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THEORETICAL NURSING Development and Progress

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THROUGHOUT the many editions and revisions of this book, I received a lot of feedback and many responses about the ideas presented. These arrived in writing, in person, in meet- ings, and in e-mails. Many responses, from many corners of the world, reflected a real intellectual engagement in the book. Some were inspired by our theoretical history, others questioned our philosophical past, but most thought the dialogues that evolved from dis- cussing the ideas in the book reaffirmed their identity in nursing and ignited their pride in the profession and the discipline of nursing. These comments, reviews, and suggestions for revisions made me realize that the major role of this book is empowering its readers. It has given the readers a voice to engage, debate, and to challenge sacred cows about how our discipline evolved and ways by which we can evaluate growth in the discipline.
The intent of this book, then, is to demys- tify theory, to chart the different strategies to use in developing and advancing theory, and to provide tools and best practices in evaluating progress in the discipline. It provides both an open invitation to embark on a journey with- out the many preconceived assumptions that may have been a barrier to pursuing knowl- edge development. Among these assumptions were that a select few could engage in devel- oping theory. Perhaps this is because, during
1950–1970, the construction of theory in nurs- ing occupied only a select few members of the discipline. The metatheoreticians and their writings attracted another select group of nurses, and they focused on suggestions about formulating theories, defining types of theories, and identifying sources for theories. Subsequently, conceptualizing nursing phe- nomena commanded the attention of a wider circle of members of the discipline. Many other assumptions shaped our history and influenced our current progress in the disci-

pline. For example, there was the assumption that a conceptual framework was essential for advancing nursing knowledge. This assump- tion changed as we entered the 21st century because the discipline was better defined and was replaced with another assumption: that empirical knowledge and research programs are the only means toward advancing knowl- edge.
An additional assumption was that the processes for theory development were new to nursing and hence, nurses in graduate pro- grams learned strategies for advancing knowl- edge from other disciplines. This assumption was debunked with the knowledge that nurses were always engaged in knowledge develop- ment, driven by their experiences in clinical practice. Because of these assumptions, most of the early writing about theory development was about outlining strategies that should be used, rather than strategies that have already been used in the discipline to develop theories. Theorists themselves did not uncover or ade- quately discuss ways by which they developed their theories, therefore the tendency was to describe processes that were based on theories developed in other disciplines, mainly the physical and social sciences. And an implicit assumption was made that there should be a single strategy for theory development, some claiming to begin the process from practice, and others believing it should be driven by research.
Another implicit assumption was that the- ory development was an elitist activity, to be engaged in only within the halls of academia. Furthermore, it was assumed that what goes on within the halls of academia had no resem- blance to the clinical work that goes on in real life. (Notice the many comments over the years about nursing theory and the lack of cli- nicians’ need for such theory.) Some believed that nursing had always borrowed its theory

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and that nursing was an applied field. To them, nursing practice theory was not needed because theories from science and ethics were enough to guide nursing. Therefore, theory development was an unnecessary process. Some critics did not consider that redevelop- ment, resynthesis, and reintegration of find- ings, ideas, and statistical wisdom were also processes for knowledge development.
Different eras provided different sets of assumptions. In many instances, biomedical sciences dominated more than biopsychologi- cal sciences. And, as educational programs in nursing became more biologically and med- ically based, theories that reflect the human sciences tended to be neglected. Therefore, major journals in nursing tended to capture empirical evidence based on more medically defined outcomes of mortality and morbidity rates as compared to quality of life, levels of functioning, perceived health status, adapta- tion, and energy levels.
The reader of this book will find that it includes many arguments that dispel many of these preconceived assumptions and that:

