1318

Advanced practice registered nurses (APRNs) may be involved in evidence-based practice (EBP), research, quality improvement (QI), and program evaluation projects (Cook & Lowe, 2012; Oberleitner, 2019; Raines, 2012). Although the purpose for each of these endeavors is different, the same methods can be used by the APRN to guide the project and expand nursing knowledge. Conceptual and theoretical frameworks provide important foundations for research, EBP, QI and program evaluation. They offer the APRN a structure for designing, implementing, and evaluating research and evidence-based and QI projects; designing and implementing program evaluation; interpreting the findings from these investigations; and designing interventions. Figure 8.1 depicts the relationship among conceptual and theoretical frameworks, research, QI, and program evaluation.

Conceptual and theoretical frameworks can be used to identify variables for study (e.g., Kamp et al., 2019; Kelley & Lowe, 2018; Lyttle et al., 2018), design measurement tools (e.g., Cleverley et al., 2018; Testa, 2017), and develop interventions (e.g., Lucas et al., 2019), which can then be tested through research (e.g., Lucas et al., 2019). Conceptual and theoretical frameworks can also be used to guide implementation of evidence-based interventions (e.g., Harvey & Kitson, 2016; Lazenby et al., 2019) and the evaluation of new or existing programs (e.g., Chao et al., 2015; Liska et al., 2018). Without a conceptual or theoretical framework, research, EBP, QI, and program evaluation projects lack coherence not only within the project, but also in relation to previous knowledge about a given topic.

The APRN who would like to use a theoretical or conceptual framework in practice-focused scholarship (American Association of Colleges of Nursing [AACN], 2015) is challenged with deciding which framework is most appropriate. Since there are many frameworks from which to choose (i.e., nursing grand theories, middle-range theories, and situation-specific theories; learning, leadership and management theories; and theories from the sociological, behavioral, and biomedical sciences; McEwen & Wills, 2019), the APRN must be able to evaluate the appropriateness and applicability of the theoretical or conceptual framework. This chapter includes a discussion of the relationships among theories, theoretical/conceptual frameworks, practice, and research; the characteristics of theory; and the criteria for evaluating a theory and its use in research, EBP, QI, and program evaluation.

■ THEORETICAL AND CONCEPTUAL FRAMEWORKS

There has been considerable debate about the definition of the different terms—theory, theoretical framework, and conceptual framework, with Risjord (2019) proposing that “model” be used instead of “theory” for middle-range theories. The consensus among authors is that theoretical and conceptual frameworks are more abstract than theories. Conceptual frameworks link concepts in meaningful ways but are usually not considered to be as fully developed as theoretical frameworks. This leads some to assert that the development of conceptual frameworks is a necessary step in the development of theories (Meleis, 2018). Other nurse theorists view conceptual frameworks as analogous to grand theories (McEwen, 2019b). Still others use the terms interchangeably (Meleis, 2018). In the end, Meleis proposes that the debate over the meaning of these terms is an academic issue of “semantics” (p. 123), which not only has led to confusion within the discipline, but also has delayed progress in the development of theories useful to research and practice. Meleis suggests that the use of the term “theory” is sufficient.

A theory (or theoretical framework) is a “set of logically interrelated concepts, statements, propositions, and definitions” (McEwen, 2019a, p. 28), which presents a systematic view of a phenomenon from which one may ask questions and specify relations among variables in order to describe, explain, and/or predict phenomena and prescribe actions (McEwen, 2019a; Peterson & Bredow, 2017). Theories help define and differentiate a discipline, explain events, structure, and organize knowledge, guide APRNs by identifying the goals and outcomes of practice, and contribute to a rational practice that questions and validates intuition and assumptions.

Over time, there has been considerable debate about whether nursing should only use theories developed by and for nursing or could also use theories that were developed in other disciplines. The rationale for the former is that theories help define the boundaries of a discipline. In other words, theories developed by and for nurses articulate the purpose of nursing and identify nursing interventions and research that use theories developed within nursing that contribute to the development of nursing knowledge. The widespread use of non-nursing theories in research and practice lends support to the assertion that the origin of the theory is less important than the theory’s pragmatic utility. Those who find the use of theories developed in disciplines other than nursing (borrowed theories) acceptable assert that knowledge is not confined to a particular discipline, but rather is available to all. Moreover, in this day of interdisciplinary research and practice, knowledge and theories are shared within a team; theories provide a common language to frame 133research and practice. As an applied discipline, nurses use knowledge from the physical and social sciences. Likewise, theories developed within nursing may also contain concepts shared by other disciplines. In other words, the boundaries that separate disciplines may not be rigid and impenetrable. When theories from other disciplines are used in research or practice, they should be consistent with a nursing perspective, and regardless of the term used or whether nursing or borrowed theories are employed, a theory must be meaningful and relevant (McEwen & Wills, 2019).

