Fundamentals Chapter 4: Theoretical Foundations of Nursing Practice

13. Nurses have developed theories in response to: (Select all that apply.) 1. Changes in health care. 2. Prior nursing theories. 3. Changes in nursing practice. 4. Research findings. 5. Government regulations. 6. Theories from other disciplines. 7. Physician opinions.

1. Changes in health care. 2. Prior nursing theories. 3. Changes in nursing practice. 4. Research findings. 6. Theories from other disciplines.

2. Theory is essential to nursing practice because it: (Select all that apply.) 1. Contributes to nursing knowledge. 2. Predicts patient behaviors in situations. 3. Provides a means of assessing patient vital signs. 4. Guides nursing practice. 5. Formulates health care legislation. 6. Explains relationships between concepts.

1. Contributes to nursing knowledge. 2. Predicts patient behaviors in situations. 4. Guides nursing practice. 6. Explains relationships between concepts.

1. Your nursing class is debating the issue of the usefulness of grand theories in current practice. Make a case for the applicability of grand theories in modern nursing and describe how nurses can use the original nursing theory—Nightingale's environmental theory—in the following settings: a. Critical Care Unit b. Emergency Department (ED) c. Home Health

1. Grand theories focus on the total picture of nursing, which has become increasingly holistic in today's world. Although they are no longer being developed, they are continually being refined and serve as a springboard for the development of middle-range and practice theories and are often used as the conceptual framework for nursing research. The grand theories provide the strong foundation on which nursing profession has been built. Nightingale's theory can be applied in the following settings: Critical care unit: Patients often become disoriented in a critical care unit because of the constant activity and noise. The nurse controls noise levels as much as possible and dims the lights to allow for "quiet periods" during the day and at night to promote rest and healing. Nurses sometimes use music therapy to help patients and families relax in this stressful environment. Critical care units are often the setting for patients to develop health care-acquired infections. As in all clinical situations, proper handwashing prevents transmission of disease. ED: A nurse in the ED strives to maintain a clean environment and prevent contamination by blood and other body substances. Nurses quickly isolate patients who potentially have a contagious disease to protect other patients and staff. Home health: In the home or community setting a nurse ensures that patients have a safe, clutter-free, clean environment and access to clean water, food, shelter, heat/cold, and appropriate clothing in addition to needed medical supplies. When appropriate, nurses promote sunlight and fresh air for patients who are home bound and continually assess a patient's sleep patterns to ensure adequate rest.

8. Which of the following statements related to theory-based nursing practice are correct? (Select all that apply.) 1. Nursing theory differentiates nursing from other disciplines. 2. Nursing theories are standardized and do not change over time. 3. Integrating theory into practice promotes coordinated care delivery. 4. Nursing knowledge is generated by theory. 5. The theory of nursing process is used in planning patient care. 6. Evidence-based practice results from theory-testing research.

1. Nursing theory differentiates nursing from other disciplines. 3. Integrating theory into practice promotes coordinated care delivery. 4. Nursing knowledge is generated by theory. 6. Evidence-based practice results from theory-testing research.

9. A nurse is caring for a patient who recently lost a leg in a motor vehicle accident. The nurse best assists the patient to cope with this situation by applying which of the following theories? 1. Roy 2. Levine 3. Watson 4. Johnson

1. Roy

7. Match the following description to the appropriate middle-range theory. 1. Benner's Skill Acquisition 2. AACN's Synergy Model 3. Mishel's Uncertainty in Illness 4. Kolcaba's Theory of Comfort a. The nurse strives to relieve patients' distress. b. The nurse progresses through five stages of expertise. c. The nurse helps the patient to process and find meaning related to his or her illness. d. Matching nurse competencies to patient needs can improve patient outcomes.

1b, 2d, 3c, 4a.

5. Match the following types of theory with the appropriate description. 1. Middle-range theory 2. Shared theory 3. Grand theory 4. Practice theory a. Very abstract; attempts to describe nursing in a global context b. Specific to a particular situation; brings theory to the bedside c. Applies theory from other disciplines to nursing practice d. Addresses a specific phenomenon and reflects practice

1d, 2c, 3a, 4b.

