Even complicated and confusing topics will be easily developed and covered if you request our help writing an essay. Place an order today!

power point presentation to explain in details  about specific theory :
Professional Advancement Model ( from Novice to Expert) by Patricia Benner 

need to add some pictures to  the PTT 
should be from perfect references, I will upload two books I have but you can add more references
this PTT will be reference for  me and my colleagues in final exam 
Theory presentation:
about the theorist
definition of the theory and terms
concepts and models
purpose ,goal
factors, importance
metaparadigm
critique
how used in research 
hoe leiningers theory help our practice also, evaluation of theory

Evaluation of-a-nursing-theory-nursing-theory-ppt Presentation Transcript

Title: Evaluation of a Nursing Theory

Six Questions are Propose for Complete

Describing Theory.
Guide for the Description of Theory

1. What is the

purpose of this

theory?

This question addresses

why the theory was

formulated and reflects

the contexts and

situations to which the

theory can be applied.

 Why is this theory formulated?

 Is there an overall purpose for the theory?

 The purpose is positive, negative, neutral?

 is there is specific purpose for the theory

 Is there a hierarchy of theory ?

 Is the all metapradigm element receiving care, nursing, the person, ,

Society and Environment?

 What is the value orientation of the purpose?

 Does achieving the theoretic purpose require a nursing context?

 Does the purpose reflect understanding, creation of meaning,

explanation, and prediction of phenomena?

 When would the theory cases to be applicable? what is the end point?

 what purpose not explicitly, embedded in the matrix of the theory can

be identified?

2. What are the

concepts of this

theory?

This question identifies

the ideas that are

structured and related

within the theory. It

questions the qualitative

and quantitative

dimensions of concepts.

 Is there one major concept with sub-concepts organized under it?

 How many concepts are there ?

 How many major (or minor) ones? ?

 can the concepts be ordered, related? Arranged into any configuration?

 Are there concepts that cannot be interrelated?

 Are concepts broad in scope? Narrow?

 How abstract or empiric are the concepts broad in scope? Narrow?

What is the balance between highly abstract and highly empiric are concepts?

are defined?

3. How are the This question clarifies  Which concepts are defined?

concepts

defined?

the meaning for

concepts within the

theory. It questions how

empiric experience is

represented by the ideas

within the theory.

 Which concepts are defined explicitly? Which are implied ?

 How much meaning needs to be inferred?

 which concepts are defined specifically? generally?

 are there competing definitions for some concepts?

 Are there similar definitions for different concepts?

Are any concepts defined contrary to common convention?

4. What is the

nature of

relationships?

 This question

addresses how

concepts are linked

together. It focuses

on the various forms

relationship

statements can take

and how they give

structure to the

theory.

 What are the major relationships within the theory?

 Which relationships are obvious? Which are implied?

 Do relationships include all concepts? Which are not included?

 Are some concepts included in multiple relationships?

 Is there a hierarchy of relationships? Do relationships create

relationships? meaning and understanding? describing, explaining?

predicting? What mix of each?

are relationships illustrated?

5. What is the

structure of the

theory?

 This question

addresses the overall

form of the

conceptual

interrelationships.

 It discerns whether

the theory contains

partial structures or

has one basic form.

 How are overall and individual ideas organized?

 If outlined, what would the theory look like?

 do relationships expand concepts into large wholes or vice versa?

 do they link concepts in a linear fashion?

 does the structure move concepts away from or toward the purposes?

 Are there several structures that emerge? What is their form? Do they

fit together?

6. On what

assumptions
does the theory

build?

 This question

addresses the basic

truths that underlie

theoretic reasoning.

 It questions whether

assumptions reflect

philosophic values

 What assumptions underlie the theory?

 Are assumptions explicit, implicit, or derivable from context and

meanings?

 What are the individual, nurse, society, environment, and health

assumed to be like?

 Do assumptions be factually verified?

or factual assertions

factual assertions

 Can assumptions be hierarchically arranged or otherwise? ordered?

Guide for the Description of Theory

1

.
PURPOSE  Why is this theory formulated?

 Is there an overall purpose for the theory?

 The purpose is positive, negative, neutral?

 is there is specific purpose for the theory

 Is there a hierarchy of theory ?

 Is the all metapradigm element receiving care, nursing, the person, , Society and Environment?

 What is the value orientation of the purpose?

 Does achieving the theoretic purpose require a nursing context?

 Does the purpose reflect understanding, creation of meaning, explanation, and prediction of

phenomena?

 When would the theory cases to be applicable? what is the end point?

 what purpose not explicitly, embedded in the matrix of the theory can be identified?

2. Concepts  Is there one major concept with sub-concepts organized under it?

 How many concepts are there ?

 How many major (or minor) ones? ?

 can the concepts be ordered, related? Arranged into any configuration?

 Are there concepts that cannot be interrelated?

 Are concepts broad in scope? Narrow?

 How abstract or empiric are the concepts broad in scope? Narrow?

 What is the balance between highly abstract and highly empiric are concepts? are defined?

3. Definitions  Which concepts are defined?

 Which concepts are defined explicitly? Which are implied ?

 How much meaning needs to be inferred?

 which concepts are defined specifically? generally?

 are there competing definitions for some concepts?

 Are there similar definitions for different concepts?

 Are any concepts defined contrary to common convention?

4. Relationships  What are the major relationships within the theory?

 Which relationships are obvious? Which are implied?

 Do relationships include all concepts? Which are not included?

 Are some concepts included in multiple relationships?

 Is there a hierarchy of relationships? Do relationships create relationships? meaning and understanding?

describing, explaining? predicting? What mix of each?

 are relationships illustrated?

5. Structure  How are overall and individual ideas organized?

 If outlined, what would the theory look like?

 do relationships expand concepts into large wholes or vice versa?

 do they link concepts in a linear fashion?

 does the structure move concepts away from or toward the purposes?

 Are there several structures that emerge? What is their form? Do they fit together?

6. Assumptions  What assumptions underlie the theory?

 Are assumptions explicit, implicit, or derivable from context and meanings?

 What are the individual, nurse, society, environment, and health assumed to be like?

 Do assumptions be factually verified?

 Can assumptions be hierarchically arranged or otherwise? ordered?

Criteria for the evaluation of theory

Accuracy  As a noun, Accuracy defined as exactness or precision, while

as an adjective, as without mistakes or errors, perfect, correct

 In relation to nursing theory, accuracy pertains to describing

nursing as it exists today, not the nursing of the future or of

the past.

Consistency  Kuhn (1977) describes consistency in terms of the theory

being internally consistent as well as being consistent with
accepted theories.

 Internal consistency described as consistency in language , the

existence of logical order, and connectedness

 Inconsistencies should be avoided, a theory with an

inconsistency does not necessitate that the whole theory be

scrapped.

 operational definition should be used for concepts, assumptions

and propositions.

 It must uses the terms coherent and logically presented to

describe clarity.

Fruitful  Fruitful, is related conceptually to criteria to criteria proposed

by others

 (Synonymous with fertile, bountiful, productive, and prolific

 Kuhn (1977), in describing fruitful, states that theory should

expose new feelings, new phenomenon, or previously

unknown relationships among

 Fruitful refers to success in explaining observable

phenomenon and the evlautionon of emperical work resulting

from a theory

 Newton-Smith (1981) describes (fertile) as the scope for .

further development.

 Consistent with this is Ellis‟s (1968) criteria of generation of

information-the theory should generate hypotheses.

 A theory that generate many hypotheses, even some without

high probability, or some that are difficult to test, can

contribute to understanding.

Simplicity  Simplicity as an important evaluative criterion not complexity

 Meleis (1985) takes a more pragmatic complexity approach:

whether the theory has a lot of phenomena and relationships

(complexity) or if it focuses on fewer concepts and few

(simplicity)?

 Simplicity is useful characteristic of a good theory in nursing,

and important in the evaluation of nursing theory.

Scope  Scope has been dichotomized as either broad or narrow

 “The broader the scope, in terms of the number and variety of

facts or concepts related, the greater is the significance of the

theory

 Hardy (1974) states “the more general a theory, the more useful

it is Broad vs. narrow scope can also be dichotomized in

relation to its generalities, or the use of the term theory and

conceptual framework/ model.

 Scope may be conceptualized in relation to the level of theory,

e.g. a grand theory or middle range theory.

Acceptance  Meleis (1985)states acceptance “when the theory begins to

cross several concentric circles from where it originated, its

circle of contagiousness increases and we can infer that the

theory is receiving.

 Laudan (1977) discusses the importance of acceptance and

pursuit by other members of the discipline in that the theory

shows promise if others are accepting and „buying into‟ the

theory.

 It is important for the advancement of nursing as a profession

to have members of the discipline communicate regarding its

multicultural acceptance and adoption by others.

Testability  Testability refers to the theory‟s research potential or empirical

adequacy.

 Testability has been long felt to be an important criterion for

the evaluation of nursing theory, and touted as a method to

advance the science of nursing.

 lack of empirical validation of nursing theory has hindered the

development of the nursing science

 have proposed criteria for evaluating theory-testing research,

and discuss important philosophical and methodological issues

in the testing of nursing theory.

Socio-cultural

utility

 Socio-cultural utility encompasses social congruence and

social significance.

 Social congruence encompasses the beliefs, values and

expectations of different cultures that should shape and direct

the type of theory most useful to it.

 Meleis (1985) explains, self-care and independence are goals

consistent with some cultures‟ value systems but not others.

this is inappropriate in some societies and cultures, and should

be avoided.

 Fruitful, is related conceptually to criteria17. Fruitful ( 效果好的 ,收益多 ) Synonymous with fertile, bountiful,

productive, andproposed by others. Kuhn (1977), in describing fruitful, states that theory should exposeprolific. new

feelings, new phenomenon, or previously unknown relationships among Fruitful refers to success in explaining

observablephenomenon already known. phenomenon, and the evaluation of empirical work resulting from a theory.

 Newton-Smith (1981) describes (fertile) as the scope for18. Fruitful  The theory should contain ideas to further

research.further development. Consistent with this is Ellis‟s (1968) criteria of generation of information-the theory should

generate Ellis (1968) states “A theory that generateshypotheses. many hypotheses, even some without high probability, or

some that are difficult to test, can contribute to understanding.

 Simplicity as an important evaluative criterion19. Simplicity( 單純 ;簡單 ) (Kuhn, 1977; Newton-Smith, 1981; Chin and

Jacobs, 1983) others propose Meleis (1985) takes a more pragmatic(complexity (Ellis, 1968; Barnum, 1990). 務實的 )
approach: whether the theory has a lot of phenomena and relationships (complexity) or if it focuses on fewer concepts and few

relationships Kuhn‟s, (1977) describes as “bringing order to phenomenon that in(simplicity)? Simplicity is a seemingly(

表面上 )its absence would be isolated and confused”. useful characteristic of a good theory in nursing, and important in the
evaluation of nursing theory.

  Scope has been dichotomized as either broad or narrow.20. Scope( 範圍 ) Ellis (1968) and Hardy (1974). “The broader the
scope, in terms of the number and variety of facts or concepts related, the greater is the significance of the Hardy (1974) states

“the more general a theory, the more useful ittheory” . Broad vs. narrow scope can also be dichotomized in relation to

itsis.” generalities, or the use of the term theory and conceptual framework/ model. Scope may be conceptualized in

relation to the level of theory, eg. a grand theory or middle range theory.

 Meleis (1985)states acceptance “when the theory begins to21. Acceptance cross several concentric circles from where it

originated, its circle of contagiousness( 蔓延的 ) increases and we can infer that the theory is receiving Laudan (1977)

discusses themore acceptability, uninfluenced by the theorist” . importance of acceptance and pursuit by other members of

the discipline in that the theory shows promise if others are accepting and „buying into‟ the theory. It is important for the

advancement( 促進 ) of nursing as a profession to have members of the discipline communicate regarding its multicultural

acceptance and adoption( 採用 ) by others.

 Testability refers to the theory‟s research potential or22. Testability Testability has been long felt to be an important

criterionempirical adequacy. for the evaluation of nursing theory, and touted ( 招徠 ) as a method to advance Acton et al.

(1991)and Silva (1986) describe how thethe science of nursing. lack of empirical validation of nursing theory has hindered

the development of Silva and Sorrel1 (1992) have proposed criteria for evaluatingnursing science. theory-testing research,

and discuss important philosophical and methodological issues in the testing of nursing theory.

 Socio-cultural utility encompasses( 包圍 ) social23. Socio-cultural utility Johnson (1974), Meleis (1985) andcongruence(

適合 ) and social significance Social congruenceFawcett (1989)in their criteria for the evaluation of theory. encompasses the

beliefs, values and expectations of different cultures that As Meleis (1985)should shape and direct the type of theory most

useful to it. explains, self-care and independence are goals consistent with some cultures‟ Theories with such goals would be

incongruent(value systems but not others. 不一致 的 ) and inappropriate in some societies and cultures, and should be
avoided.

 Nurses in all roles24. Conclusion of criteria for the evaluation of theory will hopefully use these criteria proposed here to

guide their choice of theory There has been awhen using nursing theory in practice, education and research. dearth ( 缺乏 )

of empirical testing of theories in nursing, testing is only one A set of criteria for the evaluation ofpart of the evaluation of

theory. theory has been proposed here that includes: accuracy, consistency, fruitfulness, simplicity/complexity, scope,

acceptability and socio-cultural utility.

 Meleis, A. I. (2007). Theoretical Nursing: Development25. Theory Critique & Progress (4rd ed.). Philadelphia. PA:

Lippincott.(Ch9)(pp.186- 211)

 26. Table 11-5THEORY CRITIQUE— RELATIONSHIP BETWEENSTRUCTURE AND FUNCTION; DIAGRAM OF

THEORY;AND CIRCLE OF CONTAGIOUSNESSCRITERIA UNITS OF ANALYSISRelationship Claritybetween structure

Consistencyand function Simplicity/Complexity Tautology( 同義反複 )/Teleology( 目的論 )Diagram of theory Visual and
graphic presentation Logical representation ClarityCircle of Geographical origin of theory and geographicalcontagiousness

spread influence of theorist vs. theory

 27. Table 11-6THEORY CRITIQUE—USEFULNESSCRITERIA UNITS OF ANALYSISPractice Direction Cost

effectiveness Applicability Relevance GeneralizabilityResearch Consistency Predictability TestabilityEducation Philosophical

statement Concepts ObjectivesAdministration Structure of care Organization of care Guidelines for patient care Patient

classification system

 28. Table 11-7THEORY CRITIQUE—EXTERNAL COMPONENTSOF THEORYCRITERIA UNITS OF

ANALYSISPersonal values Theorist implicit/explicit values Critic implicit/explicit valuesCongruence with other

Complementarity( 補足 )professional values Esotericism( 祕傳性 )Congruence with social Beliefs Competitionvalues Values
CustomsSocial significance Value to humanity

 This question29. Forming a complete critical reflection1. Is this clear? Clarity and consistencyaddresses the clarity and

consistency of presentation. This question addressesmay be both semantic and structural.2. Is this simple? Complexitythe

number of structural components and relationships within theory. implies numerous relational components within theory;

simplicity implies fewer relational components.

 This question30. Forming a complete critical reflection3. Is this general? Generality infers a wideaddresses the scope of

experiences covered by theory. scope of phenomena, whereas specificity narrows the range of events included in This

question addresses the extent to whichtheory.4. Is this accessible? concepts within the theory are grounded in empirically

identifiable phenomena.5. This question addresses the extent to which theory leads toIs this important? valued nursing goals

in practice, research, and education.

 31. Guide for the critical reflection of theory 1.HOW CLEAR IS THIS THEORY? Are significant concepts not defined?

Are Are major concepts defined?  Are words coined? Are coineddefinitions clear? Congruent( 適合的 )? Consistent?

Are words borrowed from other disciplines and used differentlywords defined? Is the amount of explanation appropriate?

Too much? Notin this context? Not helpful? Needed Are examples or diagrams helpful? meaningful? enough? and not

present?

 Are basic assumptions consistent with32. 1.HOW CLEAR IS THIS THEORY? Are the Is the view of person and

environment compatible( 能共 處 )?purposes? Are Are different terms defined similarly?same terms defined differently?

Are compatible andconcepts used in a manner consistent with their definition? Cancoherent( 協調一致的 ) structures

suggested for different parts of the theory? Are there any ambiguities( 模稜兩可 ) as a result ofthe theory be followed?

Does the theorist accomplish what she or he sets outsequence of presentation? to do?

 How many relationships are contained33. 2.HOW SIMPLE IS THIS THEORY? How many concepts are How are the

relationships organized?within the theory?  Are some concepts differentiated into sub-concepts?contained in the theory?

Is the theoryCan concepts be combined without losing theoretic meaning? Does the theory tend to describe,complex some

areas and not in others? explain, or predict? Impact understanding? Create meaning?

 How specific are the purposes of this34. 3.HOW GENERAL IS THIS THEORY Is thus theorytheory? Do they apply to

all or only some practice areas? When? Is the purposespecific to nursing? If not, who else could use it? Why? If

subpurposes exist, do they reflect nursingjustifiably a nursing purpose? actions? How broad are the concepts within the

theory?

 How Are the concepts broad or narrow?35. 4.HOW ACCESSIBLE IS THIS THEORY Are the concepts‟specific or

general are definitions within the theory? empiric indicators identifiable in reality? Are they within the realm of Do the

definitions provided for the concepts adequately reflect theirnursing? Is a very narrow definition offered for a broad

concept? A broadmeanings? If words are coined, are they defined?meaning for a narrow concept?

 Does the theory have potential to36. 5.HOW IMPORTANT IS THIS THEORY? Does the theory influenceinfluence

nursing actions? If so, to what end? Hoenursing education? research? If so, to what end? Is that end desirable? specific are

the purposes of the theory? Do they provide a general framework Is the theory‟s positionwithin which to act or a means to

predict phenomena? about people, about nursing, and about the environment consistent with nursing‟s Given the purpose of

the theory and its orientation, what ofphilosophy? significance for nursing or health care has been omitted?

 Is the started or implied purpose one37. 5.HOW IMPORTANT IS THIS THEORY? Will use of the theory help or

hinderthat is important to nursing? Why? Will application of this theory resolve any importantnursing in any way? Is the

theory futuristic andissues in nursing? Will it resolve any problems?  Will research based on the theory answer important

questions?forward-looking? Do I like this theory? Why?Are the concepts within the domain of nursing?

 Theory development and evaluation are cyclical, continuous,38. Conclusion Theory evaluationand dynamic process. One

can not exist without the other. including description, concept analysis, theory critique, testing and support. These process are

based on the view that science is a human process that includes not only valid findings but also observation, agreements, useful

Theory evaluation is central to the development ofsolutions to problems. theory; it is the responsibility of each clinician,

academician.

 Kuhn(1977) “we can delineate such criteria and that39. Conclusion accuracy, consistency, broad scope, simplicity and

fruitfulness in research are However, “everyessential as objective criteria for judging competing theories” individuals choice

between competing theories depends on a mixture of objective The subjective factors are dependent on individualsand

subjective factors” Both objective and subjective factors have apreferences and personalities. place in our understanding of

the philosophy of science.

 40. Adaptation Model

 41. Exercise: Application of Roys Adaptation Model in Nursing Practicehttp://currentnursing.com/nursing_theory/applicat1.

What is the purpose of this theory?2. What are the concepts of this theory?3. How are the concepts defined?4. What is the

nature of relationships?5. What is the structure of the theory? .6. On what assumptions does the theory build?

Evaluation of-a-nursing-theory-nursing-theory-ppt from Maria Poly

Evaluation of-a-nursing-theory-nursing-theory-ppt Presentation Transcript

 1. Evaluation of a Nursing Theory

 2. Forming a Complete Description:Six Questions are Propose for Describing Theory.

 3. 1. What is the purpose of this theory? This question addresses why the theory was formu- lated and reflects the contexts and

situations to which the theory can be applied.2. What are the concepts of this theory? This question identifies the ideas that are

structured and related within the theory. It questions the quali- tative and quantitative dimensions of concepts.3. How are the

concepts defined? This question clarifies the meaning for concepts within the theory. It questions how empiric experi- ence is

represented by the ideas within the theory.

 4. 4. What is the nature of relationships? This question addresses how concepts are linked together. It focuses on the various

forms relationship statements can take and how they give structure to the theory.5. What is the structure of the theory? This

question addresses the overall form of the con- ceptual interrelationships. It discerns whether the theory contains partial

structures or has one basic form.6. On what assumptions does the theory build? This question addresses the basic truths that

underlie theoretic reasoning. It questions whether assumptions reflect philosophic values or factual assertions factual

assertions.

 Why is this theory5. Guide for the Description of Theory 1. PURPOSE Is there an overall purpose for the theory? A

hierarchy offormulated? Is there a purpose for the nurse? Thepurposes? Separate numerous purposes? How broad or

narrow is theperson receiving care? Society? Environment? What is the value orientation of the purpose? Positive,

negative,purpose? neutral?

 Does achieving the theoretic purpose require a nursing6. 1. PURPOSE Does the purpose reflect understanding? Creation of

meaning?context? When would the theoryDescription, explanation, and prediction of phenomena? What purpose not

explicitly( 明確地cases to be applicable? What is the end point? ) embedded( 植入 ) in the matrix of the theory can be
identified?

 Is there one major concept with sub-concepts organized under7. 2. CONCEPTS Can the How many major (or minor)

ones? How many concepts are there?it? concepts be ordered, related? Arranged into any configuration?

 Are Are there concepts that cannot be interrelated?8. 2. CONCEPTS How abstract( 抽象 ) or empiric( 經驗 ) are

theconcepts broad in scope? Narrow? What is the balance between highly abstract and highly empiricconcepts? concepts?

 Which Which concepts are defined? Which are not?9. 3. DEFINITIONS How much meaningconcepts are defined

explicitly? Which are implied( 隱喻 )? Are Which concepts are defined specifically? Generally?needs to be inferred ?

there competing definitions for some concepts? Are there similar definitions for Are any concepts defined contrary to common

convention( 習俗different concepts? , 常規 )?

  What are the major relationships within the theory?10. 4. RELATIONSHIPS Do relationships includeWhich

relationships are obvious? Which are implied? Are some concepts included in multipleall concepts? Which are not included?

Is there a hierarchy of relationships? Do relationships createrelationships? meaning and understanding? Do they do this by

describing, explaining? Are relationships illustrated?Predicting? What mix of each?

 If How are overall and individual ideas organized?11. 5. STRUCTURE Do relationships expand conceptsoutlined, what

THEORETICAL
BASIS

for Nursing

McEwen_FM.indd 1 10/10/13 11:21 AM

McEwen_FM.indd 2 10/10/13 11:21 AM

THEORETICAL
BASIS

for Nursing

Melanie McEwen, PhD, RN, CNE, ANEF
Associate Professor
University of Texas Health Science Center at Houston
School of Nursing
Houston, Texas

Evelyn M. Wills, PhD, RN
Professor (Retired)
Department of Nursing
College of Nursing and Allied Health Professions
University of Louisiana at Lafayette
Lafayette, Louisiana

F O U R T H E D I T I O N

McEwen_FM.indd 3 10/10/13 11:21 AM

Acquisitions Editor: Patrick Barbera
Product Development Editor: Helen Kogut
Editorial Assistant: Dan Reilly
Production Project Manager: Cynthia Rudy
Design Coordinator: Holly McLaughlin
Illustration Coordinator: Jennifer Clements
Manufacturing Coordinator: Karin Duffield
Prepress Vendor: Absolute Service, Inc.

4th edition

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007,
2002 Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No
part of this book may be reproduced or transmitted in any form or by any means, including as
photocopies or scanned-in or other electronic copies, or utilized by any information storage and
retrieval system without written permission from the copyright owner, except for brief quotations
embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as
part of their official duties as U.S. government employees are not covered by the above-mentioned
copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce
Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our
website at lww.com (products and services).

9 8 7 6 5 4 3 2 1

Printed in China

Library of Congress Cataloging-in-Publication Data
McEwen, Melanie, author.
Theoretical basis for nursing / Melanie McEwen, Evelyn M. Wills.—Edition 4.

p. ; cm.
Includes bibliographical references and indexes.
ISBN 978-1-4511-9031-1
I. Wills, Evelyn M., author. II. Title.
[DNLM: 1. Nursing Theory. WY 86]
RT84.5
610.73–dc23

2013035526

Care has been taken to confirm the accuracy of the information presented and to describe generally
accepted practices. However, the author(s), editors, and publisher are not responsible for errors
or omissions or for any consequences from application of the information in this book and make
no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the
contents of the publication. Application of this information in a particular situation remains the
professional responsibility of the practitioner; the clinical treatments described and recommended
may not be considered absolute and universal recommendations.

The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dos-
age set forth in this text are in accordance with the current recommendations and practice at the time of
publication. However, in view of ongoing research, changes in government regulations, and the constant
flow of information relating to drug therapy and drug reactions, the reader is urged to check the package
insert for each drug for any change in indications and dosage and for added warnings and precautions.
This is particularly important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have U.S. Food and Drug Ad-
ministration (FDA) clearance for limited use in restricted research settings. It is the responsibility of
the health care provider to ascertain the FDA status of each drug or device planned for use in his or
her clinical practice.

LWW.com

McEwen_FM.indd 4 10/10/13 11:21 AM

Proudly sourced and uploaded by [StormRG]
Kickass Torrents | The Pirate Bay | ExtraTorrent

To Kaitlin and Grant—You have helped me broaden my thoughts
and consider all kinds of possibilities; I hope I’ve done the same
for you.

Also for Helen and Keith—Our children chose well. Besides,
you have given us Madelyn, Logan, Brenna, Liam, Lucy, and
Andrew; they are gifts beyond words.

Melanie McEwen

To Tom, Paul, and Vicki, who light up my life, and to Marian,
who is my applause. To Teddy, Gwen, Merlyn, and Madelyn,
who have been so patient and loving during this process.
A thousand thank yous to Peggy, who has supported me through
this writing process.

Evelyn M. Wills

D E D I C A T I O N

McEwen_FM.indd 5 10/10/13 11:21 AM

Grace Bielkiewicz, RN, PMHCNS-BC
Assistant Professor (Retired)
Department of Nursing
Southern University
Baton Rouge, Louisiana
Chapter 13: Theories From the Sociologic Sciences

Debra Brossett Garner, DNP, APRN, ACNS-BC, PMHNP-BC
Psychiatric Mental Health Nurse Practitioner
Delhi Rural Health Clinic
Delhi, Louisiana
Chapter 14: Theories From the Behavioral Sciences

Melinda Granger Oberleitner, DNS, RN
Associate Dean, College of Nursing and Allied Health Professions
Professor, Department of Nursing
SLEMCO/BORSF Endowed Professor of Nursing
University of Louisiana at Lafayette
Lafayette, Louisiana
Chapter 16: Theories, Models, and Frameworks From Administration and
Management
Chapter 20: Application of Theory in Nursing Administration and
Management

C O N T R I B U T O R S

vi

McEwen_FM.indd 6 10/10/13 11:21 AM

R E V I E W E R S

Kimamer Amer, PhD
Associate Professor
Department of Nursing
DePaul University
Chicago, Illinois

Margaret Barnes, MSN, RN
Assistant Professor
School of Nursing, RNBSN Post-Licensure Division
Indiana Wesleyan University
Florence, Kentucky

Shari Cherney, RN, BScN, MHSc
Professor
Department of Nursing
George Brown College
Toronto, Ontario, Canada

Cheryl Delgado, PhD
Associate Professor
Department of Nursing
Cleveland State University
Cleveland, Ohio

Dolores Furlong, PhD
Professor
Department of Nursing
University of New Brunswick
Fredericton, New Brunswick, Canada

Maryanne Garon, DNSc
Professor
Department of Nursing
California State University Fullerton
Fullerton, California

Carol Grantham, PhD, MSN, CPNP-PC
Faculty
Byrdine F. Lewis School of Nursing & Health

Professions
Georgia State University
Atlanta, Georgia

Barbara Harris, PhD
Assistant Professor
School of Nursing
DePaul University
Chicago, Illinois

Seongkum Heo, PhD
Assistant Professor
Department of Nursing
University of Arkansas for Medical Sciences
Little Rock, Arkansas

Donna Murnaghan, PhD
Associate Professor
School of Nursing
University of Prince Edward Island
Charlottetown, Prince Edward Island, Canada

Pamela Reis, PhD, CNM
Assistant Professor
Department of Nursing
East Carolina University
Greenville, North Carolina

Sue Robertson, PhD
Assistant Professor
Department of Nursing
California State University, Fullerton
Fullerton, California

Denice Sheehan, PhD
Assistant Professor
Department of Nursing
Kent State University
Kent, Ohio

Ida Slusher, DSN
Professor & Nursing Education Coordinator
Department of Baccalaureate & Graduate Nursing
Eastern Kentucky University
Richmond, Kentucky

Sharon Van Sell, BSN, MEd, MS, EdD
Professor
Department of Nursing
Texas Woman’s University
Dallas, Texas

vii

McEwen_FM.indd 7 10/10/13 11:21 AM

P R E F A C E

viii

Frequently, nursing students respond with a cringing expression or a resounding
“ugh!” when faced with the requirement of taking a course on theory. Indeed, many
fail to see theory’s relevance to the real world of nursing practice and often have
difficulty applying the information in later courses and in their research. This book
is the result of the frustration felt by a group of nursing instructors who met a num-
ber of years ago to adopt a textbook for a theory course. Indeed, because of student
complaints and faculty dissatisfaction, we were changing textbooks yet again. A fairly
lengthy discussion arose in which we concluded that the available books did not meet
the needs of our students or course faculty. Ultimately, we determined to “build a
better mousetrap.” Our intent was to write a book that was a general overview of
theory per se, stressing how it is—and should be—used by nurses to improve practice,
research, education, and management/leadership.

As in past editions, an ongoing review of trends in nursing theory and nursing
science has shown an increasing emphasis on middle range theory, evidence-based
practice, and situation-specific theories. To remain current and timely, in this fourth
edition, we have added a new chapter discussing evidence-based practice, highlighting
how it relates to theory in nursing, and presenting several evidence-based practice
models commonly used by nurses. We have also included new middle range nursing
theories and added a significant section discussing situation-specific nursing theories,
describing how they relate to evidence-based practice. Updates and application exam-
ples have been added throughout the discussions on the various theories.

Organization of the Text

Theoretical Basis for Nursing is designed to be a basic nursing theory textbook that
includes the essential information students need to understand and apply theory.

The book is divided into four units. Unit I, Introduction to Theory, provides
the background needed to understand what theory is and how it is used in nursing.
It outlines tools and techniques used to develop, analyze, and evaluate theory so
that it can be used in nursing practice, research, administration and management,
and education. In this unit, we have provided a balanced view of “hot” topics (e.g.,
philosophical world views and utilization of shared or borrowed theory). Also, rather
than espousing one strategy for activities such as concept development and theory
evaluation, we have included a variety of strategies.

Unit II, Nursing Theories, focuses largely on the grand nursing theories and
begins with a chapter describing their historical development. This unit divides the
grand nursing theories into three groups based on their focus (human needs, in-
teractive process, and unitary process). The works of many of the grand theorists
are briefly summarized in Chapters 7, 8, and 9. We acknowledge that these analyses

McEwen_FM.indd 8 10/19/13 3:59 AM

Preface ix

are not comprehensive; rather, they are intended to provide the reader with enough
information to understand the basis of the work and to whet the reader’s appetite to
select one or more for further study.

Chapters 10 and 11 cover the significant topic of middle range nursing theory.
Chapter 10 presents a detailed overview of the origins and growth of middle range
theory in nursing and gives numerous examples of how middle range theories have
been developed by nurses. Chapter 11 provides an overview of some of the grow-
ing number of middle range nursing theories. The theories presented include some
of the most commonly used middle range nursing theories (e.g., Pender’s Health
Promotion Model and Leininger’s Culture Care Diversity and Universality Theory)
as well as some that are less well known but have a growing body of research sup-
port (e.g., Meleis’ Transitions Theory, the Theory of Unpleasant Symptoms, and the
Uncertainty in Illness Theory). The intent is to provide a broad range of middle range
theories to familiarize the reader with examples and to encourage them to search for
others appropriate to their practice or research. Ultimately, it is hoped that readers
will be challenged to develop new theories that can be used by nurses.

Chapter 12, which discusses evidence-based practice (EBP), is new to this edi-
tion. This chapter explains and defines the idea/process of EBP and describes how it
relates to nursing theory and application of theory in nursing practice and research.
The chapter concludes with a short presentation and review of five different EBP
models that have been widely used by nurses and are well supported in the literature.

Unit III, Shared Theories Used by Nurses, is rather unique in nursing litera-
ture. Our book acknowledges that “shared” or “borrowed” theories are essential to
nursing and negates the idea that the use of shared theory in practice or research is
detrimental. In this unit, we have identified some of the most significant theories that
have been developed outside of the discipline of nursing but are continually used in
nursing. We have organized these theories based on broad disciplines: theories from
the sociologic sciences, behavioral sciences, and biomedical sciences, as well as from
administration and management and learning. Each of these chapters was written by
a nurse with both educational and practical experience in her respective area. These
theories are presented with sufficient information to allow the reader to understand
the theories and to recognize those that might be appropriate for her or his own
work. These chapters also provide original references and give examples of how the
concepts, theories, and models described have been used by other nurses.

Finally, Unit IV, Application of Theory in Nursing Practice, explains how the-
ories are applied in nursing. Separate chapters cover nursing practice, nursing research,
nursing administration and management, and nursing education. These chapters in-
clude many specific examples for the application of theory and are intended to be a
practical guide for theory use. The heightened development of practice theories and
EBP guidelines are critical to theory application in nursing today, so these areas have
been expanded. The unit concludes with a chapter that discusses some of the future
issues in theory within the discipline.

McEwen_FM.indd 9 10/19/13 3:59 AM

x Preface

■ New Chapter 12, Evidence-Based Practice and Nursing Theory
■ More detailed explanation of EBP and its relationship to theory in nursing
■ Enhanced attention to situation-specific theories and how they relate to EBP
■ Numerous recent examples of application of theories in nursing practice,

nursing research, leadership/administration, and education
■ NEW instructional support

New To This Edition

Student Resources Available on

■ Literature Assessment Activity provides an interactive tool featuring journal
articles along with questions that will encourage students to think critically
about the literature. Students can print or e-mail their responses to their
instructor.

■ Case Studies with applicable questions guide students in understanding how
the various theories link to nursing practice.

■ Learning Objectives for each chapter help focus the student.
■ Internet Resources provide live web links to pertinent sites so that students

can further their study and understanding of the various theories.
■ Journal Articles for each chapter offer opportunities to gain more knowledge

and understanding of the chapter content.

Key Features
In addition to numerous tables and boxes that highlight and summarize important
information, Theoretical Basis for Nursing contains case studies, learning activities,
exemplars, and illustrations that help students visualize various concepts. New to this
edition is a special feature called Link to Practice.

