Nursing 525-Theoretical Foundations in Nursing Final Examination (25 percent of Course Grade)-Due Dec. 18 at 5 p.m.

Directions: Please note that you must answer all 16 questions to earn a possible 100 percent for a total of 25 percent of your course grade. Please write substantively, comprehensively, and succinctly. It is expected that your answers are well edited with correct spelling, grammar, and complete sentences. If you use references, please cite them such that I can validate the reference, based on the citation alone. 1. Which one of the following quotes best describes your conceptualization of theory? Why? (10 percent of exam).

"Theory is the name for the questions that arise when the answers we have about a topic no longer seem adequate to our understanding."-- Gerald Graff I identify with this quote the most when it comes to nursing theory. To me, the value of theory lies in its ability to explain and articulate complex phenomena with the goal of understanding the particular phenomena well enough to use it in order to improve practice. Theory can help elucidate vague concepts and articulate phenomena that we recognize, but have not fully conceptualized. Reality is infinitely complex and is more easily grasped by conceptualizing it within theory. Theory is how we understand and explain reality unless we have received view from a source or sources that we hold irrefutable (e.g., absolutism; fundamentalism) (Miller, 2008a). According to Meleis (2007), theory is a symbolic depiction of aspects of reality that are discovered or invented for describing, explaining, predicting, or prescribing responses, events, situations, conditions, or relationships (p. 37). Theory provides an organized framework from which to generate knowledge. It not only helps find answers to difficult questions, but it also helps us know which questions to ask next. For example, nursing has always claimed to care but what exactly is caring? Is it an action or is it a special way of being? Is caring unique to nursing? How can caring be recognized? Is it displayed by the nurses actions and words, or by the patients response? Theory can help start to answer some of these complex questions. Another quote I found that was consistent with my conceptualization of nursing research and theory is from Albert Einstein: The whole of science is nothing more than a refinement of everyday thinking. Theory helps humans make sense of the world. 2. Should nurses be tested for competency in theory and the application of nursing theory? Why or why not? (5 percent of exam).

Yes, nurses should be tested for competency in nursing theory and application of theory to practice. Nursing involves a great deal of critical thinking, and nurses must be able to demonstrate strong critical thinking skills. According to Meleis (2007), critical thinking is essential for theoretical thinking (p. 5). In order for nursing to be considered a true profession, as opposed to an occupation, it must be a primarily thinking role. Nursing is not merely about completing tasks, but should be focused on knowing the

reasons behind why the tasks are performed. Since nursing requires critical thinking, competency in theory will fulfill this requirement and help to inform nursing practice. Meleis also claims that theory provides nurses with the framework and the goals for assessment, diagnosis, and interventionTheory is a tool that renders practice more efficient and more effective and helps in identifying outcomes (p. 46). Therefore, nurses need to be competent in theory and use theory to improve and inform practice. If theory renders practice more effective and more efficient, it is beneficial for nurses to understand and use theory, as well as for employers to require and test nurses for competency. I do not believe that nurses should be tested on the content of specific theories or theorists. The focus should not be on memorization of selected theories. Rather, the emphasis of competency testing should be on the ability to understand and apply theory to guide practice. For instance, a test question should not ask What are the seven subsystems of Johnsons behavioral theory? In contrast, the question should present the seven subsystems and then ask the nurse to explain what the theory means to him or her personally and how it could be applied to improve practice outcomes. 3. Is theory essential for nursing to advance as a profession, and why? (5 percent of exam).

Yes, theory is essential for nursing to advance as a profession. Without theory, nursing would fail to qualify as a profession at all. Furthermore, theory helps to define, test, and build a unique body of knowledge that will allow the progress of the profession. According to Schlotfeldt (1989) one of the two criteria for a profession is that a profession must support a cadre of investigators whose role is to advance its knowledge continuously with a view toward improving its practices (p. 14). In order to be defined as a profession, a discipline must have a body of unique, continuously growing and evolving knowledge. Theory is also required in order to meet the definition of a profession as defined by Flexner. According to Flexner, a profession is basically intellectual (as opposed to physical), based on a body of knowledge that can be learned and is refreshed and refined through research, and is both practical and theoretical (Chitty, 2007, p. 70). In addition to theory being a requirement for the professionalization of nursing, it also helps the profession evolve and advance over time. As theory continues to refine and clarify nursing knowledge, that knowledge can be applied in practice to improve patient outcomes and further the advancement of the profession. 4. What is the most significant contribution nursing has made to the generation of knowledge in health care? (5 percent of exam).

