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Where Did the Theory Come From
This Assignment addresses this course outcome:
MN502-2: Explain how theoretical frameworks influence advance.
Purpose
The purpose of this Assignment is to explore how a theorist explicates his or her
philosophy and thoughts behind a theoretical field. As in other fields of study,
nursing has a plethora of theorists and theories. These theorists have developed
their paradigm over time enriching it with research and dialogue with other
theorists.
Directions
You are going to explore how a theorist of your choice created his or her theory.
Did it develop as an acorn becoming a mighty oak over the decades? Did it arrive
as a burst of light like the big bang as some believe created our universe? Was it
developed from a blueprint like a spaceship where thousands of scholars worked
together to create a rocket to the moon? In point of fact, how is a theory
developed? This is what we are exploring.
You will pick a theorist who interests you, it does not have to be a nurse theorist.
You may also choose from other disciplines such as: behavioral, leadership,
business, education, technology.
You will become the theorist immersing yourself in the writings from the earliest
mentioned to the most current.
As you read, look at how you (taking on the persona of the theorist) developed
the theory.
In the first stage, theorizing occurs. This is where you, as the theorist, identify
the concepts of what nursing is and is not. Perhaps you questioned what
concepts were guiding those in nursing practice and then started to question your
role. You started asking yourself, “Where am I in nursing, and where the
profession is going? Is there some overarching concept that guides the
professional in his or her practice?” This is where you recognize that a theory is
needed.
In the second stage, syntax is developed. This is where you will define the
terms. Look for changing definitions of terms. Consider, for example, Jean
Watson. She starts by defining the word “caring.” Within the last ten years she
has refined her terminology changing the term caring to caritas. This
demonstrates a growth and maturation from decades of research she and other
scholars did to produce the theory of caring.
The third stage is theory testing. Defined as the phenomena behind the theory
that are exposed through research. The definitions of terms are refined. The
theorists and other researchers consider whether this theory helps answer
questions that arise in practice. This is where your theory is used in by a
widening group of researchers. For example, graduate nursing students request
the tool you developed while testing your theory.
The fourth and last stage is evaluation. This is where philosophical debate
occurs as the concepts are applied through evidenced based practice in the act
of providing nursing care.
Assignment Details
For this Assignment, you are going to write an article for a nursing journal
explaining how you developed your theory through the four stages (theorizing,
syntax, theory testing, and evaluation).Your paper must be 3 to 5 pages, not
including the title and reference pages.
To view the Grading Rubric for this Assignment, please visit the Grading
Rubrics section of the Course Home.
Assignment Requirements
Before finalizing your work, you should:

be sure to read the Assignment description carefully (as displayed
above);

consult the Grading Rubric (under the Course Home) to make sure you
have included everything necessary; and

utilize spelling and grammar check to minimize errors.
Your writing Assignment should:

follow the conventions of Standard American English (correct grammar,
punctuation, etc.);

be well ordered, logical, and unified, as well as original and insightful;