■ Link to Practice: All chapters include at least one “Link to Practice” box,
which presents useful information or clinically related examples related to the
subject being discussed. The intent is to give additional tools or resources that
can be used by nurses to apply the content in their own practice or research.

■ Case Studies: At the end of Chapter 1 and the beginning of Chapters 2 to 22,
case studies help the reader understand how the content in the chapter relates
to the everyday experience of the nurse, whether in practice, research, or other
aspects of nursing.

■ Learning Activities: At the end of each chapter, learning activities pose critical
thinking questions, propose individual and group projects related to topics
covered in the chapter, and stimulate classroom discussion.

■ Exemplars: In five chapters, an exemplar discusses a scholarly study from the
perspectives of concept analysis (Chapter 3); theory development (Chapter 4);
theory analysis and evaluation (Chapter 5); middle range theory develop-
ment (Chapter 10); and theory generation via research, theory testing via
research, and use of a theory as the conceptual framework for a research study
(Chapter 19).

■ Illustrations: Diagrams and models are included throughout the book to help
the reader better understand the many different theories presented.

McEwen_FM.indd 10 10/10/13 11:21 AM

Preface xi

Instructor Resources Available on
■ Instructor’s Guide includes application-level discussion questions and classroom/

online activities that Melanie McEwen uses in her own teaching!
■ Strategies for Effective Teaching of Nursing Theory provide ideas for

instructors to help make the nursing theory class come alive.
■ Test Generator Questions provide multiple-choice questions that can be used

for testing general content knowledge.
■ PowerPoints with audience response (Iclicker) questions, based on

the ones used by Melanie McEwen in her own classroom, help highlight
important points to enhance the classroom, experience.

■ Case Studies with questions, answers, and related activities offer opportunities
for instructors to make the student case studies an exciting, fun, and rewarding
classroom/online experience.

■ Image Bank provides images from the text that instructors can use to enhance
their own presentations.

In summary, the focus of this learning package is on the application of theory rather
than on the study, analysis, and critique of grand theorists or a presentation of a
specific aspect of theory (e.g., construction or evaluation). It is hoped that practic-
ing nurses, nurse researchers, and nursing scholars, as well as graduate students and
theory instructors, will use this book and its accompanying resources to gain a better
understanding and appreciation of theory.

Melanie McEwen, PhD, RN, CNE, ANEF
Evelyn M. Wills, PhD, RN

McEwen_FM.indd 11 10/10/13 11:21 AM

xii

A C K N O W L E D G M E N T S

Our heartfelt thanks to Product Development Editor, Helen Kogut, for her assis-
tance, patience, and persistence in helping us complete this project. She has made a
difficult task seem easy! We also want to thank Acquisitions Editor, Christina Burns,
for her wonderful support and assistance in getting this project started and Patrick
Barbera for seeing it through to the end. Finally, a huge word of thanks to our con-
tributors who have diligently worked to present the notion of theory in a manner that
will engage nursing students and to look for new examples and applications to help
make theory fresh and relevant.

McEwen_FM.indd 12 10/10/13 11:21 AM

xiii

C O N T E N T S

Unit I: Introduction to Theory 1
1. Philosophy, Science, and Nursing 2

Melanie McEwen
Nursing as a Profession 2
Nursing as an Academic Discipline 4
Introduction to Science and Philosophy 5
Science and Philosophical Schools of Thought 7
Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing 11
Knowledge Development and Nursing Science 12
Research Methodology and Nursing Science 16

2. Overview of Theory in Nursing 23
Melanie McEwen

Overview of Theory 24
The Importance of Theory in Nursing 25
Terminology of Theory 26
Historical Overview: Theory Development in Nursing 26
Classification of Theories in Nursing 36
Issues in Theory Development in Nursing 40

3. Concept Development: Clarifying Meaning of Terms 49
Evelyn M. Wills, Melanie McEwen

The Concept of “Concept” 50
Concept Analysis/Concept Development 54
Strategies for Concept Analysis and Concept Development 57

4. Theory Development: Structuring Conceptual Relationships
in Nursing 72

Melanie McEwen
Overview of Theory Development 73
Categorizations of Theory 73
Components of a Theory 79
Theory Development 82

5. Theory Analysis and Evaluation 95
Melanie McEwen

Definition and Purpose of Theory Evaluation 96
Historical Overview of Theory Analysis and Evaluation 97
Comparisons of Methods 106
Synthesized Method of Theory Evaluation 106

McEwen_FM.indd 13 10/10/13 11:21 AM

xiv Contents

6. Overview of Grand Nursing Theories 116
Evelyn M. Wills

Categorization of Conceptual Frameworks and Grand Theories 118
Specific Categories of Models and Theories for This Unit 124
Analysis Criteria for Grand Nursing Theories 124
The Purpose of Critiquing Theories 127

7. Grand Nursing Theories Based on Human Needs 131
Evelyn M. Wills

Florence Nightingale: Nursing: What It Is and What It Is Not 132
Virginia Henderson: The Principles and Practice of Nursing 136
Faye G. Abdellah: Patient-Centered Approaches to Nursing 139
Dorothea E. Orem: The Self-Care Deficit Nursing Theory 142
Dorothy Johnson: The Behavioral System Model 146
Betty Neuman: The Neuman Systems Model 149

8. Grand Nursing Theories Based on Interactive Process 159
Evelyn M. Wills

Myra Estrin Levine: The Conservation Model 160
Barbara M. Artinian: The Intersystem Model 164

Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain:
Modeling and Role-Modeling 169

Imogene M. King: King’s Conceptual System and Theory of Goal Attainment and
Transactional Process 173

Sister Callista Roy: The Roy Adaptation Model 177
Jean Watson: Caring Science as Sacred Science 182

9. Grand Nursing Theories Based on Unitary Process 192
Evelyn M. Wills

Martha Rogers: The Science of Unitary and Irreducible Human Beings 193
Margaret Newman: Health as Expanding Consciousness 198
Rosemarie Parse: The Humanbecoming Paradigm 202

10. Introduction to Middle Range Nursing Theories 213
Melanie McEwen

Purposes of Middle Range Theory 214
Characteristics of Middle Range Theory 215
Concepts and Relationships for Middle Range Theory 216
Categorizing Middle Range Theory 217
Development of Middle Range Theory 217
Analysis and Evaluation of Middle Range Theory 225

11. Overview of Selected Middle Range Nursing Theories 229
Melanie McEwen

High Middle Range Theories 230
Middle Middle Range Theories 241
Low Middle Range Theories 248

12. Evidence-Based Practice and Nursing Theory 258
Evelyn M. Wills, Melanie McEwen

Overview of Evidence-Based Practice 259
Definition and Characteristics of Evidence-Based Practice 259
Concerns Related to Evidence-Based Practice in Nursing 261
Evidence-Based Practice and Practice-Based Evidence 261

Unit II: Nursing Theories 115

McEwen_FM.indd 14 10/10/13 11:21 AM

Contents xv

Promotion of Evidence-Based Practice in Nursing 263
Theory and Evidence-Based Practice 263
Theoretical Models of EBP 264

Unit III: Shared Theories Used by Nurses 277
13. Theories From the Sociologic Sciences 278

Grace Bielkiewicz
Exchange Theories 279
Interactionist Frameworks 284
Conflict Theories 289
Chaos Theory 295
Postmodern Social Theory 298

14. Theories From the Behavioral Sciences 305
Debra Brossett Garner

Psychodynamic Theories 306
Behavioral and Cognitive-Behavioral Theories 313
Humanistic Theories 315
Stress Theories 318
Social Psychology 321

15. Theories From the Biomedical Sciences 331
Melanie McEwen

Theories and Models of Disease Causation 332
Theories and Principles Related to Physiology and Physical Functioning 339

16. Theories, Models, and Frameworks From Leadership
and Management 354

Melinda Granger Oberleitner
Overview of Concepts of Leadership and Management 355
Early Leadership Theories 355
Contemporary Leadership Theories 362
Organizational/Management Theories 365
Motivational Theories 366
Concepts of Power, Empowerment, and Change 368
Problem-Solving and Decision-Making Processes 372
Conflict Management 374
Quality Improvement 375
Evidence-Based Practice 380

17. Learning Theories 386
Evelyn M. Wills, Melanie McEwen

What Is Learning? 387
What Is Teaching? 388
Categorization of Learning Theories 388
Behavioral Learning Theories 389
Cognitive Learning Theories 392
Summary of Learning Theories 404
Learning Styles 405
Principles of Learning 406
Application of Learning Theories in Nursing 407

McEwen_FM.indd 15 10/10/13 11:21 AM

xvi Contents

Unit IV: Application of Theory in Nursing 411
18. Application of Theory in Nursing Practice 412

Melanie McEwen
Relationship Between Theory and Practice 413
Theory-Based Nursing Practice 414
The Theory–Practice Gap 416
Situation-Specific/Practice Theories in Nursing 418
Application of Theory in Nursing Practice 422

19. Application of Theory in Nursing Research 430
Melanie McEwen

Historical Overview of Research and Theory in Nursing 431
Relationship Between Research and Theory 432
Types of Theory and Corresponding Research 434
How Theory Is Used in Research 437
Nursing and Non-Nursing Theories in Nursing Research 444
Other Issues in Nursing Theory and Nursing Research 445

20. Application of Theory in Nursing Administration and
Management 452

Melinda Granger Oberleitner
Organizational Design 453
Shared Governance 456
Transformational Leadership in Nursing and in Health Care 458
Patient Care Delivery Models 459
Case Management 466
Disease/Chronic Illness Management 468
Quality Management 470

21. Application of Theory in Nursing Education 479
Evelyn M. Wills, Melanie McEwen

Theoretical Issues in Nursing Curricula 481
Theoretical Issues in Nursing Instruction 488

22. Future Issues in Nursing Theory 497
Melanie McEwen

Future Issues in Nursing Science 499
Future Issues in Nursing Theory 500

Theoretical Perspectives on Future Issues in Nursing Practice, Research,
Administration and Management, and Education 502

Glossary 513
Author Index 523
Subject Index 554

McEwen_FM.indd 16 10/10/13 11:21 AM

U N I T I

Introduction to Theory

McEwen_CH01.indd 1 10/10/13 10:53 AM

Philosophy,
Science, and
Nursing
Melanie McEwen

C H A P T E R 1

2

Largely due to the work of nursing scientists, nursing theorists, and nursing scholars
over the past five decades, nursing has been recognized as both an emerging
profession and an academic discipline. Crucial to the attainment of this distinction
have been numerous discussions regarding the phenomena of concern to nurses and
countless efforts to enhance involvement in theory utilization, theory generation, and
theory testing to direct research and improve practice.

A review of the nursing literature from the late 1970s until the present shows
sporadic discussion of whether nursing is a profession, a science, or an academic
discipline. These discussions are sometimes pleading, frequently esoteric, and
occasionally confusing. Questions that have been raised include: What defines a
profession? What constitutes an academic discipline? What is nursing science? Why
is it important for nursing to be seen as a profession or an academic discipline?

Nursing as a Profession

In the past, there has been considerable discussion about whether nursing is a profes-
sion or an occupation. This is important for nurses to consider for several reasons. An
occupation is a job or a career, whereas a profession is a learned vocation or occupa-
tion that has a status of superiority and precedence within a division of work. In gen-
eral terms, occupations require widely varying levels of training or education, varying
levels of skill, and widely variable defined knowledge bases. In short, all professions
are occupations, but not all occupations are professions (Finkelman & Kenner, 2013).

Professions are valued by society because the services professionals provide are ben-
eficial for members of the society. Characteristics of a profession include (1) defined
and specialized knowledge base, (2) control and authority over training and education,
(3) credentialing system or registration to ensure competence, (4) altruistic service to
society, (5) a code of ethics, (6) formal training within institutions of higher education,
(7) lengthy socialization to the profession, and (8) autonomy (control of professional
activities) (Ellis & Hartley, 2012; Finkelman & Kenner, 2013; Rutty, 1998). Professions

McEwen_CH01.indd 2 10/10/13 10:53 AM

Chapter 1 Philosophy, Science, and Nursing 3

must have a group of scholars, investigators, or researchers who work to continually ad-
vance the knowledge of the profession with the goal of improving practice (Schlotfeldt,
1989). Finally, professionals are responsible and accountable to the public for their work
(Hood, 2010). Traditionally, professions have included the clergy, law, and medicine.

Until near the end of the 20th century, nursing was viewed as an occupation
rather than a profession. Nursing has had difficulty being deemed a profession because
many of the services provided by nurses have been perceived as an extension of those
offered by wives and mothers. Additionally, historically, nursing has been seen as sub-
servient to medicine, and nurses have delayed in identifying and organizing profes-
sional knowledge. Furthermore, education for …

2

3

4

5

Acquisitions Editor: Christina Burns
Development Editor: Michael Kerns
Editorial Coordinator: Tim Rinehart
Editorial Assistant: Kaitlin Campbell
Production Project Manager: Kim Cox
Design Coordinator: Elaine Kasmer
Illustration Coordinator: Jennifer Clements
Manufacturing Coordinator: Karin Duffield
Prepress Vendor: Absolute Service, Inc.

Fifth Edition

Copyright © 2019 Wolters Kluwer Health.

Copyright © 2014, 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2002 Lippincott Williams & Wilkins. All
rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means,
including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written
permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book
prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To
request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via
email at [email protected], or via our website at lww.com (products and services).

9 8 7 6 5 4 3 2 1

Printed in China

Library of Congress Cataloging-in-Publication Data

Names: McEwen, Melanie, author. | Wills, Evelyn M., author.
Title: Theoretical basis for nursing / Melanie McEwen, Evelyn M. Wills.
Description: Fifth edition. | Philadelphia : Wolters Kluwer, [2018] |

Includes bibliographical references and index.
Identifiers: LCCN 2017049174 | ISBN 9781496351203
Subjects: | MESH: Nursing Theory
Classification: LCC RT84.5 | NLM WY 86 | DDC 610.73—dc23 LC record available at https://lccn.loc.gov/2017049174

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the author(s),
editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and
make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application
of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and
recommended may not be considered absolute and universal recommendations.

The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance
with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government
regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for
each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the
recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have U.S. Food and Drug Administration (FDA) clearance for limited use in
restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use
in his or her clinical practice.

LWW.com

6

mailto:[email protected]

http://lww.com

https://lccn.loc.gov/2017049174

http://LWW.com

D E D I C AT I O N

To Kaitlin and Grant—You have helped me broaden my thoughts and consider all kinds of possibilities;
I hope I’ve done the same for you.

Also for Helen and Keith—Our children chose well. Besides, you have given us Madelyn, Logan,
Brenna, Liam, Lucy, Andrew, Michael, and Jacob; they are gifts beyond words.

Melanie McEwen

To Tom, Paul, and Vicki, who light up my life, and to Marian, who left us for a better place. You were
always my best listener. To Teddy, Gwen, Merlyn, and Madelyn, who have been so patient and loving
during this process.

My deepest gratitude to Leslie, who has supported me through this writing process.

Evelyn M. Wills

7

C O N T R I B U T O R S

Sattaria Smith Dilks, DNP, APRN-BC, FNP, PMHNP/CNS
Professor and Co-Coordinator Graduate Program
College of Nursing
McNeese State University
Lake Charles, Louisiana
Chapter 14: Theories From the Behavioral Sciences

Joan C. Engebretson, DrPH, AHN-BC, RN, FAAN
Judy Fred Professor in Nursing
University of Texas Health Science Center at Houston
School of Nursing, Department of Family Nursing
Houston, Texas
Chapter 13: Theories From the Sociologic Sciences

Melinda Granger Oberleitner, DNS, RN
Associate Dean, College of Nursing & Allied Health Professions
Professor, Department of Nursing
SLEMCO/BORSF Endowed Professor of Nursing
University of Louisiana at Lafayette
Lafayette, Louisiana
Chapter 17: Theories, Models, and Frameworks From Leadership and Management
Chapter 21: Application of Theory in Nursing Administration and Management

Cathy L. Rozmus, PhD, RN
PARTNERS Endowed Professorship in Nursing
Vice Dean
Department of Family Health
The University of Texas Health Science Center at Houston
School of Nursing
Houston, Texas
Chapter 16: Ethical Theories and Principles

Jeffrey P. Spike, PhD
Professor of Family and Community Medicine
The University of Texas Health Science Center at Houston
School of Medicine
Professor, Department of Management, Policy, and Community Health
University of Texas Health Science Center School of Public Health
Houston, Texas
Chapter 16: Ethical Theories and Principles

8

R E V I E W E R S

Cynthia Dakin, PhD, RN
Director of Graduate Studies
Associate Professor
Department of Nursing
Elms College
Chicopee, Massachusetts

Janet DuPont, RNC-OB, MSN, MEd, PhD
Master of Science in Nursing Instructor/Developer
Nursing Program
Norwich University
Northfield, Vermont

Ruth Neese, PhD, RN, CEN
Assistant Professor
Department of Nursing
Indian River State College
Fort Pierce, Florida

Brandon N. Respress, PhD, RN, MPH, MSN
Assistant Professor
College of Nursing and Health Innovation
University of Texas at Arlington
Arlington, Texas

Jacqueline Saleeby, PhD, RN, CS
Associate Professor
Department of Nursing
Maryville University
St. Louis, Missouri

Stephen J. Stapleton, PhD, MS, RN, CEN, FAEN
Associate Professor
Mennonite College of Nursing
Illinois State University
Normal, Illinois

Kathleen Williamson, MSN, PhD, RN
Associate Professor and Chair
Wilson School of Nursing
Midwestern State University
Wichita Falls, Texas

Cindy Zellefrow, DNP, MSEd, RN, LSN, APHN-BC
Assistant Professor of Clinical Practice
Assistant Director, Center for Transdisciplinary and Evidence-based Practice

9

College of Nursing
The Ohio State University
Columbus, Ohio

10

P R E FA C E

Rare is the student who enrolls in a nursing program and is excited about the requirement of taking a course
on theory. Indeed, many fail to see theory’s relevance to the real world of nursing practice and often have
difficulty applying the information in later courses and in their research. This book is the result of the
frustration felt by a group of nursing instructors who met a number of years ago to adopt a textbook for a
theory course. Indeed, because of student complaints and faculty dissatisfaction, we were changing textbooks
yet again. A fairly lengthy discussion arose in which we concluded that the available books did not meet the
needs of our students or course faculty. We were determined to write a book that was a general overview of
theory per se, stressing how it is—and should be—used by nurses to improve practice, research, education,
and management/leadership.

As in past editions, an ongoing review of trends in nursing theory and nursing science has shown an
increasing emphasis on middle range theory, evidence-based practice (EBP), and situation-specific theories.
To remain current and timely, in this fifth edition, we have added a new chapter entitled “Ethical Theories and
Principles,” presenting information on these topics and describing how they relate to theory in nursing. We
have also included new middle range and situation-specific nursing theories as well as new “shared” theories
from non-nursing disciplines. One notable addition is a significant section discussing Complexity Science and
Complex Adaptive Systems in Chapter 13 (Theories From the Sociologic Sciences) helping to explain their
importance to nursing. Updates and application examples have been added throughout the discussions on the
various theories.

Organization of the Text
Theoretical Basis for Nursing is designed to be a basic nursing theory textbook that includes the essential
information students need to understand and apply theory in practice, research, education, and
administration/management.

The book is divided into four units. Unit I, Introduction to Theory, provides the background needed to
understand what theory is and how it is used in nursing. It outlines tools and techniques used to develop,
analyze, and evaluate theory so that it can be used in nursing practice, research, administration and
management, and education. In this unit, we have provided a balanced view of “hot” topics (e.g.,
philosophical world views and utilization of shared or borrowed theory). Also, rather than espousing one
strategy for activities such as concept development and theory evaluation, we have included a variety of
strategies.

Unit II, Nursing Theories, focuses largely on the grand nursing theories and begins with a chapter
describing their historical development. This unit divides the grand nursing theories into three groups based
on their focus (human needs, interactive process, and unitary process). The works of many of the grand
theorists are briefly summarized in Chapters 7, 8, and 9. Because this volume is intended to serve as a broad
foundation, these analyses provide the reader with enough information to understand the basis of the work and
to whet the reader’s appetite to select one or more for further study rather than delving into significant detail.

Chapters 10 and 11 cover the significant topic of middle range nursing theory. Chapter 10 presents a
detailed overview of the origins and growth of middle range theory in nursing and gives numerous examples
of how middle range theories have been developed by nurses. Chapter 11 provides an overview of some of the
growing number of middle range nursing theories. The theories presented include some of the most
commonly used middle range nursing theories (e.g., Pender’s Health Promotion Model and Leininger’s
Culture Care Diversity and Universality Theory) as well as some that are less well known but have a growing
body of research support (e.g., Meleis’s Transitions Theory, the Theory of Unpleasant Symptoms, and the

11

Uncertainty in Illness Theory). The intent is to provide a broad range of middle range theories to familiarize
the reader with examples and to encourage them to search for others appropriate to their practice or research.
Ultimately, it is hoped that readers will be challenged to develop new theories that can be used by nurses.

Chapter 12, which discusses EBP, explains and defines the idea/process of EBP and describes how it
relates to nursing theory and application of theory in nursing practice and research. The chapter concludes
with a short presentation and review of five different EBP models that have been widely used by nurses and
are well supported in the literature.

Unit III, Shared Theories Used by Nurses, is rather unique in nursing literature. Our book
acknowledges that “shared” or “borrowed” theories are essential to nursing and negates the idea that the use
of shared theory in practice or research is detrimental. In this unit, we have identified some of the most
significant theories that have been developed outside of the discipline of nursing but are continually used in
nursing. We have organized these theories based on broad disciplines: theories from the sociologic sciences,
behavioral sciences, biomedical sciences, and philosophy as well as from administration, management, and
learning. Each of these chapters was written by a nurse with both educational and practical experience in his
or her respective area. These theories are presented with sufficient information to allow the reader to
understand the theories and to recognize those that might be appropriate for his or her own work. These
chapters also provide original references and give examples of how the concepts, theories, and models
described have been used by other nurses.

Chapter 16, new to the fifth edition, describes ethical theories and principles that apply to nursing practice.
This addition was suggested by nursing faculty who recognized the importance of maintaining an ethical
perspective within the very complex health care system. This information is vital to professional nursing
practice and absolutely essential for nurses in advanced practice, management, or educational roles.

Finally, Unit IV, Application of Theory in Nursing, explains how theories are applied in nursing.
Separate chapters cover nursing practice, nursing research, nursing administration and management, and
nursing education. These chapters include many specific examples for the application of theory and are
intended to be a practical guide for theory use. The heightened development of practice theories and EBP
guidelines are critical to theory application in nursing today, so these areas have been expanded. The unit
concludes with a chapter that discusses some of the future issues in theory within the discipline.

Key Features
In addition to numerous tables and boxes that highlight and summarize important information, Theoretical
Basis for Nursing contains case studies, learning activities, exemplars, and illustrations that help students
visualize various concepts. New to this edition is a special boxed feature in most chapters that highlights how
a topic is outlined in the American Association of Colleges of Nursing (AACN’s) The Essentials of Master’s
Education in Nursing or The Essentials of Doctoral Education for Advanced Nursing Practice. Other key
features include:

■ Link to Practice: All chapters include at least one “Link to Practice” box, which presents useful
information or clinically related examples related to the subject being discussed. The intent is to give
additional tools or resources that can be used by nurses to apply the content in their own practice or
research.

■ Case Studies: At the end of Chapter 1 and the beginning of Chapters 2 to 23, case studies help the
reader understand how the content in the chapter relates to the everyday experience of the nurse,
whether in practice, research, or other aspects of nursing.

■ Learning Activities: At the end of each chapter, learning activities pose critical thinking questions,
propose individual and group projects related to topics covered in the chapter, and stimulate classroom
discussion.

■ Exemplars: In five chapters, an exemplar discusses a scholarly study from the perspectives of concept
analysis (Chapter 3); theory development (Chapter 4); theory analysis and evaluation (Chapter 5);
middle range theory development (Chapter 10); and theory generation via research, theory testing via
research, and use of a theory as the conceptual framework for a research study (Chapter 20).

■ Illustrations: Diagrams and models are included throughout the book to help the reader better

12

understand the many different theories presented.

New to This Edition
■ New Chapter 16, Ethical Theories and Principles
■ Detailed section on Complexity Science and Complex Adaptive Systems in Chapter 13.
■ More detailed explanation of EBP, situation-specific theories, and their relationship to theory in nursing
■ Numerous recent examples of application of theories in nursing practice, nursing research,

leadership/administration, and education
■ Enhanced instructional support, focusing on activities and information directed toward online learning

Student Resources Available on
■ Literature Assessment Activity provides an interactive tool featuring journal articles along with

critical thinking questions that will encourage students to engage with the literature. Students can print
or e-mail their responses to their instructor.

■ Case Studies with applicable questions guide students in understanding how the various theories link
to nursing practice.

■ Learning Objectives for each chapter help focus the student on outcomes.
■ Internet Resources provide live web links to pertinent sites so that students can further their study and

understanding of the various theories.
■ Journal Articles for each chapter offer opportunities to gain more knowledge and understanding of the

chapter content.

Instructor Resources Available on
■ Instructor’s Guide includes application-level discussion questions and classroom/online activities that

Melanie McEwen uses in her own teaching!
■ Strategies for Effective Teaching of Nursing Theory provide ideas for instructors to help make the

nursing theory class come alive.
■ Test Generator Questions provide multiple-choice questions that can be used for testing general

content knowledge.
■ PowerPoints with audience response (Iclicker) questions, based on the ones used by Melanie

McEwen in her own classroom, help highlight important points to enhance the classroom experience.
■ Case Studies with questions, answers, and related activities offer opportunities for instructors to make

the student case studies an exciting, fun, and rewarding classroom/online experience.
■ Image Bank provides images from the text that instructors can use to enhance their own presentations.

In summary, the focus of this learning package is on the application of theory rather than on the study,
analysis, and critique of grand theorists or a presentation of a specific aspect of theory (e.g., construction or
evaluation). It is hoped that practicing nurses, nurse researchers, and nursing scholars, as well as graduate
students and theory instructors, will use this book and its accompanying resources to gain a better
understanding and appreciation of theory.

Melanie McEwen, PhD, RN, CNE, ANEF
Evelyn M. Wills, PhD, RN

13

A C K N O W L E D G M E N T S

Our heartfelt thanks to Senior Development Editor, Michael Kerns, and Editorial Coordinator, Tim Rinehart,
for their assistance, patience, and persistence in helping us complete this project. They made a difficult task
seem easy! We also want to thank Senior Acquisitions Editor, Christina Burns, and Helen Kogut, for their
support and assistance in getting this project started and help with previous editions. Finally, a huge word of
thanks to our contributors who have diligently worked to present the notion of theory in a manner that will
engage nursing students and to look for new examples and applications to help make theory fresh and
relevant.

14

C O N T E N T S

Unit I: Introduction to Theory

1. Philosophy, Science, and Nursing
Melanie McEwen

Case Study
Nursing as a Profession
Nursing as an Academic Discipline
Introduction to Science and Philosophy

Overview of Science
Overview of Philosophy

Science and Philosophical Schools of Thought
Received View (Empiricism, Positivism, Logical Positivism)

Contemporary Empiricism/Postpositivism
Nursing and Empiricism

Perceived View (Human Science, Phenomenology, Constructivism, Historicism)
Nursing and Phenomenology/Constructivism/Historicism

Postmodernism (Poststructuralism, Postcolonialism)
Nursing and Postmodernism

Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing
Nursing Philosophy
Nursing Science
Philosophy of Science in Nursing

Knowledge Development and Nursing Science
Epistemology

Ways of Knowing
Nursing Epistemology
Other Views of Patterns of Knowledge in Nursing
Summary of Ways of Knowing in Nursing

Research Methodology and Nursing Science
Nursing as a Practice Science
Nursing as a Human Science
Quantitative Versus Qualitative Methodology Debate

Quantitative Methods
Qualitative Methods
Methodologic Pluralism

Summary
Key Points

Learning Activities

2. Overview of Theory in Nursing
Melanie McEwen

Overview of Theory
The Importance of Theory in Nursing
Terminology of Theory

15

Historical Overview: Theory Development in Nursing
Florence Nightingale
Stages of Theory Development in Nursing

Silent Knowledge Stage
Received Knowledge Stage
Subjective Knowledge Stage
Procedural Knowledge Stage
Constructed Knowledge Stage
Integrated Knowledge Stage

Summary of Stages of Nursing Theory Development
Classification of Theories in Nursing

Scope of Theory
Metatheory
Grand Theories
Middle Range Theories
Practice Theories

Type or Purpose of Theory
Descriptive (Factor-Isolating) Theories
Explanatory (Factor-Relating) Theories
Predictive (Situation-Relating) Theories
Prescriptive (Situation-Producing) Theories

Issues in Theory Development in Nursing
Borrowed Versus Unique Theory in Nursing
Nursing’s Metaparadigm

Relationships Among the Metaparadigm Concepts
Other Viewpoints on Nursing’s Metaparadigm

Caring as a Central Construct in the Discipline of Nursing
Summary
Key Points

Learning Activities

3. Concept Development: Clarifying Meaning of Terms
Evelyn M. Wills and Melanie McEwen

The Concept of “Concept”
Types of Concepts

Abstract Versus Concrete Concepts
Variable (Continuous) Versus Nonvariable (Discrete) Concepts
Theoretically Versus Operationally Defined Concepts

Sources of Concepts
Concept Analysis/Concept Development

Purposes of Concept Development
Context for Concept Development
Concept Development and Conceptual Frameworks
Concept Development and Research

Strategies for Concept Analysis and Concept Development
Walker and Avant

Concept Analysis
Concept Synthesis
Concept Derivation
Examples of Concept Analysis Using Walker and Avant’s Techniques

Rodgers
Schwartz-Barcott and Kim

Theoretical Phase

16

Fieldwork Phase
Analytical Phase

Meleis
Concept Exploration
Concept Clarification
Concept Analysis

Morse
Concept Delineation
Concept Comparison
Concept Clarification

Penrod and Hupcey
Comparison of Models for Concept Development

Summary
Key Points

Learning Activities

4. Theory Development: Structuring Conceptual Relationships in Nursing
Melanie McEwen

Overview of Theory Development
Categorizations of Theory

Categorization Based on Scope or Level of Abstraction
Philosophy, Worldview, or Metatheory
Grand Theories
Middle Range Theories
Practice Theories
Relationship Among Levels of Theory in Nursing

Categorization Based on Purpose
Descriptive Theories
Explanatory Theories
Predictive Theories
Prescriptive Theories

Categorization Based on Source or Discipline
Components of a Theory

Purpose
Concepts and Conceptual Definitions
Theoretical Statements

Existence Statements
Relational Statements

Structure and Linkages
Assumptions
Models

Theory Development
Relationship Among Theory, Research, and Practice

Relationship Between Theory and Research
Relationship Between Theory and Practice
Relationship Between Research and Practice

Approaches to Theory Development
Theory to Practice to Theory
Practice to Theory
Research to Theory
Theory to Research to Theory
Integrated Approach

Process of Theory Development

17

Concept Development: Creation of Conceptual Meaning
Statement Development: Formulation and Validation of Relational Statements
Theory Construction: Systematic Organization of the Linkages
Validating and Confirming Theoretical Relationships in Research
Validation and Application of Theory in Practice

Summary
Key Points

Learning Activities

5. Theory Analysis and Evaluation
Melanie McEwen

Definition and Purpose of Theory Evaluation
Theory Description
Theory Analysis
Theory Evaluation

Historical Overview of Theory Analysis and Evaluation
Characteristics of Significant Theories: Ellis
Theory Evaluation: Hardy
Theory Analysis and Theory Evaluation: Duffey and Muhlenkamp
Theory Evaluation: Barnum
Theory Analysis: Walker and Avant
Theory Analysis and Evaluation: Fawcett
Theory Description and Critique: Chinn and Kramer
Theory Description, Analysis, and Critique: Meleis
Analysis and Evaluation of Practice Theory, Middle Range Theory, and Nursing Models:
Whall
Theory Evaluation: Dudley-Brown

Comparisons of Methods
Synthesized Method of Theory Evaluation
Summary
Key Points

Learning Activities

Unit II: Nursing Theories

6. Overview of Grand Nursing Theories
Evelyn M. Wills

Categorization of Conceptual Frameworks and Grand Theories
Categorization Based on Scope
Categorization Based on Nursing Domains
Categorization Based on Paradigms

Parse’s Categorization
Newman’s Categorization
Fawcett’s Categorization

Specific Categories of Models and Theories for This Unit
Analysis Criteria for Grand Nursing Theories

Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships
Usefulness
Testability
Parsimony

18

Value in Extending Nursing Science
The Purpose of Critiquing Theories
Summary
Key Points

Learning Activities

7. Grand Nursing Theories Based on Human Needs
Evelyn M. Wills

Florence Nightingale: Nursing: What It Is and What It Is Not
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships
Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Virginia Henderson: The Principles and Practice of Nursing
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Faye G. Abdellah: Patient-Centered Approaches to Nursing
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Dorothea Orem: The Self-Care Deficit Nursing Theory
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Dorothy Johnson: The Behavioral System Model
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts
Relationships

Usefulness

19

Testability
Parsimony
Value in Extending Nursing Science

Betty Neuman: The Neuman Systems Model
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Summary
Key Points

Learning Activities

8. Grand Nursing Theories Based on Interactive Process
Evelyn M. Wills

Barbara Artinian: The Intersystem Model
Background of the Theorist
Philosophic Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain: Modeling and Role-
Modeling

Background of the Theorists
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Imogene King: King’s Conceptual System and Theory of Goal Attainment and
Transactional Process

Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

20

Sister Callista Roy: The Roy Adaptation Model
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Jean Watson: Human Caring Science, A Theory of Nursing
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Summary
Key Points

Learning Activities

9. Grand Nursing Theories Based on Unitary Process
Evelyn M. Wills

Martha Rogers: The Science of Unitary and Irreducible Human Beings
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Margaret Newman: Health as Expanding Consciousness
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Rosemarie Parse: The Humanbecoming Paradigm
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

21

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Summary
Key Points

Learning Activities

10. Introduction to Middle Range Nursing Theories
Melanie McEwen

Purposes of Middle Range Theory
Characteristics of Middle Range Theory
Concepts and Relationships …

power point presentation to explain in details  about specific theory :
Professional Advancement Model ( from Novice to Expert) by Patricia Benner 

need to add some pictures to  the PTT 
should be from perfect references, I will upload two books I have but you can add more references
this PTT will be reference for  me and my colleagues in final exam 
Theory presentation:
about the theorist
definition of the theory and terms
concepts and models
purpose ,goal
factors, importance
metaparadigm
critique
how used in research 
hoe leiningers theory help our practice also, evaluation of theory

Evaluation of-a-nursing-theory-nursing-theory-ppt Presentation Transcript

Title: Evaluation of a Nursing Theory

Six Questions are Propose for Complete

Describing Theory.
Guide for the Description of Theory

1. What is the

purpose of this

theory?

This question addresses

why the theory was

formulated and reflects

the contexts and

situations to which the

theory can be applied.

 Why is this theory formulated?

