The development of theory in British nursing: current position and future prospects

Abstract

This paper is concerned with the development of theory in the discipline of nursing as it is practised in Great Britain. It stems from dissatisfaction with the generally uncritical adoption by British nurses of models of nursing which have been developed to explain and enhance North American practice. After the introductory paragraph, four roles for nursing theory are proposed. These are: to define nursing by describing nursing phenomena; to form a realistic basis for curriculum design; to provide tools for the professional practice of nursing; and to provide a nursing language. It is then argued that although British nurses have recognized the need for an adequate theoretical basis for practice, their response has been rather uncritical adoption of American models of nursing. As a basis for practice, it is argued that American models generally fail to meet the needs described above, and therefore fail to have impact on clinical work. Structural and philosophical reasons for this failure are identified. Following a brief discussion of the inductive and deductive approaches to the development of theory, the paper closes with the argument that British nurses should be concerned with the development of new theory which, if grounded in the reality of practice, would be likely to be both useful and realistic.

Mid‐range theory building and the nursing theory‐practice gap: a respite care case study

“…If nursmg's claim to act as the patient's advocate and to offer hohstic care is to have any credibility, it is contended that the profession will need to adopt a balanced approadi to theory develo|wiient Hence, mggestions that theones borrowed from other disaphnes do not advance the cause of nursing m movmg towards a unique body trf knowledge (Draper 1990) are, like the %arch for a unified theory.…”

“…The theory was developed and refined from a user perspective and this is increasingly seen as representing a positive attnbute of future nursing theones Previous theones have been cntiazed for their narrow professional focus which has often lacked a user or consumer dimension Nursing models are the perspectives of nurses, of certam nurses The perspective of the consumer does not enter mto them, except as interjjreted by the nurse theorist Oanforum 1986) Thus, whilst it IS argued that practice-informmg theory should be developed mductively from the actions of nurses themselves (Clarke 1986, Draper 1990, some wnters advocate that theones must take adequate account of both nurses' and users' views (Meleis 1991), or even that the users' view be given the major consideration (Morse et al 1990)…”

“…It was suggested m the introduction that, m their search for a unified theory of nursing, the work of many nursing theonsts has alienated rather than enthused practitioners Mid-range theory was offered as a possible solution to this problem By the application of Chenitz's (1983) theory of relocation to a qualitatively different form of admission and its subsequeit revision, it is considered that the utility of the mid-range theory has been danonstrated Traditionally therefore, a theory is judged by its ability to descnbe, explain and predict the phenomena of mterest Ultimately, however, it is usually considered that nursing theory must also prescnbe or act as a giude to nursmg practice (McFarlane 1976, Craig 1980, Qarke 1986, Walker & Avant 1983, Draper 1990, Torres 1990, Chmn & Krammer 1991, Ingram 1991, Meleis 1991 The authors would contend that Chenitz's (1983) theory has demonstrated its ability to descnbe and explam It also has the potential to predict which combination of arcumstances would lead to respite care bemg accepted (either embraced or strategically) or resisted and, moreover, to suggest which nursmg actions might ameliorate these reactions As Meleis (1991) advocates, it provides a basis for the fundamental components of nursmg practice assessment, diagnosis, intervention and evaluation…”

“…At first sight it appears to be a relatively easy matter to present a case for the positive contnbution theory has made to the development of nursmg The literature offers seductive arguments extollmg the virtues of theory and its potential for buildmg a unique body of knowledge to enhance the professional status of nursmg, facilitate communication between practitioners and improve patient care (McFarlane 1976, Craig 1980, Walker & Avant 1983, Torres 1990, Meleis 1991, Chinn & Krammer 1991 It IS in particular this last quality which is held to be the ultimate benefit of theory to a practice disapline such as nursmg smce, by the practical application of theones, nursing action might be rendered more efiiaent and effedive (Chinn & Krammer 1991, Meleis 1991, Ingram 1991 Retsntly, wnters (Moore 1990, Girot 1990, Draper 1990, Ingram 1991 have reflected upon and questioned the role send value of nursir^ theory to the development of mirsmg m getwral aad nursu^ practice m particular Such Comstxmdaict DrM Nohm, Senior Ledurer m Nurar^ Research School of Nursit« r, Gurymdd LL57 ZDC, Woks eAndence suggests that theory carmot be said to have facilitated conunumcation given the 'utter semantic confusion' (McFarlane 1976) created by the conflictmg use of terms, a situation which hardly seems to have improved with conceptual distmctions remairung 'hair-sphtting, unclear and confusmg' (Meleis 1991) If theonsts themselves fmd such aspects difficult to unravel, practitioners have often reacted by rejecting theory itself This has resulted in what has been termed the theory-pradice gap (Craig 1980, Miller 1985, Gruendmg 1985, Qarke 1986, with the nft now bemg so wide that it has been referred to as a 'chasm' (Lewis 1988) Resultant debates have tended to develop mto a viaous cirde, with theonsts berahng praditioners for their lack of concem with the conceptual basis for their adions, whilst practitioners bemoan theoretical approaches which are seen as having little or no relevance to their daily work Theory related to practice Miller (1985) argues Hiat if it is virtually impossible for expenenced nurses to relate theory to their practice then there is somethmg wrong with either theory or practice Draper (1990) has no such doubts and lays the blame fairly and squarely with theory The root of, and possible solution to, this problem appears to he m the scope and abstraction of many nursmg theones Kitson (1985) contends that m att...…”

Exploration of the Gap between Theory and Practice in Tunisia Nurse Education System: A Cross-Sectional Descriptive Study with a Focus on Hand Hygiene

“…An exploration of this particular phenomenon from the perspectives of three user groups, students, nurse educators, and clinical preceptors , showed that all the identified groups highlighted the existence of a deep discrepancy between what is taught in classrooms as nursing theory and what is encouraged by the clinical preceptors as good practice habits at the bedside (Corlett, 2000;Hussein & Osuji, 2016) Some researchers argue that this phenomenon is due to a certain misconception about the exact nature of the relationship linking nursing theory and the practice of the nursing profession some these researchers went as far as to identify certain specific contributing factors such as students' feelings of powerlessness and abandonment by clinical faculty (Dadgaran, Parvizy, & Peyrovi, 2012;Hussein & Osuji, 2016;Rolte, 2001) One of the main reasons explaining the gap between practice and theory is the attempt of nurse theorists to define grounded rules which are in direct abstractions of the situations dealt with in the clinical domain (Hislop, Inglis, Cope, Stoddart, & McIntosh, 1996). It has been noted in serval cases that a large number of nurse theorists give different meanings to the same term, which in turn hinders nurses and clinical preceptors from reaching the assumption that one author's use of a term is going to be the same for another (Draper, 1990;Upton, 1999), this fact would explain why in some cases nurse educators and clinical preceptors assign different meanings to the same concept. As such the existence of this phenomenon speaks to the difficulty in grounding highly abstract intellectual concepts in practice.…”