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Theory: who needs it? What is it? (Meleis, 1997), Chapter 2

Theory: is the goal of all scientific work; theorizing is a central process in all scientific
endeavors; and theoretical thinking is essential to all professional undertakings. Critical
thinking is essential for theoretical thinking (Meleis, 1997).
Meleis (1997) has a feminist perspective and the tradition of symbolic interactionism
(Mead, 1934).

Philosophy: is a distinct discipline that is concerned with the values and beliefs of a
discipline and with the values and beliefs held by the members of the discipline. An
individual’s values and beliefs may or may not be congruent with those of the discipline.
The philosophy provides the framework for asking both ontological and epistemological
questions about central values, assumptions, concepts, propositions, and actions of the
discipline. It also provides the assumptions inherent in its theoretical structure (Meleis,
1997).

The philosophy of a science: deals with the values that govern the scientific
development and the justification of the discipline. It helps in defining or questioning
priorities and goals.

Science: is a unified body of knowledge about phenomena that is supported by agreed on

evidence. Science includes disciplinary questions and provides answers to questions that
are central to the discipline (Meleis, 1997).

Paradigm: defined as those aspects of a discipline that are shared by its scientific
community (Meleis, 1997, based off of Kuhn’s definition).

Kuhn proposed to replace it with Disciplinary Matrix: Includes the shared

commitments of the community of scholars, the shared symbolic generalizations, and the
exemplars, which are the shared problems and solutions in the discipline (Meleis, 1997).

Domain: Perspective and the territory of the discipline. It contains subject matter of a
discipline, the main agreed-on values and beliefs, the central concepts, the phenomenon
of interest, its central problems, and the methods used to provide some answers in the
discipline (Meleis, 1997).

Phenomenon: Aspect of reality that can be consciously sensed or experienced.

Phenomena within a discipline are the aspects that reflect the domain or the territory of
the discipline (Meleis, 1997).
A phenomenon is the term, description, or label given to describe an idea about an event,
situation, a process, a group of events, or a group of situation from an evidence that is
sense base (Meleis, 1997).

Assumptions: Statements that describe concepts or connect two concepts that are factual,
accepted as truths, and represent values, beliefs, or goals (Meleis, 1997). Are taken for
granted statements of the theory, the concept, or the research that preceded.

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Concept: Term used to describe a phenomenon or a group of phenomena. A concept

denotes some degree of classification or categorization. It provides us with a concise
summary of thoughts related to a phenomenon. It is a concise labeling to describe a
phenomenon (Meleis, 1997).

Theory: Organized, coherent, and systematic articulation of a set of statements, related to

significant questions in a discipline that are communicated in a meaningful whole. It 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 (Meleis, 1997).

Nursing Theory: Definition has been problematic and numerous different definitions in
the literature (Meleis, 1997).

Nursing theory: is a conceptualization of some aspect of reality (invented or discovered)

that pertains to nursing. The conceptualization is articulated for the purpose of describing,
explaining, predicting, or prescribing nursing care (Meleis, 1997).

Types of theories

Level of abstraction: (grand, mid-range, and situation specific theoris)

Grand theories: Systematic constructions of the nature of nursing, the mission of

nursing, and the goals of nursing care (Meleis, 1997).

Mid-range theories: Theories that have more limited scope, less abstraction, address
specific phenomena or concepts, and reflect practice (administrative, clinical, or
teaching) (Meleis, 1997).

Situation-Specific Theories: Theories that focus on specific nursing phenomena that

reflect clinical practice and that are limited to specific populations or to a particular field
of practice. The scope and questions driven by them are limited (Meleis, 1997).

Goal Orientation: descriptive or prescriptive

Descriptive Theories

One that describes a phenomenon, an event, a situation, or a relationship; identify

its properties and its components; and identify some of the circumstances under which it
occurs. Describe relationships between phenomena, describe nurses’ and patients’
relationships, and describe guidelines for interventions (Meleis, 1997).
- Descriptive theories are complete theories and have the potential for guiding research.
- Their contribution to knowledge is to help sort out observations and meanings regarding
the phenomenon.
- They are not action oriented and do not produce a situation.

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Two Types: Factor-Isolating, category formulating, or labeling theory, and

explanatory theory:
Factor- Isolating: Describes the properties and dimensions of phenomena.
Explanatory Theory: Describes and explains the nature of relationships of certain
phenomena to other phenomena.

Prescriptive Theories

Those addressing nursing therapeutics and the consequences of interventions.

Includes propositions that call for change and predict the consequences of a certain
strategy of nursing intervention (Meleis, 1997).
It should designate the prescription and its components, the type of client to
receive the prescription, the conditions under which the prescription should occur, and
the consequences.

Theory, research, and Practice

Theory and theoretical thinking is not limited to theoreticians in the discipline. It is

integral to researcher, clinician, consultant, and administrator.

