symbolically and seek to illuminate a given phenomenon
4. Conceptual and pragmtic principles forming a general frame of
reference for a field of inquiry: theory provides a philosophic view that
guides inquiry and also serves a pragmatic or practical purpose.
Concept:
Creating conceptual meaning
Metaparadigm: global concepts that identify the phenomena of interest to a
discipline and global propositions that state the relationships among those
phenomena.
The functions of Metaparadigm：(4)
1. metaparadigm must identify a domain that is distinctive from other
discipline
2. encompass all phenomena of interest
3. perspective neutral
4. international in scope and substance
Health, person (vs. client) , environment, nursing (nursing therapeutics,
nursing process;
1
Concept development
10/12/87
Why is concept development/analysis important to nursing?
(a) important roles of concepts in the quest for knowledge
(b) individual, contextual, social, cultural and authoritative influences on
knowledge; contextual forces shape conceptual development and
variation. I.e. pain, grief, suffering menopause, addiction
(c) classification of nursing phenomena
(d) the need for new ways to address or describe a situation in nursing
(e) synthesis of existing knowledge concerning a concept of interest
What are the important roles of concepts in the quest for knowledge?
What are the contributions of concept development in the scientific
enterprise of nursing?
Conceptual problems facing nursing inquiry are vague terminology,
ambiguity definitions, inconsistencies among theories, inadequate
operationalization.
Concept enables the management of a range of intellectual and
conversational tasks that share features common to the concept.
The advancement of nursing Knowledge:
a. Knowledge synthesis ：literature review
b. concept development：concept analysis/development
The Systematic concept clarification and differentiation are critical to the
advancement of knowledge and the development of scientific discipline.
The purpose of concept clarification: (Haase, Leidy, Coward, Britt & Penn,
1993; Concept development in Nursing, p.175).
1. The evolution of theory
2. Development of measurement technique
3. Generation and testing of hypotheses
4. Clear and precise communication among members of discipline
& (p. 236)
5. individual clarification of ideas：initial conceptualization of a study; use
to identify appropriate focus
6. teaching strategy
7. providing a descriptive basis
8. attention to conceptual problems
Concepts: basic building blocks of theory.
phenomenon.
Types of concept: primitive; concrete; abstract
A mental image of a
2
Everyday concepts
Levels of concept:
VS
scientific concepts
Concept:
Empirical reality
Cognition
Language
The nature of Concept:
Cognitive in nature,
Comprised of attributes abstracted from reality
Expressed in some form (language)
Utilized for some purpose
Essential view of concept:
Concepts as ideas means concept is mental processes, resided exclusively in
the individual mind, reflect essence of a empirical reality. The logic of
Concept: present a characteristic of the object.
The important emphasis of social aspect of concepts refers to as
probabilistic view (cluster concept). Possible variations in concepts across
contexts, change over time.
Toulmin considered concepts to be developed through social interaction.
Emphasized to (1) identify contextual or disciplinary differences (2)
greater variation through the influence of diverse theories.
