Week 2 - Course ResourcesTheory Development – Barrier and Stimul.docx

Week 2 - Course Resources
Theory Development – Barrier and Stimulants
Development of a theoretical body of knowledge, unique to the
nursing domain, is directly proportional to equivalent strides
taken in the area of research. Effective integration of theory and
practice is essential for the survival and growth of the nursing
profession. To continue the cycle of meaningful advancements,
researchers need to identify barriers and overcome them. Along
with this, they also need to take note of factors that stimulate
the process of theory development. Let's examine how
knowledge has played a crucial role in setting obstacles in the
path of theory development on the one hand and, on the other,
how it has facilitated the development of nursing theories.
How did knowledge act as a barrier to the process of theory
development?
How did knowledge act as a stimulant in the process of theory
development?
Use of the knowledge of other disciplines was long seen as
superior to that developed by nurses.
Knowledge breeds knowledge; existing theory now provides
impetus for further refinement and development.
Other disciplines, such as sociology, psychology, and
physiology, prepared their students to do research in nursing
and develop theories for nurses, rather than encouraging nursing
to prepare its own students to do research and theory
development.
Old paradigms are challenged by new ones as they are
influenced by social factors, factors in healthcare, and practice
changes.
The National League for Nursing (NLN) requirement for
colleges and universities often resulted in the development of
curricula with esoteric content.
The new worldview is less mechanistic, more congruent with
women's views of science and nurses' views of health; it is more

wholistic and ecological.
The knowledge base developed was unrelated to practice and
was far removed from preparing students to be change agents in
practice.
Nurses are trained to observe record, analyze, and solve
problems, and this unique source of knowledge has provided
research efforts that are, finally, far more based in the practice
realm than ever before.
The academic focus was on conceptual models as a way to
develop theories and theoretical thinking, and often lost sight of
the reason to conceptualize in the first place, that is, the
underpinnings of nursing practice and patient care.
Nurses spend long hours with patients and family, and are better
able to identify and understand patterns of phenomena, rather
than perceive health and nursing as a series of isolated
incidents.
Development of conceptual models and theories was encouraged
as a way to justify and define the status of nursing as a
profession, and required the existence of theories.
The move toward the development of middle-range theories,
rather than grand theories and conceptual models, has allowed
nurses involved directly in the provision of care to ask practice-
based questions, do research to answer those questions, and
develop new information on a more manageable scale.
Professional Barriers and Stimulants
In addition to knowledge, other factors have hindered or
promoted the development of theories. These barriers and
facilitators can be professional and social.
Before 1970, women entered nursing because of its service
orientation rather than its professional potential. Women were
not career oriented; nursing was seen as an in-and-out
occupation, one that could be carried out on a part-time basis. It
was seen as preparation for an eventual role as wife and mother;
the self-identity of nursing students lay in their roles as women,

rather than in a professional identity.
Let's examine the impact of some professional factors on theory
development. Sex role stereotyping, for instance, has been a
major influence.
How did gender and social status act as a barrier to the process
of theory development?
· Role stagnation discouraged the creativity necessary for
theoretical thinking, and issues existed over the nature/nurture
conflict and giver/scientist role.
· Recognition in nursing was based on the practitioner or
educator roles and not based on the roles of researcher or
developer of theory, as is the case in other disciplines.
· The self-perception of members of the profession for the
discipline was that of low autonomy, poor advancement, and
less availability of intellectual stimulation.
· Education has the role of training individuals in thinking,
analysis, and conceptualization; nurses were provided training,
not education.
· Former nursing training methods served to decrease curiosity
and the questioning attitude. These methods thus succeeded in
fostering the handmaiden image to doctors, in addition to
emphasizing the role of executing orders and implementing
hospital policies.
· The focus was on doing tasks, not on thinking. Hospitals
played a paternalistic role in which rules and regulations were
made by non-nurses, and this created an environment in which
questioning was discouraged and rebelliousness punished.
Social Barriers
Social factors too have influenced nursing theory development
considerably. The social barriers and stimulants to theory
development are:
How did gender and social status act as a barrier to the process
of theory development?
How did gender and social status act as a stimulant in the
process of theory development?

