CHAPTER 4 After reading this chapter, you should be able to do the following: • Identify the purpose of conceptual and theoretical frameworks for nursing research. • Describe how a conceptual framework guides research. • Differentiate between conceptual and operational definitions. • Describe the relationship between theory, research, and practice. • Describe the points of critical appraisal used to evaluate the appropriateness, cohesiveness, and consistency of a framework guiding research. • Explain the ways in which theory is used in nursing research. Go to Evolve at http://evolve.elsevier.com/LoBiondo/ for review questions, critiquing exercises, and additional research articles for practice in reviewing and critiquing. Marie smiled. “Fortunately this is a pattern that we see quite frequently. Many of our kids are amazingly resilient.” Marie told Emily about the work of several nursing researchers who studied the phenomenon of resilience and gave her a list of articles reporting on their findings. Emily followed up with Marie’s prompting and learned about “psychosocial resilience in adolescents” (Tusaie et al., 2007) and “adolescent resilience” (Ahern, 2006; Ahern et al., 2008). These works led her to a “middle range theory of resilience” (Polk, 1997). From her readings, she gained insight into resilience, learning to recognize it in her patients. She also identified ways she might encourage and even promote resilience in children and teenagers. Eventually, she decided to enroll in a graduate nursing program to learn how to research different phenomena of concern to her patients and discover ways to apply the findings to improve nursing care and patient outcomes. Several important aspects of how theory is used in nursing research are embedded in Emily’s story. First, it is important to notice the links among practice, theory, and research. Each is intricately connected with the others to create the knowledge base for the discipline of nursing (Figure 4-1). In her practice, Emily recognized a pattern of characteristics in some patients that appeared to enhance their recovery. Her mentor directed her to research that other nurses had published on the phenomenon of “resilience.” Emily was then able to apply the information on resilience and related research findings as she planned and implemented care. Her goal was to enhance each child’s resilience as much as possible and thereby improve their outcomes. In nursing, science is the result of the interchange between research and theory. The purpose of research is to build knowledge through the generation or testing of theory that can then be applied in practice. To build knowledge, research should develop within a theoretical structure or blueprint that facilitates analysis and interpretation of findings. The use of theory provides structure and organization to nursing knowledge. It is important that nurses understand that nursing practice is based on the theories that are generated and validated through research (McEwen & Wills, 2011). In an integrated, reciprocal manner, theory guides research and practice; practice enables testing of theory and generates research questions; and research contributes to theory-building and establishing practice guidelines (see Figure 4-1). Therefore, what is learned through practice, theory, and research interweaves to create the knowledge fabric of nursing. From this perspective, like Emily in the case study, each nurse should be involved in the process of contributing to the knowledge or evidence-based practice of nursing. Several key terms are often used when discussing theory. It is necessary to understand these terms when considering how to apply theory in practice and research. They include concept, conceptual definition, conceptual/theoretical framework, construct, model, operational definition, and theory. Each term is defined and summarized in Box 4-1. Concepts and constructs are the major components of theories, and convey the essential ideas or elements of a theory. When a nurse researcher decides to study a concept/construct, the researcher must precisely and explicitly describe and explain the concept, devise a mechanism to identify and confirm the presence of the concept of interest, and determine a method to measure or quantify it. To illustrate, Table 4-1 shows the key concepts and conceptual and operational definitions provided by Alhusen and colleagues (2012) in their study on maternal fetal attachment and neonatal outcomes (see Appendix B). TABLE 4-1 CONCEPTS AND VARIABLES: CONCEPTUAL AND OPERATIONAL DEFINITIONS Likewise, BSN-prepared nurses use principles of administration and management and learning theories in their patient-centered, holistic practices. Table 4-2 lists a few of the many theories and concepts from other disciplines that are commonly used by nurses in practice and research that become part of the foundational framework for nursing. TABLE 4-2 THEORIES USED IN NURSING PRACTICE AND RESEARCH
Theoretical frameworks for research
Practice-theory-research links
Overview of theory
CONCEPT
CONCEPTUAL DEFINITION
VARIABLE
OPERATIONAL DEFINITION
Maternal-fetal attachment (Alhusen et al., 2012)
“The extent to which women engage in behaviors that represent an affiliation and interaction with their unborn child”
MFA
Total score on Maternal-Fetal Attachment Scale (a 24-item, Likert-type questionnaire)
Health practices (Alhusen et al., 2012)
Health practices that mother engages in during pregnancy
Health practices
Total score on the Health Practices in Pregnancy Questionnaire II (a 34-item, Likert-type questionnaire)
Neonatal outcomes
Compilation of birth weight and gestational age
Neonatal outcomes
Scores based on gestational age and scored against reference values of birth weight at 22-44 completed weeks of gestation
Types of theories used by nurses
Theories from related disciplines used in nursing practice and research
DISCIPLINE
EXAMPLES OF THEORIES/CONCEPTS USED BY NURSES
Biomedical sciences
Germ theory (principles of infection), pain theories, immune function, genetics/genomics, pharmacotherapeutics
Sociologic sciences
Systems theory (e.g., VonBertalanffy), family theory (e.g., Bowen), role theory (e.g., Merton), critical social theory (e.g., Habermas), cultural diversity (e.g., Leininger)
Behavioral sciences
Developmental theories (e.g., Erikson), human needs theories (e.g., Maslow), personality theories (e.g., Freud), stress theories (e.g., Lazarus & Folkman), health belief model (e.g., Rosenstock)
Learning theories
Behavioral learning theories (e.g., Pavlov, Skinner), cognitive development/interaction theories (e.g., Piaget), adult learning theories (e.g., Knowles)
Leadership/management
Change theory (e.g., Lewin), conflict management (e.g., Rapaport), quality framework (e.g., Donabedian)
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