This work will be a two-page text about concept analysis/development. This will prepare you toward gaining a beginning understanding of knowledge dev

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Fifth Edition

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Copyright © 2014, 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2002 Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and services).

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Library of Congress Cataloging-in-Publication Data

Names: McEwen, Melanie, author. | Wills, Evelyn M., author. Title: Theoretical basis for nursing / Melanie McEwen, Evelyn M. Wills. Description: Fifth edition. | Philadelphia : Wolters Kluwer, [2018] |

Includes bibliographical references and index. Identifiers: LCCN 2017049174 | ISBN 9781496351203 Subjects: | MESH: Nursing Theory Classification: LCC RT84.5 | NLM WY 86 | DDC 610.73—dc23 LC record available at https://lccn.loc.gov/2017049174

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the author(s), editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations.

The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have U.S. Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his or her clinical practice.

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D E D I C AT I O N

To Kaitlin and Grant—You have helped me broaden my thoughts and consider all kinds of possibilities; I hope I’ve done the same for you.

Also for Helen and Keith—Our children chose well. Besides, you have given us Madelyn, Logan, Brenna, Liam, Lucy, Andrew, Michael, and Jacob; they are gifts beyond words.

Melanie McEwen

To Tom, Paul, and Vicki, who light up my life, and to Marian, who left us for a better place. You were always my best listener. To Teddy, Gwen, Merlyn, and Madelyn, who have been so patient and loving during this process.

My deepest gratitude to Leslie, who has supported me through this writing process.

Evelyn M. Wills

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C O N T R I B U T O R S

Sattaria Smith Dilks, DNP, APRN-BC, FNP, PMHNP/CNS Professor and Co-Coordinator Graduate Program College of Nursing McNeese State University Lake Charles, Louisiana Chapter 14: Theories From the Behavioral Sciences

Joan C. Engebretson, DrPH, AHN-BC, RN, FAAN Judy Fred Professor in Nursing University of Texas Health Science Center at Houston School of Nursing, Department of Family Nursing Houston, Texas Chapter 13: Theories From the Sociologic Sciences

Melinda Granger Oberleitner, DNS, RN Associate Dean, College of Nursing & Allied Health Professions Professor, Department of Nursing SLEMCO/BORSF Endowed Professor of Nursing University of Louisiana at Lafayette Lafayette, Louisiana Chapter 17: Theories, Models, and Frameworks From Leadership and Management Chapter 21: Application of Theory in Nursing Administration and Management

Cathy L. Rozmus, PhD, RN PARTNERS Endowed Professorship in Nursing Vice Dean Department of Family Health The University of Texas Health Science Center at Houston School of Nursing Houston, Texas Chapter 16: Ethical Theories and Principles

Jeffrey P. Spike, PhD Professor of Family and Community Medicine The University of Texas Health Science Center at Houston School of Medicine Professor, Department of Management, Policy, and Community Health University of Texas Health Science Center School of Public Health Houston, Texas Chapter 16: Ethical Theories and Principles

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R E V I E W E R S

Cynthia Dakin, PhD, RN Director of Graduate Studies Associate Professor Department of Nursing Elms College Chicopee, Massachusetts

Janet DuPont, RNC-OB, MSN, MEd, PhD Master of Science in Nursing Instructor/Developer Nursing Program Norwich University Northfield, Vermont

Ruth Neese, PhD, RN, CEN Assistant Professor Department of Nursing Indian River State College Fort Pierce, Florida

Brandon N. Respress, PhD, RN, MPH, MSN Assistant Professor College of Nursing and Health Innovation University of Texas at Arlington Arlington, Texas

Jacqueline Saleeby, PhD, RN, CS Associate Professor Department of Nursing Maryville University St. Louis, Missouri

Stephen J. Stapleton, PhD, MS, RN, CEN, FAEN Associate Professor Mennonite College of Nursing Illinois State University Normal, Illinois

Kathleen Williamson, MSN, PhD, RN Associate Professor and Chair Wilson School of Nursing Midwestern State University Wichita Falls, Texas

Cindy Zellefrow, DNP, MSEd, RN, LSN, APHN-BC Assistant Professor of Clinical Practice Assistant Director, Center for Transdisciplinary and Evidence-based Practice

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College of Nursing The Ohio State University Columbus, Ohio

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P R E FA C E

Rare is the student who enrolls in a nursing program and is excited about the requirement of taking a course on theory. Indeed, many fail to see theory’s relevance to the real world of nursing practice and often have difficulty applying the information in later courses and in their research. This book is the result of the frustration felt by a group of nursing instructors who met a number of years ago to adopt a textbook for a theory course. Indeed, because of student complaints and faculty dissatisfaction, we were changing textbooks yet again. A fairly lengthy discussion arose in which we concluded that the available books did not meet the needs of our students or course faculty. We were determined to write a book that was a general overview of theory per se, stressing how it is—and should be—used by nurses to improve practice, research, education, and management/leadership.

