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LITERATURE REVIEW
and
USE OF THEORY

Dr.Christantie Effendy, S.Kp., M.Kes.

Research

• is systematic inquiry that uses

disciplined methods to answer
questions or solve problems.
 • The ultimate goal of research is to
develop, refine, and expand
knowledge.

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Nursing

research
• is systematic inquiry designed to
develop trustworthy evidence about
issues of importance to the nursing
profession, including nursing practice,
education, administration, and
informatics

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 • The relationship among the three
cornerstones of nursing—
Practice, research, and theory—
and discuss the theory-practice gap as
an impediment to theory-based
practice

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 Relationship

THEORY

RESEARCH
PRACTICE

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 Relationship
• Practice, research, and theory are the
cornerstones of the nursing profession. •
The relationship of these three
cornerstones are reciprocal and cyclical.
Clinical practice generates research
questions and knowledge for theory

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 • Research guides our practice and build
knowledge through theory
development.
• Theory guides research and improve
practice.

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 • Effective nursing practice requires the
application of knowledge, skills, caring,
and art to care for patients in an
effective, efficient, and considerate way.
• An important part of the knowledge used
in making nursing clinical decisions is
produced by research findings

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 • Ideally, all patient care decisions should be
based on research-evidence.
• Research findings are used to develop a
protocol and the protocol is followed in daily
nursing practice.

RESEARCH

FINDING PROTOCOL DAILY

PRACTICE

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 SCIENCE

RESEARCH

THEORY
Science is the result of the relationship
between the process of inquiry (research) and
the product of knowledge (theory)

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 Theory
• is integral to the research process where
it is important to use theory as a
framework to provide perspective and
guidance to the research study.
• Theory can also be used to guide the
research process by generating and
testing phenomena of interest.

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 • The primary purpose of theory in the profession
of nursing is to improve practice by positively
influence the health and quality of life of
patients.
• The relationship between theory and practice
is reciprocal.

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Theory as a
type of
knowledge
 • Improving human conditions and affairs
in general by directing us to better ways
of handling problems we encounter in
our lives, in managing human practice in
particular by grounding our practice in
specialized knowledge.

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Practice
• is the basis for the development of
nursing theory whereas nursing theory
must be validated in practice.

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• the “GAP” between theory and practice

is a common perception among nurses. •
Practicing nurses rarely use the language
of nursing theory unless mandated to do
so by accrediting bodies.

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 • There are several factors that contribute
to the theory-practice gap.
• Theory development has been viewed as
the domain of nurse educators and
scholars rather than the concerns of
practicing nurses.

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 "More than any other journal, [Research and
Theory for Nursing Practice] addresses the
theory-practice gap at an international level. Its
diversity reflects the concerns of nurses across
the globe."
—Barbara Hayes, PhD, RN,
James Cook University, Australia

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 "The research [in Research and Theory for
Nursing Practice] is high quality and covers
topics of great importance to nurses, nurse
educators, and nurse researchers."
—Lillie Shortridge-Baggett, PhD, RN,
Pace University

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dŚĞŽƌLJ ŐƵŝĚĞĚ ƉƌĂĐƟĐĞ ŝŶ ŶƵƌƐŝŶŐ
Usama S. Saleh

Saleh US. Theory guided practice in nursing. J Nurs Res Pract. 2018;2(1): 18

making nursing clinical decisions is produced by research findings. Ideally, all patient care and scholars rather than of practicing nurses. Nursing theory and practice have been vdifferent and
EDITORIAL decisions should be based on research-evidence. Research findings are used to develop a separate nursing activities. Nursing theories contand construct that must be explained before
protocol and the protocol is followed in daily nursing practice. applying themFinally, practice often develop without theory, and knowing thguarantee for good

