THEORY DEVELOPMENT

INTRODUCTION
Most began constructing a theory as a way to improve the care delivered to clients,
whether through direct clinical practice or through the education of nurses. The theorists were
risk takers with lifelong commitments to the nursing profession. They viewed nursing as a
career rather than as an alternative to marriage, which was the view of many nurses during
the 1940s, 1950s, and 1960s.
Without nursing theory, nursing activities and intervention are guided by rote,
tradition, some outside authority , hunches or they may simply be random
Theories are not discovered, instead they are invented. In the past, nursing leaders saw
theory development as a means of clearly establishing nursing as a profession and developed
models and theories to guide nursing practice.
AIMS OF DEVELOPMENT OF THEORY
Theory development seeks to help the nurse understand the practice in a more complete
and insightful way and provides a method of identifying and expressing key ideas about the
essence of practice

It is a global term to refer to the process and methods used to create, modify or refine
a theory

Theory development is a complex, time consuming process that covers a number of

stages or phases from inception of concepts to testing of theoretical propositions
through research.

The process begins with one or more concepts that are derived within a disciplines
metatheory or philosophy

theory construction, on the other hand, is used to describe one of the final steps of
theory development in which the components of the theory are organized and linkages
specified

In the 1970s and 1980s, a number of nursing programs recognized the major concepts
of some nursing models, structuring these concepts into a conceptual framework, and
built the complete curriculum around the framework .

PURPOSE OF DEVELOPMENT OF THEORY

The general purpose of theory development primarily is to ensure adequate

and quality nursing delivery and to clarify and improve the status of Nursing
as a profession

THEORY DEVELOPMENT IN NURSING (HISTORICAL APPROACH)

Most nursing scholars credit Florence Nightingale with being the first modern nursing
theorist. Nightingale was the first to delineate what she considered nursings goal and practice
domain and she postulated that to nurse meant having charge of the personal health of

someone. She believes the role of the nurse was seen as placing the client in the best
condition for nature to act upon him.
According to nightingale, formal training for nurses was necessary to teach not only
what is to be done but how to do it. She was the first to advocate the teaching of symptoms
and what they indicate. Further, she taught the importance of rationale for actions and
stressed the significance of trained powers of observation and reflection.
Her framework for nursing emphasized the utility of empirical knowledge, and she
believed that knowledge developed and used by nurses should be distinct from medical
knowledge. She insisted that trained nurses control and staff nursing schools and manage
nursing practice in home s and hospitals.
STAGES IN THE DEVELOPMENT OF NURSING THEORY
Stage
Silent Knowledge

Source of Knowledge
Blind obedience to medical
authority

Received
Knowledge

Learning through listening to

others

Subjective
knowledge

Authority was internalized

and a new sense of self
emerged

Procedural
Knowledge

Included both separate and

connected knowledge

Constructed
Knowledge

Integration of different types

of knowledge (intuition,
reason and self-knowledge)

Impact on Theory and Research

Little attempt to develop theory
Research was limited to collection of
epidemiologic data
Theories were borrowed from other
disciplines. As nurses acquired
nonnursing doctoral degrees, they relied
on the authority of educators,
sociologists, psychologists, physiologists,
and anthropologists to provide answers to
nursing problems.
Research was primarily educational
research or sociologic research
A negative attitude toward borrowed
theories and science emerged
Nurse scholars focused on defining
nursing on developing theories about and
for nursing
Nursing research focused on nurse rather
than on clients and clinical situations
Proliferation of approaches to theory
development. Application of theory in
practice was frequently
underemphasized. Emphasis was placed
on the procedures used to acquire
knowledge with over attention to the
appropriateness of methodology, the
criteria for evolution and statistical
procedure for data analysis
Nursing theory should be based on prior
empirical studies, theoretical literature,
client reports of clinical experience and

feelings and the nurse scholars intuition

or related knowledge about the
phenomenon of concerns.
SIGNIFICANT EVENTS IN THEORY DEVELOPMENT IN NURSING
Year
1859

Event
Nightingale published Notes on Nursing

1868
1920
1924
1948
1949
1950

AMA advocated formal training for nurses

Columbia University Doctorate in Education degree in nursing
Yale University began the first collegiate school of nursing
Nursing for the Future Dr. Esther Brown
State licensure for registration became standard
Nursing Research first published

1952

H. Peplaus Interpersonal Relations in Nursing

1954
1956

PhD program in nursing University of Pittsburg

Health Amendments Act passed funded graduate nursing education

1960-1966

Process of theory development (Abdella, Orlando, Henderson)

