Theory Development Process

Theory Development Process 

Sonya R. Hardin and Sue Marquis Bishop

Theory development in nursing is an essential component of nursing scholarship undertaken to advance the knowledge of the discipline. Nursing theories that clearly set forth an understanding of nursing phenomena guide scholarly development of the science of nursing practice through research. Once a nursing theory addressing a phenomenon of interest has been proposed, several considerations follow, such as its completeness and logic, internal consistency, and correspondence with empirical findings, and whether it has been defined operationally for testing. Analyses of this nature lead logically to further development of the theory. Scientific evidence accumulates through repeated rigorous research that supports or refutes theoretical assertions and guides modifications or extensions of the theory. Nursing theory development is not a mysterious activity, but a scholarly endeavor that is pursued systematically. Rigorous development of nursing theories, then, is a high priority for the future of the discipline and the practice of the profession of nursing.

It is important to understand the concept of systematic development because approaches to construction of theory differ. One aspect that they have in common is that they approach theory development in a precise, systematic manner, making the stages of development explicit. The nurse who systematically devises a theory of nursing and publishes it for the nursing community to review and debate engages in a process that is essential to advancement of theory development. As scholarly work is published in the literature, nurse theoreticians and researchers review and critique the adequacy of the logical processes used in the development of the theory with fresh eyes in relation to practice and available research findings.


Development of theory requires an understanding of selected scholarly terms, definitions, and assumptions, so that scholarly review and analysis may occur. Attention is given to terms and defined meanings to enhance understanding of the theory development process that was used. Therefore, the clarity of terms and their scientific utility and value to the discipline are important considerations in the process.

Hage (1972) identified six theory components and specified the contributions that they make to theory (Table 4-1). Three categories of theory for these components are presented as a basis for understanding the function of each element in the theory-building process.

Concepts and Definitions

Concepts, the building blocks of theories, classify the phenomena of interest (Kaplan, 1964). It is crucial that concepts are considered within the theoretical system in which they are embedded and from which they derive their meaning, because concepts may have different meanings in various theoretical systems. Scientific progress is based on critical review and testing of a researcher’s work by the scientific community.

Concepts may be abstract or concrete. Abstract concepts are constructed mentally independent of a specific time or place, whereas concrete concepts are experienced directly and relate to a particular time or place (Chinn & Kramer, 2008; Hage, 1972; Reynolds, 1971).

Abstract Concepts Concrete Concepts
Social system The Marquis family
2 South Surgery Floor
Memorial Hospital
Nurse-patient-family caregiver
Debate Obama-McCain Debate
Telemetry Electrocardiogram, Holter monitor
Loss of relationship Divorce, widowhood
Nurse competency Cultural, nasogastric tube placement, medication administration


The Marquis family, the surgery unit, the hospital, and the nurse-patient-family caregiver are examples of concrete concepts of the abstract concept, social system; the other examples illustrate the abstract to concrete difference. In a given theoretical system, the definition, characteristics, and functioning of a social system clarify more specific instances, such as the nurse-patient-family caregiver social system.

Concepts may be classified as discrete or continuous concepts. This system of labels differentiates types of concept that specify categories of phenomena. A discrete concept identifies categories or classes of phenomena, such as patient, nurse, health, or environment. A student can become a nurse or can choose another profession, but he or she cannot become a partial nurse. Phenomena identified as belonging to, or not belonging to, a given class or category may be called nonvariable concepts. Sorting phenomena into nonvariable, discrete categories conveys the assumption that the associated reality is captured by the classification (Hage, 1972). The amount or degree of the variable is not an issue.

Theories may be used as a series of nonvariable discrete concepts (and subconcepts) that can be used 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 4-2. Participants are of one gender or the other; no degree of how much they adhere to this is shown in this discrete category. If the illustration is taken further, the typology can be partitioned while the discrete concept of children is added. Participants would be classified for gender and marital status, and as having or not having children.

A continuous concept, on the other hand, permits classification of dimensions or gradations of a phenomenon, indicating degree of marital conflict. Marital couples may be classified, with a range representing degrees of marital conflict in their relationships.


Other continuous concepts that may be used to classify couples might include extent of communication, number of shared activities, and number of children. Examples of continuous concepts used to classify patients include degree of temperature, level of anxiety, and 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 so they can better understand their pain threshold or pain experience.


Continuous concepts are not expressed in either/or terms but rather 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 additional aspects of the phenomenon. Instruments may measure a concept and may 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, are used to characterize healthcare organizations. Although nonvariable concepts are useful in classifying phenomena in theory development, Hage (1972) points out major breakthroughs in several disciplines as the focus shifted from nonvariable to variable concepts, because variable concepts permit scoring of the full range of variation of the phenomenon.

The development of concepts, then, permits description and classification of phenomena (Hage, 1972). The labeled concept specifies boundaries for selecting phenomena for observation and for reasoning about the phenomena of interest. New concepts may focus attention on new phenomena or may 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 given in the nursing literature. See Table 4-3 for references to analyses carried out using different approaches.

Concept analysis is an important beginning step in the process of theory development undertaken to develop a conceptual definition. It is crucial that concepts are defined clearly 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 empirical indicators. For example, Spear and Kulbok (2004) published a concept analysis of the autonomy of adolescents, in which autonomy was defined theoretically as independence or self-governance during the adolescent years. The concept of autonomy was operationalized as an active, individualized, holistic, contextual, and developmental process–oriented state of being.

Theories are tested in reality; therefore the concepts must be linked to operational definitions that relate the concepts to observable phenomena specifying empirical indicators. See Table 4-4 for examples of concepts and their theoretical definitions and operational definitions. These linkages are vital to the logic of the theory, its observation, and its measurement.

Relational Statements

Statements in a theory may state definitions or relations among concepts. Whereas definitions provide descriptions of the concept, relational statements propose relationships between and among two or more concepts. Concepts are the building blocks of theory, and theoretical statements are the chains that link the blocks to build theory. Concepts must be connected with one another in a series of theoretical statements to devise a nursing theory.

In connections between variables, one variable may be proposed to influence a second. In this case, the first variable may be viewed as the antecedent or determinant (independent) and the second as the consequent or resultant (dependent) variable (Giere, 1997). Zetterberg (1966) concluded that the development of two-variate theoretical statements could be an important intermediate step in the development of a theory. These statements can be reformulated later as the theory evolves, or as new information becomes available. An example of an antecedent and a consequence is explained by looking at the concept of autonomy in which the antecedents of autonomy were identified as experience, education, ability to prioritize, ability to discriminate, self-discipline, and acceptance of responsibility; consequences are identified with accountability. These antecedents and consequences were developed from the literature (Keenan, 1999).

Theoretical assertions are a necessary or sufficient condition, or both. These labels characterize conditions that help explain the nature of the relationship between two variables in theoretical statements. For example, a relational statement expressed as a sufficient condition could be the following: If nurses react with approval of patients’ self-care behaviors (NA), patients increase their efforts in self-care activities (PSC). This is a type of compound statement that links antecedent and consequent variables. The statement does not assert the truth of the antecedent. Rather, the assertion is made that if the antecedent is true, then the consequence is true (Giere, 1979). In addition, no assertion appears in the statement to explain why the antecedent is related to the consequence. In symbolic notation form, the statements may be expressed as follows:


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Feb 9, 2017 | Posted by in NURSING | Comments Off on Theory Development Process

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