I believe the most significant contribution nursing has made to knowledge in health care is the marriage of science and humanism. Nursing has been consistently defined as both an art and a science. The unique way of viewing a patient as a whole person is what nursing brings to the table. The acknowledgment of the fact that spiritual, emotional, cultural, relational, and psychosocial components of a person have profound effects on health and healing in addition to physiological and environmental factors has resulted in the nurses ability to improve outcomes for patients. For example, Florence

Nightingale and Martha Rogers were concerned with how the environment affects health; Madeline Leininger was concerned with caring from a culturally congruent perspective; Hildegard Peplau recognized the importance of interpersonal relationships in nursing; Dorothy Johnson, Sister Callista Roy, and Betty Neuman all viewed the nursing client as a behavioral system influenced by a variety of factors. What all of these theorists have in common is that they all contributed to knowledge in health care by considering the patient in the context of their humanity, and not simply in terms of physiology. This integration of science with humanism to understand people in the context of their humanity is the most significant contribution nursing has made to knowledge in health care. 5. Should nursing expend more resources for theory development or for theory testing? (5 percent of exam).

Yes. From an economic perspective, using resources for theory development and testing can be considered an investment or even a cost containing measure. This is because theory-based nursing practice produces better outcomes. According to Raudonis & Acton (1997), A theoretical perspective allows the nurse to plan and implement care purposefully and proactively. When nurses practice purposefully and systematically, they are more efficient, have better control over the outcomes of their care, and are better able to communicate with others (p. 138). Furthermore, theory serves as a framework from which nursing research can be conducted in order to advance knowledge and evidencebased practice. The more theory is tested and refined, the more useful it can be for education, practice, and research. From a political perspective, nursing must invest in theory development in order to protect, preserve, and promote the profession. As stated above in the response for question 3, the sustainability of a profession is grounded in the possession of unique knowledge, and knowledge produces autonomy. Therefore, using resources for theory development can be considered a prudent investment. 6. Why are the issues of validity, reliability, and relevance critical to theory development? (5 percent of exam).

Validity means that you are indeed measuring what you think you are measuring and what you intended to measure. Reliability means that the measurement is consistent and will produce the same results regardless of who is measuring or how many times the measurement is repeated. If data collection is unreliable, then it is automatically invalid. However, reliability does not ensure validity. If you are measuring the wrong thing, it does not matter if you get reliable or consistent results. A measurement must be both reliable and valid in order to be meaningful. Relevance is important because research should contribute to knowledge in a way that can be applied to practice. If one is going to spend significant time and resources investigating a certain topic, it is important that the topic is relevant. This means that the results of the research are understandable, the implications are cost effective, and fit into the structure of how nursing care is delivered. It may also mean that the results of the research can be applied to improve nursing care

and/or patient outcomes. If a topic is irrelevant, it is probably not worth investigating, and will not make a significant contribution to nursing theory and research. For example, if research is done to support the claim that nursing presence is imperative to nursing practice, but also claims that it is not possible to teach presence, then the research is not particularly relevant. If something cannot be taught, or cannot be measured, then it has less relevance than something that can be taught and used to improve or inform practice. 7. How does the lack of/or recognition of nursing theory define nursings place in health care? (5 percent of exam).

