CONCEPT ANALYSIS PAPER

Choose a concept relevant to your nursing practice [present or future]. Following the guidelines given in Chinn & Kramer [Chapter 7], or Walker and Avant, analyze the concept and develop cases: model, contrary, related, and borderline. The paper length should not exceed 10 pages.  The paper must be submitted through Safe Assign to check similarity index prior to submission.

Rubric Criteria for concept analysis paper:

1. Identification of Concept Background & significance of concept: Discuss the meaning of the concept as used in 1 theory.	10
2. Incorporate relevant research that has been conducted. Discuss why this concept analysis is necessary for nursing.	10
3. Aims of This Analysis: Discuss what will be generated by this analysis.	5
4. Definitions: Provide definitions for concept & other terms used. Needs to include antecedents and consequences.	10
5. Development of Cases: Provide cases: Model, contrary, related & borderline.	30
6. Tentative criteria: Discuss criteria developed for concept. Include an operational definition.	15
7. Summary and Conclusion	10
8. Clarity, logic, grammar, spelling, & APA format (7th Ed)	10
Total	100%

Subtitle or Section:

Please use headings to separate the sections of the paper. Suggested headings are Identification of Concept, Relevant Research, Aims of Analysis, Definitions, Development of Cases, Criteria for Concept, Summary and Conclusion.

I am stepdown Icu/Tele Rn and this class is for AGNP program.

 

 

Knowledge Development in Nursing – E-Book

Peggy L. Chinn; Maeona K. Kramer

 

CHAPTER 7

Empiric Knowledge Development

There seems to be general agreement that there is a critical need for knowledge about the empirical world, knowledge that is systematically organized into general laws and theories for the purpose of describing, explaining, and predicting phenomena of special concern to the discipline of nursing.

Barbara Carper (1978, p. 14)

The opening quote suggests that the discipline of nursing requires systematic knowledge about the empirical world—knowledge that describes, explains, and predicts events and phenomena that nurses deal with on a daily basis. Nursing, however, is often characterized as a human science, which means that its disciplinary knowledge focuses on phenomena and events that are very different from phenomena within the physical sciences. Understanding (and developing) shared empiric knowledge about human responses to a life-changing event is much different than understanding how solid matter responds to the application of heat or force.

 Consider This…

Early one evening, as off-duty pediatric nurse Connie prepared dinner in her suburban home, three neighbor children ran into her kitchen and asked her to come quickly because “Noah fell and is hurt.” Noah is a 2-year-old neighbor boy who was born to a 15-year-old girl. He lives with his mother, Shalyn, as well as Shalyn’s four siblings and parents in a recently remodeled home. As Connie reaches the living room where Noah is laying, Shalyn is near panic at the sight of her child motionless on the floor. Connie glances up, notices a loft area, and infers that Noah apparently climbed the stairs, put a stool against the loft railing, climbed over, and fell about 16 feet to the wooden floor below. At the time of Noah’s fall, the only other people who were home were Shalyn and her 10-year-old brother. Shalyn heard Noah fall, but did not see how he landed. As Connie approaches Noah, she can see that his eyes are open. He has no visible injuries, and he responds with whimpers and soft crying when he was approached. Shalyn showed great relief as Noah got up and walked toward her. While Noah was being held by Shalyn, Connie was able to check his movements and pupils and palpate his head. Although he had a bump on the side of his head, Connie found nothing else unusual, despite his significant fall.

Recognizing the potential seriousness of the situation, Connie advises Shalyn to take Noah to a nearby emergency department for evaluation. Shalyn calls her mother immediately and asks her to leave work to drive them to the hospital. As Connie waits for Shalyn’s mother to arrive, Shalyn says that she is worried that her father might become very angry and physically hurtful and blame her for Noah’s fall. At the hospital, Noah is diagnosed with a skull fracture and kept overnight. When Noah was released, watchful waiting was recommended, and he recovered without incident. Connie called Shalyn’s father that evening to verify that he understood the urgency of securing the loft so that Noah stays safe, and to determine if he was handling the situation without becoming abusive. She also checked with Shalyn to address her fears about his response.

In this case, Connie’s scientific-empiric knowledge of the signs and symptoms of neurologic injury made it possible for her to assess Noah’s condition immediately following the fall, knowing the effect of head trauma on motor and sensory function as well as how children might respond differently to trauma as compared with adults. Her advice to take Noah for further assessment and observation was based on scientific-empiric knowledge about how and why symptoms of head injury might not immediately be seen, and the necessity to monitor signs and symptoms of a head injury in the first 24 to 48 hours. Her empirical knowledge of patterns of domestic violence also informed her decision to check in with the family to assess whether this had become a factor. Connie’s knowledge of each aspect of the situation (head injury and domestic violence) developed from her own experiences with children as well as background knowledge that had been verified and communicated to her through texts, research reports, and classroom experiences.

In this chapter we address the dimensions of empiric knowing and knowledge development—the critical questions, creative processes, and forms of expressions for the pattern of empirics. The term empiric has a number of nuanced, interrelated meanings. From a traditional standpoint, an empiric (noun) is an individual who relies on experience for knowledge about the world. In this way, knowledge deemed empirical was based on personal observation and experience; the person with that knowledge was an “empiric.” In the clinical health care context today, an empiric treatment or care approach is one that has been demonstrated, through observation and experience of professionals, to be effective. There may or may not be scientific evidence to support the treatment. Empirical knowledge of this sort can be shared and transmitted. However, it does not come about through research, extrapolation from theory, nor does it originate in formal logic processes.

From a more scientific perspective on knowledge, empiric knowledge still refers to that which is known through sensory perception, either directly or indirectly, and what is known can be shared across observers. To be considered scientific, however, knowledge must have a degree of verifiability or authentication. Our use of the term “empiric” pertains to scientific knowledge and is knowledge that arises out of direct or indirect perceptual experience. As disciplinary knowledge, what constitutes scientific empirical knowledge is developed using a broad array of approaches. These include such things as controlled experimental studies as well as various naturalistic methods or analytic approaches. These approaches require interacting with and understanding the nature of experience as it is perceived, or represented—in language or text. This definition is broad to be sure, but the bottom line is that what constitutes empirics emanates from direct and indirect sensory perception and relies on direct and indirect perception for authentication. Not all empiric knowledge can be considered scientific. To be scientific, empirically generated knowledge must be verified using accepted professional methods. When we discuss empirics and use that term, we assume a focus on scientific-empirics rather than empirics as “knowledge from experience that seems to work.”

 

FIG. 7.1 Dimensions of Empiric Knowledge Development.

Dimensions of Empiric Knowledge Development

Fig. 7.1 shows the empiric quadrant of our model for nursing knowledge development. As the critical questions “What is this?” and “How does it work?” are asked, the creative processes of conceptualizing and structuring are initiated. As with the other patterns, these questions are also asked, not deliberatively, but more intuitively, in the moment of practice as empiric knowledge is integrated with the other patterns of knowing. The creative processes of conceptualizing and structuring provide insights and tentative “answers” to the critical questions of empirics. Out of the creative processes comes the generation or reconfiguring of formal expressions of empirics. Table 7.1 Summarizes the dimensions of empiric knowing. In this chapter we address the dimensions of critical questions, creative processes and formal expressions.

Our focus on empirical knowledge is primarily on empiric theory, however much of what follows applies to other forms of empiric knowledge as well. Formalized descriptions based on direct and indirect sensory observation, as well as empiric research reports, are other forms of empiric knowledge that arise from the critical questions and creative processes of empirics.

Critical Questions: What Is This? How Does It Work?

