Nursing theory wk 2

Module 2:

How do we know what we know? When writing about theory, it is important to consider knowledge, since knowledge development within a discipline occurs basically through the development of theories. Knowledge is defined as "familiarity, gained experience; the act or state of understanding; clear perception of facts or truth" (Merriam-Webster, n.d.). In addition, specialized knowledge defines the particular competence of a group, establishes a legitimate basis for the authority of the group, provides status and prestige, and facilitates the socialization of new members into the group. Theorists have classified knowledge development in different ways.<

Carper identified four patterns of knowing which include:

· empirics: the science of nursing (describes, explains, and predicts phenomena of special concern to the discipline of nursing)

· aesthetics: the art of nursing (perceives through empathy; expresses through creativity, designing and providing efficient nursing care)

· personal knowledge: (knows the self; accepts others; engages in process of becoming)

· ethics: the moral component (focuses on obligation, moral code, and responsibility)

Empirical research, whether quantitative or qualitative, provides the foundation for evidence-based practice. Just a few years ago, only quantitative research was regarded as being "real". Qualitative methods constituted the "poor stepchildren" of empirical investigation, and often were viewed as what researchers used when their research was not good enough to fit into quantitative patterns.

Fig. 6: Ethics

That is by no means the case today, as researchers have worked for several years to improve the quality of qualitative investigation. Today, qualitative methods may be preferable because they consider the needs and wishes of the patient, who is charged with taking on greater responsibility for his own care.

Ethical knowledge is that which relates to moral issues and the need to make judgments in a given situation. This is a concept well known to active, practicing nurses, and it is one that many face on a daily basis.

2. The Role of Theory in Science and Practice

Nursing theory development is characterized by nursing’s unique perspective: a distinct focus of the discipline of nursing. In a recognized nursing theory, nursing metaparadigm concepts of person, environment, health, and nursing are defined, and the interrelationships among those concepts are described. Knowledge development in the discipline of nursing generates philosophical, theoretical, and scientific knowledge, which serve as a basis for further reflections, investigations, and refinement, and as a source of new knowledge. In addition, nursing theory development is related to borrowed or shared theories from or with other disciplines such as anthropology, education, sociology, and psychology.

Nursing theories are very important for guiding education, research, and practice as well as for strengthening the links among those areas. Nursing theories are necessary and important for the discipline of nursing; they define the body of nursing knowledge, promote further knowledge development, establish nursing as a profession, and aim to give directions to nursing practice. Fawcett (2000) asserted that nursing theory is "characterized as sets of concepts, definitions, and propositions that address the metaparadigm phenomena of person, environment, health and nursing, by specifying relations among variables derived from these phenomena" (p. 11). Additionally, Meleis stated that nursing theory provides insights about nursing practice situations and research and gives direction to nursing practice. Thus, nursing theory is viewed as contributing to a well-founded basis for nursing practice and it is useful in describing nursing phenomena, in analyzing and explaining relationships among those phenomena, in predicting consequences, and in prescribing actions.

3. Defining Conceptual Meaning

Nursing theories are normally derived from conceptual models in which the nursing metaparadigm phenomena are clearly identified. For this reason, the conceptual model is considered a precursor of nursing theory. A conceptual model of nursing is a set of defined concepts and propositions obtained from practicing nurses that are integrated into a meaningful configuration, and represent an involvement in theoretical formulations by describing nursing phenomena and their interrelationships in abstract terms. Consequently, it is implied that the concepts and their definitions, and propositions of a nursing theory are derived from a nursing conceptual model. Once a phenomenon of interest is identified, four practice-dependent activities are required to refine the meaning of the concept(s). First, empirical indicators must be identified. These may be identified through practice experiences or current theoretical concepts. The question pertaining to the phenomenon of interest that must be asked is "What is my experience with this concept?"

Next, similar concepts must be differentiated. In other words, the concept pertaining to the phenomenon of interest and similar concepts must be differentiated in order to begin a clear conceptualization of the concept of interest. For example, in studying the emotional burden of living with diabetes, the concept "emotional burden" must be differentiated from other types of burden, which may manifest as an emotional burden, such as the financial burden or social burden of living with diabetes which may be exhibited as an emotional burden or contribute to the emotional burden.

New concepts may be identified in the quest for creating new conceptual meanings. Whether from practice or research, different uses/definitions of the concept may be found in model, borderline, related, or contrary cases. Consideration of these concepts may initiate new ideas that contribute to the formation a new concept or concepts. For example, the literature on glycemic control in individuals with diabetes sites the impact of depression, anxiety, spousal relationships, economics, and diabetes education. However, the literature lacks research on the overall burden of living with diabetes. Thinking of experiences in practice, you may become aware of the overall burden described by individuals with diabetes - the burden of monitoring their blood sugar, administering medications, depression, social relationships, and the financial consequences of diabetes. This awareness may contribute to the conceptualization.

4. Validation and Application

Identifying a concept and refining conceptual meaning is not an endpoint in theory development. Instead, the major focus is to provide a clear and rational starting point for further inquiry. Consequently, one reasonable next step is to test, apply, and evaluate the theory to determine its usefulness. A theory’s usefulness is only of utility and value to the extent that it serves its intended purpose. This utility, therefore, must be evaluated through practical application and testing.

Once it has been determined that a theory is appropriate for use in practice and serves to improve nursing practice, it must be applied to practice to determine the value of the theory to practice.