1
Concept analysis of
pragmatic utility
• Determine the
applicability
• Degree of
operationalization
• Level of maturity
1
School of thoughts
A. Highlight definitions of term(s)
variables used (attributions, characteristics)
B. Identify and record assumptions
from research questions
researcher’s focus (bias)
inference from variables used
C. Sort literature by researcher (discipline), or methods,
or time periods
1
Class exercise: using clinical research data to inductively identify a
concept, its attributes and relationship (process)
乳癌婦女接受乳房切除手術後身體改變的經驗
The concept of normalization:
正常化之過程包括認知及行為兩要素，認知指的是承
認自己的異常性且對這個異常現象的社會意義加以
否決，之後採取一些策略使不正常的情形成為正常。
研究中發現乳癌婦女術後認知到身體外觀明顯改變
並感受到癌症之社會烙印，自覺異於常人且有不愉快
之感受，因而藉由各種方式來遮掩身體上之缺陷，其
目的是使自己的外表看起來與別人相同。
1
一、身體外觀改變
"你看，不是很明顯嗎？大小不是很明顯嗎？這個較高，那個較低"(C03)，"總是
一個好好的東西被這樣切成這樣的話，莫名其妙，然後每天面對著一個刀疤在那
邊，穿衣服就，早上起來穿衣服就一邊高一邊低的(C07)"
就是說你平的時候，你一高一低人家會多看你一眼，嘖！
"我剛開刀回來，我有一感覺就是怎麼好像人家跟我講話喔！他們的眼光都在看
我的胸部這樣，我就感覺很尷尬"(C03)，"當然這個是因為要裝給別人看，免得
別人看到覺得很詫異，是別人詫異，那我是怕我沒有戴是，是嚇到別人，呵！呵！
呵！，自己就會覺得說與其引起人家一種側目，那不如就是說自己不要那麼張揚
(C04)"
我在公園就被人家發現了，你怎麼一個大，一個小，我就實話給他說。所以你不
戴義乳的話，覺得走路一晃一晃的，太明顯(C02)"。
二、社會烙印
一下子割掉一個奶子了，哈！好像自己進入另一個階層的感覺，好像我今天是屬
於一個標誌，是一個有癌症的人，這樣子"(C01)
"有的人就會覺得是，呦！好像很可怕的那個味道，後來我就學會了，我就不隨
便去跟人家講，我生乳癌...因為我從別人眼光中可以發現，你得乳癌好像給人家
蠻恐怖的感覺"(C01)
"有一個病友說，她那時候她弟弟跟她弟媳婦就會說耶！不要跟她坐在一起，好
像要離她遠一點那樣子，好像怕有點帶衰的感覺"(C09)，
"那我媽又跟我說，你嬸婆說你現在怪怪的，我就覺得說，（個案聲音上揚）怎
麼親戚都這樣子講，因為是我生病就覺得說我怪怪的，我就覺得說如果我沒生病
他就不會說怪怪的這樣子"(C11)
三、遮掩(cover up)
"總想把自己的背ㄏㄡˋ駝起來，好像覺得這樣子人家就不容易發現我身體有改
變"(C06)，"反正大小邊，...我現在都ㄍㄨ，ㄍㄨ啊！就是嘖！不敢挺胸啊！挺胸
就好像很明顯啊！"(C03)
"假設你覺得可以遮掩讓人家看不出來你這種狀況的話，你就穿外套，有時候冬
天你不戴也沒有關係
我喜歡穿有口袋的，ㄏㄡˋ，有口袋的衣服，可以稍微遮一下那個不那
麼明顯的胸部
"只想說那個能戴，能夠穿出去不要是怪怪的就好，因為一般看到我的
人也都覺得我好像沒病一樣"(C09)
2
(I) Concept analysis:to distinguish between the defining attributes of a
Reach operational definition
concept and its irrelevant attributes
(factor-isolating)
These methods are adopted from Wilson method
8 steps: (Walker & Avant; 1995)
1.select a concept
2.determine the aims or purposes of analysis
3.identify all uses of the concept that you can discover
4.determine the defining attributes
5.construct a model case
6.construct borderline, related, contrary, invented and illegitimate cases
7.identify antecedents and consequences
8.define empirical references
11 steps: (Avant, 1993)
1. isolating questions of concept
2. finding right answer
3. model cases
4. contrary cases
5. related cases
6. borderline cases
7. invented cases
8. social context
9. underlying anxiety
10. practical results
11. results in language
Evolutionary method:
1. Identify the concept of interest and associated expressions
2. Identify and select an appropriate realm (setting and sample) for data
collection
3. Collect data regarding the attributes of the concept, along with surrogate
terms, references, antecedents, and consequences
4. Identify concepts related to the concept of interest
5. Analyze data regarding the above characteristics of the concept
6. Conduct interdisciplinary or temporal comparisons, or both, if desired
7. Identify a model case of the concept, if appropriate
8. Identify hypotheses and implications for further development
The example case:
1. Identify the concept of interest
2. Choosing the setting and sample
3. Collecting and managing the data
4. Analyzing the data
5. Identifying a model case
6. Interpret the results
3
7. Identifying implications
Hybrid model:
D. Theoretical phase
1. selecting a comcept
2. searching the literature
3. dealing with meaning and measurement
4. choosing a working definition
E. fieldwork phase
1. setting the stage
2. negotiating entry
3. selecting cases
4. collecting and analyzing data
F. Final analytical phase
1. weighing, working and writing up the findings
Norris method of concept clarification
1. Identifying the concept, observe and describe the phenomena repeatedly,
describe the phenomena from the point of view of other disciplines
2. Systematize the observations and descriptions
3. Derive an operational definition of the concept under study
4. Produce a model of the concept that includes all its component parts
5. Formulate hypotheses
Three components of results of concept analysis:
1. operational definition
2. defining characteristics
3. antecedents
Fruitful uses: tool development and developing nursing diagnosis
(II) Concept synthesis: a strategy of developing concepts based on
observation or other forms of empirical evidence; to generate new
ideas
Methods for Concept synthesis:
1.quantitative approach:factor analysis; Q sort, delphi technique
2.literary approach:
3.qualitative : grounded theory
steps:
4
gain data,.