 Is there an overall purpose for the theory?

 The purpose is positive, negative, neutral?

 is there is specific purpose for the theory

 Is there a hierarchy of theory ?

 Is the all metapradigm element receiving care, nursing, the person, ,

Society and Environment?

 What is the value orientation of the purpose?

 Does achieving the theoretic purpose require a nursing context?

 Does the purpose reflect understanding, creation of meaning,

explanation, and prediction of phenomena?

 When would the theory cases to be applicable? what is the end point?

 what purpose not explicitly, embedded in the matrix of the theory can

be identified?

2. What are the

concepts of this

theory?

This question identifies

the ideas that are

structured and related

within the theory. It

questions the qualitative

and quantitative

dimensions of concepts.

 Is there one major concept with sub-concepts organized under it?

 How many concepts are there ?

 How many major (or minor) ones? ?

 can the concepts be ordered, related? Arranged into any configuration?

 Are there concepts that cannot be interrelated?

 Are concepts broad in scope? Narrow?

 How abstract or empiric are the concepts broad in scope? Narrow?

What is the balance between highly abstract and highly empiric are concepts?

are defined?

3. How are the This question clarifies  Which concepts are defined?

concepts

defined?

the meaning for

concepts within the

theory. It questions how

empiric experience is

represented by the ideas

within the theory.

 Which concepts are defined explicitly? Which are implied ?

 How much meaning needs to be inferred?

 which concepts are defined specifically? generally?

 are there competing definitions for some concepts?

 Are there similar definitions for different concepts?

Are any concepts defined contrary to common convention?

4. What is the

nature of

relationships?

 This question

addresses how

concepts are linked

together. It focuses

on the various forms

relationship

statements can take

and how they give

structure to the

theory.

 What are the major relationships within the theory?

 Which relationships are obvious? Which are implied?

 Do relationships include all concepts? Which are not included?

 Are some concepts included in multiple relationships?

 Is there a hierarchy of relationships? Do relationships create

relationships? meaning and understanding? describing, explaining?

predicting? What mix of each?

are relationships illustrated?

5. What is the

structure of the

theory?

 This question

addresses the overall

form of the

conceptual

interrelationships.

 It discerns whether

the theory contains

partial structures or

has one basic form.

 How are overall and individual ideas organized?

 If outlined, what would the theory look like?

 do relationships expand concepts into large wholes or vice versa?

 do they link concepts in a linear fashion?

 does the structure move concepts away from or toward the purposes?

 Are there several structures that emerge? What is their form? Do they

fit together?

6. On what

assumptions
does the theory

build?

 This question

addresses the basic

truths that underlie

theoretic reasoning.

 It questions whether

assumptions reflect

philosophic values

 What assumptions underlie the theory?

 Are assumptions explicit, implicit, or derivable from context and

meanings?

 What are the individual, nurse, society, environment, and health

assumed to be like?

 Do assumptions be factually verified?

or factual assertions

factual assertions

 Can assumptions be hierarchically arranged or otherwise? ordered?

Guide for the Description of Theory

1

.
PURPOSE  Why is this theory formulated?

 Is there an overall purpose for the theory?

 The purpose is positive, negative, neutral?

 is there is specific purpose for the theory

 Is there a hierarchy of theory ?

 Is the all metapradigm element receiving care, nursing, the person, , Society and Environment?

 What is the value orientation of the purpose?

 Does achieving the theoretic purpose require a nursing context?

 Does the purpose reflect understanding, creation of meaning, explanation, and prediction of

phenomena?

 When would the theory cases to be applicable? what is the end point?

 what purpose not explicitly, embedded in the matrix of the theory can be identified?

2. Concepts  Is there one major concept with sub-concepts organized under it?

 How many concepts are there ?

 How many major (or minor) ones? ?

 can the concepts be ordered, related? Arranged into any configuration?

 Are there concepts that cannot be interrelated?

 Are concepts broad in scope? Narrow?

 How abstract or empiric are the concepts broad in scope? Narrow?

 What is the balance between highly abstract and highly empiric are concepts? are defined?

3. Definitions  Which concepts are defined?

 Which concepts are defined explicitly? Which are implied ?

 How much meaning needs to be inferred?

 which concepts are defined specifically? generally?

 are there competing definitions for some concepts?

 Are there similar definitions for different concepts?

 Are any concepts defined contrary to common convention?

4. Relationships  What are the major relationships within the theory?

 Which relationships are obvious? Which are implied?

 Do relationships include all concepts? Which are not included?

 Are some concepts included in multiple relationships?

 Is there a hierarchy of relationships? Do relationships create relationships? meaning and understanding?

describing, explaining? predicting? What mix of each?

 are relationships illustrated?

5. Structure  How are overall and individual ideas organized?

 If outlined, what would the theory look like?

 do relationships expand concepts into large wholes or vice versa?

 do they link concepts in a linear fashion?

 does the structure move concepts away from or toward the purposes?

 Are there several structures that emerge? What is their form? Do they fit together?

6. Assumptions  What assumptions underlie the theory?

 Are assumptions explicit, implicit, or derivable from context and meanings?

 What are the individual, nurse, society, environment, and health assumed to be like?

 Do assumptions be factually verified?

 Can assumptions be hierarchically arranged or otherwise? ordered?

Criteria for the evaluation of theory

Accuracy  As a noun, Accuracy defined as exactness or precision, while

as an adjective, as without mistakes or errors, perfect, correct

 In relation to nursing theory, accuracy pertains to describing

nursing as it exists today, not the nursing of the future or of

the past.

Consistency  Kuhn (1977) describes consistency in terms of the theory

being internally consistent as well as being consistent with
accepted theories.

 Internal consistency described as consistency in language , the

existence of logical order, and connectedness

 Inconsistencies should be avoided, a theory with an

inconsistency does not necessitate that the whole theory be

scrapped.

 operational definition should be used for concepts, assumptions

and propositions.

 It must uses the terms coherent and logically presented to

describe clarity.

Fruitful  Fruitful, is related conceptually to criteria to criteria proposed

by others

 (Synonymous with fertile, bountiful, productive, and prolific

 Kuhn (1977), in describing fruitful, states that theory should

expose new feelings, new phenomenon, or previously

unknown relationships among

 Fruitful refers to success in explaining observable

phenomenon and the evlautionon of emperical work resulting

from a theory

 Newton-Smith (1981) describes (fertile) as the scope for .

further development.

 Consistent with this is Ellis‟s (1968) criteria of generation of

information-the theory should generate hypotheses.

 A theory that generate many hypotheses, even some without

high probability, or some that are difficult to test, can

contribute to understanding.

Simplicity  Simplicity as an important evaluative criterion not complexity

 Meleis (1985) takes a more pragmatic complexity approach:

whether the theory has a lot of phenomena and relationships

(complexity) or if it focuses on fewer concepts and few

(simplicity)?

 Simplicity is useful characteristic of a good theory in nursing,

and important in the evaluation of nursing theory.

Scope  Scope has been dichotomized as either broad or narrow

 “The broader the scope, in terms of the number and variety of

facts or concepts related, the greater is the significance of the

theory

 Hardy (1974) states “the more general a theory, the more useful

it is Broad vs. narrow scope can also be dichotomized in

relation to its generalities, or the use of the term theory and

conceptual framework/ model.

 Scope may be conceptualized in relation to the level of theory,

e.g. a grand theory or middle range theory.

Acceptance  Meleis (1985)states acceptance “when the theory begins to

cross several concentric circles from where it originated, its

circle of contagiousness increases and we can infer that the

theory is receiving.

 Laudan (1977) discusses the importance of acceptance and

pursuit by other members of the discipline in that the theory

shows promise if others are accepting and „buying into‟ the

theory.

 It is important for the advancement of nursing as a profession

to have members of the discipline communicate regarding its

multicultural acceptance and adoption by others.

Testability  Testability refers to the theory‟s research potential or empirical

adequacy.

 Testability has been long felt to be an important criterion for

the evaluation of nursing theory, and touted as a method to

advance the science of nursing.

 lack of empirical validation of nursing theory has hindered the

development of the nursing science

 have proposed criteria for evaluating theory-testing research,

and discuss important philosophical and methodological issues

in the testing of nursing theory.

Socio-cultural

utility

 Socio-cultural utility encompasses social congruence and

social significance.

 Social congruence encompasses the beliefs, values and

expectations of different cultures that should shape and direct

the type of theory most useful to it.

 Meleis (1985) explains, self-care and independence are goals

consistent with some cultures‟ value systems but not others.

this is inappropriate in some societies and cultures, and should

be avoided.

 Fruitful, is related conceptually to criteria17. Fruitful ( 效果好的 ,收益多 ) Synonymous with fertile, bountiful,

productive, andproposed by others. Kuhn (1977), in describing fruitful, states that theory should exposeprolific. new

feelings, new phenomenon, or previously unknown relationships among Fruitful refers to success in explaining

observablephenomenon already known. phenomenon, and the evaluation of empirical work resulting from a theory.

 Newton-Smith (1981) describes (fertile) as the scope for18. Fruitful  The theory should contain ideas to further

research.further development. Consistent with this is Ellis‟s (1968) criteria of generation of information-the theory should

generate Ellis (1968) states “A theory that generateshypotheses. many hypotheses, even some without high probability, or

some that are difficult to test, can contribute to understanding.

 Simplicity as an important evaluative criterion19. Simplicity( 單純 ;簡單 ) (Kuhn, 1977; Newton-Smith, 1981; Chin and

Jacobs, 1983) others propose Meleis (1985) takes a more pragmatic(complexity (Ellis, 1968; Barnum, 1990). 務實的 )
approach: whether the theory has a lot of phenomena and relationships (complexity) or if it focuses on fewer concepts and few

relationships Kuhn‟s, (1977) describes as “bringing order to phenomenon that in(simplicity)? Simplicity is a seemingly(

表面上 )its absence would be isolated and confused”. useful characteristic of a good theory in nursing, and important in the
evaluation of nursing theory.

  Scope has been dichotomized as either broad or narrow.20. Scope( 範圍 ) Ellis (1968) and Hardy (1974). “The broader the
scope, in terms of the number and variety of facts or concepts related, the greater is the significance of the Hardy (1974) states

“the more general a theory, the more useful ittheory” . Broad vs. narrow scope can also be dichotomized in relation to

itsis.” generalities, or the use of the term theory and conceptual framework/ model. Scope may be conceptualized in

relation to the level of theory, eg. a grand theory or middle range theory.

 Meleis (1985)states acceptance “when the theory begins to21. Acceptance cross several concentric circles from where it

originated, its circle of contagiousness( 蔓延的 ) increases and we can infer that the theory is receiving Laudan (1977)

discusses themore acceptability, uninfluenced by the theorist” . importance of acceptance and pursuit by other members of

the discipline in that the theory shows promise if others are accepting and „buying into‟ the theory. It is important for the

advancement( 促進 ) of nursing as a profession to have members of the discipline communicate regarding its multicultural

acceptance and adoption( 採用 ) by others.

 Testability refers to the theory‟s research potential or22. Testability Testability has been long felt to be an important

criterionempirical adequacy. for the evaluation of nursing theory, and touted ( 招徠 ) as a method to advance Acton et al.

(1991)and Silva (1986) describe how thethe science of nursing. lack of empirical validation of nursing theory has hindered

the development of Silva and Sorrel1 (1992) have proposed criteria for evaluatingnursing science. theory-testing research,

and discuss important philosophical and methodological issues in the testing of nursing theory.

 Socio-cultural utility encompasses( 包圍 ) social23. Socio-cultural utility Johnson (1974), Meleis (1985) andcongruence(

適合 ) and social significance Social congruenceFawcett (1989)in their criteria for the evaluation of theory. encompasses the

beliefs, values and expectations of different cultures that As Meleis (1985)should shape and direct the type of theory most

useful to it. explains, self-care and independence are goals consistent with some cultures‟ Theories with such goals would be

incongruent(value systems but not others. 不一致 的 ) and inappropriate in some societies and cultures, and should be
avoided.

 Nurses in all roles24. Conclusion of criteria for the evaluation of theory will hopefully use these criteria proposed here to

guide their choice of theory There has been awhen using nursing theory in practice, education and research. dearth ( 缺乏 )

of empirical testing of theories in nursing, testing is only one A set of criteria for the evaluation ofpart of the evaluation of

theory. theory has been proposed here that includes: accuracy, consistency, fruitfulness, simplicity/complexity, scope,

acceptability and socio-cultural utility.

 Meleis, A. I. (2007). Theoretical Nursing: Development25. Theory Critique & Progress (4rd ed.). Philadelphia. PA:

Lippincott.(Ch9)(pp.186- 211)

 26. Table 11-5THEORY CRITIQUE— RELATIONSHIP BETWEENSTRUCTURE AND FUNCTION; DIAGRAM OF

THEORY;AND CIRCLE OF CONTAGIOUSNESSCRITERIA UNITS OF ANALYSISRelationship Claritybetween structure

Consistencyand function Simplicity/Complexity Tautology( 同義反複 )/Teleology( 目的論 )Diagram of theory Visual and
graphic presentation Logical representation ClarityCircle of Geographical origin of theory and geographicalcontagiousness

spread influence of theorist vs. theory

 27. Table 11-6THEORY CRITIQUE—USEFULNESSCRITERIA UNITS OF ANALYSISPractice Direction Cost

effectiveness Applicability Relevance GeneralizabilityResearch Consistency Predictability TestabilityEducation Philosophical

statement Concepts ObjectivesAdministration Structure of care Organization of care Guidelines for patient care Patient

classification system

 28. Table 11-7THEORY CRITIQUE—EXTERNAL COMPONENTSOF THEORYCRITERIA UNITS OF

ANALYSISPersonal values Theorist implicit/explicit values Critic implicit/explicit valuesCongruence with other

Complementarity( 補足 )professional values Esotericism( 祕傳性 )Congruence with social Beliefs Competitionvalues Values
CustomsSocial significance Value to humanity

 This question29. Forming a complete critical reflection1. Is this clear? Clarity and consistencyaddresses the clarity and

consistency of presentation. This question addressesmay be both semantic and structural.2. Is this simple? Complexitythe

number of structural components and relationships within theory. implies numerous relational components within theory;

simplicity implies fewer relational components.

 This question30. Forming a complete critical reflection3. Is this general? Generality infers a wideaddresses the scope of

experiences covered by theory. scope of phenomena, whereas specificity narrows the range of events included in This

question addresses the extent to whichtheory.4. Is this accessible? concepts within the theory are grounded in empirically

identifiable phenomena.5. This question addresses the extent to which theory leads toIs this important? valued nursing goals

in practice, research, and education.

 31. Guide for the critical reflection of theory 1.HOW CLEAR IS THIS THEORY? Are significant concepts not defined?

Are Are major concepts defined?  Are words coined? Are coineddefinitions clear? Congruent( 適合的 )? Consistent?

Are words borrowed from other disciplines and used differentlywords defined? Is the amount of explanation appropriate?

Too much? Notin this context? Not helpful? Needed Are examples or diagrams helpful? meaningful? enough? and not

present?

 Are basic assumptions consistent with32. 1.HOW CLEAR IS THIS THEORY? Are the Is the view of person and

environment compatible( 能共 處 )?purposes? Are Are different terms defined similarly?same terms defined differently?

Are compatible andconcepts used in a manner consistent with their definition? Cancoherent( 協調一致的 ) structures

suggested for different parts of the theory? Are there any ambiguities( 模稜兩可 ) as a result ofthe theory be followed?

Does the theorist accomplish what she or he sets outsequence of presentation? to do?

 How many relationships are contained33. 2.HOW SIMPLE IS THIS THEORY? How many concepts are How are the

relationships organized?within the theory?  Are some concepts differentiated into sub-concepts?contained in the theory?

Is the theoryCan concepts be combined without losing theoretic meaning? Does the theory tend to describe,complex some

areas and not in others? explain, or predict? Impact understanding? Create meaning?

 How specific are the purposes of this34. 3.HOW GENERAL IS THIS THEORY Is thus theorytheory? Do they apply to

all or only some practice areas? When? Is the purposespecific to nursing? If not, who else could use it? Why? If

subpurposes exist, do they reflect nursingjustifiably a nursing purpose? actions? How broad are the concepts within the

theory?

 How Are the concepts broad or narrow?35. 4.HOW ACCESSIBLE IS THIS THEORY Are the concepts‟specific or

general are definitions within the theory? empiric indicators identifiable in reality? Are they within the realm of Do the

definitions provided for the concepts adequately reflect theirnursing? Is a very narrow definition offered for a broad

concept? A broadmeanings? If words are coined, are they defined?meaning for a narrow concept?

 Does the theory have potential to36. 5.HOW IMPORTANT IS THIS THEORY? Does the theory influenceinfluence

nursing actions? If so, to what end? Hoenursing education? research? If so, to what end? Is that end desirable? specific are

the purposes of the theory? Do they provide a general framework Is the theory‟s positionwithin which to act or a means to

predict phenomena? about people, about nursing, and about the environment consistent with nursing‟s Given the purpose of

the theory and its orientation, what ofphilosophy? significance for nursing or health care has been omitted?

 Is the started or implied purpose one37. 5.HOW IMPORTANT IS THIS THEORY? Will use of the theory help or

hinderthat is important to nursing? Why? Will application of this theory resolve any importantnursing in any way? Is the

theory futuristic andissues in nursing? Will it resolve any problems?  Will research based on the theory answer important

questions?forward-looking? Do I like this theory? Why?Are the concepts within the domain of nursing?

 Theory development and evaluation are cyclical, continuous,38. Conclusion Theory evaluationand dynamic process. One

can not exist without the other. including description, concept analysis, theory critique, testing and support. These process are

based on the view that science is a human process that includes not only valid findings but also observation, agreements, useful

Theory evaluation is central to the development ofsolutions to problems. theory; it is the responsibility of each clinician,

academician.

 Kuhn(1977) “we can delineate such criteria and that39. Conclusion accuracy, consistency, broad scope, simplicity and

fruitfulness in research are However, “everyessential as objective criteria for judging competing theories” individuals choice

between competing theories depends on a mixture of objective The subjective factors are dependent on individualsand

subjective factors” Both objective and subjective factors have apreferences and personalities. place in our understanding of

the philosophy of science.

 40. Adaptation Model

 41. Exercise: Application of Roys Adaptation Model in Nursing Practicehttp://currentnursing.com/nursing_theory/applicat1.

What is the purpose of this theory?2. What are the concepts of this theory?3. How are the concepts defined?4. What is the

nature of relationships?5. What is the structure of the theory? .6. On what assumptions does the theory build?

Evaluation of-a-nursing-theory-nursing-theory-ppt from Maria Poly

Evaluation of-a-nursing-theory-nursing-theory-ppt Presentation Transcript

 1. Evaluation of a Nursing Theory

 2. Forming a Complete Description:Six Questions are Propose for Describing Theory.

 3. 1. What is the purpose of this theory? This question addresses why the theory was formu- lated and reflects the contexts and

situations to which the theory can be applied.2. What are the concepts of this theory? This question identifies the ideas that are

structured and related within the theory. It questions the quali- tative and quantitative dimensions of concepts.3. How are the

concepts defined? This question clarifies the meaning for concepts within the theory. It questions how empiric experi- ence is

represented by the ideas within the theory.

 4. 4. What is the nature of relationships? This question addresses how concepts are linked together. It focuses on the various

forms relationship statements can take and how they give structure to the theory.5. What is the structure of the theory? This

question addresses the overall form of the con- ceptual interrelationships. It discerns whether the theory contains partial

structures or has one basic form.6. On what assumptions does the theory build? This question addresses the basic truths that

underlie theoretic reasoning. It questions whether assumptions reflect philosophic values or factual assertions factual

assertions.

 Why is this theory5. Guide for the Description of Theory 1. PURPOSE Is there an overall purpose for the theory? A

hierarchy offormulated? Is there a purpose for the nurse? Thepurposes? Separate numerous purposes? How broad or

narrow is theperson receiving care? Society? Environment? What is the value orientation of the purpose? Positive,

negative,purpose? neutral?

 Does achieving the theoretic purpose require a nursing6. 1. PURPOSE Does the purpose reflect understanding? Creation of

meaning?context? When would the theoryDescription, explanation, and prediction of phenomena? What purpose not

explicitly( 明確地cases to be applicable? What is the end point? ) embedded( 植入 ) in the matrix of the theory can be
identified?

 Is there one major concept with sub-concepts organized under7. 2. CONCEPTS Can the How many major (or minor)

ones? How many concepts are there?it? concepts be ordered, related? Arranged into any configuration?

 Are Are there concepts that cannot be interrelated?8. 2. CONCEPTS How abstract( 抽象 ) or empiric( 經驗 ) are

theconcepts broad in scope? Narrow? What is the balance between highly abstract and highly empiricconcepts? concepts?

 Which Which concepts are defined? Which are not?9. 3. DEFINITIONS How much meaningconcepts are defined

explicitly? Which are implied( 隱喻 )? Are Which concepts are defined specifically? Generally?needs to be inferred ?

there competing definitions for some concepts? Are there similar definitions for Are any concepts defined contrary to common

convention( 習俗different concepts? , 常規 )?

  What are the major relationships within the theory?10. 4. RELATIONSHIPS Do relationships includeWhich

relationships are obvious? Which are implied? Are some concepts included in multipleall concepts? Which are not included?

Is there a hierarchy of relationships? Do relationships createrelationships? meaning and understanding? Do they do this by

describing, explaining? Are relationships illustrated?Predicting? What mix of each?

 If How are overall and individual ideas organized?11. 5. STRUCTURE Do relationships expand conceptsoutlined, what

THEORETICAL
BASIS

for Nursing

McEwen_FM.indd 1 10/10/13 11:21 AM

McEwen_FM.indd 2 10/10/13 11:21 AM

THEORETICAL
BASIS

for Nursing

Melanie McEwen, PhD, RN, CNE, ANEF
Associate Professor
University of Texas Health Science Center at Houston
School of Nursing
Houston, Texas

Evelyn M. Wills, PhD, RN
Professor (Retired)
Department of Nursing
College of Nursing and Allied Health Professions
University of Louisiana at Lafayette
Lafayette, Louisiana

F O U R T H E D I T I O N

McEwen_FM.indd 3 10/10/13 11:21 AM

Acquisitions Editor: Patrick Barbera
Product Development Editor: Helen Kogut
Editorial Assistant: Dan Reilly
Production Project Manager: Cynthia Rudy
Design Coordinator: Holly McLaughlin
Illustration Coordinator: Jennifer Clements
Manufacturing Coordinator: Karin Duffield
Prepress Vendor: Absolute Service, Inc.

4th edition

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007,
2002 Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No
part of this book may be reproduced or transmitted in any form or by any means, including as
photocopies or scanned-in or other electronic copies, or utilized by any information storage and
retrieval system without written permission from the copyright owner, except for brief quotations
embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as
part of their official duties as U.S. government employees are not covered by the above-mentioned
copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce
Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our
website at lww.com (products and services).

9 8 7 6 5 4 3 2 1

Printed in China

Library of Congress Cataloging-in-Publication Data
McEwen, Melanie, author.
Theoretical basis for nursing / Melanie McEwen, Evelyn M. Wills.—Edition 4.

p. ; cm.
Includes bibliographical references and indexes.
ISBN 978-1-4511-9031-1
I. Wills, Evelyn M., author. II. Title.
[DNLM: 1. Nursing Theory. WY 86]
RT84.5
610.73–dc23

2013035526

Care has been taken to confirm the accuracy of the information presented and to describe generally
accepted practices. However, the author(s), editors, and publisher are not responsible for errors
or omissions or for any consequences from application of the information in this book and make
no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the
contents of the publication. Application of this information in a particular situation remains the
professional responsibility of the practitioner; the clinical treatments described and recommended
may not be considered absolute and universal recommendations.

The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dos-
age set forth in this text are in accordance with the current recommendations and practice at the time of
publication. However, in view of ongoing research, changes in government regulations, and the constant
flow of information relating to drug therapy and drug reactions, the reader is urged to check the package
insert for each drug for any change in indications and dosage and for added warnings and precautions.
This is particularly important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have U.S. Food and Drug Ad-
ministration (FDA) clearance for limited use in restricted research settings. It is the responsibility of
the health care provider to ascertain the FDA status of each drug or device planned for use in his or
her clinical practice.

LWW.com

McEwen_FM.indd 4 10/10/13 11:21 AM

Proudly sourced and uploaded by [StormRG]
Kickass Torrents | The Pirate Bay | ExtraTorrent

To Kaitlin and Grant—You have helped me broaden my thoughts
and consider all kinds of possibilities; I hope I’ve done the same
for you.

Also for Helen and Keith—Our children chose well. Besides,
you have given us Madelyn, Logan, Brenna, Liam, Lucy, and
Andrew; they are gifts beyond words.

Melanie McEwen

To Tom, Paul, and Vicki, who light up my life, and to Marian,
who is my applause. To Teddy, Gwen, Merlyn, and Madelyn,
who have been so patient and loving during this process.
A thousand thank yous to Peggy, who has supported me through
this writing process.

Evelyn M. Wills

D E D I C A T I O N

McEwen_FM.indd 5 10/10/13 11:21 AM

Grace Bielkiewicz, RN, PMHCNS-BC
Assistant Professor (Retired)
Department of Nursing
Southern University
Baton Rouge, Louisiana
Chapter 13: Theories From the Sociologic Sciences

Debra Brossett Garner, DNP, APRN, ACNS-BC, PMHNP-BC
Psychiatric Mental Health Nurse Practitioner
Delhi Rural Health Clinic
Delhi, Louisiana
Chapter 14: Theories From the Behavioral Sciences

Melinda Granger Oberleitner, DNS, RN
Associate Dean, College of Nursing and Allied Health Professions
Professor, Department of Nursing
SLEMCO/BORSF Endowed Professor of Nursing
University of Louisiana at Lafayette
Lafayette, Louisiana
Chapter 16: Theories, Models, and Frameworks From Administration and
Management
Chapter 20: Application of Theory in Nursing Administration and
Management

C O N T R I B U T O R S

vi

McEwen_FM.indd 6 10/10/13 11:21 AM

R E V I E W E R S

Kimamer Amer, PhD
Associate Professor
Department of Nursing
DePaul University
Chicago, Illinois

Margaret Barnes, MSN, RN
Assistant Professor
School of Nursing, RNBSN Post-Licensure Division
Indiana Wesleyan University
Florence, Kentucky

Shari Cherney, RN, BScN, MHSc
Professor
Department of Nursing
George Brown College
Toronto, Ontario, Canada

Cheryl Delgado, PhD
Associate Professor
Department of Nursing
Cleveland State University
Cleveland, Ohio

Dolores Furlong, PhD
Professor
Department of Nursing
University of New Brunswick
Fredericton, New Brunswick, Canada

Maryanne Garon, DNSc
Professor
Department of Nursing
California State University Fullerton
Fullerton, California

Carol Grantham, PhD, MSN, CPNP-PC
Faculty
Byrdine F. Lewis School of Nursing & Health

Professions
Georgia State University
Atlanta, Georgia

Barbara Harris, PhD
Assistant Professor
School of Nursing
DePaul University
Chicago, Illinois

Seongkum Heo, PhD
Assistant Professor
Department of Nursing
University of Arkansas for Medical Sciences
Little Rock, Arkansas

Donna Murnaghan, PhD
Associate Professor
School of Nursing
University of Prince Edward Island
Charlottetown, Prince Edward Island, Canada

Pamela Reis, PhD, CNM
Assistant Professor
Department of Nursing
East Carolina University
Greenville, North Carolina

Sue Robertson, PhD
Assistant Professor
Department of Nursing
California State University, Fullerton
Fullerton, California

Denice Sheehan, PhD
Assistant Professor
Department of Nursing
Kent State University
Kent, Ohio

Ida Slusher, DSN
Professor & Nursing Education Coordinator
Department of Baccalaureate & Graduate Nursing
Eastern Kentucky University
Richmond, Kentucky

Sharon Van Sell, BSN, MEd, MS, EdD
Professor
Department of Nursing
Texas Woman’s University
Dallas, Texas

vii

McEwen_FM.indd 7 10/10/13 11:21 AM

P R E F A C E

viii

Frequently, nursing students respond with a cringing expression or a resounding
“ugh!” when faced with the requirement of taking a course on theory. Indeed, many
fail to see theory’s relevance to the real world of nursing practice and often have
difficulty applying the information in later courses and in their research. This book
is the result of the frustration felt by a group of nursing instructors who met a num-
ber of years ago to adopt a textbook for a theory course. Indeed, because of student
complaints and faculty dissatisfaction, we were changing textbooks yet again. A fairly
lengthy discussion arose in which we concluded that the available books did not meet
the needs of our students or course faculty. Ultimately, we determined to “build a
better mousetrap.” Our intent was to write a book that was a general overview of
theory per se, stressing how it is—and should be—used by nurses to improve practice,
research, education, and management/leadership.

As in past editions, an ongoing review of trends in nursing theory and nursing
science has shown an increasing emphasis on middle range theory, evidence-based
practice, and situation-specific theories. To remain current and timely, in this fourth
edition, we have added a new chapter discussing evidence-based practice, highlighting
how it relates to theory in nursing, and presenting several evidence-based practice
models commonly used by nurses. We have also included new middle range nursing
theories and added a significant section discussing situation-specific nursing theories,
describing how they relate to evidence-based practice. Updates and application exam-
ples have been added throughout the discussions on the various theories.

Organization of the Text

Theoretical Basis for Nursing is designed to be a basic nursing theory textbook that
includes the essential information students need to understand and apply theory.

The book is divided into four units. Unit I, Introduction to Theory, provides
the background needed to understand what theory is and how it is used in nursing.
It outlines tools and techniques used to develop, analyze, and evaluate theory so
that it can be used in nursing practice, research, administration and management,
and education. In this unit, we have provided a balanced view of “hot” topics (e.g.,
philosophical world views and utilization of shared or borrowed theory). Also, rather
than espousing one strategy for activities such as concept development and theory
evaluation, we have included a variety of strategies.

Unit II, Nursing Theories, focuses largely on the grand nursing theories and
begins with a chapter describing their historical development. This unit divides the
grand nursing theories into three groups based on their focus (human needs, in-
teractive process, and unitary process). The works of many of the grand theorists
are briefly summarized in Chapters 7, 8, and 9. We acknowledge that these analyses

McEwen_FM.indd 8 10/19/13 3:59 AM

Preface ix

are not comprehensive; rather, they are intended to provide the reader with enough
information to understand the basis of the work and to whet the reader’s appetite to
select one or more for further study.

Chapters 10 and 11 cover the significant topic of middle range nursing theory.
Chapter 10 presents a detailed overview of the origins and growth of middle range
theory in nursing and gives numerous examples of how middle range theories have
been developed by nurses. Chapter 11 provides an overview of some of the grow-
ing number of middle range nursing theories. The theories presented include some
of the most commonly used middle range nursing theories (e.g., Pender’s Health
Promotion Model and Leininger’s Culture Care Diversity and Universality Theory)
as well as some that are less well known but have a growing body of research sup-
port (e.g., Meleis’ Transitions Theory, the Theory of Unpleasant Symptoms, and the
Uncertainty in Illness Theory). The intent is to provide a broad range of middle range
theories to familiarize the reader with examples and to encourage them to search for
others appropriate to their practice or research. Ultimately, it is hoped that readers
will be challenged to develop new theories that can be used by nurses.

Chapter 12, which discusses evidence-based practice (EBP), is new to this edi-
tion. This chapter explains and defines the idea/process of EBP and describes how it
relates to nursing theory and application of theory in nursing practice and research.
The chapter concludes with a short presentation and review of five different EBP
models that have been widely used by nurses and are well supported in the literature.

Unit III, Shared Theories Used by Nurses, is rather unique in nursing litera-
ture. Our book acknowledges that “shared” or “borrowed” theories are essential to
nursing and negates the idea that the use of shared theory in practice or research is
detrimental. In this unit, we have identified some of the most significant theories that
have been developed outside of the discipline of nursing but are continually used in
nursing. We have organized these theories based on broad disciplines: theories from
the sociologic sciences, behavioral sciences, and biomedical sciences, as well as from
administration and management and learning. Each of these chapters was written by
a nurse with both educational and practical experience in her respective area. These
theories are presented with sufficient information to allow the reader to understand
the theories and to recognize those that might be appropriate for her or his own
work. These chapters also provide original references and give examples of how the
concepts, theories, and models described have been used by other nurses.

Finally, Unit IV, Application of Theory in Nursing Practice, explains how the-
ories are applied in nursing. Separate chapters cover nursing practice, nursing research,
nursing administration and management, and nursing education. These chapters in-
clude many specific examples for the application of theory and are intended to be a
practical guide for theory use. The heightened development of practice theories and
EBP guidelines are critical to theory application in nursing today, so these areas have
been expanded. The unit concludes with a chapter that discusses some of the future
issues in theory within the discipline.

McEwen_FM.indd 9 10/19/13 3:59 AM

x Preface

■ New Chapter 12, Evidence-Based Practice and Nursing Theory
■ More detailed explanation of EBP and its relationship to theory in nursing
■ Enhanced attention to situation-specific theories and how they relate to EBP
■ Numerous recent examples of application of theories in nursing practice,

nursing research, leadership/administration, and education
■ NEW instructional support

New To This Edition

Student Resources Available on

■ Literature Assessment Activity provides an interactive tool featuring journal
articles along with questions that will encourage students to think critically
about the literature. Students can print or e-mail their responses to their
instructor.

■ Case Studies with applicable questions guide students in understanding how
the various theories link to nursing practice.

■ Learning Objectives for each chapter help focus the student.
■ Internet Resources provide live web links to pertinent sites so that students

can further their study and understanding of the various theories.
■ Journal Articles for each chapter offer opportunities to gain more knowledge

and understanding of the chapter content.

Key Features
In addition to numerous tables and boxes that highlight and summarize important
information, Theoretical Basis for Nursing contains case studies, learning activities,
exemplars, and illustrations that help students visualize various concepts. New to this
edition is a special feature called Link to Practice.

■ Link to Practice: All chapters include at least one “Link to Practice” box,
which presents useful information or clinically related examples related to the
subject being discussed. The intent is to give additional tools or resources that
can be used by nurses to apply the content in their own practice or research.

■ Case Studies: At the end of Chapter 1 and the beginning of Chapters 2 to 22,
case studies help the reader understand how the content in the chapter relates
to the everyday experience of the nurse, whether in practice, research, or other
aspects of nursing.

■ Learning Activities: At the end of each chapter, learning activities pose critical
thinking questions, propose individual and group projects related to topics
covered in the chapter, and stimulate classroom discussion.

■ Exemplars: In five chapters, an exemplar discusses a scholarly study from the
perspectives of concept analysis (Chapter 3); theory development (Chapter 4);
theory analysis and evaluation (Chapter 5); middle range theory develop-
ment (Chapter 10); and theory generation via research, theory testing via
research, and use of a theory as the conceptual framework for a research study
(Chapter 19).

■ Illustrations: Diagrams and models are included throughout the book to help
the reader better understand the many different theories presented.