As in past editions, an ongoing review of trends in nursing theory and nursing science has shown an increasing emphasis on middle range theory, evidence-based practice (EBP), and situation-specific theories. To remain current and timely, in this fifth edition, we have added a new chapter entitled “Ethical Theories and Principles,” presenting information on these topics and describing how they relate to theory in nursing. We have also included new middle range and situation-specific nursing theories as well as new “shared” theories from non-nursing disciplines. One notable addition is a significant section discussing Complexity Science and Complex Adaptive Systems in Chapter 13 (Theories From the Sociologic Sciences) helping to explain their importance to nursing. Updates and application examples have been added throughout the discussions on the various theories.

Organization of the Text Theoretical Basis for Nursing is designed to be a basic nursing theory textbook that includes the essential information students need to understand and apply theory in practice, research, education, and administration/management.

The book is divided into four units. Unit I, Introduction to Theory, provides the background needed to understand what theory is and how it is used in nursing. It outlines tools and techniques used to develop, analyze, and evaluate theory so that it can be used in nursing practice, research, administration and management, and education. In this unit, we have provided a balanced view of “hot” topics (e.g., philosophical world views and utilization of shared or borrowed theory). Also, rather than espousing one strategy for activities such as concept development and theory evaluation, we have included a variety of strategies.

Unit II, Nursing Theories, focuses largely on the grand nursing theories and begins with a chapter describing their historical development. This unit divides the grand nursing theories into three groups based on their focus (human needs, interactive process, and unitary process). The works of many of the grand theorists are briefly summarized in Chapters 7, 8, and 9. Because this volume is intended to serve as a broad foundation, these analyses provide the reader with enough information to understand the basis of the work and to whet the reader’s appetite to select one or more for further study rather than delving into significant detail.

Chapters 10 and 11 cover the significant topic of middle range nursing theory. Chapter 10 presents a detailed overview of the origins and growth of middle range theory in nursing and gives numerous examples of how middle range theories have been developed by nurses. Chapter 11 provides an overview of some of the growing number of middle range nursing theories. The theories presented include some of the most commonly used middle range nursing theories (e.g., Pender’s Health Promotion Model and Leininger’s Culture Care Diversity and Universality Theory) as well as some that are less well known but have a growing body of research support (e.g., Meleis’s Transitions Theory, the Theory of Unpleasant Symptoms, and the

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Uncertainty in Illness Theory). The intent is to provide a broad range of middle range theories to familiarize the reader with examples and to encourage them to search for others appropriate to their practice or research. Ultimately, it is hoped that readers will be challenged to develop new theories that can be used by nurses.

Chapter 12, which discusses EBP, explains and defines the idea/process of EBP and describes how it relates to nursing theory and application of theory in nursing practice and research. The chapter concludes with a short presentation and review of five different EBP models that have been widely used by nurses and are well supported in the literature.

Unit III, Shared Theories Used by Nurses, is rather unique in nursing literature. Our book acknowledges that “shared” or “borrowed” theories are essential to nursing and negates the idea that the use of shared theory in practice or research is detrimental. In this unit, we have identified some of the most significant theories that have been developed outside of the discipline of nursing but are continually used in nursing. We have organized these theories based on broad disciplines: theories from the sociologic sciences, behavioral sciences, biomedical sciences, and philosophy as well as from administration, management, and learning. Each of these chapters was written by a nurse with both educational and practical experience in his or her respective area. These theories are presented with sufficient information to allow the reader to understand the theories and to recognize those that might be appropriate for his or her own work. These chapters also provide original references and give examples of how the concepts, theories, and models described have been used by other nurses.

Chapter 16, new to the fifth edition, describes ethical theories and principles that apply to nursing practice. This addition was suggested by nursing faculty who recognized the importance of maintaining an ethical perspective within the very complex health care system. This information is vital to professional nursing practice and absolutely essential for nurses in advanced practice, management, or educational roles.

