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Nursing theory across curricula: A status report from midwest nursing schools
Nursing Theory Across Curricula: A Status Report From Midwest Nursing Schools DONNA L. ALGASE, PHD, RN, FAAN,* SARAH E. NEWTON, PHD, RN,† AND PATRICIA A. HIGGINS, PHD, RN‡
This article reports on an informal survey conducted for the Theory Development Section of the Midwest Nursing Research Society. Its purposes were to describe current practices in teaching nursing theory at three levels of curricula and to compare these practices between nursing programs in liberal arts colleges and research universities, between schools with and without doctoral programs, and between faculty with nursing and nonnursing doctorates who teach nursing theory. Findings indicate greatest consistency of practices at baccalaureate and doctoral levels, though few baccalaureate programs have required courses in nursing theory. Few differences were found between types of schools, but faculty with nursing doctorates tended to emphasize theory-practice linkages at the baccalaureate level. Further study that uses this work as a platform is suggested. (Index words: Nursing theory, curriculum, nursing education) J Prof Nurs 17:248-255, 2001. Copyright © 2001 by W.B. Saunders Company
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HE DEVELOPMENT OF NURSING theory is central to the evolution of the discipline, profession, and practice of nursing. So central is the importance of nursing theory that no topic in the history of nursing has probably engendered more discussion and debate. From the origin of the term in the 1960s to the present day, diverse meanings and perspectives characterize dialogues and writings about nursing theory. Surprisingly, despite this acknowledged importance and competing points of view, no accepted set of competencies pertaining to nursing theory exists for graduates at each level of nursing curricula. Unlike nursing research, for which the American Nurses Association (ANA) has promulgated such competencies (ANA *Professor, University of Michigan, Ann Arbor, MI. †Assistant Professor, Oakland University, Rochester, MI. ‡Assistant Professor, Case Western Reserve University, Cleveland, OH. Address correspondence and reprint requests to Dr. Algase: University of Michigan, 400 North Ingalls, Room 2160, Ann Arbor, MI 48109-0482. Copyright © 2001 by W.B. Saunders Company 8755-7223/01/1705-0010$35.00/0 doi:10.1053/jpnu.2001.26305 248
Commission on Nursing Research, 1981), specifications for theory-related knowledge and competencies appropriate to each level of nursing curricula have not been promoted. Neither the National League for Nursing (Baccalaureate and Higher Degree Programs in Nursing, 1997) nor the American Commission on Collegiate Nursing Education (1998) has addressed this topic in their accreditation guidelines. The American Association of Colleges of Nursing (AACN, 1996a), in its monograph on the essentials of master’s education, has specified that graduates of master’s programs “should be prepared to critique, evaluate, and utilize appropriate theory within one’s practice” (p. 10). However, the AACN has not delineated a parallel set of outcomes in their corresponding publication on baccalaureate education (AACN, 1996b). Without a set of appropriate, professionally established competencies, the general expectations for graduates as related to nursing theory are unclear at all levels of nursing education. Further, no fundamental knowledge about nursing theory can be assumed of graduates, and even basic competencies, such as use of a common language with agreed on terms and definitions are uncertain. These basics are essential for coherent and intelligent debate from which advances in our discipline can continue to emerge. This article reports on an informal survey conducted to explicate extant practices pertaining to the teaching of nursing theory in a group of Midwestern nursing schools. Our intention was to determine if sufficient commonality exists as a basis for suggesting theoryrelated competencies across three levels of nursing curricula and to identify areas in which diverse practices prevail so that clarification and standardization can be sought.
Background
This project originated from a discussion in the Theory Development Section of the Midwest Nursing Research Society (MNRS). MNRS is a 1,300-member
Journal of Professional Nursing, Vol 17, No 5 (September–October), 2001: pp 248-255
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organization of nurse scientists and scholars that promotes the dissemination and utilization of nursing research, both within and outside its 13-state Midwest region (MNRS, 1999). Members of the Theory Development Section are self-identified as interested in the development and teaching of nursing theory. During the 1998 meeting, section members concurred that the scope and depth of theoretical developments in nursing had evolved considerably in recent years to include various levels of nursing theory (e.g. Blegen & TrippReimer, 1997; Cody, 1999; Good & Moore, 1996; Lenz, Suppe, Gift, Pugh, & Milligan, 1995) and extensions to the philosophic basis of our discipline (e.g. Meleis, 1996; Rawnsey, 1998; Reed, 1995; 1997; Schumacher, 1992). However, beyond each member’s individual institution, we had little general knowledge of what outcomes and approaches guided current teaching of nursing theory across levels of curricula and whether or not various types of schools and faculty were incorporating these recent advances into their programs. Thus, the group sanctioned an informal survey and report from its membership to examine systematically current practices in teaching nursing theory within academic institutions represented by its members. A subsequent search of the literature revealed surprisingly few articles with a focus on collegiate teaching of nursing theory. Acknowledging that nursing theory has its skeptics, Levine (1995) argued for the importance of including nursing theory, which she called the intellectual life of nursing, in nursing curricula. She identified a frequent failure of students to embrace nursing theory and attributed this to a failure of the faculty to fully grasp the importance of nursing theory and to make the difficult transition for students from the possibilities of a theory to its relevance for education and practice. Although she advocated that theory should be taught at every level of nursing education and offered approaches to overcoming shortfalls in teaching nursing theory, she did not address specifically desired competencies for any given level of student. Based on 15 years’ experience in teaching nursing theory, Jacobs-Kramer and Huether (1988) explicated then current practices for teaching nursing theory at various curricular levels. They defined nursing theory as “theory about the discipline and nature of nursing” and, further, nursing meta-theory as being “about the features and purposes of nursing theory that are appropriate for the discipline” (p. 373). These investigators acknowledged a lack in documented evidence pertaining to the extent of nursing theory taught at the bacca-
