EMERGENCE of CONCEPT,

THEORY AND MODELS in

NURSING

Presented by: LAIDEE CAMILLE B. ACACIO, R.N.

On the way to Theoretical Nursing:
Stages and Milestones

ROGERS (1970)
Offered a conception of nursing that focused on the constant human
interaction with the environment.

JOHNSON (1980)

Developed the notion that a human being- a biological system- is

also an abstract system of behavior centered on innate needs.

LEVINE (1967) & OREM (1971)

Proposed guidelines for nursing therapeutics that preserve the

integrity of the human being, the psychology, the community affiliation.

TOULMIN (1977)

Proposed that human behavior in general represents too broad a

domain to be encompassed within a single body of theory.

3 Themes in Nursing evolved:

Acceptance of the complexity of nursing and the inevitability
of multiple paradigms.
Acceptance of the need to test and corroborate major
propositions of differing theories before dismissing any of
them.
The idea that concepts or theories remaining in the field,
through a cumulative effect, become the basis of the
development of perspective.
Dualism and pluralism were the norms of this stage.
In this stage, nursing developed the boundaries to focus its
flexibility to allow expansion through creative endeavor.
 MILESTONES in THEORY DEVELOPMENT

Prior to 1955: From Florence Nightingale to Nursing Research

This period was otherwise uneventful for nursing theory, except

that the establishment of nursing research publications provided the
framework for a questioning attitude that has inquiries into theoretical
nursing.

Establishment of the journal, Nursing Research, with the goal of

reporting on scientific investigations for nursing by nurses.

1955-1960 The Birth of Nursing Theory: The Columbia University Teachers

College Approach

They offered graduate programs that focused on educational and

administration theories. Nurses are being prepared in the functional roles
and experiencing a sense of competency in preparing syllabi, staffing
patterns and so on.

1961-1965 Theory: A National Goal in Nursing

Nursing was considered a process rather than an end, an

interaction between unrelated nurse and patient.

Availability of time and resources was significant in providing the

necessary push and the environment to reflect on nursings mission and
goals.

American Nurses Association

Defined nursing and articulated the position that one of the most
significant goals of nursing was theory development.
 Thereby, supporting the need for an articulate theoretical mission to
guide the further development of nursing knowledge (ANA, 1965)

It was a confirmation that nursing is an evolving science with

theoretical principles and underpinnings.

2 Significant developments occurred in this stage

1. Federal support was provided to nurses wishing to pursue
doctoral education in one of the basic sciences.
2. The inauguration of the journal, NURSING SCIENCE, it was a
medium for exchange of ideas on theory and science in
nursing.

1966-1970 Theory Development: A Tangible Goal for Academics

Three symposia
1. Nursing Research
2. Definition of Nursing Theory
3. Theories used in conjunction

Nursing Research
Considered as perceptions and conceptions of theoretical nursing
from an isolated number of theorists.

Nursing Theory
It was defined, goals for theory development were set and
the confirmation of outsiders was productive.
Theories used in conjunction
It was used in conjunction with education and not in
practice.
Debates existed as to whether the theories should be basic
or borrowed, pure or applied, descriptive or prescriptive.

Accomplishments at this stage can be summarized as:

Nursing is a field amenable to theorizing.
Nurses can develop theories.
Practice is a rich area for theory.
Practice theory should be the goal for theory development
in nursing.
 Nurses highest theory goal should be prescriptive theory,
but it is all right to develop descriptive and explanatory
theories.

1971-1975 Theory Syntax

The emphasis of this period was on the components of
theory and the process of theory analysis and critque.
Education of nurses in basic, natural, and social sciences
through the federally supported nurse-scientist programs
produced who shared common goal.
Discussions of what constituted theory and identification of
theory syntax seemed to be the means in achieving the
goal.

American Nurses Association

Acknowledged the significance of theory development.

National League for Nursing

Made theory-based curriculum a requirement for accreditation. It
increased the use of theory and discussions about theory and prompted
more writing about the syntax of theory.

1976-1980 A Time to Reflect

This was the time for nurse academicians to utilize nursing theories
as guiding frameworks for curriculum.

Advances in Nursing Science

It focuses on the full range of activities involved in the development
of science.

Journal Theory & Theory Development

 To add support to the significance of theoretical nursing
and give nurses medium to present their ideas.
This period is characterized by questioning if nursings
progress would benefit from the single paradigm and a
single theory of truth.

1981-1985 Nursing Theories Revival:

Emergence of the Domain Concepts

This period is characterized by the nursing theory advocates who
pleaded for the use of nursing perspective in general or specific utilization
of nursing theory.

This period is characterized by a greater clarity in the relationship

between theory and research than theory and practice.

Advocates
Promote nursing theory and demonstrate its use in one research
project or in a limited practice arena.

Synthesizers
Limited use to describe and analyze how nursing theory may have
influenced nursing practice, education, research, and administration.

THEORY

Chinn and Jacobs, 1987:70

Is a set of concepts, definitions and propositions that project s
systematic view of phenomena by designating specific interrelationships
among concepts for the purpose of describing, explaining, predicting
and/or controlling phenomena.

Duldt and Griffin (1985:5)

 A system of interrelated propositions which should enable
phenomena to be described, explained, predicted and controlled.

Chinn and Kramer 1995: 20

A careful and rigorous structuring of ideas that project a tentative,
purposeful and systematic view of phenomena.

Barnum (1990: 16)

A theory is a statement that purports to account for or characterize
some phenomenon.

Types of Theory Definitions

Chinn and Jacobs (1983)
1. Definitions focusing on structure.
2. Definitions focusing on practice goals.
3. Definitions focusing on tentativeness.
4. Definitions focusing on reseach.

Meleis (1985)
1. Definitions focusing on multiple uses.
2. Definitions focusing on one or more of the specified domain
concepts.
3. Definitions focusing on any of the domain concepts and
health.

Theory
Logically interrelated sets of confirmed hypotheses.
A conceptual system invented for some purpose.
A statement that purports to account for the characterization
of some phenomenon.
A coherent set of hypothetical, conceptual, and pragmatic
principles forming a general frame of reference for a field of
inquiry.
Made up of concepts and propositions.
Phenomena with much greater specificity than do conceptual
models.
The metaparadigm phenomenon of person, environment,
health, and nursing by specifying relationships among
variables derived from these phenomena.
 Nursing Theory

Is defined as an articulated and communicated conceptualization of invented

or discovered reality in or pertaining to nursing care.

Examples of phenomena and relationships depicted in nursing theories are:

A nursing client is conceptualized as self-care agent.

A nursing client is biopsychological being.
A nursing client is a system with a number of behavioral
subsytems.

Concept

Meleis (1991: 12)

A label used to describe a phenomenon or a group of

phenomena.
A concept is a tool and not a real entity- it merely facilitates
observation of a real phenomenon.
It refers to the properties of a phenomenon; the concept is
not the phenomenon itself, rather it is a name one gives to a
phenomenon.
Concepts give meaning for filing purposes, enabling us to
categorize, interpret and structure the phenomenon.
Concepts are also the building blocks of theory, they convey
the ideas within the theory.

Fawcett and Downs (1992)

The concepts of a theory are its special vocabulary.

 Model

McFarlane, 1986a

A representation of reality.

Stockwell, 1985

A simplified way of organizing a complex phenomenon.

Fawcett,1992

Is a set of concepts and the assumptions that integrate them

into a meaningful configuration.

Rambo, 1984

Is a way of representing a situation in logical terms in order

to show the structure of the original idea or object.

McKenna, 1994b: 16

A diagrammatic representation of care which is

systematically constructed and which assists practitioners in
organizing their thinking about what they do in and in the
transfer of their thinking into practice for the benefit of the
client and the profession.

Chapman, 1985, used three dimensions to describe them.

One-dimensional models

1. Presented in one-dimensional format take the form of verbal

statements or philosophical beliefs about the phenomena.
2. It tends to be at a high level of abstraction. They cannot be
taken apart or explicitly observed, but they can be thought
about mentally manipulated.

Two-dimensional models
Includes diagrams, drawings, graphs or pictures.

Three-dimensional models
1. Refers to as physical models
2. These are scale models or structural replicas of things.
 Paradigm

Derives from the Greek word paradeigma, meaning pattern.

Fawcett, 1992:66

Maintains that a paradigm represents global ideas about the

individuals, groups, situations and events of interest to a
discipline.

4 Main Paradigms used in Nursing Theories

Systems paradigm
Is a collection of parts that function as a whole entity for a particular
purpose.

These interrelationships may form sub-systems within the parent

system.

Interactional Paradigm
It emphasizes the relationships between people and the roles they
play in society.

Developmental Paradigm
The central themes are growth, development, maturation and change.

Behavioral Paradigm
Assumes that individuals normally exist and survive by meeting their
won needs.

REFERENCES:

Theoretical Nursing Development and Progress 4th Edition, Afaf Ibratim Meleis RT 84.5
M482 2007

Nursing Theorist and Their Works 6th Edition, Ann Marriner Tomey; Martha Raie Alligood,
RT 84.5 N948 n 2006

Fundamentals of Nursing; Barbara Kozier

COMPARATIVE ANALYSIS OF
CONCEPT, THEORY AND
MODEL

PRESENTED BY:

JINKY RIVERA, RN
 DEFINITION OF TERMS

Assumptions statements supposed to be true without proof or

demonstration

Borrowed or shared Theory - a theory developed in another discipline

that is not adopted to the worldview and practice of nursing.

Conceptual model/ Framework- set of interrelated concepts that

symbolically represents and conveys a mental image of phenomenon.

Construct- comprised of more than one concept and typically constructed

by the theorist to fit a purpose. Concept is a more general term- all
constructs are concept but not all concept are constructs

Empirical Indicator - instructions, experimental conditions and

procedures used to observe/ measure the concepts of a theory.

Epistemology- theories of knowledge or how people come to have

knowledge.

Hypotheses - tentative suggestions that a specific relationship exist

between two concepts

Knowledge- awareness of reality acquired through insight, learning or

investigation.

Laws- proposition about the relationship between concepts in a theory that

has been repeatedly validated.

Metaparadigm- represents the worldview of a discipline. Nursings

metaparadigm is generally thought to consist of the concepts of person,
environment, health and nursing.

