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Nursing Theories: Building the Future Using the Past
Monica D. Sleboda
School of Nursing, Liberty University
Author Note
Monica D. Sleboda
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Monica D. Sleboda
Email: mdsleboda@liberty.edu
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Nursing Theories: Building the Future Using the Past
Nursing research and theory has been around since Florence Nightingale first reported
that by improving conditions in which patients were cared for would improve the health of the
patient back in the early 1850’s. Since then, many more nursing theories have been developed to
support the nursing profession and to provide evidenced-based research. Much research has since
been produced to support, debunk, or grow older nursing theories to meet today’s needs.
However, much is still needed to be done to make nursing theory and research relevant to current
times. This paper will discuss the process of theory in research, look at a current paper and break
down the theoretical framework used, and finally, look at whether non-nursing theories
(borrowed theories) are relevant to building new nursing theory or if only nursing theories should
build new theories and research.
Theory in Research
Theory in research is very important as it allows researchers to provide a foundational
knowledge of why things are done the way they are done, and it allows nurses to convey
evidence which supports the methodologies behind their practice. Theory guides research which
in turn improves clinical practice (Saleh, 2018) and it brings organization to the study itself
(McEwen & Wills, 2019). There are three ways in which nursing theory shows up in research:
the theory may be generated as the outcome of a study, a research project may be undertaken to
test a theory, or a theory is used in a research project as the context for a study (McEwen &
Wills, 2019).
Theory-Generating Research
Theory-generating research (TGR) is such that the research is designed to develop and
describe the relationships between and among experiences without imposing preconceived
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notions of what these experiences may mean (McEwen & Wills, 2019). There are several steps
with TGR, including, researchers identifying observations with common characteristics or
themes within a particular group or setting, then translating these observations into more abstract
concepts by determining what the observations mean, then the researchers will identify any
notable patterns, which will then lead the researcher to translate the observations into statements
so that they may combine the concepts into a framework or tentative theory (McEwen & Wills,
2019).
Theory-Testing
McEwen & Wills (2019) explain that theory-testing research is when “theoretical
statements are translated into questions and hypothesis” (p. 462). This process requires deductive
reasoning that will follow several steps including the researcher choosing a theory of interest and
selecting a propositional statement from the theory in which the research test will be built from
(McEwen & Wills, 2019). Theory testing is rarely performed due to the fact that there is lack of
clarity as to what constitutes theory testing (McEwen & Wills, 2019).
Theory as the Conceptual Framework or Context of a Study
Conceptual framework of theory provides the overall context of the study, whereas the
theoretical framework explains the relationships that are being explored within the study
(Burkholder et al., 2020). Conceptual framework is the most common form of using theory in the
process of research studies because the theory itself drives and guides the entire study as well as
provide value to the findings of the research (McEwen & Wills, 2019). Essentially, this process
involves the researcher conducting literature review who then identifies an existing theory
framework and applies it to the study. The one downside to this style of research process
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according to McEwen & Wills (2019) is that the study may fail to lead to meaningful
conclusions.
Theory as a Conceptual Framework
Using the study performed by Liu et al. (2016), titled The Influence of work-related
fatigue, work conditions, and personal characteristics on intent to leave among new nurses, the
conceptual framework of the study will be assessed. The study variables, conceptual definitions,
instruments, findings, relationship to findings, implications for nursing practice, and
recommendations for further research will all be assessed. Finally, the debate on whether nursing
theories or non-nursing theories or a combination of the two should be used in nursing research
will be discussed.
Study Variable
The study performed by Liu et al, was performed to look at whether work-related fatigue,
working conditions, and personal characteristics of new nurses played a significant role in their
intent to leave the field of nursing. The variables looked at in this research project are work-
related fatigue, working conditions, personal characteristics of the nurse, and the nurses intent to
leave.
Conceptual Definitions
Personal characteristics assessed during the study included age, education level, work
experience, and overall health status (Liu, Yi,PhD, RN et al., 2016). Working conditions covered
average hours worked per week and the overall workload as perceived by the nurse using a scale
of 0-10 (0=perception of low workload; 10= perception of high workload). Work-related fatigue
was measured using Winwood et al.’s Occupational Fatigue Exhaustion Recovery scale (Liu,
Yi,PhD, RN et al., 2016). It is important to note that “work-related fatigue can be classified as
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acute fatigue, recovery from exhaustion, and chronic fatigue” (Liu, Yi,PhD, RN et al., 2016).
