Lecture 2: Overview of Theory in Nursing

Describe 6 uses of theory in nursing.

• guides standards for nursing practice

• identifies who the recipients of nursing care are

• identifies what health is

• identifies setting in which nursing practice occurs

• sets goals for nursing assessments, care, outcomes

• directs the delivery of nursing services

Describe 4 specific ways that theory sets goals.

• parameters for client assessment

• labels/diagnoses for patient problems

• strategies for planning and intervening

• sets criteria for evaluation of intervention outcomes

Describe 2 specific ways that theory directs the delivery of nursing services.

• prioritizes what gets included in clinical information systems

  • admission database

  • nursing orders

  • care plan

  • progress notes

  • discharge summary

• prioritizes the nature of quality assurance programs

List the levels/categorization of theories from most abstract to most concrete.

• nursing metaparadigms

• worldviews/paradigms

• grand theories/schools of thought

• conceptual models

• middle-range theories

• practice theories

• concepts

• indicators

In the nursing metaparadigm, what does person represent?

• human energy field

• being with physical, intellectual, biochemical, and psychosocial needs

• holistic being

• open system

• integrated whole

• being who is greater than the sum of his or her parts

In the nursing metaparadigm, what does environment represent?

• external elements that affect the person

• internal and external conditions that influence the organism

• significant others with whom the person interacts

• an open system with boundaries that permit the exchange of matter, energy, and information

In the nursing metaparadigm, what does health represent?

• the ability to function independently

• successful adaptation to life’s stressors

• achievement of one’s full life potential

• unity of mind, body, and soul

In the nursing metaparadigm, what does nursing represent?

a science, art, and practice discipline

Within the nursing metaparadigm, what are the goals of nursing?

• care of the well

• care of the sick

• assist with self-care

• help individuals attain their human potential

Define paradigm.

patterns of beliefs and practices that regulate inquiry within a discipline by providing lenses, frames, and processes through which investigation is accomplished

Name 3 different worldviews.

• Received view: Empiricism, Positivism, Postpositivism

• Perceived view: Interpretive, Constructivism

• Critical view: Critical, Ideological

What fields of study hold the dominant received worldview?

pure and basic sciences

Describe received worldview.

• what is experienced through the senses is what exists

• examines parts to understand the whole

• knowledge is described and verified through scientific methods

• objectivity and reliability

In received view, what does research aim to do?

• research and discovery are value-free

• through rigour and objectivity:

  • discover rules

  • patterns that describe, explain, and predict phenomena

What fields of study hold the dominant worldview of perceived worldview?

social/human sciences

Describe the perceived view.

• focus is on perceptions of the subject and the researcher

• phenomena are studies and described through the eyes of people in their lived experiences

• desire is to understand the actions and meaning of individuals

What does research in the perceived worldview want to emphasize?

• investigates the individual’s world with emphasis on:

  • subjectivity

  • multiple truths

  • trends and patterns

  • discovery

  • description

  • understanding

How does perceived worldview determine what exists?

what exists depends on what individuals perceive exist

What does the perceived worldview believe about knowledge?

knowledge is subjective and created by individuals

What perspectives make up the received view?

Empiricism, Positivism, Postpositivism

What perspectives make up the perceived view?

Interpretive, Constructivism

What perspectives make up the critical view?

Critical, Ideological

Describe the critical view.

• philosophical approach that seeks to confront the social, historical, and ideological forces that produce and constrain society

• deals with emancipatory concerns within the context of oppressive socio-economic, political, and ideological concerns

Aim of critical view?

social transformation

Three criteria of critical view?

• explanatory

• practical

• normative

What other perspectives does the critical view include?

• feminism

• queer perspectives

• postmodernism

  • post-structuralism

  • post-colonialism

Describe a paradigm vs. a theory.

• Paradigm: gathering information, worldview, helps to create the theory you want to work with

• Theory: specific, works off of a hypothesis, framework that you will base your research on

Generally define nursing science.

system of relationships of human response in health and illness

What 2 sciences make up nursing?

1. Practice sciences

2. Human sciences

How do practice sciences develop knowledge?

typically use quantitative research methods

How do human sciences develop knowledge?

typically use qualitative research methods

Example of practice sciences research methods?

controlled experimentation

Examples of human sciences research methods?

phenomenology and ethnography

What notion did Kuhn introduce about paradigms?

• refers to major currents of thoughts, or ways of seeing and understanding the world

• defined as “universally recognized scientific achievements that, for a time, provide model problems and solutions to a community of practitioners

• the way we look at a situation and interpret it is part of a paradigm and influences our view of the situation

What notion did Kuhn introduce about scientific revolutions or paradigm shifts?

