Conceptual-Theoretical-Empirical Structure, Research Paper Example

Introduction

Nurses are expected to take theory and implement it in practice. In order to do this there must be a transitional phase of knowledge engagement within the field of nursing that serves as the linkage between research and practice. This is the middle range theory that combines the conceptual with the theoretical and the empirical. As there are many health issues in the nursing field, there are many middle range theories that associate with them. The following will evaluate the theory of Goal Attainment by Imogene King.

Evaluation of the conceptual-theoretical-empirical linkages.

One of the most complex aspects of nursing is the expectation of nurses in clinical settings to translate theory to be utilized in research and practice. In response to this challenge, the epistemology of nursing breaks down health issues into three frameworks, conceptual, theoretical and empirical. Middle range theory represents the the middle level of these three, and it is understood as theory functioning as the linkage between practice and research.  Addressing health issues through this three level framework is recognized within nursing research circles as holarchy. In numerous publications on nursing, Fawcett (2005) structured the concepts of philosophy, metaparadigm, conceptual models, empirical indicators and theory around the concept of holarchy. Fawcett utilized holarchy to define the levels through which conceptual-theoretical-empirical (C-T-E) were defined.

Evaluation of the selected theory

The selected theory for this research is  the theory of Goal Attainment by Imogene King. Imogene King is known within the field of nursing  for “Kings Conceptual Framework”.  Imogene King is   a “mid range theorist.” A  Middle-range theorist focuses on a narrower range of concepts than a grand nursing theorist. Imogene King’s theory provides three levels of interacting systems that shape and influence the driving factors for individual growth, their development, their work, and their death.  The three levels proposed by the theory are personal systems, interpersonal systems, and social systems. Personal systems refers to concepts related to understanding human beings and the understanding of them such as self, development, body image, perception space, and time. Interpersonal systems refers to communication and interaction between individuals such as transactions, role, stress, communication and interactions.  Social systems represent groups of people that function within a society or community  who share common value, interest and goals.

Evaluation of the empirical indicators

On the topic of pragmatic adequacy in nursing, authors Jacqueline Fawcwett and Joan Garity note that pragmatic adequacy refers to the use of a theory as evidence for the creation and use  of measurement tools, specifically in regards to the use of a theory in practice. She notes that pragmatic adequacy requires that the theory as whole be used in the development of furthering knowledge and research in the respective field through the use of empirical indicators. The empirical indicators are those key signifiers that trigger the possibility that a particular theory might be applicable in a specific clinical setting.

The empirical indicator associated with the theory of goal attainment is accessibility, as the theory itself does not lend itself directly to empirical testing.  The empirical indicators associated with Goal attainment are the perceived indicators of change from a normal patient’s physical or mental functioning to an alternate state of functionality. Patients can self report their symptoms but of course the main goal within goal attainment theory is a positive outcome. The empirical indicators of clinical outcomes are observed and assessed through a wide range of measurable dimensions such as timing, intensity, quality and distress. Strength or severity of clinical outcomes is measured by the intensity of their impact on the patient. Timing refers to the frequency and duration of their occurrence. Distress is identified as the perceived discomfort the patient feels, and quality refers to the patient’s description of the symptoms.

Evaluation of research findings

Goal attainment researchers utilize a method known as program planning in their research to retain valuable knowledge across the nursing epistemology. Dogherty and Graham explain program planning as a process through which evidence based practice in nursing is established and cultivated. They take the position that the most effective setting for symptom management in a clinical environment is one where the most current resources and research is accessible, but also where findings can be actively documented for research purposes as well as patient care.  They state that “further understanding of what facilitators are actually doing to enable changes in nursing practice based on research findings will provide the groundwork for the design and evaluation of practical strategies for evidence-based practice in nursing” (Dogherty & Graham, 2010, p.1111).  They go on to note that research in respect to symptom management is still inadequate in relation to the wide range of medication mistakes and mis-diagnoses that still occur within the field of nursing, largely related to misunderstanding of symptom similarities in relation to one another. There is a wide body of research on symptom management available, but the argument these authors present puts into question whether the information gained is being put to practical use within the medical field (Dogherty & Graham, 2010).

Evaluation of the utility and soundness of the practice theory

The final step in the evaluation process of the C-T-E structure when it comes to generating theories and testing theories brings the focus of the research back to the component of the conceptual model. This step which entails the evaluation of utility and soundness of the practice theory is referred to as legitimacy (Fawcett, 2005). In order for the theory to be classified as legitimate the conceptual model must be useful for research and the research design and findings must be believable and sound.  The importance of the theory can be seen in how nurse-patient interactions result in a higher consciousness of medical issues within the field and Goal Oriented Nursing Record Quality Assurance programs monitors the attainment of goals through measuring outcomes. As King notes, “outcomes indicate a measure of quality care” (King, 1988, p. 293).  In regards to the soundness of the practice of the theory of Goal attainment, current health care issues and constant advancements in technology in the industry create new challenges for continuing staff. Specifically in the nursing profession, with each season as new technology innovations arise, the industry finds new ways to enhance symptom diagnosis management and the transfer of information between practitioners.

Conclusion

As medical practitioners work on a daily basis to bridge the gap between knowledge utilization and knowledge generation, the theory of goal attainment better equips them to make sound diagnoses of patient symptoms. This is the only way nurses and other medical professionals can ensure they are  providing adequate care. It is quite possible one symptom can be mistaken for another and it is only through and understanding of all of these symptoms, their similarities to one another, and their empirical indicators assess within a wide range of clinical contexts, can a sound diagnoses be provided.  Despite the fact bedside technology, such as bar coding has the capability to develop medication safety, it can also have a significant impact on work-flow of nursing. For example, when technology of bar code causes nurses to take distance to administer medications, this could switch nurses from other pertinent patient-care activities that can have a related cause to decreasing staff ratios for nurses and result in  poorer patient results (DeYoung, Vanderkooi and Barletta, 2009). The continuous study of middle-range theories like TOUS remains a practical tool to sustain knowledgeable evidence-based research within nursing in regards to symptom management.

References

DeYoung, J. L., Vanderkooi, M. E., & Barletta, J. F. (2009). Effect of bar-code-assisted medication administration on medication error rates in an adult medical intensive care unit. American journal of health system pharmacy AJHP official journal of the American Society of Health System Pharmacists, 66(12), 1110-1115.

Dogherty, E. J., Harrison, M. B., & Graham, I. D. (2010). Facilitation as a Role and Process in   Achieving Evidence?Based Practice in Nursing: A Focused Review of Concept and Meaning. Worldviews on Evidence?Based Nursing, 7(2), 76-89.

Fawcett, J. (2005). Middle range nursing theories are necessary for the advancement of the discipline. Aquichan, 5(1).

King, I.M. (1971). Toward a theory for Nursing: General Concepts of Human Behavior.

New York: Wiley. Retrieved from: http://imogeneking.blogspot.com/

King, I. M. (1988). The nurse theorists: Portraits of excellence—Imogene King [Videotape and CD].  Athens, OH: Fuld Institute for Technology in Nursing Education. Retrieved from http://www.virtualcurriculum.com/N3225/Fawcett_King.pdf

Nursing Theories. (2011,Janurary). Imogene King’s Theory of Goal Attainment. Retrieved from http://currentnursing.com/nursing_theory/goal_attainment_theory.html

Lierh, P. (2005). Looking at symptoms with a middle-range theory lens. Adv Stud Nurs, 3(5),     152-7