Theoretical thinking could be demonstrated in all aspects of the research process:

1. It is demonstrated in identifying the phenomenon within the domain of nursing, in

differentiating between relevant and irrelevant phenomenon, and in deciding how the
research questions are related to the theoretical domain of nursing and to the focus of
nursing practice. Theoretical thinking helps to raise questions. When thee questions are
asked, discussed and answered, a process of theoretical thinking has already occurred.

2. After defining a phenomenon, theoretical thinking continues to guide the process of

research. The researcher seeks theories that can help in describing the phenomenon or its
relationship to other phenomena, or that can prescribe a nursing action for it.

3. After evaluation, a hunch may evolve and propositions may be developed to guide
research process or test the theory.

4. after testing a theory or propositions of a theory, the researcher may complete the task
by simply describing the findings on relationship to the original theory, perhaps choosing
too refine, extend, or modify the original theory.

The professional clinicians goes through a similar process in deciding:

1. What to assess in her clients, the timing of assessment, how she defines the needed
actions, and what interventions are the best for the situation.
2. She develops hunches, pursues some, and refutes others.
3. She develops priorities; she modifies them, and records them in the process.

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4. She makes some “automatic” decisions and others that require careful consideration
and deliberation.
Some of these decisions are based on theory; others could be the impetus for theoretical
development.

Uses of theory

Theory and Research

1. Nursing theories stimulate nurse scientists to explore significant problems in the

field of nursing, in doing so the potential for the development of nursing knowledge
increases.

2. The theory sets limits on what questions to ask and what methods to use to pursue
answers to the questions.

3. Nursing theories have provided nurses researchers with many new propositions for
nursing research.

4. The objective of theory is to formulate a minimum set of generalizations that allow

one to explain a maximum number of observable relationships among the variables in
a given field of inquiry (Meleis, 1997).

5. The relationship is cyclical in nature, the results of research can be then used to
verify, modify, disprove, or support a theoretical proposition.

6. Nursing research has been driven in the past by educational, sociological, and
psychological theories and less by nursing theories.

Theory and Practice

1. The primary uses of theory are to provide insights about nursing practice situations
to guide research (Meleis, 1997). Through interaction with practice, theory is shaped
and guidelines for practice evolve. Research validates and modifies theory. Theory
then guides practice. Until empirical validation, modification, ad support are
completed, theory can be given support through clinical utilization and validation and
can therefore be allowed to give direction to practice.

2. Theory provides the nurse with the goals for assessment, diagnosis, and
intervention. A nurse focus on those aspects of care that are related to a theory in
practice for more effective assessment of a health care client. Diagnosis is related to
those areas in which the nurse plans an intervention.

3. Theory is a tool that renders practice more efficient and more effective. Just by
being goal directed, our energies in assessing extraneous areas are minimized. The

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nurse conserves her own energy, time, and talent for the areas and phenomena for
which she is well prepared.

4. Language of theory provides us with common grounds and communication and

with labels and definitions for phenomena. Well defined with conceptual and
construct validity enhance the cyclical communication among practitioners, theorists,
clinicians, and educators.

5. Professional autonomy and accountability are enhanced by theory use in practice.

Articulation of actions, goals, and consequences of actions enhances nurses
accountability. Defining focus and the means to achieving that focus and being able
to predict consequences increase our control of our practice and therefore increase our
autonomy.

Milestones in theory development

Prior to 1955: from Florence Nightingale to nursing research

1. The significant milestones which influenced the development of all nursing science,
was the establishment of the journal, nursing research, with the goal of reporting
scientific investigations for nursing by nurses and other: The establishment of this journal
confirmed that nursing is indeed a scientific discipline and that its progress will depend
on whether or not nurses purse the truth through research. The publications of this journal
also provided the framework for a questioning attitude that may have set the stage for
inquires into theoretical nursing.

2. Although Nightingale may have provided the beginning impetus for research and
theory, her impact was most keenly felt in nursing education. Education of nurses had
predominantly occurred in diploma programs.

1955–1960 - The birth of nursing theory: The Colombia University Teachers college
approach.

1. It was not until Mid-1950s that nurse began to articulate a theoretical view of nursing.
Questions about the nature of nursing, its mission and goal, and about nurse roles drove
nurses educators to capture the answer to these questions and present them in a more
coherent whole.

2. The interest in changes in educational preparations of nurses from diploma to

baccalaureate programs. Colombia University offered graduate programs that focused on
education and administration to prepare graduates as expert educators and administrators.
Most theorists were educated at the teachers college (such as Peplau, Henderson,
Abdellah, and Rogers). Therefore, it may have been other experiences and programs that
indirectly influence these scholars in their theoretical pursuits.

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3. Examples: Peplau (1952) produced the first articulated concept of nursing as an

interpersonal relationship. Henderson developed the seeds of nursing theory about the
principles ad practice of nursing. Abdellah’s conceptualization f nursing care by focusing
on patient rather than on techniques.