The lack of theory and lack of recognition of theory in nursing is detrimental to the professions place in health care. If nursing theory is not appreciated and recognized both by nurses and those outside of nursing, the progress of the profession will be hindered. A lack of theory recognition defines nursing as passive rather than active. According to Meleis (2007), theory development is an active process, but early research characterized nurses as passive (p. 56). If nurses are not continuously engaged and active in building and applying a body of knowledge, the profession will not be respected in health care. A lack of theory recognition also defines nursing as a functional occupation as opposed to a thinking discipline. According to Meleis, the functional orientation of nursing is the act of performing procedures rather than thinking, reflecting, and solving problems (p. 56). Anyone can be trained to perform procedures and tasks, but nurses bring something unique to the table. A lack of theory and theory recognition defines nursing as having nothing original or unique to offer. It defines nursing as a dependent occupation instead of an independent profession. This devalues nursing as a profession and threatens the professions place within the health care system. Meleis quotes Fuller by acknowledging that the autonomy of a profession rests firmly on the uniqueness of its knowledgeknowledge often results in the ascription of power and is accompanied by autonomy (p. 47). If nursing fails to articulate the unique and indispensable value it brings to health care, then the profession will be dependent on the system, instead of enjoying autonomy grounded in the intrinsic value of unique knowledge. Dependency is dangerous for the sustainability of a profession, especially in the context of economic hardship. If nurses do not prove that they have a unique and valuable service to offer, they are more susceptible to losing status in the health care system. Theory helps to define and articulate the knowledge that nursing brings to the table and will help to protect and preserve nursings place in health care. 8. Identify a research method that is primarily inductive and a research method that is primarily deductive and one that is both inductive and deductive (5 percent of exam).

Deductive research works from the general to the specific and is informally referred to as a top down approach (Trochim, 2006). A quantitative experimental design primarily uses deductive reasoning to arrive at a testable hypothesis (Miller, 2008c). An example of a research method that was primarily deductive or quantitative is Colling, Owen, McCreedy and Newman (2003). The researchers used Johnsons seven subsystems behavioral model as a framework to test pattern urge-response toileting (PURT) in older incontinent adults. The hypothesis was that PURT would reduce incontinent episodes and contribute to restored 4

balance in the eliminative behavioral subsystem, which would therefore produce balance and enhance well-being. The experiment had an experimental group and a control group and tested the variable of urinary incontinence frequency and volume. The results of the study found that 75% of the experimental subjects improved continence to some degree over the 6-week study period (Colling et al., 2003, p. 122). This is an example in which a deductive research method took a theory and applied it to a hypothesis in order to confirm the theory and apply it to a practice situation. Inductive research works from the specific to the general, and is sometimes referred to as bottom up (Trochim, 2006). Qualitative research uses primarily inductive reasoning to propose a research statement (Miller, 2008c). Induction starts with an observation or observations, and research is conducted to generalize the observations and induce a theory. For example, Kristen M. Swanson used inductive research when she empirically derived her theory of caring by observing the phenomenon of caring in the context of perinatal loss (Swanson, 1991). She studied caring in the contexts of perinatal loss, the neonatal intensive care unit, and with pregnant women. Swanson then generalized her findings to induce her phenomenological theory of caring. Her approach was inductive because the data led to the theory, whereas in a deductive approach, the theory leads to the data. Most research draws on both quantitative and qualitative data and uses deductive and inductive approaches. Often times, research is circular. It starts from the top, progresses to the bottom and then back up to the top. A hypothesis is tested, data is produced, then further testing is conducted on the data to refine the original theory through induction. 9. What is nursing theory-science from the perspective of Meleis (10 percent of exam).

According to Meleis, science is a unified body of knowledge about phenomena that is supported by agreed-on evidence (p. 36). Science includes the questions of a particular discipline and the answers to those questions. Theory is organized, coherent, and systematic articulation of a set of statements related to significant questions in a discipline that are communicated in a meaningful whole (p. 37). Theories are a symbolic representation of reality that is useful for organizing knowledge. Meleis states that theory is for describing, explaining, predicting, or prescribing responses, events, situations, conditions, or relationships (p. 37) The concepts that are developed in nursing theory relate to each other to form theoretical statements. Meleis claims theory can be invented or discovered, depending on the method of investigation. According to my understanding, science is the body of knowledge, and theory helps to create, develop, and refine that knowledge. This differs from my original perception of science, which was that science was a method or a process of gaining knowledge, not the knowledge itself. Nursing theory-science is simply the theories and corresponding knowledge that pertains to nursing concepts or phenomena, such as caring, wholeness, comfort, motivation, family care, etc. Theory is the way in which the questions that guide or make up a science are framed and theory guides research in order to refine those questions. Meleis also claims that nursing theories serve as reservoirs to hold findings related to nursing

concepts, and for answers to questions about specific phenomena. The notion of theory as reservoirs are useful for organizing knowledge and answers to phenomenological questions. 10. Where does theory fit in writing a thesis or a dissertation? (5 percent of exam)

