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Nursing—A maturing discipline?
FROM OUR COLUMNISTS Research
Nursing A Maturing Discipline? LAST few years there has been a growing trend to F IORTHE conceptualize nursing as a maturing discipline. Lenz, Suppe, Gift, Pugh, and Milligan (1995, 1997) contended that nursing as a disdpline must move from focusing on the current grand theories to middle-range theories if continued development is to occur. This most cogent argument is based on Merton's (1968) stages of developing disdplines. Merton's first stage was accomplished when nursing distanced itself from medidne. The second stage occurred when the discipline achieved academic legitimization. Nursing is presently in Merton's third stage wherein substantive research is the norm. Is there empirical evidence to support the position ofLenz et al. (1995, 1997) that the discipline must move from addressing the grand theories to developing and testing middle-range theories? Silva (1986) conducted a study to identify which nursing theories were tested in nursing research. She reported finding 62 artides in which the author(s) "used" either Johnson's, Ro)?s, Orem's, Rogers', or Newman's nursing theory. Of the 62 artides, the authors of only 9 contended to test a theoretical proposition. Deets (1990) reviewed 300 aixides published between 1986 and 1987 to identify studies that tested one or more of the nursing paradigm concepts (health, environment, person, and nursing). Only six articles addressed one or more of the four concepts. A serendipitous finding was that the studies dustered in theoretically relevant categories, all of which were more similar to middle- range than grand theories. Once again there was no explanation for the lack of theory testing, but in this study the articles were identified as addressing specific concepts, ie, those inherent in middle-range theories. The fact that few research studies were designed to test a theory leads one to speculate on why this was so. Silva (1986) conduded that there is a lack of commitment to theory testing on the part of the disdpline. Another explanation is that the propositions/axioms/relationship statements from grand theo-
CAROL DEETS, EDD, R N AssociateDeanfar Research, Universi{yof Cincinnati CollegeofNursingand Health, W~lliamCooperProcterHall PO Box 210038 Cindnnati, 0H45221-0038 Copyright © 1998 by W..B.Saunders Company 8755-7223/98/1402-0002503.00/0
ties are not testable, thus supporting the contention that the majority of current nursing theories are indeed grand theories. The content for many of these studies was theoretically relevant to the discipline, but they seldom reflected the concepts in current grand theories, ie, health, environment, person, and nursing. In these studies, the phenomena were more specific, addressing such topics as pain, stress, and health behavior. If the discipline is maturing as Lenz et al. (1995, 1997) contend, what an exciting time to be involved in nursing research. The changes in beliefs about the sophistication of nursing as a discipline will impact nursing research well into the next c e n ~ The emphasis will be on moving from grand theories to middle-range theories. If middle-range theories become the norm, research will change dynamically with new methods to complement the theories. Interventions will be theory based, thus allowing prediction and explanation of the phenomena. Researchers ~ be acknowledged for their achievements, not criticized because they did not employ one of the "nursing theories" as the basis for their research. Teaching nursing content regarding theory and research will be revolutionized as well. How will courses be taught when the four concepts of health, environment, person, and nursing are no longer seen as those that must be accounted for in a nursing theory? What will happen to the grand theories? One speculation is that they will become the philosophical basis for different paradigms in nursing. Each paradigm will have multiple middlerange theories addressing the phenomena of concern to that paradigm. Indeed, the next few years will be exciting in nursing! References
Deets, C. (1990). Nursing'sparadigm and a search for its methodology. In N. Chaska (Ed.), The nursingprofession: Turningpoints. St. Louis, MO: Mosby. Lenz, E. R., Suppe, E, Gift, A. G., Pugh, L. C., & Milligan, 1L A. (1995). Collaborative development of middle-range nursing theories:Toward a theory of unpleasant symptoms.Advancesin Nursing Science, 17, 1-13. Lenz, E. R., Pugh, L. C., Milligan, R. A, Gift, A,, & Suppe, E (1997), The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, I9, 14-27. Merton, R. IC (1968). On sodologicaltheoriesof the middle range. In tL IC Merton (Ed.), Socialtheoryand socialstructure. New York: Free Press. Silva,M. C. (1986). Researchtestingnursing theory: State of the art. Advancesin Nursing Science,9, 1-11.