Finally, intent to leave had three questions which nurses rated using the 7-point Likert scale from
0 (strongly disagree) to 6 (strongly agree) (Liu, Yi,PhD, RN et al., 2016).
Instruments
Instruments used when performing this research included the use of questionnaire
surveys for nurses to answer. Once the surveys were received the data was analyzed using SPSS
version 19.0 and AMOS version 21.0, as well as structural equation modeling to determine
model fit (Liu, Yi,PhD, RN et al., 2016).
Findings
It was found in the research that age, education, and work experience were not
significantly correlated with the intent to leave so these three factors were removed from the
model (Liu, Yi,PhD, RN et al., 2016). However, health was significantly correlated with acute
fatigue, chronic fatigue, intershift recovery, working hours and workload which, when combined,
affected a new nurses’ intent to leave (Liu, Yi,PhD, RN et al., 2016). In previous studies
referenced, it was noted that generational factors and external factors also need to be considered
in correlation to work-related fatigue on an individual’s intent to leave (Hayes et al., 2012) (Liu,
Yi,PhD, RN et al., 2016).
Relationships of Findings to Framework
By using prior studies, such as those performed by Hayes et al. and MacKusick &
Minick, Liu et al. were able to research whether the variables listed affected a new nurse’s intent
to leave their current job or the field of nursing all together. Some variables were eventually
excluded from the study since there was no basis of support for them. For the most part, this
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researcher was able to find support for the framework that some variables affected a nurse’s
intent to leave when combined with other specific variables.
Implications for Nursing Practice
It was found in the study that the implications for nursing practice is the need of close
assessment of new nurses to ensure reduced hours which in turn will reduce work-related fatigue.
Mentors should also be considered for new nurses to assess the new nurses perceived fatigue and
work-load levels. By supporting new nurses early on with the matching of a mentor can assist in
reducing work related fatigue and intent to leave.
Recommendations for Further Research
It was suggested by Liu et al., that further research should be performed using a
longitudinal study to assess the change of work-related fatigue over a longer period of time than
what their study focused on. This longer study would allow for researchers to determine a trend
of fatigue levels and strategies that could be developed to reduce work-related fatigue (Liu,
Yi,PhD, RN et al., 2016).
Nursing vs Non-Nursing Theories in Research
Nursing theory is a dynamic system that changes regularly. Ronald Hickman (2019)
insists that “the expansion of nursing’s discipline knowledge is dependent upon an evolution in
nursing theory that in turns influences the direction of scientific inquiry and empiric support for
evidence-based nursing care” (p. 85). He later suggests that nursing theories need a major
overhaul as most nursing theories are old and outdated. The question now is, should nursing
theories direct future nursing theories or can non-nursing theories drive the future of new nursing
theories? There are several non-nursing theories in existence today that have been used to drive
newer nursing theory. These include Maslow’s Hierarchy of Needs Theory, Change Theory, and
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Erikson’s Theory of Psychological Development. However, many argue that only nursing
theories should drive the future of new nursing theories because only nursing models can truly
deal with the scope and direction of nursing interventions (McEwen & Wills, 2019). In a study
performed by Keri Jensen (2019), it is reported that when examining theses written by PhD
candidates in nursing science, that nursing theories had little presence in the 61 theses examined
by her. When comparing the use of nursing theories and non-nursing theories to develop new
nursing theories or for research purposes, I agree that nursing theories need to be used with little
help from non-nursing theories. “Using nursing theories supports the discipline of nursing,
whereas using borrowed theories from other disciplines does not, it only builds evidence for the
other discipline” (Florczak, 2020).
Conclusion
Nursing theory has come a long way over the last few centuries, but unfortunately it still
has a long way to go. There is a need for new theories to be established and other older theories
to be re-evaluated so they may become current and relevant again. Theory in research is
important to show why the nursing community does what they do and is supported with
evidence-based research. Proverbs 19:2 and 25:2 are both great verses to back up the importance
of garnering more knowledge. “Desire without knowledge is not good, and whoever makes haste
with his feet misses his way” (Proverbs 19:2, ESV) and “It is the glory of God to conceal things,
but the glory of kings is to search things out” (Proverbs 25:2, ESV). As graduate level nurses, it
is important for us to participate in nursing theory and research to add to the body of knowledge
for future nurses.
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