6. Match the following descriptions to the appropriate grand theorist. 1. King 2. Henderson 3. Orem 4. Neuman a. Based on the theory that focuses on wellness and prevention of disease b. Based on the belief that people who participate in self-care activities are more likely to improve their health outcomes c. Based on 14 activities, the belief that the nurse should assist patients with meeting needs until they are able to do so independently d. Based on the belief that nurses should work with patients to develop goals for care

1d, 2c, 3b, 4a.

10. Using Maslow's hierarchy of needs, identify the priority for a patient who is experiencing chest pain and difficulty breathing. 1. Self-actualization 2. Air, water, and nutrition 3. Safety 4. Esteem and self-esteem needs

2. Air, water, and nutrition

14. Which of the following types of theory influence the "evidence" in current "evidence-based practice (EBP)"? 1. Grand theory 2. Middle-range theory 3. Practice theory 4. Shared theory

2. Middle-range theory

4. The nurse is caring for a patient admitted to the neurological unit with the diagnosis of a stroke and right-sided weakness. The nurse assumes responsibility for bathing and feeding the patient until the patient is able to begin performing these activities. The nurse in this situation is applying the theory developed by: 1. Neuman. 2. Orem. 3. Roy. 4. Peplau.

2. Orem.

2. You are providing care to a patient with chronic obstructive pulmonary disease (COPD) who has been readmitted 3 times within the past month for difficulty breathing. Explain how you would apply Peplau's interpersonal theory to help this patient prevent complications and promote self-management of his disease.

2. Using Peplau's theory, a nurse develops a relationship of mutual respect and trust with the patient. During the orientation phase of the relationship, the nurse works with the patient to identify the specific reasons for frequent readmissions and barriers the patient experiences in caring for self. In the working phase the nurse and patient develop a plan to overcome identified barriers and build the patient's confidence in his or her ability to self-manage the disease by becoming an empowered member of the health care team. Once the patient successfully demonstrates improved self-care management of the disease, the nurse ensures that the patient has access to appropriate community resources, and the relationship is terminated.

12. While working in a rehabilitation facility, it is important to obtain nursing histories and develop a therapeutic nurse-patient relationship. List in correct order the phases of Peplau's theory as applied in this setting. The nurse: 1. Ensures that the patient has access to appropriate community resources for long-term care. 2. Collaborates with the patient to identify specific patient needs. 3. Collects essential information from the patient's health record. 4. Works with the patient to develop a plan for resolving patient issues.

3, 2, 4, 1 3. Collects essential information from the patient's health record. 2. Collaborates with the patient to identify specific patient needs. 4. Works with the patient to develop a plan for resolving patient issues. 1. Ensures that the patient has access to appropriate community resources for long-term care.

15. A nurse is preparing to begin intravenous fluid therapy for a patient. Which category of theory would be most helpful to the nurse at this time? 1. Grand theory 2. Middle-range theory 3. Practice theory 4. Shared theory

3. Practice theory

11. Which of the following categories of shared theories would be most appropriate for a patient who is grieving the loss of a spouse? 1. Biomedical 2. Leadership 3. Psychosocial 4. Developmental

3. Psychosocial

3. For the same patient described previously, how would you apply Orem's self-care deficit theory to help the patient? Compare and contrast the use of Peplau's and Orem's theories for this patient.

3. Using Orem's theory, the nurse assesses the patient's ability to self-manage the disease and arranges for assistance with disease management. The nurse continually monitors the patient's status and provides education and support in addition to meeting the patient's physical, psychosocial, and spiritual needs. As the patient's condition stabilizes and he or she demonstrates the ability to care for self, the nurse becomes more of a coach and guide and allows the patient to progressively take control of meeting his needs and managing his disease. Both theories focus on gradually preparing the patient to become more self-sufficient in managing the disease, but the specific approaches vary. Peplau's theory is centered on the therapeutic relationship, trust, and communication that develop between the nurse and the patient; whereas Orem's theory focuses on meeting patients' needs until they are able to care for themselves.

3. A nurse ensures that each patient's room is clean; well ventilated; and free from clutter, excessive noise, and extremes in temperature. Which theorist's work is the nurse practicing in this example? 1. Henderson 2. Orem 3. King 4. Nightingale

4. Nightingale

1. The components of the nursing metaparadigm include: 1. Person, health, environment, and theory 2. Health, theory, concepts, and environment 3. Nurses, physicians, health, and patient needs 4. Person, health, environment, and nursing

4. Person, health, environment, and nursing

Health

A condition of physical, mental, and social well-being and the absence of disease or other abnormal condition. It is not a static condition. Constant change and adaptation to stress result in homeostasis.

concept

A construct or abstract idea or thought that originates and remains within the mind.