classify,
hierarchical structure,
verify empirically, theoretical definition
(III) Concept derivation: redefining concepts from parent field to fit the
new field, a new set of concepts is created; generate new ways of thinking
about and looking at some phenomenon.
Integrative literature reviews in the development of concepts (P.153): Past
research is summarized by drawing overall conclusions from many studies.
1. concept identification and research questions: delimit the search and
key words
2. search process
3. extraction of information: summarize document information from each
piece of literature (concise and easily retrievable way)
4. coding: develop a codebook
5. critical evaluation of the research: Quality of Study Instrument
For example:
Performance
Public health nursing practice
Job satisfaction
Competence
Effectiveness
Outcomes
Role and function
1
Morse’s method of concept development: (qualitative method)
1. review of literature
2. retrieve dictionary definitions and explore the etymological derivations of
the term
3. identifying the attributes
4. verifying the attributes：interview samples for each groups and keep data
separate, then compare and contrast data for “rule of relations”
5. identifying manifestations of the concept
1
Compare and contrast of various methods for concept analysis/development:
Methods
Wilsonian
Essentialism
develop exemplary cases
1.special feature
empirical
2.purposes
3.data sources
produce tentative attributes
tentative criteria
Evolutionary
Hybrid
identification of characteristics
essential aspects of
common to a class of objects
definition and measurement
approach
attention to contextual and temporal
aspects for further inquiry
identify, analyze, refine concept
for theory development
higher level
abstraction
literature; clinical data
literature (data bases as population
selection)
inductive inquiry
5.fieldwork/
yes
not necessarily
6.final results
operational definition
for tool development
develop nursing diagnosis
identify direction for further inquiry
Generate hypothesis
4.data collection
methods
yes
Norris
yes
1
Theory development
10/6/86
Study questions:
7. What are the components of a theory?
8. Compare and contrast three concepts: theory, conceptual framework,
conceptual model (Fawcett, 1995; p. 27;
9. Discuss the steps of theory development
10. Compare and contrast three concepts: concept analysis, concept
synthesis, concept derivation
11. What are the characteristics of a theory (conceptual framework)?
12. Analyze the levels of theory
Please add readings of Walker and Avant, Chap. 3-5.
Theory, conceptual framework, conceptual model (Fawcett, 1995, p. 27-29;
Melies, 1997, p.135-139) in terms of their 1. Definitions, 2.
Interrelationships, 3. Level of abstraction
conceptual model
general guides that must be
specified further by relevant
and logically congruent theories
before action can occur
theory
four more steps needed before testing:
1. must be formulated
2. a theory must be derived from
conceptual model
3.instruments or procedures that can measure
the theory concepts must be specified
4.empirically testable hypotheses must be
specified.
conceptual model: a set of concepts that are interrelated into a coherent
whole and a set of propositions.
