Unit 2: Chapter 8 Theoretical and Conceptual Frameworks

Conceptual models of nursing definition

- formal explanation of nursing practice - models have more impact on nursing education and clinical practice than on research

Health Belief Model

- framework for explaining people's health related behavior, such as compliance with a medical regimen - health related behavior is influenced by person's perception of a threat posed by a health problem and the value associated with actions aimed at reducing the threat - also includes concept of self-efficacy

Conceptual framework definition

- framework of a study that is based on a conceptual model - also has same definition as conceptual model

Critiquing frameworks in qualitative studies

- grounded theory: may not have enough information to refute proposed theory because only evidence supporting theory presented - phenomenological: look for the philosophy of phenomenology

Transtheoretical Model

- looks at stages of change, conceptualizes continuum of motivation readiness to change problem behaviors - argues that successful self changers use different processes at each stage - supports interventions that are individualized to person's stage of readiness for change

What does the building of a theory depend on?

- observable evidence and theorist's ability to make sense of evidence - theories are tentative, not just out there waiting to be discovered

Theory of Planned behavior

- offers framework for understanding people's behavior and its psychological determinants - behavior that is volitional is determined by people's intentions to perform that behavior - intentions are affected by attitudes toward behaviors, subjective norms, and perceived behavioral control - i.e. can use framework for study of pregnant women's intentions toward physical activity and resting behavior

Critical theory

- paradigm that involves a critique of society, societal processes, and structures - used as framework in qualitative studies

Concept analysis

- process of analyzing a concept with the aim of identifying the boundaries and definitions of the concept - i.e. trying to conceptually define "spiritual care" in nursing

Qualitative researchers and frameworks

- qualitative researcher more likely to identify framework than quantitative - framework is usually part of research tradition - i.e. ethnographers begin with study of culture

Theory and relationship with research

- research and theory have reciprocal relationship, plays dual and continuing role in theory building and testing - through research, theories evolve (tested via hypothesis) and sometimes discarded - theories are built inductively from observations, research is a source for observations

When are theoretical linkages that are contrived most likely to occur?

- researchers first formulate research problem and then later find a theoretical context to fit it - if research problem linked to a conceptual framework then design of study, measure of key constructs, and analysis/interpretation of data will flow from that conceptualization

Critiquing Frameworks of quantitative studies

- see if study has an explicit conceptual framework - if doesn't mention theory, model or framework need to consider if this diminishes value of the study - if study involves test of a hypothesis or complex intervention without formal framework, suggests conceptual fuzziness - if does have explicit framework, can assess appropriateness and whether link between problem and theory is genuine

Grounded research theories

- symbolic interaction - try to hold prior substantive theory about the phenomena in suspension until their own theory emerges (similar to phenomenologists) - goal is to develop understanding of a phenomena that is grounded in actual observations - often develop concept maps to illustrate how social or psychological processes unfolds

Framework definition

- the conceptual underpinning of a study - every study has a framework, but not every study is based on a theory or model - studie's framework usually not formally described/acknowledged (implicit)

Using Theories in Qualitative Research

- theory is embedded in the research tradition being used (i.e. ethnography or phenomenology) - some researchers use atheoretical stance, goal is to suspend prior conceptualizations (substantive theories) that might bias their inquiry

Grand theory/Macrotheory

- theory that explains large aspects of human experiences  - i.e. explanation of the whole of nursing - ex: Parse's Humanbecoming Paradigm

Middle Range Theories

- theory that explains specific aspect of human experience - i.e. stress, comfort, health promotion - are more specific and amenable to empirical testing than grand theories

Roy's Adaptation Model

- type of conceptual model of nursing - humans viewed as biopsychosocial system that cope with environmental change through process of adaption - 4 subsystems of human system: physiologic/physical, self concept/group identity, role function, and interdependence - subsystems constitute adaptive modes that provide coping mechanisms - goal of nursing: promote client adaptation

Mishel's Uncertainty in Illness Theory

- type of middle range nursing theory - focuses on concept of uncertainty (inability of a person to determine meaning of illness related events) - people develop subjective appraisals to assist them in interpreting experience of illness and treatment and use resources to adapt to situation - uncertainty occurs when people are unable to recognize and categorize stimuli, results in inability to have clear conception of a situation

2. Schematic Models (conceptual maps)

- visually represent relationships among phenomena - are used in quantitative and qualitative research - concepts and linkages between phenomena depicted graphically through boxes, arrows, or other symbols

Theoretical framework definition

framework of a study that is based on theory

Subjective norms definition

perceived social pressure to perform or not perform the behavior

Theory definition in nursing education

refers to content covering in classrooms as opposed to actual nursing practice

Ideational theories

suggests cultural conditions stem from mental activity and ideas

Materialistic theories

views material conditions (i.e. resources, production) as the source of cultural developments