display superior content, organization, style, and mechanics; and

use APA 6th Edition format.
Nursing Theorists
1.
Florence Nightingale – Environment theory
2.
Hildegard Peplau – Interpersonal theory
3.
Virginia Henderson – Need Theory
4.
Fay Abdella – Twenty One Nursing Problems
5.
Ida Jean Orlando – Nursing Process theory
6.
Dorothy Johnson – System model
7.
Martha Rogers -Unitary Human beings
8.
Dorothea Orem – Self-care theory
9.
Imogene King – Goal Attainment theory
10. Betty Neuman – System model
11. Sister Calista Roy – Adaptation theory
12. Jean Watson – Philosophy and Caring Model
13. Madeleine Leininger -Transcultural nursing
14. Patricia Benner – From Novice to Expert
15. Lydia E. Hall – The Core, Care and Cure
16. Joyce Travelbee – Human-To-Human Relationship Model
17. Margaret Newman – Health As Expanding Consciousness
18. Katharine Kolcaba – Comfort Theory
19. Rosemarie Rizzo Parse – Human Becoming Theory
20. Ernestine Wiedenbach – The Helping Art of Clinical Nursing
http://currentnursing.com/nursing_theory/nursing_t
heorists.html
MN 502 Unit 5: Where Did the Theory Come
1. Introduction-brief
paragraph or two that
describes the purpose of
the manuscript -5%
2. Stage 1: Theorizing;
….15%
3. Stage 2 Syntax:15%
Introductory
Emergent
0 -1.9
2 – 2.9
This part of the assignment The introduction does not
does not address any or all identify the purpose of the
of this section.
assignment.
This part of the assignment This part contains one
does not address any or all concept identified to what
of this section.
nursing is and what nursing
is not.
This part of the assignment This part of the assignment
does not address any or all contains one term, clarity
of this section.
needed to definition
4. Stage 3: Theory testing: This part of the assignment Provides one example of
does not address any or all how theory was applied
in this section you will
of this section.
within
describe…15%
quantitative/qualitative
research to different
populations in nursing.
Stage 4: Evaluation:…15% This part of the assignment Provides one to two
does not address any or all examples of how theory is
of this section.
applied through evidenced
based practice in the act of
providing nursing care.
There is no indication the
Conclusion- presents a
author tried to make a
broad look at the four
stages you went through conclusion
to develop your theory and
projects its future use in
the nursing profession15%
Poor spelling and grammar
All organization,
are apparent. Does not use
documentation, and
APA style formatting when
references must follow
needed.
APA format. 20%
Conclusion is weak with
moost points not
supported.
Poor spelling and grammar
are apparent. Rarely uses
APA style formatting when
needed.
Total available points =
Rubric Score
Low
3.5
2.5
1.7
1.0
0.0
Grade points
High
4.0
3.49
2.49
1.69
1.00
Low
0
0
0
0
0
here Did the Theory Come From
Practiced
Proficient/Mastered
3 – 3.9
4
Purpose of the assignment Purpose of the
described missing key
assignment clearly
elements
described in a paragraph
or two
This part contains two
concepts identified to what
nursing is and what
nursing is not.
This part contains at least
three concepts identified
to what nursing is and
what nursing is not.
This part of the assignment This part of the
contains one term clearly assignment contains at
defined
least two or more terms
clearly defined
Provides one example of
Provides two or more
how theory was applied to examples of how theory
quantitative/qualitative
was applied to
research to a widening
quantitative/qualitative
group of researchers
research consisting of
outside the discipline of
different populations and
nursing.
a widening group of
researchers outside the
discipline of nursing.
Provides three to four
Provides at least five
examples of how theory is examples of how theory is
applied through evidenced applied through
based practice in the act of evidenced based practice
providing nursing care.
in the act of providing
nursing care.
Some of the conclusions, The author was able to
were not supported.
make succinct and
precise conclusions
Uses Standard American
English with rare errors
and misspellings. Minor
errors in APA style
formatting.
Consistently uses
Standard American
English with rare
misspellings. Appropriate
mechanics and APA style
formatting.
Score
Weight
Final
Score
5%
0.00
15%
0.00
15%
0.00
15%
0.00
15%
0
15%
0.00
20%
0.00
100%
Final Score
Percentage
4
Grade points
Percentage
High
0
0
0
0
0
Low
90%
80%
70%
60%
0
High
100%
89.99%
79.99%
69.99%
59.99%
0.00
0
#DIV/0!
Running Head: ANALYSIS OF THE QUALITY-CARING MODEL
Analysis of the Quality-Caring Model
XXXXXXX
Kaplan University
1
Running Head: ANALYSIS OF THE QUALITY-CARING MODEL
2
Analysis of the Quality-Caring Model
There are theories about everything that people wonder about, which is everything. From
the grand: how the Universe was formed, why we fall in love and why we are here, to the
mundane: why does toast fall butter side down, how do birds know to migrate at the same time
and what does happen to that other sock in the dryer. Of course, the importance of theories are
relative and what one may find grand, another find mundane, so even in the classification there
will be arguments and reclassifications. For the purposes of this paper, a grand theory is one that
seeks to further develop one aspect of a conceptual model, while a middle range theory seeks to