Conceptual framework

A group of concepts that are broadly defined and systematically organized to provide a focus, a rationale, and a tool for the integration and interpretation of information.

Paradigm

A pattern that may serve as a model or example.

Psychosocial theories are needed in nursing because nursing is a diverse discipline that strives to meet which criteria? (Select all that apply.) a. Physiological needs of the patient b. Psychological needs of the patient c. Sociocultural needs of the patient d. Spiritual needs of the patient e. The nurse-patient relationship

A, B, C, D a. Physiological needs of the patient b. Psychological needs of the patient c. Sociocultural needs of the patient d. Spiritual needs of the patient

A paradigm is useful in describing the domain of a discipline. Nursing's paradigm includes which of the following? (Select all that apply.) a. Person b. Disease c. Health d. Environment e. Nursing

A, C, D, E a. Person c. Health d. Environment e. Nursing

Grand theory: Roy

Adaptation Application: Nurses help a patient cope with or adapt to changes in physiological, self-concept, role function, and interdependence domains.

Shared theory

Also known as a borrowed or interdisciplinary theory, a shared theory explains a phenomenon specific to the discipline that developed the theory.

Theory

An abstract statement formulated to predict, explain, or describe the relationships among concepts, constructs, or events. Theory is developed and tested by observation and research, using factual data.

Grand theory: Johnson

Behavioral system Application: Nurses perceive patients as being more important than their disease; a patient is viewed as a collection of subsystems that form an overall behavioral system focused on meeting basic drives of achievement, affiliation, aggression/protection, dependence, elimination, ingestion, sex, and restoration. The goal of nursing is to help the patient attain/maintain balance, function, and stability in each of the subsystems.

Grand theory: Rogers/Parse/Newman

Behavioral system Application: Nurses view a patient as a unique, dynamic energy field in constant energy exchange with the environment; nursing care focuses on helping a patient use his or her own potential to identify and alter personal rhythms/patterns (e.g., eating, breathing, sleeping, communicating, touching) to promote and maintain health. Nurses understand that patients are responsible for their own health and that health stems from how patients live their lives in accordance with their own values; the nurse's role is to be truly present with the patient and accepting of his or her view of reality while providing guidance to the patient in making health-related choices in accordance with his or her belief system

Assumptions

Beliefs taken for granted without examination.

Grand theory: Watson

Caring Application: Nurses understand that caring is a fundamental component of professional nursing practice and is based on 10 carative factors (see Chapter 7). The purpose of nursing is to understand the interrelationship among health, illness, and human behavior rather than focus on the disease-cure model. Caring occurs when a nurse and patient engage in a transpersonal relationship that facilitates the patient's ability for self-healing

Middle-range theory: Eakes, Burke, and Hainsworth

Chronic sorrow Application: Nurses understand that the disparity between desired and actual reality often leads to continuous cycles of grief. For example, chronic sorrow sometimes occurs in parents of children with disabilities or in individuals diagnosed with a chronic illness.

Middle-range theory: Kolcaba

Comfort Application: Nurses facilitate health-seeking behaviors in patients by striving to relieve physical, emotional, social, environmental, and/or spiritual distress.

Grand theory: Levine

Conservation Application: Nurses promote balance between nursing interventions and patient participation to help patients conserve energy needed for healing; conserve structural integrity by limiting the extent of tissue involvement/damage; conserve personal integrity by involving them in their care decisions; and conserve social integrity by facilitating patient interactions with family and loved ones.

Feedback

Feedback serves to inform a system about how it functions. *For example, in the nursing process the outcomes reflect the patient's responses to nursing interventions *Patient successfully or unsuccessfully functions in the environment

Grand theory: King

Goal attainment Application: Nurses view a patient as a unique personal system that is constantly interacting/transacting with other systems (e.g., nurse, family, friends); nurses help patients become active participants in their care by working with them to establish goals for attaining, restoring, or maintaining health.

Grand theory

Grand theories intend to answer the question, "What is nursing" and focus on the whole of nursing rather than on a specific type of nursing.