P ractice research, and theory are the cornerstones of the nursing
profession. The relationship of these three cornerstones are reciprocal and cyclical. Clinical
practice generates research questions and knowledge for theory. Research guides our practice and The relationship between research and theory is reciprocal where research
build knowledge through theory development. Theory guides research and improve practice. In this
editorial, I will describe the relationship among the three cornerstones of nursing—
Practice, research, and theory—and discuss the theory-practice gap as an impediment to theory-
based practice.
Effective nursing practice requires the application of knowledge, skills, caring, and art to care for
patients in an effective, efficient, and considerate way. An important part of the knowledge used in
dŚĞŽƌLJ ŐƵŝĚĞĚ ƉƌĂĐƟĐĞ ŝŶ ŶƵƌƐŝŶŐ
generate more knowledge and theory. Theory is integral to the research
Usama S. Saleh
Saleh US. Theory guided practice in nursing. J Nurs Res Pract. 2018;2(1): 18
P
ractice research, and theory are the cornerstones of the nursing
In any discipline, science is the result of the relationship between the process of inquiry (research)
and the product of knowledge (theory). In addition to guiding nursing practice, the purpose of
practice.
There have been several calls to relate theory, practice, and researthe profession triangle remains
research is to build knowledge in a discipline through the generation of theory and or testing theory. fragmented and unrecognized.the nursing profession’s ability to meet the societal obligationto be an
ongoing reciprocal and cyclical relationship among theand research. This will help close the
perceived “gap” betwee
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practice and promote the theory guided practice.
unless mandated to do so by accrediting bodies. There are sever Nursing leaders must work toward keeping the reciprocal relationship among theory, practice, and
research by bridgibetween theory and practice. These can be done by continuebetween nursing
researchers/scholars and practicing nurses.
contribute to the theory-practice gap. Theory development hasas the domain of nurse educators
need to increase undergraduate and graduate student nurs
process where it is important to use theory as a framework to provide
to theoretical principles. As well, we need to stress theoreticonstructs, and principles following the completion of formal eneed to provide nursing
theorists/scholars and researchers the
perspective and guidance to the research study. Theory can also be used to guide the research Clinical practice generates research questions and knowledge for theory. Research
process by generating and testing phenomena of interest. guides our practice and build knowledge through theory development. Theory guides
The primary purpose of theory in the profession of nursing is to improve practice by positively
research and improve practice. In this editorial, I will describe the relationship among the
influence the health and quality of life of patients. The relationship between theory and practice is three cornerstones of nursing—
reciprocal. Practice is the basis for the development of nursing theory whereas nursing theory must Practice, research, and theory—and discuss the theory-practice gap as an impediment
be validated in practice. to theory-based practice.
for clinical involvement to minimize the disparity between tnursing theorists and scholars and the Effective nursing practice requires the application of knowledge, skills, caring, and art to
world of practicing nuwe need to address current healthcare and nursing issues froperspectives. care for patients in an effective, efficient, and considerate way. An important part of the
knowledge used in making nursing clinical decisions is produced by research findings.
Theory guided practice, in the form of practice theory, is tnursing. Practice theories are narrow,
circumscribed theories prspecific type of practice. As we progress into the 21st century, n Ideally, all patient care decisions should be based on research-evidence. Research
findings are used to develop a protocol and the protocol is followed in daily nursing
profession. The relationship of these three cornerstones are reciprocal and cyclical. practice.
 In any discipline, science is reciprocal. Practice is the basis for the development of nursing theory whereas nursing
the result of the relationship theory must be validated in practice.
between the process of unless mandated to do so by accrediting bodies. There are several factors that Despite
inquiry (research) and the the development, evolution, and study of nursing theory in the past a
product of knowledge
(theory). In addition to contribute to the theory-practice gap. Theory development has been viewed few decades,
guiding nursing practice, the the “gap” between theory and practice is a common perception
purpose of research is to as the domain of nurse educators and scholars rather than the concerns among nurses.
build knowledge in a Practicing nurses rarely use the language of nursing theory
discipline through the
generation of theory and or of practicing nurses. Nursing theory and practice have been viewed as two different and
testing theory. The separate nursing activities. Nursing theories contain concepts and construct that must
relationship between be explained before applying them to practice. Finally, practice often develop without
research and theory is theory, and knowing theory is not a guarantee for good practice.
reciprocal where research There have been several calls to relate theory, practice, and research. However, the
generate more knowledge profession triangle remains fragmented and unrecognized. To promote the nursing
and theory. Theory is profession’s ability to meet the societal obligations, there need to be an ongoing
integral to the research reciprocal and cyclical relationship among theory, practice, and research. This will help
process where it is close the perceived “gap” between theory and practice and promote the theory guided
important to use theory as a practice.
framework to provide
perspective and guidance to Nursing leaders must work toward keeping the reciprocal and cyclical relationship
the research study. Theory among theory, practice, and research by bridging the “gap” between theory and
can also be used to guide practice. These can be done by continued interaction between nursing
the research process by researchers/scholars and practicing nurses. Second, we need to increase
undergraduate and graduate student nurses’ exposure to theoretical principles. As well,
generating and testing we need to stress theoretical concepts, constructs, and principles following the
phenomena of interest. completion of formal education. We need to provide nursing theorists/scholars and
The primary purpose of researchers the opportunity for clinical involvement to minimize the disparity between
theory in the profession of the world of nursing theorists and scholars and the world of practicing nurses. Finally,
nursing is to improve we need to address current healthcare and nursing issues from theoretical perspectives.
practice by positively
influence the health and Theory guided practice, in the form of practice theory, is the future of
quality of life of patients. Nursing Faculty, Grand Canyon University, USA
The relationship between nursing. Practice theories are narrow, circumscribed theories proposed for a
theory and practice is scientists, researchers, and practitioners must place theory-guidthe core of nursing. To provide
effective, efficient, and holisticmust rely on sound theoretical principles to develop and impleof care.