The critical questions of empirics assume that some degree of objectivity exists, and that it can be understood through observation and inferences based on indirect observations. In other words, the critical questions of empirics address objects, experiences, and perceptions that are assumed to be somewhat tangible. To claim something is “real” or tangible suggests that the meaning of the object, experience, or perception is similar across observers. This further implies that meaning is more located in the object, experience, or perception itself than within the person perceiving it.

TABLE 7.1

Dimensions of Empiric Knowledge Development

Dimension	Empirics
Critical questions	What is this? How does it work?
Creative processes	Conceptualizing Structuring
Formal expressions	Facts Models Formal descriptions Theories Thematic descriptions Empiric research reports
Authentication processes	Confirmation Validation
Integrated expression in practice	Scientific competence

 Consider This…

Suzie: “Wow, Alison, I love that aqua scarf you’re wearing!”

Alison: “Thanks, Suzie; I really love aqua blue.”

Suzie: “Me too! It reminds me of the Caribbean Sea and memories of Mexico.”

• Is knowledge of the scarf’s color empirical?
• If so, what makes it empirical?
• What determines why the scarf is said to be blue?
• Would you say knowledge about agreement on color is scientific as well as empirical?

In this example of a blue scarf, Alison and Suzi both agree that the scarf is aqua blue, and likely others would also. This suggests that aqua is a property of the scarf itself. Had Alison commented that Suzi’s scarf was unattractive on her, while Suzi thought it looked attractive we would conclude that attractiveness was not an obvious inherent property of the scarf itself.

 Discuss This…

Suppose you encounter an emotionally withdrawn child during a pediatric rotation. Recognizing this withdrawal pattern for a child in these circumstances as unusual and counterproductive, you ask: What is this? What does it mean? There could be several reasons. Discuss with your peers the possible explanations, including:

• Emotional self-protection?
• Effects of a medication?
• Pain?

Are your explanations adequate? What would you need to do to create or have an adequate explanation? What do you mean by “emotional withdrawal”?

Creative Processes: Conceptualizing and Structuring

The creative processes initiated by the critical questions can take various forms, each of which can lead to credible empirical knowledge. Regardless of form, creative processes will involve conceptualizing and structuring. Conceptualizing refers to thinking about and systematically considering the nature and meaning of ideas, expressing that meaning in language or symbols, and formulating empirically knowable referents for those ideas. Consider the idea of “emotional withdrawal.” Conceptualizing using the processes for empirical knowledge means you will need to carefully and rigorously formulate or designate a meaning for “emotional withdrawal.”

Conceptualizing can occur informally through careful thought about the meaning you discern or intend for an idea, or formally through rigorous methods of concept clarification that might be required for some types of research or theory construction. Conceptualizations can also emerge or be better understood from certain forms of inductive research inquiry. Conceptualizing involves creative processes of making meaning; it involves exploring a wide range of possible meanings for a concept and creating or designating a meaning that is relevant to your purpose.

Structuring refers to the organization of ideas, into various forms of empirical knowledge such as theories, descriptions, or written analyses. The structuring process also takes many forms but universally involves organizing concepts into a linguistic or visual structure in a way that represents them as fully as possible. Structuring can occur by using text to organize ideas into a logical or coherent form as in an interpretive study report. Or, structuring might be done by formulating hypotheses for testing as in a quasi-experimental research approach. Basically, structuring requires a language that represents the ideas the knowledge developer is working with.

 Imagine This…

Imagine that you have frequently observed emotional withdrawal in children undergoing chemotherapy, and are interested in finding out if therapy dogs might alleviate their emotional withdrawal. You might arrange for therapy dogs to visit with children undergoing chemotherapy, interview parents about their perceptions of their child’s response, and then structure your findings in a narrative. Or, you might formulate hypotheses related to the nature and timing of exposure to therapy dogs and design an experiment to test whether certain features of timing or other variables affect response. Either way, you are structuring ideas as knowledge.

We have said that conceptualizing and structuring in the context of empiric knowledge development is a rigorous process that must be done carefully. If the meaning of the ideas you are considering is inappropriate for the context, or your approach to inquiry is inadequate, the validity of the knowledge will be questionable and authentication cannot be achieved. The next section considers the nature of concepts and techniques for conceptualizing within the context of knowledge development. While creating conceptual meaning is considered first, it should be noted that structuring may lead to clarifying conceptual meaning and both processes tend to be intermingled.

The Nature of Concepts and Conceptual Meaning

We define the term concept as a complex mental formulation of experience. By “experience,” we mean perceptions of the world, including objects, other people, visual images, color, movement, sounds, behavior, and interactions; in other words, we refer to the totality of what is perceived. Experience is considered empiric when it can be symbolically shared and verified by others with sensory evidence.

Fig. 7.2 shows the three sources of experience interacting to form the meaning of the concept: (1) the word or other symbolic label; (2) the thing itself (object, property, or event); and (3) the feelings, values, and attitudes associated with the word and with the perception of the thing. As any one of these elements changes over time, the concept itself changes.

 

FIG. 7.2 Sources of Experience Forming Conceptual Meaning.

 Consider This…

Consider the concept of mouse. Until the 1980s, this word symbol was almost exclusively connected to a little critter that wreaks havoc in people’s basements and prompts screams of terror in movies. In a very short time frame, this word symbol came to signify not only that little critter but also a very different object: a device that is used to navigate a cursor on a computer. At first, this device was thought to be optional and mainly useful for the playing of games. However, it quickly became not optional but necessary (which is an attitude or feeling), and certainly not an object that elicits screams and screeches. Almost any word could have been chosen for this little object, but its originators selected the word mouse, which derives from the resemblance of early models that had a cord attached to the rear part of the device (suggesting a tail) to the common rodent “mouse.” More recently the concept of a mouse as it relates to computer navigation has changed from something that was once necessary to something that is no longer required once track pads for navigation were introduced.

The same word may be used to represent more than one concept or mental image. For example, the word cup may be used to represent several different kinds of objects or ideas. Each use of the word carries with it different perceptions and meanings. If the object is a fancy teacup, a very different mental image forms than if the object is the cup into which a golf ball falls on a putting green. When creating, designating, or deciding conceptual meaning, you examine the range of meanings signified by a word symbol, and make a reasoned decision about what elements of meaning are important for your purpose.

All concepts can be located on a continuum from the more empiric (i.e., more directly experienced) to the abstract (i.e., more mentally constructed) (Jacox, 1974; Kaplan, 1964). In one sense, all concepts are both empiric and abstract. They are empiric because they are formed from perceptual encounters with the world as it is experienced, but they are abstract because they are mental images of that experience.

Some concepts are formed from very direct experiences that can be more readily verified by others. Others are formed from experiences that are commonly recognized but inferred indirectly. Fig 7.3 illustrates this continuum. Relatively empiric concepts are ideas that are formed from the direct observation of objects, properties, or events. As concepts become more abstract, they are inferred from indirect evidence. The most abstract concepts are mental constructions that encompass a complex network of subconcepts.

The most concrete empiric concepts have direct forms of measurement. Concepts formed around objects such as a cup or properties such as temperature are examples of highly empiric concepts, because the object or property that represents the idea (i.e., the empiric indicator) can be directly experienced through the senses and confirmed by many different people. Properties such as height and weight can be measured with standardized instruments.

As concepts become more abstract, their observational signifiers (i.e., their empiric indicators) become less concrete and less directly measurable. The assessment of an abstract concept depends increasingly on indirect means. Although an indirect assessment or observation is different from direct measurement, it is still considered a reasonable indicator of the concept. An individual’s hemoglobin level is representative of a concept that cannot be directly observed but that can be indirectly measured with the aid of laboratory instruments, which is a less direct form of measurement.