Middle-range theory: Pender

Health promotion Application: Nurses understand that a patient's personal characteristics, experiences, and beliefs affect his or her motivation for adopting healthy behaviors.

Shared Theory: Developmental

Humans have a common pattern of growth and development.

Shared Theory: Stress/adaptation

Humans respond to actual or perceived threats by adapting to maintain function and life.

Input

Input for the nursing process is the data or information that comes from a patient's assessment. *Patient interaction with the environment, including interactions from the following domains: Psychological Physiological Developmental Sociocultural Environmental Spiritual

Grand theory: Erickson-Tomlin- Swain

Modeling/role modeling Application: Nurses understand a patient's model of the world or world view (e.g., how the patient thinks, acts, feels, communicates) and help a patient use internal and external resources to make appropriate changes (role modeling) to attain optimal health.

Practice theories

Narrow in scope and focus, these theories guide the nursing care of a specific patient population at a specific time.

Shared Theory: Human needs

Need motivates human behavior. Maslow's hierarchy of basic human needs includes five levels of priority (e.g., physiological, safety and security, love and belonging, self-esteem, and self-actualization)

Output

Output is the end product of a system; and in the case of the nursing process it is whether the patient's health status improves, declines, or remains stable as a result of nursing care. *Patient's health status for returning to the environment

Grand theory: Abdellah

Patient-centered care Application: Nurses address 21 "nursing problems" to meet patients' physical, psychological, and social needs and should strive to know each patient. Nurses use knowledge constructed from previous experiences to determine a general plan of care and then personalizes the plan to the patient to provide patient-centered care. A nurse should involve a patient's family in the plan of care.

Grand theory: Henderson

Principles and practice of nursing Application: Nurses assist patients with 14 activities (breathing, eating/drinking, elimination, movement/positioning, sleep/rest, clothing, body temperature, hygiene, safety, communication/socialization/play, practice of faith, learning) until patients can meet these needs for themselves; or they help patients have a peaceful death.

Middle-range theory: Benner

Skill acquisition Application: Nurses progress through five stages of skill acquisition: novice, advanced beginner, competent, proficient, and expert

Middle-range theory: American Association of Critical-Care Nurses

Synergy Application: Matching nurse competencies to patient needs in the critical care environment improves patient outcomes

Grand theory: Neuman

Systems Application: Nurses view a patient (physical, psychological, sociocultural, developmental, and spiritual) as being an open system that is in constant energy exchange with both internal and external environments. Nurses help a patient/client (individual, group, family, or community) cope with intrapersonal, interpersonal, and extra-personal stressors that can break through the patient's line of defense and cause illness. The role of nursing is to stabilize a patient or situation, and the focus is on wellness and prevention of disease.

Shared Theory: Psychosocial

Theory explains and/or predicts human responses within the physiological, psychological, sociocultural, developmental, and spiritual domains

Shared Theory: Biomedical

Theory explains causes of disease; principles related to physiology.

Shared Theory: Educational

Theory explains the teaching-learning process by examining behavioral, cognitive, and adult learning principles.

Shared Theory: Leadership/management

Theory promotes organization, change, power/empowerment, motivation, conflict management, and decision-making.

Nursing theory

Theory whose function is to characterize, explain, or predict phenomena (events) evident within nursing.

Middle-range theory: Mishel

Uncertainty in illness Application: Nurses facilitate patient coping and adaptation by performing interventions aimed at helping patients process and find meaning related to their illness.

The prospective nursing student is trying to decide on which nursing program to attend. She is examining the nursing philosophies of each program. She believes that the essence of nursing is "Caring." Which of the following theories would most likely meet her needs? a. Benner and Wrubel's theory of nursing b. Roy's adaptation theory c. Orem's self-care deficit theory d. Rogers' theory

a. Benner and Wrubel's theory of nursing

The nurse is caring for a patient who is known as a "frequent flyer," and who has been labeled as "noncompliant" by most of the staff because she does not follow her prescribed regimen for diabetes management. As a prescriber to Orem's theory, the nurse interviews the patient in an attempt to identify the cause of the patient's "noncompliance." This is because Orem's theory a. Is useful in designing interventions to promote self-care. b. Does not allow for environmental influences on care. c. Allows for development of a plan of care that the patient must follow. d. Is not useful in promoting self-care regimens.

a. Is useful in designing interventions to promote self-care.