Finally, Unit IV, Application of Theory in Nursing, explains how theories are applied in nursing. Separate chapters cover nursing practice, nursing research, nursing administration and management, and nursing education. These chapters include many specific examples for the application of theory and are intended to be a practical guide for theory use. The heightened development of practice theories and EBP guidelines are critical to theory application in nursing today, so these areas have been expanded. The unit concludes with a chapter that discusses some of the future issues in theory within the discipline.

Key Features In addition to numerous tables and boxes that highlight and summarize important information, Theoretical Basis for Nursing contains case studies, learning activities, exemplars, and illustrations that help students visualize various concepts. New to this edition is a special boxed feature in most chapters that highlights how a topic is outlined in the American Association of Colleges of Nursing (AACN’s) The Essentials of Master’s Education in Nursing or The Essentials of Doctoral Education for Advanced Nursing Practice. Other key features include:

■ Link to Practice: All chapters include at least one “Link to Practice” box, which presents useful information or clinically related examples related to the subject being discussed. The intent is to give additional tools or resources that can be used by nurses to apply the content in their own practice or research.

■ Case Studies: At the end of Chapter 1 and the beginning of Chapters 2 to 23, case studies help the reader understand how the content in the chapter relates to the everyday experience of the nurse, whether in practice, research, or other aspects of nursing.

■ Learning Activities: At the end of each chapter, learning activities pose critical thinking questions, propose individual and group projects related to topics covered in the chapter, and stimulate classroom discussion.

■ Exemplars: In five chapters, an exemplar discusses a scholarly study from the perspectives of concept analysis (Chapter 3); theory development (Chapter 4); theory analysis and evaluation (Chapter 5); middle range theory development (Chapter 10); and theory generation via research, theory testing via research, and use of a theory as the conceptual framework for a research study (Chapter 20).

■ Illustrations: Diagrams and models are included throughout the book to help the reader better

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understand the many different theories presented.

New to This Edition ■ New Chapter 16, Ethical Theories and Principles ■ Detailed section on Complexity Science and Complex Adaptive Systems in Chapter 13. ■ More detailed explanation of EBP, situation-specific theories, and their relationship to theory in nursing ■ Numerous recent examples of application of theories in nursing practice, nursing research,

leadership/administration, and education ■ Enhanced instructional support, focusing on activities and information directed toward online learning

Student Resources Available on ■ Literature Assessment Activity provides an interactive tool featuring journal articles along with

critical thinking questions that will encourage students to engage with the literature. Students can print or e-mail their responses to their instructor.

■ Case Studies with applicable questions guide students in understanding how the various theories link to nursing practice.

■ Learning Objectives for each chapter help focus the student on outcomes. ■ Internet Resources provide live web links to pertinent sites so that students can further their study and

understanding of the various theories. ■ Journal Articles for each chapter offer opportunities to gain more knowledge and understanding of the

chapter content.

Instructor Resources Available on ■ Instructor’s Guide includes application-level discussion questions and classroom/online activities that

Melanie McEwen uses in her own teaching! ■ Strategies for Effective Teaching of Nursing Theory provide ideas for instructors to help make the

nursing theory class come alive. ■ Test Generator Questions provide multiple-choice questions that can be used for testing general

content knowledge. ■ PowerPoints with audience response (Iclicker) questions, based on the ones used by Melanie

McEwen in her own classroom, help highlight important points to enhance the classroom experience. ■ Case Studies with questions, answers, and related activities offer opportunities for instructors to make

the student case studies an exciting, fun, and rewarding classroom/online experience. ■ Image Bank provides images from the text that instructors can use to enhance their own presentations.

In summary, the focus of this learning package is on the application of theory rather than on the study, analysis, and critique of grand theorists or a presentation of a specific aspect of theory (e.g., construction or evaluation). It is hoped that practicing nurses, nurse researchers, and nursing scholars, as well as graduate students and theory instructors, will use this book and its accompanying resources to gain a better understanding and appreciation of theory.

Melanie McEwen, PhD, RN, CNE, ANEF Evelyn M. Wills, PhD, RN

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A C K N O W L E D G M E N T S

Our heartfelt thanks to Senior Development Editor, Michael Kerns, and Editorial Coordinator, Tim Rinehart, for their assistance, patience, and persistence in helping us complete this project. They made a difficult task seem easy! We also want to thank Senior Acquisitions Editor, Christina Burns, and Helen Kogut, for their support and assistance in getting this project started and help with previous editions. Finally, a huge word of thanks to our contributors who have diligently worked to present the notion of theory in a manner that will engage nursing students and to look for new examples and applications to help make theory fresh and relevant.