McEwen_FM.indd 10 10/10/13 11:21 AM

Preface xi

Instructor Resources Available on
■ Instructor’s Guide includes application-level discussion questions and classroom/

online activities that Melanie McEwen uses in her own teaching!
■ Strategies for Effective Teaching of Nursing Theory provide ideas for

instructors to help make the nursing theory class come alive.
■ Test Generator Questions provide multiple-choice questions that can be used

for testing general content knowledge.
■ PowerPoints with audience response (Iclicker) questions, based on

the ones used by Melanie McEwen in her own classroom, help highlight
important points to enhance the classroom, experience.

■ Case Studies with questions, answers, and related activities offer opportunities
for instructors to make the student case studies an exciting, fun, and rewarding
classroom/online experience.

■ Image Bank provides images from the text that instructors can use to enhance
their own presentations.

In summary, the focus of this learning package is on the application of theory rather
than on the study, analysis, and critique of grand theorists or a presentation of a
specific aspect of theory (e.g., construction or evaluation). It is hoped that practic-
ing nurses, nurse researchers, and nursing scholars, as well as graduate students and
theory instructors, will use this book and its accompanying resources to gain a better
understanding and appreciation of theory.

Melanie McEwen, PhD, RN, CNE, ANEF
Evelyn M. Wills, PhD, RN

McEwen_FM.indd 11 10/10/13 11:21 AM

xii

A C K N O W L E D G M E N T S

Our heartfelt thanks to Product Development Editor, Helen Kogut, for her assis-
tance, patience, and persistence in helping us complete this project. She has made a
difficult task seem easy! We also want to thank Acquisitions Editor, Christina Burns,
for her wonderful support and assistance in getting this project started and Patrick
Barbera for seeing it through to the end. Finally, a huge word of thanks to our con-
tributors who have diligently worked to present the notion of theory in a manner that
will engage nursing students and to look for new examples and applications to help
make theory fresh and relevant.

McEwen_FM.indd 12 10/10/13 11:21 AM

xiii

C O N T E N T S

Unit I: Introduction to Theory 1
1. Philosophy, Science, and Nursing 2

Melanie McEwen
Nursing as a Profession 2
Nursing as an Academic Discipline 4
Introduction to Science and Philosophy 5
Science and Philosophical Schools of Thought 7
Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing 11
Knowledge Development and Nursing Science 12
Research Methodology and Nursing Science 16

2. Overview of Theory in Nursing 23
Melanie McEwen

Overview of Theory 24
The Importance of Theory in Nursing 25
Terminology of Theory 26
Historical Overview: Theory Development in Nursing 26
Classification of Theories in Nursing 36
Issues in Theory Development in Nursing 40

3. Concept Development: Clarifying Meaning of Terms 49
Evelyn M. Wills, Melanie McEwen

The Concept of “Concept” 50
Concept Analysis/Concept Development 54
Strategies for Concept Analysis and Concept Development 57

4. Theory Development: Structuring Conceptual Relationships
in Nursing 72

Melanie McEwen
Overview of Theory Development 73
Categorizations of Theory 73
Components of a Theory 79
Theory Development 82

5. Theory Analysis and Evaluation 95
Melanie McEwen

Definition and Purpose of Theory Evaluation 96
Historical Overview of Theory Analysis and Evaluation 97
Comparisons of Methods 106
Synthesized Method of Theory Evaluation 106

McEwen_FM.indd 13 10/10/13 11:21 AM

xiv Contents

6. Overview of Grand Nursing Theories 116
Evelyn M. Wills

Categorization of Conceptual Frameworks and Grand Theories 118
Specific Categories of Models and Theories for This Unit 124
Analysis Criteria for Grand Nursing Theories 124
The Purpose of Critiquing Theories 127

7. Grand Nursing Theories Based on Human Needs 131
Evelyn M. Wills

Florence Nightingale: Nursing: What It Is and What It Is Not 132
Virginia Henderson: The Principles and Practice of Nursing 136
Faye G. Abdellah: Patient-Centered Approaches to Nursing 139
Dorothea E. Orem: The Self-Care Deficit Nursing Theory 142
Dorothy Johnson: The Behavioral System Model 146
Betty Neuman: The Neuman Systems Model 149

8. Grand Nursing Theories Based on Interactive Process 159
Evelyn M. Wills

Myra Estrin Levine: The Conservation Model 160
Barbara M. Artinian: The Intersystem Model 164

Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain:
Modeling and Role-Modeling 169

Imogene M. King: King’s Conceptual System and Theory of Goal Attainment and
Transactional Process 173

Sister Callista Roy: The Roy Adaptation Model 177
Jean Watson: Caring Science as Sacred Science 182

9. Grand Nursing Theories Based on Unitary Process 192
Evelyn M. Wills

Martha Rogers: The Science of Unitary and Irreducible Human Beings 193
Margaret Newman: Health as Expanding Consciousness 198
Rosemarie Parse: The Humanbecoming Paradigm 202

10. Introduction to Middle Range Nursing Theories 213
Melanie McEwen

Purposes of Middle Range Theory 214
Characteristics of Middle Range Theory 215
Concepts and Relationships for Middle Range Theory 216
Categorizing Middle Range Theory 217
Development of Middle Range Theory 217
Analysis and Evaluation of Middle Range Theory 225

11. Overview of Selected Middle Range Nursing Theories 229
Melanie McEwen

High Middle Range Theories 230
Middle Middle Range Theories 241
Low Middle Range Theories 248

12. Evidence-Based Practice and Nursing Theory 258
Evelyn M. Wills, Melanie McEwen

Overview of Evidence-Based Practice 259
Definition and Characteristics of Evidence-Based Practice 259
Concerns Related to Evidence-Based Practice in Nursing 261
Evidence-Based Practice and Practice-Based Evidence 261

Unit II: Nursing Theories 115

McEwen_FM.indd 14 10/10/13 11:21 AM

Contents xv

Promotion of Evidence-Based Practice in Nursing 263
Theory and Evidence-Based Practice 263
Theoretical Models of EBP 264

Unit III: Shared Theories Used by Nurses 277
13. Theories From the Sociologic Sciences 278

Grace Bielkiewicz
Exchange Theories 279
Interactionist Frameworks 284
Conflict Theories 289
Chaos Theory 295
Postmodern Social Theory 298

14. Theories From the Behavioral Sciences 305
Debra Brossett Garner

Psychodynamic Theories 306
Behavioral and Cognitive-Behavioral Theories 313
Humanistic Theories 315
Stress Theories 318
Social Psychology 321

15. Theories From the Biomedical Sciences 331
Melanie McEwen

Theories and Models of Disease Causation 332
Theories and Principles Related to Physiology and Physical Functioning 339

16. Theories, Models, and Frameworks From Leadership
and Management 354

Melinda Granger Oberleitner
Overview of Concepts of Leadership and Management 355
Early Leadership Theories 355
Contemporary Leadership Theories 362
Organizational/Management Theories 365
Motivational Theories 366
Concepts of Power, Empowerment, and Change 368
Problem-Solving and Decision-Making Processes 372
Conflict Management 374
Quality Improvement 375
Evidence-Based Practice 380

17. Learning Theories 386
Evelyn M. Wills, Melanie McEwen

What Is Learning? 387
What Is Teaching? 388
Categorization of Learning Theories 388
Behavioral Learning Theories 389
Cognitive Learning Theories 392
Summary of Learning Theories 404
Learning Styles 405
Principles of Learning 406
Application of Learning Theories in Nursing 407

McEwen_FM.indd 15 10/10/13 11:21 AM

xvi Contents

Unit IV: Application of Theory in Nursing 411
18. Application of Theory in Nursing Practice 412

Melanie McEwen
Relationship Between Theory and Practice 413
Theory-Based Nursing Practice 414
The Theory–Practice Gap 416
Situation-Specific/Practice Theories in Nursing 418
Application of Theory in Nursing Practice 422

19. Application of Theory in Nursing Research 430
Melanie McEwen

Historical Overview of Research and Theory in Nursing 431
Relationship Between Research and Theory 432
Types of Theory and Corresponding Research 434
How Theory Is Used in Research 437
Nursing and Non-Nursing Theories in Nursing Research 444
Other Issues in Nursing Theory and Nursing Research 445

20. Application of Theory in Nursing Administration and
Management 452

Melinda Granger Oberleitner
Organizational Design 453
Shared Governance 456
Transformational Leadership in Nursing and in Health Care 458
Patient Care Delivery Models 459
Case Management 466
Disease/Chronic Illness Management 468
Quality Management 470

21. Application of Theory in Nursing Education 479
Evelyn M. Wills, Melanie McEwen

Theoretical Issues in Nursing Curricula 481
Theoretical Issues in Nursing Instruction 488

22. Future Issues in Nursing Theory 497
Melanie McEwen

Future Issues in Nursing Science 499
Future Issues in Nursing Theory 500

Theoretical Perspectives on Future Issues in Nursing Practice, Research,
Administration and Management, and Education 502

Glossary 513
Author Index 523
Subject Index 554

McEwen_FM.indd 16 10/10/13 11:21 AM

U N I T I

Introduction to Theory

McEwen_CH01.indd 1 10/10/13 10:53 AM

Philosophy,
Science, and
Nursing
Melanie McEwen

C H A P T E R 1

2

Largely due to the work of nursing scientists, nursing theorists, and nursing scholars
over the past five decades, nursing has been recognized as both an emerging
profession and an academic discipline. Crucial to the attainment of this distinction
have been numerous discussions regarding the phenomena of concern to nurses and
countless efforts to enhance involvement in theory utilization, theory generation, and
theory testing to direct research and improve practice.

A review of the nursing literature from the late 1970s until the present shows
sporadic discussion of whether nursing is a profession, a science, or an academic
discipline. These discussions are sometimes pleading, frequently esoteric, and
occasionally confusing. Questions that have been raised include: What defines a
profession? What constitutes an academic discipline? What is nursing science? Why
is it important for nursing to be seen as a profession or an academic discipline?

Nursing as a Profession

In the past, there has been considerable discussion about whether nursing is a profes-
sion or an occupation. This is important for nurses to consider for several reasons. An
occupation is a job or a career, whereas a profession is a learned vocation or occupa-
tion that has a status of superiority and precedence within a division of work. In gen-
eral terms, occupations require widely varying levels of training or education, varying
levels of skill, and widely variable defined knowledge bases. In short, all professions
are occupations, but not all occupations are professions (Finkelman & Kenner, 2013).

Professions are valued by society because the services professionals provide are ben-
eficial for members of the society. Characteristics of a profession include (1) defined
and specialized knowledge base, (2) control and authority over training and education,
(3) credentialing system or registration to ensure competence, (4) altruistic service to
society, (5) a code of ethics, (6) formal training within institutions of higher education,
(7) lengthy socialization to the profession, and (8) autonomy (control of professional
activities) (Ellis & Hartley, 2012; Finkelman & Kenner, 2013; Rutty, 1998). Professions

McEwen_CH01.indd 2 10/10/13 10:53 AM

Chapter 1 Philosophy, Science, and Nursing 3

must have a group of scholars, investigators, or researchers who work to continually ad-
vance the knowledge of the profession with the goal of improving practice (Schlotfeldt,
1989). Finally, professionals are responsible and accountable to the public for their work
(Hood, 2010). Traditionally, professions have included the clergy, law, and medicine.

Until near the end of the 20th century, nursing was viewed as an occupation
rather than a profession. Nursing has had difficulty being deemed a profession because
many of the services provided by nurses have been perceived as an extension of those
offered by wives and mothers. Additionally, historically, nursing has been seen as sub-
servient to medicine, and nurses have delayed in identifying and organizing profes-
sional knowledge. Furthermore, education for …

2

3

4

5

Acquisitions Editor: Christina Burns
Development Editor: Michael Kerns
Editorial Coordinator: Tim Rinehart
Editorial Assistant: Kaitlin Campbell
Production Project Manager: Kim Cox
Design Coordinator: Elaine Kasmer
Illustration Coordinator: Jennifer Clements
Manufacturing Coordinator: Karin Duffield
Prepress Vendor: Absolute Service, Inc.

Fifth Edition

Copyright © 2019 Wolters Kluwer Health.

Copyright © 2014, 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2002 Lippincott Williams & Wilkins. All
rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means,
including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written
permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book
prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To
request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via
email at [email protected], or via our website at lww.com (products and services).

9 8 7 6 5 4 3 2 1

Printed in China

Library of Congress Cataloging-in-Publication Data

Names: McEwen, Melanie, author. | Wills, Evelyn M., author.
Title: Theoretical basis for nursing / Melanie McEwen, Evelyn M. Wills.
Description: Fifth edition. | Philadelphia : Wolters Kluwer, [2018] |

Includes bibliographical references and index.
Identifiers: LCCN 2017049174 | ISBN 9781496351203
Subjects: | MESH: Nursing Theory
Classification: LCC RT84.5 | NLM WY 86 | DDC 610.73—dc23 LC record available at https://lccn.loc.gov/2017049174

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the author(s),
editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and
make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application
of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and
recommended may not be considered absolute and universal recommendations.

The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance
with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government
regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for
each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the
recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have U.S. Food and Drug Administration (FDA) clearance for limited use in
restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use
in his or her clinical practice.

LWW.com

6

mailto:[email protected]

http://lww.com

https://lccn.loc.gov/2017049174

http://LWW.com

D E D I C AT I O N

To Kaitlin and Grant—You have helped me broaden my thoughts and consider all kinds of possibilities;
I hope I’ve done the same for you.

Also for Helen and Keith—Our children chose well. Besides, you have given us Madelyn, Logan,
Brenna, Liam, Lucy, Andrew, Michael, and Jacob; they are gifts beyond words.

Melanie McEwen

To Tom, Paul, and Vicki, who light up my life, and to Marian, who left us for a better place. You were
always my best listener. To Teddy, Gwen, Merlyn, and Madelyn, who have been so patient and loving
during this process.

My deepest gratitude to Leslie, who has supported me through this writing process.

Evelyn M. Wills

7

C O N T R I B U T O R S

Sattaria Smith Dilks, DNP, APRN-BC, FNP, PMHNP/CNS
Professor and Co-Coordinator Graduate Program
College of Nursing
McNeese State University
Lake Charles, Louisiana
Chapter 14: Theories From the Behavioral Sciences

Joan C. Engebretson, DrPH, AHN-BC, RN, FAAN
Judy Fred Professor in Nursing
University of Texas Health Science Center at Houston
School of Nursing, Department of Family Nursing
Houston, Texas
Chapter 13: Theories From the Sociologic Sciences

Melinda Granger Oberleitner, DNS, RN
Associate Dean, College of Nursing & Allied Health Professions
Professor, Department of Nursing
SLEMCO/BORSF Endowed Professor of Nursing
University of Louisiana at Lafayette
Lafayette, Louisiana
Chapter 17: Theories, Models, and Frameworks From Leadership and Management
Chapter 21: Application of Theory in Nursing Administration and Management

Cathy L. Rozmus, PhD, RN
PARTNERS Endowed Professorship in Nursing
Vice Dean
Department of Family Health
The University of Texas Health Science Center at Houston
School of Nursing
Houston, Texas
Chapter 16: Ethical Theories and Principles

Jeffrey P. Spike, PhD
Professor of Family and Community Medicine
The University of Texas Health Science Center at Houston
School of Medicine
Professor, Department of Management, Policy, and Community Health
University of Texas Health Science Center School of Public Health
Houston, Texas
Chapter 16: Ethical Theories and Principles

8

R E V I E W E R S

Cynthia Dakin, PhD, RN
Director of Graduate Studies
Associate Professor
Department of Nursing
Elms College
Chicopee, Massachusetts

Janet DuPont, RNC-OB, MSN, MEd, PhD
Master of Science in Nursing Instructor/Developer
Nursing Program
Norwich University
Northfield, Vermont

Ruth Neese, PhD, RN, CEN
Assistant Professor
Department of Nursing
Indian River State College
Fort Pierce, Florida

Brandon N. Respress, PhD, RN, MPH, MSN
Assistant Professor
College of Nursing and Health Innovation
University of Texas at Arlington
Arlington, Texas

Jacqueline Saleeby, PhD, RN, CS
Associate Professor
Department of Nursing
Maryville University
St. Louis, Missouri

Stephen J. Stapleton, PhD, MS, RN, CEN, FAEN
Associate Professor
Mennonite College of Nursing
Illinois State University
Normal, Illinois

Kathleen Williamson, MSN, PhD, RN
Associate Professor and Chair
Wilson School of Nursing
Midwestern State University
Wichita Falls, Texas

Cindy Zellefrow, DNP, MSEd, RN, LSN, APHN-BC
Assistant Professor of Clinical Practice
Assistant Director, Center for Transdisciplinary and Evidence-based Practice

9

College of Nursing
The Ohio State University
Columbus, Ohio

10

P R E FA C E

Rare is the student who enrolls in a nursing program and is excited about the requirement of taking a course
on theory. Indeed, many fail to see theory’s relevance to the real world of nursing practice and often have
difficulty applying the information in later courses and in their research. This book is the result of the
frustration felt by a group of nursing instructors who met a number of years ago to adopt a textbook for a
theory course. Indeed, because of student complaints and faculty dissatisfaction, we were changing textbooks
yet again. A fairly lengthy discussion arose in which we concluded that the available books did not meet the
needs of our students or course faculty. We were determined to write a book that was a general overview of
theory per se, stressing how it is—and should be—used by nurses to improve practice, research, education,
and management/leadership.

As in past editions, an ongoing review of trends in nursing theory and nursing science has shown an
increasing emphasis on middle range theory, evidence-based practice (EBP), and situation-specific theories.
To remain current and timely, in this fifth edition, we have added a new chapter entitled “Ethical Theories and
Principles,” presenting information on these topics and describing how they relate to theory in nursing. We
have also included new middle range and situation-specific nursing theories as well as new “shared” theories
from non-nursing disciplines. One notable addition is a significant section discussing Complexity Science and
Complex Adaptive Systems in Chapter 13 (Theories From the Sociologic Sciences) helping to explain their
importance to nursing. Updates and application examples have been added throughout the discussions on the
various theories.

Organization of the Text
Theoretical Basis for Nursing is designed to be a basic nursing theory textbook that includes the essential
information students need to understand and apply theory in practice, research, education, and
administration/management.

The book is divided into four units. Unit I, Introduction to Theory, provides the background needed to
understand what theory is and how it is used in nursing. It outlines tools and techniques used to develop,
analyze, and evaluate theory so that it can be used in nursing practice, research, administration and
management, and education. In this unit, we have provided a balanced view of “hot” topics (e.g.,
philosophical world views and utilization of shared or borrowed theory). Also, rather than espousing one
strategy for activities such as concept development and theory evaluation, we have included a variety of
strategies.

Unit II, Nursing Theories, focuses largely on the grand nursing theories and begins with a chapter
describing their historical development. This unit divides the grand nursing theories into three groups based
on their focus (human needs, interactive process, and unitary process). The works of many of the grand
theorists are briefly summarized in Chapters 7, 8, and 9. Because this volume is intended to serve as a broad
foundation, these analyses provide the reader with enough information to understand the basis of the work and
to whet the reader’s appetite to select one or more for further study rather than delving into significant detail.

Chapters 10 and 11 cover the significant topic of middle range nursing theory. Chapter 10 presents a
detailed overview of the origins and growth of middle range theory in nursing and gives numerous examples
of how middle range theories have been developed by nurses. Chapter 11 provides an overview of some of the
growing number of middle range nursing theories. The theories presented include some of the most
commonly used middle range nursing theories (e.g., Pender’s Health Promotion Model and Leininger’s
Culture Care Diversity and Universality Theory) as well as some that are less well known but have a growing
body of research support (e.g., Meleis’s Transitions Theory, the Theory of Unpleasant Symptoms, and the

11

Uncertainty in Illness Theory). The intent is to provide a broad range of middle range theories to familiarize
the reader with examples and to encourage them to search for others appropriate to their practice or research.
Ultimately, it is hoped that readers will be challenged to develop new theories that can be used by nurses.

Chapter 12, which discusses EBP, explains and defines the idea/process of EBP and describes how it
relates to nursing theory and application of theory in nursing practice and research. The chapter concludes
with a short presentation and review of five different EBP models that have been widely used by nurses and
are well supported in the literature.

Unit III, Shared Theories Used by Nurses, is rather unique in nursing literature. Our book
acknowledges that “shared” or “borrowed” theories are essential to nursing and negates the idea that the use
of shared theory in practice or research is detrimental. In this unit, we have identified some of the most
significant theories that have been developed outside of the discipline of nursing but are continually used in
nursing. We have organized these theories based on broad disciplines: theories from the sociologic sciences,
behavioral sciences, biomedical sciences, and philosophy as well as from administration, management, and
learning. Each of these chapters was written by a nurse with both educational and practical experience in his
or her respective area. These theories are presented with sufficient information to allow the reader to
understand the theories and to recognize those that might be appropriate for his or her own work. These
chapters also provide original references and give examples of how the concepts, theories, and models
described have been used by other nurses.

Chapter 16, new to the fifth edition, describes ethical theories and principles that apply to nursing practice.
This addition was suggested by nursing faculty who recognized the importance of maintaining an ethical
perspective within the very complex health care system. This information is vital to professional nursing
practice and absolutely essential for nurses in advanced practice, management, or educational roles.

Finally, Unit IV, Application of Theory in Nursing, explains how theories are applied in nursing.
Separate chapters cover nursing practice, nursing research, nursing administration and management, and
nursing education. These chapters include many specific examples for the application of theory and are
intended to be a practical guide for theory use. The heightened development of practice theories and EBP
guidelines are critical to theory application in nursing today, so these areas have been expanded. The unit
concludes with a chapter that discusses some of the future issues in theory within the discipline.

Key Features
In addition to numerous tables and boxes that highlight and summarize important information, Theoretical
Basis for Nursing contains case studies, learning activities, exemplars, and illustrations that help students
visualize various concepts. New to this edition is a special boxed feature in most chapters that highlights how
a topic is outlined in the American Association of Colleges of Nursing (AACN’s) The Essentials of Master’s
Education in Nursing or The Essentials of Doctoral Education for Advanced Nursing Practice. Other key
features include:

■ Link to Practice: All chapters include at least one “Link to Practice” box, which presents useful
information or clinically related examples related to the subject being discussed. The intent is to give
additional tools or resources that can be used by nurses to apply the content in their own practice or
research.

■ Case Studies: At the end of Chapter 1 and the beginning of Chapters 2 to 23, case studies help the
reader understand how the content in the chapter relates to the everyday experience of the nurse,
whether in practice, research, or other aspects of nursing.

■ Learning Activities: At the end of each chapter, learning activities pose critical thinking questions,
propose individual and group projects related to topics covered in the chapter, and stimulate classroom
discussion.

■ Exemplars: In five chapters, an exemplar discusses a scholarly study from the perspectives of concept
analysis (Chapter 3); theory development (Chapter 4); theory analysis and evaluation (Chapter 5);
middle range theory development (Chapter 10); and theory generation via research, theory testing via
research, and use of a theory as the conceptual framework for a research study (Chapter 20).

■ Illustrations: Diagrams and models are included throughout the book to help the reader better

12

understand the many different theories presented.

New to This Edition
■ New Chapter 16, Ethical Theories and Principles
■ Detailed section on Complexity Science and Complex Adaptive Systems in Chapter 13.
■ More detailed explanation of EBP, situation-specific theories, and their relationship to theory in nursing
■ Numerous recent examples of application of theories in nursing practice, nursing research,

leadership/administration, and education
■ Enhanced instructional support, focusing on activities and information directed toward online learning

Student Resources Available on
■ Literature Assessment Activity provides an interactive tool featuring journal articles along with

critical thinking questions that will encourage students to engage with the literature. Students can print
or e-mail their responses to their instructor.

■ Case Studies with applicable questions guide students in understanding how the various theories link
to nursing practice.

■ Learning Objectives for each chapter help focus the student on outcomes.
■ Internet Resources provide live web links to pertinent sites so that students can further their study and

understanding of the various theories.
■ Journal Articles for each chapter offer opportunities to gain more knowledge and understanding of the

chapter content.

Instructor Resources Available on
■ Instructor’s Guide includes application-level discussion questions and classroom/online activities that

Melanie McEwen uses in her own teaching!
■ Strategies for Effective Teaching of Nursing Theory provide ideas for instructors to help make the

nursing theory class come alive.
■ Test Generator Questions provide multiple-choice questions that can be used for testing general

content knowledge.
■ PowerPoints with audience response (Iclicker) questions, based on the ones used by Melanie

McEwen in her own classroom, help highlight important points to enhance the classroom experience.
■ Case Studies with questions, answers, and related activities offer opportunities for instructors to make

the student case studies an exciting, fun, and rewarding classroom/online experience.
■ Image Bank provides images from the text that instructors can use to enhance their own presentations.

In summary, the focus of this learning package is on the application of theory rather than on the study,
analysis, and critique of grand theorists or a presentation of a specific aspect of theory (e.g., construction or
evaluation). It is hoped that practicing nurses, nurse researchers, and nursing scholars, as well as graduate
students and theory instructors, will use this book and its accompanying resources to gain a better
understanding and appreciation of theory.

Melanie McEwen, PhD, RN, CNE, ANEF
Evelyn M. Wills, PhD, RN

13

A C K N O W L E D G M E N T S

Our heartfelt thanks to Senior Development Editor, Michael Kerns, and Editorial Coordinator, Tim Rinehart,
for their assistance, patience, and persistence in helping us complete this project. They made a difficult task
seem easy! We also want to thank Senior Acquisitions Editor, Christina Burns, and Helen Kogut, for their
support and assistance in getting this project started and help with previous editions. Finally, a huge word of
thanks to our contributors who have diligently worked to present the notion of theory in a manner that will
engage nursing students and to look for new examples and applications to help make theory fresh and
relevant.

14

C O N T E N T S

Unit I: Introduction to Theory

1. Philosophy, Science, and Nursing
Melanie McEwen

Case Study
Nursing as a Profession
Nursing as an Academic Discipline
Introduction to Science and Philosophy

Overview of Science
Overview of Philosophy

Science and Philosophical Schools of Thought
Received View (Empiricism, Positivism, Logical Positivism)

Contemporary Empiricism/Postpositivism
Nursing and Empiricism

Perceived View (Human Science, Phenomenology, Constructivism, Historicism)
Nursing and Phenomenology/Constructivism/Historicism

Postmodernism (Poststructuralism, Postcolonialism)
Nursing and Postmodernism

Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing
Nursing Philosophy
Nursing Science
Philosophy of Science in Nursing

Knowledge Development and Nursing Science
Epistemology

Ways of Knowing
Nursing Epistemology
Other Views of Patterns of Knowledge in Nursing
Summary of Ways of Knowing in Nursing

Research Methodology and Nursing Science
Nursing as a Practice Science
Nursing as a Human Science
Quantitative Versus Qualitative Methodology Debate

Quantitative Methods
Qualitative Methods
Methodologic Pluralism

Summary
Key Points

Learning Activities

2. Overview of Theory in Nursing
Melanie McEwen

Overview of Theory
The Importance of Theory in Nursing
Terminology of Theory

15

Historical Overview: Theory Development in Nursing
Florence Nightingale
Stages of Theory Development in Nursing

Silent Knowledge Stage
Received Knowledge Stage
Subjective Knowledge Stage
Procedural Knowledge Stage
Constructed Knowledge Stage
Integrated Knowledge Stage

Summary of Stages of Nursing Theory Development
Classification of Theories in Nursing

Scope of Theory
Metatheory
Grand Theories
Middle Range Theories
Practice Theories

Type or Purpose of Theory
Descriptive (Factor-Isolating) Theories
Explanatory (Factor-Relating) Theories
Predictive (Situation-Relating) Theories
Prescriptive (Situation-Producing) Theories

Issues in Theory Development in Nursing
Borrowed Versus Unique Theory in Nursing
Nursing’s Metaparadigm

Relationships Among the Metaparadigm Concepts
Other Viewpoints on Nursing’s Metaparadigm

Caring as a Central Construct in the Discipline of Nursing
Summary
Key Points

Learning Activities

3. Concept Development: Clarifying Meaning of Terms
Evelyn M. Wills and Melanie McEwen

The Concept of “Concept”
Types of Concepts

Abstract Versus Concrete Concepts
Variable (Continuous) Versus Nonvariable (Discrete) Concepts
Theoretically Versus Operationally Defined Concepts

Sources of Concepts
Concept Analysis/Concept Development

Purposes of Concept Development
Context for Concept Development
Concept Development and Conceptual Frameworks
Concept Development and Research

Strategies for Concept Analysis and Concept Development
Walker and Avant

Concept Analysis
Concept Synthesis
Concept Derivation
Examples of Concept Analysis Using Walker and Avant’s Techniques

Rodgers
Schwartz-Barcott and Kim

Theoretical Phase

16

Fieldwork Phase
Analytical Phase

Meleis
Concept Exploration
Concept Clarification
Concept Analysis

Morse
Concept Delineation
Concept Comparison
Concept Clarification

Penrod and Hupcey
Comparison of Models for Concept Development

Summary
Key Points

Learning Activities

4. Theory Development: Structuring Conceptual Relationships in Nursing
Melanie McEwen

Overview of Theory Development
Categorizations of Theory

Categorization Based on Scope or Level of Abstraction
Philosophy, Worldview, or Metatheory
Grand Theories
Middle Range Theories
Practice Theories
Relationship Among Levels of Theory in Nursing

Categorization Based on Purpose
Descriptive Theories
Explanatory Theories
Predictive Theories
Prescriptive Theories

Categorization Based on Source or Discipline
Components of a Theory

Purpose
Concepts and Conceptual Definitions
Theoretical Statements

Existence Statements
Relational Statements

Structure and Linkages
Assumptions
Models

Theory Development
Relationship Among Theory, Research, and Practice

Relationship Between Theory and Research
Relationship Between Theory and Practice
Relationship Between Research and Practice

Approaches to Theory Development
Theory to Practice to Theory
Practice to Theory
Research to Theory
Theory to Research to Theory
Integrated Approach

Process of Theory Development

17

Concept Development: Creation of Conceptual Meaning
Statement Development: Formulation and Validation of Relational Statements
Theory Construction: Systematic Organization of the Linkages
Validating and Confirming Theoretical Relationships in Research
Validation and Application of Theory in Practice

Summary
Key Points

Learning Activities

5. Theory Analysis and Evaluation
Melanie McEwen

Definition and Purpose of Theory Evaluation
Theory Description
Theory Analysis
Theory Evaluation

Historical Overview of Theory Analysis and Evaluation
Characteristics of Significant Theories: Ellis
Theory Evaluation: Hardy
Theory Analysis and Theory Evaluation: Duffey and Muhlenkamp
Theory Evaluation: Barnum
Theory Analysis: Walker and Avant
Theory Analysis and Evaluation: Fawcett
Theory Description and Critique: Chinn and Kramer
Theory Description, Analysis, and Critique: Meleis
Analysis and Evaluation of Practice Theory, Middle Range Theory, and Nursing Models:
Whall
Theory Evaluation: Dudley-Brown

Comparisons of Methods
Synthesized Method of Theory Evaluation
Summary
Key Points

Learning Activities

Unit II: Nursing Theories

6. Overview of Grand Nursing Theories
Evelyn M. Wills

Categorization of Conceptual Frameworks and Grand Theories
Categorization Based on Scope
Categorization Based on Nursing Domains
Categorization Based on Paradigms

Parse’s Categorization
Newman’s Categorization
Fawcett’s Categorization

Specific Categories of Models and Theories for This Unit
Analysis Criteria for Grand Nursing Theories

Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships
Usefulness
Testability
Parsimony

18

Value in Extending Nursing Science
The Purpose of Critiquing Theories
Summary
Key Points

Learning Activities

7. Grand Nursing Theories Based on Human Needs
Evelyn M. Wills

Florence Nightingale: Nursing: What It Is and What It Is Not
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships
Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Virginia Henderson: The Principles and Practice of Nursing
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Faye G. Abdellah: Patient-Centered Approaches to Nursing
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Dorothea Orem: The Self-Care Deficit Nursing Theory
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Dorothy Johnson: The Behavioral System Model
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts
Relationships

Usefulness

19

Testability
Parsimony
Value in Extending Nursing Science

Betty Neuman: The Neuman Systems Model
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Summary
Key Points

Learning Activities

8. Grand Nursing Theories Based on Interactive Process
Evelyn M. Wills

Barbara Artinian: The Intersystem Model
Background of the Theorist
Philosophic Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain: Modeling and Role-
Modeling

Background of the Theorists
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Imogene King: King’s Conceptual System and Theory of Goal Attainment and
Transactional Process

Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

20

Sister Callista Roy: The Roy Adaptation Model
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Jean Watson: Human Caring Science, A Theory of Nursing
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Summary
Key Points

Learning Activities

9. Grand Nursing Theories Based on Unitary Process
Evelyn M. Wills

Martha Rogers: The Science of Unitary and Irreducible Human Beings
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Margaret Newman: Health as Expanding Consciousness
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Rosemarie Parse: The Humanbecoming Paradigm
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

21

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Summary
Key Points

Learning Activities

10. Introduction to Middle Range Nursing Theories
Melanie McEwen

Purposes of Middle Range Theory
Characteristics of Middle Range Theory
Concepts and Relationships …

power point presentation to explain in details  about specific theory :
Professional Advancement Model ( from Novice to Expert) by Patricia Benner 

need to add some pictures to  the PTT 
should be from perfect references, I will upload two books I have but you can add more references
this PTT will be reference for  me and my colleagues in final exam 
Theory presentation:
about the theorist
definition of the theory and terms
concepts and models
purpose ,goal
factors, importance
metaparadigm
critique
how used in research 
hoe leiningers theory help our practice also, evaluation of theory

Evaluation of-a-nursing-theory-nursing-theory-ppt Presentation Transcript

Title: Evaluation of a Nursing Theory

Six Questions are Propose for Complete

Describing Theory.
Guide for the Description of Theory

1. What is the

purpose of this

theory?

This question addresses

why the theory was

formulated and reflects

the contexts and

situations to which the

theory can be applied.

 Why is this theory formulated?

 Is there an overall purpose for the theory?

 The purpose is positive, negative, neutral?

 is there is specific purpose for the theory

 Is there a hierarchy of theory ?

 Is the all metapradigm element receiving care, nursing, the person, ,

Society and Environment?

 What is the value orientation of the purpose?

 Does achieving the theoretic purpose require a nursing context?

 Does the purpose reflect understanding, creation of meaning,

explanation, and prediction of phenomena?

 When would the theory cases to be applicable? what is the end point?

 what purpose not explicitly, embedded in the matrix of the theory can

be identified?

2. What are the

concepts of this

theory?

This question identifies

the ideas that are

structured and related

within the theory. It

questions the qualitative

and quantitative

dimensions of concepts.

 Is there one major concept with sub-concepts organized under it?

 How many concepts are there ?

 How many major (or minor) ones? ?

 can the concepts be ordered, related? Arranged into any configuration?

 Are there concepts that cannot be interrelated?