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laureate level. They also reported that their experience with baccalaureate graduates reflected the use of multiple frameworks structuring basic nursing curricula, but a general lack of knowledge and skill about nursing theory among these graduates. On the other hand, they asserted that standards for the inclusion of nursing theory were best documented at the graduate level. Content on nursing theory and theory analysis were identified as commonly introduced at the master’s level. Based on informal reviews of course syllabi from multiple nursing masters’ programs, a marked similarity in content was noted. These courses commonly included content on major nurse theorists and their models and skills in the analysis and critique of theory. These investigators also believed that there was a consensus on the content focus pertaining to nursing theory at the doctoral level, that being knowledge development. Meleis and Price (1988) offered a most cogent discussion of the topic by reframing it more broadly from the teaching of nursing theory to the teaching of theoretical thinking in nursing. They proposed components of theoretical nursing and delineated pertinent knowledge for each degree level from baccalaureate to doctoral. In general, expectations for baccalaureate education were an appreciation and awareness of theoretical nursing and an ability to implement it in practice. Particularly, this expectation included knowledge of schools of thought in nursing, of frameworks guiding the curriculum, of central concepts as frameworks for practice, and of assessment and intervention strategies for a nursing situation congruent with a given theoretical context. Expectations for master’s education included the ability to analyze and synthesize theory. These expectations were determined to include knowledge of interdisciplinary underpinnings of nursing, appreciation of the process of theory development, analysis of domain concepts within a field of nursing specialization, comparison of various theories in relation to a specific clinical question, critical use of theory, identification of nursing phenomena, and the ability to develop and/or derive concepts. Finally, the general expectation for doctoral education was to develop, critique, and test theory. Specific knowledge domains included philosophic underpinnings of theories, critical assessment of nursing domains (including redefining of boundaries, development of parameters for new missions, and extension of theory), development of new theories from practice and research, and use of advanced theory development strategies. The balance of literature identified and reviewed addressed either general approaches or more particular strategies for teaching nursing theory, either as a
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curricular component or thread or within a dedicated course (Batra, 1987; Fontes, 1994; Frank, 1994; Hautman, 1997; Murphy, 1991; Slaninka, 1999). Articles that highlighted particular strategies reflected a creative array of ideas for conveying abstract information in a concrete and meaningful way. Although interesting, these articles were generally limited in their scope and applicability and were not particularly useful in illuminating the larger question of the status of nursing theory across curricula or in delineating necessary competencies for graduates at each level. Specific examples of competencies in relation to nursing theory were reported in only one article and these related to doctoral education. In this example, doctoral students are expected to develop, test, synthesize, and expand theory to guide practice (LaMontagne, Pressler, & Salisbury, 1996). These investigators specified the theory-related competencies for this program as manifesting abstract and theoretical thinking; analyzing and critiquing assumptions that direct knowledge development; showing knowledge and analysis of philosophic bases of nursing knowledge; analyzing theoretical literature critically; articulating historic, current, and prospective views of the discipline; and analyzing ethical and sociopolitical issues that are central to the discipline of nursing. The results of this literature review support a reassessment of nursing theory taught in collegiate nursing programs as a timely undertaking. Previous assessments were more than a decade old and, though based on experience and expert opinion, were not systematic or empirically based. The meaning of “nursing theory” reflected in these works was often equated with conceptual models of well-known nurse theorists, such as Orem, Rogers, or Roy, and did not clearly encompass current thinking about nursing theory. Data from nursing programs themselves also were absent in the literature. In designing this project, the authors set out to address two major aims. The first was to compare, at three program levels, requirements for nursing theory courses and credits, and content taught about nursing theory; teaching and evaluations strategies used to convey this content; and emphasis placed in the curriculum on linkages of nursing theory to practice, research, and education. We also aimed to compare these strategies between nursing schools in liberal arts colleges and research universities, between schools with and without doctoral programs, and between faculty with
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nursing and nonnursing doctorates who teach nursing theory. Methods
An informal survey of MNRS Theory Development section members was conducted to describe and compare nursing theory issues across baccalaureate, master’s, and doctoral programs in two types of institutions: 4-year colleges that specialize in undergraduate education and research universities. Although authorization for this work limited its scope, we sought to maximize exploration of this relatively unknown topic by using a snowballing method to reach other faculty within the schools encompassed by section members. Because faculty teaching at one level of the curriculum may be relatively unfamiliar with courses at other levels, we thought that multiple respondents from a given school would give a more complete picture of the school’s practices. Therefore, each current member of the Theory Development Section (n ⫽ 57) received a one-time mailing containing five copies of the questionnaire and self-addressed stamped envelopes for their return. Members were asked to complete one copy independently. Section members also were asked to distribute copies of the survey to colleagues who did not receive the mailing but who teach nursing theory at their school. Return of the completed questionnaire constituted consent to participate and to use grouped data in reports. QUESTIONNAIRE
After no suitable instrument could be located, a questionnaire was developed based on ideas generated by members at the 1998 MNRS Theory Section meeting and further informed by issues and examples identified in the literature review. As a first attempt at tool development, our goal was to create a questionnaire that would assess how nursing theory is taught and how it is reflected in the curricula of baccalaureate, master’s, and doctoral programs. A secondary purpose was to elicit descriptive information about the faculty and schools to be used for grouping purposes in planned analyses. The two developers of the questionnaire are experienced in the area of nursing theory. Each has a doctoral degree in nursing, teaches nursing theory at the master’s and/or doctoral level, and has published articles related to various aspects of nursing theory. The questionnaire was also reviewed by two individuals with similar backgrounds. Thus, a panel of experts in nurs-
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ing theory developed and assessed the questionnaire for content validity. The resulting questionnaire was structured into six main sections. Three sections were organized to address aspects of a course (i.e., objectives and content [13 items], teaching strategies [8 items], assignments and evaluation practices [12 items]). The other three sections addressed questions of how the curriculum linked theory to practice (6 items), to education (4 items), and to research (5 items). A sample item for practice linkages is: indicate if your school’s curriculum addresses the idea of theory as a guide to assessment. Similarly, for the education linkages, indicate if your school’s curriculum is structured by a specific nursing theory. And, finally, for research linkages, indicate if your school’s curriculum addresses theorydriven measurement. Cronbach’s alpha for the six segments of the questionnaire averaged .78 and ranged from .61 for evaluation methods to .88 for practice linkages. Respondents answered yes or no to each item as it pertained to its inclusion at each level of curricula with which they were familiar at their school. In addition, information on courses and credits allotted to nursing theory, whether structured as discrete courses or integrated within other courses, was sought for each level of curricula. Demographic and descriptive information about respondents and schools were contained in a final section of the questionnaire. Respondents also were asked to include objectives for discrete theory courses, but few actually did. Data were analyzed by using descriptive statistics, Chi-square, and ANOVA techniques.
