SOURCES OF THEORY IN

NURSING RESEARCH AND

THEORY TESTING IN
RESEARCH

SAWROOP DHILLON
MSc (N)-1ST YEAR
 INTRODUCTION
Nurses have available to them a wealth
of theories on which to base their
research. These theories have been
developed in nursing and in many other
disciplines. At the present time, nurses
continue to use many theories from
other disciplines.
 SOURCES OF THEORY

Theories from Nursing Theories from other disciplines

 THEORIES FROM NURSING
There are certain theories which the nurse
researchers have generally used, though
that were not developed by nurses.

. Examples of these models are Orem self

care deficit theory, Roys adaptation
model, King’s theory of goal attainment
and Neumen’s systems model etc.
ERICKSON'S MODELING AND
ROLE MODELING THEORY
Care of
patient

Respect Nurturin
uniqueness g patient
 Commonalities

• Basic needs
• Attachment and loss ideas
• Degree of need satisfaction( Erikson’s
Psychosocial stages theory)
• Thinking abilities develop in sequential
order (Cognitive theory of Piaget’s)
 differences
• Inherent endowement
• Adaptation
• Adaptation potential
• Stress
• Self care
• Self care knowledge
• Self care resources
• Self care action.
• When it comes to research:

• The individual's ability to contend with

new stressors is directly related to the
ability to mobilize resources needed.
• The individual's ability to mobilize
resources is directly related to their
need deficits and assets.
• Distressors are unmet basic needs;
stressors are unmet growth.
• Prolonged grief due to an unavailable or
inadequate object results in morbid grief.
• Unmet basic and growth needs interfere
with growth processes for the patient.
• Repeated satisfaction of basic needs is a
prerequisite to working through
developmental tasks and resolution of
related developmental crises.
• Morbid grief is always related to need
deficits.
• Objects that repeatedly facilitate the
individual patient in need take on significance
for that individual patient. When this occurs,
attachment to the significant object occurs.
• Secure attachment produces feelings of
worthiness.
• Feelings of worthiness result in a sense of
futurity.
• Real, threatened, or perceived loss of the
attachment object results in morbid grief.
• An adequate alternative object must be
perceived as available in order for the patient
to resolve his or her grief process.
JOHSON’S BEHAVIORAL SYSTEM
MODEL
Behavior
system( patie
nt)

environ Subsyste
ment ms
JOHSON’S BEHAVIORAL SYSTEM
MODEL
• Model concerns with behavioral
functioning that results in equilibrium
of the integrated systems.
• Here the function of the nursing is to
help restore the balance of each
subsystem in the event of
disequilibrium and to prevent future
system disturbances.
JOHSON’S BEHAVIORAL SYSTEM
MODEL
• In research:- Several researchers
have designated this model as their
conceptual basis.
• For example:- Holaday focused on
this model’s concept for her study
of the vocal and visual interactions
occurring between mothers and
their chronically ill infants.
 KING’S OPEN SYSTEM MODEL
It includes three types of dynamics
interacting system:-
• Personal systems( represented by the
individual)
• Interpersonal systems (represented by
such dyadic interactions as nurse-patient
dialogue)
• Social systems(represented by larger
institutions such as hospitals and
families).
• In research:- King herself conducted a
descriptive observational study of nurse-
client encounters that yielded a
proposition that goal attainment was
facilitated by accurate nurse-client
perceptions, satisfactory communication,
and mutual goal setting.
• Example:- Hanucharurnkui and Vinyanguaug
(1991) employed this model in their study
of the effects of participation in self-care
on postoperative recovery and satisfaction
with care.
LEVINE’S CONSERVATION MODEL

• It focuses on individual as a holistic

being and the major area of
concern for nurses is maintenance
of the person’s wholeness.
• Levine’s model identifies several
principles of conservation that aim
to facilitate patient’s adaptation
processes.
LEVINE’S CONSERVATION MODEL

• Example in research:-
• Schaefer and Potylycki (1993)
based their study of fatigue
associated with CHF on
Levine’s model.
 NEUMAN’S HEALTH CARE
SYSTEM MODEL
• It focuses on the person as a complete
system
• In this model the person maintains
balance and harmony between internal
and external environments by adjusting
to stress and by defending against
tension-producing stimuli.
• The goal of nurse is to maintain clients
stability.
 NEUMAN’S HEALTH CARE
SYSTEM MODEL
• Example in research:- Ross and
Bourbonnais described the interpersonal
stressors identified in the home care
of man after MI.
• They developed nursing interventions
directed towards strengthening the
flexible lines of defense and resistance.
OREM’S MODEL OF SELF-
CARE
Focuses on each individual’s ability to perform
self-care

Self Depend
care ent care
agency agency
OREM’S MODEL OF SELF-
CARE
Orem identified three types of nursing
system:

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OREM’S MODEL OF SELF-
CARE
In research:- Orem’s self care model
has generated considerable inerest
among nurse researchers.

