2. Introduction
• Graduate students and advanced practice
nurses must be familiar with the components
and levels of abstraction in nursing
knowledge.
• One way to conceptualize this information is
by using the structural holarchy developed by
Jacqueline Fawcett.
3. Components of Nursing Knowledge
• Nursing knowledge is the cumulative, ever-
evolving result of prior learning, experience,
theory, and research.
• Fawcett (2005) places nursing knowledge into
a structural holarchy with five components:
– Metaparadigm
– Philosophy
– Conceptual model
– Theory
– Empirical indicator
4. Knowledge Holarchies
• A holarchy is a hierarchy in which each level is a
whole but is also part of a larger whole.
• Each holon or node functions independently but
also interacts with other holons or nodes.
• Within a holarchy, holons coordinate and include
holons on subordinate levels.
• Some holons also interact with other holons of
the same level.
• Can be viewed through either testing theory or
generating theory.
5. Metaparadigms
• A metaparadigm is the most abstract view of a
discipline, and it consists of the concepts that
define that discipline.
• In nursing, the most common metaparadigm
concepts are human beings, environment,
health, and nursing.
• Because it has a metaparadigm, nursing is
accurately classified as a discipline, or “a
distinct way of viewing all phenomena.”
6. Philosophies (1 of 3)
• Broadly speaking, a philosophy is the search
for and communication of a viewpoint.
• According to Fawcett (2005), the function of a
philosophy is “to communicate what the
members of a discipline believe to be true in
relation to the phenomena of interest to that
discipline.”
7. Philosophies (2 of 3)
• There are four areas of philosophical inquiry:
– Ontological area: Involves the study of reality and what
the members of a discipline believe to exist.
– Epistemology area: Involves the study of knowledge,
including how it can be created, disseminated, and
categorized.
– Ethics area: Involves inquiry about what is valued by a
discipline in terms of actions and practices.
– Logic area: Is a method of inquiry through which
arguments are presented and evaluated.
8. Philosophies (3 of 3)
• Nursing scholars use three main philosophies:
– Reaction world view: States that humans react to stimuli in a
linear, causal manner and change only when necessary for
survival.
– Reciprocal interaction world view: States that humans are
active, have reciprocal reactions with the environment, and
may or may not change under certain circumstances.
– Simultaneous action world view: States that humans change
continuously and are in mutual rhythmical interchange with
the environment.
9. Conceptual Models (1 of 3)
• Also called conceptual framework, conceptual
system, paradigm, and disciplinary matrix.
• Fawcett (2005) defines a conceptual model as a
“set of relatively abstract and general concepts that
address the phenomena of central interest to a
discipline, the propositions that broadly describe
those concepts, and the propositions that state
relatively abstract and general relations between
two or more of the concepts.”
10. Conceptual Models (2 of 3)
• Conceptual models characterize relationships
among phenomena to shape a distinctive
frame of reference.
• Individuals can interpret and characterize the
same reality in different ways using different
conceptual models.
• These models have practical value because
they guide research and practice.
11. Conceptual Models (3 of 3)
• Fawcett recognizes seven conceptual models
of nursing.
• According to Fawcett, these models are the
foundation of nursing as a discipline.
• Conceptual models are more abstract than
theories, and they can be distinguished from
theories using a series of if-then
determinations.
12. Theories (1 of 2)
• According to Fawcett (2005), a theory is “one
or more relatively concrete and specific
concepts that are derived from a conceptual
model, the propositions that narrowly
describe those concepts, and the propositions
that state relatively concrete and specific
relations between two or more concepts.”
13. Theories (2 of 2)
• Theories can be defined in different ways:
– Based on structure
– Based on practice goals
– Based on tentativeness
– Based on research
– Based on creativity in developing and connecting
concepts
– Based on progression from conceptual models to
theory
14. Functions of Theory:
Theory to Practice
• The usefulness of a theory is closely connected to
“how good” the theory is.
• Theory development serves two functions:
– Testing and generating theories drives research
– Finding research-based evidence for theories drives
changes in practice
• The relationship of theory development to
practice is called the conceptual-theoretical-
empirical (C-T-E) formalization.
15. Theory by Levels of Abstractions
(1 of 2)
• Theories can be categorized as follows based
on their levels of abstraction and scope:
– Metatheory: A philosophical stance about theory
and its methods for generating knowledge
– Grand theory: A set of concepts that is less broad
than a conceptual model but too abstract to state
relationships or hypotheses in empirical terms
16. Theory by Levels of Abstractions
(2 of 2)
– Middle-range theory: A set of concepts that is not
as broad as a grand theory and is strongly
supported by empirical data.
– Practice theory: A narrow theory that results from
empirical testing; sometimes called situation-
specific theory or micro theory.
17. Middle-Range Theory and Nursing
• Middle-range theories are important because
they have specificity for nursing practice.
• A middle-range theory may be categorized as:
– Descriptive: “Information presenting”
– Explanatory: “Knowledge building”
– Predictive: “Knowledge confirming”
– Prescriptive: “Knowledge utilizing”
• Good middle-range theories are closely linked to
specific conceptual models.
18. Empirical Indicators
• Defined by Fawcett (2005) as “an actual
instrument, experimental condition, or
procedure that is used to observe or measure a
middle-range theory concept.”
• Information derived from these indicators is
commonly known as data.
• Empirical indicators provide a way to test or
generate middle-range theories.
19. Using the Components in Practice
(1 of 2)
• As mentioned, the C-T-E system can be used to
connect theory and practice.
• When applying the system, three elements must
be considered:
– Translation of the metaparadigm of nursing into
practice (e.g., via hospital mission statements)
– Translation of philosophies into practice (e.g., via codes
of ethics , patient bills of rights, and statements of
nursing philosophy)
20. Using the Components in Practice
(2 of 2)
– Translation of conceptual models, theories, and
empirical indictors into a “formal nursing
knowledge system” (e.g., via practice standards,
assessment designs, intervention protocols, and
evaluation programs).
21. Summary
• Fawcett’s holography connects five main
components of nursing knowledge:
metaparadigm, philosophy, conceptual model,
theory, and empirical indicator.
• Middle-range theories must be closely linked to
conceptual models if nursing is to retain its status
as a discipline.
• The C-T-E system is necessary for translating
nursing models and theories into practice.
