As nursing develops as a practice discipline, the need for theoretical structures which allow understanding of phenomena encountered in practice and which permit linkages between concepts becomes increasingly evident. Two concepts of interest to nursing practice are caring and professional role development. Tb date, there is no literature which explains or describes the process of the development of the caring perspective in nurse professional role-taking and the impact of the bureaucratic setting on its development.
Leininger (1981; 1984) believes that caring is the essence of nursing and has devoted much effort to exploring and explaining the concept. Heidegger (1962) holds that caring constitutes authentic being for individuals through intersubjective relationships. Paterson and Zderad (1976) and Watson (1979) see humanistic intersubjective interactions between nurses and patients as focal to nursing. Kramer (1974) describes and explains role difficulties experienced by new nurses caused by the lack of congruence between ideal role expectations and the expectations of the institutions where they practice. Murphy (1978) points out the difficulties created by bureaucratic structures which prevent nurses from acting in the most morally desirable ways.
To facilitate understanding of the phenomenon of development of the caring perspective within the professional nurse role, the strategy of theory derivation was selected to structure points of view in a process of developing the caring perspective within the professional nurse role.
Theory Derivation Strategy
Walker and Avant (1983) describe theory derivation as a method which utilizes analogy from one field of interest to another field of interest for the purpose of obtaining explanations or predictions in another field. An entire structure and/or entire sets of interrelated statements are transposed from one field to another with the redefinition of concepts and statements which make it meaningful to the new field. The strategy was deemed appropriate because several concepts and relationships of concepts could be seen as analogous to an already existing theory.
In the present case, ideas and concepts already culled from the literature on caring, role and bureaucratic structure of health care delivery systems, role theory, and moral development in nurses were used as the content of the theory to be derived. A description and explanation of the selected strategy follows.
Steps in Theory Derivation
Walker and Avant (1983) prescribe the following basic steps for theory derivation:
1. Become thoroughly familiar with the literature on the topic of interest. This implies that the theorist is cognizant of the level of theory development in his or her field and has evaluated the scientific usefulness of any such developments. If none of the current theories are suitable for the purpose of the theorist then theory derivation can proceed.
2. Read widely in other fields for ideas. Reading widely enables a theorist to understand ways of putting theory together in other disciplines. Reading widely is not enough. The theorist must read while allowing imagination and creativity free reign. Discovering analogies is often done accidentally or as a creative intuitive leap rather than systematically.
3. Select a parent theory to use for derivation. The parent theory should be chosen because it offers a new and insightful way of explaining or predicting about a phenomenon in the theorist's field of interest. Just any theory won't do. Many theories will shed no light at all on the concepts of interest or will provide no useful structure for the concepts and are therefore worthless to the theorist. Keep in mind here that the whole parent theory may not be needed to form the new theory. Only those portions which are analogous and therefore relevant need be used.
4. Identify what content and/or structure from the parent theory is to be used. Perhaps only the concepts or only the statements are analogous, but not the structure. Or perhaps the structure is perfect but the parent concepts and statements are not. Perhaps the theorist needs both concepts and statements as well as structure. In the derivation strategy, the theorist is free to choose what best fits the needs of the situation.
5. Develop or redefine any new concepts or statements from the content or structure of the parent theory in terms of the phenomenon of interest to the theorist. This is the hardest part of theory derivation, but also the most fun. It requires creativity and thoughtfulness on the part of the theorist. Basically, the concepts or structure that is borrowed from the parent field is modified in such a way that it becomes meaningful in the theorist's field. Often the modifications are small, but occasionally they will need to be substantial before the theory makes sense in the new setting (pp. 165-166).
Steps Applied to a Derived Theory
1. The writer was already familiar with the literature on caring and the literature on cognitive moral development in general. She was also familiar with the literature on cognitive moral development in nurses, and had a fairly good background knowledge of the literature related to role theory and bureaucratic institutions.
2. Much reading had been done in the area of cognitive moral development and a brief review of that literature indicated the potential usefulness of the structure of sequential development as a possible way to organize and understand the concepts of interest.
3. The parent field selected is Psychology and the parent theory is Lawrence Kohlberg's Theory of Cognitive Moral Development (1976). The theory is based on sequential developmental cognitive processes which allow the individual to expand his moral point of view from one of egocentric moral perspective to one of universalistic moral perspective. Kohlberg's theory describes and explains the development of the moral perspective in a sequence consisting of three levels of moral development with two stages within each level. The structure of the sequences was what was considered to be useful for describing and explaining the development of a caring perspective within the professional nurse role.
4. The stage and level structure were borrowed from the parent theory to provide structure for the concepts and content of the new theory. Several of the major statements were borrowed and their formal structure but not their content was used to derive statements for the new theory.
