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.