3. The request from the International Council of Nursing (ICN) to define nursing and its
mission led the subsequent ICN statement in 1958 that appeared in publication with wide
distribution and what was adapted internationally (Henderson, 1966). The message given
by Peplau and Henderson was that nursing has a specific and unique mission and that this
mission and that this mission has some order and organization that can be communicated.
These articulated whole represented the beginnings of theories in nursing.

4. Independent of the teachers college group of theorist, Johnson was beginning to play a
central role in conceptualizing nursing. Johnson’s (1959) analysis of the nature of science
in nursing advocate the development of unique nursing knowledge.

5. The establishment of the special nursing research fellowship program to facilitate,

support, and encourage nurses’ education for research careers.

1961-1965 - Theory: A National Goal for Nursing

1. From a reduced conception of a human being as “an illness: or “a surgery” with signs
and symptom, nursing theory, in the late 1950s, refocused nursing attention on the
individual as a set of needs and nursing as a set of unique functions.

2. The 1960s, the influence of Peplau may have promoted the refocusing of nursing from
its stated mission of meeting the patient’s needs to the goal of establishing a relationship
between the nurse and the client.

3. During this period, the Yale School of Nursing position, influenced by the Columbia
Teachers College graduates who became faculty members at Yale, was beginning to
formulated. To them nursing was considered a process rather than an end, an interaction
rather than content, and a relationship between two human beings rather than an
interaction between unrelated nurse and patient. Although the work of the faculty of the
Yale School of Nursing may have profoundly influenced nursing research in United
States in the 1960s, its influence on theory was not as marked at the time.

4. It was the American Nursing Association’s (ANA) position paper in which nursing
was defined as care, cure, and coordination and in which theory development was
identified as a most significant goal for the profession of nursing that may have been
influential in the further development of theoretical nursing (1965).

5. Federal support was provided to nurses wishing to pursue doctoral education in one of
the basic science. The graduates of those, who in the mid 1970s further develop
metatheoretical ideas.

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6. The establishment of the journal Nursing Science. Although short lived, it was a
medium for exchange of ideas on theory and science in nursing and a confirmation that
nursing is an evolving science with theoretical principles and underpinning.

1966-1970- Theory development: A tangible goal for academics.

1. With the ANA’s recommendations that theory development was of highest priority in
the profession, and with the availability of federal support, a symposium sponsored by
Case Western Reserve University was held as part of the nursing science program. This
symposium was divided into three parts. The part focusing on theory was held on
October, 7 1967 and was considered a milestone during this period.

2. Nurses also received confirmation from two philosophers and nurse theorist who had
been involved in teaching nurse at Yale for five years that theories are significant for the
practice of nursing, that the practice of nursing is amenable to theoretical development,
and that nurses are capable of developing theories (Dickoff, James, and Wiedenbach,
1968). Nursing theory was defined, goals for theory development were set, and the
confirmation of outsiders was productive.

3. Skepticism about theory: the evidence for skepticism is derived from omission rather
than commission, when theories were used during this period; they were used in
conjunction with education and not practice or research (except for the New York and
Yale students).

4. The metatheorists in nursing started their questioning during this period. Questions of
this era were related to what types of theories nurses should develop rather than the
nature of the content of those theories. The first metatheorists were Ellis (1968) and
Wiedenbach (Dickoff, James, and Wiedenbach, 1968). Debates occurred about whether
the theories should be basic or borrowed, pure or applied, descriptive or prescriptive.

5. Accomplishment s at the stage can be summarized as :

- Nursing is a field amenable to theorizing
- Nurses can develop theories
- Practice is a rich area of theory
- Practice theory should be the goal for theory development in nursing
- Nurses’ highest theory goal should be the prescriptive theory, but it is
acceptable to develop descriptive and explanatory theories.

1971-1975 – Theory syntax

1. During this period attempts at identifying the structural components of theory.

Metatheorists dominated this period. The emphasis was on articulating, defining, and
explicating theory components and on the processes inherent in theory analysis and
critique. Nurse theorists were no longer questioning whether we need theories or not;
questions of this period focused on what is meant by theory (Ellis, 1968), on what are the
major components of theory, and on what ways to analyze and critique a theory.

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2. Education of nurses in basic, natural, and social sciences through the federally
supported nurse-scientist programs produced a group of nurses who shared common goal:
the establishment of the unique knowledge base of nursing.

3. The National League of Nursing not only acknowledged theory but also made theory
based curriculum a requirement for accreditation.

4. Schools of nursing were expected to select, develop, and implement a conceptual

framework for their curricula. This requirement for accreditation was both a moving
force and a major barrier to theory development. To use theory for curriculum
development further heightened awareness of academic nursing to the significance of
theory and to the available nursing theories. However, this requirement diverted the goal
of developing theories for practice to the goal of using theory for education.