J o u r n a l o f ProfessionalNursing, Vol 14, N o 2 (March-April), 1998: p 65
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Nursing A Maturing Discipline? LAST few years there has been a growing trend to F IORTHE conceptualize nursing as a maturing discipline. Lenz, Suppe, Gift, Pugh, and Milligan (1995, 1997) contended that nursing as a disdpline must move from focusing on the current grand theories to middle-range theories if continued development is to occur. This most cogent argument is based on Merton's (1968) stages of developing disdplines. Merton's first stage was accomplished when nursing distanced itself from medidne. The second stage occurred when the discipline achieved academic legitimization. Nursing is presently in Merton's third stage wherein substantive research is the norm. Is there empirical evidence to support the position ofLenz et al. (1995, 1997) that the discipline must move from addressing the grand theories to developing and testing middle-range theories? Silva (1986) conducted a study to identify which nursing theories were tested in nursing research. She reported finding 62 artides in which the author(s) "used" either Johnson's, Ro)?s, Orem's, Rogers', or Newman's nursing theory. Of the 62 artides, the authors of only 9 contended to test a theoretical proposition. Deets (1990) reviewed 300 aixides published between 1986 and 1987 to identify studies that tested one or more of the nursing paradigm concepts (health, environment, person, and nursing). Only six articles addressed one or more of the four concepts. A serendipitous finding was that the studies dustered in theoretically relevant categories, all of which were more similar to middle- range than grand theories. Once again there was no explanation for the lack of theory testing, but in this study the articles were identified as addressing specific concepts, ie, those inherent in middle-range theories. The fact that few research studies were designed to test a theory leads one to speculate on why this was so. Silva (1986) conduded that there is a lack of commitment to theory testing on the part of the disdpline. Another explanation is that the propositions/axioms/relationship statements from grand theo-
CAROL DEETS, EDD, R N AssociateDeanfar Research, Universi{yof Cincinnati CollegeofNursingand Health, W~lliamCooperProcterHall PO Box 210038 Cindnnati, 0H45221-0038 Copyright © 1998 by W..B.Saunders Company 8755-7223/98/1402-0002503.00/0
ties are not testable, thus supporting the contention that the majority of current nursing theories are indeed grand theories. The content for many of these studies was theoretically relevant to the discipline, but they seldom reflected the concepts in current grand theories, ie, health, environment, person, and nursing. In these studies, the phenomena were more specific, addressing such topics as pain, stress, and health behavior. If the discipline is maturing as Lenz et al. (1995, 1997) contend, what an exciting time to be involved in nursing research. The changes in beliefs about the sophistication of nursing as a discipline will impact nursing research well into the next c e n ~ The emphasis will be on moving from grand theories to middle-range theories. If middle-range theories become the norm, research will change dynamically with new methods to complement the theories. Interventions will be theory based, thus allowing prediction and explanation of the phenomena. Researchers ~ be acknowledged for their achievements, not criticized because they did not employ one of the "nursing theories" as the basis for their research. Teaching nursing content regarding theory and research will be revolutionized as well. How will courses be taught when the four concepts of health, environment, person, and nursing are no longer seen as those that must be accounted for in a nursing theory? What will happen to the grand theories? One speculation is that they will become the philosophical basis for different paradigms in nursing. Each paradigm will have multiple middlerange theories addressing the phenomena of concern to that paradigm. Indeed, the next few years will be exciting in nursing! References
Deets, C. (1990). Nursing'sparadigm and a search for its methodology. In N. Chaska (Ed.), The nursingprofession: Turningpoints. St. Louis, MO: Mosby. Lenz, E. R., Suppe, E, Gift, A. G., Pugh, L. C., & Milligan, 1L A. (1995). Collaborative development of middle-range nursing theories:Toward a theory of unpleasant symptoms.Advancesin Nursing Science, 17, 1-13. Lenz, E. R., Pugh, L. C., Milligan, R. A, Gift, A,, & Suppe, E (1997), The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, I9, 14-27. Merton, R. IC (1968). On sodologicaltheoriesof the middle range. In tL IC Merton (Ed.), Socialtheoryand socialstructure. New York: Free Press. Silva,M. C. (1986). Researchtestingnursing theory: State of the art. Advancesin Nursing Science,9, 1-11.
J o u r n a l o f ProfessionalNursing, Vol 14, N o 2 (March-April), 1998: p 65
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