Theoretical perspectives for nursing PDF
Preview Theoretical perspectives for nursing
• Bonnie Weaver Duldt Kim Giffin .. . fl I ~I ~[Ii \111111111111111111111 .01oomsvurJ liealthca~ L1DraJ~J Groui:10 i{loor 52 Go,V2r Sll"eet LONDON WC1E 6EB J'el: 4)20 73~0 Q097 'J DULT 21839 'Iheoretical perspectives ,,. DATE- ·• -4. JMi. 1992 ·· d. -ivil. I/ J L - . I... vVL. I, / { ·i , , ~ DULT l ~ .,; , 21839 --· $3 1 -- tJi Theoretical l ibrary Perspectives '~I Ed . B''orirr1c-- h ,,~,;r---.1,::1 ,., -~-,.. · · , ·~ne o: ,, urse ucatrorl 1\/lacDc·;~-:;, . ·, "~- ·· -n tr. .i: •. .,,., for Nursing - . ,,, , u """ ·;:, j 1>1h ,, ] S -• I •,tf,-, • ..t , ~ ··' • ~ \, + ' .J ,,,,, • f:l,1,,,, C'i ~ ,t ) t\.., I \.. • r Lonucn \,V 1 £:1\N •., 1 •. ;.. ;4-:;;~·l··' ~ MIDDLESEX HOSPITAL NURSES' LIBRARY. r9 F , , ... l" J' '- • L..1I . • ., L '} - ,j_ .><Iii I.I JL "),''l ,, . :n-r -- ,., "'- I fll'!,, ,V-...,/ ., - ' ..\, . .., . . , \ J...4/u .... • ,_,___ j .. " t 1'"'" ..) . I I,.... • ... / .... ,1 -· • vI.t. H.·.,. .. ·•,· . .. ,; .,: ••. ,, , r ,,. 7,, I • I ..... J , ''"'' ,, 1..., i I. . •, ; ',/ ,I .. ' .. ·-· ... I ' , 'I• \.~ 23. NOV. 1S? ) -, .,a.o..o 1 rr3 '19° i A 1 • I l.' , 7 1 . \. ' ,, ) ' \ \7. OC1 1994 ·,..I...'.. . , ..... ' -5: MAY 1?7 '. -t JllL 1 I j ; •C.•. I.. // I -4. JMt 1992 25. MAR. 199 4 K.B. ' Form No. 9194 Theoretical Perspectives for Nursing Bonnie Weaver Duldt, R.N., Ph.D. of Professor Nursing of Assistant Dean GraduaJe Programs School of Nursing East Carolina University, Greenville, N.C. Kim Giffin, Ph.D. Professor Emeritus of Communication Studies University of Kansas, Lawrence Little, Brown and Company Boston Toronto Library of Congress Cataloging in Publication Data Duldt, Bonnie Weaver. Theoretical perspectives for nursing. Bibliography: p. Includes index. 1. Nursing-Philosophy. I. Giffin, Kim, 1918- 11. Title. [DNLM: 1. Philosophy, Nursing. WY 86 D881t) RT84.5.O85 1985 610.73'01 84-28937 ISBN 0-316-19528-6 Copyright© 1985 by Bonnie Weaver Duldt and Kim Giffin All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means including information storage and retrieval systems without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review. Library of Congress Catalog Card Number 84-28937 ISBN 0- 316- 19528-6 9 8 7 6 5 4 3 2 1 MV Published simultaneously in Canada by Little, Brown & Company (Canada) Limited Printed in the United States of America Acknowledgments begin on page 277. Preface In recent years, the nursing profession has started, to move away from a topical, subject-oriented approach toward a conceptual and theoret ical perspective. Theories of closely related professions and disci plines, such as Maslow's and Erikson's, have been utilized in attempting to understand phenomena observed in human wellness and illness. Since the mid-1960s, nurses themselves have begun to develop theories proposing a systematic view of phenomena observed in the practice of nursing. Such recent nurse-theorists and their theories include Roy's adaptation model, Yura and Walsh's theory of nursing process, and Patterson and Zderad's theory of humanistic nursing. Introductory courses are being formulated in nursing programs to orient students (and practitioners) to one or more of these theories. Nursing educators are using concepts and theories as a basis for curriculum design as well as a framework for content of courses. We wrote this book for four reasons. 1. A review of current literature reveals few texts whose authors deal with analysis of theories generally, and documentation of how to ana lyze a nursing theory is rare. Books have been written on development of a theory, such as Dubin's Theory Building or Reynold's Primer in Theory Construction. But these and other authors are not health profes sionals. In nursing, a few authors seek to analyze nursing theories at a level so complex that it is too difficult for novices. Their perspective is usually within the discipline of nursing, and frequently they coin words; these characteristics separate aspiring nursing scholars from a communication network intelligible to other disciplines. This book is unique in that we describe the process of theory-building and analysis that is applicable to nursing theories as well as to theories in other disciplines. We use processes of analysis derived from speech com munication, rhetorical criticism, and debate. Our perspective