The definitions of theory (Chinn & Kramer, 1995, p. 62-73)
1. A logically interconnected set of confirmed hypotheses
2. A conceptual system or framework invented to some purpose
3. An imaginative grouping of knowledge, ideas, and experience that are
represented symbolically and seek to illuminate a given phenomenon
4. Conceptual and pragmatic principles forming a general frame of
reference for a field of inquiry
The purpose of theory:
describe, explain, predict
2
Levels of theory:
Meta-theory; grand nursing theories; middle-range theory; practice theory
Meta-theory：focuses on broad issues related to theory in nursing
Issues include:
1. analyzing the purpose and kind of theory needed in nursing
2. proposing and critiquing sources and methods of theory development
3. proposing the criteria most suited for evaluating theory in nursing
grand nursing theories （Conceptual models by Fawcett）: proposed to
give some broad perspective to the goals and structure of nursing practice
middle-range theory：contain limited numbers of variables and are limited
in scope (i.e. health belief model)
practice theory：The essence of practice theory is a desired goal and
prescriptions for action to achieve the goal.
Through four phases of theorizing to lead to practice theory:
factor-isolating, factor-relating, situation-relating, situation-producing.
Linkages among levels of theory development: Clarify, guide, direct
Steps of theory development:
1. concept analysis, concept synthesis, concept derivation
2. Statement analysis, Statement synthesis, Statement derivation
3. Theory analysis, Theory synthesis, Theory derivation
Elements of a theory:
Assumptions, Concepts, propositions.
Assumptions：underlying givens that are presumed to be true. They are
not intended to be empirically tested for soundness, but they can be
challenged philosophically and may be investigated empirically.
Implicit or explicit assumptions.
Examples of Assumptions :
holism; human beings are complex;
propositions：a descriptive statement of the properties and dimensions of a
concept or a statement that links two or more concepts together. Provide
the theory with the power of description, explanation or prediction.
3
A theory should have more propositions than assumptions so that it can
have more power to explain or predict.
Types of propositions:
1. existence propositions：constructed around one phenomenon
2. relational propositions：link concepts to explain；including describe
relationship, predict relationship, direction of relationship,
3. Dimensions of propositions:
a. reversible
b. deterministic or stochastic
c. sequential or coexisting
d. sufficient or contingent
e. necessary or substitute
1
Evaluation and analysis of theories
10/13/86
Study questions:
3.
4.
5.
6.
What are the steps involved in the evaluation of a theory?
Compare and contrast various models for evaluating a theory
What are the units of analysis included in the structural components of a
theory?
What are the units of analysis included in the functional components of
a theory?
PS. Please read, Hardy, M. E. (1974). Theories: Components, development,
and evaluation. Nursing Research. 23(2), 100-107.
Analysis
Present an objective and
specific
Nonjudgmental Description
of the origin and content of
A conceptual model
vs.
evaluation
judge if the model satisfies
external criteria
Why is the evaluation of a theory necessary?
1. To decide which theory is more appropriate to use as a framework for
research, teaching, administration or consultation
2. To identify effective theories in exploring some aspect of practice or in
guiding a research project
3. To compare and contrast different explanations of the same
phenomenon
4. To enhance the potential of constrictive changes and further theory
development
5. To identify epistemological approaches of a discipline through
attention to the sociocultural context of the theorist and the theory
6. To assess the ontological beliefs in a discipline
7. To identify schools of thought in a discipline
8. To affect changes in clinical practice, to define research priorities, and
to identify content for teaching and guidelines for nursing
administration
9. To have nursing frameworks to justify nursing to the public
10. To identify strategies for theory development
11. To define a discipline’s domain
12. To be a critical consumer of theories
According to Hardy (1974), the criteria for evaluating theories:
1. Meaning and logical adequacy
2.Operational adequacy: （testability）Whether the concepts can be measured.
2
Accuracy of the operational definition reflect theoretical definition
3.Empirical adequacy (of a theory):empirical support by examining the existing
research. Sampling process, research design.
4.Generality:abstractness of concepts, Semantic adequacy-determined by semantic
agreement and empirical import.
5.Contribution to understanding: Usefulness and significance, application.
6.Predictability
7.Pragmatic adequacy
Fawcett (1995):
I. Analysis of conceptual models:
1.
