Janet Turner works as a nurse on a postsurgical, cardiovascular floor. Because she desires a broader view of nursing knowledge and wants to become a clinical specialist or family nurse practitioner, she recently began an online RN to BSN degree program that would prepare her to enter a master’s degree program in nursing. The requirements for a course entitled “Scholarly Foundations of Nursing Practice” led Janet to become familiar with some of the many nursing theories. From her readings, she learned about a number of ways to classify theories: grand theory, conceptual model, middle range theory, practice theory, borrowed theory, interactive–integrative model, totality paradigm, and simultaneous action paradigm. She came to the conclusion that there is no cohesion among authors of nursing theory and even wondered what relation theory had to what she was doing in her critical care nursing practice.
Janet’s theory course was delivered through online distance learning methods. To express her frustration and to try to understand the material, she consulted with her theory professor via the Web-based live chat room that was part of the course. The entire class eventually logged on to the chat and a long discussion resulted in which students shared their frustration with these new and abstract ideas. The instructor, a teacher who had come from an RN to BSN program herself, shared with them that frustration and confusion were the normal feelings one had when learning these abstractions. She presented them with several interesting ways to conceptualize grand nursing theories. The chat broke up with the agreement that each student would review the assigned readings again and return to next week’s live chat ready to discuss their findings.
Theories evolved from several schools of philosophical thought and differing scientific traditions. To better understand the theories, Janet looked for ways to group or categorize them based on similarities of perspective. As she studied theories based on similar perspectives, she was able to read and analyze the theories more effectively, and to select three that she intended to examine further.
In Chapter 2, the reader was introduced to grand nursing theories and given a brief historical overview of their development. Fawcett and DeSanto-Madeya (2013) distinguish between conceptual models and grand theories, and this chapter discusses that differentiation in an effort to assist nursing students to understand the material. According to Fawcett and DeSanto-Madeya (2013), conceptual models are broad formulations of philosophy that are based on an attempt to include the whole of nursing reality as the scholar understands it. The concepts and propositions are abstract and not likely to be testable in fact. Grand nursing theories, by contrast, may be derived from conceptual models and are the most complex and widest in scope of the levels of theory; they attempt to explain broad issues within the discipline. Grand theories are composed of relatively abstract concepts and propositions that are less abstract than those of conceptual models (p. 15) and may not be directly amenable to testing (Butts, 2011; Fawcett & DeSanto-Madeya, 2013; Higgins & Moore, 2000). They were developed through thoughtful and insightful appraisal of existing ideas as opposed to empirical research and may provide the basis for scholars to produce innovative middle range or practice theories (Figure 6-1).
FIGURE 6-1: Relationship of conceptual model, theory, and hypotheses.
The grand nursing theories guide research and assist scholars to integrate the results of numerous diverse investigations so that the findings may be applied to education, practice, further research, and administration. Eun-Ok and Chang (2012), in their review of literature, found support for the idea that grand theories have an important place in nursing, for example, in research and clinical practice. They also found that theorists are further refining concepts and theories. They stated that theories are “essential for our discipline at multiple levels” (p. 162). Eun-Ok and Chang (2012) also noted that the grand theories provide a background of philosophical reasoning that allows nurse scientists to develop organizing principles for research or practice, sometimes referred to as middle range theory (middle range theories will be discussed in Chapters 10 and 11.) One of the most important benefits of invoking theories in education, administration, research, and practice has been the systematization of those domains of nursing activity.
Practitioners are more likely to succeed in analyzing research results using meta-analysis for evidence-based practice (EBP) when the research fits into a particular theoretical framework. Cody (2003) stated that “nursing theory guided practice can be shown to enhance health and quality of life when it is implemented with strong, well-qualified guidance” (p. 167). Mark, Hughes, and Jones (2004) echoed his beliefs and posited that theory-guided research results not only in greater patient safety but also in more predictable outcomes. These beliefs among nursing scientists provide clear direction that theory-guided research is necessary for evaluating nursing interventions in practice.
Over the last five decades of theory development, review of the health care literature demonstrates that changes in health care, society, and the environment, as well as changes in population demographics (e.g., aging, urbanization, and increase in minorities), led to a need to renew or update existing theories and to develop different theories. In fact, some theoretical writers would exclude the grand theory–middle range theory–microtheory relationship in favor of value-based and socially attuned constructions of nursing knowledge that fit contemporary understanding of human interactions (Risjord, 2010).
Health care delivery is a constantly changing process, and to be relevant to health care, theories require constant renewal and reevaluation. Indeed, many established nursing theorists continue to write, reevaluate, and improve their theories in light of these changes. Inspiration for many of the newer theories is linked not only to the changes in the health sciences but also to changes in society worldwide (Boykin & Schoenhofer, 2001). Such theorists as Roper, Logan, and Tierney (2000) (United Kingdom), Ray (Canada), and Martinson (Norway) have achieved worldwide recognition. This chapter introduces conceptual frameworks and grand nursing theories. Chapters 7 through 9 provide additional information about some of the more commonly known and widely recognized nursing frameworks and theories. To better assist the reader in understanding the conceptual frameworks and grand nursing theories, this chapter presents methods for categorizing or classifying them and describes the criteria that will be used to examine them in the subsequent chapters.