is outside the discipline of nursing, looking in. Our terminology is shared by other disciplines, making it easier for the reader to join the commu nication network among scholars and scientists. V Vi Preface 2. Nursing as a discipline is perceived as on the way to becoming a science and a profession. A consensus among scholars seems to be that a theoretical body of knowledge is essential for both a discipline and a profession. Johnson comments on the sparseness of theoretical and scientific giants in nursing's heritage, upon whose work current nurs ing scholars might build. Consequently, theories and models have been borrowed from other disciplines and professions and applied with varying appropriateness to nursing. Efforts toward achieving knowl edge and practice based on theory and research in nursing have occurred only in the past fifteen years. 3. Peer evaluation and accreditation have established criteria and expectations for theory-based nursing education. The National League for Nursing's Criteria for Appraisal of Baccalaureate and Higher Degree Programs states that curricula for baccalaureate programs are to be developed within a conceptual framework. Bevis advocates use of the ories in curricula to aid both teachers and students "in differentiating the important from the inconsequential in dealing with nursing prob lems."1 4. Nurses have to manage innate and unique barriers as they create theoretical perspectives about nursing. One barrier is the current level of preparation of nursing practitioners. Traditionally, it is expected that development of research and theory will be done by members of a discipline with doctoral-level preparation. We don't have many- cur rently about two thousand out of more than one million Registered Nurses in the United States. Compared with other disciplines, too large a proportion of our doctorally prepared nurses are not involved in developing or testing theory, and many have limited access to clinical nursing contexts. Therefore we need to have nondoctorally prepared nurses understanding theories and conducting theory-testing research. Another covert barrier is that too many nurses who are involved in research avoid theories. A few minutes flipping through nursing research journals reveals very few articles or research reports that test theoret ical statements of relationship, compared to research journals of other academic disciplines. More of our research must test theoretical state ments. A third barrier is the historical tendency of nurses to look to medicine or other health-care professions for guidance in developing as a profession and a discipline. We are acutely aware that nursing is derived from many areas of the academic arena, and it seems reason able that we broaden our perspective and look at the whole academic array of disciplines as we determine our own development as a dis cipline and a practicing profession. The corrective we suggest is that 1. Em Olivia Bevis, Curriculum Building in Nursing: A Process, 2nd ed. (Saint Louis: C. V. Mosby, 1978). .. Vii Preface more nurses need to appreciate how important it is to conduct research to test theoretical statements, thus creating a base of scientific and scholarly knowledge for the discipline. Until recently the rank and file of nurse practitioners have not been trained in developing theory or conducting research. Thus theory development at the practice level tends not to occur. Yet it is at this level that relevant phenomena, concepts, and relationships among concepts need to be observed, defined, researched, and implemented as new knowledge. Nursing as a disci pline and a profession is at the preconceptual level of development in its theory-building. If our goal is to achieve theory- and research-based nursing practice, then we need to make knowledge about theories and theory testing more easily accessible to all nurses, It is our hope that this book will help achieve this goal. We aim this book at exerting intluence on moving the nursing body of knowledge toward meeting the theoretical criteria of a discipline and a profession. Designed as a text for introductory courses in nursing theories, it is a basis upon which undergraduate and graduate nursing students may develop skills in conceptual thinking and theory devel opment in nursing and a framework for comparative analysis and eval uation of theories. In