Origins of the conceptual model:
a.Historical evolution，author’s motivation for development of theory
b.author’s philosophical claims, knowledge development strategies
c.which scholars influenced author’s thinking
d.world view
2. Unique focus : distinct views of nursing interventions
3. Content of the models:
a. definitions and descriptions of concepts
b. linkage of the concepts: propositions
II. Evaluation: Comparing content with criteria
1. Explicit of origins: author’s beliefs and values
2. Comprehensiveness of content:
Depth:
Cover 4 concepts of metaparadigm
relational propositions complete link four concepts
Breadth:
sufficient guidance in research, clinical practice, educational curriculum,
administrative organization for service
3. Logical congruence: internal structure
judgments on world views and category of nursing knowledge
4. Generation of theory: middle range theories can be deduced and testable
hypotheses can be formulated
5. Credibility of conceptual model:
a. social utility: educational requirements, feasibility of implementing, degree
of utilization in research, education, service, administration
3
b.
social congruence: compatibility between model-based nursing activities with
expectation of patients, community and health care system
c. social significance: effect on patient health status by informal and formal
methods
6. Contribution to the discipline of nursing
Melies (1997):
Criteria
Structural
Unit of analysis
Assumptions
Concepts
propositions
Functional
focus
client
nursing
health
nurse-patient interactions
environment
nursing problem
nursing therapeutics
Analysis of a theory:
I. Theorist: educational background, experiential background, professional network,
sociocultural context
II. Paradigmatic origin: references, citations, assumptions, concepts, propositions,
hypotheses, laws
III. Internal dimensions: rational, system of relation, content, beginnings, scope, goal,
context, abstractness, method
1
The role of conceptual models in nursing practice
1.
2.
3.
4.
identification of the patient’s clinical problem and the nursing intervention
achieve the goal
identifies environment care given; patient characteristics receiving care
apply nursing process by identify assessment format, labeling diagnosis,
mode of intervention and technologies used, method of evaluation
specify the nature of intervention contributes to health of client
1
Culture care diversity and Universality: A theory of nursing
Madeleine M. Leininger
Credentials and Background of Leininger
- a leader in transcultural nursing and human care theory
- the first professional nurse to hold a Ph.D. in cultural and social anthropology.
1950
1954
Mid
1950
1960
1968
1969
1968
1969
1950
-60
1974
1974
1975
1976
1978
Born in Sutton, Nebraska (1932?)
graduated from a diploma program at St. Anthony's School of Nursing in
Denver
 obtained a B.S. degree in biological science from Benedictine College,
Atchison, Kansas
 served as an instructor, staff nurse, and head nurse on a medical-surgical unit
and opened a new psychiatric unit as director at St. Joseph's Hospital in Omaha
 obtained an M.S.N. in psychiatric nursing from Catholic University of America
in Washington, D.C.
 began the first graduate clinical specialist program in child psychiatric
nursing ; initiated and directed the first graduate nursing program in psychiatric
mental health nursing at the University of Cincinnati.
 posed many questions to herself and the staff about cultural differences of the
children in a child guidance home and decided to pursue doctoral study at the
University of Washington with a focus on cultural and psychological
anthropology
 wrote Basic Psychiatric Nursing Concepts with Hofling which was published
in 11 languages and used worldwide
 Received PhD degree in anthropology, had done fieldwork in New Gunea,
attempting to blend nursing and anthropology
 initiated the Committee on Nursing and Anthropology (CONNA) with the
American Anthropological Association.
 was appointed Dean and Professor of Nursing and Lecturer in Anthropology at
the University of Washington.
 established the first academic nursing department on Comparative Nursing
Care Systems and established the Research Facilitation Office
 published Nursing and Anthropology: Two Worlds to Blend, which was the
first book in transcultural nursing
 was appointed Dean and Professor of Nursing at the College of Nursing and
Adjunct Professor of Anthropology at the University of Utah in Salt Lake City
and initiated the first master's and doctoral programs in transcultural nursing
 initiated the National Transcultural Nursing Society Organization
 received an Honorary Doctorate of Human Letters from Benedictine College,
Atchison, Kansas
 was presented an Award of Recognition for unique and significant
contributions to the American Association of Colleges of Nursing
 published her second book, Transcultural Nursing: Concepts, Theories and
Practicer identified major concepts, practices theory and conceptual
framework in transcultural nursing and definitive ways of how the disciplines
of anthropology and nursing are complementary
 initiated the National Research Care Conferences to help nurses focus
2
1981 

specifically on the study of human care phenomena
was recruited to Wayne State University, Detroit, where she has been Professor
of Nursing and Adjunct Professor of Anthropology and developed transcultural
nursing courses in baccalaureate, master's, doctoral, and postdoctoral programs
While at Wayne State University, she has received the Board of Regents'
Distinguished Faculty Award, Distinguished Researcher Award, and the
President's Excellence in Teaching Award.