As women, nurses had distinctly dual roles resulting in role
overload that resulted in a state not conducive to questioning,
investigation, analysis, and theory development.
Women, as an oppressed minority, have had to deal creatively
with situations in which others controlled the resources; as a
result, women developed flexibility, innovation, and creativity
in finding alternative resources to accomplish their goals.
Nurses, as women, are using what they have, valuing their
uniqueness.
Female characteristics have long been conceived of as
antithetical to creativity and scientific productivity.
Women's cognitive styles are learned in a lifetime of
socializing, negotiating, and fostering team efforts. These have
been highly valued in the increasingly
team-driven, business world of healthcare.
Women were seen as less analytical and cognitive and were
expected to apply, rather than create, knowledge.
Women are a minority in other fields, but are a majority in
nursing, and are appreciating the full citizenship this gives them
in their own field.
Women suffer from ambivalence when they break away from the
mold and often experience
achievement-related conflict.
The resulting different attitudes toward nursing and its
professional status led to a different attitude toward its
theoretical underpinnings.
Internal, intradisciplinary debates, territory/turf issues, and lack
of professional cohesion have confused other disciplines and the
public about the true nature of nursing as a scientifically-based
profession, with its own theoretical foundations and research-
tested methodologies.
Women are now recognized for their observational and abstract
thinking abilities. Observation is central to nursing practice,
and the ability to think abstractly is critical for theorizing. Also
important for theorizing is the ability to record what is
happening in a nursing care situation. Nurses are adept at

describing and explaining, one of the basic elements of the
nursing process.
Context, Content, and Process
The impetus for theory development increased dramatically
when the NLN required a conceptual framework for nursing
curricula. Each nursing education program was required to
develop a theoretical framework for the delivery of nursing
education. This could be the adoption of a single theory or an
amalgamation of several, and were not required to be nursing
theories. This became the impetus for theory development
primarily in the realm of nursing education. Thus, emerging
theories were used to guide teaching, but not practice or
research.
Nursing scientists searched for one theory for the entire
discipline. Resulting theories were too abstract and complex, or
too simplistic. Practitioners believed that the theory movement
required them to choose a single theory and adhere to it
throughout their practice efforts. None of the theoretical models
addressed all aspects of nursing. Therefore, practitioners
avoided, ignored, or refused to acknowledge the use of theory in
practice. Eventually, two themes evolved at this stage:
· Acceptance of the complexity of nursing and the inevitability
of multiple theories to address nursing phenomena
· Acceptance of the need to test elements of theory through
research before discarding them.
Now the focus moved to formulating questions about the unique
nature of nursing knowledge.
Social Barriers and Stimulants
Context, Content, and Process
The impetus for theory development increased dramatically
when the NLN required a conceptual framework for nursing
curricula. Each nursing education program was required to
develop a theoretical framework for the delivery of nursing
education. This could be the adoption of a single theory or an
amalgamation of several, and were not required to be nursing

theories. This became the impetus for theory development
primarily in the realm of nursing education. Thus, emerging
theories were used to guide teaching, but not practice or
research.
Nursing scientists searched for one theory for the entire
discipline. Resulting theories were too abstract and complex, or
too simplistic. Practitioners believed that the theory movement
required them to choose a single theory and adhere to it
throughout their practice efforts. None of the theoretical models
addressed all aspects of nursing. Therefore, practitioners
avoided, ignored, or refused to acknowledge the use of theory in
practice. Eventually, two themes evolved at this stage:
· Acceptance of the complexity of nursing and the inevitability
of multiple theories to address nursing phenomena
· Acceptance of the need to test elements of theory through
research before discarding them.
Now the focus moved to formulating questions about the unique
nature of nursing knowledge.
Early Influences
Theories explain the world. Every profession and discipline has
a foundation that explains how and why it works. Every branch
of science works the same way. Early theories were extremely
basic and simple. Newton sat under that tree and was hit by the
apple, leading him to speculate about the existence of gravity.
Once a theoretical speculation is made, it is tested through
research. Newton conducted many studies or experiments that
would seem, well, silly to us today. They had to do with going
to various heights and dropping things. Then he dropped things
of different weights to see what difference that would make.
These experiments served to prove his theory and allowed him
to refine it.
Today, we readily acknowledge the existence of gravity and
even do complicated experiments in space where it does not
exist. Thus, theory is all around us and is not unique to nursing.
We are evolving new nursing theory all the time as we speculate
about a new response to a nursing phenomenon and try it out.

