Critically appraise the relationship between theory, research, and evidence-based practice
Weekly Objectives:
Critically appraise the relationship between theory, research, and evidence-based practice (CO 2).
Apply a theoretical framework to support an evidence-based practice change (CO 2).
Main Topics and Concepts:
Relationship Among Theory, Research, and Practice
Required Reading:
Butts, B. J. & Rich, L. K. (2018). Philosophies and theories for advanced nursing practice (3rd ed.). Jones & Bartlett Learning. Chapters 25, 26
Recommended:
Dwyer, T., Craswell, A., Rossi, D. & Holzberger, D. (2017). Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service. BMC Health Services Research, 17(33), 1-11. https://doi.org/10.1186/s12913-017-1977-x
Morone, J. (2017). An integrative review of social determinants of health assessment and screening tools used in pediatrics. Journal of Pediatric Nursing, 37.2. https://doi.org/10.1016/j.pedn.2017.08.022
Schierhour, G., Hains, J., Si, D., Kennedy, C., Cox, R., Kwedza, R., O”Donoghue, L., Gittock, M., Brands, J., Longergan, K., Dowden, M., & Bailie, R. (2013). Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change. Implementation Science, 8, 1-16. https://doi.org/10.11.1186/1748-5908-8-119.
Week 7: Relationship Among Theory, Research, and Practice
Table of Contents
Introduction
In applied healthcare disciplines, such as nursing, practice is based on theories that have been identified and validated through research. Thus, practice, theory, and research affect each other in a circular, cyclic, and interactive way (Melnyk & Fineout-Overholt, 2011; McEwen & Wills, 2014).
Research is the key element in developing the nursing discipline.
Theories can be identified and tested in practice settings through research.
Theories guide nursing practice, as well as provide insights into situations for the assessment, diagnosis, and patient-care interventions.
Theories render practice more effective and efficient to benefit patient care.
Theories stimulate nurse scientists to explore significant problems in the field of nursing.
Research modifies and validates theories.
Approaches to Theory Development
Many strategies are used to develop, modify, or expand theories in nursing practice (Parker & Smith, 2015). Open the activity below to view approaches to theory development.
Approaches to Theory Development
Many strategies are used to develop, modify, or expand theories in nursing practice (Parker & Smith, 2015).
Approaches to Theory Development (Links to an external site.)
Transcript
Approaches to Theory Development
Theory-Practice-Theory
The theory-practice-theory approach assumed that the nurse researcher constructs an approach to theory according to a personal experience, educational experience, or as an attempt to describe a phenomenon of interest (Melnyk & Fineout-Overholt, 2011; McEwen & Wills, 2014). This approach assumes that the theory can assist in describing a phenomenon of interest, but it is not yet fully explored or defined in nursing practice. This means that the phenomenon of interest is examined and developed through prior knowledge of theories borrowed from another discipline. The nurse researcher could modify concepts or consider associations among different concepts that were not addressed in the original theory. To accomplish this, the nurse researcher would need to do the following.
Have an understanding and/or basic knowledge of the borrowed theory.
Analyze and evaluate each component of the borrowed theory.
Use assumptions to describe the phenomenon under interest.
Redesign assumptions to reflect nursing practice.
Reconstruct the theory using exemplars representing and redesigning new assumptions and concepts.
(Parker & Smith, 2015)
Practice-Theory
If there is no conceptual framework or theory from another discipline to describe or explain a phenomenon, nursing theories can be developed from clinical-practice situations (Melnyk & Fineout-Overholt, 2011; McEwen & Wills, 2014). In the practice-theory approach, it is assumed that nursing theory evolves directly from observation of nursing practice and encounters. The nurse researcher observes the new phenomenon of interest in the practice setting and develops new concepts in the practice area. Categories emerge and are linked together in a meaningful way (Parker & Smith, 2015).
Research-Theory
The research-theory approach is the most accepted strategy for theory development in the nursing profession because of its emphasis on research findings. Theory development is considered a product of research knowledge because the theories are evolved from confirmed research findings (Melnyk & Fineout-Overholt, 2011; McEwen & Wills, 2014). In this approach, the nurse researcher selects a phenomenon that occurs in the discipline and lists characteristics of the phenomenon. A science of knowledge about a particular nursing field is recognized and accepted. A nursing research project that focuses on a manageable number of variables with patterns that are easily detectable and allow for hypothesis testing can be generated. Data is collected and used to verify research hypotheses (Parker & Smith, 2015).