Despite the development, evolution, and study of nursing theory in the past a few decades, the “gap” between theory and practice is scientists, researchers, and practitioners must place theory-guided practice at
a common perception among nurses. Practicing nurses rarely use the language of nursing theory the core of nursing. To provide effective, efficient, and holistic care, nurses
Correspondence: Usama S. Saleh, Nursing Faculty, Grand Canyon University, USA. Telephone: +1-859-402-1616, e-mail: U_saleh@yahoo.com
specific type of practice. As we progress into the 21st century, nurse scholars,

Received: October 30, 2017, Accepted: December 11, 2017, Published: January 7, 2018 This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-
must rely on sound theoretical principles to develop and implement the plan
of care. creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the oriproperly cited and the reuse is restricted to
noncommercial purposes. For commercial reuse, contact reprints@pulsus.com

J Nurs Res Pract Vol 2 No 1 March 2018

19

THEORETICAL STUDIES doi: 10.1111/j.1471-6712.2010.00835.x Nursing Faculty, Grand Canyon University, USA
Who uses nursing theory? A univariate descriptive analysis of
Correspondence: Usama S. Saleh, Nursing Faculty, Grand Canyon University, USA. Telephone: +1-859-402-1616, e-mail:
U_saleh@yahoo.com Received: October 30, 2017, Accepted: December 11, 2017, Published: January 7, 2018
five years’ research articles
This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://
creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is
properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact reprints@pulsus.com
A. Elaine Bond DNSc, APRN, CCRN (Director)1, Nidal Farid Eshah PhD, RN (Faculty Member)2, Mohammed Bani-Khaled MSc,
RN (Lt Colonel, PhD Candidate)2, Atef Omar Hamad PhD, RN (Faculty Member)2, Samira
J Nurs Res Pract Vol 2 No 1 March 2018
18 Habashneh MS, RN (PhD Candidate)2, Hussein Kataua’ MS, RN (PhD Candidate)2, Imad al-
Jarrah MS, RN (Lt Colonel, PhD Candidate)2, Andaleeb Abu Kamal PhD, RN (Faculty Member)2, Falastine Rafic Hamdan MS, RN (PhD
Candidate)2 and Roqia Maabreh MS, RN (Colonel, PhD Candidate)2
1
Nursing PhD Program, Fulbright Scholar, University of Jordan, Amman, Jordan and 2Faculty of Nursing, University of Jordan, Amman, Jordan

guide their research, with which to improve practice.