Results RESPONDENTS
There were 51 respondents who identified affiliation with 22 different Midwestern schools of nursing. The number of respondents per school ranged from 1 to 5. By comparison, a review of the section membership list revealed that 42 members were associated with 27 schools in three countries, but remaining members could not be associated with a specific school. The majority of respondents (63 per cent) were faculty from research universities; another 24 per cent indicated they taught at a liberal arts college. Twenty-two respondents (43 per cent) taught at a school of nursing with a doctoral program. The educational preparation of respondents varied; 56 per cent held a nursing doctorate, 32 per cent had a
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nonnursing doctorate, and 12 per cent had completed their education with a master’s degree. A statistically significant difference was observed in the respondents’ years of graduation from their terminal degree programs. Results from an analysis of variance (ANOVA) test revealed that, on average, respondents with nursing doctorates had graduated most recently (M ⫽ 1991, P ⬍ .0001), followed-up by respondents with nonnursing doctorates (M ⫽ 1984), and those with a master’s degree (M ⫽ 1978). Faculty with nursing doctorates (37.5 per cent) were more likely than those with nonnursing doctorates (12.5 per cent) to teach in liberal arts colleges, but this association did not reach significance (2 ⫽ 2.7, P ⫽ .08). Among all respondents, 17 had taught nursing theory at the baccalaureate level, 31 at the master’s level, and 11 at the doctoral level. A clear majority of respondents (92.2 per cent) were currently teaching nursing theory. Twelve (23.5 per cent) respondents described themselves as currently developing a nursing theory, 17 (33.3 per cent) as active in meta-theoretical issues, 29 (56.9 per cent) as publishing theory-related papers, and 12 as members of a nursing theory group other than MNRS. Faculty teaching nursing theory at the baccalaureate level are not likely to teach at the master’s (2 ⫽ 4.74, P ⫽ .03) or doctoral level (2 ⫽ 3.58, P ⫽ .06). No differentiation was found between master’sand doctoral-level faculty.
COMPARISONS OF NURSING THEORY AS TAUGHT ACROSS THREE LEVELS OF CURRICULA
Respondents indicated that discrete courses in nursing theory were included in 34 per cent of the baccalaureate programs represented, 98 per cent of the master’s programs, and 100 per cent of the doctoral programs. Further, nursing theory content was integrated in 95 per cent of the baccalaureate programs, 70 per cent of the master’s programs, and 73 per cent of the doctoral programs. The extent to which discrete nursing theory courses were required varied across programs. Fourteen (29.6 per cent) respondents indicated that their baccalaureate programs required 1 to 4 credits of course work (mode ⫽ 2–3 credits), 34 indicated that their master’s program required 2 to 6 credits (mode ⫽ 3 credits), and 17 indicated that their doctoral programs required 2 to 12 credits (mode ⫽ 6 credits). Data about 13 content areas is summarized in Table 1. All content areas were taught in some portion of represented programs and respondents named no additional content areas. However, the percentage of re-
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TABLE 1. Ranking of Content Areas and Per Cent of Programs Containing Content by Program Level Content Area
Baccalaureate
Nursing as a science Nursing as a discipline Grand theories Practice-level theory Middle range theories Borrowed vs. discipline-specific theories Nursing as an applied vs. basic science Theory as content vs. structure vs. process Philosophy of science Empirical theory development strategies Other theory development strategies
Master’s
Doctoral
Rank
%
Rank
%
Rank
%
1 2 3 4 6 8 9 10 11 12 12
88 86 76 69 56 51 49 38 15 12 12
2 2 4 9 1 6 7 12 10 11 13
95 95 91 86 98 90 88 69 79 77 65
1 8 10 10 1 7 8 12 1 1 1
100 90 85 85 100 94 90 83 100 100 100
spondents indicating inclusion of each content area varied by level of the curriculum. As reflected in these percentages, variation in the range of included content decreases as curricula advance. In other words, there was greater agreement as to content areas to be taught at higher levels of the curriculum Data about the use of eight teaching strategies is contained in Table 2. All strategies were used to some extent in represented programs and respondents named no additional strategies. Although the percentage of respondents indicating use of each strategy varied by level of the curriculum, seminars and group activities were used widely and consistently at all program levels. Data pertaining to 12 evaluation methods are displayed in Table 3. All methods but two were used in represented programs and no additional evaluation methods strategies were identified. The use of each evaluation method varied by level of the curriculum. Top-ranking evaluation methods used in baccalaureate programs were bottom-ranking methods in doctoral programs and vice versa. At the master’s level, the picture was more mixed. Data about theory-practice linkages revealed differing areas of emphasis at each program level. In most baccalaureate curricula, emphasis was placed on using
nursing theory as a general orientation to or frame of reference for practice (80 per cent) and as a framework for problem identification (79 per cent). In most master’s curricula, these same uses of theory were also strongly emphasized (92 per cent each), but most master’s programs also addressed theory as a guide to intervention (90 per cent). At the doctoral level, the dominant link between theory and practice was as a framework for problem identification (82 per cent). Data about theory-education linkages revealed that a larger percentage of represented programs reflected a combination of nursing theories in their philosophy (69 per cent to 84 per cent) over one theory (17 per cent to 24 per cent) at all levels of curricula. Similarly, a larger percentage of programs structured their curricula by using a combination of nursing theories (61 per cent to 67 per cent) over one theory (8 per cent to 18 per cent). Finally, data pertaining to theory-research linkages indicated greater emphasis at graduate levels and only a few baccalaureate curricula addressed the link between theory and research. For example, only 12 per cent of respondents indicated that concept development was included as part of their curriculum at the baccalaureate level. The item addressing inclusion of theory or hypothesis-generating studies, though the most widely
TABLE 2. Ranking of Teaching Strategies and Per Cent of Programs Using Them by Program Level Teaching Strategy
Lecture Group activities Seminar/discussion Audiovisual material Internet activities Field experiences Self-study/independent study Conferences
Baccalaureate
Master’s
Doctoral
Rank
%
Rank
%
Rank
%
1 2 2 2 5 6 7 8
86 64 64 64 56 27 26 12
2 2 1 4 5 8 6 7
86 86 95 67 54 20 49 34
4 3 1 7 6 8 7 2
75 81 100 50 53 27 50 94
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TABLE 3. Ranking of Evaluation Methods and Per Cent of Programs Using Each Method by Program Level Evaluation Method
Application to a clinical problem Objective test Overview of a specific theory Analysis of a theory’s usefulness in practice Group presentation about a theory Essay test Concept analysis paper Critique a study’s use of a nursing theory Group presentation about a theory topic Position paper/critique a nursing theory issue Formal theory analysis/evaluation Design a proposal or test/evaluate a theory
Baccalaureate
Master’s
Doctoral
Rank
%
Rank
%
Rank
%
1 2 3 4 5 6 6 6 9 9 11 11
79 67 58 42 26 23 23 23 14 14 0 0
1 11 4 2 6 8 5 7 10 9 3 12
89 29 78 86 72 58 77 61 51 53 80 23
10 12 8 10 8 7 4 7 3 1 4 1
50 8 62 50 62 69 85 94 86 100 85 100
addressed idea in this category, was included in only 45 per cent of baccalaureate curricula. Conversely, doctoral programs incorporated all but one area (atheoretical studies) at rates over 94 per cent. COMPARISONS BY TYPE OF SCHOOL AND FACULTY