Meleis identifies one definition of theory (Ellis, 1968) that claims the purpose of theory is to guide research (p. 39). This is the definition that supports the following process: First, you begin with a question. Research must be done on a question that the researcher is interested in. The research design will depend on the purpose of the researchliterature review, to learn what other researchers have already established in your area of interest. A literature review will help form the research proposal, and should include an overview of the current theorists and theories/models/frameworks that are relevant to the topic. After a literature review, you may discover that you need to rephrase your question, or you may even decide that you need to ask a different question altogether. Once you have an idea of the appropriate question, which is called the core question, outline the idea in an essay called a research proposal. If no research has been done on your topic whatsoever, then your dissertation will be exploratory. You may choose to design a qualitative study which collects data. The goal of this type of study is to obtain data that will form a tentative hypothesis, which may lead to development of a theory. This would be an inductive approach. However, if your topic or area of interest has a body of literature, there is likely to be a theory or theories about the topic. If theory pertaining to your topic already exists, then you will test a hypothesis that is based on the theory. The hypothesis should be based on current theory, knowledge, and understanding related to the topic (Miller, 2008c). If you are using the scientific (or qualitative) method, you will want to compare two variables and control for other variables in the experiment. If the hypothesis is confirmed through your research, then that part of the theory is validated. This is called the deductive approach, because the direction is top down, starting with a theory, and generating data from a hypothesis that is based on the theory. Qualitative research could still be done, even if there is existing theory pertaining to your topic. For example, if you explore the application of a theory in a new context, this may be a qualitative design (Miller, 2008c). Through this continuous process of theory formation, hypothesis formation, data collection, and theory modification, nursing knowledge is developed. 11. What is the scientific method and what are its strengths and limitations in terms of the development of theory? (5 percent of exam)

The scientific method is associated with the empiricist worldview or paradigm. This method focuses on true experimental design, control, objectivity, precise measurement, quantification of data, and statistical description of results (Monti & Tingen, 1999). The ontological assumption of empiricism is that there is one reality, which is out there somewhere, which can be validated through the senses (Monti & Tingen, 1999, p. 31). One strength of the scientific method is that the results of an experiment can be statistically analyzed so that the results are relatively hard and irrefutable. Another advantage is control. Since the experiment typically works with numerical data, variables are easy to manipulate. The scientific method produces results that are easy to generalize and duplicate in other settings. Control allows the variable of interest to be examined without influence by

other extraneous factors. The advantage of control in terms of theory development is that it can isolate particular parts of a theory or particular relationships between concepts in a theory and validate those relationships. This leads to validation, confirmation, and refinement of theory through the testing of hypotheses. As stated by Monti & Tingen (1999), Establishment of valid relationships enables theories to be used to explain, predict, and prescribe notions that are essential and relevant for clinical practice (p. 32). The limitations of using the scientific method for development of nursing theory lie in its incompatibility with many of the beliefs and assumptions that nurses have embraced. For example, empiricism views humans as closed systems, the sum of their parts, and treats them like machines that respond to manipulation of their environments. This view is rather dehumanizing, and is inconsistent with the holistic view of nursing that humans are greater than the sum of their parts. The scientific method tends to break concepts or phenomena down into parts for the purpose of analysiswhile some phenomena observed in nursing are all or nothing and cannot be broken down into parts without losing some aspect of their value. Another limitation of the scientific method is that it does not recognize alternative ways of knowing, such as practice knowledge, intuition, and the value of knowing through being embedded in a subjective experience of reality. This is an important limitation, because it ignores and devalues significant aspects of nursing knowledge. One of the advantages of the scientific method is control. However, it can be difficult to control variables when using humans for research, like many nursing research studies do. Excessive control produces an artificial situation that bears no resemblance to reality and thus decreases generalizability (Monti & Tingen, 1999, p. 32). If an empiricist approach produces results that do not necessarily apply to reality, then it is less useful in practice. The value of nursing theory lies in its application to practice and its ability to structure nursing care to improve outcomes for patients. 12. There are several major camps in family theory. Which of these camps do you believe to be most beneficial to your future role as a nurse in advance practice and why? Be sure to address the underpinnings of the model you choose and explicate how you would use the model in practice (10 percent of exam).