• Nurses have a fine and useful theoretical heritage that is worthy of analysis. By understanding how and why our heritage evolved as it did, we may be in a better position to consciously and deliberately drive the development of theoretical nursing to meet the mission that we have articulated about our discipline.
• There are sources and resources by which nurses can conceptualize different aspects of the nursing universe for the purpose of facilitating understanding, increasing autonomy in their actions, and enhancing control over their domain. The ultimate
objective is to provide quality care utilizing the different tools and strategies for theory development. The reader will find support that clinicians are as valuable in advancing nursing knowledge as theoreticians because they articulate their practical wisdom into exemplars that may help to solve other clin- ical problems.
• The scientific development of the discipline of nursing has followed a unique path,

charted by members of the discipline to suit its unique features and the context of its nursing care complexities. The sociology and the philosophy of nursing science are
legitimate and significant areas of investiga- tion to discern the progress and develop- ment of the discipline. As nurses questioned the empiricist’s view of science and embraced other more dynamic and chang- ing conceptions of science, the behavior of scientists and theoreticians, the processes of selection of research and theories, the his- torical environment, and the sociocultural context for the development and utility of
the discipline’s theories become legitimate and provide central questions for the domain.
• And finally, our theoretical history, our epistemology, and our domain are the bases for our theoretical future. The novice should be acquainted with them, the advanced should explore and question the relation- ships between the parts and, together with the experienced, they should shape and reshape nursing knowledge.

Demystifying theory and dispelling assump- tions are essential but not sufficient conditions for empowerment. The metaphors that describe the current stage in theory development are epistemic diversity and integrative process, both of which are an acknowledgment and val- uation of nursing history, heritage, and prac- tice. Both of these metaphors reflect and accept the central role of practice in advancing nurs- ing knowledge and nurses’ ways of knowing as vital in uncovering and developing knowl- edge. Empowerment is also about believing in one’s self, abilities, and capacities to advance knowledge and about using these capacities to become an agent for continuous learning and creating. It is about being a criti- cal thinker, an innovative advocate, and an agent for change.
In this book, I present and provide sup- port for our domain as we see it today. The future progress of the discipline depends on the extent to which members of the discipline
will embrace epistemic diversity and integra-
tive approaches to theory development, and


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the extent to which evidence is translated, utilized, and evaluated. The scholars of the future are those who are as comfortable with theorizing as with researching, practicing, and teaching. They will be able to understand and speak the languages of different disciplines, translate their findings to the different practice fields, and engage in changing policies.
In short, the major goals of this book are to make a contribution to raising the con- sciousness of the reader about the theoretical development and progress of our discipline, to acknowledge our theoretical history, to place the present in the context of our history, and to develop an awareness of the potential inherent in members of the discipline, both men and women. It is about the pride we must have in the contributions our discipline makes to the health and well-being of people.
I offer the ideas in this book as tentative thoughts to provide an even platform to

enforce self-agency in students, faculty, clini- cians, researchers, and theoreticians to drive the development of new coherent frameworks to advance nursing science. By knowing equally, each may be empowered to leverage their competency and use their expertise. A democratization of the processes in developing theory is an empowering process to you, the reader, to believe in your own voice, to respect and value the voices that came before you, but to challenge and build on them.
Every time I work on a new edition, I feel
renewed, inspired, and regenerated. It has been a privilege for me to be a nurse, and it is an incredible privilege to write this book honoring the past and envisioning the future. To readers near and far, I thank you for dialoguing with the ideas in this text. I truly value your responses and comments, so keep sending them.

Afaf Ibrahim Meleis, PhD, FAAN

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Ketersediaan

P00131S

610.7301 AFA t

My Library

Tersedia

Informasi Detail

Judul Seri

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No. Panggil

610.7301 AFA t

Penerbit

Philadelphia : Lippincott Williams & Wilkins., 2012

Deskripsi Fisik

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Bahasa

English

ISBN/ISSN

9781605472119

Klasifikasi

610.7301

Tipe Isi

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Tipe Media

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Tipe Pembawa

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Edisi

-

Subjek

Nursing Theory

Info Detail Spesifik

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Pernyataan Tanggungjawab

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Versi lain/terkait

Lampiran Berkas

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