Paradigm- organizing framework that contains concepts, theories,

assumptions, beliefs, values and principles that form the way a discipline
interprets the subject matter with which it is concerned. It describes work
 to be done and frames an orientation within which the work will be
accomplished.

Praxis- application of a theory to cases encountered in experience

Model- graphic or symbolic representations of phenomena that present
certain perspectives or point of view about nature or function or both.
Models may be:
Theoretical- something not directly observable expressed in
language or symbol

Empirical- observable reality, example model of an eye

Phenomena- designation of an aspect of reality

Practice/ microtheory- discrete phenomena that are not expanded to

include their link with the boad concerns of a discipline.

OVERVIEW OF THEORY

Theory is a systematic explanation of event in which constructs and

concepts are identified and relationships are proposed and predictions
made.(Streubert- Speziale, 2006)

It is a creative and rigorous structuring of ideas that project a tentative,

purposeful and systematic view of phenomena. (Chinn and Kramer, 2008)

A set of interpretative assumptions, principles or propositions that help

explain or guide actions. ( Young, Taylor and Renpenning, 2001)

Theory is invented rather than found in or discovered from reality. (Dickoff

and James, 1968)

Offers structure and organization to nursing knowledge and provides a

systematic means of collecting data to describe, explain and predict
nursing practice.

Theories make nursing practice more overtly purposeful by stating not only
the focus of practice but specific goals and outcome.

Promotes rational and systematic practice by challenging and validating

intuition.

Theories define and clarify nursing and the purpose of nursing practice to
distinguished it from other caring professions by setting professional
boundaries
 Use of theory in nursing lead to coordinated and less fragmented care.

THEORY DEVELOPMENT IN NURSING

Florence nightingale

First modern nursing theorist

First to delineate what she considered nursings goal and practice domain

Postulated that to nurse meant having charge of the personal health of

someone

Believed that role of the nurse was seen as placing the client in the best
condition for nature to act upon him

Stressed the significance of trained powers of observation and reflection

Notes on Nursing, 1859

Notes on nursing, 1859

basic premises for nursing practice

In her view, nurses must make astute observations of the sick and
their environment, record observations and develop knowledge about
factors that promoted healing.

STAGES OF THEORY DEVELOPMENT

Silent Knowledge Stage

American Medical Association advocated the formal training of Nurses and

suggested that schools of Nursing be attached to hospitals with instructions
being provided by medical staff and resident physician.

Education practice were based on rules, principles, and traditions that were
passed along through an apprenticeship form of education.

By 1909 there were 1006 such programs, a meager amount of theory was
taught by physicians and practice was taught by experienced nurses.

Few nursing books were available and the emphasis was on carrying out
doctors order.
 Nursing education and practice focused on the performance of technical skills
and application of a few basic principles, such as aseptic technique and
principles of mobility

Largely adhered to the medical model which views body and mind separately
and focuses on cure and treatment of pathologic problems.

Hospital admin. view nurses as inexpensive labor.

Nurses were exploited. They were taught to be submissive and obedient and
they learned to fulfill their responsibilities to physicians without question.

This model of nursing education persisted for 80 years.

Yale University started the first autonomous school of nursing in 1924.

Professional training was strengthened by in depth exposure to underlying
theory of disease as well as the social, psychological and physical aspects of
client welfare.

the growth of collegiate programs lagged, however due to opposition from

many physicians who argued the university-educated nurses were over
trained.

Hospital schools continued to insist that nursing education meant acquisition

of technical skills and knowledge of theory was unnecessary and might
actually handicapped the nurse.

RECEIVED KNOWLEDGE STAGE

After World War II substantive changes were made in nursing education.

1948 report, Nursing for the Future, by Esther Brown, PhD, compared nursing
with teaching. She said that the current model of nursing education was
central to the problems of the profession and recommended that efforts be
made to focus nursing education in universities , with formal education, as
opposed to the apprenticeship system that existed in most hospital programs.

Professional org. for nurses were restructured and began to grow

State Licensure testing for registration took effect and by 1949, 41 states
required testing. The registration requirement necessitated that education
programs review the content matter they were teaching to determine
minimum criteria and some degree of uniformity.

In 1950, the journal Nursing Research was first published .

American Nurses Association began a program to encourage nurses to pursue

graduate education to study nursing functions and practice
 Books on research methods and explicit theories of nursing began to appear.

1856, the Health Amendments Act authorized funds for financial aid to
promote graduate education for full time study to prepare nurses for
administration, supervision and teaching. These resulted in slow but steady
increase in graduate nursing education programs.

First Doctoral programs in nursing Teachers College, Columbia University

(1933) and New York University ( 1934).

By 2007, there were 107 doctoral programs granting PhD OR DNS and 73
doctorate of nursing practice (DNP)

Graduate nursing education allowed nurse scholars to debate ideas that were
taken for granted in nursing and the traditional basis in which nursing was
practiced.

SUBJECTIVE KNOWLEDGE STAGE

James Dickoff, Patricia James and Ernestine Weidenbach described theory

development and the nature of theory for a practice discipline.

Approaches to Theory development combined direct observations of practice,

insights derived from existing theories and other literature sources and
insights derived from explicit philosophical perspectives about nursing and the
nature of health and human experience.

1960s a number of nurse leaders developed and published their views of

nursing. Their definition of nursing evolved from personal, professional and
educational experiences and reflect their perception of ideal nursing practice.

Theorist during this period:

PROCEDURAL KNOWLEDGE STAGE

By the 1970s, the nursing profession viewed itself as a scientific discipline

evolving toward a theoretically based practice focusing on the client.

Late 1960s and early 1970s, several nursing theory conferences were held.

1972- National League for Nursing implemented a requirement that nursing

curricula be based on conceptual frameworks.

Many nursing theorists published their beliefs and ideas in nursing and some
developed conceptual models.

1970s, a consensus developed among nursing leaders regarding common

elements of nursing. These were the nature of nursing (roles/ actions), the
individual recipient of care (client), the context of nurse-client interactions
(environment) and health.

Nurses debated whether there should be one conceptual model for nursing or
several models to describe the relationships among the nurse, client,
environment and health.

Graduate School developed courses on analysis and application of theory.

Researchers identified nursing theories as conceptual frameworks for their

studies.
 Late 1970s and early 1980s theories moved to characterizing nursings role
from what they do to what nursing is. This moved nursing from context-
dependent, reactive position to context independent, proactive arena.

CONSTRUCTE KNOWLEDGE STAGE

Late 1980s scholars began to concentrate on the need to develop substantive

theory that provides meaningful foundation for nursing practice.

A call to develop substance in theory and to focus on nursing concepts

grounded in practice and linked to research.

1990s and early 21st century saw an increasing emphasis on philosophy and
philosophy of science in nursing

Attention shifted from grand theories to middle range and practice or

situation specific theories as well as application of theory in research and
practice.

This is the current stage of theory development in nursing.

It is anticipated that the importance of application of middle range and

practice theories in research and practice will continue to be stressed.
Correspondingly, less attention will be given to grand theories and conceptual
frameworks.

CLASSIFICATION OF THEORIES IN NURSING

Classification Based in Scope

refers to complexity and degree of abstraction.

to describe philosophical basis of the discipline: Metatheory, Philosophy or

worldview

grand theory or macrotheory to describe the comprehensive conceptual

frameworks.

Middle range / midrange theory to describe frameworks that are relatively

more focused than grand theories

Microtheory, situation-specific theory or practiced theory to describe those

smallest in scope

1. METATHEORY
it refers to theory about theory
Focuses on broad issues such as the process of generating new
knowledge and theory development
Philosophical and methodological issues at the metatheory or
worldview level include:
identifying the purposes and kinds of theory needed for
nursing,
developing and analyzing methods for creating nursing theory
proposing criteria for evaluating theory.

Walker and Avant (2005) Historical Trends in Nursing Metatheory

1960s- discussions involve nursing as an academic discipline

and the relationship of nursing to basic sciences
Later discussions addressed the predominant philosophical
worldviews ( received vs perceived view) and methodological
issues related to research
Recent issues relate to the philosophy of nursing and address
what levels of theory development are needed to nursing
practice, research and education.

2. GRAND THEORIES
the most complex and broadest in scope
Explain broad areas within the discipline and may incorporate numerous
other theories
Macrotheory- used to describe a theory that is broadly conceptualized and
is usually applied to general area of specific discipline.
Comprised of relatively of abstract concepts that lack operational
definition
The majority of conceptual frameworks ( Orem, Roy, Rogers) are
considered to be grand theories. OREM, ROY, HALL, NEUMAN, KING
3. Middle Range Theories
lies within the nursing models and are more circumscribed, concrete ideas
(practice theories) PEPLAU,

Comprised of relatively concrete concepts that are operationally defined

and relatively concrete propositions that may be empirically tested.

Fawcett (2000) states that a middle theory may be

description of a particular phenomenon

Explanation of the relationship between phenomena
Prediction of effects of one phenomenon or another
Provide the basis for generating testable hypotheses related to particular
nursing phenomena and to particular client populations. Examples: social
support, quality of life and health promotion

4. Practice Theories
also called as microtheories, prescriptive theories or situation specific
theories and are the least complex

Produce specific directions for practice

Contain fewest concepts and refer to specific; easily defined phenomena,

narrow in scope, explain a small aspect of reality and tend to be prescriptive.

Limited to specific populations or fields of practice theories developed and

used by nurses are theories of infant bonding and oncology pain
management.
 5. Partial Theories
theories that are in the development stage

Some concepts have been identified, some relationships between them

have been identified but the theory is not complete

Keck (1998) states that theories derived from the social sciences, including
nursing, are probably exclusively partial theories because they are few, if
any, phenomena that have been totally and completely explained.

Comparison of the scope of nursing theories

TYPE OR PURPOSE OF THEORY

Factor-isolating theories

Describe, observe and name concepts, properties and dimensions

Descriptive theory identifies and describes the major concepts of

phenomena but does not explain how or why the concepts are related.
 Purpose: to provide observation and meaning regarding the
phenomena.

Generated and tested by descriptive research techniques including

concept analysis, case studies, literature review phenomenology,
ethnography and grounded theory.