5. The limited number of journals that acknowledged and promote theoretical nursing, the
focus on promoting the publication of empirical research findings, and the growing
financial difficulties of some journals were barriers to written exchanges on theory and
theorizing.

1976-1980- Time to reflect

1. Nurse theorists were invited to participate in presentations, discussions, and debates in

conferences sponsored by nurse educators, marking a significant milestone in nursing. A
national conference devoted to nursing theory and the formation of nursing theory was
Think Tank in 1978.

2. This was the tie for nurse academicians, who had used nursing theories as guiding
frameworks for curricula, to consider putting theory to other uses, particularly in practice.

3. The establishment of the journal, Advances in nursing science, with its focus on the
“full range of activities involved in the development of science” including “theory
construction, concept, and analysis” and the application of theory was another significant
milestone.

4. This period is characterized by questioning if nurses progress would benefit from the
adoption of a single paradigm and a single theory of truth (Carper, 1978; Silva, 1977).
More debates were on which theory is needed (Beckstrand, 1978), and about issues in
theory. a more solid commitment to the development of theory combined with a specific
direction to nurses effort in theory development (Hardy, 1978, Donaldson & Crowley,
1978).

5. The relationship between theory and research was discussed, the path was charted to
bridging theory-research gaps between theory and practice, theory and philosophy were
examined (Silva, 1977) and the role of each in the development of nursing knowledge
was clarified.

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1981-1985- Nursing theories revival: emergence of the domain concepts

1. Theory began to be questioned less. This period was characterized by an acceptance of

the significance of theory for nursing and by the inevitability of the need for the
development of nursing theory. Doctoral programs in nursing incorporated theory into
their curricula.

2. The questions of this period included:

- What have we learned form theory?
- How can we use theory?

3. Knowledge of the syntax emerging as a previous milestone was used to analyze

existing theories (Fawcett, 1984). In addition, existing theories came to be thought of as
means to develop unique body of knowledge. The concepts central to nursing theory were
identified.

4. This period was characterized by the nursing theory advocates who pleaded for the use
of nursing perspective in general or for the specific use of nursing theory (Adam, 1983).
Another group also emerged during this period: the theory synthesizers. The difference
between the two groups was in the level of the scope of analysis. The advocates promoted
nursing theory and demonstrated its use in research projects or in limited practice arena.
The synthesizers went beyond that limit use to describe and analyze how nursing theory
had influenced nursing practice, education, research, and administration (Fwacett, 1984;
Fitzpatrick and Whall, 1983).

5. The Rogerian First National Conference (1983) and subsequent ones were planned by
theory synthesizers. In this conference, theoreticians, practitioners, and researchers
discussed the utility of Rogers’ theory from different perspectives.

5. This period was characterized by an acceptance of theory as a tool that comes from
significant practice problem and can be used for practice and research. This period was
characterized by a greater clarity in the relationship between theory and research than
between theory and practice.

6. One remaining confusion during this period was related t semantic. Conceptual models
were referred to as conceptual frameworks, theories, metatheories, paradigms, and when
differentiated, boundaries were not totally clear and properties not entirely distinct.

1986-1990- From metatheory to concept development.

1. This period was characterized by Epistemological debates: these debates included

questions related to describing alternative approaches to knowledge development, such as
the use of phenomenology, critical theory, and feminist or empiricist methodologies (e.g
Allen, 1985). These debated were related to development of theory in nursing.

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2. Ontological analysis: effective analyses were those focused on ontological beliefs

related to central nursing concepts such as environment (Stevens, 1996) and health
(Allen, 1985). These concept analyses added a contextual approach to understand each
concept. These analyses raised awareness to the necessity of using frameworks that allow
for integrative, holistic, and contextual description of nursing phenomena.

3. The increase in writings related to concept development: these analyses were different
from the earlier questions such as what is nursing? These analyses were more practice
oriented, integrative and represented early attempts in the development of single domain
theories (Chinn, 1987, Meleis, 1987).

4. Process debates were more a potential force for theory development. Therefore instead
of debating whether critical theory or feminist theories were more appropriate as
philosophical base for the discipline, one may argue whether it was more effective to
view environment or comfort from either or more perspectives,

1991-1995 - Mid range and situation specific

1. One significant milestone was the numerous Mid-range theories that evolved during
this period (e.g. Mishel’s theory of Uncertainty). Mid-range theories focus on specific
nursing phenomena that reflect and emerge from nursing practice, and focus on clinical
process (Meleis, 1987). They provide a conceptual focus and a mental image that reflects
the discipline’s values, but they don’t provide presentations for practice or specific
practice guidelines (Chinn, 1994).

2. Situation-specific theories may be emerging as another milestone. They are theories

that are more clinically specific, theories that reflect a particular context, and may include
blueprints for action. The situation specific theories may emerge from synthesizing and
integrating research findings and clinical exemplars about a specific situation or
population with the intent of giving a framework or blueprint to understand a particular
situation of a group of clients. (Example: a conceptualization of patterns of responses to
health-illness transitions of Middle Eastern immigrants (Meleis et al, 1995).