explain concrete and specific events (Butts, 2015). The theory we will be discussing is the
formation of the Quality-Caring Model by Joanne Duffy, which is a middle range theory devised
to address the very real patient care perception of uncaring nurses. This paper will address how
this theory was conceived, grew, refined and is now currently being used in nursing practice and
research.
Theorizing
During my nursing practice, I heard repeatedly that “nurses don’t seem to care.” In 2003,
I and Dr. Lois Hoskins began developing this theory building on earlier works of Watson, King,
Donabedian, Mitchell, Ferketich and Jennings and Irvine, Sidani & Hall, as I noticed that
nursing’s focus seemed to be shifting to the mechanical work of nursing, electronic charting and
cost containment and away from the basic tenet of nursing, which is caring. This was disturbing
to me as I could see the cognitive dissonance being felt by nurses who had entered this
profession to care and felt daily more disconnected from the actual act of nursing.
Running Head: ANALYSIS OF THE QUALITY-CARING MODEL
3
Dissatisfaction among nurses grew right along with the dissatisfaction level of the patients. With
these changes also came changes to patient outcomes, which are closely linked to work
satisfaction and motivation of the actual nurses. Around this time, I participated in the national
Acute Physiology and Chronic Health Evaluation study of ICU’s which broadened my focus to
include the effect of the nurse-physician relationship on patient outcomes. I wanted to find out
what could be done to close the gap between how caregivers wanted to provide care and what
was actually being done, with the goal of improving patient care. It was designed to “expose the
hidden value of nursing” and support the connection between nursing caring and quality health
outcomes. I knew that I wanted to give nurses a tool that could provide a guide for self-caring
that included remaining more aware in order to deepen each nurses ability to be present for
patients and families (Duffy, 2015).
In conducting research, I found a particular poignant quote from Watson stating that
“caring is the essence of nursing and the most central and unifying focus of nursing practice”
In addition to this, studies have shown that caring is what patients want most from nurses and is
the strongest determinant of patient satisfaction (O’Nan, Jenkins, Morgan, Adams, & Davis,
2014). In my initial publication, I presented a three point approach to this theory which I invited
others to evaluate and analyze. These three points were to “reaffirm and expose the hidden work
of nursing, describe the conceptual-theoretical-empirical linkages between quality of care and
human caring, and propose approaches for testing the accuracy of the model” (Duffy, 2003).
One real problem I encountered was how to quantify such a nebulous concept as caring.
To do this, I developed the Caring Assessment tool (CAT), which measures patients’ assessment
of their nurses. I was able to use this tool to extrapolate how nurse caring is linked to patient
Running Head: ANALYSIS OF THE QUALITY-CARING MODEL
4
satisfaction (Duffy, 2015). Previously, it was understood that there was a very real link between
professional nursing and patient outcomes; but before this tool it was unclear what the exact
mechanism for that link was. One problem the nursing profession has had and continues to have
is that the acts and decisions that nurses make fade into the general day to day activities of life
rendering them invisible. Nursing care is provided twenty four hours a day in every part of the
world and in every possible health care setting and needs to be recognized as an invaluable
means to improvement of optimum patient health (Duffy & Hoskins, 2003).
There are several assumptions of this theory, one being that caring must be done in
human relationships; second, that caring is an integral part of the in the daily work of nursing;
third, and probably the most difficult, is that the care found in relationships can be measured;
fourth, the awareness of these relationships is very important to nursing and health care in
general; fifth, the study of these relationships and nursing care will determine nursing’s
contribution to health care. The overarching concept is that relationships characterized by caring
greatly increase positive outcomes for patients/families and in doing so, health care providers,
and health care systems (Duffy & Hoskins, 2003).
Syntax
I have defined caring as “a process that involves the person of the nurse relating with the
person of the patient” (Duffy, 2013). There are several components to this theory and their
definitions. The major “structure-process-outcomes components’ are blended with major
constructs in the Human Caring Model and provide the central components of the model” (Duffy
& Hoskins, 2003). The second major component is actually the focus of this theory, which is the
Running Head: ANALYSIS OF THE QUALITY-CARING MODEL
5
actual hands-on part of the nursing care. Process, as used here is defined by Donabedian as what
is done for patients (Duffy & Hoskins, 2003). Some concepts that are included are:
participants, the people involved in the relationship, patients, providers and the organization;