 

FIG. 7.3 Empiric–Abstract Continuum.

Cardiovascular fitness is an example of a concept in the middle range on the empiric–abstract continuum. Concepts increase in complexity in this range, and several empiric indicators must be assessed. Because no actual object that can be called “cardiovascular fitness” exists, a definition is required if we are to know what it is. Although definitions for less empirically based concepts are thoughtfully formulated, these are arbitrary because many different definitions could be chosen. As concepts become increasingly abstract, definitions become more dependent on a meaning for the concept that is created in relation to the purpose for defining it.

Self-esteem is an example of a highly abstract concept for which there is no direct measure. The instruments or tools that are developed to assess self-esteem depend on definitions that serve a specific purpose and are built on many behaviors and personality characteristics that experts agree are associated with the concept. Ideas about these characteristics may be derived from a theory, scholarly writings, or from creating conceptual meaning. Each behavioral trait that is contained in a self-esteem measurement tool can be considered a partial indicator of self-esteem. When the composite behaviors and personal characteristics are built into an assessment tool, it is usually a more adequate indicator of the abstract concept than any one behavior alone. The composite score obtained from the tool is then considered to be a measurement that has been constructed as an empiric indicator.

Highly abstract concepts are sometimes called constructs. Constructs are the most complex type of concept on the empiric–abstract continuum. These concepts include ideas with a reality base so abstract that meaning is constructed from multiple sources of direct and indirect evidence. An example of a construct is wellness. Although the idea of wellness exists, it cannot be directly observed. Fig. 7.3 illustrates the idea that highly abstract concepts are constructed from other concepts. All concepts shown on the continuum (as well as others) can be included in the concept of wellness.

Some abstract concepts have little meaning outside of the context of a theory. For example, Levine (1967) coined the word trophicogenic to mean “nurse-induced illness.” Abstract concepts may also acquire additional meanings through gradual transfer into common language usage. Freud’s concept of ego is an example. The word ego once had no common meaning outside of Freud’s theory, but now almost everyone who speaks American English knows the meaning of the phrase “a big ego.”

A single object, property, or event can also be represented by several different words. Each word conveys a slightly different meaning and often reflects nuances that relate to socially derived value meanings. For example, the words jalopy, puddle-jumper, Beemer, and Hot Wheels all refer to one basic thing: an automobile. The use of any of these words to describe an automobile conveys the perspective of the person who is using the word, as well as the features of the object itself.

Feelings, values, and attitudes are inner processes that are associated with concepts. For example, the word mother carries feelings, values, and attitudes that form from human experience with an actual person. Varying experiences with a certain mother (the person) account for the range of feelings that people associate with the word mother. At the same time, the meaning of the concept mother is formed from shared cultural and societal heritages. A concept such as mother, which can carry simple and specific or highly complex meanings, changes in its level of abstraction, depending on the context of usage. For example, a specific and simple meaning might be in the context of a questionnaire when a yes or no box is provided for responders to check indicating if they are a biological mother (i.e., have given birth). This simple and specific meaning contrasts with the meaning of mother if one is trying to discern the characteristics of early childhood mothering that is protective, nurturing, and enduring.

 Why Is This Important?

Nurses often claim that they tend to be very “concrete”—that they do not relate to theoretic abstractions. At the same time, nurses regularly address experiences such as grief, anxiety, and hopelessness, all concepts that are highly abstract. These concepts come to be seen as more “concrete” because the behavioral manifestations that we associate with them have been commonly accepted.

Although it usually is not possible or necessary to identify precisely where concepts fit on the empiric–abstract continuum, it is important to understand that concepts vary in the degree they are connected to what is perceived as experience and the extent to which their meaning is mentally constructed. Many nursing concepts are highly abstract. When you begin to work with an abstract concept, it is natural to wonder why it is difficult to grasp the meaning of the term and understand all that is conveyed by the concept.

Methods for Creating Conceptual Meaning

We talk about creating conceptual meaning because, in the context of knowledge development in nursing, concepts are often highly abstract and a meaning needs to be created from among a set of competing and nuanced meanings. Even when the concept is quite empirically grounded, designating a meaning is still an act of creation because even more empirically based concepts can have multiple meanings.

Creating conceptual meaning produces a tentative definition of the concept. We emphasize tentative because the definition can and may need to be revised. This does not mean, however, that “anything goes” or that any definition that suits the author will do. The use of tentative here means that the definition is open and can be changed as new insights and understandings come to light, or as circumstances change.

There are various methods for creating conceptual meaning, each of which has advantages and drawbacks (Beckwith, Dickinson, & Kendall, 2008). These techniques are designated as concept clarification, concept development, or concept analysis. Most of the methods have been used for several decades and can be usefully employed systematic, reliable methods. Norris (1982) described several methods for concept clarification. Walker and Avant (2010) detailed a method of concept analysis based on the work of Wilson (1963). Morse (1995) proposed methods of concept development and analysis that draw on qualitative and quantitative research approaches to validate meanings projected by analytic processes. Moscou (2008) described a method of concept analysis based on research evidence. An “evolutionary” method of concept analysis proposed by Rodgers and Knafl (2000) recognizes that conceptual meaning is dependent on context. Morrow (2009) described a creative process for selecting and conceptualizing meaning on the basis of the contemplation of a painting, then placing the meaning within a nursing framework. Bonis (2013) described an approach to concept analysis that focuses on detecting differences in the conceptual understandings embedded in different disciplines, so that nurses can better judge the value of borrowing research instruments from other disciplines.

Our approaches to creating conceptual meaning are similar to some of the processes described by other authors, but our approach assumes that meanings are created for a particular purpose and do not remain static but rather change over time and in different contexts. Therefore, it is not possible to make a claim that a concept is “mature” or sufficiently developed. Meanings are not inherent in objects or in a reality that exists independently; rather, they are shaped and formed in relation to a particular purpose and a particular context. For example, consider again the example of the word mouse and the two very different conceptual meanings that it carries. The conceptual meanings you would bring with you to a pet store and those you would bring to a computer store intending to purchase a mouse are shaped by the purpose of your shopping trip and the type of store that you enter to achieve this purpose.

When creating meaning, a wide variety of sources and methods can be used. Some are more formal and rigorous; others less so. Whether you go through a formal process of concept clarification, use a standard definition, or rely on professional literature to establish meaning depends on your purpose. There is no recipe or specific method to follow, and the approach to creating meaning can shift according to the purpose for which your concept is intended or used. The following sections provide guidelines that you can select, adapt, and blend as guided by your purpose. Not all concepts require formal methods for establishing meaning. When necessary for one’s purposes, however, these approaches are extremely important and valuable. In these next sections, we consider more formal methods for creating conceptual meaning.

Regardless of your approach to creating conceptual meaning, you start with the designated concept. Concept selection is guided by your purpose and expresses values related to your purpose. For example, your purpose might be to work with the concept dependence for a research project. Eventually, you will need a clear conceptualization of dependence as well as ideas about how to measure or assess it. Another purpose might be to differentiate between two closely related concepts, such as sympathy and empathy. In this case, your concern is to create definitions that differentiate on the basis of a thorough familiarity with the meanings that are possible.

Another reason for creating conceptual meaning is to examine the ways in which concepts are used in existing writings. For example, the concept of intuition frequently appears in nursing literature, with many different but related meanings. The meanings that are conveyed reflect different assumptions about the phenomenon. As you become aware of these meanings, you become familiar with meanings that are consistent with your own purpose.