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Toward the development of the discipline of nursing: Epistemological issues.

Meleis (1997) Chapter 5

Epistemology: is the branch of philosophy that conceders the history of knowledge. It

raises and answer questions related to the kinds, the origin, the nature, the structure, the
scope, the trustworthiness, the methods, and the limitations in knowledge development
and outlines various criteria by which knowledge is accepted.

The study of epistemological issues helps us to accomplish the following:

1. Increase our awareness of the complexity and diversity of perspectives, views, and
theories of scientific progress, truth, and the methodology of truth.

2. Distinguish between different kinds of problems in knowledge and development.

3. Deal with epistemological constraints.

Theoretical Growth: Revolution, Evolution, or Integration (Table 5-1).

Theories that describe patterns of scientific progress:

1. Revolution: Kuhn (1970, 1977 develop the revolutionary theory.

Revolution is defined by Webster’s third international dictionary as “a sudden, radical, or

complete change” characterized by “overthrowing” fundamental changes. Kuhn’s theory
is based on this definition. Sciences to Kuhn, develop by leaps and bounds only through
periods of crisis in which theories compete.

Normal Science: is a period when members of the field accept a unified way a common
paradigm. The transition from a crisis to normal science marks a scientific revolution.

Kuhn assets that: scientific development is non cumulative, meaning an aspect of one
theory that is useful is not added to another competing theory to render it more useful.
The competition between paradigms does not evolve into collaborative paradigms; rather,
only one prevails to the destruction of other. Older paradigms, whether or not useful on
the whole or in part, are incompatible with newly conceived paradigms (Kuhn, 1970).

Kuhn’s central ideas:

1. A paradigm is defined as an entire repertoire (range or list) of beliefs, values, laws,
principles, theory methodologies, ways of application, and instrumentation.

2. A paradigm encompasses substantive theoretical assumptions about the subject matter

to the discipline and the methodological strategies as well as a degree of consensus about
theory methods and techniques.

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3. A paradigm includes questionable areas in the field and some puzzle solutions that
could act as examples to help members of that scientific community to solve the reminder
of the normal science problems in the discipline.

4. A discipline matures when it has such paradigm. Before paradigmatic stage, there is
haphazard in the processes of answering the discipline questions. This period is
characterized as perparadigmatic stage of the discipline. The movement toward a
paradigmatic stage occurs only when one of the paradigms become dominant and is
accepted by the community of scholars. It is only then that the period of normal science
is achieved.

The process is revolutionary one characterized by sudden changes, and its

cornerstone is competition. A paradigm may be discarded and replaced by another
competing paradigm because the exemplar attached to it is more successful and other in
the field are in agreement on it.

Once a paradigm dominates, competition is halted because one paradigm clearly

prevails. This is the period of normal science. Kuhn’s ideas led to a belief that disciplines
develop by convergence. A convergent process is closed rather than open. The term
paradigm was substituted in Kuhn’s later writings with disciplinary matrix, denoting the
same definition of the paradigm with the addition of the shared exemplars. Because
content boundaries are implicit not explicit. Exemplars are models that provide the
problems and the solutions in the discipline. Kuhn’s ideas have been revered and
criticized.

Laudan Challenged Kuhn’s assertion and proposed that competition is continuous and
that scientific disciplines include a variety of coexisting research tradition (Laudan,
1981). Laudan identifies five major flaws in Kuhn’s philosophical view of the
development of scientific discipline:

1. Kuhn’s failure to see the role of conceptual problem in scientific debates and in
paradigm evaluation. Kuhn appears to use only a positivistic view of science by
comparing the number of facts a theory is able to address. An empirical view addresses
elements in verifications and falsifications of theories, but no conceptual coherence,
logic, social congruence, or other significant components of usefulness.

2. Kuhn never really resolves the crucial question of the relationship between a paradigm
and its constituent’s theory. Do theories explain and describe paradigms or visa versa?

3. The notion of prevailing paradigm does not allow for changes and discoveries that
characterize our present science, where parts of theories are justified, and others are
changed.

4. Kuhn does not advocate explicit articulation of paradigms or disciplinary matrices. .

Therefore, such implicitness does not account for nursing’s attempt to make boundaries
and assumption of the discipline explicit.

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5. Because paradigms are implicit and can only e identified by pointing to their exemplar.
It follows that whenever two scientists use the same exemplars they are for Kuhn
committed to the same paradigm. However, coping with transition was treated effectively
by those scientists adhering to sociocultural views and psychoanalytical views.

The sixth flaw has been identified by Toulmin (1972).

6. How the transitions from competing paradigms, to revolution, to normal science occur
is not clear in Kuhn’s writing. Do the scientist share a common language, how could they
agree on one rather than the other paradigm?