caring relationships, feeling cared for and healthy; individuals, “unique bio–psycho-sociocultural-spiritual beings who process characteristics, attitudes, behaviors and life experiences”
(Duffy & Hoskins, 2003); caring relationships, individual exchanges grounded in caring actions
and attitudes; caring behaviors, this includes directed knowledge, attitudes and behaviors
toward health and healing. It is my finding that this caring relationship is an autonomous
function of nursing and one that nurses are held solely responsible for.
Collaborative relationships are multidisciplinary and include health care professionals
such as physician, therapists and case managers. These relationships should ensure that
continuity of care is achieved, furthering the feeling of being cared for by the patient and their
family. The concept of feeling cared for is vital as it results in patients feeling content that their
needs have been met, that they are accepted and that their status is validated. These feelings lead
not only to higher patient satisfaction but also higher nurse satisfaction, as once the patience feel
cared for they experience ease, protection from harm and maintenance of the their human
dignity, this relaxation creates room for teaching and learning which is one of the main things
nurses do to feel they have made a true difference in a patient’s health (Duffy & Hoskins, 2003).
Theory Testing
One of the first in-depth looks at my theory took place in 1990, when a panel of experts,
to include Dr. Jean Watson established that the content of the CAT showed validity. At the same
Running Head: ANALYSIS OF THE QUALITY-CARING MODEL
6
time, I supported another study of 86 medical surgical patients. With this and two additional
studies I showed internal consistency reliability as .98. Another study in 2006 included 557
participants from five acute care institutions; this study showed overall internal consistency
reliability of .96 (O’Nan, Jenkins, Morgan, Adams, & Davis, 2014).
In 2009, I realized the model needed some revisions and incorporated the aspect of how
relationships with other members of the health care team affect patient care. I felt that blending
measurable outcomes with the unique, caring relationships central to daily nursing practice
represented a practical, postmodern approach. To get measurable outcomes, eight factors related
to caring that were preliminarily validated through research were used. They are: mutual
problem solving, attentive reassurance, human respect, encouraging manner, healing
environment, appreciation of unique meanings, affiliation needs and basic human needs. In
2013, as health care systems grew proportionally larger, I once again revised the theory to take
this factor into account (Duffy, 2015).
While it seems difficult on the face of the issue to measure nurse caring and types of
relationships, the development of CAT allowed these data to be empirically validated. I always
considered this theory one of constant change where evaluation would lead to intervention and
then action, continuously, much like the nursing process (O’Nan, Jenkins, Morgan, Adams, &
Davis, 2014).
In 2014, researchers realized that reviews of literature failed to produce any studies which
longitudinally examined implementation of the model. Therefore, it was proposed that a study
take place at a medium sized southeastern hospital, examining the longitudinal impact of this
Running Head: ANALYSIS OF THE QUALITY-CARING MODEL
7
theory’s implementation, with a specific eye on patients’ perceptions of nurse caring using the
CAT (O’Nan, Jenkins, Morgan, Adams, & Davis, 2014).
The 10 month study did show that implementing caring behaviors increased patient
satisfaction. At the beginning of the study the mean ranking was 92.31 which is at the low end
of the scale and at the end of 10 months was 129.07, which represents moderate caring. This is a
huge shift in nursing culture in a relatively short time. Nursing management worked to add even
more caring interventions to their nursing culture. Evaluation showed a continued need to
change nursing care processes to impact patient and family outcomes (O’Nan, Jenkins, Morgan,
Adams, & Davis, 2014).
Evaluation
This theory can be used in several different ways, the first being in the direct care role, a
nurse can role model self caring; complete systematic/holistic assessments of individuals,
communities or systems, initiate and carry out caring relationships with patients and families to
include their education, make clinical decision and advance interdisciplinary objectives with
other health professionals (Duffy, 2015).
Although there are currently more than 40 US hospitals implementing this theory as a
basis for practice with several using it to develop patient care delivery systems, more evaluation
in diverse populations using specific nursing-sensitive and cost efficiency outcomes measures
are needed (Duffy, 2015).
Running Head: ANALYSIS OF THE QUALITY-CARING MODEL
8
The evaluation of the ten month study was that “The Quality Caring Model provides a
practical framework to assist with transforming nursing practice into an effective relationshipcentered professional atmosphere, an essential component in the current healthcare market”
(O’Nan, Jenkins, Morgan, Adams, & Davis, 2014). The study authors wen …
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