Since the early 1960s, Leininger academic vitae records nearly 600 national and
international conferences, keynote addresses, and workshops in the United States,
Canada, Lurope, Pacific Islands and Asia.
During the past 30 years, Leininger has further developed and explicated her
transcultural care theory through the study of many cultures using primarily
qualitative ethnomethods to obtain emic (inside views) of human care.
Leininger has authored or edited 22 books, more than 265 articles and 40
chapters plus numerous films and research projects, served on editorial boards of 10
major publications.
Leininger has received many awards and recognition of her accomplishments.
She is listed in Who's Who of American Women, Who's Who in Health Care, Who's
Who in Community Leaders' The World's Who's Who of Women in Educator, The
International Who's Who in Community Services, and The Who's Who in International
Women, and other such listings. Her name appears on The National Register of
Prominent Americans and International Notables, International Women, and The
National Register of Prominent Community Leaders.
Her other affiliations include Sigma Theta Tau, the National Honor Society of
Nursing; Delta Kappa Gamma, the National Honorary Society in Education; and the
Scandinavian College of Caring Science in Stockholm.
She has served as distinguished visiting scholar or lecturer in 48 universities in
this country and abroad and was recently visiting professor at six universities in
Sweden, in two universities in Japan, and five in Australia and New Zealand.
1
Influences:
Creative thinking: potential interrelationship between culture and care
Scholars: Margaret Mead,
＊＊Transcultural
VS
cross-cultural
VS
international
Philosophical orientations:
Holistic nursing,
＊＊Individualism
VS
families, communities, cultures
Concepts:
Generic care was coined to refer to the folk, familiar, natural, and lay care that is
used and relied upon by cultures as their basic primary care practices.
Professional care refers to the learned and practiced care by nurses prepared in
schools of nursing and used largely in clinical professional contexts (Leininger, 1981,
1984,1991,1995).
Orientational Theory Definitions
Culture: the lifeways of a particular group with its values, beliefs, norms, patterns,
and practices that are learned, shared, and transmitted inter-generationally.
Care: the abstract and manifest phenomena and expressions related to assisting,
supporting, enabling, and facilitating ways to help others with evident or
anticipated needs in order to improve health, a human condition, or a
lifeway.
Culture Care: refers to culturally derived, assistive, supportive, or facilitative acts
toward or for another individual or group with evident or anticipated needs
which guide nursing decisions and actions and are held to be beneficial to
the health or the well-being of people, or to face disabilities, death, or other
human conditions.
Culture Care Diversity: refers to cultural variability or differences in care
meanings, patterns, values, symbols, and lifeways among and between
cultures.
2
Culture Care Universality: refers to the commonalities or similar culturally
based care meanings, patterns, values, symbols, and lifeways among and
between cultures.
Generic care: refers to the lay, folk, indigenous, and known care values, beliefs,
and practices used by cultures over time.
Professional care: refers to values, beliefs, and practices of a body of knowledge
that has been learned in professional schools and held by health
professionals to be therapeutic or beneficial to clients.
Worldview: the way an individual or group looks out upon and understands their
world around them, and provides a value stance, picture, or perspective
about their life and world.
Emic: refers to the local or insider's views and values about a phenomenon.
Etic: refers to the outsider's views and values about a phenomenon.
Cultural and Social Structure Dimensions: refers to the dynamic, holistic, and
interrelated patterns or features of culture (or subculture) related to religion
(spirituality), kinship (social), political (and legal), economic, education, technology,
cultural values, language and ethnohistorical factors of different cultures.
Environmental Context: refers to the totality of an event, situation, and life
experiences that give meaning and order to guide human expressions and
decisions within a particular setting, situation, or geographic area.