Other purposes behind creating conceptual meaning include generating research hypotheses, formulating nursing diagnoses, and developing computerized databases for clinical decision making. Creating conceptual meaning is also a valuable process for learning critical-thinking skills (Kramer, 1993). When you keep your purpose as clear as possible, you have an anchor that provides a sense of direction when you seem to be lost.

 Why Is This Important?

Because nursing has many broad, wholistic, and inclusive interests, it is easy to lose sight of the fact that a nursing perspective brings important insights to conceptual meaning. When choosing concepts, in addition to your purpose, the role and context of nursing is important to the choice. As you create conceptual meaning, it is important to make choices that help ensure meanings are useful to nurses as they manage human responses and help persons to move toward health. The important question is not, “Is this a nursing concept?” but rather, “Is this concept of interest to nursing, and is the meaning created useful for nursing’s purposes?”

Sociopolitical considerations will also influence your choice of a concept and your approach to understanding it, often in ways that are subtle and difficult to perceive. For example, if you choose to examine the concept of transition for daughters who must place their mothers in nursing homes, you may eventually be lead to consider the consequences of women’s caretaking within a society that devalues its elders and women’s caregiving work.

Some concepts are not appropriate as a focus for the process of creating conceptual meaning. Some are too empirically grounded, and others are too expansive to yield a useful outcome. Concepts that represent empirically knowable objects (e.g., antiembolic stockings) are usually not good choices, because they are highly empirically grounded and can be demonstrated by a display of the thing itself. You do not need to examine the concepts to understand their meanings, and having criteria for recognizing them will not help you clinically in any significant way. Broad concepts such as caring and stress pose another set of problems. Because these types of concepts are so vast, creating meaning can result only in a broad understanding that omits necessary detail and that may be misleading. This is not to say that creating conceptual meaning for very narrow or broad concepts is never useful, and for some purposes, it may be justifiable. In our experience, the concepts that are most often amenable to the creation of conceptual meaning are those in the middle range. It often is helpful when choosing a concept to place it within the context of use, stress as associated with first-time mothers, to narrow its scope in relation to your purpose. In this case, stress still remains the concept of interest but you situate it within a context that will limit your exploration of meanings.

Once you have selected or encountered a concept that you believe needs to be subjected to formal processes of creating conceptual meaning, processes for creating conceptual meaning can be initiated.

Sources of Evidence

The sources that you choose and the extent to which you use various sources depend on your purposes. Early in the process of gathering evidence for the concept you have chosen, tentative criteria are proposed, and those criteria are refined in the light of additional information provided by continued gathering of evidence. We recommend beginning the process of criteria formulation early so that useful information is not lost. Criteria are succinct statements that describe essential characteristics and features that distinguish the concept as a recognizable entity and that differentiate this entity from other related ideas. Establishing tentative criteria using an exemplar case is a useful beginning strategy.

Exemplar Case

An exemplar case is a description or depiction of a situation, experience, or event that satisfies the following statement: “If this is not x (insert your concept), then nothing is.” The case can be drawn from nursing practice, literature, art, film, or any other source in which the concept is represented or symbolized. The case is selected because it represents the concept to the best of your present understanding. When you deal with more abstract nursing concepts, exemplar cases of abstract concepts involve experiences and circumstances that are described in words. Exemplar cases may be created from your own experience, or you may find cases in the literature that have been constructed or described by others. However, you should always trust your own judgment about whether cases found in the literature are useful. You may find a case that is said to represent your concept, but you may decide it is not an adequate representation for your purposes.

 Discuss This…

Discuss developing an exemplar case for the concept of mothering with a group of your peers.

• Start with this scenario as an exemplar case: An infant cries, and an adult picks up the infant.
• Is this an adequate case to represent mothering? If not, why not?
• What circumstances, behaviors, motives, attitudes, and feelings would need to be included in your case so that everyone can agree that it is an exemplar case of mothering?

When you create your own exemplar case, it is important to work with your ideas and revise your description until you are satisfied that the case fully represents your concept. In the exemplar case of mothering, the adult initially might be portrayed as female. Later, you might portray a male in the same case. In the absence of any evidence one way or the other, you might tentatively decide that the idea of mothering that you are creating will be deliberately limited to instances that involve women. Because your decision is tentative, you can change your construction for another purpose or circumstance.

While you are working with exemplar cases, pose the following question: What makes this an instance of this concept? The responses to this question form the basis for a tentative list of features that must be present for mothering to occur. These features will become criteria that are designed to allow you to recognize the concept and to differentiate it from related concepts. In the case of mothering, the features serve to distinguish your concept (for example, mothering) from similar concepts (such as caring, nurturing, or helping).

Definitions

Two additional sources that provide information about conceptual meaning are dictionary definitions and usages of the concept you are exploring. Dictionary definitions are often circular and do not give a complete sense of meaning for the concept, but they do help to clarify common usages and ideas associated with the concept. They are also useful for tracing the origins of words, which provides clues about core meaning.

Existing theories and professional literature can provide definitions that extend beyond the limits of common usage. The way that concepts are used in the context of professional literature convey meanings within the domain of the discipline. For example, the term mother as defined in the dictionary reflects the social and biologic role of parenting and includes a few characteristics of the role, such as authority and affection. In the context of psychologic theories, however, the meanings that are conveyed include values, roles, functions, and characteristics of people such as parenting, physical care, responsibility, and power.

Visual Images

Visual images such as photographs, cartoons, calendars, paintings, and drawings are useful sources for creating conceptual meaning (Morrow, 2009). Images may be explicitly labeled or named as the concept of interest, or you may judge them to reasonably represent it. Suppose you find a painting that the artist has labeled “Sorrow.” The artist’s linking of the visual image to the concept through language provides further information about the meaning of the concept, enriches the range of meaning, and helps to minimize any bias inherent in your own views of the meaning of the concept. In some instances, you or others might deliberately create images that represent the concept that is being clarified rather than use existing sources.

Whether you personally create and examine an image or ask others to create images, the idea is to compare them for similarities and differences and reflect that information against your tentative criteria. Often, visual imagery will highlight some aspect of the concept that is significant. Visual imagery of depression, for example in drug ads, often depicts women; this suggests the condition is female specific. Visual images that represent concepts well also highlight difficulties with expressing meaning using words. A photograph may express rich dimensions of the concept of dignity, yet the essence of dignity expressed by the photo is impossible to describe—an example of how aesthetic expressions of concepts contribute to empiric knowledge.

Popular and Classical Literature

A variety of literature resources can provide information about conceptual meaning. Literature reflects meanings that arise from the culture and provides rich sources of exemplar cases for concepts. Classical prose and poetry are often good sources of meaning for concepts used in nursing. For example, images of love and longing may be found in the poetic works of Emily Dickinson. Louisa May Alcott’s classic Little Women provides information about the nature of intimacy and caring. The popular current literature is also a source of valuable data about conceptual meaning. Popular self-help books on topics such as overcoming negative thinking and codependency often can clarify commonly understood (or misunderstood) conceptual meanings. Fairy tales, myths, fables, and stories can provide relevant insights whereas usages expressed in popular jargon and cartoons may highlight borderline meanings.