■ CLASSIFICATION OF THEORIES

There are two major ways of classifying theories. The first is by scope and the second is by purpose (McEwen, 2019b). This section focuses on these two major classifications.

Scope

Scope refers to the breadth of phenomena encompassed by the theory and is correlated with the degree of theoretical abstractness. In terms of scope, a theory may be classified as grand, middle-range, or practice/situation specific. Grand theories focus on broad areas of a discipline. In nursing, the grand theories explain phenomena of central concern to nursing, such as the meta-paradigm concepts of person, health, nursing, and environment. Grand theories incorporate highly abstract concepts that often lack operational definitions. Therefore, the propositions are not considered to be accessible to testing (McEwen, 2019b). However, there is evidence that grand theories are used as frameworks for nursing research (Im & Chang, 2012). Some examples include the Neuman Systems Model (Yarcheski et al., 2010), Watson’s Theory of Human Caring (Gillespie et al., 2012), and Orem’s Self-Care Theory (Peters & Templin, 2010).

Middle-range theories are more focused and limited in scope than grand theories. Middle-range theories encompass a limited number of concepts that tend to be more concrete than those found in grand theories. Thus, the concepts can usually be operationally defined. The theoretical properties are more specific and accessible to testing than those found in grand theories (McEwen, 2019b). There has been a significant growth in the development of middle-range theories (Peterson & Bredow, 2017). One reason may be their applicability to both research and practice. One theory that has been used in research and practice is the Transitions Theory (e.g., Stixrood, 2019). Briefly, Meleis and colleagues describe the types and properties of transitions people experience, the conditions that facilitate or inhibit movement through transitions, process and outcome indicators, and nursing interventions (Meleis et al., 2000).

Middle-range theories may be developed in several ways (Im, 2018; Liehr & Smith, 2017; Peterson & Bredow, 2017). They may be developed from grand theories (e.g., Pickett et al., 2014), non-nursing theories (e.g., Pender et al., 2011), reviews of the literature (e.g., Spratling & Weaver, 2012), research (e.g., Baydoun et al., 2018; Walter, 2017), a combination of research and literature reviews (e.g., Siaki et al., 2013), or clinical practice (Liehr & Smith, 2017; Peterson & Bredow, 2017). For example, a theory of weight management was developed from Orem’s Theory of Self-Care (Pickett et al., 2014). Major components of this middle-range theory of weight management are weight management contextual factors, weight management agency, and weight management behaviors Spratling and Weaver (2012) developed a theoretical framework of resilience in medically fragile adolescents from reviews of the risk and resilience literature in this population. Sanford et al. (2011) developed a theoretical model of decision-making in heart failure from their grounded theory study of the ways caregivers of people with heart failure make decisions. 134Siaki et al. (2013) constructed a middle-range theory of risk perception from their synthesis of the literature and qualitative and quantitative data from a study of Samoan Pacific Islanders who were at high risk for developing diabetes and cardiovascular disease. Finally, Riegel et al. (2019) expanded their Middle-Range Theory of Self-Care of Chronic Illness by incorporating knowledge from models and theories related to illness symptoms.

Situation-specific or practice theories are the most focused and least complex theories. Situation-specific theories contain a limited number of concepts that are easily defined and explain a small aspect of reality. Situation-specific theories tend to be prescriptive (McEwen, 2019b). Unlike grand or middle-range theories that are generalizable across populations and situations, situation-specific theories are most applicable in specific contexts. Situation-specific theories are limited to specific populations or particular areas of interest and take sociopolitical, cultural, and historical contexts into consideration (Im & Meleis, 2018). Situation-specific theories may be developed from middle-range theories, research, and practice (Peterson & Bredow, 2017). An example of a situation-specific theory is the Asian Immigrant Menopausal Symptom (AIMS) theory (Im, 2010). This theory was developed using an integrative approach of literature synthesis and research and describes the process by which Asian women progress through menopause and the factors that influence how Asian women experience menopause and the symptoms they experience.

Purpose

Theories may be classified as descriptive, explanatory, predictive, or prescriptive. Descriptive theories describe or name concepts, properties, and dimensions, but do not explain how the concepts in the theory are related. Descriptive theories tend to be generated from descriptive research such as concept analyses, case studies, literature reviews, surveys, phenomenology, or grounded theory research (McEwen, 2019b). Explanatory theories describe associations or relationships among concepts or propositions, explaining how and why these concepts are related. These studies are developed using correlational research or in-depth reviews of the literature (McEwen, 2019b). Predictive theories describe the relationships between concepts and the conditions under which particular outcomes will occur. These theories are generated and tested using research designs such as pretest, posttest, quasi-experimental, and experimental designs (McEwen, 2019b). Prescriptive theories prescribe interventions that will achieve a particular outcome and are thought to be the highest level in theory development (McEwen, 2019b).

■ COMPONENTS OF THEORIES

Stay updated, free articles. Join our Telegram channel

Join