 Are concepts broad in scope? Narrow?

 How abstract or empiric are the concepts broad in scope? Narrow?

What is the balance between highly abstract and highly empiric are concepts?

are defined?

3. How are the This question clarifies  Which concepts are defined?

concepts

defined?

the meaning for

concepts within the

theory. It questions how

empiric experience is

represented by the ideas

within the theory.

 Which concepts are defined explicitly? Which are implied ?

 How much meaning needs to be inferred?

 which concepts are defined specifically? generally?

 are there competing definitions for some concepts?

 Are there similar definitions for different concepts?

Are any concepts defined contrary to common convention?

4. What is the

nature of

relationships?

 This question

addresses how

concepts are linked

together. It focuses

on the various forms

relationship

statements can take

and how they give

structure to the

theory.

 What are the major relationships within the theory?

 Which relationships are obvious? Which are implied?

 Do relationships include all concepts? Which are not included?

 Are some concepts included in multiple relationships?

 Is there a hierarchy of relationships? Do relationships create

relationships? meaning and understanding? describing, explaining?

predicting? What mix of each?

are relationships illustrated?

5. What is the

structure of the

theory?

 This question

addresses the overall

form of the

conceptual

interrelationships.

 It discerns whether

the theory contains

partial structures or

has one basic form.

 How are overall and individual ideas organized?

 If outlined, what would the theory look like?

 do relationships expand concepts into large wholes or vice versa?

 do they link concepts in a linear fashion?

 does the structure move concepts away from or toward the purposes?

 Are there several structures that emerge? What is their form? Do they

fit together?

6. On what

assumptions
does the theory

build?

 This question

addresses the basic

truths that underlie

theoretic reasoning.

 It questions whether

assumptions reflect

philosophic values

 What assumptions underlie the theory?

 Are assumptions explicit, implicit, or derivable from context and

meanings?

 What are the individual, nurse, society, environment, and health

assumed to be like?

 Do assumptions be factually verified?

or factual assertions

factual assertions

 Can assumptions be hierarchically arranged or otherwise? ordered?

Guide for the Description of Theory

1

.
PURPOSE  Why is this theory formulated?

 Is there an overall purpose for the theory?

 The purpose is positive, negative, neutral?

 is there is specific purpose for the theory

 Is there a hierarchy of theory ?

 Is the all metapradigm element receiving care, nursing, the person, , Society and Environment?

 What is the value orientation of the purpose?

 Does achieving the theoretic purpose require a nursing context?

 Does the purpose reflect understanding, creation of meaning, explanation, and prediction of

phenomena?

 When would the theory cases to be applicable? what is the end point?

 what purpose not explicitly, embedded in the matrix of the theory can be identified?

2. Concepts  Is there one major concept with sub-concepts organized under it?

 How many concepts are there ?

 How many major (or minor) ones? ?

 can the concepts be ordered, related? Arranged into any configuration?

 Are there concepts that cannot be interrelated?

 Are concepts broad in scope? Narrow?

 How abstract or empiric are the concepts broad in scope? Narrow?

 What is the balance between highly abstract and highly empiric are concepts? are defined?

3. Definitions  Which concepts are defined?

 Which concepts are defined explicitly? Which are implied ?

 How much meaning needs to be inferred?

 which concepts are defined specifically? generally?

 are there competing definitions for some concepts?

 Are there similar definitions for different concepts?

 Are any concepts defined contrary to common convention?

4. Relationships  What are the major relationships within the theory?

 Which relationships are obvious? Which are implied?

 Do relationships include all concepts? Which are not included?

 Are some concepts included in multiple relationships?

 Is there a hierarchy of relationships? Do relationships create relationships? meaning and understanding?

describing, explaining? predicting? What mix of each?

 are relationships illustrated?

5. Structure  How are overall and individual ideas organized?

 If outlined, what would the theory look like?

 do relationships expand concepts into large wholes or vice versa?

 do they link concepts in a linear fashion?

 does the structure move concepts away from or toward the purposes?

 Are there several structures that emerge? What is their form? Do they fit together?

6. Assumptions  What assumptions underlie the theory?

 Are assumptions explicit, implicit, or derivable from context and meanings?

 What are the individual, nurse, society, environment, and health assumed to be like?

 Do assumptions be factually verified?

 Can assumptions be hierarchically arranged or otherwise? ordered?

Criteria for the evaluation of theory

Accuracy  As a noun, Accuracy defined as exactness or precision, while

as an adjective, as without mistakes or errors, perfect, correct

 In relation to nursing theory, accuracy pertains to describing

nursing as it exists today, not the nursing of the future or of

the past.

Consistency  Kuhn (1977) describes consistency in terms of the theory

being internally consistent as well as being consistent with
accepted theories.

 Internal consistency described as consistency in language , the

existence of logical order, and connectedness

 Inconsistencies should be avoided, a theory with an

inconsistency does not necessitate that the whole theory be

scrapped.

 operational definition should be used for concepts, assumptions

and propositions.

 It must uses the terms coherent and logically presented to

describe clarity.

Fruitful  Fruitful, is related conceptually to criteria to criteria proposed

by others

 (Synonymous with fertile, bountiful, productive, and prolific

 Kuhn (1977), in describing fruitful, states that theory should

expose new feelings, new phenomenon, or previously

unknown relationships among

 Fruitful refers to success in explaining observable

phenomenon and the evlautionon of emperical work resulting

from a theory

 Newton-Smith (1981) describes (fertile) as the scope for .

further development.

 Consistent with this is Ellis‟s (1968) criteria of generation of

information-the theory should generate hypotheses.

 A theory that generate many hypotheses, even some without

high probability, or some that are difficult to test, can

contribute to understanding.

Simplicity  Simplicity as an important evaluative criterion not complexity

 Meleis (1985) takes a more pragmatic complexity approach:

whether the theory has a lot of phenomena and relationships

(complexity) or if it focuses on fewer concepts and few

(simplicity)?

 Simplicity is useful characteristic of a good theory in nursing,

and important in the evaluation of nursing theory.

Scope  Scope has been dichotomized as either broad or narrow

 “The broader the scope, in terms of the number and variety of

facts or concepts related, the greater is the significance of the

theory

 Hardy (1974) states “the more general a theory, the more useful

it is Broad vs. narrow scope can also be dichotomized in

relation to its generalities, or the use of the term theory and

conceptual framework/ model.

 Scope may be conceptualized in relation to the level of theory,

e.g. a grand theory or middle range theory.

Acceptance  Meleis (1985)states acceptance “when the theory begins to

cross several concentric circles from where it originated, its

circle of contagiousness increases and we can infer that the

theory is receiving.

 Laudan (1977) discusses the importance of acceptance and

pursuit by other members of the discipline in that the theory

shows promise if others are accepting and „buying into‟ the

theory.

 It is important for the advancement of nursing as a profession

to have members of the discipline communicate regarding its

multicultural acceptance and adoption by others.

Testability  Testability refers to the theory‟s research potential or empirical

adequacy.

 Testability has been long felt to be an important criterion for

the evaluation of nursing theory, and touted as a method to

advance the science of nursing.

 lack of empirical validation of nursing theory has hindered the

development of the nursing science

 have proposed criteria for evaluating theory-testing research,

and discuss important philosophical and methodological issues

in the testing of nursing theory.

Socio-cultural

utility

 Socio-cultural utility encompasses social congruence and

social significance.

 Social congruence encompasses the beliefs, values and

expectations of different cultures that should shape and direct

the type of theory most useful to it.

 Meleis (1985) explains, self-care and independence are goals

consistent with some cultures‟ value systems but not others.

this is inappropriate in some societies and cultures, and should

be avoided.

 Fruitful, is related conceptually to criteria17. Fruitful ( 效果好的 ,收益多 ) Synonymous with fertile, bountiful,

productive, andproposed by others. Kuhn (1977), in describing fruitful, states that theory should exposeprolific. new

feelings, new phenomenon, or previously unknown relationships among Fruitful refers to success in explaining

observablephenomenon already known. phenomenon, and the evaluation of empirical work resulting from a theory.

 Newton-Smith (1981) describes (fertile) as the scope for18. Fruitful  The theory should contain ideas to further

research.further development. Consistent with this is Ellis‟s (1968) criteria of generation of information-the theory should

generate Ellis (1968) states “A theory that generateshypotheses. many hypotheses, even some without high probability, or

some that are difficult to test, can contribute to understanding.

 Simplicity as an important evaluative criterion19. Simplicity( 單純 ;簡單 ) (Kuhn, 1977; Newton-Smith, 1981; Chin and

Jacobs, 1983) others propose Meleis (1985) takes a more pragmatic(complexity (Ellis, 1968; Barnum, 1990). 務實的 )
approach: whether the theory has a lot of phenomena and relationships (complexity) or if it focuses on fewer concepts and few

relationships Kuhn‟s, (1977) describes as “bringing order to phenomenon that in(simplicity)? Simplicity is a seemingly(

表面上 )its absence would be isolated and confused”. useful characteristic of a good theory in nursing, and important in the
evaluation of nursing theory.

  Scope has been dichotomized as either broad or narrow.20. Scope( 範圍 ) Ellis (1968) and Hardy (1974). “The broader the
scope, in terms of the number and variety of facts or concepts related, the greater is the significance of the Hardy (1974) states

“the more general a theory, the more useful ittheory” . Broad vs. narrow scope can also be dichotomized in relation to

itsis.” generalities, or the use of the term theory and conceptual framework/ model. Scope may be conceptualized in

relation to the level of theory, eg. a grand theory or middle range theory.

 Meleis (1985)states acceptance “when the theory begins to21. Acceptance cross several concentric circles from where it

originated, its circle of contagiousness( 蔓延的 ) increases and we can infer that the theory is receiving Laudan (1977)

discusses themore acceptability, uninfluenced by the theorist” . importance of acceptance and pursuit by other members of

the discipline in that the theory shows promise if others are accepting and „buying into‟ the theory. It is important for the

advancement( 促進 ) of nursing as a profession to have members of the discipline communicate regarding its multicultural

acceptance and adoption( 採用 ) by others.

 Testability refers to the theory‟s research potential or22. Testability Testability has been long felt to be an important

criterionempirical adequacy. for the evaluation of nursing theory, and touted ( 招徠 ) as a method to advance Acton et al.

(1991)and Silva (1986) describe how thethe science of nursing. lack of empirical validation of nursing theory has hindered

the development of Silva and Sorrel1 (1992) have proposed criteria for evaluatingnursing science. theory-testing research,

and discuss important philosophical and methodological issues in the testing of nursing theory.

 Socio-cultural utility encompasses( 包圍 ) social23. Socio-cultural utility Johnson (1974), Meleis (1985) andcongruence(

適合 ) and social significance Social congruenceFawcett (1989)in their criteria for the evaluation of theory. encompasses the

beliefs, values and expectations of different cultures that As Meleis (1985)should shape and direct the type of theory most

useful to it. explains, self-care and independence are goals consistent with some cultures‟ Theories with such goals would be

incongruent(value systems but not others. 不一致 的 ) and inappropriate in some societies and cultures, and should be
avoided.

 Nurses in all roles24. Conclusion of criteria for the evaluation of theory will hopefully use these criteria proposed here to

guide their choice of theory There has been awhen using nursing theory in practice, education and research. dearth ( 缺乏 )

of empirical testing of theories in nursing, testing is only one A set of criteria for the evaluation ofpart of the evaluation of

theory. theory has been proposed here that includes: accuracy, consistency, fruitfulness, simplicity/complexity, scope,

acceptability and socio-cultural utility.

 Meleis, A. I. (2007). Theoretical Nursing: Development25. Theory Critique & Progress (4rd ed.). Philadelphia. PA:

Lippincott.(Ch9)(pp.186- 211)

 26. Table 11-5THEORY CRITIQUE— RELATIONSHIP BETWEENSTRUCTURE AND FUNCTION; DIAGRAM OF

THEORY;AND CIRCLE OF CONTAGIOUSNESSCRITERIA UNITS OF ANALYSISRelationship Claritybetween structure

Consistencyand function Simplicity/Complexity Tautology( 同義反複 )/Teleology( 目的論 )Diagram of theory Visual and
graphic presentation Logical representation ClarityCircle of Geographical origin of theory and geographicalcontagiousness

spread influence of theorist vs. theory

 27. Table 11-6THEORY CRITIQUE—USEFULNESSCRITERIA UNITS OF ANALYSISPractice Direction Cost

effectiveness Applicability Relevance GeneralizabilityResearch Consistency Predictability TestabilityEducation Philosophical

statement Concepts ObjectivesAdministration Structure of care Organization of care Guidelines for patient care Patient

classification system

 28. Table 11-7THEORY CRITIQUE—EXTERNAL COMPONENTSOF THEORYCRITERIA UNITS OF

ANALYSISPersonal values Theorist implicit/explicit values Critic implicit/explicit valuesCongruence with other

Complementarity( 補足 )professional values Esotericism( 祕傳性 )Congruence with social Beliefs Competitionvalues Values
CustomsSocial significance Value to humanity

 This question29. Forming a complete critical reflection1. Is this clear? Clarity and consistencyaddresses the clarity and

consistency of presentation. This question addressesmay be both semantic and structural.2. Is this simple? Complexitythe

number of structural components and relationships within theory. implies numerous relational components within theory;

simplicity implies fewer relational components.

 This question30. Forming a complete critical reflection3. Is this general? Generality infers a wideaddresses the scope of

experiences covered by theory. scope of phenomena, whereas specificity narrows the range of events included in This

question addresses the extent to whichtheory.4. Is this accessible? concepts within the theory are grounded in empirically

identifiable phenomena.5. This question addresses the extent to which theory leads toIs this important? valued nursing goals

in practice, research, and education.

 31. Guide for the critical reflection of theory 1.HOW CLEAR IS THIS THEORY? Are significant concepts not defined?

Are Are major concepts defined?  Are words coined? Are coineddefinitions clear? Congruent( 適合的 )? Consistent?

Are words borrowed from other disciplines and used differentlywords defined? Is the amount of explanation appropriate?

Too much? Notin this context? Not helpful? Needed Are examples or diagrams helpful? meaningful? enough? and not

present?

 Are basic assumptions consistent with32. 1.HOW CLEAR IS THIS THEORY? Are the Is the view of person and

environment compatible( 能共 處 )?purposes? Are Are different terms defined similarly?same terms defined differently?

Are compatible andconcepts used in a manner consistent with their definition? Cancoherent( 協調一致的 ) structures

suggested for different parts of the theory? Are there any ambiguities( 模稜兩可 ) as a result ofthe theory be followed?

Does the theorist accomplish what she or he sets outsequence of presentation? to do?

 How many relationships are contained33. 2.HOW SIMPLE IS THIS THEORY? How many concepts are How are the

relationships organized?within the theory?  Are some concepts differentiated into sub-concepts?contained in the theory?

Is the theoryCan concepts be combined without losing theoretic meaning? Does the theory tend to describe,complex some

areas and not in others? explain, or predict? Impact understanding? Create meaning?

 How specific are the purposes of this34. 3.HOW GENERAL IS THIS THEORY Is thus theorytheory? Do they apply to

all or only some practice areas? When? Is the purposespecific to nursing? If not, who else could use it? Why? If

subpurposes exist, do they reflect nursingjustifiably a nursing purpose? actions? How broad are the concepts within the

theory?

 How Are the concepts broad or narrow?35. 4.HOW ACCESSIBLE IS THIS THEORY Are the concepts‟specific or

general are definitions within the theory? empiric indicators identifiable in reality? Are they within the realm of Do the

definitions provided for the concepts adequately reflect theirnursing? Is a very narrow definition offered for a broad

concept? A broadmeanings? If words are coined, are they defined?meaning for a narrow concept?

 Does the theory have potential to36. 5.HOW IMPORTANT IS THIS THEORY? Does the theory influenceinfluence

nursing actions? If so, to what end? Hoenursing education? research? If so, to what end? Is that end desirable? specific are

the purposes of the theory? Do they provide a general framework Is the theory‟s positionwithin which to act or a means to

predict phenomena? about people, about nursing, and about the environment consistent with nursing‟s Given the purpose of

the theory and its orientation, what ofphilosophy? significance for nursing or health care has been omitted?

 Is the started or implied purpose one37. 5.HOW IMPORTANT IS THIS THEORY? Will use of the theory help or

hinderthat is important to nursing? Why? Will application of this theory resolve any importantnursing in any way? Is the

theory futuristic andissues in nursing? Will it resolve any problems?  Will research based on the theory answer important

questions?forward-looking? Do I like this theory? Why?Are the concepts within the domain of nursing?

 Theory development and evaluation are cyclical, continuous,38. Conclusion Theory evaluationand dynamic process. One

can not exist without the other. including description, concept analysis, theory critique, testing and support. These process are

based on the view that science is a human process that includes not only valid findings but also observation, agreements, useful

Theory evaluation is central to the development ofsolutions to problems. theory; it is the responsibility of each clinician,

academician.

 Kuhn(1977) “we can delineate such criteria and that39. Conclusion accuracy, consistency, broad scope, simplicity and

fruitfulness in research are However, “everyessential as objective criteria for judging competing theories” individuals choice

between competing theories depends on a mixture of objective The subjective factors are dependent on individualsand

subjective factors” Both objective and subjective factors have apreferences and personalities. place in our understanding of

the philosophy of science.

 40. Adaptation Model

 41. Exercise: Application of Roys Adaptation Model in Nursing Practicehttp://currentnursing.com/nursing_theory/applicat1.

What is the purpose of this theory?2. What are the concepts of this theory?3. How are the concepts defined?4. What is the

nature of relationships?5. What is the structure of the theory? .6. On what assumptions does the theory build?

Evaluation of-a-nursing-theory-nursing-theory-ppt from Maria Poly

Evaluation of-a-nursing-theory-nursing-theory-ppt Presentation Transcript

 1. Evaluation of a Nursing Theory

 2. Forming a Complete Description:Six Questions are Propose for Describing Theory.

 3. 1. What is the purpose of this theory? This question addresses why the theory was formu- lated and reflects the contexts and

situations to which the theory can be applied.2. What are the concepts of this theory? This question identifies the ideas that are

structured and related within the theory. It questions the quali- tative and quantitative dimensions of concepts.3. How are the

concepts defined? This question clarifies the meaning for concepts within the theory. It questions how empiric experi- ence is

represented by the ideas within the theory.

 4. 4. What is the nature of relationships? This question addresses how concepts are linked together. It focuses on the various

forms relationship statements can take and how they give structure to the theory.5. What is the structure of the theory? This

question addresses the overall form of the con- ceptual interrelationships. It discerns whether the theory contains partial

structures or has one basic form.6. On what assumptions does the theory build? This question addresses the basic truths that

underlie theoretic reasoning. It questions whether assumptions reflect philosophic values or factual assertions factual

assertions.

 Why is this theory5. Guide for the Description of Theory 1. PURPOSE Is there an overall purpose for the theory? A

hierarchy offormulated? Is there a purpose for the nurse? Thepurposes? Separate numerous purposes? How broad or

narrow is theperson receiving care? Society? Environment? What is the value orientation of the purpose? Positive,

negative,purpose? neutral?

 Does achieving the theoretic purpose require a nursing6. 1. PURPOSE Does the purpose reflect understanding? Creation of

meaning?context? When would the theoryDescription, explanation, and prediction of phenomena? What purpose not

explicitly( 明確地cases to be applicable? What is the end point? ) embedded( 植入 ) in the matrix of the theory can be
identified?

 Is there one major concept with sub-concepts organized under7. 2. CONCEPTS Can the How many major (or minor)

ones? How many concepts are there?it? concepts be ordered, related? Arranged into any configuration?

 Are Are there concepts that cannot be interrelated?8. 2. CONCEPTS How abstract( 抽象 ) or empiric( 經驗 ) are

theconcepts broad in scope? Narrow? What is the balance between highly abstract and highly empiricconcepts? concepts?

 Which Which concepts are defined? Which are not?9. 3. DEFINITIONS How much meaningconcepts are defined

explicitly? Which are implied( 隱喻 )? Are Which concepts are defined specifically? Generally?needs to be inferred ?

there competing definitions for some concepts? Are there similar definitions for Are any concepts defined contrary to common

convention( 習俗different concepts? , 常規 )?

  What are the major relationships within the theory?10. 4. RELATIONSHIPS Do relationships includeWhich

relationships are obvious? Which are implied? Are some concepts included in multipleall concepts? Which are not included?

Is there a hierarchy of relationships? Do relationships createrelationships? meaning and understanding? Do they do this by

describing, explaining? Are relationships illustrated?Predicting? What mix of each?

 If How are overall and individual ideas organized?11. 5. STRUCTURE Do relationships expand conceptsoutlined, what

THEORETICAL
BASIS

for Nursing

McEwen_FM.indd 1 10/10/13 11:21 AM

McEwen_FM.indd 2 10/10/13 11:21 AM

THEORETICAL
BASIS

for Nursing

Melanie McEwen, PhD, RN, CNE, ANEF
Associate Professor
University of Texas Health Science Center at Houston
School of Nursing
Houston, Texas

Evelyn M. Wills, PhD, RN
Professor (Retired)
Department of Nursing
College of Nursing and Allied Health Professions
University of Louisiana at Lafayette
Lafayette, Louisiana

F O U R T H E D I T I O N

McEwen_FM.indd 3 10/10/13 11:21 AM

Acquisitions Editor: Patrick Barbera
Product Development Editor: Helen Kogut
Editorial Assistant: Dan Reilly
Production Project Manager: Cynthia Rudy
Design Coordinator: Holly McLaughlin
Illustration Coordinator: Jennifer Clements
Manufacturing Coordinator: Karin Duffield
Prepress Vendor: Absolute Service, Inc.

4th edition

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007,
2002 Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No
part of this book may be reproduced or transmitted in any form or by any means, including as
photocopies or scanned-in or other electronic copies, or utilized by any information storage and
retrieval system without written permission from the copyright owner, except for brief quotations
embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as
part of their official duties as U.S. government employees are not covered by the above-mentioned
copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce
Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our
website at lww.com (products and services).

9 8 7 6 5 4 3 2 1

Printed in China

Library of Congress Cataloging-in-Publication Data
McEwen, Melanie, author.
Theoretical basis for nursing / Melanie McEwen, Evelyn M. Wills.—Edition 4.

p. ; cm.
Includes bibliographical references and indexes.
ISBN 978-1-4511-9031-1
I. Wills, Evelyn M., author. II. Title.
[DNLM: 1. Nursing Theory. WY 86]
RT84.5
610.73–dc23

2013035526

Care has been taken to confirm the accuracy of the information presented and to describe generally
accepted practices. However, the author(s), editors, and publisher are not responsible for errors
or omissions or for any consequences from application of the information in this book and make
no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the
contents of the publication. Application of this information in a particular situation remains the
professional responsibility of the practitioner; the clinical treatments described and recommended
may not be considered absolute and universal recommendations.

The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dos-
age set forth in this text are in accordance with the current recommendations and practice at the time of
publication. However, in view of ongoing research, changes in government regulations, and the constant
flow of information relating to drug therapy and drug reactions, the reader is urged to check the package
insert for each drug for any change in indications and dosage and for added warnings and precautions.
This is particularly important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have U.S. Food and Drug Ad-
ministration (FDA) clearance for limited use in restricted research settings. It is the responsibility of
the health care provider to ascertain the FDA status of each drug or device planned for use in his or
her clinical practice.

LWW.com

McEwen_FM.indd 4 10/10/13 11:21 AM

Proudly sourced and uploaded by [StormRG]
Kickass Torrents | The Pirate Bay | ExtraTorrent

To Kaitlin and Grant—You have helped me broaden my thoughts
and consider all kinds of possibilities; I hope I’ve done the same
for you.

Also for Helen and Keith—Our children chose well. Besides,
you have given us Madelyn, Logan, Brenna, Liam, Lucy, and
Andrew; they are gifts beyond words.

Melanie McEwen

To Tom, Paul, and Vicki, who light up my life, and to Marian,
who is my applause. To Teddy, Gwen, Merlyn, and Madelyn,
who have been so patient and loving during this process.
A thousand thank yous to Peggy, who has supported me through
this writing process.

Evelyn M. Wills

D E D I C A T I O N

McEwen_FM.indd 5 10/10/13 11:21 AM

Grace Bielkiewicz, RN, PMHCNS-BC
Assistant Professor (Retired)
Department of Nursing
Southern University
Baton Rouge, Louisiana
Chapter 13: Theories From the Sociologic Sciences

Debra Brossett Garner, DNP, APRN, ACNS-BC, PMHNP-BC
Psychiatric Mental Health Nurse Practitioner
Delhi Rural Health Clinic
Delhi, Louisiana
Chapter 14: Theories From the Behavioral Sciences

Melinda Granger Oberleitner, DNS, RN
Associate Dean, College of Nursing and Allied Health Professions
Professor, Department of Nursing
SLEMCO/BORSF Endowed Professor of Nursing
University of Louisiana at Lafayette
Lafayette, Louisiana
Chapter 16: Theories, Models, and Frameworks From Administration and
Management
Chapter 20: Application of Theory in Nursing Administration and
Management

C O N T R I B U T O R S

vi

McEwen_FM.indd 6 10/10/13 11:21 AM

R E V I E W E R S

Kimamer Amer, PhD
Associate Professor
Department of Nursing
DePaul University
Chicago, Illinois

Margaret Barnes, MSN, RN
Assistant Professor
School of Nursing, RNBSN Post-Licensure Division
Indiana Wesleyan University
Florence, Kentucky

Shari Cherney, RN, BScN, MHSc
Professor
Department of Nursing
George Brown College
Toronto, Ontario, Canada

Cheryl Delgado, PhD
Associate Professor
Department of Nursing
Cleveland State University
Cleveland, Ohio

Dolores Furlong, PhD
Professor
Department of Nursing
University of New Brunswick
Fredericton, New Brunswick, Canada

Maryanne Garon, DNSc
Professor
Department of Nursing
California State University Fullerton
Fullerton, California

Carol Grantham, PhD, MSN, CPNP-PC
Faculty
Byrdine F. Lewis School of Nursing & Health

Professions
Georgia State University
Atlanta, Georgia

Barbara Harris, PhD
Assistant Professor
School of Nursing
DePaul University
Chicago, Illinois

Seongkum Heo, PhD
Assistant Professor
Department of Nursing
University of Arkansas for Medical Sciences
Little Rock, Arkansas

Donna Murnaghan, PhD
Associate Professor
School of Nursing
University of Prince Edward Island
Charlottetown, Prince Edward Island, Canada

Pamela Reis, PhD, CNM
Assistant Professor
Department of Nursing
East Carolina University
Greenville, North Carolina

Sue Robertson, PhD
Assistant Professor
Department of Nursing
California State University, Fullerton
Fullerton, California

Denice Sheehan, PhD
Assistant Professor
Department of Nursing
Kent State University
Kent, Ohio

Ida Slusher, DSN
Professor & Nursing Education Coordinator
Department of Baccalaureate & Graduate Nursing
Eastern Kentucky University
Richmond, Kentucky

Sharon Van Sell, BSN, MEd, MS, EdD
Professor
Department of Nursing
Texas Woman’s University
Dallas, Texas

vii

McEwen_FM.indd 7 10/10/13 11:21 AM

P R E F A C E

viii

Frequently, nursing students respond with a cringing expression or a resounding
“ugh!” when faced with the requirement of taking a course on theory. Indeed, many
fail to see theory’s relevance to the real world of nursing practice and often have
difficulty applying the information in later courses and in their research. This book
is the result of the frustration felt by a group of nursing instructors who met a num-
ber of years ago to adopt a textbook for a theory course. Indeed, because of student
complaints and faculty dissatisfaction, we were changing textbooks yet again. A fairly
lengthy discussion arose in which we concluded that the available books did not meet
the needs of our students or course faculty. Ultimately, we determined to “build a
better mousetrap.” Our intent was to write a book that was a general overview of
theory per se, stressing how it is—and should be—used by nurses to improve practice,
research, education, and management/leadership.

As in past editions, an ongoing review of trends in nursing theory and nursing
science has shown an increasing emphasis on middle range theory, evidence-based
practice, and situation-specific theories. To remain current and timely, in this fourth
edition, we have added a new chapter discussing evidence-based practice, highlighting
how it relates to theory in nursing, and presenting several evidence-based practice
models commonly used by nurses. We have also included new middle range nursing
theories and added a significant section discussing situation-specific nursing theories,
describing how they relate to evidence-based practice. Updates and application exam-
ples have been added throughout the discussions on the various theories.

Organization of the Text

Theoretical Basis for Nursing is designed to be a basic nursing theory textbook that
includes the essential information students need to understand and apply theory.

The book is divided into four units. Unit I, Introduction to Theory, provides
the background needed to understand what theory is and how it is used in nursing.
It outlines tools and techniques used to develop, analyze, and evaluate theory so
that it can be used in nursing practice, research, administration and management,
and education. In this unit, we have provided a balanced view of “hot” topics (e.g.,
philosophical world views and utilization of shared or borrowed theory). Also, rather
than espousing one strategy for activities such as concept development and theory
evaluation, we have included a variety of strategies.

Unit II, Nursing Theories, focuses largely on the grand nursing theories and
begins with a chapter describing their historical development. This unit divides the
grand nursing theories into three groups based on their focus (human needs, in-
teractive process, and unitary process). The works of many of the grand theorists
are briefly summarized in Chapters 7, 8, and 9. We acknowledge that these analyses

McEwen_FM.indd 8 10/19/13 3:59 AM

Preface ix

are not comprehensive; rather, they are intended to provide the reader with enough
information to understand the basis of the work and to whet the reader’s appetite to
select one or more for further study.

Chapters 10 and 11 cover the significant topic of middle range nursing theory.
Chapter 10 presents a detailed overview of the origins and growth of middle range
theory in nursing and gives numerous examples of how middle range theories have
been developed by nurses. Chapter 11 provides an overview of some of the grow-
ing number of middle range nursing theories. The theories presented include some
of the most commonly used middle range nursing theories (e.g., Pender’s Health
Promotion Model and Leininger’s Culture Care Diversity and Universality Theory)
as well as some that are less well known but have a growing body of research sup-
port (e.g., Meleis’ Transitions Theory, the Theory of Unpleasant Symptoms, and the
Uncertainty in Illness Theory). The intent is to provide a broad range of middle range
theories to familiarize the reader with examples and to encourage them to search for
others appropriate to their practice or research. Ultimately, it is hoped that readers
will be challenged to develop new theories that can be used by nurses.

Chapter 12, which discusses evidence-based practice (EBP), is new to this edi-
tion. This chapter explains and defines the idea/process of EBP and describes how it
relates to nursing theory and application of theory in nursing practice and research.
The chapter concludes with a short presentation and review of five different EBP
models that have been widely used by nurses and are well supported in the literature.

Unit III, Shared Theories Used by Nurses, is rather unique in nursing litera-
ture. Our book acknowledges that “shared” or “borrowed” theories are essential to
nursing and negates the idea that the use of shared theory in practice or research is
detrimental. In this unit, we have identified some of the most significant theories that
have been developed outside of the discipline of nursing but are continually used in
nursing. We have organized these theories based on broad disciplines: theories from
the sociologic sciences, behavioral sciences, and biomedical sciences, as well as from
administration and management and learning. Each of these chapters was written by
a nurse with both educational and practical experience in her respective area. These
theories are presented with sufficient information to allow the reader to understand
the theories and to recognize those that might be appropriate for her or his own
work. These chapters also provide original references and give examples of how the
concepts, theories, and models described have been used by other nurses.

Finally, Unit IV, Application of Theory in Nursing Practice, explains how the-
ories are applied in nursing. Separate chapters cover nursing practice, nursing research,
nursing administration and management, and nursing education. These chapters in-
clude many specific examples for the application of theory and are intended to be a
practical guide for theory use. The heightened development of practice theories and
EBP guidelines are critical to theory application in nursing today, so these areas have
been expanded. The unit concludes with a chapter that discusses some of the future
issues in theory within the discipline.

McEwen_FM.indd 9 10/19/13 3:59 AM

x Preface

■ New Chapter 12, Evidence-Based Practice and Nursing Theory
■ More detailed explanation of EBP and its relationship to theory in nursing
■ Enhanced attention to situation-specific theories and how they relate to EBP
■ Numerous recent examples of application of theories in nursing practice,

nursing research, leadership/administration, and education
■ NEW instructional support

New To This Edition

Student Resources Available on

■ Literature Assessment Activity provides an interactive tool featuring journal
articles along with questions that will encourage students to think critically
about the literature. Students can print or e-mail their responses to their
instructor.

■ Case Studies with applicable questions guide students in understanding how
the various theories link to nursing practice.

■ Learning Objectives for each chapter help focus the student.
■ Internet Resources provide live web links to pertinent sites so that students

can further their study and understanding of the various theories.
■ Journal Articles for each chapter offer opportunities to gain more knowledge

and understanding of the chapter content.

Key Features
In addition to numerous tables and boxes that highlight and summarize important
information, Theoretical Basis for Nursing contains case studies, learning activities,
exemplars, and illustrations that help students visualize various concepts. New to this
edition is a special feature called Link to Practice.

■ Link to Practice: All chapters include at least one “Link to Practice” box,
which presents useful information or clinically related examples related to the
subject being discussed. The intent is to give additional tools or resources that
can be used by nurses to apply the content in their own practice or research.

■ Case Studies: At the end of Chapter 1 and the beginning of Chapters 2 to 22,
case studies help the reader understand how the content in the chapter relates
to the everyday experience of the nurse, whether in practice, research, or other
aspects of nursing.

■ Learning Activities: At the end of each chapter, learning activities pose critical
thinking questions, propose individual and group projects related to topics
covered in the chapter, and stimulate classroom discussion.

■ Exemplars: In five chapters, an exemplar discusses a scholarly study from the
perspectives of concept analysis (Chapter 3); theory development (Chapter 4);
theory analysis and evaluation (Chapter 5); middle range theory develop-
ment (Chapter 10); and theory generation via research, theory testing via
research, and use of a theory as the conceptual framework for a research study
(Chapter 19).

■ Illustrations: Diagrams and models are included throughout the book to help
the reader better understand the many different theories presented.

McEwen_FM.indd 10 10/10/13 11:21 AM

Preface xi

Instructor Resources Available on
■ Instructor’s Guide includes application-level discussion questions and classroom/

online activities that Melanie McEwen uses in her own teaching!
■ Strategies for Effective Teaching of Nursing Theory provide ideas for

instructors to help make the nursing theory class come alive.
■ Test Generator Questions provide multiple-choice questions that can be used

for testing general content knowledge.
■ PowerPoints with audience response (Iclicker) questions, based on

the ones used by Melanie McEwen in her own classroom, help highlight
important points to enhance the classroom, experience.

■ Case Studies with questions, answers, and related activities offer opportunities
for instructors to make the student case studies an exciting, fun, and rewarding
classroom/online experience.

■ Image Bank provides images from the text that instructors can use to enhance
their own presentations.