I hope to develop my advanced practice role within emergency nursing. In the fastpaced environment of the emergency department, I do not see myself being able to conduct family interviews or comprehensive family assessments. In the ED there is often not time for even a ten minute interview. Furthermore, a time of crisis may not be the proper time to assess the family comprehensively. However, I can still pick up cues from the family about their family dynamics and assess them to determine the best approach when working with them. It is crucial to apply family nursing theory to my area of practice by the way in which I view the family. Therefore, camp that I identify most with the see as most beneficial for my future role is systems theory as applied to the family. Systems theory acknowledges that the family is greater than the sum of its individual members. It also takes into account environmental effects on the family and the way the family can influence the environment. The most useful underlying assumption of systems theory for me is that a change in one family member affects all family members. This is important, since I may be encountering the family in the acute stage of change, during a family crisis. Recognizing this fact helps me

in dealing compassionately with family member that may not be acting at their best. It is important that no matter where I practice, I view the family as a system in a holistic manner. For example, I realize that simple interventions, like asking a patient if they have a family member that they would like to call or calling the family and giving them updates on their loved one is beneficial to the family as a whole. One issue that I am interested in exploring for my future advanced practice role in emergency nursing is the issue of family presence during resuscitation in the ED. Research has consistently shown that both the patient and the family benefits from allowing the family to be present during resuscitation (Moreland, 2005). In spite of the evidence, there is still much controversy over this sensitive issue. Currently, the organization that I work for has a fairly paternalistic medical model in which the family usually waits in the family room while the emergency team is resuscitating their loved one. When the team is finished with resuscitation, the patient is cleaned up, and presented to the family. Sometimes, often if the patient is a child, the family is allowed in the room if they request to be there. This is an issue that really bothers me. In my opinion, you cannot separate the family with physical boundaries during a crisis of this magnitude, because they are in theory a holistic system. Separating them physically only adds to the distress of the family. The family member who is the patient in distress is not an individual, but part of a whole. Each family member affects the environment, which affects the family member, which affects the environment and so on. For example, codes have been shown to run more smoothly (less chaos, less arguing, more cooperation) when family members are present. Clearly the familys presence affects the nature of the care given to the patient by the emergency team. Perhaps this is because having the family present helps the team view the patient as a unique individual with unique circumstances, as opposed to a generic cardiac arrest, or whatever the code may be. It may not be appropriate for every family to be present during every code. For example, if the family members are out of control, or compromising the emergency teams effort to save the victim, then the family should not be in the room. However, nurses can take the lead in assessing whether or not it would be beneficial for the family if the entire family was present during resuscitation. I am currently looking at the clinical nurse leader (CNL) role and would like to apply it to emergency nursing. As an emergency department CNL, I will work to change the attitude and the policies in the emergency department in order to improve holistic, family-centered care. One of the central premises of family systems theory is that family systems organize themselves to carry out the daily challenges and tasks of life, as well as adjusting to the developmental needs of its members. Critical to this premise is the concept of holism. In this context, 13. What is holism and why is it critical to family theory (5 percent of exam)?

One of the theoretical foundations of the Calgary Family Assessment Model is systems theory (Wright & Leahey, 2005). The concept of holism is related to systems theory and acknowledges that the whole is greater than the sum of its parts. When applied to the family, it asserts that the family as a whole is more than the sum of each individual member. Holism implies that individuals are better understood within the context of their larger family system. To study individual family members separately does not equate to studying

the family as a unit (Wright & Leahey, 2005, p. 34). Each family member affects the other members as well as the family system as a whole. A common analogy related to holism is baking. The cake that comes out of the oven is more than the individual ingredients that went into it. Similarly, the family is more than the individual members that compose the family unit. It is the way in which the members come together that defines the family. An example of how holism can be applied to a family assessment is if a child were having trouble with potty training. A non-holistic, individualized approach would be to assess the child for developmental delays, cognitive reasons that may hinder potty training, or physiological reasons why the child was having difficulty potty training. A holistic approach would look at the child in the context of the family and the way the family was interacting. Perhaps the mother just had another baby, and the child is having a hard time adjusting to the new addition to the family, which can lead to delays or regression in development. A new baby adds a new component to the system and can affect all of the individual members and their interactions. Perhaps the parental approach to potty training is not effective for the childs learning style. Perhaps the parents do not have adequate time to spend on potty training at this point in their lives due to other factors. All of these assessments are helpful when viewing the family as a whole, rather than assessing individual members. 14. How do families draw boundaries and what do these boundaries do for the family (5 percent of exam)?