For example- Jirovec and

Kasno(1993)studied the predictors
of self-care abilities among the
institutionalized elderly.
 PARSE’S MODEL OF MAN-
LIVING-HEALTH
• It views a human being as an open system
freely able to choose from among a series of
options in giving meaning to a situation
• The goal of the Man-Living-Health model in
nursing practice is to encourage a client to
share his or her thoughts and feelings about
the meaning of a situation.
• The explication of the meaning changes the
situation, and new meaning occurs. Clients
may then be guided to plan for change from
the known health patterns to new health
patterns.
• In research:-
• The Parse framework is a relatively young
one but has already generated several
applications in the research literature,
particularly among qualitative researchers.
• For example- Banonis relied on the Parse
model in her study of the experience of
recovering from an addiction.
• Smith used this model for exploring the
experience of struggling through a
difficult time among people who are
unemployed.
 ROGER’S MODEL OF THE
UNITARY PERSON
• It focuses on the individual as a unified
whole in constant interaction with
environment.
• The unitary person is viewed as an energy
field.
• Nursing science is devoted to the study
of the nature and direction of unitary
human development.
• Nursing practice helps individuals achieve
maximum well-being within their
potential.
 ROGER’S MODEL OF THE
UNITARY PERSON

Example:- Alligood tested this

model in her study of the
relationship among creativity,
actualization and empathy over
the life course.
ROY’S ADAPTATION MODEL
• The human are biopsychosocial adaptive
systems who cope with environmental
change through the process of
adaptation.
• Within the human system, there are
four subsystems :
– physiologic needs
– self-concept
– role function
– inter-dependence.
ROY’S ADAPTATION MODEL
Example:- Christian studied the
relationship between women’s
symptoms of endometriosis and
self-esteem.
-Fawcett and Weiss used this
model in their study of cross-
cultural adaptation to cesarean
birth.
 PENDER'S HEALTH PROMOTION
MODEL
• It defines health as a positive dynamic state rather
than simply the absence of disease.
• Health promotion is directed at increasing a
patient's level of well-being.
• The health promotion model describes the
multidimensional nature of persons as they interact
within their environment to pursue health.
• Model focuses on three areas:
– individual characteristics and experiences
– behavior-specific cognitions and affect
– behavioral outcomes.
PENDER'S HEALTH PROMOTION MODEL

It defines health as a positive

dynamic state rather than simply
the absence of disease. Health
promotion is directed at increasing a
patient's level of well-being.
• In research:-

• Prior behavior and inherited and

acquired characteristics influence beliefs,
affect, and enactment of health-
promoting behavior.
• Persons commit to engaging in
behaviors from which they anticipate
deriving personally valued benefits.
• Perceived barriers can constrain
commitment to action, a mediator of
behavior as well as actual behavior.
• Perceived competence or self-efficacy to
execute a given behavior increases the
likelihood of commitment to action and
actual performance of the behavior.
• Greater perceived self-efficacy results in
fewer perceived barriers to a specific health
behavior.
• Positive affect toward a behavior results in
greater perceived self-efficacy, which can in
turn, result in increased positive affect.
• When positive emotions or affect are associated
with a behavior, the probability of commitment
and action is increased.
• Persons are more likely to commit to and engage
in health-promoting behaviors when significant
others model the behavior, expect the behavior
to occur, and provide assistance and support to
enable the behavior.
• Families, peers, and health care providers are
important sources of interpersonal influence that
can increase or decrease commitment to and
engagement in health-promoting behavior.
• Situational influences in the external environment
can increase or decrease commitment to or
participation in health-promoting behavior.
• The greater the commitments to a
specific plan of action, the more likely
health-promoting behaviors are to be
maintained over time.
• Commitment to a plan of action is less
likely to result in the desired behavior
when competing demands over which
persons have little control require
immediate attention.
• Persons can modify cognitions, affect, and
the interpersonal and physical
environment to create incentives for
health actions.
NIGHTINGALE'S ENVIRONMENT THEORY