• occurs when a paradigm is challenged

• when the present way of thinking no longer allows the discipline to provide a valid explanation for new arising facts

What does questioning in paradigm shifts lead to?

the introduction of another new way of understanding the world

What paradigms did Parse introduce?

• Totality paradigm

• Simultaneity-humanbecoming paradigm

Describe the totality paradigm.

humans adapt to the environment

Describe the simultaneity-humanbecoming paradigm.

person and environment are inseparable

What paradigms did Newman introduce?

• Particulate deterministic paradigm (Positivism)

• Interactive Integrative paradigm (Post-positivism)

• Unitary transformative paradigm (Humanism)

Describe concepts.

• refer to or describe phenomena that occur in thought or nature

• symbolize ideas and express abstractions that are the subject matter of the theories of a discipline

• building blocks of something bigger

• represent categories of information that contain defining attributes

Describe specific traits of concepts.

• concrete or abstract

• variable (continuous) or non-variable (discrete)

• theoretical and/or operational

What is a concept analysis?

• rigorous process of examining the basic elements of a concept

• process of inquiry that explores the meaning of concepts to bring clarity to the definition of concepts and promote understanding

According to Walker & Avant, what are the 8 steps to concept analysis?

1. Select a concept

2. Determine the purpose of the analysis

3. Identify uses of the concept

4. Determine defining attributes

5. Identify a model case

6. Identify borderline, related, contrary, invented, and illegitimate cases

7. Identify antecedents and consequences

8. Define empirical referents

Describe a related case.

does not contain all of the defining attributes

Describe a contrary case.

clear example of what is NOT the concept

Describe an illegitimate case.

example of the concept used improperly or out of context

What is the goal of step 4 (determine defining attributes) in concept analysis?

list the attributes most frequently associated with the concept

Define antecedents.

events or incidents that happen prior to

Define consequences.

events or incidents that happen as a result

What are the 4 categories of consequences defined by Musona et al.?

• early

• late physical

• behavioural

• family, societal, economic

Define empirical referents.

measurable ways to demonstrate occurence of a concept

What does Post Positivist worldview believe about truth?

• things exist independent of perception

• there is one observable reality independent of human perception

What does Constructivist worldview believe about truth?

• meanings are constructed by humans as they engage with the world they are constantly interpreting

• truth is relative and dependent on human perception

What does Critical worldview believe about truth?

• between the extremes of subjectivism and objectivism

• an absolute representation of objective reality cannot be achieved

What is the Critical worldview’s stance on reality?

although a reality does exist outside of our perception, empirical claims about it are always contingent and potentially fallible

What is the Constructivist worldview’s stance on reality?

• reality is constructed → subjective and experiential

• some constructions may be shared

What is the Post positivist worldview’s stance on reality?

• the world we can perceive with our senses is real

• knowledge comes from the senses

What is the Critical worldview’s belief on the role of context?

• the status quo is context-laden

• socio-historical context is especially important to an understanding of reality

What is the Constructivist worldview’s belief on the role of context?

• humans make sense of their world based on social and historical perspectives

• context is inseparable from knowledge

What is the Post positivist worldview’s belief on the role of context?

should be controlled to create value-free or context-free knowledge

What is the Critical worldview’s purpose of inquiry?

• emancipation of the oppressed

• reduction in stigma

• critique of ideology

• philosophical drivers

What is the Constructivist worldview’s purpose of inquiry?

• understanding and exploring

• theory generation

What is the Post positivist worldview’s purpose of inquiry?

• to create generalizable truths

• to identify causal relationships

• theory verification

What research methods are used in Post positivist worldview?

Quantitative methods

• Study design: randomized controlled trial, surveys, correlation

• Data analysis: statistics

What research methods are used in Constructivist worldview?

Qualitative methods

• Data collection: interviews, focus groups

• Analysis: phenomenology, grounded theory

What research methods are used in Critical worldview?

Qualitative methods

• Analysis: ethnography, discourse analysis, imminent critique

• Study design: Participatory Action Research, critical ethnography

What is the role of the researcher’s values in Critical worldview?

• knowledge should not be owned by the researcher, it belongs to the participants who generated the data

• researcher should practice reflexivity

What is the role of the researcher’s values in Constructivist worldview?

• the researcher is a tool and inevitably impacts data collection

• use of reflexivity and bracketing

What is the role of the researcher’s values in Post positivist worldview?

researcher should be objective to eliminate bias

Other dimensions in Critical worldview?

• about values, power, and politics

• at any time and in any situation, there are both visible and invisible power relations and patterns of dominance seeking to oppress and control certain members of civil society

Other dimensions in Constructivist worldview?

• emic view

• inductive

Other dimensions in Post positivist worldview?

• deterministic

• deductive reductionist

• etic

• variables must be controlled

• comparison necessary