Music and Poetry

The imagery of music or poetry may be useful for the creation of conceptual meaning. You can find music or poetry by seeking out lyrics or titles that name the concept under consideration. The music itself or the title or lyrics may reasonably suggest the concept. Music and poetry can effectively convey meanings through rhythm, tones, lyrical or linguistic forms and metaphors, or musical moods that reflect experiences in life events with which nurses deal. For example, the Shaker folk tune “Simple Gifts” suggests criteria for concepts of authenticity, genuineness, centeredness, and community. The tune itself conveys a sense of inner happiness and peace; the lyrics reflect relationships between inner peace and the ability to build strong relationships. The popular Cole Porter song “Don’t Fence Me In” conveys through its musical mood, rhythm, and lyrics what it feels like to be confined emotionally and projects a yearning to be free.

 Think About It…

Jot down some criteria for the concept of mothering, then search the Internet for “songs about mother.” How do they refine your ideas about the concept of mothering? How has the imagery in those songs changed over the years?

Professional Literature

Professional literature often provides meanings that are pertinent to the practice of nursing. For example, philosophers as well as nurses have written about the concept of presence as a way of being with another. When the work of a scholar in another discipline coincides with your experience as a nurse, the scholar’s work can augment your conceptual meaning. When you find contradictions with your experience as a nurse, this prompts you to clarify your own insights about the phenomenon.

Anecdotal Accounts and Opinions

Peers, coworkers, hospitalized individuals, other professional workers, and people who are not connected to nursing can provide valuable information about the meaning of a concept. It may be useful to seek others’ opinions if your direct experience with the concept is limited. Nurses who work with the concept daily may be able to shed light on nuances of meaning. For example, a nurse who works with people whose lung function is severely compromised might observe that anxiety, although usually characterized by increased activity, evokes a different reaction in these patients. Rather than random activity, anxiety may be accompanied by a deliberate quieting of behavior to conserve energy. Asking knowledgeable others to share their opinions and understandings grounds your meaning in everyday perception and tests professional meanings in relation to everyday assumptions about a phenomenon.

Testing Your Criteria

As you examine your sources of evidence, you begin the process of testing the soundness of your conceptualization of whatever conceptual meaning you are creating in relation to your purpose. Some meanings may seem reasonable or plausible but not well suited to your purpose. For example, someone who is interested in mothering as it pertains to a foster mother may not find useful information contained in the 1915 song that spells out M-O-T-H-E-R (see http://parlorsongs.com/issues/2000-5/2000-5.php for lyrics and information about this song).

Contrary Cases

Contrary cases are those cases that are certainly not instances of the concept—they are the antithesis of the exemplar case that the process begins with. For more concrete concepts, contrary cases are relatively easy. A saucer or a spoon can be presented as things that are not cups, and green is certainly not the color red. For the concept of hopelessness, hope could be presented as a contrary case.

As you consider contrary cases, ask the following: What makes this instance different from the concept that I have selected? By comparing the differences between exemplar and contrary cases, you will begin to revise, add to, or delete from the tentative criteria that are emerging. In constructing a narrative that describes hope, you might notice that a certain type of body position with walking movement seems to be associated with hopelessness. If you are having difficulty with constructing a contrary case, ask someone to suggest a scenario that is definitely not what you are trying to describe. Sometimes you can locate a contrary case in the literature. Contrary cases that contribute to meaning often reveal important aspects of the exemplar case that are hidden in assumptions you may be making about the concept.

Related Cases

Related cases represent a different but similar concept. Related cases may share several criteria with the concept of interest, but one or more criteria will be particularly associated with the exemplar case and will distinguish the exemplar case from the related cases.

For the concept of mothering, you could create a related case of child tending, such as care provided by a nanny, that would be similar to the exemplar case. You might make a child care worker the adult or substitute an elderly person for the infant. Again, you consider differences and similarities between the exemplar case and the related cases and revise the tentative criteria to reflect your new insights. For example, you might conclude that mothering requires an investment in the ongoing welfare of the infant, whereas nannying or tending does not, rather in instances of tending investment in the child’s welfare is time limited.

Borderline Cases

A borderline case is found when the same word is used in a different context. For example, if you are examining the concept of fatigue in chronic illness, a useful borderline case of the use of the term fatigue would be “military fatigue clothing.” To offer a “cup of cheer” is an exemplary borderline usage of the term cup. This highlights the feature of cups as being capable of holding something. For the concept of anxiety, when a 5-year-old child jumps up and down and exclaims, “I’m so anxious for my birthday to be here!” the meaning of anxious is not the same meaning that concerns nurses. What the child’s usage does convey is the physical agitation that accompanies the experience of anxiety within the context of nursing practice.

Slang terms and terms used to describe technologic operations or features are rich sources of borderline cases when they are first entering the language. After they become well accepted, they are no longer borderline; they move to more central conceptual meanings, and they may even become exemplary cases. During the early 1990s, the word web probably would have prompted a mental image of something that a spider creates, and a reference to the Internet would have been considered a borderline case. By the end of the 1990s, the word web (i.e., World Wide Web) was so fully associated with the Internet that it might have become a model case of web.

For the concept of mothering, a borderline case might be a computer motherboard, and you might choose this borderline usage to help clarify features of the concept of mother that can be seen as foundational to the concept of mothering. These features could also include the central importance of the mother in some cultures for defining the scope of relationships or structuring the energy of all relationships within the system.

Paradoxic cases are variants of borderline cases that are useful to highlight the central meanings of concepts. Paradoxically, these cases embody elements of both exemplar and contrary cases. For example, when exploring the meaning of dignity, you might create a case in which actions that violate dignity occur to preserve a central feature of dignity. Your case might be the emergency cardiopulmonary resuscitation of a person in a public space to preserve the life of that person. Such a case is paradoxic in that it violates some criteria for dignity but highlights the importance, indeed precedence, of worthiness as a feature of dignity by highlighting actions that aim to maintain the individual’s worth (e.g., life and health) regardless of circumstances. You may invent other varieties of cases during the process of creating conceptual meaning. How the cases are classified or the number and variety of sources, including cases, is not critical. Rather, their important function is to assist you with discerning the range of possible meanings important for creating a meaning that is useful for your purpose. Although creating conceptual meaning is a rigorous and thoughtful process, it is centrally important to remember that sources of evidence are somewhat arbitrary, and are historically and culturally situated. What you call them is not essential to the process; what is important is the meaning that you derive from the conceptual exploration and the investigation.

Exploring Contexts and Values

The values and meanings for concepts that grow out of personal experience do not occur in a vacuum; rather they occur in social contexts that have embedded cultural meanings that influence the mental representations of experience. For example, consider the values and meanings surrounding the concept of judgment if you are a student taking an examination, or a magistrate preparing to impose a sentence. When you explore conceptual meaning across a variety of contexts, you likely will be made aware of meanings and values that shape meanings that you previously had not considered.

One way to explore conceptual meaning across various contexts is to place your exemplar cases in different contexts and ask: What would happen in a different situation? For example, if you place an exemplar case of the color red in the context of a magazine advertisement, what symbolic meaning is conveyed? In the context of traffic signs and symbols, what meaning does the color now convey? What about a woman wearing a red suit in a boardroom where everyone else is dressed in dark suits? What might you learn about mothering in the context of a same-sex household? In a single-father or -mother household? As you consider various possible combinations of context, you will illuminate how meanings are influenced by context.

Placing the concept in a subtly differing context also reveals values. The concept of mothering has a relatively positive connotation for many people. Most people agree that humans require “good” mothering to grow and develop adequately. However, people differ widely with regard to what they consider to be good mothering; these differences are often associated with the cultural context. For example, people probably would disagree about whether encouraging a child’s obedience to rules or encouraging independent decision making is good mothering. What is considered mothering, and good and bad mothering, reflects deeply embedded cultural values. When you consider your exemplar case across different social contexts, you create an avenue for perceiving important meanings that are grounded in differing values and cultural contexts and you can make deliberate choices about the importance those meanings.