When data about curricula at 4-year colleges were compared with those of research universities, we found little difference in nursing theory content, teaching strategies, evaluation methods, or linkages to practice, education, and research. However, respondents from research universities were significantly more likely than those from 4-year colleges to have publications related to nursing theory (2 ⫽ 5.5; P ⫽ .02). Comparisons between schools with and without doctoral programs revealed several differences. In schools with a doctoral program, respondents were more likely to teach content about nursing as an applied versus a basic science (2 ⫽ 4.69; P ⫽ .04) and to evaluate student performance by using position papers (2 ⫽ 5.70; P ⫽ .02) at the master’s level. However, in schools that did not have doctoral programs, faculty teaching at the baccalaureate level were more likely to include content on practice theory (2 ⫽ 6.46, P ⫽ .01) and less likely to evaluate student performance by using proposals designed to test theory (2 ⫽ 4.38, P ⫽ .04). In these same schools, faculty at the master’s level were more likely to include content on metaparadigm concepts (2 ⫽ 3.85, P ⫽ .05) and to use field experiences as a teaching strategy (2 ⫽ 5.61, P ⫽ .02). However, they were less likely to use attendance at conferences (2 ⫽ 6.31, P ⫽ .01) as a teaching strategy. When comparing faculty with nursing doctorates with those with nonnursing doctorates, regardless of school, each reported teaching similar content by level
of curriculum. However, more faculty members who had nursing doctorates reported that baccalaureate curricula emphasized theory-practice linkages than did faculty members with nonnursing doctorates. The three specific theory-practice linkages emphasized at the baccalaureate level by these respondents were use of theory to design programs of care (2 ⫽ 9.0, P ⫽ .003), as a general philosophy in practice (2 ⫽ 3.94, P ⫽ .05), and as a general framework for practice (2 ⫽ 3.94, P ⫽ .05). The increased emphasis on theorypractice linkages by faculty with nursing doctorates was not as evident at either the master’s or doctoral level. Discussion
In comparing required courses and credits, content, teaching strategies, and evaluation methods across three levels of nursing curricula, several conclusions can be drawn. Only one third of represented baccalaureate programs require courses in nursing theory and, when they do, few credit hours are required. The requirement for courses and credits at the graduate level is more uniform and at a higher level in doctoral programs. At all program levels, nursing theory content was also highly integrated. This finding is congruent with recommendations of Levine (1995), JacobsKramer and Huether (1988), and Meleis and Price (1988). Although all identified content can be found at all levels of the curriculum, certain content (theory as content vs. structure vs. process, philosophy of science, empirical theory development strategies, and theory development strategies) is seldom included in baccalaureate programs. A greater proportion of graduate, as compared with undergraduate, programs addressed
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meta-theory issues, levels of theory, and issues and strategies related to theory development. Given the advanced nature of these topics, this is not a surprising revelation. Rather, these findings support JacobsKramer’s and Huether’s (1988) assertions that there is a consensus as to appropriate theoretical content at the doctoral level and that the prevailing attitude was that these advanced topics are best suited to graduate study. There was considerable consistency across curricular levels in the teaching methods used and these were fairly traditional. Few programs, regardless of level, used field experiences or the Internet. Although respondents had the option of listing additional strategies, none did. Although more recent literature on the topic of teaching nursing theory includes a number of creative strategies, such as the use of maps as analogies to theory (Fontes, 1994), theory “walks” (Frank, 1994), and the integration of esthetics and theory (Hautman, 1997), these did not appear to be widely adopted. Evaluation methods reflected expectations for higher levels of cognitive performance as curricula progressed. Practice applications and objective tests prevailed at the baccalaureate level. A wider range of methods was commonly used at the graduate level. However, neither objective tests nor proposals were common in master’s programs whereas theory critique and proposal design were commonly used in doctoral programs. Most of these strategies are implied in the expectations outlined by Meleis and Price (1988) and alternatives, such as use of creative writing (Slaninka, 1999), were not reported. Linkages between nursing theory and practice and education and research were reported at all levels of curricula. This is particularly the case for theory-practice linkages. Given that the goal of theory in a practice discipline is to improve practice, this finding validates the effort of faculty to address Levine’s (1995) challenge of making the transition from theory as speculative and tentative to theory being relevant for practice. Theory-education linkages favored the use of multiple over single theories as the basis for an educational philosophy or curricular structure. This finding reflects the maturation of nursing as a discipline and its movement toward pluralism and postmodern views of science and knowledge development. Theory-research linkages showed a clear pattern of ascension with each advancing level of the curriculum. Again, congruent with Jacobs-Kramer and Huether (1988) and Meleis and Price (1988), this finding indicates greater clarity
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of purpose with regard to nursing theory in the curriculum at graduate levels. In comparisons between 4-year colleges and research universities, little difference was found for any aspect of nursing theory in curricula and none was necessarily expected or desired. In comparisons between faculty with nursing or nonnursing doctorates, an emphasis on theory-practice linkages at the baccalaureate level were reported by nursing doctorates, particularly those at 4-year colleges. Overall, there appears to be greater consistency in nursing theory taught within baccalaureate and doctoral curricula. At the master’s level, greater diversity appears to exist. This phenomenon may be connected to the presence or absence of a doctoral program. Conclusions
In this article we set out to reveal current practices pertaining to the teaching of nursing theory in a group of Midwest nursing schools and, further, to determine if there was sufficient consistency in practice to form a basis for suggesting student competencies. Current practices have been described and reveal areas of consistency as well as diversity. From this article, clear expectations for baccalaureate programs cannot be inferred because more than half of reporting programs have no requirement. Yet, the 34 per cent that do have such requirements show areas of agreement around content, teaching strategies, and evaluation methods as well as an emerging emphasis on theory-practice linkages. In doctoral programs, this report evidences an expectation for breadth and depth of knowledge concerning nursing theory. Competencies for the development and evaluation of nursing theory are one clear expectation. Although almost all master’s programs have required courses in nursing theory, these data show less agreement as to the range of information and competencies expected. Both practice- and researchrelated expectations are evident and the data are insufficient to fully evaluate expected depth in regard to each. These dual expectations may reflect a double goal of master’s education (i.e., preparation of advanced practitioners and preparation for doctoral education). This survey was a beginning effort to shed light on the status of nursing theory across all levels of nursing curricula. Further work, building on this platform, but using a more rigorous design and a national sampling frame, is needed to more fully inform the development of educational competencies concerning nursing theory.