EXAMPLES

Robles-Silva (2008)

used ethnography to construct a theory explaining the multiple phases that

caregivers experience while working with poor, chronically ill adults in Mexico.

Register and Herman (2008)

Used comprehensive literature review to develop a middle range theory for

generative quality of life for elders

Factor-Relating theories

also known as Explanatory Theories, are those that relate concepts to

one another, describe the interrelationships among concepts or
propositions and specify the associations or relationships among some
concepts.

how or why the concepts are related and may deal with cause and
effect and correlations and rules that regulate interactions.

Developed by Correlational Research

EXAMPLES

Hastings-Tolsma, 2006

proposed Theory of Diversity of Human Field Pattern. It was developed from

descriptive corelational study that examined the relationships between risk-
taking behavior and time movement, within the context of energy flow and
field patterns.

Haight, Barba, Tesh & Courts, 2002

Thriving Model, which builds in previous work related to failure to thrive in

elders by defining the constructs thriving and failure to thrive.
 SITUATION-Relating theories

Also known as Predictive Theories

achieved when the conditions under which concepts are related are
stated and the relational statements are able to describe future
outcomes consistently.

Move to prediction of precise relationships between concepts

Experimental Research is used to generate and test them

EXAMPLES

Auvil- Noval 1997

presented the development of middle range theory of chronotherapeutic

intervention for post surgical pain based on three experimental studies of pain
relief among postsurgical clients. The theory uses a time-dependent approach
of pain assessment and provides directed nursing interventions to address
postoperative pain.

ISSUES IN THEORY DEVELOPMENT IN NURSING

Borrowed vs. unique theory

Opponents of Using Borrowed Theory Proponents of Using Borrowed Theory

only theories that are grounded in knowledge belongs to the scientific

nursing should guide the actions of the community and to society at large and it
discipline is not the property of individuals or
disciplines.
They believe borrowing requires returning
and that the theory is not in essence knowledge is not a private domain of one
nursing if concepts are borrowed discipline and the use of knowledge
generated by other discipline is not
borrowed but shared.

NURSINGS METAPARADIGM

Metaparadigm is the global perspective of a discipline that identifies the

primary phenomena of interest to that discipline and explains how the
discipline deals with those phenomena in a unique manner.
 Purpose: to summarize the intellectual and social missions of the discipline
and place boundaries on the subject matter of that discipline.

Requirements for a metaparadigm (Fawcett and Malinski, 1996)

Must identify a domain that is distinctive from the domain of

other disciplines

Must encompass all phenomena of interest to the discipline in

a parsimonious manner

Must be perspective-neutral

Must be international in scope and substance

1970s and early 1980s- growing consensus that the dominant phenomena
within the science of nursing revolved around the concepts of man
(person) , health, environment and nursing

Wagner (1986)

Examined the nursing metaparadigm in depth. Her sample of 160 doctorate-

prepared chairpersons, deans or directors of programs for bachelors of science in
nursing revealed that between 94% and 98% of the respondents agreed that the
concepts that comprise the nursing metaparadigm are person, health, nursing and
environment. She concluded that this findings indicated a consensus within the
discipline of nursing that these are the dominant phenomena within the science.

Person

refers to a being composed of physical, intellectual, biochemical

psychosocial needs; a human energy field; a holistic being in
the world; an open system; an integrated whole; an adaptive
system; a being who is greater than the sum of his parts
Health

ability to function independently; successful adaptation to lifes

stressors ; achievement of ones full life potential; and unity of
mind, body and soul.
Environment

the external elements that affect the person; internal and

external conditions that influence the organisms; significant
others with whom the person interacts and an open system
with boundaries that permit the exchange of matter, energy
and information with human beings
Nursing

is a science, an art and a practice of discipline and involves

caring.
 Goals: Care of the well, the sick, assisting with self-care

activities, helping individuals attain their human potential and
discovering and using natures law of health.
Kim (1987, 1989)

Identified four domains (client, client-nurse, practice and environment)

as an organizing framework or typology of nursing. The most significant
difference appears to be in placing health issues (i.e. health care expenses)
within the client domain and differentiating the nursing practice domain from
the client-nurse domain.

Meleis, 2005

Maintained that nursing encompasses seven central concepts:

interaction, nursing client, transitions, nursing process, environment, nursing
therapeutics and health. Addition of the concepts of interaction, transition
and nursing process denotes the greatest difference between this framework
and the more commonly described person/ health/ environment/ nursing
framework.

Concept of caring in nursing

Caring as the essence of nursing

Thorne and Colleagues cited three major areas of contention in the debate
about caring in nursing.

Diverse views on the nature of caring

Use of caring terminology to conceptualize a specialize role

Implication for the future development of the profession should

nursing espouse caring as its unique mandate

Fawcett and Maliniski (1996)

Argued that although caring is included in several conceptualizations of

the discipline of nursing, it is not a dominant term in every conceptualizations of the
discipline-wide viewpoint. Furthermore caring is not uniquely a nursing phenomenon
and caring behaviors may not be generalizable across national and cultural
boundaries.
 CONCEPT DEVELOPMENT

Abstract term derived from particular attributes.

A symbolic statement describing a phenomenon or a class of phenomena.

Formulated in words that enable people to communicate their meanings about

realities in the world and give meaning to phenomena that can directly or
indirectly be seen, tasted, smelled or touch.

Compared to bricks in a wall that lend structure to science

ABSTRACT VERSUS CONCRETE CONCEPTS

Concept Characteristics Examples

Enumerative concepts Are always present and universal Age, height, weight

Associative concepts Exist only in some conditions within Income, presence of disease,
a phenomenon; may have a zero anxiety
value

Relational concepts Can be understood only through Elderly (must combine concepts of
the combination or interaction of age and longevity)
two or more enumerative or
associative concepts Mother (must combine man,
woman, and birth)

Statistical concepts Relate the property of one Average blood pressure

thing in terms of its distribution HIV/AIDS prevalence rate
in the population rate

Summative concepts Represent an entire complex Nursing, health, and

entity of a phenomenon; are environment
complex and not measurable
DISCRETE VERSUS CONTINUOUS

THEORETICALLY VS. OPERATIONALLY DEFINED CONCEPTS

EXAMPLE: THE CONCEPT OF COPING

Vinson J. A. (2002)

Children with Asthma : Initial Developing of the Child Resilience Model

Theoretical Definition: Cognitive and behavioral efforts to manage specific external

and/ or internal demands that are appraised as taxing and exceeding the resources
of the person

Operational Definition: Score on the Coping Health Inventory for Children

SOURCES OF CONCEPTS
Concept Source Characteristics Examples from Nursing
Literature
Naturalistic Present in nursing May be defined and Body weight, pain,
concepts practice developed for use in thermoregulation,
research and theory depression, hematologic
development. Often complications, circadian
have medical dysregulation
implications as well as
nursing use

Research- Developed through a Often relate to a Hope, grief, cultural

based concepts qualitative research nursing specialty competence, chronic pain
processes (i.e.,
grounded theory or
existential
phenomenology)

Existing Borrowed from otherDeveloped for nursingJob satisfaction, quality of

concepts disciplines practice, but are usefullife, abuse, adaptation,
in research and theory stress

CONCEPT ANALYSIS AND DEVELOPMENT

Process of inquiry that examines concept for their level of development as

revealed by their internal structure, use, representativeness and relationship
to other concepts.

Explores the meaning of concepts to promote understanding

PURPOSES OF CONCEPT DEVELOPMENT

Clarifying, recognizing and defining concepts that describe phenomena

Identifying gaps in nursing knowledge

Determine the need to refine and clarify a concept when it appears to have
multiple meanings

Evaluating the adequacy of competing concepts in their relation to other

phenomena

Examining the congruence between the definition of the concept and the way
it has been operationalized

Determining the fit between the definition of the concept and its clinical
application.
CONTEXT FOR CONCEPT DEVELOPMENT

Example: before we had a concept labeled burnout, we did not see burnout never
though the syndrome may have existed in one form or another. Because we do not
have a label to give to that constellation of behaviors; we did not have a reservoir in
which we could connect and deposit those seemingly discrete feelings and responses
of apathy, irritability, impatience and the urge to flee and change ones life.
Therefore, describing the varied behaviors and actions related to them may have
been limited and somewhat ineffective.

CONCEPT DEVELOPMENT AND RESEARCH

STRATEGIES USED IN NURSING LITERATURE FOR

ANALYZING CONCEPTS
Wilson Method of Concept Analysis

1. Identify and isolate the questions of the concept

Facts - answered by existing knowledge about the concept

Values- answered based on moral principles of should and should

nots

Meanings- best considered in terms of concepts

2. Consider the possible answers to the questions and identify the essential elements
of these questions

3. Identify and describe exemplars to reflect the different critical and essential
characteristics of the concept.

4. . Identify contrary cases, that is, those exemplars that do not include any of the
properties of the concept.

5. Identify describe and use some related cases in which the concept may be
connected or similar in some way or as it occurs in similar texts.

6. Provide borderline cases as exemplars

7. Develop and present invented cases

8. Identify and define the social contexts and analyze concepts as to who may use it,
why it may be used and how it could be used.

9. Beware of underlying anxiety related to concepts or generated by the concepts.

10. Define and explain the potential practical results related to the concept.

11. Choose the language for describing the results and the label carefully.

WALKER AND AVANT METHOD OF CONCEPT ANALYSIS

1. Concept Analysis

It is an approach to clarify the meanings of terms and to define

terms so that writers and readers share a common language.

Conducted when concepts require classification or further development

to define them for a nurse scholars purposes, whether that is
research, theory development or practice

Steps in Concept Analysis

Step 1: select the concept of interest

A concept may be selected which originates from an intuitive feeling or an

area of concern. The best concept analyses tend to have their roots in clinical
phenomena. This helps to bridge the theory practice gap in that the end
result has more credibility and relevance for practice. The concept can also
lead to the development of theory which can be more easily used and tested
in practice.

Meleis (1991) suggest that while giving care a practitioners attention may
be attracted to a particular phenomenon. She refers to this as attention
grabbing and states that can occur concurrently during the care episode or
retrospectively when the nurse is reflecting about the care given. The
attention-grabbing phase is followed by the attention-giving phase. This
is a more active and deliberate process. Answers to the following attention-
giving questions may help to clarify the hunch that the nurse has about the
phenomenon of interest.