Formulating Criteria for Concepts

For cases where concepts require formal processes of creating conceptual meaning, we suggest using criteria as an expression of conceptual meaning. Criteria provide a sensitive and succinct form for conveying essential conceptual meaning. Criteria are particularly useful as tools to initiate other processes of empiric theory development, including designating ways to assess or measure the concept. As we have said, criteria for the concept emerge gradually and continuously as you consider definitions, various cases, other sources, and varying contexts and values. As you develop the criteria, you will naturally refine them so that they reflect the meaning that you intend. Criteria often express both qualitative and quantitative aspects of meaning and should suggest a definition of the concept. Because criteria are more complex than a limited word definition, they amplify the meaning and suggest direction for the processes of developing empiric knowledge, including theory.

 Consider This…

For concrete objects, the criteria may be relatively simple but they have the same challenges as more complicated abstract concepts. For the concept of a cup, examples of criteria might include the following:

• The object is cylindric or conic in shape.
• The object is capable of containing physical matter.
• The height normally is between 3 and 7 inches, and the widest diameter is 3 to 4 inches.
• When the object contains liquid, it can safely hold hot liquids.

Notice that this set of criteria is phrased so that a disposable foam cup or a golfing green cup can be included. This choice is guided by the purpose. If you needed to make sure that the golfing green cup was not included as a cup, you might revise the criteria to include “the object is capable of being held in the hand, regardless of what it contains.” This criterion places a limit on the volume and weight of the cup and implies that it must be a portable object.

Developing criteria for more abstract concepts is a more complex process, and the criteria are thus often more abstract. Criteria for the concept of mothering might include the following:

• The mothering person must have visual contact with the person who receives the mothering in a manner that can be observed.
• The person who receives the mothering must be physically touched by the mothering person.
• Some positive feeling must be experienced by the mothering person and by the person who receives the mothering.
• There must be a reciprocal interaction between the mothering person and the person who receives mothering.
• Vocalization by the mothering person must occur.

These criteria do not limit the mothering person by gender, age, or species. If the purpose of applying the criteria is to distinguish between instances of mothering and fathering, these criteria would need to be revised to specify at least gender role. If the purpose is to differentiate between mothering and neglect, they might be adequate.

The following question arises during the course of creating conceptual meaning: How do I know that the meaning that I have created is adequate? You can examine your conceptual meaning for adequacy in relation to the processes that are used to create meaning as well as the conceptual meaning that you have created. Fuller (1991) suggested examining the process and the product of conceptualization in terms of both validity and reliability. A conceptualization is valid if it is based on multiple examples that are fully representative of the range of meanings for the concept, if you used multiple interpretive stages during the clarification process, and if the essential structure (or pattern) of the concept can be understood from the criteria. The conceptualization is reliable if the concept can be consistently recognized on the basis of the criteria that you have created. You may never know for sure that the meaning is adequate; however, the meaning can be considered adequate if it reflects a reasonable and communicable understanding that is useful for your purposes. If your aims reflect valued nursing goals, if you have been careful when choosing and using resources, and if you understand why you have made the choices that you have, you will have created an adequate and useful meaning. Additional processes for knowledge development will provide a check on conceptual meaning and will contribute to further refinements.

Creative Processes: Structuring Empiric Knowledge

In addition to conceptualizing, structuring is a basic creative process within the empiric pattern. Structuring empiric knowledge requires systematic and rigorous approaches. Research is a central means of structuring empirical knowledge and developing empiric theory. As hypotheses link empirical referents for testing, knowledge is generated about how the concepts as represented are related (e.g., conceptualized and defined). Structuring can also occur through inductive methods, such as grounded theory, as information emerges from interviews. More interpretive and naturalistic methods also involve structuring. Structuring can also occur apart from research by carefully considering and making judgments about how concepts are related. There is no shortage of professional literature devoted to research methods for generating empiric knowledge. However, methods for generating empiric theory as a form of empiric knowledge are less well understood and approaches vary. Because of this, we focus on empiric theory development in this text.

Structuring Empiric Theory

Structuring empiric theory involves forming systematic linkages between and among concepts. Many approaches can be used (Alligood & Tomey, 2013; Dubin, 1978; George, 2011; Grace & Perry, 2013; Masters, 2014; Newman, 1979; Reynolds, 2007). The choice of a particular approach depends on your purposes, what you already know or assume to be true, and your underlying philosophic ideas about the nature of nursing knowledge. If you begin with an entirely new idea about something, with very little reported about it in the existing literature, the form of the theoretical relationships that you construct may be a categorization of the concepts into a relational taxonomy that essentially describes your ideas. If you begin with an idea that builds on other theorists’ descriptions or a body of research, you might develop a theoretic structure that provides explanations of the complex interrelationships among concepts. If you are structuring theory as an outcome of grounded research, the interrelationships between data clusters guide the theoretic structure that you create. It should be noted that approaches to empiric theory generation, indeed the nature of theory itself, varies across disciplines as well as within the discipline of nursing. There is no accepted template for generating or characterizing “theory” in nursing. Our approach to structuring and contextualizing empiric theory are described in detail in the next sections and include the following:

• Identifying and defining the concepts.Concepts are important elements that convey the focus and meaning of the theory. Definitions of concepts can evolve from the processes of creating conceptual meaning, they can be thoughtfully borrowed from other theories, or they can be formulated from other sources. Definitions should indicate as clearly and concisely as possible the theoretic meaning of important concepts within the theory.
• Identifying assumptions.Assumptions are the basic underlying premises from which and within which theoretic reasoning proceeds.
• Clarifying the context within which the theory is placed.Contextual placement describes the circumstances within which the theoretic relationships are expected to be relevant. Clear statements about context are particularly important if the theory is to be used in practice.
• Designing relationship statements.Projected relationships between and among the concepts of the theory, taken as a whole, provide the substance and form of the theory.

Identifying and Defining Concepts

Structuring theory requires that you identify the concepts that will form the basic fabric of the theory. The concepts can come from life experiences, clinical practice, basic or applied research, knowledge of the literature, and the formal processes of creating conceptual meaning that were just described. Often, theory emerges because of a conviction that existing knowledge and theories are not adequate to represent an experience.

Some concepts are better suited for theory development than others. Concepts that are extremely abstract carry broad meanings and refer to a wide range of experience. They usually are not suitable as a beginning point for theory development. For example, concepts such as social structure, stress, and caring refer to such a broad range of experiences that relating them meaningfully is extremely difficult.

If concepts are extremely narrow and concrete, they refer to only a narrow range of experience, and the level of abstraction may not be sufficient for theoretic purposes. For example, concepts such as toothache or post appendectomy surgical pain apply to relatively few instances of pain. Chronic pain and acute pain may be more suitable concepts from which to develop theory. What is considered a suitable level of abstraction for theory varies in the field of nursing. The recent trends toward middle-range, situation-specific theory and evidence-based practice provide useful guidelines for decisions about the level of abstraction required for theoretic concepts.

As the concepts are specified or begin to form, early ideas about the structure of their relationships begin to emerge. There are usually one or two primary or central concepts around which the theoretic relationships build. Thinking about possible relationships helps to clarify what concepts the theory needs to include. Previous research, existing theories, philosophies, and personal experience provide a background for forming theoretic relationships. Initially, you might simply note concepts that you think are related on the basis of your experience, what you find in the literature, or ongoing research.