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C O N T E N T S

Unit I: Introduction to Theory

1. Philosophy, Science, and Nursing Melanie McEwen

Case Study Nursing as a Profession Nursing as an Academic Discipline Introduction to Science and Philosophy

Overview of Science Overview of Philosophy

Science and Philosophical Schools of Thought Received View (Empiricism, Positivism, Logical Positivism)

Contemporary Empiricism/Postpositivism Nursing and Empiricism

Perceived View (Human Science, Phenomenology, Constructivism, Historicism) Nursing and Phenomenology/Constructivism/Historicism

Postmodernism (Poststructuralism, Postcolonialism) Nursing and Postmodernism

Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing Nursing Philosophy Nursing Science Philosophy of Science in Nursing

Knowledge Development and Nursing Science Epistemology

Ways of Knowing Nursing Epistemology Other Views of Patterns of Knowledge in Nursing Summary of Ways of Knowing in Nursing

Research Methodology and Nursing Science Nursing as a Practice Science Nursing as a Human Science Quantitative Versus Qualitative Methodology Debate

Quantitative Methods Qualitative Methods Methodologic Pluralism

Summary Key Points

Learning Activities

2. Overview of Theory in Nursing Melanie McEwen

Overview of Theory The Importance of Theory in Nursing Terminology of Theory

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Historical Overview: Theory Development in Nursing Florence Nightingale Stages of Theory Development in Nursing

Silent Knowledge Stage Received Knowledge Stage Subjective Knowledge Stage Procedural Knowledge Stage Constructed Knowledge Stage Integrated Knowledge Stage

Summary of Stages of Nursing Theory Development Classification of Theories in Nursing

Scope of Theory Metatheory Grand Theories Middle Range Theories Practice Theories

Type or Purpose of Theory Descriptive (Factor-Isolating) Theories Explanatory (Factor-Relating) Theories Predictive (Situation-Relating) Theories Prescriptive (Situation-Producing) Theories

Issues in Theory Development in Nursing Borrowed Versus Unique Theory in Nursing Nursing’s Metaparadigm

Relationships Among the Metaparadigm Concepts Other Viewpoints on Nursing’s Metaparadigm

Caring as a Central Construct in the Discipline of Nursing Summary Key Points

Learning Activities

3. Concept Development: Clarifying Meaning of Terms Evelyn M. Wills and Melanie McEwen

The Concept of “Concept” Types of Concepts

Abstract Versus Concrete Concepts Variable (Continuous) Versus Nonvariable (Discrete) Concepts Theoretically Versus Operationally Defined Concepts

Sources of Concepts Concept Analysis/Concept Development

Purposes of Concept Development Context for Concept Development Concept Development and Conceptual Frameworks Concept Development and Research

Strategies for Concept Analysis and Concept Development Walker and Avant

Concept Analysis Concept Synthesis Concept Derivation Examples of Concept Analysis Using Walker and Avant’s Techniques

Rodgers Schwartz-Barcott and Kim

Theoretical Phase

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Fieldwork Phase Analytical Phase

Meleis Concept Exploration Concept Clarification Concept Analysis

Morse Concept Delineation Concept Comparison Concept Clarification

Penrod and Hupcey Comparison of Models for Concept Development

Summary Key Points

Learning Activities

4. Theory Development: Structuring Conceptual Relationships in Nursing Melanie McEwen

Overview of Theory Development Categorizations of Theory

Categorization Based on Scope or Level of Abstraction Philosophy, Worldview, or Metatheory Grand Theories Middle Range Theories Practice Theories Relationship Among Levels of Theory in Nursing

Categorization Based on Purpose Descriptive Theories Explanatory Theories Predictive Theories Prescriptive Theories

Categorization Based on Source or Discipline Components of a Theory

Purpose Concepts and Conceptual Definitions Theoretical Statements

Existence Statements Relational Statements

Structure and Linkages Assumptions Models

Theory Development Relationship Among Theory, Research, and Practice

Relationship Between Theory and Research Relationship Between Theory and Practice Relationship Between Research and Practice

Approaches to Theory Development Theory to Practice to Theory Practice to Theory Research to Theory Theory to Research to Theory Integrated Approach