Example. The nurse may ask; why do patients get angry with their
spouse during visiting time?, or what is it happens when patients
decide not to attend a clinic?, or what are the properties of pre-operative
anxiety?

Meleis urges the nurse to persist with probing questions:

How is the phenomenon related to nursings body of

knowledge?
Would understanding the phenomenon contribute to better
understanding of a patient care issue?
How would questions relating to the phenomenon be significant
for nursing?

Once these questions have been answered, the nurse labels the phenomenon
with a word or a short phrase. Labels should be precise, used consistently
when referring to phenomenon, contain one cardinal idea and be
fundamental to the definition/description of the phenomenon (Meleis, 1991).

Example: In your everyday clinical work, you may notice that ward
sisters are able to predict client mishaps before they occur and without
knowing precisely how they are able to do this. The concept intuition is
the term you should select to describe this phenomenon.

From other clinical experiences you may also be interested in clarifying what
the concepts loss, loneliness, compassion or spirituality really mean.

Moody (1990) suggest that it may be helpful to categorize the concept

requiring analysis within the metaparadigm. For instance, the concept well-
being maybe subsumed under health; identity or body image under
person; caring or empathy under nursing; and energy field under
environment.
 avoid broad concepts: if you were to select communications as a concept
you would find it extremely difficult to identify manageable indicators which
are representative of this concept.

Step 2: define the aims of the analysis

Step 2 should provide a good rationale as to why you are undertaking the
process at all.
may provide a research-based justification for selecting a particular concept.
Government reports and health care strategies may highlight old
concepts being used in new ways (quality of care) or new concepts being
used to denote old ideas (nursing diagnosis).
It is recommended that a short rationale is constructed to justify why a
particular concepts should be analyzed.
In most cases, the prime purpose for undertaking an analysis is to elucidate
and to create conceptual meaning for a clinical phenomenon. For instance,
the term caring is often used in many confusing ways, and an analysis of
this concept would tell you what it is and what it is not.
Step 2 will set the parameters for later steps in process.
For instance, if the purpose was to investigate fear or hopelessness among
coronary care patients then this will guide you towards those indicators and
attributes identified as an aid to recognizing and investigating these
concepts.

Step 3: identify meaning of the concepts

This step involves trawling the literature to find as many pertinent meanings
of the concept as possible.
The search will provide a range of different ways in which the concept is
thought about and used.
Walker and Avant (1995) suggest that you should cast your net as wide as
possible in seeking meanings for the concepts.
Rodgers (1994) also recommends sampling a range of uses, stating that
this increases the rigor of the analysis.

Example: If the concept was caring, you will note that it could be
perceived as a noun or an adjective, whereas care could be a verb.
Care could also mean caution or attention or protection. It is a good
idea to keep searching until you reach the stage of `diminishing
returns, where no new meanings are being uncovered. Dictionaries
will give you information on the Latin or Greek origins of the concept
of the interest. Thesauri will provide you with a range of similar
concepts. However, definitions are often unclear and ambiguous, so
simply providing a list of definitions of a concept should not be
construed as undertaking an analysis.
It is also recommended that you examine what theorist or researchers have
said about the concept. You do not have to confine your search to nursing,
but may include all those who have attempted to use the concept within their
theory or study.
 There are other sources that may give an insight into the use of the concept.
These include professional, popular, classical and philosophical literature,
poetry, books of quotations, music, paintings, cartoons and photographs.

Example: The film Philadelphia may be an excellent source of

information on the concept `loss, Schindlers list may provide a
unique view of the concept `sorrow; and The Silence of the Lambs
may give a different perspective on the concept `fear.

it must be remembered that the objective is to uncover meaning, not to

describe, explain or predict relationships between the concept of interest and
other similar or dissimilar concepts.

Step 4: determine the defining attributes

the defining attributes distinguish the concept (as envisaged in Step2) from
similar or related concepts.
By isolating the defining attributes, the `semantic space that the concept
shares with similar concepts is reduced (Moody, 1990).
For each concept there may be a list of several defining attributes, but extra
superfluous defining attributes should not be added just because the list
appears too short. It is better to have three or four defining attributes that
really characterize the concept well, than to have many that are only
tangentially related to the concept.

Example: A defining attribute of caring may be `providing for
another, a defining attribute for empathy may be demonstrating
concern, and defining attribute for attachment may be `visual
contact.

Kim (1983) argues that when nurses are undertaking conceptual analysis
they should ensure that the defining attributes are examined for their degree
of consistency with nursings perspective. She argues that such an approach
will help focus the analysis on the phenomena of specific concern to the
discipline.
The defining attributes play a key role in differentiating the concept being
analyzed from dissimilar concepts.
Moody (1990) calls this `test for necessity, where failure to pass means
that more work has to be done to identify the defining attributes.
The test of sufficiency should also be applied. Here, the entire list of defining
attributes is considered and, if a contrary case can be identified that meets
all the attributes, then an essential attribute has been omitted.
Moody (1990) gives the example of an analysis of a right-angled triangle
(a concrete concept). She identified the following thee defining attributes:

1. Two-dimensional geometric figure;

2. Composed of three sides;
3. The sum of the internal angles equals 180 degrees

Since Attribute 1 could be applied to any geometric figure, the test of

necessity indicates that it is not necessary attribute for defining a right-
 angled triangle: this attribute can be removed from the list. The other two
attributes pass the `test of necessity.Applying the `test of sufficiency to the
remaining two attributes it is noted that other types of triangle meet this
criteria (e.g., an equilateral triangle). It is obvious that some key attributes
which differentiate this concept from other similar concepts are missing.
Clearly, attributes indicating that one of the angles must be 90 degrees and
the other two angles must be 45 degrees each should be included as defining
attributes. While the test of necessity and sufficiency help in the identification
of defining attributes, it must be remembered that the concepts of interest to
nurses are not concrete as right-angled triangles.

Therefore, the identification of defining attributes is an inexact science, but it

is valuable in that it does yield important information for the clarification of
concepts for clinical and research purposes.

McCance (1996) undertook a concept analysis of caring. From a wealth of

literature (Step 3 above) she identified the following defining attributes of
caring:

Serious attention
Concern
Providing for
Regard, respect, or linking

Step 5: identify a model case

A model case is a pure example of the concept being use and should include
all defining attributes. It may be written in one or two paragraphs indicating a
hypothetical case, an extract from literature illustrating a real-life event or,
preferably, a clinical example that accurately describes the concept.
Rodgers (1994) argues that by providing a real-life example that includes
defining attributes, a model case enhances the degree of clarification and
credibility of the concept.
A rule of thumb is that there must be no contradictions between the model
case and the defining attributes. In other words, a model case must include
all defining attributes.
McCance (1996) presented the model case to illustrate the concept
`caring:

Case model: caring

Mr Cook was in the terminal stages of congestive heart failure. He had two
myocardial infarctions. He was alone, his family were out of town. We knew
he wasnt doing well . . . When I touched his hand and introduced myself . . .
he squeezed my hand and began to talk . . . I sat on his bed, and he reached
out and held my hand. He talked to me about his life, about his family, the
things he wanted to do but wasnt able to . . . I ignored everything else that
was going on in the unit at that time: and it was busy. I pulled the curtains
around one side of the bed because there was some activity coming from that
side. I just sat and listened as he spoke.
(Ford, 1990: 160, cited in McCance, 1996)
 Each of the four defining attributes identified by McCance above were
included in this model case.

Step 6: identify alternative cases

Alternative cases are identified to provide examples of what is not the

concept.
To do this often helps clarify with certainty what is the concept.
Alternative cases includes:

Contrary cases,
Related cases,
Borderline cases,
Invented cases and
Illegitimate cases.

Contrary case
This case represents what is not the concept being analyzed.
When examining the concept of `caring, a contrary case would be an
example of an interaction where a nurse was consciously harming a client.
With some of the more nebulous concept in nursing, a contrary case may be
easier to identify than a model case and may subsequently help in the
identification of a model case.
McCance (1996) presents the contrary case shown in Box 3.2 in her analysis
of caring.
It is description of a nurse given by a patient with lupus
erythematosis.

Contrary case: caring

She was always in hurry, she didnt have time to talk or even she had time
she didnt really seem to want to talk. Her body languages let me know she
wasnt interested in what I had to say. All she was here to do was to perform
her duty and go home. She stood at a distance, she didnt even come close.
She made me feel I have some kind of illness and it may rub off on her. When
I was talking to her she wouldnt look at me directly. When I ask her a
question she would be snappy even on defensive side. She wasnt
interested in the person as a whole. She would cut me off short and she
talked in such a rush. She never would say when shed be back. I was not at
ease. I was uncomfortable. I became depressed by not being able to talk. I
felt I had to keep my mouth shut.

The nurse in the above case shows no concern, provides no help or comfort to
the patient, is in no way present or attentive and makes no attempt to get to
know this patient and what is important to them .
 Within McCances analysis, the defining attributes are missing here, this is a
clear example of what caring is not.

Related case
In a related case all the defining attribute are missing but the concept
is still seen as similar in meaning to the concept being analyzed.
Related cases may represent concepts that are often confused with the
concept under study.
For instance, innovation is sometimes misconstrued with change, the
concept `stress with burnout, fear with anxiety, adaptation with
coping, and the concept comfort is often confused with care.
Using these concepts as related cases demonstrates examples that
are similar to the concept of interest but differ from it when you
examine them closely.

Borderline case
This example is very similar to a model case but some of the defining
attributes are missing.
This inclusion of some of the defining attributes in a borderline case
also differentiates it from a related case.
Identifying borderline cases helps to clarify the attributes which are an
essential perquisite of the model case and helps to reduce the blurring
of the boundaries between cases.
Meleis (1991) recommends what she calls analogising. Here the
concept is compared to similar concepts which have been reached well
and studied more extensively so that the examination of the better
understood concept may shed more light on what the new concept is.
Box 3.3 Borderline case: caring

Jim Smith was forty-five years old when i met him...he was admitted to the
cardiopulmonary unit where I was working. The patient had an eight-hour
history of slurred speech and blurred vision. The symptoms had cleared up
prior to his admission and he was now admitted for a diagnostic workup...He
was worked for transitory ischemic arterial spasm. Four days later he went
home with a negative work up. Two days after he was readmitted after having
a seizure at home, I was on holiday the time, and by the time I had returned
he had a diagnosis of metatistic lung cancer.

