Analysis and Evaluation of Nursing Theory

It is important to understand definitions of nursing theory before moving to theory analysis and evaluation. These definitions direct examination of structure, content, and purposes of theories. Although each of these definitions is adequate for study of any nursing theory, the definition that seems to best fit with the particular purpose for study of theory should be chosen. For example, one of the definitions by Chinn and Jacobs (1987) and Chin and Kramer (1995) may be chosen for using theory in research. The definition by Silva (1997) may be more appropriate for study of nursing theory for use in practice. Another way to think about this is to consider whether the definition of nursing theory in use fits the theory being analyzed and evaluated. Look carefully at the theory, read the theory as presented by the theorist, and read what others have written about the theory. The whole theory must be studied. Parts of the theory without the whole will not be fully meaningful and may lead to misunderstanding. Before selecting a guide for analysis and evaluation, consider the level and scope of the theory, as discussed in the previous chapter. Is the theory a grand nursing theory? A philosophy? A middle-range nursing theory? A practice theory? Not all aspects of theory described in an evaluation guide will be evident in all levels of theory. For example, questions about the metaparadigm are probably not appropriate to use in analyzing middle-range theories. Whall (1996) recognizes this in offering particular guides for analysis and evaluation that vary according to three types of nursing theory: models, middle-range theories, and practice theories.

Theory analysis and evaluation may be thought of as one process or as a two-step sequence. It may be helpful to think of analysis of theory as necessary for adequate study of a nursing theory and evaluation of theory as the assessment of the utility of a theory for particular purposes. Guides for theory evaluation are intended as tools to inform us about theories, and to encourage further development, refinement, and use of theory. There are no guides for theory analysis and evaluation that are adequate and appropriate for every nursing theory.

Johnson (1974) wrote about three basic criteria to guide evaluation of nursing theory. These have continued in use over time and offer direction for guides in use today. These criteria are that the theory should: • define the congruence of nursing practice with societal expectations of nursing decisions and actions; • clarify the social significance of nursing, or the impact of nursing on persons receiving nursing; and • describe social utility, or usefulness of the theory in practice, research, and education.

Following are outlines of the most frequently used guides for analysis and evaluation. These guides are components of the entire work about nursing theory of the individual nursing scholar and offer various interesting approaches to the study of nursing theory. Each guide should be studied in more detail than is offered in this introduction and should be examined in context of the whole work of the individual nurse scholar.

The approach to theory analysis set forth by Chinn and Kramer (1995) is to use guidelines for describing nursing theory that are based on their definition of theory that is presented in Chapter 1. The guidelines set forth questions that clarify the facts about aspects of theory: purpose, concepts, definitions, relationships, structure, assumptions, and scope. These authors suggest that the next step in the process of evaluation is critical reflection about whether and how the nursing theory works. Questions are posed to guide this reflection:
• Is the theory clearly stated?
• Is it stated simply?
• Can the theory be generalized?
• Is the theory accessible?
• How important is the theory?

Fawcett (1993) developed a framework of questions that separates the activities of analysis and evaluation. Questions for analysis in this framework flow from the structural hierarchy of nursing knowledge proposed by Fawcett. The questions for evaluation guide examination of theory content and use for practical purposes. Following is a summary of the Fawcett (1993) framework.

For Theory Analysis, Consideration Is Given To:
• scope of the theory
• metaparadigm concepts and propositions included in the theory
• values and beliefs reflected in the theory
• relation of the theory to a conceptual model and to related disciplines
• concepts and propositions of the theory

For Theory Evaluation, Consideration Is Given To:
• significance of the theory and relations with structure of knowledge
• consistency and clarity of concepts, expressed in congruent, concise language
• adequacy for use in research, education, and practice

• feasibility to apply the theory in practical contexts

Meleis (1997) states that the structural and functional components of a theory should be studied prior to evaluation. The structural components are assumptions, concepts, and propositions of the theory. Functional components include descriptions of the following: focus, client, nursing care, health, nurse-client interactions, environment, and nursing problems and interventions. After studying these dimensions of the theory, critical examination of these elements may take place, as summarized below:
• Relations between structure and function of the theory, including clarity, consistency, and simplicity
• Diagram of theory to understand further the theory by creating a visual representation
• Contagiousness, or adoption of the theory by a wide variety of students, researchers, and practitioners, as reflected in the literature
• Usefulness in practice, education, research, and administration
• External components of personal, professional, and social values, and significance