Process of Theory Development

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Concept Development: Creation of Conceptual Meaning Statement Development: Formulation and Validation of Relational Statements Theory Construction: Systematic Organization of the Linkages Validating and Confirming Theoretical Relationships in Research Validation and Application of Theory in Practice

Summary Key Points

Learning Activities

5. Theory Analysis and Evaluation Melanie McEwen

Definition and Purpose of Theory Evaluation Theory Description Theory Analysis Theory Evaluation

Historical Overview of Theory Analysis and Evaluation Characteristics of Significant Theories: Ellis Theory Evaluation: Hardy Theory Analysis and Theory Evaluation: Duffey and Muhlenkamp Theory Evaluation: Barnum Theory Analysis: Walker and Avant Theory Analysis and Evaluation: Fawcett Theory Description and Critique: Chinn and Kramer Theory Description, Analysis, and Critique: Meleis Analysis and Evaluation of Practice Theory, Middle Range Theory, and Nursing Models: Whall Theory Evaluation: Dudley-Brown

Comparisons of Methods Synthesized Method of Theory Evaluation Summary Key Points

Learning Activities

Unit II: Nursing Theories

6. Overview of Grand Nursing Theories Evelyn M. Wills

Categorization of Conceptual Frameworks and Grand Theories Categorization Based on Scope Categorization Based on Nursing Domains Categorization Based on Paradigms

Parse’s Categorization Newman’s Categorization Fawcett’s Categorization

Specific Categories of Models and Theories for This Unit Analysis Criteria for Grand Nursing Theories

Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships Usefulness Testability Parsimony

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Value in Extending Nursing Science The Purpose of Critiquing Theories Summary Key Points

Learning Activities

7. Grand Nursing Theories Based on Human Needs Evelyn M. Wills

Florence Nightingale: Nursing: What It Is and What It Is Not Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships Usefulness Testability Parsimony Value in Extending Nursing Science

Virginia Henderson: The Principles and Practice of Nursing Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Assumptions Concepts

Usefulness Testability Parsimony Value in Extending Nursing Science

Faye G. Abdellah: Patient-Centered Approaches to Nursing Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Assumptions Usefulness Testability Parsimony Value in Extending Nursing Science

Dorothea Orem: The Self-Care Deficit Nursing Theory Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Concepts Relationships

Usefulness Testability Parsimony Value in Extending Nursing Science

Dorothy Johnson: The Behavioral System Model Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Assumptions Concepts Relationships

Usefulness

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Testability Parsimony Value in Extending Nursing Science

Betty Neuman: The Neuman Systems Model Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Concepts Relationships

Usefulness Testability Parsimony Value in Extending Nursing Science

Summary Key Points

Learning Activities

8. Grand Nursing Theories Based on Interactive Process Evelyn M. Wills

Barbara Artinian: The Intersystem Model Background of the Theorist Philosophic Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Assumptions Concepts Relationships

Usefulness Testability Parsimony Value in Extending Nursing Science

Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain: Modeling and Role- Modeling

Background of the Theorists Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Concepts Relationships

Usefulness Testability Parsimony Value in Extending Nursing Science

Imogene King: King’s Conceptual System and Theory of Goal Attainment and Transactional Process

Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Assumptions Concepts Relationships

Usefulness Testability Parsimony Value in Extending Nursing Science

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Sister Callista Roy: The Roy Adaptation Model Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Concepts Relationships

Usefulness Testability Parsimony Value in Extending Nursing Science

Jean Watson: Human Caring Science, A Theory of Nursing Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Assumptions Concepts Relationships

Usefulness Testability Parsimony Value in Extending Nursing Science

Summary Key Points

Learning Activities

9. Grand Nursing Theories Based on Unitary Process Evelyn M. Wills

Martha Rogers: The Science of Unitary and Irreducible Human Beings Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Concepts Relationships

Usefulness Testability Parsimony Value in Extending Nursing Science

Margaret Newman: Health as Expanding Consciousness Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Concepts Relationships

Usefulness Testability Parsimony Value in Extending Nursing Science

Rosemarie Parse: The Humanbecoming Paradigm Background of the Theorist Philosophical Underpinnings of the Theory Major Assumptions, Concepts, and Relationships

Concepts Relationships

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Usefulness Testability Parsimony Value in Extending Nursing Science

Summary Key Points

Learning Activities

10. Introduction to Middle Range Nursing Theories Melanie McEwen

Purposes of Middle Range Theory Characteristics of Middle Range Theory Concepts and Relationships for Middle Range Theory Categorizing Middle Range Theory Development of Middle Ran

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