I do not how he responded to the initial diagnosis when I returned; I didnt

go to see him for a couple of days. I was really frightened about seeing him
because I did not know what to say or do. He made it easy for me, and I did
begin working with him again, concentrating on teaching him about
chemotherapy and radiotherapy. I felt I was teaching him a lot, but actually
he taught me. One day he said to me, you are doing OK job Mary, but i can
tell that every time you walk in that door are walking out.

He was right. He had developed so much meaning in his illness and life that i
was relating to. This man had really expanded the context of his life into
areas where I could have been effective, had I had some understanding.
(Benner and Wrubel,1989: 16, cited in McCance, 1996)
 McCance (1996) presents the example of a borderline case of caring
in It can be seen that two of the defining attributes identified by
McCance above are missing from this case.
Defining attributes serious attention and regard for are missing in
this case while providing for and concern are present.

Invented case
This refers to a case that takes the concept out of its normal context
and places it in an invented, out-of-the-ordinary situation.
For instance, subterranean humanoids for aging in the pit of a volcano
gathering sustaining food for their offspring may be an example of the
concept caring.
According to Moody (1990), invented cases are particularly useful
when a concept describes an unfamiliar phenomenon or when clarity is
needed for a familiar concept whose existence is often overlooked
under normal circumstances.
The analyst may also identify an invented alternative case, in other
words, an invented case that is not caring.

Illegitimate Case
This type of case is a real-life example of the concept being used
inappropriately for the purpose of the analysis.
For example, if the concept being analysed was attachment, an
illegitimate case could be an attachment for a portable drill or saw.
Similarly, if the concept was curing, an illegitimate case may involve
a butcher curing bacon.

Step 7: Identify Antecedents and Consequences

This type is useful in that it gives an indication of the purpose of the

analysis and the clinical arena in which the concept is normally used.
Antecedents are those events that precede the occurrence of the
concept. Antecedents is not synonymous with causality.
An antecedent may contribute to the occurrence of the concept, it may
be associated with its occurrence or it may need to be present for the
concept to be present.
Walker and Avant (1995) maintain that something cannot be
antecedent and a defining attribute at the same time.
McCance (1996) identified the following antecedents of caring: a
respect for persons, an amount of time and the intention to care.
You can see that respect for persons could be confused as a defining
attribute for caring. However, in order to be a defining attribute it
would have to be respect for the person(s) being cared for rather than
respect for persons in general.
Consequences are those events or outcomes that happen after the
occurrence of the concept.
 If the concept was anxiety, an antecedent may be bad news or a
request to go to the chief executives office. Consequences of anxiety
may be physiological changes and avoidance behaviour. Once more,
care must be taken that the consequences are not seen as defining
attributes for the concept.
Well being, both physical and mental, was seen as one of the
consequences of caring as analysed by McCance (1996).

Step 8: Identify Empirical Indicators

These are explicit referents for measuring or appraising the existence of the
concept.
This step is often referred to as the operationalization of a concept.
In other words, armed with these indicators, it would be possible to see
beyond a shadow of a doubt if the concept was present.
In some cases, the empirical indicators will be the same as the defining
attributes identified in step 4 above. However, according to Walker and
Avant (1995) sometimes the concept is so abstract that the defining
attributes are also abstract, and therefore would not make good empirical
indicators.
For instance, a defining attribute for care would be providing for, while an
empirical indicator for care may be actually physically interacting with
someone.
Such indicators are useful in research and practice because they can provide
criteria by which a concept can be measured.
Chin and Kramer (1995), for instance, analysed mothering.
They identified several empirical indicators two of which are:
The persons who receive mothering must be physically touched
by the mothering person;
Some positive feeling must be experienced by the mothering
person and by the person who receives the mothering.

2. Concept Synthesis
used when concepts require development based on observation or
other forms of evidence
Methods of synthesizing concepts:
Qualitative Synthesis sensory data
Quantitative Synthesis- numerical data
Literary Synthesis review of literature

3. Concept Derivation
Necessary when there are few concepts currently available to a
nurse that explain a problem area
When a comparison or analogy can be made between one field or
area that is conceptually defined and another that is not
 Helpful in generating new ways of thinking about a phenomenon of
interest.

Steps in Concept Derivation

Become thoroughly familiar with the existing literature
Search other fields of interest for new ways of viewing
the topic
Search a parent concept that gives an insightful view of
topic
Redefine the concepts in terms of the topic of interest

RODGERS METHOD OF CONCEPT ANALYSIS,1989

Concept analysis is necessary because concepts are dynamic , it must be

continually refined and variations introduced to achieve a clearer and more
useful meaning.

Steps:

1. Identify the concept and associated terms

2. Select an appropriate realm (a setting or a sample) for a data

collection

3. Collect data to identify the attributes of the concept and the contextual
basis of the concept

4. Analyze the data regarding the characteristics of the concept

5. Identify an exemplar of the concept, if appropriate

6. Identify hypotheses and implications for further development.

The Hybrid Strategy by Schwartz-Barcott and Kim

Phase Activities

Theoretical phase Select a concept

Review the literature
Determining meaning and measurement
Choose a working definition
Fieldwork phase Set the stage
Negotiate entry into a setting
Select cases
Collect and analyze data
 Final analytical phase Weight findings
Write report

Example: Review of Withdrawal by Schwartz-Barcott,

They began with the review of pervasiveness of the concept in nursing

and discovered that it is relatively underdeveloped. They then defined the concept as
flight response that is used as defense to an actual or anticipated threat. They
described it in terms of biological adaptation an instinctive physical response.

Then they discussed how it is measured in research through a

literature review. Subsequently, they observed it clinically, developed a set of key
questions related to observations, developed case studies to reflect the different
responses and validated earlier notions about withdrawal . It is through this process
that common factors were identified to describe and refine withdrawal.

MELEIS STRATEGY OF CONCEPT DEVELOPMENT, 2007

1. Concept Exploration

Used when concepts are new and ambiguous in a discipline or when a

concept from another discipline is being redesigned for use in nursing.

Steps in Concept Exploration

1. Identifying the major components and dimensions of the

concept

2. Raising appropriate questions about the concept

3. Proposing triggers for continuing the exploration

4. Identifying and defining the advantages to the discipline of

continuing the exploration of the concept.

2. Concept Clarification
Is used to refine concepts that have been used in nursing without a clear,
shared, and conscious agreement on the properties of meanings attributed
to the concept.
It is a way to refine existing concepts when they lack clarity for a specific
nursing endeavor.

3. Concept Analysis
 This process implies that the concept will be broken down to its essentials
and then reconstructed for its contribution to the nursing lexicon.

The goal of the analysis is to bring the concept close to use in research or
clinical practice and to ultimately contribute to instrument development
and theory testing.

Focused on an integrated approach to concept development, which

includes defining, differentiating, delineating antecedents, and
consequences, modeling, and analogizing, and synthesizing.

Process Task or Activity

Defining Creating theoretical and operational definitions that clarify

ambiguities, enhance precision, and relate concepts to empirical
referents

Differentiating Sorting in and out similarities and differences between the

concept being developed and other like concepts

Delineating Defining the contextual conditions under which the concept is

antecedents perceived and expected to occur

Delineating Defining events, situations, or conditions that may result from

consequences the concept

Modeling Defining and identifying exemplars (i.e., clinical referents or

research referents) to illustrate some aspect of the concept.
Models may be same or like models, or contrary models
Analogizing Describing the concept through another concept or phenomenon
that is similar and has been studied more extensively
Synthesizing Bringing together findings, meanings, and properties that have
been discovered and describing future steps in theorizing

MORSE STRATEGY OF CONCEPT DEVELOPMENT, 1995

Advance Techniques of Concept Analysis

1. Concept Delineation

Is a strategy that requires an extensive literature search and assists in

separating two terms that seem closely linked

Concepts compared and contrasted to identify commonalities, similarities, and

differences
2. Concept Comparison

It clarifies competing concepts, again using a extensive literature review and

keeping the literature for each concept separate.

Phases in comparison are:

o Preconditions - the status of the concept in nursing and its use in

teaching or clinical practice

o Process- the type of nursing response to the concept, at what level of

consciousness it occurs, and, if it is identified with the client, at what
level

o Outcomes - whether the concept was used to identify process or

product, its accuracy in prediction, the clients condition, and the
clients experience with the concept

3. Concept Clarification

Is used with concepts that are mature and have a large body of literature
identifying and using them.

It requires a literature review to identify the underlying values and to

identify, describe and compare and contrast the attributes of each

Examples:

o Olson and Morse (2005) delineated the concept of fatigue using a

system of analytic questions;

o Whitehead (2004) used Morses method to analyze health promotion

and health education;

o Fanacht (2003) used Morse method to refine the concept of creativity;

PENROD AND HUPCEY STRATEGY OF CONCEPT DEVELOPMENT, 2005

They termed their method principle- based concept analysis explaining the
intent to determine and evaluate the state of science surrounding the
concept and produce evidence that reveals scholars best estimate of
probable truth in the scientific literature(2005)\

Four principles for their method are: epistemological, pragmatic, linguistic,

and logical
 Findings are summarized as a theoretical definition that integrates an
evaluative summary of each of the criteria posed by the four over- reaching
principles. Researchers consider three issues:

Selection of appropriate disciplinary literature for review

assurance of the adequacy and appropriateness of the sample derived

from the literature, and

employment of within- and across- discipline analytic techniques

Four Principles of Concept Analysis

Epistemological Is the concept clearly defined and well differentiated

principle from other concepts?

Pragmatic principle Is the concept applicable and useful within the scientific
realm or inquiry? Has it been operationalized?

In this principle they believe that an operationalized

concept has achieved a level of maturity

Epistemological Is the concept clearly defined and well differentiated

principle from other concepts?