The nurse is caring for a patient who is actively bleeding. The physician orders blood transfusions. The nurse notes in the chart that the patient is a Jehovah's Witness and informs the patient of the physician's order. The patient states that she is a Jehovah's Witness and does not want blood products. The nurse contacts the physician to tell him that blood cannot be given to this patient and requests alternative treatment. In doing so, the nurse is operating within which of the following theories? a. Leininger's cultural care diversity and universality theory b. Roy's adaptation theory c. Watson's philosophy of transpersonal caring d. Orem's self-care deficit theory

a. Leininger's cultural care diversity and universality theory

The nurse is visiting a patient at home after he was discharged from the hospital following a heart attack. She listens to the patient's concerns about being an invalid for the rest of his life because of his bad heart, but he is afraid of having "open heart" surgery. The nurse explains the different surgical procedures that are available to the patient, as well as other options such as cardiac rehabilitation. After several such visits, the patient states that he believes that car-diac rehabilitation therapy would be best for him, and asks the nurse how he can get in. The nurse calls the patient's physician and sets up a referral for cardiac rehabilitation. This action most closely fits which of the following theories? a. Peplau's theory b. Henderson's theory c. Nightingale's theory d. Orem's self-care deficit theory

a. Peplau's theory

The nurse researcher is evaluating whether holding pressure at an injection site after injecting the anticoagulant enoxaparin (Lovenox) will reduce bruising at the injection site. This study involves a prescriptive theory because it a. Tests a specific nursing intervention. b. Explains why bruising occurs. c. Is broad in scope and complex. d. Reflects a wide variety of nursing care situations.

a. Tests a specific nursing intervention.

Prescriptive theories

address nursing interventions for a phenomenon, guide practice change, and predict the consequences. Nurses use prescriptive theories to anticipate the outcomes of nursing interventions.

Nursing metaparadigm

allows nurses to understand and explain what nursing is, what nursing does, and why nurses do what they do. The nursing metaparadigm includes the four concepts of person (or human beings), health, environment/situation, and nursing.

Middle-range theories

are more limited in scope and less abstract. They address a specific phenomenon and reflect practice (administration, clinical, or teaching). A middle-range theory tends to focus on a concept found in a specific field of nursing such as uncertainty, incontinence, social support, quality of life, and caring rather than reflect on a wide variety of nursing care situations as the grand theories do.

Many aspects of nursing theory are based on developmental theories because human growth and development is believed to be a. Erratic and difficult to predict. b. An orderly predictive process. c. An orderly process until adulthood. d. Unpredictable during childhood.

b. An orderly predictive process.

The patient is newly diagnosed with diabetes and will be discharged in the next day or so. The nurse is teaching the patient how to draw up and self-administer his insulin. Which nursing theory is the nurse utilizing? a. Watson's philosophy of transpersonal caring b. Orem's self-care deficit theory c. Rogers' theory d. Henderson's theory

b. Orem's self-care deficit theory

The nurse is caring for a patient diagnosed with essential hypertension. The physician orders blood pressure medication that the nurse administers. The nurse then monitors the patient's blood pressure for several days to help determine the effectiveness of the administration. In doing so, the nurse evaluates which of the following system components? a. Input b. Output c. Feedback d. Content

b. Output

The type of theory that is used to develop and test specific nursing interventions is known as _____ theory. a. Grand b. Prescriptive c. Descriptive d. Middle-range

b. Prescriptive

As the initial model for nursing, Nightingale's "descriptive theory" encouraged nurses to a. Know all about the disease processes affecting their patient. b. Think about their patients and patients' environment. c. Combine nursing knowledge with medicine. d. Focus on medication administration and treatments.

b. Think about their patients and patients' environment.

The student nurse is learning nursing theories but fails to see how they relate to the nursing process. The professional nurse realizes that nursing theory a. Has a minor role in professional nursing. b. Requires the nursing process to develop knowledge. c. Can direct how a nurse uses the nursing process. d. is specific to certain patients only.

c. Can direct how a nurse uses the nursing process.

A system is made up of separate components. A closed system a. Interacts with the environment. b. Is exemplified by the human organism. c. Does not interact with the environment. d. Is exemplified by the nursing process.

c. Does not interact with the environment.