Theory-Research-Theory
In the theory-research-theory approach, theory is what drives the research questions, and the results of the research studies are used to modify or enhance the theory. In this process, a theory is selected to explain the phenomenon under interest (Melnyk & Fineout-Overholt, 2011; McEwen & Wills, 2014). The theory is the framework for operational definitions, variables, and research statements. Concepts are operationalized for research. Findings are synthesized and used to modify, redefine, or develop the original theory. The goal is to test, redefine, and develop theory and to use theory as a framework for research and theory modification (Parker & Smith, 2015).
Integrated Approach
An integrated approach to theory development describes a process useful in addressing clinical situations. It requires gathering of data from the clinical environment, identification of exemplars, discovery of solutions, and recognition of supportive information from other sources (Melnyk & Fineout-Overholt, 2011; McEwen & Wills, 2014). Integrated theory development is rooted in clinical practice. Practice drives the basic questions and provides opportunities for clinical involvement in research that is designed to answer the questions. In this process for theory development, conceptual ideas are communicated with other clinicians or participants to allow for critique and further development. The integrated approach uses skills and tools from clinical practice, various research methods, and journals in developing a framework (Parker & Smith, 2015).
Relationship Between Research, Theory, and Philosophical Schools of Thought
The relationship between research and theory poses several interesting questions that do not have easy answers. Instead, the viewpoint of the individual asking the question becomes a major element in the answer of the relationship between research and theory. To explore the application of theory to research, the following information is considered.
Research is a critical process or method used by the nursing profession to acquire new knowledge related to its paradigms. To explain the role of theory in research, the initial step is to review the philosophical foundation of the two research methodologies used by all researchers, including nurse researchers (Parker & Smith, 2015).
Quantitative research is based on the received philosophical school of thought (i.e., logical empiricism or positivism). Within quantitative research, the highest values are placed on numerical data gathered through rigor, objectivity, and control. The ultimate goal is to determine a cause-and-effect relationship between variables. Recently, quantitative nurse scholars have been expanding beyond the rigid causal quantitative research methods to include the determination of patterns and trends to describe, explain, and predict phenomena (McEwen & Wills, 2014).
Qualitative research is based upon the contrasting perceived school of philosophical thought. Within this philosophical school, a systemic, interactive, and subjective approach is used to describe and understand human experiences. Nurse scholars using the qualitative research methods believe that knowledge (or truth) is complex and dynamic and can be determined only by studying individuals within their naturalistic settings. In other words, to separate a person from his or her settings by the rigid control of variables will provide an incomplete and inaccurate picture of the individual living with a chronic illness or some other phenomenon (Parker & Smith, 2015).
There is a complimentary relationship between theory and research. Research conducted with either philosophical school of thought can clarify, modify, and/or extend a nursing theory. Basically, there are three different ways the complementary relationship between nursing theory and research occurs. These include the following:
research ideas and studies that are generated from theory;
research that tests published theoretical concepts and relationships; and
research studies that generate or produce theory.
Using a Nursing Theory as a Framework for Evidence-Based Practice
As is evident in this week’s readings, theory, practice and research are interrelated within the nursing profession. As research efforts continue to expand nursing knowledge, efforts to translate research into practice are essential to optimize health outcomes. Nursing theories provide a necessary framework for the translation of evidence into practice, offering insight, perspective, and outcome-focused value (McEwen & Wills, 2014).
Across healthcare, application of theoretical frameworks offers a systematic approach and meaningful context for evidence-based practice (EBP). To assure effective application, the framework selected must be relevant to practice and in alignment with the overarching purpose and desired outcomes. For example, as master’s prepared nurses establish clinical practice guidelines based upon research findings, the use of a nursing theory provides a context and foundation upon which to ground the EBP (McEwen & Wills, 2014). Similarly, for master’s prepared nurses who lead planned change to improve health care quality and outcomes within an organization, use of theory offers a tangible framework for the execution of the project (Kearney-Nunnery, 2016).
In addition, the specific theory which is used as a framework can serve to substantiate key concepts which are present quality initiatives or situation-specific practice guidelines (Stevens, 2013; Kearney-Nunnery, 2016). For example, a nurse educator creating a faculty mentoring program may use Benner’s Novice to Expert Theory as a framework for the project due to alignment with the concepts surrounding professional growth and development.
Master’s prepared nurses are pivotal to the translation of evidence into practice. By selecting and applying appropriate theoretical frameworks to guide EBP, nurses can facilitate outcome achievement for patients, families, health care professionals, and health care organizations.
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