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This article reports on an informal survey conducted for the Theory Development Section of the Midwest Nursing Research Society. Its purposes were to describe current practices in teaching nursing theory at three levels of curricula and to compare these practices between nursing programs in liberal arts colleges and research universities, between schools with and without doctoral programs, and between faculty with nursing and nonnursing doctorates who teach nursing theory. Findings indicate greatest consistency of practices at baccalaureate and doctoral levels, though few baccalaureate programs have required courses in nursing theory. Few differences were found between types of schools, but faculty with nursing doctorates tended to emphasize theory-practice linkages at the baccalaureate level. Further study that uses this work as a platform is suggested. (Index words: Nursing theory, curriculum, nursing education) J Prof Nurs 17:248-255, 2001. Copyright © 2001 by W.B. Saunders Company
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HE DEVELOPMENT OF NURSING theory is central to the evolution of the discipline, profession, and practice of nursing. So central is the importance of nursing theory that no topic in the history of nursing has probably engendered more discussion and debate. From the origin of the term in the 1960s to the present day, diverse meanings and perspectives characterize dialogues and writings about nursing theory. Surprisingly, despite this acknowledged importance and competing points of view, no accepted set of competencies pertaining to nursing theory exists for graduates at each level of nursing curricula. Unlike nursing research, for which the American Nurses Association (ANA) has promulgated such competencies (ANA *Professor, University of Michigan, Ann Arbor, MI. †Assistant Professor, Oakland University, Rochester, MI. ‡Assistant Professor, Case Western Reserve University, Cleveland, OH. Address correspondence and reprint requests to Dr. Algase: University of Michigan, 400 North Ingalls, Room 2160, Ann Arbor, MI 48109-0482. Copyright © 2001 by W.B. Saunders Company 8755-7223/01/1705-0010$35.00/0 doi:10.1053/jpnu.2001.26305 248
Commission on Nursing Research, 1981), specifications for theory-related knowledge and competencies appropriate to each level of nursing curricula have not been promoted. Neither the National League for Nursing (Baccalaureate and Higher Degree Programs in Nursing, 1997) nor the American Commission on Collegiate Nursing Education (1998) has addressed this topic in their accreditation guidelines. The American Association of Colleges of Nursing (AACN, 1996a), in its monograph on the essentials of master’s education, has specified that graduates of master’s programs “should be prepared to critique, evaluate, and utilize appropriate theory within one’s practice” (p. 10). However, the AACN has not delineated a parallel set of outcomes in their corresponding publication on baccalaureate education (AACN, 1996b). Without a set of appropriate, professionally established competencies, the general expectations for graduates as related to nursing theory are unclear at all levels of nursing education. Further, no fundamental knowledge about nursing theory can be assumed of graduates, and even basic competencies, such as use of a common language with agreed on terms and definitions are uncertain. These basics are essential for coherent and intelligent debate from which advances in our discipline can continue to emerge. This article reports on an informal survey conducted to explicate extant practices pertaining to the teaching of nursing theory in a group of Midwestern nursing schools. Our intention was to determine if sufficient commonality exists as a basis for suggesting theoryrelated competencies across three levels of nursing curricula and to identify areas in which diverse practices prevail so that clarification and standardization can be sought.
Background
This project originated from a discussion in the Theory Development Section of the Midwest Nursing Research Society (MNRS). MNRS is a 1,300-member
Journal of Professional Nursing, Vol 17, No 5 (September–October), 2001: pp 248-255
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organization of nurse scientists and scholars that promotes the dissemination and utilization of nursing research, both within and outside its 13-state Midwest region (MNRS, 1999). Members of the Theory Development Section are self-identified as interested in the development and teaching of nursing theory. During the 1998 meeting, section members concurred that the scope and depth of theoretical developments in nursing had evolved considerably in recent years to include various levels of nursing theory (e.g. Blegen & TrippReimer, 1997; Cody, 1999; Good & Moore, 1996; Lenz, Suppe, Gift, Pugh, & Milligan, 1995) and extensions to the philosophic basis of our discipline (e.g. Meleis, 1996; Rawnsey, 1998; Reed, 1995; 1997; Schumacher, 1992). However, beyond each member’s individual institution, we had little general knowledge of what outcomes and approaches guided current teaching of nursing theory across levels of curricula and whether or not various types of schools and faculty were incorporating these recent advances into their programs. Thus, the group sanctioned an informal survey and report from its membership to examine systematically current practices in teaching nursing theory within academic institutions represented by its members. A subsequent search of the literature revealed surprisingly few articles with a focus on collegiate teaching of nursing theory. Acknowledging that nursing theory has its skeptics, Levine (1995) argued for the importance of including nursing theory, which she called the intellectual life of nursing, in nursing curricula. She identified a frequent failure of students to embrace nursing theory and attributed this to a failure of the faculty to fully grasp the importance of nursing theory and to make the difficult transition for students from the possibilities of a theory to its relevance for education and practice. Although she advocated that theory should be taught at every level of nursing education and offered approaches to overcoming shortfalls in teaching nursing theory, she did not address specifically desired competencies for any given level of student. Based on 15 years’ experience in teaching nursing theory, Jacobs-Kramer and Huether (1988) explicated then current practices for teaching nursing theory at various curricular levels. They defined nursing theory as “theory about the discipline and nature of nursing” and, further, nursing meta-theory as being “about the features and purposes of nursing theory that are appropriate for the discipline” (p. 373). These investigators acknowledged a lack in documented evidence pertaining to the extent of nursing theory taught at the bacca-
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laureate level. They also reported that their experience with baccalaureate graduates reflected the use of multiple frameworks structuring basic nursing curricula, but a general lack of knowledge and skill about nursing theory among these graduates. On the other hand, they asserted that standards for the inclusion of nursing theory were best documented at the graduate level. Content on nursing theory and theory analysis were identified as commonly introduced at the master’s level. Based on informal reviews of course syllabi from multiple nursing masters’ programs, a marked similarity in content was noted. These courses commonly included content on major nurse theorists and their models and skills in the analysis and critique of theory. These investigators also believed that there was a consensus on the content focus pertaining to nursing theory at the doctoral level, that being knowledge development. Meleis and Price (1988) offered a most cogent discussion of the topic by reframing it more broadly from the teaching of nursing theory to the teaching of theoretical thinking in nursing. They proposed components of theoretical nursing and delineated pertinent knowledge for each degree