Assumptions also influence conceptual structure. For example, an assumption that is inherent in most empiric theory is the concept of linear time, which in turn determines the relationship linkages that various concepts have with one another. Often value assumptions underlie theory—for example, a theory accounting for how music influences discomfort during diagnostic procedures may assume that alleviating discomfort is good.

As initial ideas are formed about the relationships among concepts, the concepts themselves become clearer, and processes of creating conceptual meaning might be useful to make the meanings explicit. Some concepts might be grouped together and assigned more abstract terms to compose a different, perhaps new, concept. This occurs especially when theory is structured and conceptualized with inductive theory development processes such as grounded theory. For example, you might begin to see that self-identifiers of female caregivers such as weak, fearful, inadequate, dependent, and unworthy could be grouped to become components of the more abstract concept of caregiver powerlessness.

As the concepts of the theory are identified and conceptualized, theoretic definitions emerge. Theoretic definitions form the basis for and reflect empiric indicators and operational definitions for concepts needed for research, and they convey the general meaning of the concept. Empiric indicators are different from theoretic definitions in that they specify as clearly as possible how the concept is to be assessed in a specific study.

 Why Is This Important?

Theoretic definitions provide a basis for understanding concepts and relationships in any number of situations, whereas empiric or operational definitions limit meaning to the specific observable tools used in research. For example, a theoretic definition for the concept of mothering might read as follows:

Mothering: An interaction between a human adult and a child that conveys reciprocal feelings of attachment. The interaction is behaviorally expressed by reciprocal visual contact, touching, and vocalization.

This theoretic definition gives a general idea of the concept’s empiric indicators, which are sometimes referred to as operational definitions. The first part of the mothering definition provides a general meaning for the term, and the second part suggests behaviors associated with the concept that can be assessed. Empiric indicators would specify observational tools or measurements that would be used in a research study. Visual contact and touching could be measured by making video recordings and counting the numbers of times the mother and child have direct eye contact, and numbers of times unnecessary touch occurs. Vocalizations could be empirically observed using voice recordings that measure intensity and pitch of the sound.

Notice that the theoretic definition serves the purpose of providing the essential meaning of the concept, whereas the empiric indicators refer to how this meaning is observed and assessed in a particular research study.

Identifying Assumptions

Assumptions are underlying givens that are presumed to be true. Philosophic assumptions form the grounding for a theory. If they are challenged, the substance of the entire theory is also challenged on philosophic grounds. Assumptions that could be empirically assessed but that are not within the context of the theory also affect the value of the entire theory. For example, a theory intended to promote self-care in people who are providing care for the elderly may assume that the caregivers desire to be self-caring. Although this assumption could be empirically assessed, for purposes of the theory, it is reasonable to assume that this is true. If not true and the caregivers have little or no desire to be self-caring, the theory will not be helpful, and another approach will be required.

Stated assumptions may be easy to recognize, but many assumptions are implied or not stated and thus may be difficult to recognize. Commonly accepted truths can be viewed differently within a theoretic context, and they may need to be made recognizable even if they seem self-evident. For example, if a theory includes the concept of grief, certain underlying assumptions about the nature of life and death would influence the essential ideas of the theory, and these assumptions need to be stated. A theory of grief that is based on a view of death as a transition to another form of life will likely be different from a theory of grief when death is assumed to be the end of life.

Rogers (1970) explicitly stated her assumption that humans are unified wholes who possess their own integrity and who manifest characteristics that are more than and different from the sum of their parts. On the surface, this statement seems perfectly reasonable and sensible, but it is significant because it is an assumption of wholism that is not common to all nursing theory and conceptual models. As an assumption, it does not require empiric evidence, but it is fundamental to the relationship statements that Rogers proposed.

Assumptions influence all aspects of structuring theory as well as other forms of empirical knowledge. If the assumption of wholism is used as a basis for a theory of mothering, interrelated concepts must be consistent with a wholistic view of human experience. Patterns of behavior that reflect the whole would be subsumed in the theoretic concepts; these might include patterns of movement and communication. By contrast, if humans are assumed to be biologic and social organisms that are a “sum of parts,” then the assumption is that mothering can be understood by assessing a number of indicators such as physical responses to touch and vocalizations, stated cultural beliefs about mothering, and response of mother to distress in the child.

Clarifying the Context

Empiric theory should be placed within a context if the theory is to be useful for practice. If a theory of mothering is meant to apply only to the interactions of women and children in Western cultures, these limits on the applicability of the theory must be considered and stated. As the theory is extended, it might be useful for other cultures and for other types of intimate relationships such as adult–child, adult–adult, and adult–companion–animal interactions.

Contexts that are very broad or very narrow reflect the range of applicability of a theory. An attempt to structure a theory for many cultures may not be useful for any culture. Conversely, a theory that is structured within the context of a single institution (e.g., one specific hospital) may not be useful for other settings. Historically, as nursing incorporated an emphasis on middle-range theory, the context for which theories were developed narrowed. Broad frameworks or conceptual models that addressed phenomena such as adaptation (Roy, 1999) or conservation (Levine, 1967) were considered theory and are still useful in many nursing situations. Middle-range theories tended to focus on phenomena that were limited to some nursing situations but that were commonly recognized in nursing, such as uncertainty and hopelessness. Situation-specific theory narrowed context even further to particular situations of uncertainty or hopelessness (Im & Meleis, 1999). To be situation specific, a middle-range theory of hopelessness or uncertainty would need to be modified for use across different contexts, for example differing cultural contexts or for different age groups.

Designing Relationship Statements

Relationship statements structurally interrelate the concepts of the theory. The statements range from those that simply relate two concepts, to relatively complex statements that account for interactions among multiple concepts. Theories usually contain several levels of relationship statements, which comprise a reasonably complete explanation of how the concepts of the theory interact. The relationships begin to take form as the concepts are identified and emerge, but the process of designing the relationship statements requires specific attention to the substance, direction, strength, and quality of the interactions that occur among concepts.

Consider a relationship statement that might be formulated about the concept of mothering. A theorist might propose that, as an adult’s visual contact with an infant increases, the infant’s visual contact with the adult will also increase. This relationship statement speculates that one event (increased adult visual contact) precedes a second event (increased infant visual contact). This relationship also describes a substantive interaction (visual contact) as a component of mothering. It implies direction (an increase) as part of the interaction.

A more complex relational statement addresses further dimensions of quality, contexts, and circumstances that are proposed. Such a statement might take the following form:

Under the conditions of C1 through Cn, if x occurs, then y will occur.

A way to illustrate the concept of mothering might take the following form:

When an adult mothering figure and an infant are in close proximity (C1),

and

when the adult has a negative feeling toward the infant (C2),

and

when the frequency of physical contact is limited (C3),

then,

if the adult’s frequency of visual contact decreases,

the infant’s frequency of visual contact will also decrease.

A relationship may also be designed to introduce new concepts to the potential theory. Initially, such a relationship might read as follows:

If the infant’s frequency of visual contact is not sufficient to satisfy the mother, the adult’s frequency of visual contact will increase in a conscious effort to engage the infant in interaction.

This relationship introduces the subjective value of “sufficient to satisfy.” The idea of sufficiency is not objectively identifiable or empirically observable. As the theory is developed further, possible empiric indicators for “sufficient to satisfy” might be created, or this dimension of the theory might be viewed as something to be subjectively assessed. In this way, the theory stimulates the creation of new empiric knowledge.

