Theories may be used as a series of nonvariable discrete concepts (and subconcepts) to build typologies. Typologies are systematic arrangements of concepts within a given category. For example, a typology on marital status could be partitioned into marital statuses in which a population is classified as married, divorced, widowed, or single. These discrete categories could be partitioned further to permit the classification of an additional variable in this typology. A typology of marital status and gender is shown in Table 3-3. The participants are either one gender or the other since there are no degrees of how much they are in this discrete category. Taking the illustration further, the typology could be partitioned adding the discrete concept of children. Participants would be classified for gender, marital status, and as having or not having children.

Degree of Marital Conflict 0      ↔       120 Low                        High

Other continuous concepts that may be used to classify couples might include amount of communication, number of shared activities, or number of children. Examples of continuous concepts used to classify patients are degree of temperature, level of anxiety, or age. Another example is how nurses conceptualize pain as a continuous concept when they ask patients to rate their pain on a scale from 0 to 10 to better understand their pain threshold or pain experience.

Degree of Pain 0 _______________ 10 Low                              High

Continuous concepts are not expressed in either/or terms but in degrees on a continuum. The use of variable concepts on a continuum tends to focus on one dimension but does so without assuming that a single dimension captures all of the reality of the phenomenon. Additional dimensions may be devised to measure further aspects of the phenomenon. Instruments may measure a concept and have subscales that measure discrete concepts related to the overall concept. Variable concepts such as ratio of professional to nonprofessional staff, communication flow, or ratio of registered nurses to patients, is used to characterize health care organizations. Although nonvariable concepts are useful in classifying phenomena in theory development, Hage (1972) notes several major breakthroughs in disciplines as the focus shifts from nonvariable to variable concepts, because variable concepts permit the scoring of the phenomenon’s full range of variation.

The development of concepts, then, permits description and classification of phenomena (Hage, 1972). The labeled concept specifies boundaries for selecting phenomena to observe and for reasoning about the phenomena of interest. New concepts may focus attention on new phenomena or facilitate thinking about phenomena in a different way (Hage, 1972). Scholarly analysis of the concepts in nursing theories is a critical beginning step in the process of theoretical inquiry. The concept process continues to flourish with many examples in the nursing literature. See Table 3-4 for references to analyses carried out using different approaches.

Concept analysis is an important beginning step in the process of theory development to develop a conceptual definition. It is crucial that concepts are clearly defined to reduce ambiguity in the given concept or set of concepts. To eliminate perceived differences in meaning, explicit definitions are necessary. As the theory develops, theoretical and operational definitions provide the theorist’s meaning of the concept and the basis for the empirical indicators. For example, McMahon and Fleury (2012) published a concept analysis on wellness in older adults. Wellness in older adults was theoretically defined as wellness is a purposeful process of individual growth, integration of experience, and meaningful connection with others, reflecting personally valued goals and strengths, and resulting in being well and living values. The concept of wellness in older adults was operationalized as an ever changing process of becoming, integrating, and relating.

Theories are tested in reality; therefore, the concepts must be linked to operational definitions that relate the concepts to observable phenomena specifying empirical indicators. Table 3-5 provides examples of concepts with their theoretical and operational definitions. These linkages are vital to the logic of the theory, its observation, and its measurement.

The concept-building process emerges from practice, incorporating the literature and research findings from multiple disciplines. Concepts are built into a conceptual framework and are further refined. A 10-phase process for concept building is described in the literature (Smith & Liehr, 2008; Smith & Liehr, 2012). The process of concept building is guided by patient stories. The 10 phases are as follows: (1) write a meaningful practice story; (2) name the central phenomenon in the practice story; (3) identify a theoretical lens for viewing the phenomenon; (4) link the phenomenon to existing literature; (5) gather a story from someone who has lived the phenomenon; (6) reconstruct the shared story (from Phase 5) and create a mini-saga that captures its message; (7) identify the core qualities of the phenomenon; (8) use the core qualities to create a definition; (9) create a model of the phenomenon; and (10) write a mini-synthesis that integrates the phenomenon with a population to suggest a research direction. The process, which provides the scaffolding for beginning scholars to move from the familiarity of practice to the unfamiliarity of phenomena for research, will be shared with brief examples that demonstrate potential and lessons learned in nearly a decade of use (Smith & Liehr, 2012, p. 65).