level from baccalaureate to doctoral. In general, expectations for baccalaureate education were an appreciation and awareness of theoretical nursing and an ability to implement it in practice. Particularly, this expectation included knowledge of schools of thought in nursing, of frameworks guiding the curriculum, of central concepts as frameworks for practice, and of assessment and intervention strategies for a nursing situation congruent with a given theoretical context. Expectations for master’s education included the ability to analyze and synthesize theory. These expectations were determined to include knowledge of interdisciplinary underpinnings of nursing, appreciation of the process of theory development, analysis of domain concepts within a field of nursing specialization, comparison of various theories in relation to a specific clinical question, critical use of theory, identification of nursing phenomena, and the ability to develop and/or derive concepts. Finally, the general expectation for doctoral education was to develop, critique, and test theory. Specific knowledge domains included philosophic underpinnings of theories, critical assessment of nursing domains (including redefining of boundaries, development of parameters for new missions, and extension of theory), development of new theories from practice and research, and use of advanced theory development strategies. The balance of literature identified and reviewed addressed either general approaches or more particular strategies for teaching nursing theory, either as a
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curricular component or thread or within a dedicated course (Batra, 1987; Fontes, 1994; Frank, 1994; Hautman, 1997; Murphy, 1991; Slaninka, 1999). Articles that highlighted particular strategies reflected a creative array of ideas for conveying abstract information in a concrete and meaningful way. Although interesting, these articles were generally limited in their scope and applicability and were not particularly useful in illuminating the larger question of the status of nursing theory across curricula or in delineating necessary competencies for graduates at each level. Specific examples of competencies in relation to nursing theory were reported in only one article and these related to doctoral education. In this example, doctoral students are expected to develop, test, synthesize, and expand theory to guide practice (LaMontagne, Pressler, & Salisbury, 1996). These investigators specified the theory-related competencies for this program as manifesting abstract and theoretical thinking; analyzing and critiquing assumptions that direct knowledge development; showing knowledge and analysis of philosophic bases of nursing knowledge; analyzing theoretical literature critically; articulating historic, current, and prospective views of the discipline; and analyzing ethical and sociopolitical issues that are central to the discipline of nursing. The results of this literature review support a reassessment of nursing theory taught in collegiate nursing programs as a timely undertaking. Previous assessments were more than a decade old and, though based on experience and expert opinion, were not systematic or empirically based. The meaning of “nursing theory” reflected in these works was often equated with conceptual models of well-known nurse theorists, such as Orem, Rogers, or Roy, and did not clearly encompass current thinking about nursing theory. Data from nursing programs themselves also were absent in the literature. In designing this project, the authors set out to address two major aims. The first was to compare, at three program levels, requirements for nursing theory courses and credits, and content taught about nursing theory; teaching and evaluations strategies used to convey this content; and emphasis placed in the curriculum on linkages of nursing theory to practice, research, and education. We also aimed to compare these strategies between nursing schools in liberal arts colleges and research universities, between schools with and without doctoral programs, and between faculty with
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nursing and nonnursing doctorates who teach nursing theory. Methods
An informal survey of MNRS Theory Development section members was conducted to describe and compare nursing theory issues across baccalaureate, master’s, and doctoral programs in two types of institutions: 4-year colleges that specialize in undergraduate education and research universities. Although authorization for this work limited its scope, we sought to maximize exploration of this relatively unknown topic by using a snowballing method to reach other faculty within the schools encompassed by section members. Because faculty teaching at one level of the curriculum may be relatively unfamiliar with courses at other levels, we thought that multiple respondents from a given school would give a more complete picture of the school’s practices. Therefore, each current member of the Theory Development Section (n ⫽ 57) received a one-time mailing containing five copies of the questionnaire and self-addressed stamped envelopes for their return. Members were asked to complete one copy independently. Section members also were asked to distribute copies of the survey to colleagues who did not receive the mailing but who teach nursing theory at their school. Return of the completed questionnaire constituted consent to participate and to use grouped data in reports. QUESTIONNAIRE
After no suitable instrument could be located, a questionnaire was developed based on ideas generated by members at the 1998 MNRS Theory Section meeting and further informed by issues and examples identified in the literature review. As a first attempt at tool development, our goal was to create a questionnaire that would assess how nursing theory is taught and how it is reflected in the curricula of baccalaureate, master’s, and doctoral programs. A secondary purpose was to elicit descriptive information about the faculty and schools to be used for grouping purposes in planned analyses. The two developers of the questionnaire are experienced in the area of nursing theory. Each has a doctoral degree in nursing, teaches nursing theory at the master’s and/or doctoral level, and has published articles related to various aspects of nursing theory. The questionnaire was also reviewed by two individuals with similar backgrounds. Thus, a panel of experts in nurs-
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ing theory developed and assessed the questionnaire for content validity. The resulting questionnaire was structured into six main sections. Three sections were organized to address aspects of a course (i.e., objectives and content [13 items], teaching strategies [8 items], assignments and evaluation practices [12 items]). The other three sections addressed questions of how the curriculum linked theory to practice (6 items), to education (4 items), and to research (5 items). A sample item for practice linkages is: indicate if your school’s curriculum addresses the idea of theory as a guide to assessment. Similarly, for the education linkages, indicate if your school’s curriculum is structured by a specific nursing theory. And, finally, for research linkages, indicate if your school’s curriculum addresses theorydriven measurement. Cronbach’s alpha for the six segments of the questionnaire averaged .78 and ranged from .61 for evaluation methods to .88 for practice linkages. Respondents answered yes or no to each item as it pertained to its inclusion at each level of curricula with which they were familiar at their school. In addition, information on courses and credits allotted to nursing theory, whether structured as discrete courses or integrated within other courses, was sought for each level of curricula. Demographic and descriptive information about respondents and schools were contained in a final section of the questionnaire. Respondents also were asked to include objectives for discrete theory courses, but few actually did. Data were analyzed by using descriptive statistics, Chi-square, and ANOVA techniques.