Some nursing scholars have accepted Kuhn’s theory. Nursing progress thus been
measured against canons proposed by him (Hardy, 1978). According to those scholars
nursing is in its preparadigmatic stage. It is possible that nursing scientific revolution
may never come, not because nursing is not progressing, but because there may never be
periods of normal science. In addition the notion of one paradigm is not acceptable to
sciences, particularly to nursing which deals with human beings and complex health/
illness situations.

A theory of evolution

Evolution: denotes change in a certain direction, unfolding from lower to higher and
from simpler to more complex and headed in the direction of greater coherence.
Evolution denotes a sense of continuity and gives the impression of long-term cumulative
change. Evolutionary stand competition but accepts the inevitability of cumulation in
knowledge development.

Toulmin (1972) used the evolutionary theory of Darwin as the basis on which he
formulated the evolution framework to explain the process of knowledge development.

Principles of evolution theory

1. Each discipline contains its own body of concepts, area of concern, methodologies, and
goals, all of which can change slowly through a mutable process.

2. All ideas, concepts, and methodologies are given a chance to compete, to be discussed,
to be weeded out, only the innovation that fit will survive from generation to the next.
This process of retention of some conceptual thoughts, mutation of others, and rejection
of still others explains the stability of intellectual thought in disciplines and accounts for
transformations into new ideas.

3. Marked substantive changes in the field are possible when a number of conditions
exists. One important condition is the existence of qualified people in the discipline who
are capable of inventing new ideas, exploring new problems, and developing new ideas,
exploring new problems, and developing new theories.

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Another condition is the openness in the discipline to allow for new ideas to develop and
survive long enough to prove suitability or to be refuted.

4. the selection of the more useful ideas, concepts, and theories is based on which of them
helps to meet the demands of the local intellectual environment within the discipline.
Other competing ideas continue to be adhered to, refined, and further developed.

An evolutionary process of knowledge development contains such units of analysis as

merits, competitions, demands, and successes. One theory that my have more explanatory
power to resolve some significant conceptual problem, is generally selected over other
theory, however well established it may have been. It may incorporates parts of the
previous theory and reject other parts. Physical sciences according to Toulmin have taken
a cumulative pattern.

Certain conditions should exist as indicators that a discipline has developed cumulatively:

1. Modification of truth value: generalizations are cumulative when one generalization

modifies a previous generalization.

2. Modification of antecedent value: generalizations are cumulative if the empirical

verification of falsification of a second subsequent generalization modifies the antecedent
in the first generalization.

3. Premise or a derivation in a deductive chain: this applies to cases in which a

confirmed proposition in one theory becomes a premise preceding another proposition in
another theory.

4. Space-time independence: theories are cumulative when their propositions transcend

geography and time.

5. Practice-research-practice dependent link: this link presupposes modification of

practice based on theory or research, or vice versa.

Social and behavioral sciences are classified in Toulmin’s terms “would be disciplines”.

Propositions from theoretical nursing do not fit in a deductively tight, logically

interrelated cumulative mode. Systematic cumulative development that begins from a
common point and expands upward to become another canon cannot be detected in
nursing knowledge. If cumulation is the uni of analysis for the evolution of disciplines,
then nursing scientific development is not congruent with either q revolutionary or an
evolutionary concept. Rather, it has followed a course that may be considered
unsystematic if we impose on it the previous two theories.

Theory of integration
The features and patterns in nursing that are unique to the discipline and may support a
more integrative approach to describe its development:

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1. One unique feature is theory development. The development of nursing theory was not
based on the research of the discipline, nor did every research project make a contribution
to the development of theory.

2. Another unique feature of the discipline is that its competing ideas exist
simultaneously and have existed for decades (conceptual approaches to care, different
research methodologies), and competing theories are even being used within the same
institution. There are areas of agreements such as interest I transition, focus on health and
coping. Although each of these concepts may be viewed from a different theoretical
background, here is more and more growing agreement that these concepts are central to
the discipline.

3. In a discipline that deals with human beings, it is perhaps not feasible that only one
theory should explain, describe, predict, and change all the discipline’s phenomena.
Nursing deals with human behavior, and human behavior could not be explained by a
single, completely general and comprehensive theory.

4. As a profession nursing exists in an open system and has to be influenced by and be

responsive to society’s needs at all times. Therefore, nursing cannot afford to converge
on one paradigm to the exclusion of others. Nurses and clients’ actions continue to be
shaped by each other ad by social environment. If we decided to wait for the total
agreement, perhaps we will not be able to work on the much needed conceptual clarity
and further development of existing competing thoughts.

5. Another pattern of knowledge development in nursing is the compromise between the

old and the new concepts. In instances where there are changes, the old paradigms e
redefined rather than totally rejected.