According to the Calgary Family Assessment Model, boundaries are a subcategory of the internal structural component of a family assessment (Wright & Leahey, 2005, p. 58). The function of boundaries is to protect the differentiation of the system of subsystem (p. 67). Boundaries are often drawn by the parents. For example, a parent may tell the eldest daughter that she is not allowed to grant her brother permission to extend his curfew, because this is a parental function. Sometimes boundaries can be drawn by a child. For instance, an adolescent may decide that she no longer likes to be kissed by her parents and wants them to stay out of her room. These are physical boundaries that represent her need to differentiate into her own autonomous self. Depending on whether the boundaries are diffuse, rigid, or permeable, the differentiation of the family system can increase or decrease. If the boundaries are diffuse, the family is less differentiated. If the family is extremely close-knit with diffuse boundaries, they are more intertwined and have less individual autonomy. If the boundaries are rigid, the subsystems become highly differentiated and are at risk for disengagement. For example, a father who is very cold and not affectionate with his family will be differentiated from the family and they will not be closely connected. According to Wright and Leahey, clear permeable boundaries allow appropriate flexibility because there are rules, but the rules can be modified to fit the familys needs. Boundaries are also drawn during the addition or loss of a family member, during times of separation and divorce, and when one member is gone for extended periods of time. During these times, boundaries can be ambiguous while the system is reorganizing (p. 68). Boundaries are also drawn by families to differentiate themselves from other family systems. These boundaries could be between other families in the neighborhood, or other

families within the larger extended family. Boundaries can help the family establish its unique identity, but too rigid boundaries can isolate families from other people. 15. True or false and why (5 percent of exam)? Clinicians understand that to effectively work with families it is imperative to consider the systemic impact of any intervention.

It is true that clinicians must consider the systemic impact of family interventions. However, Im not sure if it is true that clinicians do in fact understand this concept. In family nursing, interrelations are emphasized more than components, and system-wide ripples (many causes for many changes) are emphasized more than linearity (this causes that) (Miller, 2008b). This is an advantage of family-centered nursing, because one intervention can have multiplied positive effects. However, it is important that the proposed change is compatible with the familys strengths and methods of functioning, because one poorly designed intervention could potentially have negative systemic effects. The Calgary Family Intervention Model (CFIM) proposed by Wright & Leahey (2005) is a strengths-based resiliency-oriented model. According to the CFIM, a clinician should make sure the intervention is compatible with the current positive functioning of the family system. According to Wright and Leahey, A nurse can change the family system by implementing family interventions. That is, if one family member changes, other family members cannot respond as they previously did because the individual family member now behaves differently. (p. 35). Therefore, if the nurses goal is to change the family system, it is important to consider the systemic impact of the change and ensure that this would be the optimal change for positive family functioning. There is virtually no intervention that will have isolated effects on one family member. Any change made through family intervention is bound to have systemic affects on the family. 16. Discuss your development and knowledge in relation to two of the following course objectives (10 percent of exam):

1. Establish criteria for the analysis and evaluation of nursing models/theories. Going through a formal evaluation process on a particular theory really helped me achieve this course objective. Studying a theory in depth on my own and in a group was helpful in determining how to evaluate and analyze a theory. I initially related to Swansons theory of caring because it was relevant and understandable. These are the main characteristics that first drew me to her theory. Swansons theory also did an excellent job of describing a familiar phenomenon (caring) that is difficult to articulate. Reading Swansons work was fun because it identified the essence of what nurses do in a simple yet profound way. After analyzing why it was that I liked Swansons theory so much, I realized which criteria I was using to evaluate the theory. I then looked at the criteria I had come up with and compared them to the criteria presented in class and in the text. Meleis gives several criteria in her chapter evaluation of theories. The criteria that I identify with most are whether or not the theory is relevant and applicable to practice, its internal structure and validity, and whether or not it can be taught. Swansons theory held up very well under these criteria. Completing the theory analysis and critique with a group was helpful because every group member brought in fresh perspective, and I

