Nursing theory evaluation paper

Jacqueline Fawcett (Fawcett, 1980, 1993, 1995, 2000, 2005; Fawcett & DeSanto-Madeya, 2013) used a two-phase process for analysis and evaluation of theories and conceptual frameworks. In her writings, she noted that analysis is a nonjudgmental, detailed examination of a theory. In Fawcett’s most recent work (Fawcett & DeSanto-Madeya, 2013), components of the analysis process include the theory’s origins, unique focus, and content. The theory’s “origins” refers to the historical evolution of the model/theory, the author’s motivation, philosophical assumptions about nursing, the author’s inclusion of works of nursing and non-nursing scholars, and the worldview reflected by the model. The unique focus refers to distinctive views of the metaparadigm concepts, different problems in nurse–patient situations or interactions, and differences in modes of nursing interventions. She notes that theories can be categorized as developmental, systems, interaction, needs, client-focused, person–environment interaction–focused, or nursing therapeutics–focused. The content of the model is examined to analyze the abstract and general concepts and propositions. Fawcett’s method of theory analysis specifically identifies whether and how the concepts and propositions of the metaparadigm (nursing, environment, health, and person) are included in the theory. Representative questions to be addressed relative to the content include: “How are human beings defined and described? How is environment defined and described? How is health defined? . . . What is the goal of nursing? . . . and What statements are made about the relations among the four metaparadigm concepts?” (Fawcett & DeSanto-Madeya, 2013, p. 49). Theory evaluation requires judgments to be made about a theory’s significance based on how it satisfies certain criteria (Fawcett & DeSanto-Madeya, 2013). The process of theory evaluation includes review of previously published critiques, research reports, and reports of practical application of the theory. During the process of theory evaluation, the criteria to be examined are the explication of the origins of the theory, the comprehensiveness of the content, its logical congruence, how well it can lead to generation of new theory, and its legitimacy. The legitimacy is determined by reviewing the theory’s social utility, social congruence, and social significance. The final step in theory evaluation is to examine the theory’s contribution to the discipline of nursing. Theory Description and Critique: Chinn and Kramer Peggy Chinn and Maeona Kramer (Jacobs) initially wrote on the processes used to analyze theory in 1983. They used the terms theory description and critical reflection to describe a two-phase process. Theory description has six elements: purpose, concepts, definitions, relationships, structure, and assumptions. Table 5-3 presents these elements and their defining characteristics. Table 5-3 Components of Theory Description: Chinn and Kramer Component Characteristics Purpose The purpose of the theory should be stated explicitly or at least be identifiable in the text of the theory. Concepts The concepts of the theory should be linguistically expressed. Definitions Meanings of concepts are conveyed in theoretical definitions; these definitions give character to the theory. Relationships Concepts are structured into a systematic form that links each concept with others. Structure The relationships are linked to form a whole when the ideas of the theory interconnect; structure makes it possible to follow the reasoning of the theory. Assumptions Assumptions refer to underlying truths that determine the nature of concepts, definitions, purpose, relationship, and structure; may not be explicitly stated. Source: Chinn and Kramer (2015). Critical reflection of a theory involves determining how well a theory serves its purpose. Critical reflection analyzes clarity and consistency of the theory as well as its complexity, generality, accessibility, and importance. In assessing clarity and consistency, Chinn and Kramer’s (2015) critical reflection would examine:   Semantic clarity: Are the concepts defined? Do the concepts establish empirical meaning?   Semantic consistency: Are the concepts used consistently? Are the concepts congruent with their definitions?   Structural clarity: Are the connections and reasoning within the theory understandable?   Structural consistency: Is the structure of the theory consistent in its form?   Simplicity or complexity: Is the theory simple? Is the theory complex?   Generality: Does the theory cover a wide scope of experiences and phenomena?   Accessibility: How accessible is the theory? How well are concepts grounded in empirically identifiable phenomena?   Importance: How can the theory contribute to nursing practice, research, and education? Theory Description, Analysis, and Critique: Meleis According to Meleis (1985, 2007, 2012), there are three stages involved in theory evaluation: theory description, theory analysis, and theory critique. During the process of theory description, the reviewer closely examines the structural and functional components of the theory. The structural components include assumptions (implicit and explicit), concepts, and propositions. The functional assessment considers the anticipated consequence of the theory and its purpose. Components that should be examined are the focus of the theory and how it addresses the client, nursing, health, the nurse–client interactions, environment, nursing problems, and nursing therapeutics. Theory analysis involves considering important variables that may have influenced the development of the theory. These include the theorist, paradigmatic origins of the theory, and internal dimensions of the theory. During the analysis procedure, Meleis (2012) recommends reviewing external and internal factors that influenced the theorist as well as the theorist’s experiential background, educational background, and employment history. Likewise, a reconstruction of the professional and academic networks that surrounded the theorist while the theory was evolving should be examined. Second, Meleis (2012) argues that careful consideration of use of theories from other fields or paradigms is to be encouraged. To identify the paradigm(s) from which the theory may have evolved, or to recognize other theorists who may have influenced the development of the theory, the reviewer would consider references, educational and experiential background of the theorist, and the sociocultural context of the theory as it was developed. Finally, internal dimensions of the theory should be analyzed. This will provide information about the rationale on which the theory is built, systems of relationships, content of the theory, goal of the theory, scope of the theory, context of the theory, abstractness of the theory, and method of development. Critique of a theory may follow analysis, and Meleis (2012) identified five elements to consider in this phase: the relationship between structure and function, diagram of the theory, circle of contagiousness, usefulness, and external components. The relationship between structure and function involves evaluating the theory’s clarity and consistency, level of simplicity or complexity, and tautology/teleology. In assessing the tautology of the theory, the reviewer would observe for needless repetition of an idea in different parts of the theory, which Meleis claims will decrease the clarity of the theory. Teleology occurs when definitions of concepts, conditions, and events are described by consequences rather than properties and dimensions; this should be avoided. Although not all theories contain models graphically or pictorially depicting the structure of the theory, Meleis (2012) states that theories and models are enhanced by visual representation. The reviewer should determine if the model does indeed help clarify linkages among the concepts and propositions and, thereby, enhance clarity of the theory. The circle of contagiousness refers to whether, and to what extent, the model or theory has been adopted by other experts in the field. In evaluating usefulness, Meleis (2012) suggests analysis of the theory’s usefulness in practice, research, education, and administration. The final component of this method is the review of external components of the theory. These include implicit and explicit personal values of both the theorist and the critic. It also refers to congruence with other professional values as well as with social values. Finally, the critic would determine whether the theory has social significance.