In summary, the focus of this learning package is on the application of theory rather
than on the study, analysis, and critique of grand theorists or a presentation of a
specific aspect of theory (e.g., construction or evaluation). It is hoped that practic-
ing nurses, nurse researchers, and nursing scholars, as well as graduate students and
theory instructors, will use this book and its accompanying resources to gain a better
understanding and appreciation of theory.

Melanie McEwen, PhD, RN, CNE, ANEF
Evelyn M. Wills, PhD, RN

McEwen_FM.indd 11 10/10/13 11:21 AM

xii

A C K N O W L E D G M E N T S

Our heartfelt thanks to Product Development Editor, Helen Kogut, for her assis-
tance, patience, and persistence in helping us complete this project. She has made a
difficult task seem easy! We also want to thank Acquisitions Editor, Christina Burns,
for her wonderful support and assistance in getting this project started and Patrick
Barbera for seeing it through to the end. Finally, a huge word of thanks to our con-
tributors who have diligently worked to present the notion of theory in a manner that
will engage nursing students and to look for new examples and applications to help
make theory fresh and relevant.

McEwen_FM.indd 12 10/10/13 11:21 AM

xiii

C O N T E N T S

Unit I: Introduction to Theory 1
1. Philosophy, Science, and Nursing 2

Melanie McEwen
Nursing as a Profession 2
Nursing as an Academic Discipline 4
Introduction to Science and Philosophy 5
Science and Philosophical Schools of Thought 7
Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing 11
Knowledge Development and Nursing Science 12
Research Methodology and Nursing Science 16

2. Overview of Theory in Nursing 23
Melanie McEwen

Overview of Theory 24
The Importance of Theory in Nursing 25
Terminology of Theory 26
Historical Overview: Theory Development in Nursing 26
Classification of Theories in Nursing 36
Issues in Theory Development in Nursing 40

3. Concept Development: Clarifying Meaning of Terms 49
Evelyn M. Wills, Melanie McEwen

The Concept of “Concept” 50
Concept Analysis/Concept Development 54
Strategies for Concept Analysis and Concept Development 57

4. Theory Development: Structuring Conceptual Relationships
in Nursing 72

Melanie McEwen
Overview of Theory Development 73
Categorizations of Theory 73
Components of a Theory 79
Theory Development 82

5. Theory Analysis and Evaluation 95
Melanie McEwen

Definition and Purpose of Theory Evaluation 96
Historical Overview of Theory Analysis and Evaluation 97
Comparisons of Methods 106
Synthesized Method of Theory Evaluation 106

McEwen_FM.indd 13 10/10/13 11:21 AM

xiv Contents

6. Overview of Grand Nursing Theories 116
Evelyn M. Wills

Categorization of Conceptual Frameworks and Grand Theories 118
Specific Categories of Models and Theories for This Unit 124
Analysis Criteria for Grand Nursing Theories 124
The Purpose of Critiquing Theories 127

7. Grand Nursing Theories Based on Human Needs 131
Evelyn M. Wills

Florence Nightingale: Nursing: What It Is and What It Is Not 132
Virginia Henderson: The Principles and Practice of Nursing 136
Faye G. Abdellah: Patient-Centered Approaches to Nursing 139
Dorothea E. Orem: The Self-Care Deficit Nursing Theory 142
Dorothy Johnson: The Behavioral System Model 146
Betty Neuman: The Neuman Systems Model 149

8. Grand Nursing Theories Based on Interactive Process 159
Evelyn M. Wills

Myra Estrin Levine: The Conservation Model 160
Barbara M. Artinian: The Intersystem Model 164

Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain:
Modeling and Role-Modeling 169

Imogene M. King: King’s Conceptual System and Theory of Goal Attainment and
Transactional Process 173

Sister Callista Roy: The Roy Adaptation Model 177
Jean Watson: Caring Science as Sacred Science 182

9. Grand Nursing Theories Based on Unitary Process 192
Evelyn M. Wills

Martha Rogers: The Science of Unitary and Irreducible Human Beings 193
Margaret Newman: Health as Expanding Consciousness 198
Rosemarie Parse: The Humanbecoming Paradigm 202

10. Introduction to Middle Range Nursing Theories 213
Melanie McEwen

Purposes of Middle Range Theory 214
Characteristics of Middle Range Theory 215
Concepts and Relationships for Middle Range Theory 216
Categorizing Middle Range Theory 217
Development of Middle Range Theory 217
Analysis and Evaluation of Middle Range Theory 225

11. Overview of Selected Middle Range Nursing Theories 229
Melanie McEwen

High Middle Range Theories 230
Middle Middle Range Theories 241
Low Middle Range Theories 248

12. Evidence-Based Practice and Nursing Theory 258
Evelyn M. Wills, Melanie McEwen

Overview of Evidence-Based Practice 259
Definition and Characteristics of Evidence-Based Practice 259
Concerns Related to Evidence-Based Practice in Nursing 261
Evidence-Based Practice and Practice-Based Evidence 261

Unit II: Nursing Theories 115

McEwen_FM.indd 14 10/10/13 11:21 AM

Contents xv

Promotion of Evidence-Based Practice in Nursing 263
Theory and Evidence-Based Practice 263
Theoretical Models of EBP 264

Unit III: Shared Theories Used by Nurses 277
13. Theories From the Sociologic Sciences 278

Grace Bielkiewicz
Exchange Theories 279
Interactionist Frameworks 284
Conflict Theories 289
Chaos Theory 295
Postmodern Social Theory 298

14. Theories From the Behavioral Sciences 305
Debra Brossett Garner

Psychodynamic Theories 306
Behavioral and Cognitive-Behavioral Theories 313
Humanistic Theories 315
Stress Theories 318
Social Psychology 321

15. Theories From the Biomedical Sciences 331
Melanie McEwen

Theories and Models of Disease Causation 332
Theories and Principles Related to Physiology and Physical Functioning 339

16. Theories, Models, and Frameworks From Leadership
and Management 354

Melinda Granger Oberleitner
Overview of Concepts of Leadership and Management 355
Early Leadership Theories 355
Contemporary Leadership Theories 362
Organizational/Management Theories 365
Motivational Theories 366
Concepts of Power, Empowerment, and Change 368
Problem-Solving and Decision-Making Processes 372
Conflict Management 374
Quality Improvement 375
Evidence-Based Practice 380

17. Learning Theories 386
Evelyn M. Wills, Melanie McEwen

What Is Learning? 387
What Is Teaching? 388
Categorization of Learning Theories 388
Behavioral Learning Theories 389
Cognitive Learning Theories 392
Summary of Learning Theories 404
Learning Styles 405
Principles of Learning 406
Application of Learning Theories in Nursing 407

McEwen_FM.indd 15 10/10/13 11:21 AM

xvi Contents

Unit IV: Application of Theory in Nursing 411
18. Application of Theory in Nursing Practice 412

Melanie McEwen
Relationship Between Theory and Practice 413
Theory-Based Nursing Practice 414
The Theory–Practice Gap 416
Situation-Specific/Practice Theories in Nursing 418
Application of Theory in Nursing Practice 422

19. Application of Theory in Nursing Research 430
Melanie McEwen

Historical Overview of Research and Theory in Nursing 431
Relationship Between Research and Theory 432
Types of Theory and Corresponding Research 434
How Theory Is Used in Research 437
Nursing and Non-Nursing Theories in Nursing Research 444
Other Issues in Nursing Theory and Nursing Research 445

20. Application of Theory in Nursing Administration and
Management 452

Melinda Granger Oberleitner
Organizational Design 453
Shared Governance 456
Transformational Leadership in Nursing and in Health Care 458
Patient Care Delivery Models 459
Case Management 466
Disease/Chronic Illness Management 468
Quality Management 470

21. Application of Theory in Nursing Education 479
Evelyn M. Wills, Melanie McEwen

Theoretical Issues in Nursing Curricula 481
Theoretical Issues in Nursing Instruction 488

22. Future Issues in Nursing Theory 497
Melanie McEwen

Future Issues in Nursing Science 499
Future Issues in Nursing Theory 500

Theoretical Perspectives on Future Issues in Nursing Practice, Research,
Administration and Management, and Education 502

Glossary 513
Author Index 523
Subject Index 554

McEwen_FM.indd 16 10/10/13 11:21 AM

U N I T I

Introduction to Theory

McEwen_CH01.indd 1 10/10/13 10:53 AM

Philosophy,
Science, and
Nursing
Melanie McEwen

C H A P T E R 1

2

Largely due to the work of nursing scientists, nursing theorists, and nursing scholars
over the past five decades, nursing has been recognized as both an emerging
profession and an academic discipline. Crucial to the attainment of this distinction
have been numerous discussions regarding the phenomena of concern to nurses and
countless efforts to enhance involvement in theory utilization, theory generation, and
theory testing to direct research and improve practice.

A review of the nursing literature from the late 1970s until the present shows
sporadic discussion of whether nursing is a profession, a science, or an academic
discipline. These discussions are sometimes pleading, frequently esoteric, and
occasionally confusing. Questions that have been raised include: What defines a
profession? What constitutes an academic discipline? What is nursing science? Why
is it important for nursing to be seen as a profession or an academic discipline?

Nursing as a Profession

In the past, there has been considerable discussion about whether nursing is a profes-
sion or an occupation. This is important for nurses to consider for several reasons. An
occupation is a job or a career, whereas a profession is a learned vocation or occupa-
tion that has a status of superiority and precedence within a division of work. In gen-
eral terms, occupations require widely varying levels of training or education, varying
levels of skill, and widely variable defined knowledge bases. In short, all professions
are occupations, but not all occupations are professions (Finkelman & Kenner, 2013).

Professions are valued by society because the services professionals provide are ben-
eficial for members of the society. Characteristics of a profession include (1) defined
and specialized knowledge base, (2) control and authority over training and education,
(3) credentialing system or registration to ensure competence, (4) altruistic service to
society, (5) a code of ethics, (6) formal training within institutions of higher education,
(7) lengthy socialization to the profession, and (8) autonomy (control of professional
activities) (Ellis & Hartley, 2012; Finkelman & Kenner, 2013; Rutty, 1998). Professions

McEwen_CH01.indd 2 10/10/13 10:53 AM

Chapter 1 Philosophy, Science, and Nursing 3

must have a group of scholars, investigators, or researchers who work to continually ad-
vance the knowledge of the profession with the goal of improving practice (Schlotfeldt,
1989). Finally, professionals are responsible and accountable to the public for their work
(Hood, 2010). Traditionally, professions have included the clergy, law, and medicine.

Until near the end of the 20th century, nursing was viewed as an occupation
rather than a profession. Nursing has had difficulty being deemed a profession because
many of the services provided by nurses have been perceived as an extension of those
offered by wives and mothers. Additionally, historically, nursing has been seen as sub-
servient to medicine, and nurses have delayed in identifying and organizing profes-
sional knowledge. Furthermore, education for …

2

3

4

5

Acquisitions Editor: Christina Burns
Development Editor: Michael Kerns
Editorial Coordinator: Tim Rinehart
Editorial Assistant: Kaitlin Campbell
Production Project Manager: Kim Cox
Design Coordinator: Elaine Kasmer
Illustration Coordinator: Jennifer Clements
Manufacturing Coordinator: Karin Duffield
Prepress Vendor: Absolute Service, Inc.

Fifth Edition

Copyright © 2019 Wolters Kluwer Health.

Copyright © 2014, 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2002 Lippincott Williams & Wilkins. All
rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means,
including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written
permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book
prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To
request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via
email at [email protected], or via our website at lww.com (products and services).

9 8 7 6 5 4 3 2 1

Printed in China

Library of Congress Cataloging-in-Publication Data

Names: McEwen, Melanie, author. | Wills, Evelyn M., author.
Title: Theoretical basis for nursing / Melanie McEwen, Evelyn M. Wills.
Description: Fifth edition. | Philadelphia : Wolters Kluwer, [2018] |

Includes bibliographical references and index.
Identifiers: LCCN 2017049174 | ISBN 9781496351203
Subjects: | MESH: Nursing Theory
Classification: LCC RT84.5 | NLM WY 86 | DDC 610.73—dc23 LC record available at https://lccn.loc.gov/2017049174

Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the author(s),
editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and
make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application
of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and
recommended may not be considered absolute and universal recommendations.

The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance
with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government
regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for
each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the
recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have U.S. Food and Drug Administration (FDA) clearance for limited use in
restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use
in his or her clinical practice.

LWW.com

6

mailto:[email protected]

http://lww.com

https://lccn.loc.gov/2017049174

http://LWW.com

D E D I C AT I O N

To Kaitlin and Grant—You have helped me broaden my thoughts and consider all kinds of possibilities;
I hope I’ve done the same for you.

Also for Helen and Keith—Our children chose well. Besides, you have given us Madelyn, Logan,
Brenna, Liam, Lucy, Andrew, Michael, and Jacob; they are gifts beyond words.

Melanie McEwen

To Tom, Paul, and Vicki, who light up my life, and to Marian, who left us for a better place. You were
always my best listener. To Teddy, Gwen, Merlyn, and Madelyn, who have been so patient and loving
during this process.

My deepest gratitude to Leslie, who has supported me through this writing process.

Evelyn M. Wills

7

C O N T R I B U T O R S

Sattaria Smith Dilks, DNP, APRN-BC, FNP, PMHNP/CNS
Professor and Co-Coordinator Graduate Program
College of Nursing
McNeese State University
Lake Charles, Louisiana
Chapter 14: Theories From the Behavioral Sciences

Joan C. Engebretson, DrPH, AHN-BC, RN, FAAN
Judy Fred Professor in Nursing
University of Texas Health Science Center at Houston
School of Nursing, Department of Family Nursing
Houston, Texas
Chapter 13: Theories From the Sociologic Sciences

Melinda Granger Oberleitner, DNS, RN
Associate Dean, College of Nursing & Allied Health Professions
Professor, Department of Nursing
SLEMCO/BORSF Endowed Professor of Nursing
University of Louisiana at Lafayette
Lafayette, Louisiana
Chapter 17: Theories, Models, and Frameworks From Leadership and Management
Chapter 21: Application of Theory in Nursing Administration and Management

Cathy L. Rozmus, PhD, RN
PARTNERS Endowed Professorship in Nursing
Vice Dean
Department of Family Health
The University of Texas Health Science Center at Houston
School of Nursing
Houston, Texas
Chapter 16: Ethical Theories and Principles

Jeffrey P. Spike, PhD
Professor of Family and Community Medicine
The University of Texas Health Science Center at Houston
School of Medicine
Professor, Department of Management, Policy, and Community Health
University of Texas Health Science Center School of Public Health
Houston, Texas
Chapter 16: Ethical Theories and Principles

8

R E V I E W E R S

Cynthia Dakin, PhD, RN
Director of Graduate Studies
Associate Professor
Department of Nursing
Elms College
Chicopee, Massachusetts

Janet DuPont, RNC-OB, MSN, MEd, PhD
Master of Science in Nursing Instructor/Developer
Nursing Program
Norwich University
Northfield, Vermont

Ruth Neese, PhD, RN, CEN
Assistant Professor
Department of Nursing
Indian River State College
Fort Pierce, Florida

Brandon N. Respress, PhD, RN, MPH, MSN
Assistant Professor
College of Nursing and Health Innovation
University of Texas at Arlington
Arlington, Texas

Jacqueline Saleeby, PhD, RN, CS
Associate Professor
Department of Nursing
Maryville University
St. Louis, Missouri

Stephen J. Stapleton, PhD, MS, RN, CEN, FAEN
Associate Professor
Mennonite College of Nursing
Illinois State University
Normal, Illinois

Kathleen Williamson, MSN, PhD, RN
Associate Professor and Chair
Wilson School of Nursing
Midwestern State University
Wichita Falls, Texas

Cindy Zellefrow, DNP, MSEd, RN, LSN, APHN-BC
Assistant Professor of Clinical Practice
Assistant Director, Center for Transdisciplinary and Evidence-based Practice

9

College of Nursing
The Ohio State University
Columbus, Ohio

10

P R E FA C E

Rare is the student who enrolls in a nursing program and is excited about the requirement of taking a course
on theory. Indeed, many fail to see theory’s relevance to the real world of nursing practice and often have
difficulty applying the information in later courses and in their research. This book is the result of the
frustration felt by a group of nursing instructors who met a number of years ago to adopt a textbook for a
theory course. Indeed, because of student complaints and faculty dissatisfaction, we were changing textbooks
yet again. A fairly lengthy discussion arose in which we concluded that the available books did not meet the
needs of our students or course faculty. We were determined to write a book that was a general overview of
theory per se, stressing how it is—and should be—used by nurses to improve practice, research, education,
and management/leadership.

As in past editions, an ongoing review of trends in nursing theory and nursing science has shown an
increasing emphasis on middle range theory, evidence-based practice (EBP), and situation-specific theories.
To remain current and timely, in this fifth edition, we have added a new chapter entitled “Ethical Theories and
Principles,” presenting information on these topics and describing how they relate to theory in nursing. We
have also included new middle range and situation-specific nursing theories as well as new “shared” theories
from non-nursing disciplines. One notable addition is a significant section discussing Complexity Science and
Complex Adaptive Systems in Chapter 13 (Theories From the Sociologic Sciences) helping to explain their
importance to nursing. Updates and application examples have been added throughout the discussions on the
various theories.

Organization of the Text
Theoretical Basis for Nursing is designed to be a basic nursing theory textbook that includes the essential
information students need to understand and apply theory in practice, research, education, and
administration/management.

The book is divided into four units. Unit I, Introduction to Theory, provides the background needed to
understand what theory is and how it is used in nursing. It outlines tools and techniques used to develop,
analyze, and evaluate theory so that it can be used in nursing practice, research, administration and
management, and education. In this unit, we have provided a balanced view of “hot” topics (e.g.,
philosophical world views and utilization of shared or borrowed theory). Also, rather than espousing one
strategy for activities such as concept development and theory evaluation, we have included a variety of
strategies.

Unit II, Nursing Theories, focuses largely on the grand nursing theories and begins with a chapter
describing their historical development. This unit divides the grand nursing theories into three groups based
on their focus (human needs, interactive process, and unitary process). The works of many of the grand
theorists are briefly summarized in Chapters 7, 8, and 9. Because this volume is intended to serve as a broad
foundation, these analyses provide the reader with enough information to understand the basis of the work and
to whet the reader’s appetite to select one or more for further study rather than delving into significant detail.

Chapters 10 and 11 cover the significant topic of middle range nursing theory. Chapter 10 presents a
detailed overview of the origins and growth of middle range theory in nursing and gives numerous examples
of how middle range theories have been developed by nurses. Chapter 11 provides an overview of some of the
growing number of middle range nursing theories. The theories presented include some of the most
commonly used middle range nursing theories (e.g., Pender’s Health Promotion Model and Leininger’s
Culture Care Diversity and Universality Theory) as well as some that are less well known but have a growing
body of research support (e.g., Meleis’s Transitions Theory, the Theory of Unpleasant Symptoms, and the

11

Uncertainty in Illness Theory). The intent is to provide a broad range of middle range theories to familiarize
the reader with examples and to encourage them to search for others appropriate to their practice or research.
Ultimately, it is hoped that readers will be challenged to develop new theories that can be used by nurses.

Chapter 12, which discusses EBP, explains and defines the idea/process of EBP and describes how it
relates to nursing theory and application of theory in nursing practice and research. The chapter concludes
with a short presentation and review of five different EBP models that have been widely used by nurses and
are well supported in the literature.

Unit III, Shared Theories Used by Nurses, is rather unique in nursing literature. Our book
acknowledges that “shared” or “borrowed” theories are essential to nursing and negates the idea that the use
of shared theory in practice or research is detrimental. In this unit, we have identified some of the most
significant theories that have been developed outside of the discipline of nursing but are continually used in
nursing. We have organized these theories based on broad disciplines: theories from the sociologic sciences,
behavioral sciences, biomedical sciences, and philosophy as well as from administration, management, and
learning. Each of these chapters was written by a nurse with both educational and practical experience in his
or her respective area. These theories are presented with sufficient information to allow the reader to
understand the theories and to recognize those that might be appropriate for his or her own work. These
chapters also provide original references and give examples of how the concepts, theories, and models
described have been used by other nurses.

Chapter 16, new to the fifth edition, describes ethical theories and principles that apply to nursing practice.
This addition was suggested by nursing faculty who recognized the importance of maintaining an ethical
perspective within the very complex health care system. This information is vital to professional nursing
practice and absolutely essential for nurses in advanced practice, management, or educational roles.

Finally, Unit IV, Application of Theory in Nursing, explains how theories are applied in nursing.
Separate chapters cover nursing practice, nursing research, nursing administration and management, and
nursing education. These chapters include many specific examples for the application of theory and are
intended to be a practical guide for theory use. The heightened development of practice theories and EBP
guidelines are critical to theory application in nursing today, so these areas have been expanded. The unit
concludes with a chapter that discusses some of the future issues in theory within the discipline.

Key Features
In addition to numerous tables and boxes that highlight and summarize important information, Theoretical
Basis for Nursing contains case studies, learning activities, exemplars, and illustrations that help students
visualize various concepts. New to this edition is a special boxed feature in most chapters that highlights how
a topic is outlined in the American Association of Colleges of Nursing (AACN’s) The Essentials of Master’s
Education in Nursing or The Essentials of Doctoral Education for Advanced Nursing Practice. Other key
features include:

■ Link to Practice: All chapters include at least one “Link to Practice” box, which presents useful
information or clinically related examples related to the subject being discussed. The intent is to give
additional tools or resources that can be used by nurses to apply the content in their own practice or
research.

■ Case Studies: At the end of Chapter 1 and the beginning of Chapters 2 to 23, case studies help the
reader understand how the content in the chapter relates to the everyday experience of the nurse,
whether in practice, research, or other aspects of nursing.

■ Learning Activities: At the end of each chapter, learning activities pose critical thinking questions,
propose individual and group projects related to topics covered in the chapter, and stimulate classroom
discussion.

■ Exemplars: In five chapters, an exemplar discusses a scholarly study from the perspectives of concept
analysis (Chapter 3); theory development (Chapter 4); theory analysis and evaluation (Chapter 5);
middle range theory development (Chapter 10); and theory generation via research, theory testing via
research, and use of a theory as the conceptual framework for a research study (Chapter 20).

■ Illustrations: Diagrams and models are included throughout the book to help the reader better

12

understand the many different theories presented.

New to This Edition
■ New Chapter 16, Ethical Theories and Principles
■ Detailed section on Complexity Science and Complex Adaptive Systems in Chapter 13.
■ More detailed explanation of EBP, situation-specific theories, and their relationship to theory in nursing
■ Numerous recent examples of application of theories in nursing practice, nursing research,

leadership/administration, and education
■ Enhanced instructional support, focusing on activities and information directed toward online learning

Student Resources Available on
■ Literature Assessment Activity provides an interactive tool featuring journal articles along with

critical thinking questions that will encourage students to engage with the literature. Students can print
or e-mail their responses to their instructor.

■ Case Studies with applicable questions guide students in understanding how the various theories link
to nursing practice.

■ Learning Objectives for each chapter help focus the student on outcomes.
■ Internet Resources provide live web links to pertinent sites so that students can further their study and

understanding of the various theories.
■ Journal Articles for each chapter offer opportunities to gain more knowledge and understanding of the

chapter content.

Instructor Resources Available on
■ Instructor’s Guide includes application-level discussion questions and classroom/online activities that

Melanie McEwen uses in her own teaching!
■ Strategies for Effective Teaching of Nursing Theory provide ideas for instructors to help make the

nursing theory class come alive.
■ Test Generator Questions provide multiple-choice questions that can be used for testing general

content knowledge.
■ PowerPoints with audience response (Iclicker) questions, based on the ones used by Melanie

McEwen in her own classroom, help highlight important points to enhance the classroom experience.
■ Case Studies with questions, answers, and related activities offer opportunities for instructors to make

the student case studies an exciting, fun, and rewarding classroom/online experience.
■ Image Bank provides images from the text that instructors can use to enhance their own presentations.

In summary, the focus of this learning package is on the application of theory rather than on the study,
analysis, and critique of grand theorists or a presentation of a specific aspect of theory (e.g., construction or
evaluation). It is hoped that practicing nurses, nurse researchers, and nursing scholars, as well as graduate
students and theory instructors, will use this book and its accompanying resources to gain a better
understanding and appreciation of theory.

Melanie McEwen, PhD, RN, CNE, ANEF
Evelyn M. Wills, PhD, RN

13

A C K N O W L E D G M E N T S

Our heartfelt thanks to Senior Development Editor, Michael Kerns, and Editorial Coordinator, Tim Rinehart,
for their assistance, patience, and persistence in helping us complete this project. They made a difficult task
seem easy! We also want to thank Senior Acquisitions Editor, Christina Burns, and Helen Kogut, for their
support and assistance in getting this project started and help with previous editions. Finally, a huge word of
thanks to our contributors who have diligently worked to present the notion of theory in a manner that will
engage nursing students and to look for new examples and applications to help make theory fresh and
relevant.

14

C O N T E N T S

Unit I: Introduction to Theory

1. Philosophy, Science, and Nursing
Melanie McEwen

Case Study
Nursing as a Profession
Nursing as an Academic Discipline
Introduction to Science and Philosophy

Overview of Science
Overview of Philosophy

Science and Philosophical Schools of Thought
Received View (Empiricism, Positivism, Logical Positivism)

Contemporary Empiricism/Postpositivism
Nursing and Empiricism

Perceived View (Human Science, Phenomenology, Constructivism, Historicism)
Nursing and Phenomenology/Constructivism/Historicism

Postmodernism (Poststructuralism, Postcolonialism)
Nursing and Postmodernism

Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing
Nursing Philosophy
Nursing Science
Philosophy of Science in Nursing

Knowledge Development and Nursing Science
Epistemology

Ways of Knowing
Nursing Epistemology
Other Views of Patterns of Knowledge in Nursing
Summary of Ways of Knowing in Nursing

Research Methodology and Nursing Science
Nursing as a Practice Science
Nursing as a Human Science
Quantitative Versus Qualitative Methodology Debate

Quantitative Methods
Qualitative Methods
Methodologic Pluralism

Summary
Key Points

Learning Activities

2. Overview of Theory in Nursing
Melanie McEwen

Overview of Theory
The Importance of Theory in Nursing
Terminology of Theory

15

Historical Overview: Theory Development in Nursing
Florence Nightingale
Stages of Theory Development in Nursing

Silent Knowledge Stage
Received Knowledge Stage
Subjective Knowledge Stage
Procedural Knowledge Stage
Constructed Knowledge Stage
Integrated Knowledge Stage

Summary of Stages of Nursing Theory Development
Classification of Theories in Nursing

Scope of Theory
Metatheory
Grand Theories
Middle Range Theories
Practice Theories

Type or Purpose of Theory
Descriptive (Factor-Isolating) Theories
Explanatory (Factor-Relating) Theories
Predictive (Situation-Relating) Theories
Prescriptive (Situation-Producing) Theories

Issues in Theory Development in Nursing
Borrowed Versus Unique Theory in Nursing
Nursing’s Metaparadigm

Relationships Among the Metaparadigm Concepts
Other Viewpoints on Nursing’s Metaparadigm

Caring as a Central Construct in the Discipline of Nursing
Summary
Key Points

Learning Activities

3. Concept Development: Clarifying Meaning of Terms
Evelyn M. Wills and Melanie McEwen

The Concept of “Concept”
Types of Concepts

Abstract Versus Concrete Concepts
Variable (Continuous) Versus Nonvariable (Discrete) Concepts
Theoretically Versus Operationally Defined Concepts

Sources of Concepts
Concept Analysis/Concept Development

Purposes of Concept Development
Context for Concept Development
Concept Development and Conceptual Frameworks
Concept Development and Research

Strategies for Concept Analysis and Concept Development
Walker and Avant

Concept Analysis
Concept Synthesis
Concept Derivation
Examples of Concept Analysis Using Walker and Avant’s Techniques

Rodgers
Schwartz-Barcott and Kim

Theoretical Phase

16

Fieldwork Phase
Analytical Phase

Meleis
Concept Exploration
Concept Clarification
Concept Analysis

Morse
Concept Delineation
Concept Comparison
Concept Clarification

Penrod and Hupcey
Comparison of Models for Concept Development

Summary
Key Points

Learning Activities

4. Theory Development: Structuring Conceptual Relationships in Nursing
Melanie McEwen

Overview of Theory Development
Categorizations of Theory

Categorization Based on Scope or Level of Abstraction
Philosophy, Worldview, or Metatheory
Grand Theories
Middle Range Theories
Practice Theories
Relationship Among Levels of Theory in Nursing

Categorization Based on Purpose
Descriptive Theories
Explanatory Theories
Predictive Theories
Prescriptive Theories

Categorization Based on Source or Discipline
Components of a Theory

Purpose
Concepts and Conceptual Definitions
Theoretical Statements

Existence Statements
Relational Statements

Structure and Linkages
Assumptions
Models

Theory Development
Relationship Among Theory, Research, and Practice

Relationship Between Theory and Research
Relationship Between Theory and Practice
Relationship Between Research and Practice

Approaches to Theory Development
Theory to Practice to Theory
Practice to Theory
Research to Theory
Theory to Research to Theory
Integrated Approach

Process of Theory Development

17

Concept Development: Creation of Conceptual Meaning
Statement Development: Formulation and Validation of Relational Statements
Theory Construction: Systematic Organization of the Linkages
Validating and Confirming Theoretical Relationships in Research
Validation and Application of Theory in Practice

Summary
Key Points

Learning Activities

5. Theory Analysis and Evaluation
Melanie McEwen

Definition and Purpose of Theory Evaluation
Theory Description
Theory Analysis
Theory Evaluation

Historical Overview of Theory Analysis and Evaluation
Characteristics of Significant Theories: Ellis
Theory Evaluation: Hardy
Theory Analysis and Theory Evaluation: Duffey and Muhlenkamp
Theory Evaluation: Barnum
Theory Analysis: Walker and Avant
Theory Analysis and Evaluation: Fawcett
Theory Description and Critique: Chinn and Kramer
Theory Description, Analysis, and Critique: Meleis
Analysis and Evaluation of Practice Theory, Middle Range Theory, and Nursing Models:
Whall
Theory Evaluation: Dudley-Brown

Comparisons of Methods
Synthesized Method of Theory Evaluation
Summary
Key Points

Learning Activities

Unit II: Nursing Theories

6. Overview of Grand Nursing Theories
Evelyn M. Wills

Categorization of Conceptual Frameworks and Grand Theories
Categorization Based on Scope
Categorization Based on Nursing Domains
Categorization Based on Paradigms

Parse’s Categorization
Newman’s Categorization
Fawcett’s Categorization

Specific Categories of Models and Theories for This Unit
Analysis Criteria for Grand Nursing Theories

Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships
Usefulness
Testability
Parsimony

18

Value in Extending Nursing Science
The Purpose of Critiquing Theories
Summary
Key Points

Learning Activities

7. Grand Nursing Theories Based on Human Needs
Evelyn M. Wills

Florence Nightingale: Nursing: What It Is and What It Is Not
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships
Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Virginia Henderson: The Principles and Practice of Nursing
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Faye G. Abdellah: Patient-Centered Approaches to Nursing
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Dorothea Orem: The Self-Care Deficit Nursing Theory
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Dorothy Johnson: The Behavioral System Model
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts
Relationships

Usefulness

19

Testability
Parsimony
Value in Extending Nursing Science

Betty Neuman: The Neuman Systems Model
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Summary
Key Points

Learning Activities

8. Grand Nursing Theories Based on Interactive Process
Evelyn M. Wills

Barbara Artinian: The Intersystem Model
Background of the Theorist
Philosophic Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain: Modeling and Role-
Modeling

Background of the Theorists
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Imogene King: King’s Conceptual System and Theory of Goal Attainment and
Transactional Process

Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

20

Sister Callista Roy: The Roy Adaptation Model
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Jean Watson: Human Caring Science, A Theory of Nursing
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Assumptions
Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Summary
Key Points

Learning Activities

9. Grand Nursing Theories Based on Unitary Process
Evelyn M. Wills

Martha Rogers: The Science of Unitary and Irreducible Human Beings
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Margaret Newman: Health as Expanding Consciousness
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Rosemarie Parse: The Humanbecoming Paradigm
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships

Concepts
Relationships

21

Usefulness
Testability
Parsimony
Value in Extending Nursing Science

Summary
Key Points

Learning Activities

10. Introduction to Middle Range Nursing Theories
Melanie McEwen

Purposes of Middle Range Theory
Characteristics of Middle Range Theory
Concepts and Relationships …

power point presentation to explain in details  about specific theory :
Professional Advancement Model ( from Novice to Expert) by Patricia Benner 


need to add some pictures to  the PTT 
should be from perfect references, I will upload two books I have but you can add more references
this PTT will be reference for  me and my colleagues in final exam 
Theory presentation:
about the theorist
definition of the theory and terms
concepts and models
purpose ,goal
factors, importance
metaparadigm
critique
how used in research 
hoe leiningers theory help our practice also, evaluation of theory













Evaluation of-a-nursing-theory-nursing-theory-ppt Presentation Transcript

Title: Evaluation of a Nursing Theory

Six Questions are Propose for Complete

Describing Theory.
Guide for the Description of Theory


1. What is the

purpose of this

theory?

This question addresses

why the theory was

formulated and reflects

the contexts and

situations to which the

theory can be applied.

 Why is this theory formulated?

 Is there an overall purpose for the theory?

 The purpose is positive, negative, neutral?

 is there is specific purpose for the theory

 Is there a hierarchy of theory ?

 Is the all metapradigm element receiving care, nursing, the person, ,

Society and Environment?

 What is the value orientation of the purpose?

 Does achieving the theoretic purpose require a nursing context?

 Does the purpose reflect understanding, creation of meaning,

explanation, and prediction of phenomena?

 When would the theory cases to be applicable? what is the end point?

 what purpose not explicitly, embedded in the matrix of the theory can

be identified?

2. What are the

concepts of this

theory?

This question identifies

the ideas that are

structured and related

within the theory. It

questions the qualitative

and quantitative

dimensions of concepts.

 Is there one major concept with sub-concepts organized under it?

 How many concepts are there ?

 How many major (or minor) ones? ?

 can the concepts be ordered, related? Arranged into any configuration?

 Are there concepts that cannot be interrelated?

 Are concepts broad in scope? Narrow?

 How abstract or empiric are the concepts broad in scope? Narrow?

What is the balance between highly abstract and highly empiric are concepts?

are defined?

3. How are the This question clarifies  Which concepts are defined?

concepts

defined?

the meaning for

concepts within the

theory. It questions how

empiric experience is

represented by the ideas

within the theory.

 Which concepts are defined explicitly? Which are implied ?

 How much meaning needs to be inferred?

 which concepts are defined specifically? generally?

 are there competing definitions for some concepts?

 Are there similar definitions for different concepts?

Are any concepts defined contrary to common convention?

4. What is the

nature of

relationships?

 This question

addresses how

concepts are linked

together. It focuses

on the various forms

relationship

statements can take

and how they give

structure to the

theory.

 What are the major relationships within the theory?

 Which relationships are obvious? Which are implied?

