Progress in theory building for advancing nursing science.

By Beard, Margaret T.

Nursing exists to meet societal needs, especially the need for primary health care. After five years of
publishing the Journal of Theory Construction and Testing, what has been the outcome in terms of
nursing science? A broad approach to theory building is assumed with involvement from historical,
sociocultural, economical and political influences. Theory building is an ever evolving process. However
minute, some progress has been made toward theory building in advancing nursing science. The evolving
knowledge constitutes the work of many scholars. The beginning theories are middle range and some may
be situation specific, but they are applicable to other nursing situations and disease processes.

Hypotheses have been tested. The virtues of hypotheses are the deep and highly important purpose of the
individual out of self (Kerlinger, 1973). Appropriate formulation and use enable humans to test aspects of
reality with minimum distortion by individual predictions. Hypotheses are part of the methodology of
science associated with the criterion of objectivity. These potent sources of objectivity bridge the gap
between one's belief and empirical reality. Thus, they are powerful tools for the advancement of
knowledge. Although formulated by humans, hypotheses can be tested and correctness or incorrectness
indicated apart from human values and beliefs. An important virtue of hypotheses is that they can be
deduced from theory. An example of a contribution to scientific advancement is an article on
"Observations on the usefulness of null hypothesis testing" (Marshall, 1999)

There have been writings about theory construction. An example is "The impact of the electronic domain
on theory construction" in which the author gives the characteristics of theory construction information in
the electronic domain (Cesario, 1997). Another example and one that has been requested and utilized by
doctoral nursing students is "Kuhn and Reigel: The Nature of Scientific Revolutions and Theory
Construction in Nursing". The author discusses the impact of Kuhn's writings, normal science, paradigms
and scientific revolutions. Of particular interest are the section on Kuhn's process of theory construction
and the section on philosophy of science and nursing (Antognnoli-Toland, 1999). This is a contribution to
nursing science.

Another achievement in terms of developing nursing science is the testing of a formula (theorem) from
theory construction using Gibbs' paradigm. Concepts are uncertainity and spirituality in the population of
women with HIV/AIDS (Gray & Beard, 1999). A theory of a phenomenon constructed using this
paradigm has a variety of testing options as horizontal and vertical links can be tested, theorems and
hypotheses can be tested, and the theory can be tested using the referentials (Gibbs, 1972). Also in this
article (Gray & Beard, 1999) Stinchcmbe's method of constructing social theories using a functional
explanation framework indicated support for the spiritual perspective in dealing with uncertainties of HIV
infection.

Scientific knowledge is basically a system of description, explanation, and prediction. The desirable
characteristics of scientific knowledge are abstractness (independence of time and space),
intersubjectivity (agreement about meaning), and empirical relevance (can be compared to empirical
findings) (Reynolds, 1976). As regards abstractness, scientific knowledge should make predictions about
the future. Explanations in science should not apply to a historical location. Scientific statements are
unlimited by temporal or spatial constraints. The development of models contribute to theory building and
advances in science. Among models developed are: asthma quality of life model, occupational stress
model, perception of need for nursing homes in community settings model, and Hendricks perceptual
health promotion determinants model. A model of job stress, burnout, spiritual well being and hardiness
have received requests for replication. Replication builds scientific knowledge.
There are two ongoing longitudinal large scale predictive studies, one with 4,520 women and the other
with 5,201 adolescents. The first study tested a model of breast cancer prediction (Drake & Beard, 1998);
the second tested a predictive model of adolescent loneliness (Antognoli-Toland, 2000). These are
scientific contributions as a purpose of science is prediction.

Scientific statements must not be tied to historical time. Explanations in science should not apply to a
historical location. Prediction and forecasting are methods of science. A predictive design of a middle-
range theory of family health using King's systems framework was tested with 85 families of young
adults with serious and persistent mental illness. The theory of family health was developed using a
deductive approach (Doornbos, 2000).

There are developing theories of phenomena. Among these are adolescent loneliness, patient satisfaction,
adolescents coping with maternal breast cancer, and support during adolescent pregnancy:

These are but a few examples of contributions to nursing science. There are others in terms of model
specification and testing, beginning theories of phenomena, and constructs developed as extensions of
theory.

I plan to continue to attract high quality manuscripts, provide through reviews and developmental
feedback to authors and ultimately select and help to develop the best manuscripts so that they can make
strong contributions to nursing, health and health care. Because of its' current reputation for high quality
and its' stature in the field, major improvements will be difficult. However as theoretical knowledge and
practice grows, as more middle-range theory is developed, as more situation-specific theory evolves from
practice, as technological advances enhance and facilitate levels of theory, and as new skills are learned,
the theory building and testing generated and reported will also improve.