Substantive Theory

conceptualizations of a specific phenomena under study

Using Theories in Quantitative Research

*1. may test hypotheses deduced from an existing theory* *2. test theory based interventions* - theories have implications for influencing people's attitude or behavior and hence their health outcomes - intervention rarely effects outcome directly - i.e. develop intervention based on social cognitive theory and argue that improvement in patient's self efficacy will result in positive change in health behaviors and health outcomes *3. May use theory to provide an organizing structure* - researchers assume model they espouse is valid and uses it's schemes to provide an interpretive context *4. Use findings from prior research to develop an original model* - model may incorporate elements or constructs from an existing theory *5. Fitting a problem into theory after the fact* (not recommended)

Shared Theories & Models

- Bandura's Social Cognitive Theory - Prochaska's Transtheoretical Model of Change - Becker's Health Belief Model (HBM) - Ajzen's Theory of Planned Behavior (TPB) - Lazarus & Folkman's Theory of Stress & Coping - Bowlby's Attachment Theory - Grit by Duckworth * - Kurt Lewin's Model of Change - Diffusion of Innovations by Rodgers

Middle range theories developed by nurses

- Beck's Theory of Postpartum depression - Pender's Health Promotion Model - Mishel's uncertainty in Illness Theory

Where do I find the theory or framework in articles?

- In the introduction - In the literature review - After the research questions or hypotheses - In a separate section

Health Promotion Model

- Middle range theory developed by nurses - focusing on explaining health promoting behaviors (i.e. wellness orientation) - contains propositions that can be used in developing and testing interventions and understanding health behaviors

Commonalities of theories and conceptual models

- Use concepts as building blocks, require conceptual definitions of concepts - Can be represented in a schematic model - Are created by humans, developed inductively (reasoning from specific examples to a general conclusion) - Cannot be proven, are supported to a greater or lesser degree. - Can be used to generate hypotheses, serve as a stimulus to research

Model definition

- a symbolic representation of concepts or variables and interrelationships among them - minimal use of words, can convey different meanings to different people

Descriptive theory

- a theory that describes a phenomenon - are inductive and based off of *observation* - describes characteristics of individuals, groups, or situations by summarizing their commonalities - important for qualitative studies

Theory definition

- abstraction that explains a phenomena and how they are interrelated - consists of 2 or more concepts and a set of propositions that provide a mechanism for deducing hypotheses - i.e. reinforcement theory says if behavior rewarded will be repeated, can hypothesize that children rewarded for quiet play will have fewer acting out behaviors

Ethnography and theories

- bring cultural perspective to their studies which shapes their fieldwork - cultural theories: behaviors, ideas, and materials that support the culture

Theories and phenomenologist studies

- committed to theoretical naiveté - try to hold pre-conceived views of the phenomena in check - guided by framework that focuses their inquiry on certain aspects of a person's lifeworld (i.e. lived experiences)

Conceptual model

- deals with abstractions (concepts) that are assembled into a scheme because of their relevance to a common theme - Provide a conceptual perspective on interrelated phenomena - are more loosely structured than theories and do not link concepts in logical deductive system (both still explaining phenomena) - Can serve as springboards for generating hypotheses

1. Statistical Models definition

- equations that mathematically express relationships among a set of variables - are tested statistically

Bandura's social cognitive theory (self efficacy theory)

- explains human behavior using concepts of self-efficacy, outcome expectations, and incentives - *self-efficacy*: people's belief in their capacity to carry out a behavior (i.e. stop smoking) - self efficacy expectations determines the behaviors a person chooses to perform, their degree of perseverance, and quality of performance - i.e. does self efficacy determine physical activity maintenance in cancer survivors after physical activity intervention

Guidelines for critiquing theoretical and conceptual frameworks of quantitative studies

1. Did the report describe a theoretical or conceptual framework for study? 2. Did report explain the major features fo theory or model? 3. Is theory or model appropriate for the research problem? (is there a link between problem and framework) 4. Was theory used for generating hypotheses or used as organizational or interpretive framework 5. Were concepts/interventions defined consistent with theory 6. Did framework guide study method? (i.e. quantitative v.s. qualitative) 7. Did researcher tide study findings back to framework?

Four concepts central to conceptual models of nursing

1. Human beings 2. Environment 3. Health 4. Nursing

Symbolic Interaction (3 underlying premises)

1. Humans act towards things based on the meanings that the things have for them 2. The meaning of things is derived from the human interactions 3. Meanings are handled in and modified through an interpretive process

Types of cultural theories

1. Ideational Theories 2. Materialistic Theories

5 Stages of Change according to Transtheoretical Model

1. Pre-contemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance

2 Types of Models

1. Statistical Models 2. Schematic Models

Conceptual integration

Occurs when... - research question fits chosen methods and consistent with existing evidence - there is plausible conceptual rationale for expected outcomes, hypotheses, and interventions

Classical Theory

abstract generalization that explains relationships among phenomena

Heath promotion definition according to Health promotion Model

activities directed toward developing resources that maintain or enhance a persons well being

Perceived behavioral control definition

anticipated ease or difficulty of engaging in the behavior

Shared theory definition

borrowed theory (theory from another discipline) that is tested and found to be empirically adequate in health relevant situations