THEORETICAL FRAMEWORK 1
Theoretical Framework of Lui et al.
Jennie Do Carmo
Graduate School of Nursing, Liberty University
Author Note
Jennie Do Carmo
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Jennie Do Carmo
Email: jdocarmo@liberty.edu
THEORETICAL FRAMEWORK 2
Theoretical Framework of Lui et al.
In order to thoroughly process and defend nursing theories, research of data and theory
must be conducted (McEwen & Wills, 2019). This was an identified gap in the nursing
profession, first identified by Florence Nightingale, and it was not until the 1970’s that nursing
starting formulating theoretical frameworks to test theories and define the research involved
(2019). A theoretical framework depicts the affiliation between nursing concepts and supports the
nursing theory presented. Lui et al. published a nursing theory conducting research on the
relationship between new nurses and fatigue, work conditions and personal characteristics in
order to predict the intent of leaving a nursing position. This paper will discuss and depict the
theoretical framework of Lui et. al. work.
Theory Use in Research
Prior to the beginning of a research study, a researcher must have a question that the
researcher wants to find the answer to. This question is then formed into a hypothesis, which
then leads to a theory. Theory is therefore the beginning of all research. Fitzpatrick & Kazer
(2012, as cited in McEwen &Wills, 2019) stated that a theoretical framework directs the path of
a research study. While Fitzpatrick and Kazer are correct, they neglected to identify theories in
areas of research that should be discussed and studied. When Florence Nightingale wrote her
theories, she identified numerous areas of nursing research that needed to be conducted but had
not been, such as cleanliness and sanitation in sick people (McEwen &Wills, 2019). She created
the pathway for nursing and nursing research with her theories and she identified what needed to
be done.
Theory also presents different approaches for research to discover. In nursing, Florence
Nightingale identified that the area and people surrounding a sick person will influence their
THEORETICAL FRAMEWORK 3
health (McEwen &Wills, 2019). She started the focus on having clean linen and sunlight when
caring for the ill. This was previously never discussed before Nightingale was published.
Nightingale found different health care problems to theorize and research.
Nightingale also used her nursing theories to develop nursing practice protocols which
later created nursing diagnosis based upon research findings later conducted. This is also
something that integrates theory into research. Nightingale created practice guidelines stating
that patients should have good sunlight, fresh linens, and bathed regularly, and she researched
her theories on the battlefield. Her theory then led to a change in practice guidelines within the
British government (Aravind & Chung, 2010).
Research and theory work in a congruent relationship, as evidenced by the creator of
nursing theory. Theory is the beginning of nursing research, the beginning of the identification of
nursing problems, and the foundation of developing practice guidelines which generate nursing
diagnosis (McEwen &Wills, 2019). The identification of theory in research is the beginning
process of any nursing framework. The following steps will identify the theoretical framework of
the article “The influence of work-related fatigue, work conditions, and personal characteristics
on intent to leave (ITL) among new nurses” (Liu et al., 2015).
Theory as a Conceptual Framework
Study Variables
Lui et al. identified multiple variables that would influence the research and theory. Some
of these variables include personal characteristics of the nurse, working conditions, and work-
related fatigue (Liu et al., 2015). Lui described them as latent variables, which means these
variables were not directly observed. One measurable variable that was observed was the intent
THEORETICAL FRAMEWORK 4
of the nurses to leave. Other minor variables that were observed where the background
information including sex, marital status, work unit and type of hospital (2015).
Two steps that must be determined in a research study are the tools used to measure the
intent to leave and the population to be studied. Lui et al. completes both these steps by defining
the variables involved and the description of how the intent to leave was measured. The nurses
evaluated in this study were asked to rank their health status with a 5-point Likert scale,
numbering 1 as poor to 5 as excellent. The work conditions and overall workloads were
measured using a 0-10 scale, with 10 being the highest work load. Work related fatigue was rated
upon the Occupational Fatigue Exhaustion Recovery Scale (Liu et al., 2015). In order to assess
the nurses’ intent to leave, they were asked to measure questions such as “I am intent in leaving
nursing” and “I am considering leaving this hospital”, on a 7-point Likert scale from 0 to 6, 6
being they strongly disagree (Liu et al., 2015).
Conceptual Definitions
Part of a theoretical framework is to define and construct the concepts of the theory. Lui
et al. defines one of his concepts as the major reason for new nurses to resign. According to the
article, nurses resign within one year after being hired due to work related fatigue (Liu et al.,
2015). According to Lui et al. (2015), there are different types of fatigue, which include acute
fatigue, recovery from exhaustion, and chronic fatigue. The article then goes into great detail
explaining the differences between the types of fatigue. Lui et al. (2015) also states that the
fatigue can be influenced by the variables previously mentioned, such as personal characteristics.