There are seven assumptions :

1.natural laws
2.mankind can achieve perfection
3.nursing is a calling
4.nursing is an art and a science
5.nursing is achieved through
environmental alteration
6.nursing requires a specific educational
base
7.nursing is distinct and separate from
medicine
NIGHTINGALE'S ENVIRONMENT THEORY

In research:- Its assumptions are

helpful in almost all researches where
there is a need to take certain steps/
interventions for controlling or
preventing disorders.
 NEWMAN'S HEALTH AS EXPANDING
CONSCIOUSNESS THEORY
The Health as Expanding Consciousness theory makes
the following assumptions:
• Health encompasses conditions described as illness,
or, in medical terms, pathology.
• These pathological conditions can be considered a
manifestation of the total pattern of the patient.
• The pattern of the individual patient that
eventually manifests itself as pathology is primary,
and exists prior to structural or functional changes.
• Removal of pathology will not, in itself, change the
pattern of the individual patient.
• Health is an expansion of consciousness.
In research:- Newman's Health as
Expanding Consciousness Theory is
beneficial because its assumptions can
be applied in any setting and
"generates caring interventions."
However, its drawbacks are that there
is little discussion on environment
within the model.
 THEORIES/MODELS FROM
OTHER DISCIPLINES

• HEALTH BELIEF MODEL

• THE HEALTH PROMOTION MODEL
• LAZARU’S STRESS AND COPING
MODEL
 OTHERS ARE
• Adult learning theory:
Knowles
• Anxiety: Spielberger
• Body image: Schilder
• Change theory: Lewin
• Cognitive dissonance:
Festinger
• Crisis: Caplan
• Developmental Theory:
Piaget,Freud, Erikson
• Family communication theory: •
Satir
• Family theory: Minuchin;
Duvall
• Helplessness: Seligman
• Job satisfaction: Herzberg
• Moral reasoning: Kohlberg
• Motivation: Maslow
• Pain: Mezack and Wall
• Relaxation: Benson
• Social Learning theory:
Bandaur and Rotter
• Stress: Selye
Transtheoratical model of
behavior change: Prochaska
and DiClemente
 COMBINING THEORIES FROM
NURSING AND OTHER DISCIPLINES
Example- Buchanan et al examined the
effectiveness of two smoking interventions. The
control group received standard care, which
consists of 30 minutes of on-site contact from a
certified smoking cessation councellor. The
other group received a multicomponent
treatment interventions (MTI). This intervention
was based on theories that people will change
if they believe it is important and if they have
necessary skills, knowledge and confidence.
 THEORY TESTING IN NURSING
RESEARCH
1. Review various theories that may be
appropriate to examine the identified
problems.
2. Select a theory to be tested in the study.
3. Review the literature in this theory.
4. Develop study hypothesis(es) or research
questions based on a proportional
statement or statement from the theory.
5. Define study variables using the selected
theory as the basis of the theoretical
definitions.
6. Choose study instruments that are
congruent with the theory.
7. Describe study findings in light of the
explanation provided with the theory.
8. Relate study conclusions to the theory.
9. Determine support for the theory based
on the study findings.
10. Determine implications for nursing based
on the explanatory power of the theory.
11. Make recommendations for future
research concerning the designated
theory.
CRITIQUING THE STUDY FRAMEWORK
The criteria for critiquing a theoretical framework.

1. Is the framework clearly identified?

2. Is the framework based on a nursing theory or a theory
from another discipline?
3. Does the framework appear to be appropriate for the
study?
4. Are the concepts clearly defined?
5. Are the relationships among the concepts clearly
presented?
6. Is(are) the proportional statement(s) identified that will
guide the research question(s) or hypothesis(es)?
7. Are operational definitions provided for the theoretical
concepts that will tested?
 SUMMARIZATION

• Theories from nursing.

• Theories from other disciplines.
• Combining theories from both fields.
• Theory testing in Nursing research.
• Critiquing the study frameworks.
ANY QUESTION ….?