 Do relationships include all concepts? Which are not included?

 Are some concepts included in multiple relationships?

 Is there a hierarchy of relationships? Do relationships create

relationships? meaning and understanding? describing, explaining?

predicting? What mix of each?

are relationships illustrated?

5. What is the

structure of the

theory?

 This question

addresses the overall

form of the

conceptual

interrelationships.

 It discerns whether

the theory contains

partial structures or

has one basic form.

 How are overall and individual ideas organized?

 If outlined, what would the theory look like?

 do relationships expand concepts into large wholes or vice versa?

 do they link concepts in a linear fashion?

 does the structure move concepts away from or toward the purposes?

 Are there several structures that emerge? What is their form? Do they

fit together?

6. On what

assumptions
does the theory


build?

 This question

addresses the basic

truths that underlie

theoretic reasoning.

 It questions whether

assumptions reflect

philosophic values

 What assumptions underlie the theory?

 Are assumptions explicit, implicit, or derivable from context and

meanings?

 What are the individual, nurse, society, environment, and health

assumed to be like?

 Do assumptions be factually verified?

or factual assertions

factual assertions

 Can assumptions be hierarchically arranged or otherwise? ordered?

Guide for the Description of Theory

1

.
PURPOSE  Why is this theory formulated?


 Is there an overall purpose for the theory?

 The purpose is positive, negative, neutral?

 is there is specific purpose for the theory

 Is there a hierarchy of theory ?

 Is the all metapradigm element receiving care, nursing, the person, , Society and Environment?

 What is the value orientation of the purpose?

 Does achieving the theoretic purpose require a nursing context?

 Does the purpose reflect understanding, creation of meaning, explanation, and prediction of

phenomena?

 When would the theory cases to be applicable? what is the end point?

 what purpose not explicitly, embedded in the matrix of the theory can be identified?

2. Concepts  Is there one major concept with sub-concepts organized under it?

 How many concepts are there ?

 How many major (or minor) ones? ?

 can the concepts be ordered, related? Arranged into any configuration?

 Are there concepts that cannot be interrelated?

 Are concepts broad in scope? Narrow?

 How abstract or empiric are the concepts broad in scope? Narrow?

 What is the balance between highly abstract and highly empiric are concepts? are defined?

3. Definitions  Which concepts are defined?

 Which concepts are defined explicitly? Which are implied ?

 How much meaning needs to be inferred?

 which concepts are defined specifically? generally?

 are there competing definitions for some concepts?

 Are there similar definitions for different concepts?

 Are any concepts defined contrary to common convention?

4. Relationships  What are the major relationships within the theory?

 Which relationships are obvious? Which are implied?

 Do relationships include all concepts? Which are not included?

 Are some concepts included in multiple relationships?

 Is there a hierarchy of relationships? Do relationships create relationships? meaning and understanding?

describing, explaining? predicting? What mix of each?

 are relationships illustrated?

5. Structure  How are overall and individual ideas organized?

 If outlined, what would the theory look like?

 do relationships expand concepts into large wholes or vice versa?

 do they link concepts in a linear fashion?

 does the structure move concepts away from or toward the purposes?

 Are there several structures that emerge? What is their form? Do they fit together?

6. Assumptions  What assumptions underlie the theory?

 Are assumptions explicit, implicit, or derivable from context and meanings?

 What are the individual, nurse, society, environment, and health assumed to be like?

 Do assumptions be factually verified?

 Can assumptions be hierarchically arranged or otherwise? ordered?

Criteria for the evaluation of theory

Accuracy  As a noun, Accuracy defined as exactness or precision, while

as an adjective, as without mistakes or errors, perfect, correct

 In relation to nursing theory, accuracy pertains to describing

nursing as it exists today, not the nursing of the future or of

the past.

Consistency  Kuhn (1977) describes consistency in terms of the theory

being internally consistent as well as being consistent with
accepted theories.


 Internal consistency described as consistency in language , the

existence of logical order, and connectedness

 Inconsistencies should be avoided, a theory with an

inconsistency does not necessitate that the whole theory be

scrapped.

 operational definition should be used for concepts, assumptions

and propositions.

 It must uses the terms coherent and logically presented to

describe clarity.

Fruitful  Fruitful, is related conceptually to criteria to criteria proposed

by others

 (Synonymous with fertile, bountiful, productive, and prolific

 Kuhn (1977), in describing fruitful, states that theory should

expose new feelings, new phenomenon, or previously

unknown relationships among

 Fruitful refers to success in explaining observable

phenomenon and the evlautionon of emperical work resulting

from a theory

 Newton-Smith (1981) describes (fertile) as the scope for .

further development.

 Consistent with this is Ellis‟s (1968) criteria of generation of

information-the theory should generate hypotheses.

 A theory that generate many hypotheses, even some without

high probability, or some that are difficult to test, can

contribute to understanding.

Simplicity  Simplicity as an important evaluative criterion not complexity

 Meleis (1985) takes a more pragmatic complexity approach:

whether the theory has a lot of phenomena and relationships

(complexity) or if it focuses on fewer concepts and few

(simplicity)?

 Simplicity is useful characteristic of a good theory in nursing,

and important in the evaluation of nursing theory.

Scope  Scope has been dichotomized as either broad or narrow

 “The broader the scope, in terms of the number and variety of

facts or concepts related, the greater is the significance of the

theory

 Hardy (1974) states “the more general a theory, the more useful

it is Broad vs. narrow scope can also be dichotomized in

relation to its generalities, or the use of the term theory and

conceptual framework/ model.

 Scope may be conceptualized in relation to the level of theory,

e.g. a grand theory or middle range theory.

Acceptance  Meleis (1985)states acceptance “when the theory begins to

cross several concentric circles from where it originated, its

circle of contagiousness increases and we can infer that the

theory is receiving.

 Laudan (1977) discusses the importance of acceptance and

pursuit by other members of the discipline in that the theory

shows promise if others are accepting and „buying into‟ the

theory.

 It is important for the advancement of nursing as a profession

to have members of the discipline communicate regarding its

multicultural acceptance and adoption by others.

Testability  Testability refers to the theory‟s research potential or empirical

adequacy.

 Testability has been long felt to be an important criterion for

the evaluation of nursing theory, and touted as a method to

advance the science of nursing.

 lack of empirical validation of nursing theory has hindered the

development of the nursing science

 have proposed criteria for evaluating theory-testing research,

and discuss important philosophical and methodological issues

in the testing of nursing theory.

Socio-cultural

utility

 Socio-cultural utility encompasses social congruence and

social significance.

 Social congruence encompasses the beliefs, values and

expectations of different cultures that should shape and direct

the type of theory most useful to it.

 Meleis (1985) explains, self-care and independence are goals

consistent with some cultures‟ value systems but not others.

this is inappropriate in some societies and cultures, and should

be avoided.

 Fruitful, is related conceptually to criteria17. Fruitful ( 效果好的 ,收益多 ) Synonymous with fertile, bountiful,

productive, andproposed by others. Kuhn (1977), in describing fruitful, states that theory should exposeprolific. new

feelings, new phenomenon, or previously unknown relationships among Fruitful refers to success in explaining

observablephenomenon already known. phenomenon, and the evaluation of empirical work resulting from a theory.

 Newton-Smith (1981) describes (fertile) as the scope for18. Fruitful  The theory should contain ideas to further

research.further development. Consistent with this is Ellis‟s (1968) criteria of generation of information-the theory should

generate Ellis (1968) states “A theory that generateshypotheses. many hypotheses, even some without high probability, or

some that are difficult to test, can contribute to understanding.

 Simplicity as an important evaluative criterion19. Simplicity( 單純 ;簡單 ) (Kuhn, 1977; Newton-Smith, 1981; Chin and

Jacobs, 1983) others propose Meleis (1985) takes a more pragmatic(complexity (Ellis, 1968; Barnum, 1990). 務實的 )
approach: whether the theory has a lot of phenomena and relationships (complexity) or if it focuses on fewer concepts and few


relationships Kuhn‟s, (1977) describes as “bringing order to phenomenon that in(simplicity)? Simplicity is a seemingly(

表面上 )its absence would be isolated and confused”. useful characteristic of a good theory in nursing, and important in the
evaluation of nursing theory.


  Scope has been dichotomized as either broad or narrow.20. Scope( 範圍 ) Ellis (1968) and Hardy (1974). “The broader the
scope, in terms of the number and variety of facts or concepts related, the greater is the significance of the Hardy (1974) states


“the more general a theory, the more useful ittheory” . Broad vs. narrow scope can also be dichotomized in relation to

itsis.” generalities, or the use of the term theory and conceptual framework/ model. Scope may be conceptualized in

relation to the level of theory, eg. a grand theory or middle range theory.

 Meleis (1985)states acceptance “when the theory begins to21. Acceptance cross several concentric circles from where it

originated, its circle of contagiousness( 蔓延的 ) increases and we can infer that the theory is receiving Laudan (1977)

discusses themore acceptability, uninfluenced by the theorist” . importance of acceptance and pursuit by other members of

the discipline in that the theory shows promise if others are accepting and „buying into‟ the theory. It is important for the

advancement( 促進 ) of nursing as a profession to have members of the discipline communicate regarding its multicultural

acceptance and adoption( 採用 ) by others.

 Testability refers to the theory‟s research potential or22. Testability Testability has been long felt to be an important

criterionempirical adequacy. for the evaluation of nursing theory, and touted ( 招徠 ) as a method to advance Acton et al.

(1991)and Silva (1986) describe how thethe science of nursing. lack of empirical validation of nursing theory has hindered

the development of Silva and Sorrel1 (1992) have proposed criteria for evaluatingnursing science. theory-testing research,

and discuss important philosophical and methodological issues in the testing of nursing theory.

 Socio-cultural utility encompasses( 包圍 ) social23. Socio-cultural utility Johnson (1974), Meleis (1985) andcongruence(

適合 ) and social significance Social congruenceFawcett (1989)in their criteria for the evaluation of theory. encompasses the

beliefs, values and expectations of different cultures that As Meleis (1985)should shape and direct the type of theory most

useful to it. explains, self-care and independence are goals consistent with some cultures‟ Theories with such goals would be

incongruent(value systems but not others. 不一致 的 ) and inappropriate in some societies and cultures, and should be
avoided.


 Nurses in all roles24. Conclusion of criteria for the evaluation of theory will hopefully use these criteria proposed here to

guide their choice of theory There has been awhen using nursing theory in practice, education and research. dearth ( 缺乏 )

of empirical testing of theories in nursing, testing is only one A set of criteria for the evaluation ofpart of the evaluation of

theory. theory has been proposed here that includes: accuracy, consistency, fruitfulness, simplicity/complexity, scope,

acceptability and socio-cultural utility.

 Meleis, A. I. (2007). Theoretical Nursing: Development25. Theory Critique & Progress (4rd ed.). Philadelphia. PA:

Lippincott.(Ch9)(pp.186- 211)

 26. Table 11-5THEORY CRITIQUE— RELATIONSHIP BETWEENSTRUCTURE AND FUNCTION; DIAGRAM OF

THEORY;AND CIRCLE OF CONTAGIOUSNESSCRITERIA UNITS OF ANALYSISRelationship Claritybetween structure

Consistencyand function Simplicity/Complexity Tautology( 同義反複 )/Teleology( 目的論 )Diagram of theory Visual and
graphic presentation Logical representation ClarityCircle of Geographical origin of theory and geographicalcontagiousness


spread influence of theorist vs. theory

 27. Table 11-6THEORY CRITIQUE—USEFULNESSCRITERIA UNITS OF ANALYSISPractice Direction Cost

effectiveness Applicability Relevance GeneralizabilityResearch Consistency Predictability TestabilityEducation Philosophical

statement Concepts ObjectivesAdministration Structure of care Organization of care Guidelines for patient care Patient

classification system

 28. Table 11-7THEORY CRITIQUE—EXTERNAL COMPONENTSOF THEORYCRITERIA UNITS OF

ANALYSISPersonal values Theorist implicit/explicit values Critic implicit/explicit valuesCongruence with other

Complementarity( 補足 )professional values Esotericism( 祕傳性 )Congruence with social Beliefs Competitionvalues Values
CustomsSocial significance Value to humanity


 This question29. Forming a complete critical reflection1. Is this clear? Clarity and consistencyaddresses the clarity and

consistency of presentation. This question addressesmay be both semantic and structural.2. Is this simple? Complexitythe

number of structural components and relationships within theory. implies numerous relational components within theory;

simplicity implies fewer relational components.

 This question30. Forming a complete critical reflection3. Is this general? Generality infers a wideaddresses the scope of

experiences covered by theory. scope of phenomena, whereas specificity narrows the range of events included in This

question addresses the extent to whichtheory.4. Is this accessible? concepts within the theory are grounded in empirically

identifiable phenomena.5. This question addresses the extent to which theory leads toIs this important? valued nursing goals

in practice, research, and education.

 31. Guide for the critical reflection of theory 1.HOW CLEAR IS THIS THEORY? Are significant concepts not defined?

Are Are major concepts defined?  Are words coined? Are coineddefinitions clear? Congruent( 適合的 )? Consistent?

Are words borrowed from other disciplines and used differentlywords defined? Is the amount of explanation appropriate?

Too much? Notin this context? Not helpful? Needed Are examples or diagrams helpful? meaningful? enough? and not

present?

 Are basic assumptions consistent with32. 1.HOW CLEAR IS THIS THEORY? Are the Is the view of person and

environment compatible( 能共 處 )?purposes? Are Are different terms defined similarly?same terms defined differently?

Are compatible andconcepts used in a manner consistent with their definition? Cancoherent( 協調一致的 ) structures

suggested for different parts of the theory? Are there any ambiguities( 模稜兩可 ) as a result ofthe theory be followed?

Does the theorist accomplish what she or he sets outsequence of presentation? to do?

 How many relationships are contained33. 2.HOW SIMPLE IS THIS THEORY? How many concepts are How are the

relationships organized?within the theory?  Are some concepts differentiated into sub-concepts?contained in the theory?

Is the theoryCan concepts be combined without losing theoretic meaning? Does the theory tend to describe,complex some

areas and not in others? explain, or predict? Impact understanding? Create meaning?

 How specific are the purposes of this34. 3.HOW GENERAL IS THIS THEORY Is thus theorytheory? Do they apply to

all or only some practice areas? When? Is the purposespecific to nursing? If not, who else could use it? Why? If

subpurposes exist, do they reflect nursingjustifiably a nursing purpose? actions? How broad are the concepts within the

theory?

 How Are the concepts broad or narrow?35. 4.HOW ACCESSIBLE IS THIS THEORY Are the concepts‟specific or

general are definitions within the theory? empiric indicators identifiable in reality? Are they within the realm of Do the

definitions provided for the concepts adequately reflect theirnursing? Is a very narrow definition offered for a broad

concept? A broadmeanings? If words are coined, are they defined?meaning for a narrow concept?

 Does the theory have potential to36. 5.HOW IMPORTANT IS THIS THEORY? Does the theory influenceinfluence

nursing actions? If so, to what end? Hoenursing education? research? If so, to what end? Is that end desirable? specific are

the purposes of the theory? Do they provide a general framework Is the theory‟s positionwithin which to act or a means to

predict phenomena? about people, about nursing, and about the environment consistent with nursing‟s Given the purpose of

the theory and its orientation, what ofphilosophy? significance for nursing or health care has been omitted?

 Is the started or implied purpose one37. 5.HOW IMPORTANT IS THIS THEORY? Will use of the theory help or

hinderthat is important to nursing? Why? Will application of this theory resolve any importantnursing in any way? Is the

theory futuristic andissues in nursing? Will it resolve any problems?  Will research based on the theory answer important

questions?forward-looking? Do I like this theory? Why?Are the concepts within the domain of nursing?

 Theory development and evaluation are cyclical, continuous,38. Conclusion Theory evaluationand dynamic process. One

can not exist without the other. including description, concept analysis, theory critique, testing and support. These process are

based on the view that science is a human process that includes not only valid findings but also observation, agreements, useful

Theory evaluation is central to the development ofsolutions to problems. theory; it is the responsibility of each clinician,

academician.

 Kuhn(1977) “we can delineate such criteria and that39. Conclusion accuracy, consistency, broad scope, simplicity and

fruitfulness in research are However, “everyessential as objective criteria for judging competing theories” individuals choice

between competing theories depends on a mixture of objective The subjective factors are dependent on individualsand

subjective factors” Both objective and subjective factors have apreferences and personalities. place in our understanding of

the philosophy of science.

 40. Adaptation Model

 41. Exercise: Application of Roys Adaptation Model in Nursing Practicehttp://currentnursing.com/nursing_theory/applicat1.

What is the purpose of this theory?2. What are the concepts of this theory?3. How are the concepts defined?4. What is the

nature of relationships?5. What is the structure of the theory? .6. On what assumptions does the theory build?

Evaluation of-a-nursing-theory-nursing-theory-ppt from Maria Poly
Evaluation of-a-nursing-theory-nursing-theory-ppt from Maria Poly Evaluation of-a-nursing-theory-nursing-theory-ppt Evaluation of-a-nursing-theory-nursing-theory-ppt Maria Poly Maria Poly

Evaluation of-a-nursing-theory-nursing-theory-ppt Presentation Transcript

 1. Evaluation of a Nursing Theory

 2. Forming a Complete Description:Six Questions are Propose for Describing Theory.

 3. 1. What is the purpose of this theory? This question addresses why the theory was formu- lated and reflects the contexts and

situations to which the theory can be applied.2. What are the concepts of this theory? This question identifies the ideas that are

structured and related within the theory. It questions the quali- tative and quantitative dimensions of concepts.3. How are the

concepts defined? This question clarifies the meaning for concepts within the theory. It questions how empiric experi- ence is

represented by the ideas within the theory.

 4. 4. What is the nature of relationships? This question addresses how concepts are linked together. It focuses on the various

forms relationship statements can take and how they give structure to the theory.5. What is the structure of the theory? This

question addresses the overall form of the con- ceptual interrelationships. It discerns whether the theory contains partial

structures or has one basic form.6. On what assumptions does the theory build? This question addresses the basic truths that

underlie theoretic reasoning. It questions whether assumptions reflect philosophic values or factual assertions factual

assertions.

 Why is this theory5. Guide for the Description of Theory 1. PURPOSE Is there an overall purpose for the theory? A

hierarchy offormulated? Is there a purpose for the nurse? Thepurposes? Separate numerous purposes? How broad or

narrow is theperson receiving care? Society? Environment? What is the value orientation of the purpose? Positive,

negative,purpose? neutral?

 Does achieving the theoretic purpose require a nursing6. 1. PURPOSE Does the purpose reflect understanding? Creation of

meaning?context? When would the theoryDescription, explanation, and prediction of phenomena? What purpose not

explicitly( 明確地cases to be applicable? What is the end point? ) embedded( 植入 ) in the matrix of the theory can be
identified?


 Is there one major concept with sub-concepts organized under7. 2. CONCEPTS Can the How many major (or minor)

ones? How many concepts are there?it? concepts be ordered, related? Arranged into any configuration?

 Are Are there concepts that cannot be interrelated?8. 2. CONCEPTS How abstract( 抽象 ) or empiric( 經驗 ) are

theconcepts broad in scope? Narrow? What is the balance between highly abstract and highly empiricconcepts? concepts?

 Which Which concepts are defined? Which are not?9. 3. DEFINITIONS How much meaningconcepts are defined

explicitly? Which are implied( 隱喻 )? Are Which concepts are defined specifically? Generally?needs to be inferred ?

there competing definitions for some concepts? Are there similar definitions for Are any concepts defined contrary to common

convention( 習俗different concepts? , 常規 )?

  What are the major relationships within the theory?10. 4. RELATIONSHIPS Do relationships includeWhich

relationships are obvious? Which are implied? Are some concepts included in multipleall concepts? Which are not included?

Is there a hierarchy of relationships? Do relationships createrelationships? meaning and understanding? Do they do this by

describing, explaining? Are relationships illustrated?Predicting? What mix of each?

 If How are overall and individual ideas organized?11. 5. STRUCTURE Do relationships expand conceptsoutlined, what

THEORETICAL
BASIS


for Nursing

McEwen_FM.indd 1 10/10/13 11:21 AM

McEwen_FM.indd 2 10/10/13 11:21 AM

THEORETICAL
BASIS


for Nursing

Melanie McEwen, PhD, RN, CNE, ANEF
Associate Professor
University of Texas Health Science Center at Houston
School of Nursing
Houston, Texas





Evelyn M. Wills, PhD, RN
Professor (Retired)
Department of Nursing
College of Nursing and Allied Health Professions
University of Louisiana at Lafayette
Lafayette, Louisiana






F O U R T H E D I T I O N

McEwen_FM.indd 3 10/10/13 11:21 AM

Acquisitions Editor: Patrick Barbera
Product Development Editor: Helen Kogut
Editorial Assistant: Dan Reilly
Production Project Manager: Cynthia Rudy
Design Coordinator: Holly McLaughlin
Illustration Coordinator: Jennifer Clements
Manufacturing Coordinator: Karin Duffield
Prepress Vendor: Absolute Service, Inc.








4th edition

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007,
2002 Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No
part of this book may be reproduced or transmitted in any form or by any means, including as
photocopies or scanned-in or other electronic copies, or utilized by any information storage and
retrieval system without written permission from the copyright owner, except for brief quotations
embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as
part of their official duties as U.S. government employees are not covered by the above-mentioned
copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce
Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our
website at lww.com (products and services).










9 8 7 6 5 4 3 2 1

Printed in China

Library of Congress Cataloging-in-Publication Data
McEwen, Melanie, author.
Theoretical basis for nursing / Melanie McEwen, Evelyn M. Wills.—Edition 4.



p. ; cm.
Includes bibliographical references and indexes.
ISBN 978-1-4511-9031-1
I. Wills, Evelyn M., author. II. Title.
[DNLM: 1. Nursing Theory. WY 86]
RT84.5
610.73–dc23







2013035526

Care has been taken to confirm the accuracy of the information presented and to describe generally
accepted practices. However, the author(s), editors, and publisher are not responsible for errors
or omissions or for any consequences from application of the information in this book and make
no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the
contents of the publication. Application of this information in a particular situation remains the
professional responsibility of the practitioner; the clinical treatments described and recommended
may not be considered absolute and universal recommendations.







The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dos-
age set forth in this text are in accordance with the current recommendations and practice at the time of
publication. However, in view of ongoing research, changes in government regulations, and the constant
flow of information relating to drug therapy and drug reactions, the reader is urged to check the package
insert for each drug for any change in indications and dosage and for added warnings and precautions.
This is particularly important when the recommended agent is a new or infrequently employed drug.






Some drugs and medical devices presented in this publication have U.S. Food and Drug Ad-
ministration (FDA) clearance for limited use in restricted research settings. It is the responsibility of
the health care provider to ascertain the FDA status of each drug or device planned for use in his or
her clinical practice.




LWW.com

McEwen_FM.indd 4 10/10/13 11:21 AM

Proudly sourced and uploaded by [StormRG]
Kickass Torrents | The Pirate Bay | ExtraTorrent


To Kaitlin and Grant—You have helped me broaden my thoughts
and consider all kinds of possibilities; I hope I’ve done the same
for you.



Also for Helen and Keith—Our children chose well. Besides,
you have given us Madelyn, Logan, Brenna, Liam, Lucy, and
Andrew; they are gifts beyond words.



Melanie McEwen

To Tom, Paul, and Vicki, who light up my life, and to Marian,
who is my applause. To Teddy, Gwen, Merlyn, and Madelyn,
who have been so patient and loving during this process.
A thousand thank yous to Peggy, who has supported me through
this writing process.





Evelyn M. Wills

D E D I C A T I O N

McEwen_FM.indd 5 10/10/13 11:21 AM

Grace Bielkiewicz, RN, PMHCNS-BC
Assistant Professor (Retired)
Department of Nursing
Southern University
Baton Rouge, Louisiana
Chapter 13: Theories From the Sociologic Sciences






Debra Brossett Garner, DNP, APRN, ACNS-BC, PMHNP-BC
Psychiatric Mental Health Nurse Practitioner
Delhi Rural Health Clinic
Delhi, Louisiana
Chapter 14: Theories From the Behavioral Sciences





Melinda Granger Oberleitner, DNS, RN
Associate Dean, College of Nursing and Allied Health Professions
Professor, Department of Nursing
SLEMCO/BORSF Endowed Professor of Nursing
University of Louisiana at Lafayette
Lafayette, Louisiana
Chapter 16: Theories, Models, and Frameworks From Administration and
Management
Chapter 20: Application of Theory in Nursing Administration and
Management










C O N T R I B U T O R S

vi

McEwen_FM.indd 6 10/10/13 11:21 AM

R E V I E W E R S

Kimamer Amer, PhD
Associate Professor
Department of Nursing
DePaul University
Chicago, Illinois





Margaret Barnes, MSN, RN
Assistant Professor
School of Nursing, RNBSN Post-Licensure Division
Indiana Wesleyan University
Florence, Kentucky





Shari Cherney, RN, BScN, MHSc
Professor
Department of Nursing
George Brown College
Toronto, Ontario, Canada





Cheryl Delgado, PhD
Associate Professor
Department of Nursing
Cleveland State University
Cleveland, Ohio





Dolores Furlong, PhD
Professor
Department of Nursing
University of New Brunswick
Fredericton, New Brunswick, Canada





Maryanne Garon, DNSc
Professor
Department of Nursing
California State University Fullerton
Fullerton, California





Carol Grantham, PhD, MSN, CPNP-PC
Faculty
Byrdine F. Lewis School of Nursing & Health



Professions
Georgia State University
Atlanta, Georgia



Barbara Harris, PhD
Assistant Professor
School of Nursing
DePaul University
Chicago, Illinois





Seongkum Heo, PhD
Assistant Professor
Department of Nursing
University of Arkansas for Medical Sciences
Little Rock, Arkansas





Donna Murnaghan, PhD
Associate Professor
School of Nursing
University of Prince Edward Island
Charlottetown, Prince Edward Island, Canada





Pamela Reis, PhD, CNM
Assistant Professor
Department of Nursing
East Carolina University
Greenville, North Carolina





Sue Robertson, PhD
Assistant Professor
Department of Nursing
California State University, Fullerton
Fullerton, California





Denice Sheehan, PhD
Assistant Professor
Department of Nursing
Kent State University
Kent, Ohio





Ida Slusher, DSN
Professor & Nursing Education Coordinator
Department of Baccalaureate & Graduate Nursing
Eastern Kentucky University
Richmond, Kentucky





Sharon Van Sell, BSN, MEd, MS, EdD
Professor
Department of Nursing
Texas Woman’s University
Dallas, Texas





vii

McEwen_FM.indd 7 10/10/13 11:21 AM

P R E F A C E

viii

Frequently, nursing students respond with a cringing expression or a resounding
“ugh!” when faced with the requirement of taking a course on theory. Indeed, many
fail to see theory’s relevance to the real world of nursing practice and often have
difficulty applying the information in later courses and in their research. This book
is the result of the frustration felt by a group of nursing instructors who met a num-
ber of years ago to adopt a textbook for a theory course. Indeed, because of student
complaints and faculty dissatisfaction, we were changing textbooks yet again. A fairly
lengthy discussion arose in which we concluded that the available books did not meet
the needs of our students or course faculty. Ultimately, we determined to “build a
better mousetrap.” Our intent was to write a book that was a general overview of
theory per se, stressing how it is—and should be—used by nurses to improve practice,
research, education, and management/leadership.












As in past editions, an ongoing review of trends in nursing theory and nursing
science has shown an increasing emphasis on middle range theory, evidence-based
practice, and situation-specific theories. To remain current and timely, in this fourth
edition, we have added a new chapter discussing evidence-based practice, highlighting
how it relates to theory in nursing, and presenting several evidence-based practice
models commonly used by nurses. We have also included new middle range nursing
theories and added a significant section discussing situation-specific nursing theories,
describing how they relate to evidence-based practice. Updates and application exam-
ples have been added throughout the discussions on the various theories.









Organization of the Text

Theoretical Basis for Nursing is designed to be a basic nursing theory textbook that
includes the essential information students need to understand and apply theory.


The book is divided into four units. Unit I, Introduction to Theory, provides
the background needed to understand what theory is and how it is used in nursing.
It outlines tools and techniques used to develop, analyze, and evaluate theory so
that it can be used in nursing practice, research, administration and management,
and education. In this unit, we have provided a balanced view of “hot” topics (e.g.,
philosophical world views and utilization of shared or borrowed theory). Also, rather
than espousing one strategy for activities such as concept development and theory
evaluation, we have included a variety of strategies.








Unit II, Nursing Theories, focuses largely on the grand nursing theories and
begins with a chapter describing their historical development. This unit divides the
grand nursing theories into three groups based on their focus (human needs, in-
teractive process, and unitary process). The works of many of the grand theorists
are briefly summarized in Chapters 7, 8, and 9. We acknowledge that these analyses





McEwen_FM.indd 8 10/19/13 3:59 AM

Preface ix

are not comprehensive; rather, they are intended to provide the reader with enough
information to understand the basis of the work and to whet the reader’s appetite to
select one or more for further study.



Chapters 10 and 11 cover the significant topic of middle range nursing theory.
Chapter 10 presents a detailed overview of the origins and growth of middle range
theory in nursing and gives numerous examples of how middle range theories have
been developed by nurses. Chapter 11 provides an overview of some of the grow-
ing number of middle range nursing theories. The theories presented include some
of the most commonly used middle range nursing theories (e.g., Pender’s Health
Promotion Model and Leininger’s Culture Care Diversity and Universality Theory)
as well as some that are less well known but have a growing body of research sup-
port (e.g., Meleis’ Transitions Theory, the Theory of Unpleasant Symptoms, and the
Uncertainty in Illness Theory). The intent is to provide a broad range of middle range
theories to familiarize the reader with examples and to encourage them to search for
others appropriate to their practice or research. Ultimately, it is hoped that readers
will be challenged to develop new theories that can be used by nurses.













Chapter 12, which discusses evidence-based practice (EBP), is new to this edi-
tion. This chapter explains and defines the idea/process of EBP and describes how it
relates to nursing theory and application of theory in nursing practice and research.
The chapter concludes with a short presentation and review of five different EBP
models that have been widely used by nurses and are well supported in the literature.





Unit III, Shared Theories Used by Nurses, is rather unique in nursing litera-
ture. Our book acknowledges that “shared” or “borrowed” theories are essential to
nursing and negates the idea that the use of shared theory in practice or research is
detrimental. In this unit, we have identified some of the most significant theories that
have been developed outside of the discipline of nursing but are continually used in
nursing. We have organized these theories based on broad disciplines: theories from
the sociologic sciences, behavioral sciences, and biomedical sciences, as well as from
administration and management and learning. Each of these chapters was written by
a nurse with both educational and practical experience in her respective area. These
theories are presented with sufficient information to allow the reader to understand
the theories and to recognize those that might be appropriate for her or his own
work. These chapters also provide original references and give examples of how the
concepts, theories, and models described have been used by other nurses.













Finally, Unit IV, Application of Theory in Nursing Practice, explains how the-
ories are applied in nursing. Separate chapters cover nursing practice, nursing research,
nursing administration and management, and nursing education. These chapters in-
clude many specific examples for the application of theory and are intended to be a
practical guide for theory use. The heightened development of practice theories and
EBP guidelines are critical to theory application in nursing today, so these areas have
been expanded. The unit concludes with a chapter that discusses some of the future
issues in theory within the discipline.








McEwen_FM.indd 9 10/19/13 3:59 AM

x Preface

■ New Chapter 12, Evidence-Based Practice and Nursing Theory
■ More detailed explanation of EBP and its relationship to theory in nursing
■ Enhanced attention to situation-specific theories and how they relate to EBP
■ Numerous recent examples of application of theories in nursing practice,




nursing research, leadership/administration, and education
■ NEW instructional support


New To This Edition

Student Resources Available on

■ Literature Assessment Activity provides an interactive tool featuring journal
articles along with questions that will encourage students to think critically
about the literature. Students can print or e-mail their responses to their
instructor.




■ Case Studies with applicable questions guide students in understanding how
the various theories link to nursing practice.


■ Learning Objectives for each chapter help focus the student.
■ Internet Resources provide live web links to pertinent sites so that students


can further their study and understanding of the various theories.
■ Journal Articles for each chapter offer opportunities to gain more knowledge


and understanding of the chapter content.

Key Features
In addition to numerous tables and boxes that highlight and summarize important
information, Theoretical Basis for Nursing contains case studies, learning activities,
exemplars, and illustrations that help students visualize various concepts. New to this
edition is a special feature called Link to Practice.





■ Link to Practice: All chapters include at least one “Link to Practice” box,
which presents useful information or clinically related examples related to the
subject being discussed. The intent is to give additional tools or resources that
can be used by nurses to apply the content in their own practice or research.




■ Case Studies: At the end of Chapter 1 and the beginning of Chapters 2 to 22,
case studies help the reader understand how the content in the chapter relates
to the everyday experience of the nurse, whether in practice, research, or other
aspects of nursing.




■ Learning Activities: At the end of each chapter, learning activities pose critical
thinking questions, propose individual and group projects related to topics
covered in the chapter, and stimulate classroom discussion.



■ Exemplars: In five chapters, an exemplar discusses a scholarly study from the
perspectives of concept analysis (Chapter 3); theory development (Chapter 4);
theory analysis and evaluation (Chapter 5); middle range theory develop-
ment (Chapter 10); and theory generation via research, theory testing via
research, and use of a theory as the conceptual framework for a research study
(Chapter 19).






■ Illustrations: Diagrams and models are included throughout the book to help
the reader better understand the many different theories presented.


McEwen_FM.indd 10 10/10/13 11:21 AM

Preface xi

Instructor Resources Available on
■ Instructor’s Guide includes application-level discussion questions and classroom/


online activities that Melanie McEwen uses in her own teaching!
■ Strategies for Effective Teaching of Nursing Theory provide ideas for


instructors to help make the nursing theory class come alive.
■ Test Generator Questions provide multiple-choice questions that can be used


for testing general content knowledge.
■ PowerPoints with audience response (Iclicker) questions, based on


the ones used by Melanie McEwen in her own classroom, help highlight
important points to enhance the classroom, experience.


■ Case Studies with questions, answers, and related activities offer opportunities
for instructors to make the student case studies an exciting, fun, and rewarding
classroom/online experience.



■ Image Bank provides images from the text that instructors can use to enhance
their own presentations.


In summary, the focus of this learning package is on the application of theory rather
than on the study, analysis, and critique of grand theorists or a presentation of a
specific aspect of theory (e.g., construction or evaluation). It is hoped that practic-
ing nurses, nurse researchers, and nursing scholars, as well as graduate students and
theory instructors, will use this book and its accompanying resources to gain a better
understanding and appreciation of theory.