In general, structuring processes for empirical theory as well as other theory-like empirical knowledge forms such as conceptual models or frameworks involves identifying concepts of importance to nursing and understanding the meaning of those concepts. Formal processes for creating meaning may be required for some purposes or adequate meanings may already be available in the professional literature. Concepts are linked in relation to one another, the context for which the theory is intended is identified and underlying assumptions are made explicit. We have presented general guidelines useful in structuring empiric theory. It is important to understand the process is messy and involves twists and turns that change and alter what is being created.

Empiric Knowledge Forms Other Than Theory

Our emphasis is on empiric theory as a valuable and primary empiric knowledge structure. However, our approaches for conceptualizing and structuring theory can also be used to generate other forms of empiric knowledge. Other forms include empiric research reports; findings from naturalistic, interpretive inquiry; and rigorously structured descriptions within the realm of empiric knowledge. Traditionally empiric knowledge has referred to knowledge generated through experimental and observational research methods associated with traditional science. This characterization of empirics continues to this day, but we view empirics as broader.

Although it is difficult to know where to draw the line on what constitutes “empiric” knowledge, we have drawn it in relation to knowledge generated either directly or indirectly through rigorous and controlled observation, whether those observations tend to be more factual or more interpretive. In our view, empirics requires the possibility of confirmation and validation, which involves agreement across observers that the interpretation or observation is a “correct” or reasonable one. Again, we acknowledge that not everyone would interpret empiric knowledge so broadly.

There are numerous approaches to structuring empiric knowledge. We have not detailed methods for conceptualizing and structuring that accrue from various research or analytic approaches as there is a vast literature detailing proper procedures for generating these various types of empiric knowledge (Polit & Beck, 2016). The accuracy and rigor of these methods for structuring and conceptualizing empiric knowledge is well accepted.

As we have said, there are techniques for generating theory in the disciplinary literature, but there is not agreement about these techniques or even what empiric theory is. It is for these reasons that we have focused on structuring and conceptualizing knowledge that is expressed as empiric theory as we have conceptualized it.

Conceptualizations of Theory

Because theory is defined in many different ways within and outside of the discipline of nursing, understanding what it is can be confusing. Each definition can be functional, depending on how you are using the term. Theory has common, everyday connotations that is apparent in phrases such as, “I have a theory about that,” or “My theory about x is….” These uses imply that theory is an idea or feeling or that it explains something. In this text, we use a definition that is consistent with the more everyday meanings of theory: as a collection of ideas or explanatory hunches. However, our definition goes beyond this to a characterization of theory as something that is deliberately designed for a specific purpose.

Beliefs about the nature of empiric theory in nursing differ because they arise in part from the various fields of inquiry from which nursing knowledge is developed. Some nursing theorists come from traditions in which the ideal of theory is logically linked sets of confirmed hypotheses. Others view theory as loosely connected ideas that are conjectured but not confirmed. Still others think of theory as beliefs and values about human nature and action. As a result, the nursing literature contains varying definitions of theory, but this diversity serves to stimulate the further understanding and development of theory. The following four definitions in the nursing literature emphasize different perspectives and different underlying values that involve theory. These definitions each highlight important aspects of theory that we draw on in our own definition:

• A logically interconnected set of confirmed hypotheses(McKay, 1969). This definition implies a specific form of expression that is based on rules of logic. It also requires that hypotheses be tested and confirmed with the use of methods of scientific-empiric research to generate theory.
• A conceptual system or framework that is invented to serve some purpose(Dickoff & James, 1968). This definition emphasizes the purpose for which a theory is created. The term invented implies a creative process that bypasses the type of testing and confirmation that McKay suggests. This definition emphasizes the importance of the theory having a purpose.
• An imaginative grouping of knowledge, ideas, and experiences that are represented symbolically and that seek to illuminate a given phenomenon(Watson, 1985). This definition also emphasizes creativity. For Watson, the purpose of creating theory is to enhance understanding of a given phenomenon—that is, a theory has the purpose of understanding what a phenomenon is, and such theory may or may not have direct application in practice.
• Conceptual and pragmatic principles that form a general frame of reference for a field of inquiry(Ellis, 1968). This definition does not address a specific type of purpose for theory, and it does not suggest any particular method for developing theory. For Ellis, theory provides a philosophic view that guides inquiry in a discipline.

From our perspective, theory is a creative and rigorous structuring of ideas. The ideas, as concepts, are expressed by word symbols that form a conceptual structure. The structure is created using methods that draw on the creativity of the theorist. The concepts contained within the theory must be defined, and they must have a logical relationship with one another to form a coherent structure or pattern. Empiric theory is purposeful; that is, theorists create the theory for some reason. Theoretic purposes may take many different forms, but the purpose needs to be clearly evident.

Theory is not a finalized prescription or a formula for practice; it cannot describe exactly what can be objectively observed. Instead, theory projects tentative ideas that open new perceptions and possibilities with regard to what might be beyond the common surface understandings of the world. Theory is grounded in assumptions, value choices, and the creative and imaginative judgment of the theorist. You may or may not share the values and views of the theorist, but your exposure to the theory and the views that it reveals can expand your own thinking about your experience, your profession, and the direction of your own work. The conceptualization and structuring processes we describe creates theory consistent with our definition which follows:

Empiric theory: A creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena.

The word creative underscores the role of human imagination and vision in the development and expression of theory; it does not mean that “anything goes” or that theory is improvised. As we have shown, the creative processes required to develop theory are rigorous, systematic, and disciplined, thereby yielding a well-developed conception that bears the mark of the creator. In our view, theoretic statements are always tentative and open to revision as new evidence and insights emerge. The statements are developed toward some purpose or within a specific context. Our definition does not require that a hypothesis be tested before the statements can be considered as theory. Ideas that the creator systematically develops on the basis of experience and observation can be considered as theory before formal testing occurs.

We have defined theory for the purpose of explaining to you, the reader, our view of what theory is, how to develop it, and how to evaluate it. Definitions of related terms help to make clearer the meaning of the central term (in this case, theory). Our definitions of several related terms for the context of this book are provided in Table 7.2. The definitions of related terms may not be universally accepted, but we believe that these are reasonable and reflect common meanings. In addition, no matter how rigorous the attempt to differentiate like terms by providing definitions, there will be elements of shared meaning among them.

TABLE 7.2

Conceptual Definitions of Terms Related to the Concept of Theory

Term	Definition
Science	An approach to the generation of empiric knowledge that relies on accessible sensory experience to create knowledge and to form understanding. The term also refers to the results or products generated when the systematic methods of empirics are used.
Philosophy	A discipline that discerns the nature of the world and of knowledge and knowing and that involves ways of discerning reality and principles of value. Philosophy relies on logic and reasoning rather than empiric evidence to create knowledge.
Fact	That which generally is held to be an empirically verifiable object, property, or event, which means that the phenomenon is experienced and named consistently and similarly by others in a given similar context.
Model	A symbolic representation of an empiric experience in the form of words, pictorial or graphic diagrams, mathematical notations, or physical material (e.g., a model airplane).
Theoretic or conceptual framework	A logical grouping of related concepts or theories that usually is created to draw together several different aspects that are relevant to a complex situation, such as a practice setting or an educational program.
Paradigm	A worldview or ideology. A paradigm implies standards or criteria for assigning value or worth to both the processes and the products of a discipline as well as for the methods of knowledge development within a discipline.

Conclusion

For empirics, the critical questions “What is this?” and “How does it work?” initiate the creative processes of conceptualizing and structuring. The creative processes occur in relation to the purposes of inquiry, the underlying assumptions being made, and the context in which the critical questions are asked. Empiric theory has specific characteristics that form the basis for our definition of theory. These characteristics provide a taxonomy for describing and critically reflecting theory which is detailed in Chapter 8.

References

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