Theory Development in Nursing and Health Care
The focus of this course will be on the development of a conceptual framework based on knowledge synthesized from empirical evidence. Upon completion of this course the student will be able to:
1. Trace the history of theory development in the health sciences and discuss trends and controversies in current theoretical efforts;
2. Discuss epistemological issues in knowledge development;
3. Identify key concepts and subconcepts related to the student's research area;
4. Analyze a key concept related to the proposed area of research;
5. Synthesize and write a summary of the literature related to the student's proposed research topic using techniques such as integrative literature review to identify relationships between concepts;
6. Create a beginning conceptual framework to guide the research based on empirical data or systematically evaluate and adapt an established conceptual framework.
Course Methods
This will be a shared learning experience between the students and faculty. Classes will consist of both lecture and discussion including a review of the assigned readings. The student poses questions which stimulate discussion among class participants and which demonstrate integration of readings and personal research goals. As you read each reading assignment, write questions or comments about the reading. These questions might be about something in the reading you would like explained or a question about how you might use the ideas in the reading for your own scholarly work. We will use some of these questions for class discussion each day. Each day will include time to discuss students’ own work on concept development.
Course Outline:
We will follow the outline below for the five days of classes in the first week of the course. Please note that what is proposed for each day may be revised as we progress through the course. This is an approximate listing of times.
Day 1
The nature of scholarship
History of theory development in the health sciences
Reading Assignment:
Meleis, A. I. (2007).Chapter 2: On being and becoming a scholar. In Theoretical nursing: Development and progress (4th ed.) (pp. 10-28). Philadelphia: Lippincott Williams & Wilkins.
Concept and research critique process
Knowledge representation
Reading Assignment:
Broome, M. E. (2000). Integrative literature reviews for the development of concepts. In B. L. Rodgers & K. A. Knafl (Eds.), Concept development in nursing: Foundations, techniques, and applications (2nd ed.) (pp. 231-250). Philadelphia: Saunders.
Garrard, J. (2007). Health sciences literature review made easy: The matrix method. Sudbury, MA: Jones and Bartlett. (Read Chapters 1, 2, 3, 5, 6). You will go back to this as you use the method. For now you just need an overview.
Morse, J. M. (2000). Exploring pragmatic utility: Concept analysis by critically appraising the literature. In B. L. Rodgers & K. A. Knafl (Eds.), Concept development in nursing: Foundations, techniques, and applications (2nd ed.) (pp. 333-352). Philadelphia: Saunders.
Day 2
What is science? What is theory?
How is knowledge developed?
Reading Assignment:
Knafl, K. A., & Deatrick, J. A. (2000). Knowledge synthesis and concept development in nursing. In B. L. Rodgers & K. A. Knafl (Eds.), Concept development in nursing: Foundations, techniques, and applications (2nd ed.) (pp. 39-54). Philadelphia: Saunders
What are the philosophical foundations of science?
How do philosophical beliefs influence approaches to science?
Definitions of scholarship
Jacox, A., Suppe, F., Campbell, J., & Stashinko, E. (1999). Diversity in philosophical approaches. In A. S. Hinshaw, S. L. Feetham, & J. L. F. Shaver (Eds.), Handbook of clinical nursing research (pp. 3-17). Thousand Oaks, CA: Sage.
Schumacher, K. L., & Gortner, S. R. (1992). (Mis)conceptions and reconceptions about traditional science. Advances in Nursing Science, 14(4), 1-11.
Describe the work of scientists in your field of study as exemplars of concept and theory development
Knafl, K. A., & Deatrick, J. A. (2000). Research careers and concept development: The case of normalization. In B. L. Rodgers & K. A. Knafl (Eds.), Concept development in nursing: Foundations, techniques, and applications (2nd ed.) (pp. 353-368). Philadelphia: Saunders.
Day 3
Levels of theoretical thinking
Theoretical language
Concepts: The building blocks of theory
Reading Assignment
Meleis, A. I. (2007). Theoretical nursing: Development and progress (4th ed.). Philadelphia: Lippincott Williams & Wilkins.
Chapter 7: Theory Development: Sources, Resources, and Paradoxes (pp. 133-162).
Chapter 8: Strategies for Concept Development (pp. 163-185).
Higgins, P. A., & Shirley, M. M. (2000). Levels of theoretical thinking in nursing. Nursing Outlook, 48(4), 179-183.