You may even have done this sometime yourself! Thus theory
development is a rigorous process that relies completely on
research process. It evolves continuously from areas like
nursing practice, nursing education, nursing theory, and existing
theory.
Nursing Practice
Theory development began with Florence Nightingale who used
data collection and analysis techniques to present information
about nursing and its focus. In the early days of nursing
practice, a domain for nursing was identified that included the
patient, the environment, and nursing care. Each subsequent
stage of practice enhancement helped nurses come closer to
identifying the domain for nursing and defining its theoretical
base.
Nursing Education
The development of different curricula for different levels of
nursing education in the mid-1950s resulted in the need to
articulate the different levels of nursing practice and the
educational preparation required for each. Conversely,
questions emerging about the differences in nursing care
provided by diploma, AD, BSN, and MSN graduates forced an
articulation of nursing theory to add distinctions to practice that
resulted from different educational levels. This early focus on
levels of nursing practice encouraged nursing students and
educators to focus on nursing concerns and problems, rather
than on medical concerns and problems.
Theory development during this early period attempted to
answer the questions:
· What is nursing?
· What do nurses do?
· How is nursing different from other health science disciplines?
· What is nursing knowledge?
Research

The focus on advanced education for nurses led educators to
develop increased interest in the research process through
research courses offered at the graduate level and through their
own required research. Faculty was required to develop ideas
and communicate them in the scientific arena through
presentations and publications. Their research triggered further
theory development on the part of their graduate students.
Initial interest was on systematic inquiry through research into
teaching/learning modalities, the educational milieu, and
appropriate content for nursing curricula. Data derived from this
research prompted related theory development which, in turn,
generated further research.
Existing Theory
Arguments within the profession in the early days of theory
development focused on questions of whether nursing was a
separate discipline or part of medicine and whether it was a
biological, social, or physical science. The search for a
conceptual foundation specific and unique to nursing led to the
study of the realities of nursing practice and the truths that
guided its actions. These are the phenomena of nursing.
Emerging theories addressed the nature of human beings in
interaction with the healthcare system, as well as the processes
of problem solving and decision making for bases for
intervention.
Milestones in Theory Development
Popular culture uses the media to represent the cultural
elements that prevail in any given society at a particular point
in time. People want to be part of a group and to understand
their identity in the group; mass culture allows people to define
themselves in relation to everyone else. We watch television, go
to movies, listen to music, read newspapers and magazines, use
the Internet, eat snacks, and dress in certain ways. We see
advertisements for products and services daily, and these form
part of our popular culture. It has been said that we can learn
much about a culture from its advertising. Simply consider

current television ads, especially those aimed at teenagers. It is
easy to understand what teens want from these ads. They also
give us an insight into their values. This is no less true for
nursing. The ads in nursing journals of decades ago say a great
deal about where we were and how far we have come. In the
1940s and 1950s, ads appeared for many products aimed at
nurses themselves or for nurses to recommend those drugs or
products to patients. Nurses' uniform ads were popular and
often depicted an attractively-clad nurse—being looked over
with interest by handsome doctors. We must all have been
focused on the importance of male attention, given the
importance of tight white uniform dresses! Nursing ads touted
hand cream, menstrual pain relievers, various brands of
coffee—even cigarettes! Nurses were all Caucasian women, and
diversity did not exist.
Changes began to occur in the late 1960s and 1970s as
equipment ads began to appear. Nurses could buy pink and
green and blue stethoscopes that matched the pens and penlights
and scissors. Form superseded function and the message was
that we cared more for color coordination than for quality of
equipment. Today's ads demonstrate a major shift in advertising
attitudes toward nurses. Current ads are sophisticated and
informative and assume that nurses now have significant
decision-making ability in the workplace, as reflected in the ads
for medication, hospital equipment, information resources, and
so forth. Nursing images are multicultural and include men.
These changes are profound and have been reflected in the
development of our theory and our knowledge base. The earliest
theorists wrote when nurses were being sold custom-made
uniforms and capes, white garter belts and stockings, cigarettes,
and the notion that nursing was a job, not a career, one that
would serve them until marriage, preferably to a doctor. The
theorists today write and study at a time when all things are
possible for nurses who can practice in advanced roles with
prescriptive authority and who can sit in the office of the
hospital CEO.