Results RESPONDENTS
There were 51 respondents who identified affiliation with 22 different Midwestern schools of nursing. The number of respondents per school ranged from 1 to 5. By comparison, a review of the section membership list revealed that 42 members were associated with 27 schools in three countries, but remaining members could not be associated with a specific school. The majority of respondents (63 per cent) were faculty from research universities; another 24 per cent indicated they taught at a liberal arts college. Twenty-two respondents (43 per cent) taught at a school of nursing with a doctoral program. The educational preparation of respondents varied; 56 per cent held a nursing doctorate, 32 per cent had a
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nonnursing doctorate, and 12 per cent had completed their education with a master’s degree. A statistically significant difference was observed in the respondents’ years of graduation from their terminal degree programs. Results from an analysis of variance (ANOVA) test revealed that, on average, respondents with nursing doctorates had graduated most recently (M ⫽ 1991, P ⬍ .0001), followed-up by respondents with nonnursing doctorates (M ⫽ 1984), and those with a master’s degree (M ⫽ 1978). Faculty with nursing doctorates (37.5 per cent) were more likely than those with nonnursing doctorates (12.5 per cent) to teach in liberal arts colleges, but this association did not reach significance (2 ⫽ 2.7, P ⫽ .08). Among all respondents, 17 had taught nursing theory at the baccalaureate level, 31 at the master’s level, and 11 at the doctoral level. A clear majority of respondents (92.2 per cent) were currently teaching nursing theory. Twelve (23.5 per cent) respondents described themselves as currently developing a nursing theory, 17 (33.3 per cent) as active in meta-theoretical issues, 29 (56.9 per cent) as publishing theory-related papers, and 12 as members of a nursing theory group other than MNRS. Faculty teaching nursing theory at the baccalaureate level are not likely to teach at the master’s (2 ⫽ 4.74, P ⫽ .03) or doctoral level (2 ⫽ 3.58, P ⫽ .06). No differentiation was found between master’sand doctoral-level faculty.
COMPARISONS OF NURSING THEORY AS TAUGHT ACROSS THREE LEVELS OF CURRICULA
Respondents indicated that discrete courses in nursing theory were included in 34 per cent of the baccalaureate programs represented, 98 per cent of the master’s programs, and 100 per cent of the doctoral programs. Further, nursing theory content was integrated in 95 per cent of the baccalaureate programs, 70 per cent of the master’s programs, and 73 per cent of the doctoral programs. The extent to which discrete nursing theory courses were required varied across programs. Fourteen (29.6 per cent) respondents indicated that their baccalaureate programs required 1 to 4 credits of course work (mode ⫽ 2–3 credits), 34 indicated that their master’s program required 2 to 6 credits (mode ⫽ 3 credits), and 17 indicated that their doctoral programs required 2 to 12 credits (mode ⫽ 6 credits). Data about 13 content areas is summarized in Table 1. All content areas were taught in some portion of represented programs and respondents named no additional content areas. However, the percentage of re-
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TABLE 1. Ranking of Content Areas and Per Cent of Programs Containing Content by Program Level Content Area
Baccalaureate
Nursing as a science Nursing as a discipline Grand theories Practice-level theory Middle range theories Borrowed vs. discipline-specific theories Nursing as an applied vs. basic science Theory as content vs. structure vs. process Philosophy of science Empirical theory development strategies Other theory development strategies
Master’s
Doctoral
Rank
%
Rank
%
Rank
%
1 2 3 4 6 8 9 10 11 12 12
88 86 76 69 56 51 49 38 15 12 12
2 2 4 9 1 6 7 12 10 11 13
95 95 91 86 98 90 88 69 79 77 65
1 8 10 10 1 7 8 12 1 1 1
100 90 85 85 100 94 90 83 100 100 100
spondents indicating inclusion of each content area varied by level of the curriculum. As reflected in these percentages, variation in the range of included content decreases as curricula advance. In other words, there was greater agreement as to content areas to be taught at higher levels of the curriculum Data about the use of eight teaching strategies is contained in Table 2. All strategies were used to some extent in represented programs and respondents named no additional strategies. Although the percentage of respondents indicating use of each strategy varied by level of the curriculum, seminars and group activities were used widely and consistently at all program levels. Data pertaining to 12 evaluation methods are displayed in Table 3. All methods but two were used in represented programs and no additional evaluation methods strategies were identified. The use of each evaluation method varied by level of the curriculum. Top-ranking evaluation methods used in baccalaureate programs were bottom-ranking methods in doctoral programs and vice versa. At the master’s level, the picture was more mixed. Data about theory-practice linkages revealed differing areas of emphasis at each program level. In most baccalaureate curricula, emphasis was placed on using
nursing theory as a general orientation to or frame of reference for practice (80 per cent) and as a framework for problem identification (79 per cent). In most master’s curricula, these same uses of theory were also strongly emphasized (92 per cent each), but most master’s programs also addressed theory as a guide to intervention (90 per cent). At the doctoral level, the dominant link between theory and practice was as a framework for problem identification (82 per cent). Data about theory-education linkages revealed that a larger percentage of represented programs reflected a combination of nursing theories in their philosophy (69 per cent to 84 per cent) over one theory (17 per cent to 24 per cent) at all levels of curricula. Similarly, a larger percentage of programs structured their curricula by using a combination of nursing theories (61 per cent to 67 per cent) over one theory (8 per cent to 18 per cent). Finally, data pertaining to theory-research linkages indicated greater emphasis at graduate levels and only a few baccalaureate curricula addressed the link between theory and research. For example, only 12 per cent of respondents indicated that concept development was included as part of their curriculum at the baccalaureate level. The item addressing inclusion of theory or hypothesis-generating studies, though the most widely
TABLE 2. Ranking of Teaching Strategies and Per Cent of Programs Using Them by Program Level Teaching Strategy
Lecture Group activities Seminar/discussion Audiovisual material Internet activities Field experiences Self-study/independent study Conferences
Baccalaureate
Master’s
Doctoral
Rank
%
Rank
%
Rank
%
1 2 2 2 5 6 7 8
86 64 64 64 56 27 26 12
2 2 1 4 5 8 6 7
86 86 95 67 54 20 49 34
4 3 1 7 6 8 7 2
75 81 100 50 53 27 50 94
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TABLE 3. Ranking of Evaluation Methods and Per Cent of Programs Using Each Method by Program Level Evaluation Method
Application to a clinical problem Objective test Overview of a specific theory Analysis of a theory’s usefulness in practice Group presentation about a theory Essay test Concept analysis paper Critique a study’s use of a nursing theory Group presentation about a theory topic Position paper/critique a nursing theory issue Formal theory analysis/evaluation Design a proposal or test/evaluate a theory
Baccalaureate
Master’s
Doctoral
Rank
%
Rank
%
Rank
%
1 2 3 4 5 6 6 6 9 9 11 11
79 67 58 42 26 23 23 23 14 14 0 0
1 11 4 2 6 8 5 7 10 9 3 12
89 29 78 86 72 58 77 61 51 53 80 23
10 12 8 10 8 7 4 7 3 1 4 1
50 8 62 50 62 69 85 94 86 100 85 100
addressed idea in this category, was included in only 45 per cent of baccalaureate curricula. Conversely, doctoral programs incorporated all but one area (atheoretical studies) at rates over 94 per cent. COMPARISONS BY TYPE OF SCHOOL AND FACULTY