20 Aims: The purposes of this descriptive study were to determine: (i)
Scand J Caring Sci; 2010 Were nursing scientists’ research articles in leading nursing
journals based on theory? (ii) If so, were the theories nursing
Who uses nursing theory? A theories or borrowed theories? (iii) Were the theories integrated
univariate descriptive analysis into the studies, or were they used as organizing frameworks?
of five years’ research articles Methods: Research articles from seven top ISI journals were
Background: Since the early analysed, excluding regularly featured columns, meta analyses,
1950s, nursing leaders have secondary analysis, case studies and literature reviews. The
worked diligently to build the authors used King’s dynamic Interacting system and Goal
Scientific Discipline of Attainment Theory as an organizing
Nursing, integrating Theory,
Research and Practice.
Recently, the role of theory
has again come into question,
with some scientists claiming Introduction
nurses are not using theory to
In her seminal work, The State of Nursing Science: Hallmarks of
 10
the 20th and 21st Centuries, Fawcett reiterated her earlier work on whether quantitative or qualitative. theory into their research (2–4). Some nursing scientists state
the three pieces of knowledge necessary to the future of nursing’s Results: Of 2857 articles published in the seven journals from theories ‘borrowed’ from other disciplines may be useful to lay the
discipline: nursing theory development, nursing research and 2002 to, and including, 2006, 2184 (76%) were research articles. groundwork for new nursing theories, but continued use of others’
nursing practice (1). Other nursing scientists lamented the failure Of the 837 (38%) authors who used theories, 460 (55%) used theories will not build nurs ing science, nor to help foster the work
of nursing writers to con tribute to the discipline of nursing by nursing theories, 377 (45%) used other theories: 776 (93%) of of nursing practice (1, 4).
failing to incorporate those who used theory integrated it into their studies, including Obviously, a meaningful triadic relationship in theory, research and
qualitative stud ies, while 51 (7%) reported they used theory as an practice is essential for nursing to be recog nized as a profession.
orga nizing framework for their studies. Closer analysis revealed Nursing theory helps define and ‘verify the existence of unique
theory principles were implicitly implied, even in research reports nursing knowledge (5 p. 10). There is a need for nursing scientists
Correspondence to:
that did not explicitly report theory usage. to guide the profession, in complex and dynamic health care
A. Elaine Bond, DNSc, APRN, CCRN, Director, Nursing PhD Pro gram,
Conclusions: Increasing numbers of nursing research articles changes, as they become leaders in interdisciplinary
Fulbright Scholar, University of Jordan, Amman, Jordan. E-mail:
(though not percentagewise) continue to be guided by theory, and organizations, and address nursing’s image for today’s media and
elaine_bond@byu.edu
not always by nursing theory. Newer nursing research methods the public (6). The ultimate use for nursing theory is to
! 2010 The Authors may not explicitly state the use of nursing theory, though it is
framework. They developed consensus on how to identify the implicitly implied.
integration of theory, searching the Title, Abstract, Aims, Methods,
Discussion and Conclusion sections of each research article, Submitted 30 August 2010, Accepted 7 September 2010

Scandinavian Journal of Caring Sciences ! 2010 Nordic College of Caring Science 1

10/3/22

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 The role of theory in clinical
nursing practice
• is viewed from the perspective
of knowledge-use in practice,
and is
examined in the context of the nature
of nursing practice and the structure
of nursing knowledge.

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Nursing
practice
 • as a human service practice has a
specific goal of improving human
health, and has to be guided by a
system of nursing knowledge that
includes various sorts of theory.

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Nursing
practice
• is

goal-directed, meaning it is oriented to helping

clients to deal with problems and issues
pertaining to their health both in times of health
and illness.
• This goal is socially and legally mandated, as nurses
are licensed to practice in accordance with the law
that specifies what the practice must entail.
• The goal is related to enhancing clients’ abilities
to gain or sustain healthful living or peaceful
dying

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 IMPORTANT POINTS
• Nursing theory and practice have been viewed
as two different and separate nursing
activities.
• Nursing theories contain concepts and
construct that must be explained before
applying them to practice.
• Finally, practice often develop without theory,
and knowing theory is not a guarantee for
good practice.

25

HOW TO
SOLVE THE
GAP
•

To promote the nursing profession’s ability to

 meet the societal obligations, there need to
be an ongoing reciprocal and cyclical
relationship among theory, practice, and
research.
• When perceived “gap” between theory and
practice ----🡪 promote the theory guided
practice.