Health: refers to a state of well-being that is culturally constituted, defined, valued,
and practiced by individuals or groups that enables them to function in
their daily life.
Nursing: refers to a learned humanistic and scientific profession and discipline
that is focused on human caring knowledge and competencies that are used
to assist individuals or groups to maintain or regain their health (or
well-being) or to deal with diverse human life and death conditions in
meaningful and beneficial ways.
3
The ethnonursing method data analysis:
1st phase: collecting, describing, and documenting raw data (use of field journal and
computer)
2nd phase: identifying and categorization of descriptors and components
3rd phase: Pattern and contextual analysis
4th phase: major themes, research findings, theoretical formulations and
recommendations
1
Research application: (example—culture care of Philippine and Anglo-American
nurses in a hospital context)
In a 200 bed acute care hospital located in Northeast of US. 9 key US and 10 Key
Philippine who worked full time>1 year (for specific) and 13 general and 16 general
Philippine nurses who worked part-time<1 year (for general knowledge).
Participant observation and interviews were used
Results:
Diversity theme I
US nurse
promotion of autonomous care based
on informed decision making and control
of situation; use compliance
Diversity Theme II
US nurse
Diversity theme III
US nurse
generate nurse to nurse conflict
Philippine nurse
less pt education; include more
family members; use cooperation
Philippine nurse
dedication to work; respect;
patience; obligation to care based on
care values of physical comforts
Philippine nurse
Universal theme I
heavy workload, nurses’ frustration, anability to provide professional nurisng care
ideal
Universal theme II
Institutional norms, standards, and regulations strongly influence nursing practice
1
Evaluation of a cultural theory:
1.Do the findings from the study provide sufficient credible and "thick data" from the
informants and other sources to ;upport the domain and tenets of the theory?
2.Do the findings from the study give evidence to confirm findings of the theory in
relation to the domain of inquiry and/or research questions and theory tenets?
3.Do the findings from the study reflect saturation of ideas with thick and full accounts
about the meanings, expressions, and other qualitative indicators to support the
theoretical tenets under study?
4. Do the findings show a pattern of recurrency to substantiate the theoretical tenets,
questions, or general domain of inquiry?
5. Do the findings give evidence of sufficient data to support meaning-in-context in
relation to the theoretical ideas under study?
6. Do the findings show evidence of transferability to similar contexts in relation to the
theory?
7.Do the findings reflect accurately the ideas, experiences, or beliefs as known to the key
and general informants and the researcher's observations and participatory experiences
over time?
1
Culture care diversity and Universality: A theory of nursing
Madeleine M. Leininger
Study questions:
1.
2.
3.
4.
5.
6.
7.
8.
9.
What are the philosophical bases of the Leininger’s theory?
What are the major purposes of the theory?
What are the appropriate study method for the theory?
What are the major features of ethnonursing method?
Compare and contrast the concepts of emic vs etic.
What are the differences between Orientational Definitions and theoretical
defninitions?
What are the major concepts in the theory of culture care diversity and
universality?
How does Leininger transform concepts from other disciplines into her theory?
What are the criteria to evaluate a qualitative theory according to Leininger?
How these criteria differ from Fawcett’s criteria?
References
Kleinman, A. (1978). Patients and healers in the context of culture. LA, Berkeley,
University of California Press.
Leininger, M. M. (1997). Future directions in transcultural nursing in the 21th century.
International Nursing Review. 44(1), 19-23.
Leininger, M. M. (1995). Culture care theory, research, and practice. Nursing Science
Quarterly. 9(2), 71-78.
Leininger, M. M. (1993). Letters to the editor. Nursing Outlook. 41(6), 281-283.
Leininger, M. M. (1993). Quality of life from a transcultural nursing perspective.
Nursing Science Quarterly. 7(1), 22-28.
Leininger, M. M. (ed.). (1991). Culture care diversity & universality: A theory of
nursing. New York: National League for Nursing Press. Pub. No. 15-2402.
Leininger, M. M. (1985). Qualitative research methods in nursing. Orlando, FL:
Grune & Stratton.
Leininger, M. M. (ed.). (1981). Caring: An essential human need. Utah, Salt Lake
City: Proceedings of the Three National Caring Conferences.