Pragmatic principle Is the concept applicable and useful within the scientific
realm or inquiry? Has it been operationalized?
In this principle they believe that an operationalized
concept has achieved a level of maturity

CONCEPT ANALYSIS EXEMPLAR USING RODGERS

EVOLUTIONARY METHOD

1. Identify the concept and associated terms

Concept: Chronic pain 9noncacerous pain in adults)

Associated terms: Chronic pain, persistent pain. Intractable pain, and continuous
pain

2. Select an appropriate realm (setting) for data collection

 The realm for study was nursing, psychology, and neurophysiology
professional journal publications between the year 1969 and 1999. Included were
case studies, qualitative and quantitative studies, review articles, and meta-
analysis.

3. Identify the attributes of the concept and the contextual basis of the
concept

Attributes of chronic pain: Their primary dimensions (physical, behavioral,

and psychological)

Physical dimension is characterized by quantity, intensity (level or severity),

and neurological transmission. And anatomic patterns and chronic pain

Behavioral dimension is characterized by expressive, movement, and

functional behaviors.

Psychological dimension is characterized by effective and evaluative

components.

4. Specify the characteristic of the concept

Characteristic of the chronic pain include:

Relative language (e.g.; ache) and modifiers (e.g.; annoying or

dull)

Behaviors:

Expressive behaviors (moaning and use of pain words);

Movement behaviors (grimacing, massaging, protective

movements, rhythmic movements);

Functional behaviors (used of socially defined sick-role

behaviors such as decreased mobility, inactivity, and bed rest

Time dimensions: include onset and frequency or rhythm of pain episodes.

Antecedents: no specific or physical psychological characteristics were noted that

were antecedents of chronic pain. Although trauma sometimes precedes chronic
pain, trauma is not necessary or sufficient to cause chronic pain. Chronic pain may
be related to alterations in the production and regulation of cortisol, serotonin, and
endogenous opioids and in the synthesis and release of sensory neuropeptides.

Consequences: two themes:

living with chronic pain results in alterations of psychological life patterns

including depression, anger, anxiety, grief, hopelessness, and
 helplessness, social pattern alterations may result in isolation and
loneliness; loss of work, and loss of insurance and money to pay for
medical expenses.

Coping with chronic pain-effective coping-decreases the adverse effects of

chronic pain by reducing stress and thereby pain intensity. Strategies
include distraction, meditation, positive thinking, counseling, and use of
alternative treatments (e.g.; acupuncture, massage, herbal medications,
meditation, and imagery)

5. Identify an exemplar of the concept

Chronic pain is a subjective, multidimensional, bio/psychological syndrome

that can be recognized by physical, psychological, and behavioral
patterns. It results in physical, psychological, and social alterations of
function to varying degrees. There is no known purpose and there is no
single explanation of the symptoms.

6. Identify hypotheses and implications for development

Research is needed to understand the relationship between intensity, quality,

and duration of pain, and central nervous system function.

Research is needed to explore body-brain-mind interactions in the

development, persistent, and, consequences of chronic pain.

Research is needed to identify the subjective symptoms that may differentiate

chronic pain from acute pain. If early symptoms can be identified, studies can
be conducted to determine interventions that may stop the development of
chronic pain.
 THEORY DEVELOPMENT

OVERVIEW OF THEORY DEVELOPMENT

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

complex, time- consuming process that covers a number of stages or phases

from inception of concepts to testing theoretical propositions through research

the process of theory development begins with one or more concepts that are
derived from within a disciplines metatheory or philosophy. These concepts
are further refined and relate to one another in propositions or statements
that can be submitted to empirical testing

CATEGORIZATIONS OF THEORY
 CATEGORIZATION BASED ON SOURCE OR DISCIPLINE

Shared Theory Used in Nursing practice and Research

Disciplines Examples of Theories Used by Nurses

Theories from sociological sciences Family systems theory

Feminist theory
Role theory
Critical social theory

Theories from behavioral sciences Attachment theory

Theories of self- determination
Lazrus and Folkmans theory of stress, coping, and
adaptation
Theory of planned behavior

Theories from biomedical sciences Pain

Self-regulation theory
Immune function
Symptomology
Germ theory
Theories from administration and Donabedians quality framework
management Theories of organizational behavior
Models of conflict and conflict resolution
Job satisfaction

Learning theories Banduras social codnitive learning theory

Developmental learning theory
Prospect theory

COMPONENTS OF A THEORY

TYPES OF RELATIONSHIP STATEMENTS

Type of Statement Characteristics

Axioms Consist of a basic set of statements or propositions that state the general
relationship between concepts. Axioms are relatively abstracts; therefore,
they are not directly observed or measured.

Empirical generalizations Summarize empirical evidence. It provides some confidence that the same
pattern will be repeated in concrete situations in the future under the same
conditions.

Hypotheses Statements that lack support from empirical research but are selected for
study. The source may be a variation of a law or derivation from an
axiomatic theory, or they may be generated by a scientists nutrition (a
hunch). All concepts in a hypothesis must be measurable, with operational
definitions in concrete situations.
Laws Well-grounded with strong empirical support and evidence of
empirical regulatory. It contains concepts that can measure or
identified in concrete settings.
Propositions Statements of a constant relationship between two or more
concepts or facts

Theoretical statements can be classified into two groups

Existence Statement

Consists of statement that claim the existence of phenomena referred to by

concepts. (e.g., that chair is brown or that man is nurse).

Relational Statement

Assert that a relationship exists between the properties of two or more concepts.
This relationship is basic to development of theory and is expressed in terms of
relational statements that explain, predict, understand, or control.

Associational/ Correlational - concepts that occur or exist together

Causal Relationship- one concept is considered to cause the occurrence of a second

concept
APPROACHES TO THEORY DEVELOPMENT
PROCESS OF THEORY DEVELOPMENT

1. CONCEPT DEVELOPMENT: CREATION OF CONCEPTUAL MEANING

This provides the foundation for theory development and includes specifying,
defining, and clarifying the concepts used to described the phenomenon of interest

2. STATEMENT DEVELOPMENT: FORMULATION AND VALIDATION OF

RELATIONAL STATEMENTS

Relational statements are the skeletons of theory; they are the means by
which the theory comes together. The process of formulation and validation of
relational statements involves developing the relational statements and determining
empirical referents that can validate them.

STEPS IN STATEMENT ANALYSIS

Select the statement to be analyzed.

Simplify the statement.
Classify the statement.
Examine concepts within the statement for definition and validity.
Specify relationship between concepts.
Determine stability.
3. THEORY CONSTRUCTION: SYSTEMATIC ORGANIZATION OF THE LINKAGES

This includes formulating systematic linkages between and among concepts,

which results in formal, coherent theoretical structure.

Aspects of theory construction include identifying and defining the concepts,

identifying assumptions, clarifying the context within which the theory is
placed, or relationship among the components.
4 VALIDATING AND CONFIRMING THEORETICAL RELATIONSHIPS IN
RESEARCH

Validating theoretical relationships through empirical testing

the focus is on correlating the theory with demonstrable experiences and

designing research to validate the relationships, additionally, explanations are
considered, based on the empirical evidence.

5. VALIDATION AND APPLICATION OF THEORY IN PRACTICE

research methods are used to assess how the theory can be applied in
practice.

The theoretical relationships are examined in the practice setting and results
are recorded to determine how well the theory achieves the desired
outcomes.

. Questions to be considered in this step include: are the theorys goals

congruent with the practice situation are explanations of the theory sufficient
for use in the nursing situation is there research evidence supporting use of
the theory.

THEORY DEVELOPMENT EXEMPLAR

Smith and colleagues developed the Caregiving Effectiveness

Model to be applied to home care situations in which the patient requires
technologically based treatment.

Scope of theory: Middle range

Purpose: To explain and predict outcomes of technology- based home caregiving

provided by family members. Outcomes of the model are to help nurses develop
relevant nursing interventions to support positive patient and caregiver outcomes.

Concept Definition Empirical Indicator

Caregiving The provision of technical, Caregiving Context Concepts Measures +

effectiveness physical, and emotional care Adaptive Context Concepts Measures=
by family members that
results in outcomes of Caregiving Effectiveness Outcomes
optimal patient condition, yet
maintain the well-being of
caregiver
Caregiving Caregiving Context Age, gender, educational level
characteristics Concepts

Personal characteristics
potentially affecting
caregiving

Caregiving/care Quality of relationships Mutuality scale Motivation to Help

- receiving between caregivers and
interactions patients (mutuality) and
motivation to provide home
care

Home care Educational preparation; Preparedness scale efficient use of resources

management health care services use (DEA coefficient)
strategies

Family economic Adaptive Context Concepts Health care services use/cost

stability Income adequacy; degree of
health care services use

Caregiver health Mental health status Quality of life index

status (presence or absence of Depression Score (CES-D Scale)
depression); physical health
status
Family Family coping and problem- Family Coping Scale
adaptation solving skills

Reactions to Caregiving system Caregiver Reactions Scale

caregiving

Theoretical Statement and Linkages

Caregiving Effectiveness outcomes are the result of the variables in the

Caregiving Context being mediated by adaptive Context Variables.

Caregiving characteristics mediated by the caregiver mental health status

(depression) affect Caregiving Effectiveness Outcomes.

Home-care management strategies 9preparedness) mediated by reactions to

caregiving influence patient condition.

Caregiving Effectiveness Outcome of Efficient Use of Resources is influenced

by caregiving and adaptive context variables.
ASSUMPTIONS

Caregiving with complex technological home care is stressful and disruptive to

usual family activities.

Families prefer home technological care as opposed to institutional care.

Model concepts are clinically relevant for nursing practice with patients and
their caregivers.