1967
1969

First symposium on theory development

First nursing theory conference

1972

NLN adopts requirements for conceptual framework for nursing curricula

1980s

Books written for nurses on how to critique theory, develop theory and apply
nursing theory

1990s

Philosophy and philosophy of science courses offered in doctoral programs

1999

Philosophy of Nursing first published

2000s

Books published describing, analyzing and discussing application of middle

range theory

CATEGORIES OF THEORY
BASED ON SCOPE OR LEVEL OF ABSTRACTION
1.Metatheory/ Philosophy/ Worldview
-

Philosophical or methodologic questions related to developing a theoretical base

for nursing Hickman (2002)

Deals with processes of generating knowledge and debating broad issues related
to the nature of theory Avant and Walker (2005)

1.Grand Theories
-

Composed of relatively abstract concepts that are not operationally defined and
attempt to reveal all aspects of human experience and response
Conceptual frameworks defining broad perspectives for practice and ways of
looking at nursing phenomena based on these perspectives.

2.Middle Range Theories

-

Limited in number and scope

Cover concepts such as pain, symptom management, cultural issues and health
promotion

3.Practice Theories
-

Explains prescriptions or modalities for practice

Its essence is a defined or identified goal and prescriptions for interventions or
activities to achieve the goal

BASED ON PURPOSE
1.Descriptive
-

Describe, observe and name concepts, properties and dimensions but they do not
explain the interrelationships among the concepts or propositions and they do not
indicate how changes in one concept affect other concepts
First and most important level of theory development Barnum (1998)

2.Explanatory Theories
-

Second level of theory development

Can be viewed in relation to other phenomena
Attempt to tell how or why the concepts are related and may deal with causality,
correlations and rules that regulate interactions

3.Predictive Theories
-

Describes precise relationships between concepts

Third level of theory development
Presuppose prior existence of the more elementary types of theories
Describes future outcomes consistently

4.Prescriptive Theories
-

Highest level of theory development

Prescribe activities necessary to reach definite goals

COMPONENTS OF A THEORY
1. Purpose

Explains why the theory was formulated and specifies the context and situation in
which it should be applied

2. Concepts and Conceptual Definitions

-Concepts are linguistic labels that are assigned to objects or events and are considered to be
the building blocks of theories
-Theoretical definition defines the concept in relation to other concepts and permits the
description and classification of phenomena
-Operationally defined concepts link the concept to the real world and identify empirical
referents of the concept that will permit observation and measurement

3.Theoretical Statements
-Also called propositions
-Statement about the relationship between two or more concepts and are used to connect
concepts to devise the theory.
Two Types:
a. Existence Statement- relate to specific concepts and make existence claims
about that concept; serve as adjuncts to relational statements and clarify
meaning in the theory; termed nonrelat
b. ional statements and may be right or wrong depending on the circumstance
c. Relational Statement only name and classify objects; may also be classified
as associational or causal relationship
3. Structure and Linkages
- By logical arrangement and specifying linkages of the theoretical concepts and
statements
- Determination of the order of appearance of relationships, identification of central
relationships and delineation of direction, strength and quality of relationships
4. Assumptions
- Notations that are taken to be true without proof
- Beliefs about a phenomenon that one must accept as true to accept a theory and
although they may not be empirically testable, they can be argues philosophically
5. Models
- Schematic representations of some aspect of reality
- Help illustrate the processes through which outcomes occur by specifying the
relationships among the variables in graphic form where they can be examined for
inconsistency, or errors.

REFERENCES:
1. Boorstin, Daniel J. (1983). The Discoverers: A History of Mans Search To Know His
World and Himself, Random House, Inc., 7, 398.
2. McEwen, Melanie & Wills, Evelyn M. (2007). Theoretical Basis for Nursing, Second
Edition, Lippincott Williams & Wilkins, 73-90, 186-190.
3. Mckenna, R. (2005). Nursing Theories and Models, Random House, Inc., 23-25.
4. Octaviano, Eufemia F. & Balita, Carl E. (2008). Theoretical Foundations of Nursing:
The Philippine Perspective, Ultimate Learning Series, 17, 139-150.
5. Sitzman, Kathleen L. & Eichelberger, Lisa W. (2010). Understanding the Work of
Nurse Theorists: A Creative Beginning, Jones and Bartlett Publishers,11-16, 85-89.
6. Kozier, Barbara, Erb, Glenora, Berman, Audrey, Snyder, S. (2004). Fundamentals of

Nursing: Concepts