Nursing Theory Critique
Why Analyze Theories?
Theories are analyzed and reviewed to describe the theoretical
basis for advanced nursing in professional nursing
environments. In addition, a critique also helps to apply the
knowledge gained during the critique to identify factors that aid
in improving the healthcare delivery system. One of the reasons
of the evaluation exercise is to ascertain how user friendly the
theory is and how its weaknesses can be overcome to improve
its applicability in the real environment. Further, selecting and
analyzing theories develop your analytical skills and help you
choose appropriate theories for future research.
Critique Evaluation Criteria
In the past few decades, healthcare professionals have been
trying to further develop, test, and use proposed nursing
theories. The ultimate aim of evaluation is to utilize theory in
various domains like practice, research, and education.
Evaluation lays emphasis on the depth and breadth of content.
Depth: The content should encompass the four metaparadigm
concepts in a relatively unambiguous manner. The theory should
include a description of the person or other focus of the nursing
actions, identification of the person's environment, discussion
of the author's meaning of health, a definition of nursing, a
statement of nursing goals or outcomes, and an outline of the
nursing process. The relational propositions of the model should
link all four metaparadigm concepts.
Breadth: This requires that the theory is sufficiently broad in
scope to provide guidance in clinical situations and serve as the
basis for research, education, and administration. Although the
expectation is that the theory or model is a useful frame of
reference for many nursing activities, no one theory or model is
appropriate for all clinical situations.
The four elements of theory critique are: background, theory
description, evaluation, and application. Background refers to

origin of the theory and theorist. Theory description focuses on
the major concepts of the theory. Evaluation of theory is
basically an analysis of clarity, congruence, assumptions, and
metaparadigms. Application refers to the level and usefulness of
the theory and its weaknesses. Although most theorists start
with the same view of the general purpose of nursing, in the
final form, most present distinctively different views of the
basic metaparadigm concepts. Different models are concerned
with different problems in nurse-patient situations or different
problems in person-environment interactions.
Nursing Theory and Practice
The Theory-Practice Gap
We know that the development of nursing theory is critical to
the establishment of a theoretical body of knowledge that is
peculiar to nursing as a science. However, theory development
should not take place in isolation. It should be integrated with
nursing practice if the profession is to have sustained growth
and development. There has always been serious concern on the
theory-practice gap.
This gap is based on the observation that what happens in
clinical situations rarely, if ever, matches what the textbooks
say ought to happen. The problem of the theory-practice gap is
one of the most important and fundamental issues in nursing
today, as the gap calls into question the very foundation upon
which nursing is based.
Nursing theory maintains that nursing is a science and that
nursing knowledge is advanced through the application of the
scientific method. Scientific research is seen as the predominant
method of generating new knowledge.
If nursing theory cannot and does not predict what actually
happens in clinical practice, with any degree of certainty, then
the entire body of nursing knowledge is seen by some as
redundant, and nursing is reduced to nothing more than trial and
error.
Theorists claim the theory-practice gap is between what

research and theory say ought to be happening, and what
actually happens in the imperfect clinical world. They see
practice-based nurses as failing to use research findings in
practice. Their goal and rationale is that practice should move
closer to the ideals of nursing theory, as nurses read research
and implement results in practice.
Direct care practitioners say that the gap is between what
actually works in real life and unrealistic textbooks' ideals.
They feel that the gap will be bridged by nursing theory more
closely reflecting the realities of clinical life. The gap is seen
by some as a consequence of the way in which theory has failed
to keep pace with changes in the practice of nursing.
Practitioners feel that although concepts of nursing practice
have undergone significant changes over the past 30 years,
nursing theory has not grown in the same way.
Prevailing models of education and research result from and
sustain nursing theory, often unintentionally strengthening its
separation from actual nursing practice. The result is a level of
mistrust by practitioners that academic knowledge can offer
anything of relevance to practice situations, and a frustration on
the part of academic-based researchers that practitioners will
relate theory to the provision of care.
Theory, research, and education are viewed as mutually
supportive, but practice is not seen as being included in the
equation.

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