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Whose

responsibility???
• Nursing leaders must work toward
keeping the reciprocal and cyclical
relationship among theory,
practice, and research by bridging
the “gap” between theory and
practice

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 • To guiding nursing practice, the
purpose of research is to build
knowledge in a discipline through the
generation of theory and or testing
theory
• The relationship between research and
theory is reciprocal where research
generate more knowledge and theory.

28

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Examples of
nursing
research
 questions:
• What is the effect of increased body mass
index on survival and complications following
elective open heart surgery? (Barnett et al.,
2010)
• What is it like for children with leukemia to
experience cancer-related fatigue? (Wu et al.,
2010)

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 Steps
of EBP
1. Formulate an
answerable question

2. Conduct an efficient literature

search
3. Critically appraise the evidence
4. Apply the results in health care
decisions
5. Evaluate the outcome

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Patient
Preferences
Available resources

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LWBK779-FM[i-xiv].qxd 11/11/10 4:05 AM Page i Aptara

Quick Guide to an Evidence

Hierarchy of Designs for
Cause-Probing
Questions

Level
I
a.
Systematic

review of RCTs
b. Systematic review of
nonrandomized trials
Level II
a. Single RCT
b. Single nonrandomized trial
Level III
Systematic review of correlational/observational
studies
Level IV
Single correlational/observational study
Level V

Systematic review of descriptive/qualitative/physiologic studies

Level VI
Single descriptive/qualitative/physiologic study
Level VII
Opinions of authorities, expert committees

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What is Evidence-Based Medicine?

 See a

patient
Ask a question

S
eek the best evidence

Monitor the Apply the evidence Appraise that evidence change

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Struktur pertanyaan klinik

PICO
Patient
Or Problem Luka post
 operasiRawat luka
luka

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How
to

Search?

• use your PICO !!

• Medical Subject Heading (MeSH)
• free text words
• combine (AND – OR – NOT)

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 Structure of
a search
strategy
• based on your PICO

• focus on those most likely to be found in title

& abstractP participants
I intervention
C comparison
O outcomes

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 Boolean

A ‘AND’ B
A ‘OR’ B

A ‘NOT’ B A B A BA B

38

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• Truncation:
Truncation *
 – the ‘*’ acts as a wildcard indicating any further letters,
• Keywords such as
– Child OR Childs OR Children OR childhood 🡪 child*

– Diabetics OR diabetes 🡪 diabet*

– Obese OR Obesity 🡪 obes*

– Diagnose OR Diagnosed OR Diagnosis OR diagnostic 🡪

diagnos*

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Structure for
search
strategy
• PICO P
opulation/patient, I
ntervention,
Comparison/
Control,Outco
me
• Use these components to direct your search. – It is
 also worth looking for synonyms for each component •
General structure of question
– (Population OR synonym1 OR synonym2…) AND
– (Intervention OR synonym1 OR synonym2…) AND
– (Comparator OR synonym1 OR synonym2…) AND
– (Outcome OR synonym1 OR synonym2…)

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Scenario

Joned, a smoker of 49 years goes to his GP to ask for help with

stopping smoking. He’s tried various methods in the past but
nothing has worked so far, so asks the GP whether
acupuncture might be a good option.
 41

Our
PICO
P = Smoking
I = Acupuncture
C = N/A
O = Stopping smoking

Is acupuncture an effective way of stopping

smoking?

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Develop a search strategy

Using OR then AND
to broaden then focus the search

P I O and and

smoker* tobacco acupressure

or cessation or
smoking stop*
43 or
or
acupuncture or
quit*
44

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45
46

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Where
to
search

www.ncbi.nlm.nih.gov/

pubmed/

http://highwire.stanford.edu/
 47

Journal

websites

British Medical Journal

http://www.bmj.com

New England Medical Journal

http://content.nejm.org

Pediatrics Journal
http://pediatrics.aappublications.org/

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49
 websites

Cochrane Library
http://

www.thecochranelibrary.com

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51
 http://www.nursingsociety.org/worldviews

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