It is the presence of competing theories, competing schools of thought, and debatable

ideas that makes a discipline scholarly. The right to question, critique, and challenge has
characterized all advanced disciplines. Competition, creativity, and innovation are the
hallmark of scientific growth (Melies, 1997).

The thesis of this discussion is that nursing progress seems to have charted its own path;
ideas that were rejected in one stage of development have been accepted at a different
stage.

Integration is neither a non-pattern nor a negative pattern; rather it allows for pendulum
swings and is explained as a pattern in progress. To integrationist, nursing has achieved
the disciplinary status. A careful assessment of growth and development in nursing,
milestones, stages, and phenomena demonstrate the quality and significance of the
questions asked and answers received. These units of analyses represent a synthesis
between research, theory, and practice. When nursing is analyzed in terms of these, then
it has achieved its disciplinary status.

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From the Received view to the Perceived view (Table 5-2)

The received view: which others may call the “scientific method” (Suppe, 1977). It
denotes that are not to be challenged. It is the same premise that declares that holy books
were received and therefore should not be challenged. Received view is also a label given
to the “empirical positivism” movement or “logical positivism” a nineteenth century
philosophical movement. Eventually the concept of “positivism” was dropped and
replaced with “empiricism”.

The following are the tenets of logical empiricism:

1. Statements that cannot be confirmed by sensory data and through sensory experiences
are NOT considered theoretical statements worthy of pursuing. A direct relationship has
to exist between experience and a meaningful theory.

2. True statements are only considered to be those that are based on experience and
known from experience.

3. Positivists regard most traditional metaphysics and ethical considerations as

meaningless.

4. Analyses of theories are based on analyses of completed theories, and completed

theories are based on data (Suppe, 1977). The context of justification- that is, the
verification or falsification of completed theory propositions is the only significant
context for consideration by scientists and philosophers a like.

5. Because the received view considers theories to reflect reality, documented by sensory
experiences, it therefore follows that propositions of theories are presented in a symbolic,
formal, and axiomatic manner.

6. Science is value free, and there is only one method for science, which is the scientific
method.

The scientific method that is based on the received view, is the one that espouses
“reductionism”, quantifiability, objectivity, and “operationalization” (Watson, 1981).

As a result, significant holistic problems in nursing have been ignored because they are
neither reducible, quantifiable, nor objective. The scientific method, oriented toward
quantitative methods and highly accepted and respected, could not address theory and
developing theory; therefore, it has not helped nursing to develop meaningful theories or
advanced nursing to its projected goal of scientific discipline (Melies, 1997).

Nursing theorists who have worked hard to give us their conception of the discipline of
nursing have not followed a received view approach. They have offered a number of
conceptualizations that encompass the whole of nursing- a perceived view- based o their

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experiences and incorporating ideas that are subjective, intuitive, humanistic, integrative
and in many instances, not based on sense-oriented data.

Discovery of field concepts, theory development, and processes of theorizing in nursing

has not been based on the received view or on a structured and strict scientific approach.
The context of discovery of these ideas has been traditional case studies, personal
anecdotes, and group insights. Acceptance f those visions that came from our nurses
theorists has been slow because the theories have been branded by some as unscientific.

The theoreticians in nursing have used the perceived view, which is a combination of
phenomenological and philosophical approaches, as alternate method for theory
development.

Perhaps the scholars in the field who believe that knowledge emanates from the context
of justification have helped to orient nursing toward considering concepts such as sensory
data, verification, and falsification as ways to accept or reject nursing conceptualizations.
These scholars have therefore precipitated the early mass rejection of nursing theory as
well as the continues rejection by many in the field who are skeptical about the use or the
effectiveness of nursing theories.

It is a view of science that accepts values, subjectivity, intuition, history, tradition, and
multiple realities- a view that is more congruent with nursing and its commitment to
human beings (Munhall, 1982).

To summarize, perhaps the dominant evaluative criteria for nursing research by our
funding agencies has been received view approach. In the meantime, the guiding
paradigm for nursing practice, nursing theory, and, for that matter, nursing education has
been more open, more variable, more relativistic, and more subject to experiences and
personal interpretation. It has used holistic approach; therefore, a perceived view.

It was perhaps the incongruence between the perception of the few (who evaluated
research for publishing and funding) and the perceptions of the majority of nurses
(scientists, theoreticians, and clinicians) regarding knowledge development that delayed
the acceptance of the perceived view.

Truth: from correspondence to Weltanschauung (Table 5-3)

Three views have emerged to answer epistemological questions such as: what concepts of
truth should be used in the future? When does knowledge become truth?
correspondence, coherence, and pragmatism (Kaplan, 1964).

1. Correspondence: which with its careful rules, call for sensory data, very small
variables, and operational definitions.

For generations, this view has dominated science, research, and theory construction in
physical and natural sciences. It is the method of truth on which the received or scientific

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view is based. However, the received view and truth represent two different processes.
The former addresses the process of research, the methodology by which data are
collected and theories are developed; the latter attends to examining realities, the results
of the findings. Whereas the former asks what do to know, the latter asks how to know.

