Nursing Theories and Frameworks

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Nursing Theories and Frameworks
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Learning Objectives

• Compare inductive and deductive reasoning
• Differentiate between conceptual and theoretical
  frameworks
• Describe how a framework guides research
• Differentiate between conceptual and operational
  definitions
• Describe the relationship between research and
  theory and practice

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Learning Objectives

• Differentiate between grand and midrange nursing
  theories
• Describe the criteria for critique of theoretical
  or conceptual frameworks in the nursing literature

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Approaches to Science

• Inductive Reasoning

• Deductive Reasoning

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Ladder of Abstraction

• Worldview
• Frameworks
• Theories
• Concepts
• Variables

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Concept

• Definition
• an abstraction
• creates an image of an idea we want to share
• representations of particular aspects of human
  behavior and characteristics
• Pain
• Coping
• Grief
• Resilience

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Identify the Concepts

• A theoretical model was developed and tested to
  explain the effects of learned helplessness,
  self-esteem, and depression on the health
  practices of homeless women. (Flynn, 1997)
• prevalence and consequences of verbal abuse of
  staff nurses by physicians were examined in the
  context of Lazarus stress-coping model.
  (Manderino Berkey, 1997)

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Construct

• Similar to a concept in that it refers to an
  abstraction
• Different from a concept in that it is
  deliberately invented (constructed) by
  researchers for a scientific purpose
• Health locus of control
• Self-care in Orems model

• Concept and construct are sometimes used
  interchangeably although a construct often refers
  to a more complex abstraction than a concept

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Terminology

• Conceptual framework
• Structure of concepts and theories pulled
  together like a map for the study

• Theoretical framework
• A structure of concepts that exists in the
  literature, a ready-made map for the study
• Provide a theoretical rationale for the
  development of hypotheses

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Conceptual Framework

• Explains how the variables in your study are
  expected to relate to each other
• A conceptual framework is used when the
  literature does not contain a specific theory
  that explains the relationship between study
  variables.

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Theoretical Framework

• Used when the variables have been studied before
  and have been found to be related to one another
• At Level I there may be no framework based on
  existing literature. This establishes a rationale
  for the need to conduct such a study.
• At Level II you can provide a conceptual
  framework from literature on the variables of
  your study.
• Level III studies always have theoretical
  frameworks.

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What does a framework do?

• Provides direction for the study by providing an
  organized set of ideas/variables and their
  relationships
• Reveals conceptual and operational definitions
• Guides what data is to be collected and analyzed

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Terminology

• Conceptual definition like a dictionary
  definition conveys the general meaning of a
  concept
• Operational definition specifies how the
  concept will be measured (i.e., what instruments
  will be used)

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Appendix B Van Cleve et al., 2004
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Terminology

• Theory set of interrelated concepts that
  provides a systematic view of a phenomenon
• OR Theory is an abstract generalization that
  presents a systematic explanation about the
  relationships among phenomena
• Theory guides practice and research practice
  enables testing of theory and generates questions
  for research research contributes to
  theory-building and establishing practice
  guidelines. LB-W H p. 113

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Nursing Theory

• Many theory/concepts Borrowed from other
  disciplines
• Nursing Theories
• Grand
• Mid-range
• Microrange

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Nursing Theories

• Conceptual structure that organizes practice and
  research into ideas central to the discipline
• Nursing theories are reservoirs in which
  findings related to nursing concepts, such as
  comfort, healing, recovering, mobility, rest,
  caring, enabling, fatigue, and family care, are
  stored. Meleis (1997)

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Grand Theories

• Conceptual structures that include views on
  person, health, and environment to create a
  perspective of nursing
• Historically important
• Guides discipline of nursing today
• Abstract level
• Address a phenomena of concern to nursing from a
  different perspective

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Grand Theories

• Imogene King, 1981 Open Systems Model
• Madeleine Leininger, 1991 Theory of culture
  care diversity and universality
• Dorothea Orem, 1985 Self-care Model
• Sr. Callista Roy, 1984, 1991 Adaptation Model
• Jean Watson, 1999 Theory of Caring
• These models are broad, formal explanations of
  what nursing discipline is according to the
  developers point of view

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Midrange Theories

• Are moderately abstract but composed of concepts
  that are measurable
• More focused than grand theories
• Have a stronger relationship with research and
  practice
• Lie between everyday working hypotheses and
  grand theoriesMerton (1968)

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Midrange Theories

• Tend to focus on concepts of interest to nurses
• Pain, empathy, grief, self esteem, hope, comfort,
  dignity, quality of life
• Some midrange theories have their basis in grand
  theories
• Midrange theory of self-care deficit grew out of
  Orems (1980) grand theory of self care

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Midrange Theories

• Categorized by level of abstraction
• High, middle and low
• K. Kolcaba Theory of Comfort
• R. Mercer Maternal Role Attainment
• AACN The Synergy Model for Patient Care

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Microrange Theory

• Closely related to midrange theories
• More narrow in scope
• Described at the level of hypothesis
• Questions/ hypotheses derived from practice

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Critique Criteria

• Is the theoretical or conceptual framework
  clearly identified?
• Is the framework consistent with a nursing
  perspective?
• Is the framework appropriate to guide research on
  the topic?
• Is there logical connection between the
  framework, concepts and the measurement?

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Critique Criteria

• Are the concepts clearly and operationally
  defined?
• Was sufficient literature reviewed to support the
  proposed relationships?
• Is there a logical link between the framework,
  the study concepts, and the methods of
  measurement?