When data about curricula at 4-year colleges were compared with those of research universities, we found little difference in nursing theory content, teaching strategies, evaluation methods, or linkages to practice, education, and research. However, respondents from research universities were significantly more likely than those from 4-year colleges to have publications related to nursing theory (2 ⫽ 5.5; P ⫽ .02). Comparisons between schools with and without doctoral programs revealed several differences. In schools with a doctoral program, respondents were more likely to teach content about nursing as an applied versus a basic science (2 ⫽ 4.69; P ⫽ .04) and to evaluate student performance by using position papers (2 ⫽ 5.70; P ⫽ .02) at the master’s level. However, in schools that did not have doctoral programs, faculty teaching at the baccalaureate level were more likely to include content on practice theory (2 ⫽ 6.46, P ⫽ .01) and less likely to evaluate student performance by using proposals designed to test theory (2 ⫽ 4.38, P ⫽ .04). In these same schools, faculty at the master’s level were more likely to include content on metaparadigm concepts (2 ⫽ 3.85, P ⫽ .05) and to use field experiences as a teaching strategy (2 ⫽ 5.61, P ⫽ .02). However, they were less likely to use attendance at conferences (2 ⫽ 6.31, P ⫽ .01) as a teaching strategy. When comparing faculty with nursing doctorates with those with nonnursing doctorates, regardless of school, each reported teaching similar content by level
of curriculum. However, more faculty members who had nursing doctorates reported that baccalaureate curricula emphasized theory-practice linkages than did faculty members with nonnursing doctorates. The three specific theory-practice linkages emphasized at the baccalaureate level by these respondents were use of theory to design programs of care (2 ⫽ 9.0, P ⫽ .003), as a general philosophy in practice (2 ⫽ 3.94, P ⫽ .05), and as a general framework for practice (2 ⫽ 3.94, P ⫽ .05). The increased emphasis on theorypractice linkages by faculty with nursing doctorates was not as evident at either the master’s or doctoral level. Discussion
In comparing required courses and credits, content, teaching strategies, and evaluation methods across three levels of nursing curricula, several conclusions can be drawn. Only one third of represented baccalaureate programs require courses in nursing theory and, when they do, few credit hours are required. The requirement for courses and credits at the graduate level is more uniform and at a higher level in doctoral programs. At all program levels, nursing theory content was also highly integrated. This finding is congruent with recommendations of Levine (1995), JacobsKramer and Huether (1988), and Meleis and Price (1988). Although all identified content can be found at all levels of the curriculum, certain content (theory as content vs. structure vs. process, philosophy of science, empirical theory development strategies, and theory development strategies) is seldom included in baccalaureate programs. A greater proportion of graduate, as compared with undergraduate, programs addressed
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meta-theory issues, levels of theory, and issues and strategies related to theory development. Given the advanced nature of these topics, this is not a surprising revelation. Rather, these findings support JacobsKramer’s and Huether’s (1988) assertions that there is a consensus as to appropriate theoretical content at the doctoral level and that the prevailing attitude was that these advanced topics are best suited to graduate study. There was considerable consistency across curricular levels in the teaching methods used and these were fairly traditional. Few programs, regardless of level, used field experiences or the Internet. Although respondents had the option of listing additional strategies, none did. Although more recent literature on the topic of teaching nursing theory includes a number of creative strategies, such as the use of maps as analogies to theory (Fontes, 1994), theory “walks” (Frank, 1994), and the integration of esthetics and theory (Hautman, 1997), these did not appear to be widely adopted. Evaluation methods reflected expectations for higher levels of cognitive performance as curricula progressed. Practice applications and objective tests prevailed at the baccalaureate level. A wider range of methods was commonly used at the graduate level. However, neither objective tests nor proposals were common in master’s programs whereas theory critique and proposal design were commonly used in doctoral programs. Most of these strategies are implied in the expectations outlined by Meleis and Price (1988) and alternatives, such as use of creative writing (Slaninka, 1999), were not reported. Linkages between nursing theory and practice and education and research were reported at all levels of curricula. This is particularly the case for theory-practice linkages. Given that the goal of theory in a practice discipline is to improve practice, this finding validates the effort of faculty to address Levine’s (1995) challenge of making the transition from theory as speculative and tentative to theory being relevant for practice. Theory-education linkages favored the use of multiple over single theories as the basis for an educational philosophy or curricular structure. This finding reflects the maturation of nursing as a discipline and its movement toward pluralism and postmodern views of science and knowledge development. Theory-research linkages showed a clear pattern of ascension with each advancing level of the curriculum. Again, congruent with Jacobs-Kramer and Huether (1988) and Meleis and Price (1988), this finding indicates greater clarity
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of purpose with regard to nursing theory in the curriculum at graduate levels. In comparisons between 4-year colleges and research universities, little difference was found for any aspect of nursing theory in curricula and none was necessarily expected or desired. In comparisons between faculty with nursing or nonnursing doctorates, an emphasis on theory-practice linkages at the baccalaureate level were reported by nursing doctorates, particularly those at 4-year colleges. Overall, there appears to be greater consistency in nursing theory taught within baccalaureate and doctoral curricula. At the master’s level, greater diversity appears to exist. This phenomenon may be connected to the presence or absence of a doctoral program. Conclusions
In this article we set out to reveal current practices pertaining to the teaching of nursing theory in a group of Midwest nursing schools and, further, to determine if there was sufficient consistency in practice to form a basis for suggesting student competencies. Current practices have been described and reveal areas of consistency as well as diversity. From this article, clear expectations for baccalaureate programs cannot be inferred because more than half of reporting programs have no requirement. Yet, the 34 per cent that do have such requirements show areas of agreement around content, teaching strategies, and evaluation methods as well as an emerging emphasis on theory-practice linkages. In doctoral programs, this report evidences an expectation for breadth and depth of knowledge concerning nursing theory. Competencies for the development and evaluation of nursing theory are one clear expectation. Although almost all master’s programs have required courses in nursing theory, these data show less agreement as to the range of information and competencies expected. Both practice- and researchrelated expectations are evident and the data are insufficient to fully evaluate expected depth in regard to each. These dual expectations may reflect a double goal of master’s education (i.e., preparation of advanced practitioners and preparation for doctoral education). This survey was a beginning effort to shed light on the status of nursing theory across all levels of nursing curricula. Further work, building on this platform, but using a more rigorous design and a national sampling frame, is needed to more fully inform the development of educational competencies concerning nursing theory.
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