Leininger, M. M. (1970). Nursing and anthropology: Two worlds to blend. New York:
Wiley.
Leininger, M. M. (1978). Transcultural nursing: Theories, concepts, and practices.
New York: Wiley.
1
Theoretical Basis for Nursing
87.11.16.葉曉文、陳曉悌、陳秋芳
Topic ：Theory , Research , and practice
一、分析理論與研究的關係
1.理論與研究間彼此有何影響？
2.如何發展以理論為基礎的研究？
3.評量 theory-testing research 的標準。
二、分析理論與實務的關係。
1.實務為什麼要有理論為基礎？
2.實務如何形成理論？
3.如何將理論應用在護理實務上？
三、分享並討論理論實際應用在臨床、行政、教育與研究上的優缺點，分析該理
論的適當性。
四、理論，研究與實務間的三者連結在專業發展的影響。
Required Readings
Chinn, P. L.& Kramer, M. K.（1995）. Theory and nursing：A systematic
approach.（4th ed）. St Louis:Mosby. Chap.8-9.
Fawcett, J.(1995). Analysis and evaluation of conceptual models of
nursing. （3th ed）. Philadelphia：F.A.Davis. Chap.10.
Recommended Reading
Alligood, M. R.& Marriner-Tomey, A. (1997). Nursing
Theory-utilization & application. St Louis:Mosby. Chap.3.
Fawcett, J.(1997). The Relationship Between Theory and Research: A
Double Helix. In Nicoll,L.H. Perspectives on Nursing Theory. (3th ed）.
Philadelphia: Lippincott . Chap.64.
Hoffman, A. L.& Bertus, P. A. (1992). Theory and practice : Bridging
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The relationship between theory and practice: mutually interdependence
1. theory arises out of practice(theory development)：
a. situation-producing theory: concept identification；
b. factor-isolating theory :i.e. generate and classify nursing
diagnoses; Benner’s model, from novice to expert.
c. Factor-relating theory：grounded theory；
2. theory is verified in practice (theory validation)：theoretical
proposition tested in practice. Deductive approach, concept are
operationalized, hypothesis developed through propositions
3. theory explain and direct practice；leads to theory refinement and
expansion(application)
Theory testing through research process
1. deductive and empirical approach
2. verification through critical reasoning：critique; internal testing
criteria （8 criteria）
3. description of personal experiences：inductive process to analyze
personal experiences（10 criteria）
4. application to nursing practice：assess and verifies scientific
progress in terms of a theory’s problem-solving effectiveness. （7
criteria）
How to evaluate if a research is theory-testing: (15 criteria)( in Acton,
G. J., Irvin, B. L. & Hopkins, B. A. (1991). ANS. 14(1), 52-61.)
1.The purpose of the study is to examine the empirical validity of the
cosntr4ucts, concepts, assumptions, or relationships from the
identified theoretic frame of reference
2.The theoretic frame of reference must be explicitly described and
summarized
3.The constructs and concepts to be examined are theoretically defined
4.An overview of previous studies that are based on the theoretic
framework, or that clearly show the derivation of the concepts being
tested, must be included in the review of the literature
5.The research questions or hypotheses are logically derived from the
definitions, assumptions, or propositions of the theoretic frame of
referefcnce
6.The research questions ir hypothese are specific enough to put the
theoretic frame of reference at risk for falsification
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7.The operational definitions are clearly derived from the theoretic
frame of reference
8.The design is congruent with the level of theory described in theoretic
frame of reference
9.The instruments must be theoretically valid and reliable
10. The theoretical frame of reference guided the sample selections
11. The statistics used are the most robust possible
12. The analysis of data must provide evidence for supporting, refuting
or modifying the theoretic framework
13. The research report must include an interpretive analysis of the
findings in relation to the theory being tested
14. The significance of the theory for nursing is discussed in the report
15. Ideally, the researcher makes recommendations for further research
on the basis of the theoretic frame
The process for putting theory into practice:
1. formulating a view
2. identifying problems
3. focus for applying theory：selection of nursing interventions
4. choices of interventions: enactment of interventions, environments
and resources