Models about caregiving of terminally ill and frail or cognitively impaired older
persons are not directly applicable to technology-dependent patients.
 THEORY EVALUATION

Presented by: DANICA JESSA SANCHEZ, RN

*** 12 REASONS WHY THEORY EVALUATION IS
ESSENTIAL (Meleis, 2007) ***

1. to decide which theory is more appropriate to use as framework

for research, teaching, administration or consultation

2. to identify effective theories in exploring some aspect of practice

or in guiding a research project

3. to compare and contrast different explanations of the same

phenomenon

4. to enhance the potential of constructive changes and further

theory development

5. to identify approaches of a discipline through attention to the

sociocultural context of the theory and theorist

6. to critically examine and question the beliefs in a discipline

7. to identify competing and complementary schools of thought in a

discipline

8. to effect changes in clinical practice, define research priorities and

identify content for teaching and guidelines for nursing
administration

9. to utilize coherent and integrative frameworks to communicate to

the public the rationales and goals of nursing practice

10. to identify strategies that could be used to advance the

development of theories
 11. to define and articulate the disciplines demand and
perspective

12. to be a critical consumer of theories as well as critical

consumer of evidence-based practice

Theory Evaluation- process of systematically examining a theory

- 1968: first method to describe,
analyze and critique theory

Was published

*Criteria for theory evaluation:*

1. Examination of theorys origin

2. meaning

3. logical adequacy

4. usefulness

5. generalizability

6. testability

*addl summary: theory evaluation identifies a theorys degree of

usefulness to guide practice, research and education.

-assisit in identifying a need for theory development or refinement

-provides a systematic, objective way of examining a theory that may

lead to new insights and new formulations that will add to the body of
knowledge or research (Walker & Avant 2005 )

-ultimate goal of theory evaluation: to determine the potential

contribution of the theory to scientific knowledge
*addl use :

-in nursing practice, it helps to identify which theoretical relationships

are supported by research and provides guidelines for the choice of
appropriate interventions and gives some indication of their efficacy.

-in research, it helps clarify form and structure of a theory being tested
or will allow the researcher to determine the relevance of the content of
theory for use as a conceptual framework

-it will also identify inconsistencies and gaps in the thory used in
practice or research ( Walker & Avant 2005)

Theory evaluation has been dscribed as:

1. As a single-phase process (theory analysis)- Tomey & Alligood,2002; Hardy, 1974

2. As a two-phase process( theory analysis and theory critique/evaluation)- Fawcett,

2000; Duffey and Muhlenkamp, 1974

3. As a three-phase process (theory description, theory analysis and theory

critique/evaluation)- Meleis, 2005; Moody,1990

*Theory description- initial step in the evaluation process

-review of theorists works with focus on the

historical content of the

History (Hickman, 2002)

*Theory Analysis- second phase of evaluation process

-systematic process of objectively examining the

content, structure and

function of a theory
*Theory Critique/Evaluation- final step of the evaluation process

-assess theorys potential contribution to

the disciplines

knowledge base (Fawcett,2000)

***THEORY EVALUTION BY DIFFERENT NURSING

SCHOLARS: ***

1. Rosemary Ellis
- first nursing scholar to document criteria for analyzing theories for use
by nurses, 1968

-Elliss characteristics os a significant theory:

1. scope

2. complexity

3. testability

4.usefulness

5.implicit values of theorist

6. information generation

7. meaningful terminology

2. Margaret Hardy, 1974,1978

theory should be evaluated using the 7 universal standards:
 a. meaning & logical adequacy

b. operational and empirical adequacy

***for Hardy, EMPIRICAL ADEQUACY, is the single most important

criterion for evaluating a theory applied in practiceit involves review of
related literature and relevant research***

c. testability

d. generality

e. contribution to understanding

f. predictability

g. pragmatic adequacy

3. Mary Duffey & Ann Muhlenkamp, 1974

- used the 2-phase approach

3.1 SETS OF QUESTIONS FOR THEORY ANALYSIS (PHASE ONE)

3.1.1 What is the origin of the problem/s with which the theory is concerned?

3.1.2 What methods were used in the theory development?

3.1.3 What is the character of the subject matter dealth with by the theory?

3.1.4 What kind of outcomes of testing propositions are generated by the theory?

3.2 SETS OF QUESTIONS FOR THEORY EVALUATION (PHASE TWO)

3.2.1 Does the theory generate testable hypotheses?

3.2.2 Does the theory guide practice?

3.2.3 Is it complete in terms of subject matter and perspective?

 3.2.4 Are biases and underlying values made explicit?

3.2.5 Are relationships among propositions made explicit?

3.2.6 Is the theory parsimonious/concise?

4. Barbara Barnum (Stevens), 1979,1998

USE OF: Internal and external criticism

4.1 Internal criticism- examines how components of theory fit with each other

4.1.1 Clarity
4.1.2 Consistency
4.1.3 Adequacy
4.1.4 Logical development
4.1.5 Level of theory development

4.2 External criticism- examines how a theory relates to the extant world
4.2.1 Reality convergence (how theory relates to the real world)

4.2.2 Utility

4.2.3 Significance

4.2.4 Discrimination (differentiation between nursing and other

profession)

4.2.5 Scope

4.2.6 Complexity

5. Lorraine Walker and Kay Avant, 1983,2005

-one-phase process

CRITERIA:

5.1 Origin of theory

5.2 Examine meaning of theory
 5.3 Logical Adequacy
5.4 Usefulness
5.5Generalizability
5.6 Parsimony/ Briefness
5.7Testability

6. Jacqueline Fawcett, 1980, 2000

-two-phase process evaluation

6.1 PHASE ONE: ANALYSIS

6.1.1 theorys origin

6.1.2 unique focus
6.1.3 content

6.2 PHASE TWO: CRITIQUE/ EVALUATION

6.2.1 explication of theorys origin

6.2.2 comprehensiveness of content

6.2.3 logical congruence

6.2.4 how can it lead to generation of new theory?

6.2.5 Credibility

6.2.6 How has it contributed to nursing?

7. Peggy Chinn and Maenoa Kramer (Jacobs), 1983, 2004

-two-phase process

7.1 PHASE ONE: THEORY DESCRIPTION

7.1.2
7.1.2 Concepts
7.1.3 Definitions
7.1.4 Relationships
7.1.5 Structure
 7.1.6 Assumptions

*ASSUMPTIONS are underlying truths that determine the nature of concepts,

definitions, purpose, relationships and structure.

7.2 PHASE TWO: CRITICAL REFLECTION

*How a theory serves its purpose*

7.2.1 Clarity & Consistency

7.2.2 Complexity

7.2.3 Generality

7.2.4 Accessibility

7.2.5 Importance

8. Afaf Meleis, 1985, 2005

-three-phase process

8.1 PHASE ONE: THEORY DESCRIPTION

8.1.1 Examination of theorys STRUCTURAL components:

8.1.1.1 assumptions
8.1.1.2 concepts
8.1.1.3 propositiions

8.1.2 Examination of theorys FUNCTIONAL components:

8.1.2.1 anticipated consequence of theory

8.1.2.2 purpose of theory

8.2 PHASE TWO: THEORY ANALYSIS

8.2.1 Theorist

-educational background, employment history, sociocultural influences

 8.2.2 origin of theory

-is it influence of other theorists?

8.2.3 internal dimensions of theory

-theorys rationale, goal, scope

8.3 PHASE THREE: THEORY CRITIQUE/EVALUATION

8.3.1 Clarity & Consistency

8.3.2 Level of simplicity/ complexity

8.3.3 Tautology/teleology

*TAUTOLOGY- assess needless repetition of ideas which can

decrease clarity

*TELEOLOGY- occurs when definitions of concepts, conditions and

events are described by consequences

9. Ann Whall, 1989, 2005

-3,3,3
- 3 THREE-PHASE PROCESS, THREE LEVELS OF NURSING THEORY,
THREE CRITERIA

9.1 THREE-PHASE PROCESS

9.1.1 THEORY DESCRIPTION

9.1.2 THEORY ANALYSIS
9.1.3 THEORY CRITIQUE/ EVALUATION

9.2 THREE LEVELS OF NURSING THEORY

 9.2.1 PRACTICE THEORY

9.2.2 MIDDLE RANGE THEORY

9.2.3 NURSING MODELS

9.3 THREE CRITERIA OF EVALUATION

9.3.1 BASIC CONSIDERATIONS

9.3.2 INTERNAL ANALYSIS AND EVALUATION

9.3.3 EXTERNAL ANALYSIS AND EVALUATION

LEVEL OF BASIC INTERNAL ANALYSIS AND EXTERNAL ANALYSIS

THEORY CONSIDERATIONS EVALUATION AND EVALUATION
PRACTI -Can concepts be -gaps/inconsistencies -Is theory produced and
CE organized? consistent with existing
THEOR -Are assumptions congruent to : nursing standards?
Y -Are concepts congruent
with empirical data? historical perspective? -Is theory related to nursing
Ethical standards? diagnoses, interventions and
-Do statements lead to Social policies practice?
directives for nursing
care? -conflicts with cultural groups -Is it supported by research?

-Are statements
sufficient and not
contradictory?
MIDDL -What definitions and -What are theorys assumpyions? -congruency with related
E- importance of major theory and research internal
RANGE concepts? -Relationship of concepts and external to nursing
THEOR
Y -What is the type and -consistency and congruency -relation to ethical,social
importance of policy issues and cultural
theoretical statements? -empirical adequacy aspects

-Has theory been examined to

practice and research?
 NURSIN -What are definitions of -assumptions -Is nursing research,
G metaparadigm: person, -definitions of components education and practice
MODEL nursing, health and based on the model or
S environment? -importance related to model?

-What are relationships -analyses of internal and external -What is the relationship to
among metaparadigm? consistency existing nursing diagnoses
and interventions system?
-Descriptions of other -analyses of adequacy
concepts in the model?