Instruments
Lui et al. (2015) uses multiple instruments to measure different aspects of the study. A
cross sectional questionnaire is used to question the individuals being studied. The Likert scale is
THEORETICAL FRAMEWORK 5
used to measure the degree of fatigue of the individual involved in the study. The data was also
analyzed by a Windows program called SPSS version 19.0 (Lui et al., 2015). This program then
utilized multiple small programs within itself to analyze and conceptualize the data. A Structural
Equation Model was also used to test the data, and to inquire on the accuracy of the data
(McEwen & Wills, 2019). The instruments were valid and reliable. Lui et al. (2015) utilizes
multiple previous studies as demonstrations for the research being conducted.
Findings
Lui et al. (2015) reports multiple findings. One of the findings is that there was no
correlation between ITL and age, education and work experience. These variables were then
removed from the theory. Health was found to have a significant correlation with working hours
and workloads, so it was added to the pathway of the theory. It was also found that work
conditions affected ITL through work related fatigue and that work related fatigue was a factor
on ITL of nurses.
Relationship of Findings to Framework
The findings were congruent with the initial hypothesis of the theory. The only variable
that changed, which was initially though to contribute to ITL and chronic fatigue, were personal
characteristics such as sex, age, education and work experience. Lui et al. (2015) did provide an
analysis which provided data to suggest removing these variables, and the research provided
analysis in relation to the theory being tested (McEwen & Wills, 2019). The article also provided
the Structural Equation Model, which is how the results of the date were tested.
Implications for Nursing Practice
Lui et al. (2015) provided recommendations to nurse leaders from the data presented.
Since there was a positive correlation between work related fatigue and newer nurses’ ITL, it was
THEORETICAL FRAMEWORK 6
recommended that nurse managers observe and check in on new nurses working over 10 hours a
day, and/or long overtime hours (Lui et al., 2015). It was suggested that the Likert workload
scale be used as a screening tool to assess how the nurse is feeling, and mentors should increase
the number of breaks and support. Mentors were also encouraged to tailor training programs to
the individual being trained in order to reduce work related fatigue.
Recommendations for Further Research
One of the criteria for evaluating theory-testing research, is that there should be
recommendations for further studies that research the same topic (McEwen & Wills, 2019). Lui
et al. (2015) very briefly does this. The recommendation for further studies is to focus on long
term effects of work-related fatigue and to trend the fatigue so that intervention strategies can be
advanced (Lui et al., 2015). The recommendation is very brief and does not go into detail.
Nursing Theory versus Non-Nursing Theories
There is much debate as to whether nursing research should rely on nursing theory only
or also incorporate non-nursing theory. Both should be utilized in nursing research and theory
but with a heavy reliance on nursing theory. The reason for this is quite simple; nursing is a
unique profession and has specific profession-based goals that need to be met. One of these goals
is to provide the best care possible to patients, and theories being hypothesized cannot rely on
other professions to determine the best set course. Some of the issues presented in McEwen &
Wills (2019) on utilizing nursing theory are that there are not enough nursing theories and that
they can be confusing and difficult to ascertain. Non-nursing theory should contribute to the
hypothesis, but it should not be heavily relied upon, because of the issues previously discussed.
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Conclusion
Based upon the criteria given in McEwen & Wills (2019) on evaluating theory testing
research, Lui et al. has met all the criteria. The purpose of the theory is clearly set, described and
summarized. The concepts, variables, and instruments are delivered and discussed. The research
and hypothesis are specific enough that it could be proven to be false. The data gave evidence for
modifying the theory and the significance of the theory is reported. The recommendation for
further studies is brief but present. Lui et al. (2015) also included previous research and all
previous data that was collected in other research. Based upon these criteria, Lui et al. has met all
performance goals.
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References
Aravind, M., Chung, K. C. (2010). Evidence-Based medicine and hospital reform: tracing origins
back to Florence Nightingale. Plastic and Reconstructive Surgery, 125(1), 403–409.
https://doi.org/10.1097/prs.0b013e3181c2bb89
Fitzpatrick, J. J., & Kazer, M. (2012). Encyclopedia of nursing research (3rd. Ed.). Springer
Publishing Company.
Liu, Y., Wu, L., Chou, P., Chen, M., Yang, L., & Hsu, H. (2015). The influence of work-related
fatigue, work conditions, and personal characteristics on intent to leave among new
nurses. Journal of Nursing Scholarship, 48(1), 66–73. https://doi.org/10.1111/jnu.12181
McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed., pp. 146–150).
Wolters Kluwer.
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