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Research Theories (Frameworks) and Clinical Practice Paper

Sasha T. Miller

University of Bridgeport

NURS 301 Nursing Theory & Evidence-Based Practice

Professor Patricia Mcgarigle

May 30, 2021

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Research Theories (Frameworks) and Clinical Practice Paper

At first glance, nursing is seen as a mainly practical discipline, however, this profession

also relies on theoretical development as well as on research to generate and test hypotheses and,

in turn, validate the actions or interventions that patients, stakeholders, other health professionals

and society as a whole requires (Hoeck & Delmar, 2018). The purpose of this paper is to respond

a series of questions regarding nursing and the different kinds of theories that exist.

The first question that arises is what is a grand nursing theory? Authors suggest that

nursing theory is body of academic work made of a conceptual framework focusing on the

nursing profession as the object of study (Smith & Parker, 2015). When asking what are the

elements of a grand nursing theory, these involve high levels of abstraction and do not include

many operational definitions, they are complex and their scope is broad (Wayne, 2019).

Examples of grand nursing theories include Estrin Levin’s conservation theory (Özcan &

Eryılmaz, 2017). The author highlights the necessity of organizing a structure to teach medical

and surgical nursing. Her model borrows elements from physics (the concept of energy

conservation), as well as other psychosocial elements (Özcan & Eryılmaz, 2017). This theory

relies in three principles: first, integrity, the care a patient receives must be integral (health

professionals should consider the patient as a whole); then, adaptation, defined as the need to

make necessary adjustments in the patients’ life, as well as their treatment to keep them safe; and

finally, conservation, referring to the capacity individuals have to remain functional despite they

suffer great health affections (Özcan & Eryılmaz, 2017). In way, conservation is the consequence

of adaptation, it is the way individuals respond to the changes they have undergone to preserve

themselves.
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On the other hand, when referring to middle range theory, these combine postulates in

general terms (such as those contained in grand nursing theories) with concepts that are specific

and, moreover, use measuring to provide evidence. The latter means that middle range theories

depart from merely speculative postulates and relate more to research and practice. They are not

as abstract or general as grand nursing theories and their purposes have a clearer definition, limit

and a purpose (Wayne, 2019).

When choosing a middle range theory to use as a framework for a research, it is

important to consider what is the clinical practice area that relates to the research problem. For

this case, the chosen problem is determining which substance (methadone or suboxone) works

better in terms for treatment for patients with history of opioid dependency. Therefore,

rehabilitation is the clinical practice area that relates to this research problem. A nurse who works

in rehabilitation focuses in providing help for disabled people or those who face chronic

illnesses; the main purpose is make these patients to regain functionality as well as finding a new

lifestyle patients can adapt themselves and remain healthy (Tyrrell & Pryor, 2016). By giving

patients a set of goals as well as a treatment plan that are realistic, rehabilitation nurses (as well

as other health professionals they collaborate with) contribute in making patients more

autonomous.

The chosen middle range theory is the one offered by de Oliveira Lopes et al., from their

paper “Causation and Validation of Nursing Diagnosis: A Middle Range Theory” (2015). The

authors offer a model using predictive orientation that serves them to explain what are the

relationships that exist between the different components of nursing diagnosis (Oliveira Lopes et

al., 2015). This theory will serve to establish a comparison between suboxone and methadone

when treating opioid-dependent patients with opioid dependance) of nursing diagnoses.

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Some of the concepts from this middle-range theory that fit in the clinical practice area of

rehabilitation include the difference between medical diagnoses and nursing diagnoses. For the

authors, nursing diagnoses have a more specific nature; they aim to fulfill the necessities of care

each patient has. The authors point out that, despite the existence of pre-established protocols for

nursing practice, some health professionals do not have diagnosis in mind as the first stage in the

nursing process (de Oliveira Lopes et al. 2015). This means that there is a gap that is necessary to

fill during the nursing process, that is having a nursing diagnosis that differs from a medical one.

The way this middle range theory and clinical practice area of the research question are

linked together is by the fact that there cannot be treatment without diagnosis, and therefore there

cannot be rehabilitation without treatment. For this case, determining which of the substances

has better outcomes (methadone or suboxone) in terms of rehabilitation, will serve nurses to use

in their daily practice involving opioid-dependent patients. In addition, Oliveira et al. (2015) can

be useful in terms of methodology, by using their casualty models and predictive types borrowed

from the field of epidemiology are contributing factors to provide an accurate diagnosis.

Finally, when referring to a study framework, Grove et al. (2019) define it as a written

document that includes the background of a research project as well as the theories, regulations

and guidelines that relate to it. Frameworks gather relevant aspects that provide background to

the research or helps investigators to find gaps or questions their research can answer (Grove et

al., 2019). Frameworks also serve as a basis for the research’s hypothesis (Grove, Gray, & Burns,

2019). The theory offered by Oliveira et al. serves as framework since it can be used for a

specific purpose, in this case, to establish which substance is more useful for rehabilitation for

patients with opioid dependency. This way, nurses will have elements to establish the

effectiveness of a substance over the other in terms of treatment.

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References

Grove, S. K., & Gray, J. R. (2019). Understanding Nursing Research: Building an evidence-based

practice (7th ed.). Elsevier. 

Hoeck, B., & Delmar, C. (2018). Theoretical development in the context of nursing—The hidden

epistemology of nursing theory. Nursing Philosophy, 19(1), e12196.

de Oliveira Lopes, M. V., da Silva, V. M., & Herdman, T. H. (2017). Causation and validation of

nursing diagnoses: a middle range theory. International journal of nursing knowledge,

28(1), 53-59.

Özcan, Ş., & Eryılmaz, G. (2017). Levine's Conservation Model. Turkiye Klinikleri Obstetric-

Women's Health and Diseases Nursing - Special Topics, 3 (3).

Smith, M. C., & Parker, M. E. (2015). Nursing Theories and Nursing Practice. FA Davis.

Tyrrell, E. F., & Pryor, J. (2016). Nurses as agents of change in the rehabilitation process. Journal

of the Australasian Rehabilitation Nurses' Association (JARNA), 19(1).

Wayne, G. (2019, September 18). Nursing Theories and Theorists: An Ultimate Guide for Nurses.

https://nurseslabs.com/nursing-theories/#Middle-Range-Nursing-Theories.