10.Sharon Dudley- Brown, 1997

10.1 CRITERIA:

10.1.1 Accuracy
10.1.2 Consistency
10.1.3 Fruitfulness
10.1.4 Simplicity/ Complexity
10.1.5 Scope
10.1.6 Accessibility
10.1.7 Sociocultural Utility

***SUMMARY:***
COMMON CRITERIA FOR THEORY EVALUATION:

1ST ( 7 OUT 9)

-COMPLEXITY/SIMPLICITY
-SCOPE/ GENERALITY

2ND (6 OUT OF 9)

-MEANINGFUL TERMINOLOGY
-DEFINITION OF CONCEPTS
-CONSISTENCY
-USEFULNESS
 3RD (5 OUT OF 9)

-CONTRIBUTION TO UNDERSTANDING

4TH (4 OUT OF 9)

-TESTABILITY
-LOGICAL ADEQUACY
-VALIDITY

RELATIONSHIP OF THEORY WITH THE FOLLOWING

ACCORDING TO DIFFERENT NURSING SCHOLARS:

A. NURSING PRACTICE

B. EDUCATION

C. RESEARCH
A. NURSING PRACTICE

-Nursing theory should lend itself to research testing, and research testing should
lead to knowledge that guides practice. (Chinn & Kramer, 2004)

-Nurses professional power is increased when using theoretical knowledge,

because systematically developed methods guides critical thinking and decision
making. (Tomey&Alligood, 2006)

-in nursing practice, it helps to identify which theoretical relationships are

supported by research and provides guidelines for the choice of appropriate
interventions and gives some indication of their efficacy. (McEwen & Wills,
2007)

- Through interaction with practice, theory is shaped and guidelines for practice
evolves. Research validates, refutes, and/or modifies theory as well as new theory.
Theory then guides practice.(Meleis, 2007)
-Through interaction with practice, theory is shaped and guidelines for practice
evolves. Research validates, refutes, and/or modifies theory as well as new theory.
Theory then guides practice.(Meleis, 2007)

-Theory provides nurses with framework and goals for assessment, diagnosis and
intervention. Nurses focus on aspects of care that are described theoretically for a
more effective judgment of patients situations and conditions. (Meleis, 2007)

B. EDUCATION

-Theories guide the critical thinking of nurses. (Cody, 1997)

-Theory contributes to the achievement of professional autonomy by guiding

practice, education and research within the profession. (Tomey&Alligood, 2006)

-theory evaluation identifies a theorys degree of usefulness to guide practice,

research and education. (McEwen & Wills, 2007)

-ultimate goal of theory evaluation: to determine the potential contribution of the

theory to scientific knowledge. (McEwen & Wills, 2007)

-Theories are important content for teaching nurses. (Meleis, 2007)

-Nurses utilize theories to develop nursing curricula and programs. (Meleis,

2007)

C. RESEARCH

-Because of theory, nurses can define the focus and means to achieve that focus
and being able to predict consequences increase nurses control of nursing practice
and therefore increases nurses autonomy. (Fuller, 1978)

-it will also identify inconsistencies and gaps in the theory used in practice or
research ( Walker & Avant 2005)

-assistS in identifying a need for theory development or refinement;

-provides a systematic, objective way of examining a theory that may lead to new
insights and new formulations that will add to the body of knowledge or research
(Walker & Avant 2005 )
 -in research, it helps clarify form and structure of a theory being tested or will
allow the researcher to determine the relevance of the content of theory for use as a
conceptual framework (McEwen & Wills, 2007)

-Nursing theories stimulate nurse scientists to explore significant responses in the

field of nursing and in doing so the potential for the development of knowledge that
informs daily activities of clients and nurses increases. (Meleis, 2007)

-Results of research can be used to verify, modify, disprove or support a

theoretical proposition. (Meleis, 2007)

THEORY EVALUATION EXAMPLE

EVALUATION OF:
MYRA ESTRINE LEVINE: THE CONSERVATION MODEL

A. BRIEF BACKGROUND OF THE THEORIST:

MYRA LEVINE earned her diploma in nursing from Cook County

School of Nursing, Chicago, Illinois in 1944., a bachelors degree in
science at University of Chicago in 1949 and MAN from Wayne State
University in Detroit, Michigan in 1962.

She held numerous clinical and education positions during her

long productive career (Schaefer, 2002).

She published An Introduction to Clinical Nursing in 1969,

revised it in 1973 and revised it again in 1989.

She died in 1996 at age 75, leaving a legacy to nursing

administration, practice, and scholarship.

B. PHILOSOPHICAL UNDERPINNINGS OF THE THEORY

LEVINE (1973) based the Conservation Model on the ff:

B.1 Nightingales idea that the nurse created an environment

in which healing could occur.

B.2 Tillichs unity principle of life

 B.3 Bernards principle on internal environment

B.4 Cannons Theory of Homeostasis

B.5 Waddingtons Concept of Homeorrhesis

Homeorrhesis describes the tendency of developing or changing

organisms to continue development or change towards a given state, even if
disturbed in development.

C. MAJOR ASSUMPTIONS, CONCEPTS AND RELATIONSHIPS

The 4 conservation MAJOR principles:

1. The principle of conservation of energy.

2. The principle of conservation of structural integrity.

3. The principle of conservation of personal integrity.

4. The principle of conservation of social integrity.

According to Levines theory of Conservation:

-nursing interventions are based on conservation of clients

integrity in each of the conservation domains.

-nurse is seen as part of environment and shares the repertoire of

skills, knowledge and compassion, assisting each cliet to confront
environmental challenges in resolving the problems encountered in
clients unique way.

-effectiveness of interventions is measured by the maintenance of

clients integrity

ASSUMPTIONS:

A. ASSUMPTIONS ABOUT INDIVIDUALS

 -Each individual is an active participant in interaction with environment
constantly seeking information from it.

-Individual is a sentient/conscious being and the ability to interact with

environment seems ineluctably tied to his sensory organs.

-Change is the essence of life and it is unceasing as long as life goes on. Change is
characteristic of life.

B. ASSUMPTIONS ABOUT NURSING

-Ultimate decisions for nursing intervention must be based on the unique behavior
of the individual patient.

-Patient-centered nursing care means individualized nursing care. It is predicated

on the reality of common experience: every man is a unique individual, and as such
he requires a unique constellation of skills techniques and ideas designed
specifically for him.

CONCEPTS

CONCEPT DEFINITION
ENVIRONMENT Includes both internal and external
environment

HEALTH Patterns of adaptive change of the

whole being

NURSING Human interaction relying on

communication, rooted in the organic
dependency of the individual human
being in his relationships with other
human beings

ADAPTATION Process of change and integration of the

organism in which the individual retains
integrity/wholeness
CONCEPTUAL ENVIRONMENT Part of persons environment that
includes ideas, symbolic exchange,
belief, tradition and judgment

CONSERVATION Includes joining together and is the

 product of adaptation including nursing
intervention & patient participation to
maintain a safe balance

ENERGY CONSERVATION Nursing conservation based on the

conservation of patients energy

HOLISM Singular yet integrated response of

individual to forces in environment

HOMEOSTASIS Stable state normal alterations in

physiologic parameters in response to
environmental changes; energy saving
state; a state of conservation

MODES OF COMMUNICATION Many ways in w/c information, needs

and feelings are transmitted among the
patient, family, nurses and other health
care workers

PERSONAL INTEGRITY Persons sense of identity & self-

definition wherein nursing
interventions are based

STRUCTURAL INTEGRITY Healing is a process of restoring

structural integrity through nursing
interventions that promote healing and
maintain structural integrity

SOCIAL INTEGRITY Lifes meaning gained through

interactions w/ others. Nurses intervene
to maintain relationships.

THERAPEUTIC INTERVENTIONS Interventions that influence adaptation

in a favorable way, enhancing the
adaptive response available to the
person

D. RELATIONSHIPS
Relationships are not specifically stated but can be extracted from the
descriptions given by Levine(1973). The relationships serve as the basis
for nursing interventions and include

1. Conservation of energy is based on nursing intervations to conserve

energy through a deliberate decision as to the balance between activity
and persons available energy.

2. Conservation of personal integrity is based on nursing interventions

that permit the individual to make decisions for himself or participate in
the decisions.

3. Conservation of social integrity is based on nursing interventions to

preserve the clients interactions with family and the social system to
which they belong.

4. All nursing interventions are based on careful and continued

observation over time.

E. USEFULNESS

E.1 EDUCATION:

-It was used to develop a nursing undergraduate program at

Allentown College of St. Francis de Sales in Center Valley,
Pennsylvania, where it deemed to be compatible with the mission
and philosophy of the college.( Grindley & Paradowski, 1991).

-It was also used in the undergraduate of the same school

as the framework for development of the content of graduate
nursing courses. (Schaefer, 1991).

E.2 CLINICAL SETTING

-The Emergency Department at the Hospital of the

University of Pennsylvania used the 4 conservation principles for
organizing framework for nursing practice. It was believed that
because of this, communication was strengthened and nursing
care was improved (Pond & Taney, 1991).
 -This was useful in directing nursing care practice for
children, especially the ill child (Dever, 1991)

-Mefford (2004) based her theory of health promotion for

preterm infants thru using Levines conservation model.

-Taylor (1989) implemented Levines model for nursing

diagnoses in a neurologic setting. She devised an extensive
assessment guide and a nursing care plan diagnostic template.

-Neswick(1997) suggested levines model as theoretical

basis for Enterostomal Therapy (ET) nursing. She integrated the 4
principles into wound & ostomy care

F. TESTABILITY

-Roberts, Fleming & Giese (1991) used the conservation

principles in maternity practice to study perineal integrity. It provided
framework for episiotomy in preserving maternal or fetal well-being.
They also used levines model to compare women with diff. perineal
conditions on post-partum that allowed physical and physiologic
consequences of these conditions.

-(Foreman,1991) did a research on conserving the cognitive

integrity of the hospitalized elderly

-(Hanson, Langmo, Olson, Hunter, Sauvage, Burd et al,

1991) used levines theory in the study comparing 2 methods for
prevention of pressure ulcers in a hospice setting

-In 3 qualitative case studies, Levines model was used :

a. By Pasco & Halupa in 1991, with patients who were experiencing

chronic pain and found it assisted subjects to fully adapt.

b. By Schaefer in 1991, with patients with CHF

c. By Schaefer & Potylycki in 1993, to study fatigue in patients with

CHF with focus on client adaptation
G. PARSIMONY

-Levines model is fairly parsimonious; however, there are a great

many concepts w/ comparatively unspecified relationships and unstated
assumptions.(McEwen & Wills, 2007).

-According to Levine (1991), redundancy of the domains allows

multiple means of configuring interventions.

H. VALUES IN EXTENDING NURSING SCIENCE

Levines (1973) Conservation Model has made an impact in the

discipline of nursing in education and in research, providing 4 defining
principles that are sufficiently universal to allow research and practice in
a large number of situations.

The concept of holism, although not unique to this model, was

proposed at an early stage in nursings scientific history and has made
an important difference in the care of clients.