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think we were rewarded with a richer understanding of the theory, its strengths and weaknesses. Now that Ive completed an analysis and evaluation of one theory in depth, and several other theories in less depth, I feel much more equipped to evaluate new theories as I encounter them in the future, and use them for my future advanced practice. 2. Identify the role of theory in nursing research. At the beginning of this class, I had very little understanding of the way theory and nursing research are related. I knew nursing research was useful for practice, and I had had much experience with finding and analyzing nursing research. However, I was having a hard time making the connection between theory and its usefulness in practice. The presentation by Lori Loan really helped me to make some of those crucial connections between theory and research. The most useful thing I learned from Lori was how to use theory as a framework to build and organize research. Research questions can be extremely complex, and it is hard to know how to organize all of the variables involved. I learned in this class that theory provides a mold into which one can fit data. In this way, theory guides research, and research guides practice. Since some theories predict, you can test a hypothesis with more certainty that it will be confirmed and therefore waste less time and resources on research. Another important thing I learned from Lori is that you dont have to reinvent the wheel when it comes to research. Science is continually building a body of knowledge, and you can use work that someone else has already done, to make sense of your own research questions or to clarify which questions you should be asking. Another activity that helped me achieve this course objective was reading the articles that have either inductively established nursing theories or deductively confirmed existing theory. This helped me to understand how theory relates to nursing research and how theory and its concepts are always being generated, tested, and refined for use in practice. TWM/Fall2008

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References Chitty, K. K. (2007). The professionalization of nursing. In Chitty, K. K. & Black, B. P. (5th Ed.), Professional nursing: Concepts & challenges (pp. 69-85). St. Louis: Saunders Elsevier. Colling, J., Owen, T. R., McCreedy, M. & Newman, D. (2003). The effects of a continence program on frail community-dwelling elderly persons. Urologic Nursing, 23 (2), 117-131. Miller, T. W. (2008a). An introduction to theory and Meleis chapter 3. [PowerPoint slides]. Retrieved September 12, 2008 from https://sakai.plu.edu/portal/site/NURS525_01_20790_FALL2008/page/18bdb0a283cb-4f72-9b86-fad6af103807 Miller, T. W. (2008b). Family nursing theory. [PowerPoint slides]. Retrieved November 22, 2008 from https://sakai.plu.edu/portal/site/NURS525_01_20790_FALL2008/page/18bdb0a283cb-4f72-9b86-fad6af103807. Miller, T. W. (2008c). Theory of research. [PowerPoint slides]. Retrieved October 31, 2008 from https://sakai.plu.edu/portal/site/NURS525_01_20790_FALL2008/page/18bdb0a283cb-4f72-9b86-fad6af103807 Meleis, A. I. (2007). Theoretical Nursing: Development & Progress, (4th Ed)., Philadelphia: Lippincott Williams & Wilkins. Monti, E. J. & Tingen, M. S. (1999). Multiple paradigms of nursing science. In Cody, W. K. (4th ed.). Philosophical and theoretical perspectives (pp. 27-41). Massachusetts: Jones & Bartlett. Moreland, P. (2005). Family presence during invasive procedures and resuscitation in the emergency department: a review of the literature. Journal of Emergency Nursing, 31 (1), 58-72. Raudonis, B. M. & Acton, G. J. (1997). Theory-based nursing practice. Journal of Advanced Nursing, 26, 138-145. Schlotfeldt, R. M. (1989). Structuring nursing knowledge: A priority for creating nursings future. In Cody, W. K. (4th Ed.), Philosophical and theoretical perspectives (pp. 13-17). Massachusetts: Jones & Bartlett. Swanson, K.M. (1991). Empirical development of a middle range theory of caring. Nursing Research, 40(3), 161-166. Trochim, W. M. K. (2006). Deduction and induction: Deductive and inductive thinking. Retrieved December 13, 2008 from http://www.socialresearchmethods.net/kb/dedind.php Wright, L. M. & Leahey, M. ( 2005) Nurses and Families: A Guide to Family Assessment and Intervention, (4th Ed). Philadelphia: FA Davis.

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