Methodologies for developing conceptual models in nursing

Aggleton and Chalmers (1986) described three ways in which nursing models and theories can be developed as inductive, hypothetico-deductive and reproductive approaches. According to Aggleton and Chalmers, inductive approach involves moving from specific observation to general explanation while hypothetico-deductive involves moving from existing research findings to identification of hypothesis to be tested. The third approach which is reproductive is described by Aggleton and Chalmers, Fawcett (2006) and Lee (2014) as a combination of both inductive and hypothetico-deductive approach.

Satu, Kääriäinen, Isola, and Kyngäs (2013) in support of inductive and deductive approaches to development of nursing theories argued that if both approaches are used, then they occur in turns, implying that the development process may begin using either an inductive or a deductive approach, depending on the nature of the data. However they referred to hypothetico-deductive

61 approach simply as the deductive method which involves looking for the compatibility of a general nursing theory with nursing practice. Lee (2014), however, argued that other than the two methods explained by Satu et al, (2013), nursing theories can also be derived reproductively as proposed by Aggleton and Chalmers(1986) and Fawcett (2006) through looking for the generation of ideas to devise a theory and approaches to theoretical inquiry.

Meleis (2007) came up with four different approaches which she called theory–practice–theory, practice–theory, research–theory, and theory–research–theory that may be used to initiate the process of theory development in nursing according to their origin such as theory, practice and research. According to Meleis, the theory–practice–theory is the first approach to theory

development. Its origin of this approach is a theory which is typically non-nursing but describes a phenomenon of interest. This approach assumes that the theory can help describe or explain the phenomenon, but it is not completely congruent with nursing and is not directly defined for nursing practice. However, it may be used to explain a selected clinical situation (e.g. adaptation, stress, health beliefs) with its propositions and concepts modified and applied to the clinical situation. Examples of such theories as given by Meleis (2007) include Benner’s use of Dreyfus’s Model of Skill Acquisition to describe novice to expert practice (Benner, 2001) and Roy’s use of Helson’s Adaptation Theory to describe human responses.

The second approach by Meleis (2007) is practice–theory. This is referred to as inductive

approach by other authors and begins with a question evolving from a practice situation. It relies on observation of new phenomena, development of concepts, labeling, describing, and

62 phenomenon, analyzes similarities and differences, then compares and contrasts responses. Findings are used to develop concepts and propositional statements. Examples of this approach include a situation-specific theory of Caucasian cancer patients’ pain experience (Im, 2006), and “keeping the spirit alive” among children with cancer and their families (Woodgate & Degner, 2003). The practice-theory approach or the inductive approach was deemed suitable for the current Grounded Theory methodology which is described further in the methodology section of this thesis.

Meleis’ (2007), third approach is the research–theory which emphasizes on empiricism and is therefore a deductive method. The researcher selects a phenomenon of interest to the profession, and identifies and lists its characteristics that should be measured. The method to measure the characteristics of the selected phenomenon is developed. A controlled study is designed and conducted during which the characteristics of the phenomenon are measured. The results are analyzed to determine existence of any systematic patterns which are then formalized into theoretical statements. Examples of this approach include a report outlining a conceptual framework for caring in nursing practice (McCance, 2003), and a theoretical look at the involvement of relatives in palliative care (Andershed & Ternestedt, 2001).

According to Meleis (2007), Theory–Research–Theory is the fourth approach. A selected theory is defined and propositions for testing are determined. The research findings are used to further modify and develop the original theory or create a new theory which can be used as a framework for research. Examples of this approach include a theory of genetic vulnerability developed from Roy’s Adaptation Model using Grounded Theory methodology (Hamilton & Bowers, 2007), and

63 the theory of diversity of human field pattern, which was developed from Martha Rogers’

Science of Unitary Human Beings using a quantitative research design (Hastings-Tolsma, 2006).

Although Meleis (2007) had four approaches that were labelled differently, they all use the principles of inductive or deductive approaches to theory development which utilize quantitative or qualitative designs. An inductive approach to theory generation is utilized when the purpose is to develop a theory on an area with a dearth of information such as in the current study where the views of Kenyan nurses on the four nursing metaparadigms had not been explored. Deductive methods on the other hand are utilized when theoretical presumption concerning the subject on which the theory is being formed is required.

From the literature reviewed, the main methods that are used to develop nursing theory are inductive and deductive. This conclusion is supported by Liehr and Smith (1999).In their attempt to determine the approach used in developing nursing theories and models, Liehr and Smith (1999) reviewed 10 years of nursing literature on developing middle range theories in the late 1980s and 1990s.Their findings confirmed that most of the theories were developed inductively or deductively or reproductively.