The most significant norm is that of truism of facts and their correspondence with the
theories that encompass them. One of the most significant correspondence norms is total
objectivity, a separation of the observer from observed world. Validation is based on
congruence between propositions and reality.

The positivists assert that the correspondence truth is achieved through corroboration by
verification. Popper (1959) modified the positivist view and developed the argument for
falsification. Verification of the opposite statement occurs with multiple incidents of
falsification of the statement through experience. A proposition is scientific only if it has
the potential for being falsified. Once a proposition is countered by a single falsify
instance, it should be rejected. Truth is achieved when we have exhausted all attempts at
falsifying propositions.

To the correspondence theorists, whether verification or falsification is the focus, truth is

achieved through sensory data and controlled experiments.

2. Coherence: truth through coherence is manifested in the logical way in which

relationships and judgments relates. The norms of coherence are an integration of
relationships, simplicity of presentation, and certain beauty of propositions. If the
proposition is sufficient for today then there is truth in it.

The coherence norms of logic, simplicity, an aesthetic presentation appear to be norms to

be used for both the context of discovery and the context of justification. They lend lend
themselves more to the evaluation of concepts that are in the process of development than
those in the process testing. Although norms of correspondence and coherence may
appear to contradict each other, it is nonetheless possible to consider them as
complementary. While using the coherence norms to judge and evaluate theories, we can
also use correspondence norms to judge propositions that evolve out of research.

3. Pragmatism: in 1930s, a third type of theory about truth was advanced by a group of
American philosophers called pragmatists. According to Armour (1969) there are two
types of pragmatic theory of truth:

First: An assertion is true if produces the right type of influence on its followers.
In other words, a proposition is declared to be when its usefulness is determined by its
users. Experience and the ability to solve problems are two of the norms considered of
this view of truth.
Second: a proposition or any theorized relationship is true if it receives
confirmation from a person or persons who may have conducted the right investigations
or who are designated as significant by the community of scholars. According to this
theory a consensus between theoreticians and investigators is what constitutes the truth.

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Pragmatic truth is not as dependent on evidence as it is on observation- on a declaration

of effectiveness by whatever methods the significant members of a community of
scholars use. These measures of effectiveness may be subjective, political, social, or
objective.

A pragmatic theory of truth allows for validation of theories through restructuring, use of
new techniques, or even better awareness and realizations of the meaning of old
relationships.

Humanity, tentativeness, subjectivity, collectivity, and usefulness are all qualities attached
of this concept of pragmatic truth, which evolved out of Chicago school of thought.

Problems with development nursing theories:

1. It is possible that the newness of nursing as s discipline makes it easier to reject both
competing views in favor of another, more established view of a human being to the
detriment of solving the central problem. Neither correspondence nor coherence criteria
could solve this issue; it is best addressed through a pragmatic approach to truth.

2. Nursing has also been beset (overwhelmed) by other philosophical inconsistencies

(Munhall, 1982). Existential and pragmatic philosophies have dominated clinical nursing,
and positivistic, empirical philosophies have attempted to dominate the academic
discipline.

* There was a belief that the only credible theories in nursing were those that were
inferred from observable data. However, none of the norms in isolation would provide us
with the truth. A combination of all may brig us close (Meleis, 1997).

3. The third difficulty that confronts theorists and cannot be resolved by any one of the
theories. Laudan (1977) calls “prevalent world view difficulties”. This phenomenon is
observed when the myths, the beliefs, the history, and practice are in opposition with the
developing theories. The prevalent nursing view ascribed to by clinicians is that nursing
is practical and skill oriented and that its principles as well as its skills are derived from
other disciplines. Nursing is not theoretical, says this world view, or academic.

Multiple truths in nursing

Suppe (1977) suggested that what is needed is a different way by which theories are
analyzed. He called this new way Weltanschauung. He defined it as “ a comprehensive
world view, especially fm a specified standpoint”

There is a Weltanschauung or world view of truth in theoretical nursing that includes an

integration of norms from different theories of truth. It combines rigor and intuition,
sensory data as they exist and as thy appear, perception of the subject and the
theoretician, and logic with observable clinical data.

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What have been advocated by different theorist and researchers merely as norms for
acceptance of propositions are not contradictory norms because in some situations,
events, and experiences, one set of norms I more appropriate than another.

Examples: Johnson (1974) used pragmatic theory of truth; she spoke about criteria of
acceptance of knowledge a based on social responsibility.
Rogers (1970) used the coherence norms in conceptualizing a unitary man as an energy
field.

The Weltanschauung of truth in nursing theory uses validation, verification, simplicity,

logic, consequences, clients, theorists, and actual or potential experiences as norms
against which truth of the theory is compared. It accepts different expressions, different
sources, and criteria such as a number of solved problems within a discipline e (Laudan,
1977).

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