The patient is terminally ill and is under hospice care. The nurse cares for the patient by bathing, shaving, and repositioning him. The family believes that the end is very near and would like a Catholic priest called to provide the patient with the Sacrament of the Sick. The nurse places a call to the Catholic Church the patient attended and arranges for the priest's visit. Under which of the following theories does the nurse's care fall? a. Roy's adaptation theory b. Watson's philosophy of transpersonal caring c. Henderson's theory d. Orem's self-care deficit theory

c. Henderson's theory

The nurse is making rounds and finds her older adult patient sobbing and obviously upset. She states that her doctor told her that she has cancer, and she does not want to die. "What's the sense?" she says. "I might as well die. I'm going to anyway. I guess that shows how useless I really am. Nobody wants an old lady around." The nurse notices that the patient's respirations have increased, and the tip of her nose and ear lobes are becoming cyanotic. The nurse assesses the patient and finds that the patient's pulse rate is over 150 beats per minute. According to Maslow's hierarchy of needs, the nurse should first a. Call the physician to request a psychiatric consult. b. Reassure the patient that she has value as a human being. c. Place the patient on oxygen and try to calm her. d. Call the patient's family to help her realize that she is wanted.

c. Place the patient on oxygen and try to calm her.

Nursing has its own body of knowledge that is both theoretical and practical. Which of the following is an example of theoretical knowledge? a. Reflection on care experiences b. Synthesis and integration of the art and science of nursing c. Reflection on basic values and principles d. Creating a narrow understanding of nursing practice

c. Reflection on basic values and principles

The patient is admitted to the ICU to rule out a myocardial infarction (MI). During the admission process, the patient is noted to have a history of methicillin-resistant Staphylococcus aureus (MRSA) and is placed in isolation until cultures can be obtained and the patient declared noninfectious. During the isolation process, the nurse encourages family visits, real-izing that which level of Maslow's hierarchy of needs is at risk? a. First level b. Second level c. Third level d. Fourth level e. Fifth level

c. Third level

The nursing instructor is teaching a class on nursing theory. One of the students asks, "Why do we need to know this stuff? It doesn't really affect patients." The instructor's best response would be a. "You are correct, but we have to learn it anyway." b. "Exposure to theories will help you later in graduate school." c. "Theories help keep the focus of nursing narrow." d. "Theories help explain why nurses do what they do."

d. "Theories help explain why nurses do what they do."

The nursing process is a. The generation of nursing knowledge for use in practice. b. A systematic view of a phenomenon specific to inquiry. c. A method used to inform a system about how it functions. d. A systematic process for the delivery of nursing care.

d. A systematic process for the delivery of nursing care.

Phenomenon

describes an idea or responses about an event, a situation, a process, a group of events, or a group of situations. Phenomena may be temporary or permanent.

Descriptive theories

first level of theory development. They describe phenomena and identify circumstances in which the phenomena occur

Environment/situation

includes all possible conditions affecting patients and the settings in which their health care needs occur

Domain

the perspective or territory of a profession or discipline. It provides the subject, central concepts, values and beliefs, phenomena of interest, and central problems of a discipline. The domain of nursing provides both a practical and theoretical aspect of the discipline. It is the knowledge of nursing practice and nursing history, nursing theory, education, and research. The domain of nursing gives nurses a comprehensive perspective that allows you to identify and treat patients' health care needs in all health care settings.

Content

the product and information obtained from the system.

Nursing

the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations

Person

the recipient of nursing care, including individual patients, groups, cultures, families, and communities.

Key Points

• A nursing theory conceptualizes an aspect of nursing to describe, explain, predict, and/or prescribe nursing care. • Grand theories provide complex structural frameworks for broad, abstract ideas. • Middle-range theories address specific phenomena or concepts and reflect practice. Thus they are more limited in scope and less abstract. • Practice or situation-specific theories bring theory to the bedside by focusing on specific types of patients in specific situations. • The metaparadigm of nursing identifies four concepts of interest to the profession: the person, health, environment/situation, and nursing. These four components are essential to the development of nursing theory. • Theory generates nursing knowledge used in practice. Nurses use the nursing process to apply the theory or knowledge. The integration of theory and nursing process is the basis for professional nursing. • Theory-generating research discovers and describes relationships without imposing preconceived notions (e.g., hypotheses) of what the phenomenon under study means. • Theory-testing research determines how accurately a theory describes nursing phenomena.