Challenges and issues in concept and theory development
Kirkevold, M. (1997). Integrative nursing research--an important strategy to further the development of nursing science and nursing practice. Journal of Advanced Nursing, 25(5), 977-984.
Blegen, M. A., & Tripp-Reimer, T. (1997). Implications of nursing taxonomies for middle-range theory development. Advances in Nursing Science, 19(3), 37-49.
Moons, P., Budts, W., & De Geest, S. (2006). Critique on the conceptualisation of quality of life: A review and evaluation of different conceptual approaches. International Journal of Nursing Studies, 43(7), 891-901. (will be used as an example in class)
McCain, N. L., Gray, D. P., Walter, J. M., & Robins, J. (2005). Implementing a comprehensive approach to the study of health dynamics using the psychoneuroimmunology paradigm. Advances in Nursing Science, 28(4), 320-332. (will be used as an example in class)
Lamberty, G. (1995). Developing a research application and applying to federal sources of support. MCH Research Exchange, 1(2), 57-63. (Just read the section on pages 59-60 on Conceptualization)
Day 4
What is a conceptual/theoretical framework?
Becker, P. T. (2005). Conceptual frameworks: Issues for manuscript review and the dissemination of research findings. Research in Nursing & Health, 28(5), 363-364.
Meleis, A. I. (2007). Developing middle range and situation-specific theories: Exemplars. In Theoretical nursing: Development and progress (pp. 212-237). Philadelphia: Lippincott Williams & Wilkins.
Day 5
Building models
Identifying relationships among concepts
Identifying types of relationships
Meleis, A. I. (2005). Strategies for theory development. In Theoretical nursing: Development and progress (4th ed.) (pp. 186-211). Philadelphia: Lippincott Williams & Wilkins.
McEwen, M. (2007).Theory development: Structuring conceptual relationships in nursing. In Theoretical basis for nursing (2nd ed.) (pp. 73-94). Philadelphia: Lippincott Williams & Wilkins.
Bennett, J. A. (2000). Mediator and moderator variables in nursing research: Conceptual and statistical differences. Research in Nursing & Health, 23, 415-420. (Read after class discussion of mediation and moderation)
The following article is an example of a moderator effect in a descriptive study (bring to class).
LaMontagne, L. L., Hepworth, J. T., Cohen, F., & Salisbury, M. H. (2004). Adolescents' coping with surgery for scoliosis: Effects on recovery outcomes over time. Research in Nursing & Health, 27, 237-253.
And another article for a mediation effect in an intervention study (bring to class):
Dishman, R. K., Motl, R. W., Saunders, R. Felton, G., Ward, D. S., Dowda, M. et al. (2004). Self-efficacy partially mediates the effect of a school-based physical-activity intervention among adolescent girls. Preventive Medicine, 38, 628-636.
Course assignments:
1. Readings and questions/comments related to each reading before class.
2. Knowledge representation paper (to be submitted at a date to be determined between the two week-long class sessions)
Review the research literature for one of the concepts related to your phenomenon of interest. Develop an evidence table/matrix table pertinent to this concept and complete the table for each article you have identified. Write a 2-3 page summary of the state of the science for this concept. The literature and summary in this paper will be incorporated into your final paper.
· identify a key concept and its significance to the phenomenon of interest
· present theoretical definitions/domains
· justify selection of the concept based on evidence from the literature
· critique concept development to date (ie., critique literature relevant to concept). What is known about this concept?
· propose use of the concept to your phenomenon of interest
Final presentation (the second week of the course in the spring):
Final oral presentation will include the elements of the final paper described below. Students should prepare an outline for the class (Power Point slides may be used). Students in the class and the faculty will provide critique and feedback that will provide direction for preparation of the final paper. The presentation is an opportunity to engage in scholarly dialogue with other members of the class in order to improve your final paper. The final presentation will be scheduled in the spring.
Final paper (due 6-8 weeks after presentations—date to be determined):
Conceptual Framework and Review of Literature Manuscript
The purpose of the literature review is to assist the student with synthesis of available science and with development of a conceptual orientation to the phenomenon of interest. Definitions of concepts, statements of relationships, evidence of relationships between concepts and a schematic representation of the framework should be included in the final paper. An integrative literature review will provide evidence of the appropriateness of links between concepts. This assignment may be modified in negotiation with the faculty to better meet the learning needs of students in different phases of their doctoral study.