manuscript form, this book for several years has eased students' way into the mystique of theories, and it reflects their numerous contributions, questions, needs, and feelings. We have made two assumptions. First, undergraduate students are capable of comprehending and developing theoretical perspectives, and they are currently doing so in disciplines other than nursing. Second, we cannot know which theory or theories will be in vogue over a lifetime of practice; thus, it seems important for nursing faculty to provide a framework for analysis and evaluation of theories generally. As a consequence, future rank-and-file practicing nurses can be equipped with a discriminating and cosmopolitan perspective of theories, nurs ing-care plans can be based on nursing theories, the incidence of clin ical testing of theories will be able to increase, and more of these nurses may seek graduate-level education (formal preparation for conducting research) than current statistics indicate. This book is divided into four sections. Part One is introductory. In Chapter 1 we set out to establish the need for developing theory in a discipline- and practice-oriented profession such as nursing. In Chap ters 2, 3, and 4 we focus on the person as a theorist, particularly in regard to attitudes, use of language, and modes of abstract thinking. In Chapter 5 we discuss generally the building of theories and provide examples of theorists' attitudes, language, and thinking in exploring a phenomenon. In Part Two we approach a theory as if we were in a biology labo- - _! ! ! Viii Preface ratory and as if a theory were a specimen to be dissected. In Chapter 6 we describe the whole theory or the gross anatomy, and then dissect it into four major parts: the assumptions, concepts, relationship state ments, and evaluation. This is our definition of a theory: A theory consists of a set of concepts and a set of testable statements relating the concepts within the parameters of a set of assumptions so that a phenom enon is described, explained, predicted, and perhaps controlled. Following this definition, we identify and define the four major parts of a theory in Chapters 7, 8, 9, and 10. This set of elements serves as an organizing framework for the remainder of the book. In Part Three the four major parts of a theory are used to establish a method by which one may analyze theories. Chapter 11 consists of a general explanation of the method we propose, and several theories are discussed generally as examples. In Chapter 12 we select Sister C. Roy's theory for analysis as an example of a systems model and we analyze it to demonstrate more fully the method of analysis we advo cate. Although this analysis is streamlined and simplified for clarity, it can be much more complex. Our nursing theory analysis sheets sum marizing Roy's theory are included in the appendixes to help our read ers understand this method of grasping the major aspects of any theory and arranging them for comparison with other theories. We believe the method we propose is most helpful in understanding theories and pro vides a firm basis for comparative theory analysis. In Part Four we demonstrate how a theory can be developed, using the symbolic interaction model. We present a new theory, Duldt's the ory of humanistic nursing communication, share with the profession a first complete statement of this theory, and demonstrate how a theory can be developed from a theorist's perspective. We state the assump tions in Chapter 13, and we discuss how Duldt developed these state ments, including sources of influence. Similarly, in Chapters 14 and 15 we present the relevant concepts and relationships. In Chapter 16 we select some representative criteria for evaluating a theory and use these to evaluate the theory of humanistic nursing communication. Our theory analysis sheet (Appendix ·c) is included to summarize the the ory. We believe Part Four will be helpful in "demystifying" theory development for nurses generally and for graduate nursing students in particular. Finally, in the appendixes, we include theory analysis sheets for other theories that may interest our readers. We propose that you accept the content of these worksheets as a basis for discussion, and we record our perspective on the theory. We encourage you to read the theorist's
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