Melanie McEwen, PhD, RN, CNE, ANEF
Evelyn M. Wills, PhD, RN


McEwen_FM.indd 11 10/10/13 11:21 AM

xii

A C K N O W L E D G M E N T S

Our heartfelt thanks to Product Development Editor, Helen Kogut, for her assis-
tance, patience, and persistence in helping us complete this project. She has made a
difficult task seem easy! We also want to thank Acquisitions Editor, Christina Burns,
for her wonderful support and assistance in getting this project started and Patrick
Barbera for seeing it through to the end. Finally, a huge word of thanks to our con-
tributors who have diligently worked to present the notion of theory in a manner that
will engage nursing students and to look for new examples and applications to help
make theory fresh and relevant.








McEwen_FM.indd 12 10/10/13 11:21 AM

xiii

C O N T E N T S

Unit I: Introduction to Theory 1
1. Philosophy, Science, and Nursing 2


Melanie McEwen
Nursing as a Profession 2
Nursing as an Academic Discipline 4
Introduction to Science and Philosophy 5
Science and Philosophical Schools of Thought 7
Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing 11
Knowledge Development and Nursing Science 12
Research Methodology and Nursing Science 16








2. Overview of Theory in Nursing 23
Melanie McEwen


Overview of Theory 24
The Importance of Theory in Nursing 25
Terminology of Theory 26
Historical Overview: Theory Development in Nursing 26
Classification of Theories in Nursing 36
Issues in Theory Development in Nursing 40






3. Concept Development: Clarifying Meaning of Terms 49
Evelyn M. Wills, Melanie McEwen


The Concept of “Concept” 50
Concept Analysis/Concept Development 54
Strategies for Concept Analysis and Concept Development 57



4. Theory Development: Structuring Conceptual Relationships
in Nursing 72


Melanie McEwen
Overview of Theory Development 73
Categorizations of Theory 73
Components of a Theory 79
Theory Development 82





5. Theory Analysis and Evaluation 95
Melanie McEwen


Definition and Purpose of Theory Evaluation 96
Historical Overview of Theory Analysis and Evaluation 97
Comparisons of Methods 106
Synthesized Method of Theory Evaluation 106




McEwen_FM.indd 13 10/10/13 11:21 AM

xiv Contents

6. Overview of Grand Nursing Theories 116
Evelyn M. Wills


Categorization of Conceptual Frameworks and Grand Theories 118
Specific Categories of Models and Theories for This Unit 124
Analysis Criteria for Grand Nursing Theories 124
The Purpose of Critiquing Theories 127




7. Grand Nursing Theories Based on Human Needs 131
Evelyn M. Wills


Florence Nightingale: Nursing: What It Is and What It Is Not 132
Virginia Henderson: The Principles and Practice of Nursing 136
Faye G. Abdellah: Patient-Centered Approaches to Nursing 139
Dorothea E. Orem: The Self-Care Deficit Nursing Theory 142
Dorothy Johnson: The Behavioral System Model 146
Betty Neuman: The Neuman Systems Model 149






8. Grand Nursing Theories Based on Interactive Process 159
Evelyn M. Wills


Myra Estrin Levine: The Conservation Model 160
Barbara M. Artinian: The Intersystem Model 164


Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain:
Modeling and Role-Modeling 169


Imogene M. King: King’s Conceptual System and Theory of Goal Attainment and
Transactional Process 173


Sister Callista Roy: The Roy Adaptation Model 177
Jean Watson: Caring Science as Sacred Science 182


9. Grand Nursing Theories Based on Unitary Process 192
Evelyn M. Wills


Martha Rogers: The Science of Unitary and Irreducible Human Beings 193
Margaret Newman: Health as Expanding Consciousness 198
Rosemarie Parse: The Humanbecoming Paradigm 202



10. Introduction to Middle Range Nursing Theories 213
Melanie McEwen


Purposes of Middle Range Theory 214
Characteristics of Middle Range Theory 215
Concepts and Relationships for Middle Range Theory 216
Categorizing Middle Range Theory 217
Development of Middle Range Theory 217
Analysis and Evaluation of Middle Range Theory 225






11. Overview of Selected Middle Range Nursing Theories 229
Melanie McEwen


High Middle Range Theories 230
Middle Middle Range Theories 241
Low Middle Range Theories 248



12. Evidence-Based Practice and Nursing Theory 258
Evelyn M. Wills, Melanie McEwen


Overview of Evidence-Based Practice 259
Definition and Characteristics of Evidence-Based Practice 259
Concerns Related to Evidence-Based Practice in Nursing 261
Evidence-Based Practice and Practice-Based Evidence 261




Unit II: Nursing Theories 115

McEwen_FM.indd 14 10/10/13 11:21 AM

Contents xv

Promotion of Evidence-Based Practice in Nursing 263
Theory and Evidence-Based Practice 263
Theoretical Models of EBP 264



Unit III: Shared Theories Used by Nurses 277
13. Theories From the Sociologic Sciences 278


Grace Bielkiewicz
Exchange Theories 279
Interactionist Frameworks 284
Conflict Theories 289
Chaos Theory 295
Postmodern Social Theory 298






14. Theories From the Behavioral Sciences 305
Debra Brossett Garner


Psychodynamic Theories 306
Behavioral and Cognitive-Behavioral Theories 313
Humanistic Theories 315
Stress Theories 318
Social Psychology 321





15. Theories From the Biomedical Sciences 331
Melanie McEwen


Theories and Models of Disease Causation 332
Theories and Principles Related to Physiology and Physical Functioning 339


16. Theories, Models, and Frameworks From Leadership
and Management 354


Melinda Granger Oberleitner
Overview of Concepts of Leadership and Management 355
Early Leadership Theories 355
Contemporary Leadership Theories 362
Organizational/Management Theories 365
Motivational Theories 366
Concepts of Power, Empowerment, and Change 368
Problem-Solving and Decision-Making Processes 372
Conflict Management 374
Quality Improvement 375
Evidence-Based Practice 380











17. Learning Theories 386
Evelyn M. Wills, Melanie McEwen


What Is Learning? 387
What Is Teaching? 388
Categorization of Learning Theories 388
Behavioral Learning Theories 389
Cognitive Learning Theories 392
Summary of Learning Theories 404
Learning Styles 405
Principles of Learning 406
Application of Learning Theories in Nursing 407









McEwen_FM.indd 15 10/10/13 11:21 AM

xvi Contents

Unit IV: Application of Theory in Nursing 411
18. Application of Theory in Nursing Practice 412


Melanie McEwen
Relationship Between Theory and Practice 413
Theory-Based Nursing Practice 414
The Theory–Practice Gap 416
Situation-Specific/Practice Theories in Nursing 418
Application of Theory in Nursing Practice 422






19. Application of Theory in Nursing Research 430
Melanie McEwen


Historical Overview of Research and Theory in Nursing 431
Relationship Between Research and Theory 432
Types of Theory and Corresponding Research 434
How Theory Is Used in Research 437
Nursing and Non-Nursing Theories in Nursing Research 444
Other Issues in Nursing Theory and Nursing Research 445






20. Application of Theory in Nursing Administration and
Management 452


Melinda Granger Oberleitner
Organizational Design 453
Shared Governance 456
Transformational Leadership in Nursing and in Health Care 458
Patient Care Delivery Models 459
Case Management 466
Disease/Chronic Illness Management 468
Quality Management 470








21. Application of Theory in Nursing Education 479
Evelyn M. Wills, Melanie McEwen


Theoretical Issues in Nursing Curricula 481
Theoretical Issues in Nursing Instruction 488


22. Future Issues in Nursing Theory 497
Melanie McEwen


Future Issues in Nursing Science 499
Future Issues in Nursing Theory 500


Theoretical Perspectives on Future Issues in Nursing Practice, Research,
Administration and Management, and Education 502


Glossary 513
Author Index 523
Subject Index 554



McEwen_FM.indd 16 10/10/13 11:21 AM

U N I T I

Introduction to Theory

McEwen_CH01.indd 1 10/10/13 10:53 AM

Philosophy,
Science, and
Nursing
Melanie McEwen




C H A P T E R 1

2

Largely due to the work of nursing scientists, nursing theorists, and nursing scholars
over the past five decades, nursing has been recognized as both an emerging
profession and an academic discipline. Crucial to the attainment of this distinction
have been numerous discussions regarding the phenomena of concern to nurses and
countless efforts to enhance involvement in theory utilization, theory generation, and
theory testing to direct research and improve practice.






A review of the nursing literature from the late 1970s until the present shows
sporadic discussion of whether nursing is a profession, a science, or an academic
discipline. These discussions are sometimes pleading, frequently esoteric, and
occasionally confusing. Questions that have been raised include: What defines a
profession? What constitutes an academic discipline? What is nursing science? Why
is it important for nursing to be seen as a profession or an academic discipline?






Nursing as a Profession

In the past, there has been considerable discussion about whether nursing is a profes-
sion or an occupation. This is important for nurses to consider for several reasons. An
occupation is a job or a career, whereas a profession is a learned vocation or occupa-
tion that has a status of superiority and precedence within a division of work. In gen-
eral terms, occupations require widely varying levels of training or education, varying
levels of skill, and widely variable defined knowledge bases. In short, all professions
are occupations, but not all occupations are professions (Finkelman & Kenner, 2013).







Professions are valued by society because the services professionals provide are ben-
eficial for members of the society. Characteristics of a profession include (1) defined
and specialized knowledge base, (2) control and authority over training and education,
(3) credentialing system or registration to ensure competence, (4) altruistic service to
society, (5) a code of ethics, (6) formal training within institutions of higher education,
(7) lengthy socialization to the profession, and (8) autonomy (control of professional
activities) (Ellis & Hartley, 2012; Finkelman & Kenner, 2013; Rutty, 1998). Professions







McEwen_CH01.indd 2 10/10/13 10:53 AM

Chapter 1 Philosophy, Science, and Nursing 3

must have a group of scholars, investigators, or researchers who work to continually ad-
vance the knowledge of the profession with the goal of improving practice (Schlotfeldt,
1989). Finally, professionals are responsible and accountable to the public for their work
(Hood, 2010). Traditionally, professions have included the clergy, law, and medicine.




Until near the end of the 20th century, nursing was viewed as an occupation
rather than a profession. Nursing has had difficulty being deemed a profession because
many of the services provided by nurses have been perceived as an extension of those
offered by wives and mothers. Additionally, historically, nursing has been seen as sub-
servient to medicine, and nurses have delayed in identifying and organizing profes-
sional knowledge. Furthermore, education for …






2

3

4

5

Acquisitions Editor: Christina Burns
Development Editor: Michael Kerns
Editorial Coordinator: Tim Rinehart
Editorial Assistant: Kaitlin Campbell
Production Project Manager: Kim Cox
Design Coordinator: Elaine Kasmer
Illustration Coordinator: Jennifer Clements
Manufacturing Coordinator: Karin Duffield
Prepress Vendor: Absolute Service, Inc.









Fifth Edition

Copyright © 2019 Wolters Kluwer Health.

Copyright © 2014, 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2002 Lippincott Williams & Wilkins. All
rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means,
including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written
permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book
prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To
request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via
email at [email protected], or via our website at lww.com (products and services).







9 8 7 6 5 4 3 2 1

Printed in China

Library of Congress Cataloging-in-Publication Data

Names: McEwen, Melanie, author. | Wills, Evelyn M., author.
Title: Theoretical basis for nursing / Melanie McEwen, Evelyn M. Wills.
Description: Fifth edition. | Philadelphia : Wolters Kluwer, [2018] |



Includes bibliographical references and index.
Identifiers: LCCN 2017049174 | ISBN 9781496351203
Subjects: | MESH: Nursing Theory
Classification: LCC RT84.5 | NLM WY 86 | DDC 610.73—dc23 LC record available at https://lccn.loc.gov/2017049174




Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the author(s),
editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and
make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application
of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and
recommended may not be considered absolute and universal recommendations.





The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance
with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government
regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for
each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the
recommended agent is a new or infrequently employed drug.





Some drugs and medical devices presented in this publication have U.S. Food and Drug Administration (FDA) clearance for limited use in
restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use
in his or her clinical practice.



LWW.com

6

mailto:[email protected]

http://lww.com

https://lccn.loc.gov/2017049174

http://LWW.com

D E D I C AT I O N

To Kaitlin and Grant—You have helped me broaden my thoughts and consider all kinds of possibilities;
I hope I’ve done the same for you.


Also for Helen and Keith—Our children chose well. Besides, you have given us Madelyn, Logan,
Brenna, Liam, Lucy, Andrew, Michael, and Jacob; they are gifts beyond words.


Melanie McEwen

To Tom, Paul, and Vicki, who light up my life, and to Marian, who left us for a better place. You were
always my best listener. To Teddy, Gwen, Merlyn, and Madelyn, who have been so patient and loving
during this process.



My deepest gratitude to Leslie, who has supported me through this writing process.

Evelyn M. Wills

7

C O N T R I B U T O R S

Sattaria Smith Dilks, DNP, APRN-BC, FNP, PMHNP/CNS
Professor and Co-Coordinator Graduate Program
College of Nursing
McNeese State University
Lake Charles, Louisiana
Chapter 14: Theories From the Behavioral Sciences






Joan C. Engebretson, DrPH, AHN-BC, RN, FAAN
Judy Fred Professor in Nursing
University of Texas Health Science Center at Houston
School of Nursing, Department of Family Nursing
Houston, Texas
Chapter 13: Theories From the Sociologic Sciences






Melinda Granger Oberleitner, DNS, RN
Associate Dean, College of Nursing & Allied Health Professions
Professor, Department of Nursing
SLEMCO/BORSF Endowed Professor of Nursing
University of Louisiana at Lafayette
Lafayette, Louisiana
Chapter 17: Theories, Models, and Frameworks From Leadership and Management
Chapter 21: Application of Theory in Nursing Administration and Management








Cathy L. Rozmus, PhD, RN
PARTNERS Endowed Professorship in Nursing
Vice Dean
Department of Family Health
The University of Texas Health Science Center at Houston
School of Nursing
Houston, Texas
Chapter 16: Ethical Theories and Principles








Jeffrey P. Spike, PhD
Professor of Family and Community Medicine
The University of Texas Health Science Center at Houston
School of Medicine
Professor, Department of Management, Policy, and Community Health
University of Texas Health Science Center School of Public Health
Houston, Texas
Chapter 16: Ethical Theories and Principles








8

R E V I E W E R S

Cynthia Dakin, PhD, RN
Director of Graduate Studies
Associate Professor
Department of Nursing
Elms College
Chicopee, Massachusetts






Janet DuPont, RNC-OB, MSN, MEd, PhD
Master of Science in Nursing Instructor/Developer
Nursing Program
Norwich University
Northfield, Vermont





Ruth Neese, PhD, RN, CEN
Assistant Professor
Department of Nursing
Indian River State College
Fort Pierce, Florida





Brandon N. Respress, PhD, RN, MPH, MSN
Assistant Professor
College of Nursing and Health Innovation
University of Texas at Arlington
Arlington, Texas





Jacqueline Saleeby, PhD, RN, CS
Associate Professor
Department of Nursing
Maryville University
St. Louis, Missouri





Stephen J. Stapleton, PhD, MS, RN, CEN, FAEN
Associate Professor
Mennonite College of Nursing
Illinois State University
Normal, Illinois





Kathleen Williamson, MSN, PhD, RN
Associate Professor and Chair
Wilson School of Nursing
Midwestern State University
Wichita Falls, Texas





Cindy Zellefrow, DNP, MSEd, RN, LSN, APHN-BC
Assistant Professor of Clinical Practice
Assistant Director, Center for Transdisciplinary and Evidence-based Practice



9

College of Nursing
The Ohio State University
Columbus, Ohio



10

P R E FA C E

Rare is the student who enrolls in a nursing program and is excited about the requirement of taking a course
on theory. Indeed, many fail to see theory’s relevance to the real world of nursing practice and often have
difficulty applying the information in later courses and in their research. This book is the result of the
frustration felt by a group of nursing instructors who met a number of years ago to adopt a textbook for a
theory course. Indeed, because of student complaints and faculty dissatisfaction, we were changing textbooks
yet again. A fairly lengthy discussion arose in which we concluded that the available books did not meet the
needs of our students or course faculty. We were determined to write a book that was a general overview of
theory per se, stressing how it is—and should be—used by nurses to improve practice, research, education,
and management/leadership.









As in past editions, an ongoing review of trends in nursing theory and nursing science has shown an
increasing emphasis on middle range theory, evidence-based practice (EBP), and situation-specific theories.
To remain current and timely, in this fifth edition, we have added a new chapter entitled “Ethical Theories and
Principles,” presenting information on these topics and describing how they relate to theory in nursing. We
have also included new middle range and situation-specific nursing theories as well as new “shared” theories
from non-nursing disciplines. One notable addition is a significant section discussing Complexity Science and
Complex Adaptive Systems in Chapter 13 (Theories From the Sociologic Sciences) helping to explain their
importance to nursing. Updates and application examples have been added throughout the discussions on the
various theories.









Organization of the Text
Theoretical Basis for Nursing is designed to be a basic nursing theory textbook that includes the essential
information students need to understand and apply theory in practice, research, education, and
administration/management.




The book is divided into four units. Unit I, Introduction to Theory, provides the background needed to
understand what theory is and how it is used in nursing. It outlines tools and techniques used to develop,
analyze, and evaluate theory so that it can be used in nursing practice, research, administration and
management, and education. In this unit, we have provided a balanced view of “hot” topics (e.g.,
philosophical world views and utilization of shared or borrowed theory). Also, rather than espousing one
strategy for activities such as concept development and theory evaluation, we have included a variety of
strategies.







Unit II, Nursing Theories, focuses largely on the grand nursing theories and begins with a chapter
describing their historical development. This unit divides the grand nursing theories into three groups based
on their focus (human needs, interactive process, and unitary process). The works of many of the grand
theorists are briefly summarized in Chapters 7, 8, and 9. Because this volume is intended to serve as a broad
foundation, these analyses provide the reader with enough information to understand the basis of the work and
to whet the reader’s appetite to select one or more for further study rather than delving into significant detail.






Chapters 10 and 11 cover the significant topic of middle range nursing theory. Chapter 10 presents a
detailed overview of the origins and growth of middle range theory in nursing and gives numerous examples
of how middle range theories have been developed by nurses. Chapter 11 provides an overview of some of the
growing number of middle range nursing theories. The theories presented include some of the most
commonly used middle range nursing theories (e.g., Pender’s Health Promotion Model and Leininger’s
Culture Care Diversity and Universality Theory) as well as some that are less well known but have a growing
body of research support (e.g., Meleis’s Transitions Theory, the Theory of Unpleasant Symptoms, and the







11

Uncertainty in Illness Theory). The intent is to provide a broad range of middle range theories to familiarize
the reader with examples and to encourage them to search for others appropriate to their practice or research.
Ultimately, it is hoped that readers will be challenged to develop new theories that can be used by nurses.



Chapter 12, which discusses EBP, explains and defines the idea/process of EBP and describes how it
relates to nursing theory and application of theory in nursing practice and research. The chapter concludes
with a short presentation and review of five different EBP models that have been widely used by nurses and
are well supported in the literature.




Unit III, Shared Theories Used by Nurses, is rather unique in nursing literature. Our book
acknowledges that “shared” or “borrowed” theories are essential to nursing and negates the idea that the use
of shared theory in practice or research is detrimental. In this unit, we have identified some of the most
significant theories that have been developed outside of the discipline of nursing but are continually used in
nursing. We have organized these theories based on broad disciplines: theories from the sociologic sciences,
behavioral sciences, biomedical sciences, and philosophy as well as from administration, management, and
learning. Each of these chapters was written by a nurse with both educational and practical experience in his
or her respective area. These theories are presented with sufficient information to allow the reader to
understand the theories and to recognize those that might be appropriate for his or her own work. These
chapters also provide original references and give examples of how the concepts, theories, and models
described have been used by other nurses.











Chapter 16, new to the fifth edition, describes ethical theories and principles that apply to nursing practice.
This addition was suggested by nursing faculty who recognized the importance of maintaining an ethical
perspective within the very complex health care system. This information is vital to professional nursing
practice and absolutely essential for nurses in advanced practice, management, or educational roles.




Finally, Unit IV, Application of Theory in Nursing, explains how theories are applied in nursing.
Separate chapters cover nursing practice, nursing research, nursing administration and management, and
nursing education. These chapters include many specific examples for the application of theory and are
intended to be a practical guide for theory use. The heightened development of practice theories and EBP
guidelines are critical to theory application in nursing today, so these areas have been expanded. The unit
concludes with a chapter that discusses some of the future issues in theory within the discipline.






Key Features
In addition to numerous tables and boxes that highlight and summarize important information, Theoretical
Basis for Nursing contains case studies, learning activities, exemplars, and illustrations that help students
visualize various concepts. New to this edition is a special boxed feature in most chapters that highlights how
a topic is outlined in the American Association of Colleges of Nursing (AACN’s) The Essentials of Master’s
Education in Nursing or The Essentials of Doctoral Education for Advanced Nursing Practice. Other key
features include:







■ Link to Practice: All chapters include at least one “Link to Practice” box, which presents useful
information or clinically related examples related to the subject being discussed. The intent is to give
additional tools or resources that can be used by nurses to apply the content in their own practice or
research.




■ Case Studies: At the end of Chapter 1 and the beginning of Chapters 2 to 23, case studies help the
reader understand how the content in the chapter relates to the everyday experience of the nurse,
whether in practice, research, or other aspects of nursing.



■ Learning Activities: At the end of each chapter, learning activities pose critical thinking questions,
propose individual and group projects related to topics covered in the chapter, and stimulate classroom
discussion.



■ Exemplars: In five chapters, an exemplar discusses a scholarly study from the perspectives of concept
analysis (Chapter 3); theory development (Chapter 4); theory analysis and evaluation (Chapter 5);
middle range theory development (Chapter 10); and theory generation via research, theory testing via
research, and use of a theory as the conceptual framework for a research study (Chapter 20).




■ Illustrations: Diagrams and models are included throughout the book to help the reader better

12

understand the many different theories presented.

New to This Edition
■ New Chapter 16, Ethical Theories and Principles
■ Detailed section on Complexity Science and Complex Adaptive Systems in Chapter 13.
■ More detailed explanation of EBP, situation-specific theories, and their relationship to theory in nursing
■ Numerous recent examples of application of theories in nursing practice, nursing research,





leadership/administration, and education
■ Enhanced instructional support, focusing on activities and information directed toward online learning


Student Resources Available on
■ Literature Assessment Activity provides an interactive tool featuring journal articles along with


critical thinking questions that will encourage students to engage with the literature. Students can print
or e-mail their responses to their instructor.


■ Case Studies with applicable questions guide students in understanding how the various theories link
to nursing practice.


■ Learning Objectives for each chapter help focus the student on outcomes.
■ Internet Resources provide live web links to pertinent sites so that students can further their study and


understanding of the various theories.
■ Journal Articles for each chapter offer opportunities to gain more knowledge and understanding of the


chapter content.

Instructor Resources Available on
■ Instructor’s Guide includes application-level discussion questions and classroom/online activities that


Melanie McEwen uses in her own teaching!
■ Strategies for Effective Teaching of Nursing Theory provide ideas for instructors to help make the


nursing theory class come alive.
■ Test Generator Questions provide multiple-choice questions that can be used for testing general


content knowledge.
■ PowerPoints with audience response (Iclicker) questions, based on the ones used by Melanie


McEwen in her own classroom, help highlight important points to enhance the classroom experience.
■ Case Studies with questions, answers, and related activities offer opportunities for instructors to make


the student case studies an exciting, fun, and rewarding classroom/online experience.
■ Image Bank provides images from the text that instructors can use to enhance their own presentations.


In summary, the focus of this learning package is on the application of theory rather than on the study,
analysis, and critique of grand theorists or a presentation of a specific aspect of theory (e.g., construction or
evaluation). It is hoped that practicing nurses, nurse researchers, and nursing scholars, as well as graduate
students and theory instructors, will use this book and its accompanying resources to gain a better
understanding and appreciation of theory.





Melanie McEwen, PhD, RN, CNE, ANEF
Evelyn M. Wills, PhD, RN


13

A C K N O W L E D G M E N T S

Our heartfelt thanks to Senior Development Editor, Michael Kerns, and Editorial Coordinator, Tim Rinehart,
for their assistance, patience, and persistence in helping us complete this project. They made a difficult task
seem easy! We also want to thank Senior Acquisitions Editor, Christina Burns, and Helen Kogut, for their
support and assistance in getting this project started and help with previous editions. Finally, a huge word of
thanks to our contributors who have diligently worked to present the notion of theory in a manner that will
engage nursing students and to look for new examples and applications to help make theory fresh and
relevant.







14

C O N T E N T S

Unit I: Introduction to Theory

1. Philosophy, Science, and Nursing
Melanie McEwen


Case Study
Nursing as a Profession
Nursing as an Academic Discipline
Introduction to Science and Philosophy




Overview of Science
Overview of Philosophy


Science and Philosophical Schools of Thought
Received View (Empiricism, Positivism, Logical Positivism)


Contemporary Empiricism/Postpositivism
Nursing and Empiricism


Perceived View (Human Science, Phenomenology, Constructivism, Historicism)
Nursing and Phenomenology/Constructivism/Historicism


Postmodernism (Poststructuralism, Postcolonialism)
Nursing and Postmodernism


Nursing Philosophy, Nursing Science, and Philosophy of Science in Nursing
Nursing Philosophy
Nursing Science
Philosophy of Science in Nursing




Knowledge Development and Nursing Science
Epistemology


Ways of Knowing
Nursing Epistemology
Other Views of Patterns of Knowledge in Nursing
Summary of Ways of Knowing in Nursing




Research Methodology and Nursing Science
Nursing as a Practice Science
Nursing as a Human Science
Quantitative Versus Qualitative Methodology Debate




Quantitative Methods
Qualitative Methods
Methodologic Pluralism



Summary
Key Points


Learning Activities

2. Overview of Theory in Nursing
Melanie McEwen


Overview of Theory
The Importance of Theory in Nursing
Terminology of Theory



15

Historical Overview: Theory Development in Nursing
Florence Nightingale
Stages of Theory Development in Nursing



Silent Knowledge Stage
Received Knowledge Stage
Subjective Knowledge Stage
Procedural Knowledge Stage
Constructed Knowledge Stage
Integrated Knowledge Stage






Summary of Stages of Nursing Theory Development
Classification of Theories in Nursing


Scope of Theory
Metatheory
Grand Theories
Middle Range Theories
Practice Theories





Type or Purpose of Theory
Descriptive (Factor-Isolating) Theories
Explanatory (Factor-Relating) Theories
Predictive (Situation-Relating) Theories
Prescriptive (Situation-Producing) Theories





Issues in Theory Development in Nursing
Borrowed Versus Unique Theory in Nursing
Nursing’s Metaparadigm



Relationships Among the Metaparadigm Concepts
Other Viewpoints on Nursing’s Metaparadigm


Caring as a Central Construct in the Discipline of Nursing
Summary
Key Points



Learning Activities

3. Concept Development: Clarifying Meaning of Terms
Evelyn M. Wills and Melanie McEwen


The Concept of “Concept”
Types of Concepts


Abstract Versus Concrete Concepts
Variable (Continuous) Versus Nonvariable (Discrete) Concepts
Theoretically Versus Operationally Defined Concepts



Sources of Concepts
Concept Analysis/Concept Development


Purposes of Concept Development
Context for Concept Development
Concept Development and Conceptual Frameworks
Concept Development and Research




Strategies for Concept Analysis and Concept Development
Walker and Avant


Concept Analysis
Concept Synthesis
Concept Derivation
Examples of Concept Analysis Using Walker and Avant’s Techniques




Rodgers
Schwartz-Barcott and Kim


Theoretical Phase

16

Fieldwork Phase
Analytical Phase


Meleis
Concept Exploration
Concept Clarification
Concept Analysis




Morse
Concept Delineation
Concept Comparison
Concept Clarification




Penrod and Hupcey
Comparison of Models for Concept Development


Summary
Key Points


Learning Activities

4. Theory Development: Structuring Conceptual Relationships in Nursing
Melanie McEwen


Overview of Theory Development
Categorizations of Theory


Categorization Based on Scope or Level of Abstraction
Philosophy, Worldview, or Metatheory
Grand Theories
Middle Range Theories
Practice Theories
Relationship Among Levels of Theory in Nursing






Categorization Based on Purpose
Descriptive Theories
Explanatory Theories
Predictive Theories
Prescriptive Theories





Categorization Based on Source or Discipline
Components of a Theory


Purpose
Concepts and Conceptual Definitions
Theoretical Statements



Existence Statements
Relational Statements


Structure and Linkages
Assumptions
Models



Theory Development
Relationship Among Theory, Research, and Practice


Relationship Between Theory and Research
Relationship Between Theory and Practice
Relationship Between Research and Practice



Approaches to Theory Development
Theory to Practice to Theory
Practice to Theory
Research to Theory
Theory to Research to Theory
Integrated Approach






Process of Theory Development

17

Concept Development: Creation of Conceptual Meaning
Statement Development: Formulation and Validation of Relational Statements
Theory Construction: Systematic Organization of the Linkages
Validating and Confirming Theoretical Relationships in Research
Validation and Application of Theory in Practice





Summary
Key Points


Learning Activities

5. Theory Analysis and Evaluation
Melanie McEwen


Definition and Purpose of Theory Evaluation
Theory Description
Theory Analysis
Theory Evaluation




Historical Overview of Theory Analysis and Evaluation
Characteristics of Significant Theories: Ellis
Theory Evaluation: Hardy
Theory Analysis and Theory Evaluation: Duffey and Muhlenkamp
Theory Evaluation: Barnum
Theory Analysis: Walker and Avant
Theory Analysis and Evaluation: Fawcett
Theory Description and Critique: Chinn and Kramer
Theory Description, Analysis, and Critique: Meleis
Analysis and Evaluation of Practice Theory, Middle Range Theory, and Nursing Models:
Whall
Theory Evaluation: Dudley-Brown












Comparisons of Methods
Synthesized Method of Theory Evaluation
Summary
Key Points




Learning Activities

Unit II: Nursing Theories

6. Overview of Grand Nursing Theories
Evelyn M. Wills


Categorization of Conceptual Frameworks and Grand Theories
Categorization Based on Scope
Categorization Based on Nursing Domains
Categorization Based on Paradigms




Parse’s Categorization
Newman’s Categorization
Fawcett’s Categorization



Specific Categories of Models and Theories for This Unit
Analysis Criteria for Grand Nursing Theories


Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships
Usefulness
Testability
Parsimony






18

Value in Extending Nursing Science
The Purpose of Critiquing Theories
Summary
Key Points




Learning Activities

7. Grand Nursing Theories Based on Human Needs
Evelyn M. Wills


Florence Nightingale: Nursing: What It Is and What It Is Not
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships
Usefulness
Testability
Parsimony
Value in Extending Nursing Science








Virginia Henderson: The Principles and Practice of Nursing
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships




Assumptions
Concepts


Usefulness
Testability
Parsimony
Value in Extending Nursing Science




Faye G. Abdellah: Patient-Centered Approaches to Nursing
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships




Assumptions
Usefulness
Testability
Parsimony
Value in Extending Nursing Science





Dorothea Orem: The Self-Care Deficit Nursing Theory
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships




Concepts
Relationships


Usefulness
Testability
Parsimony
Value in Extending Nursing Science




Dorothy Johnson: The Behavioral System Model
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships




Assumptions
Concepts
Relationships



Usefulness

19

Testability
Parsimony
Value in Extending Nursing Science



Betty Neuman: The Neuman Systems Model
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships




Concepts
Relationships


Usefulness
Testability
Parsimony
Value in Extending Nursing Science




Summary
Key Points


Learning Activities

8. Grand Nursing Theories Based on Interactive Process
Evelyn M. Wills


Barbara Artinian: The Intersystem Model
Background of the Theorist
Philosophic Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships




Assumptions
Concepts
Relationships



Usefulness
Testability
Parsimony
Value in Extending Nursing Science




Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain: Modeling and Role-
Modeling


Background of the Theorists
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships



Concepts
Relationships


Usefulness
Testability
Parsimony
Value in Extending Nursing Science




Imogene King: King’s Conceptual System and Theory of Goal Attainment and
Transactional Process


Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships



Assumptions
Concepts
Relationships



Usefulness
Testability
Parsimony
Value in Extending Nursing Science




20

Sister Callista Roy: The Roy Adaptation Model
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships




Concepts
Relationships


Usefulness
Testability
Parsimony
Value in Extending Nursing Science




Jean Watson: Human Caring Science, A Theory of Nursing
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships




Assumptions
Concepts
Relationships



Usefulness
Testability
Parsimony
Value in Extending Nursing Science




Summary
Key Points


Learning Activities

9. Grand Nursing Theories Based on Unitary Process
Evelyn M. Wills


Martha Rogers: The Science of Unitary and Irreducible Human Beings
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships




Concepts
Relationships


Usefulness
Testability
Parsimony
Value in Extending Nursing Science




Margaret Newman: Health as Expanding Consciousness
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships




Concepts
Relationships


Usefulness
Testability
Parsimony
Value in Extending Nursing Science




Rosemarie Parse: The Humanbecoming Paradigm
Background of the Theorist
Philosophical Underpinnings of the Theory
Major Assumptions, Concepts, and Relationships




Concepts
Relationships


21

Usefulness
Testability
Parsimony
Value in Extending Nursing Science




Summary
Key Points


Learning Activities

10. Introduction to Middle Range Nursing Theories
Melanie McEwen


Purposes of Middle Range Theory
Characteristics of Middle Range Theory
Concepts and Relationships …



testimonials icon
Students are requested to address the following question:A 9th April 2014 Straits Times report quoted an article from the Sin...
testimonials icon
CASE PRESENTATIONonAcute Gastroenteritis with Moderate Severe DehydrationGroup 5Somoray, Jude EdmundSosing, MelissaSumpingan, SIttie AinahTan, RuelTe...
testimonials icon
 Resources: "Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge"...
testimonials icon
DirectionsUsing the cited research from the textbook as a starting point, you  are to find a current (as recent as possible) related jour...
testimonials icon
( there are two outlines that have already been completed to aid you in writing this, Pleas see attached for outlines)The paper you are goin...
testimonials icon
 What involvement does management need to have to achieve buy-in from internal stakeholders?During any change with an organizati...
testimonials icon
When it comes to performance management and measurement “you get what you measure” or “you get what you set.” W...
testimonials icon
RUNNING HEAD: MODE1ModeName of AuthorInstitutional AffiliationDateMODEDefine ModeIn mathematics and statistics, mode can be defined as the most occur...
testimonials icon
Once done present a 900-word essay without counting the first and last page discussing the cultural health care beliefs of the study heritag...
testimonials icon
answer 4 econ conference discussion questions....
testimonials icon
Service Delivery Life Cycle (SDLC) Review the steps of the SDLC. Explain why quality service delivery depends on the e...

Other samples, services and questions:

Calculate Price

When you use PaperHelp, you save one valuable — TIME

You can spend it for more important things than paper writing.

Approx. price
$65
Order a paper. Study better. Sleep tight. Calculate Price!
Created with Sketch.
Calculate Price
Approx. price
$65