PARALLEL STRUCTURE OF PARENT THEORY AND DERIVED THEORY
5. New concepts and content were defined to fit the borrowed structure of stage and level sequence and for use in statements using the formal structure of the original statements in the parent theory. The concept of caring perspective was developed to describe the point of view of the nurse toward herself and the patient within the nurse-patient relationship. This was viewed as ranging from viewing the self and the patient from an objective perspective: I-It (Pre-caring Level); viewing the self and the patient from the perspective of Stereotypie role expectations for the nurse and patient: They-Self (Transcaring or role/rule bound caring); viewing the self and the patient as individuals with moral and legal rights who share a common humanity: I-Thou (Person-centered caring).
Kohlberg states: "One way to understand the three levels is to think of them as three different relationships between the self and society's rules and expectations" (1976, p. 33). A parallel statement can be made about the derived theory: One way to understand the three levels is to think of them as three different levels of relationship between the nurse and himself/herself; the nurse and the patient; the nurse and the bureaucratic structure in which he/she practices.
Demonstration of Theory Derivation
The intent of the derivation was to use the stage and level structure of the parent theory to organize the concepts of the derived theory. Content and concepts were used from the new field to derive theory with a parallel structure to the parent theory.
The parent theory is Theory of Cognitive Moral Development. The derived theory is Theory of Development of the Caring Perspective in the Professional Nurse Role (Table).
Derivation of Theoretical Statements
The following relational statements were derived using statements from the parent theory Kohlbergs Theory of Cognitive Moral Development (P) to generate theoretical statements for the derived theory of Development of Caring Perspective within the Professional Role of the Nurse (D). The portions of the parent statement (P) which are underlined indicate those concepts or content which was changed to accommodate the new content. The basic approach used was one which maintained the formal structure of the statements but which changed the content to fit the derived statement (D).
#1 (P) "Moral situations are ones of conflicts of perspectives or interests; justice principles are concepts for resolving these conflicts, for giving each his due." (Kohlberg, 1976, p. 40)
#1 (D) Nursing situations are ones for developing mutual trust and rapport; caring role behaviors promote therapeutic relationships which preserve the humanity of the nurse and the patient.
#2 (P) "A person^ sense of justice is what is most distinctly and fundamentally moral." (Kohlberg, 1976, p. 40)
#2 (D) A nurses sense of caring is what is most distinctively and fundamentally nursing.
#3 (P) "The most essential structure of morality is a justice structure." (Kohlberg, 1976, p. 40)
#3 (D) The most essential feature of nurse professional role development is the ability to care.
#4 (P) "One can act morally and question all the rules, one can oci morally and question the greater good, but one cannot act morally and question the need for justice." (Kohlberg, 1976, p. 40)
#4 (D) The nurse can care and question all the roles and rules, the nurse can care and question the bureaucratic system but the nurse cannot care and question the need to view patients as fellow human subjects.
#5 (P) "An individual's basic morality or basic moral principles is seen as preceding, or being necessary for his taking society's perspective or accepting society's laws and values." (Kohlberg, 1976, p. 36)
#5 (D) A nurses commitment to caring for and about him/ herself as a person is seen as preceding, or being necessary for him/her being able to care for and about another human being.
#6 (P) "Society's laws and values should be ones which any reasonable person could commit himself to - whatever his place in society and whatever society he belongs to." (Kohlberg, 1976, p. 36)
#6 (D) Professional and bureaucratic standards and values should be ones which any caring professional nurse could commit him/herself to - whatever his/her role in the profession or bureaucracy.
Theory derivation which borrowed structure but not concepts was used to develop a theory of Development of the Caring Perspective in the Professional Nurse Role. The empirical validity of the parent theory, Kohlbergs Theory of Cognitive Moral Development, has been established to some degree. The derived theory has potential for testing through hypothesis testing. By using the relationships specified in the structure and statements, the theorist can test hypotheses which will confirm or disconfirm the relationships between concepts in them. For example, the hypothesized structure of levels of caring perspective could be tested by testing for behaviors reflective of the levels of caring. Students could be tested at entry and at various points of progress in their nursing education, in addition to providing validation of the theorized structure and relationships between concepts, insights from such hypothesis testing might have considerable impact upon curriculum development and revision.
Empirical testing of the derived relational statements should lead to clarification of the relationship between concepts in the new theory and between relational statements in the theory. As relationships are validated through research, the theory can be refined and new dimensions of the theory discovered. The major benefit of using theory derivation is that it provides a rapid means of giving structure and form to relationships among concepts important to nursing. The technique allows description and explanation of the interplay between concepts and lays the groundwork for useful theory development through hypothesis testing.
- Heidegger, M. (1962). Being and time. (J. Macquarrie & E. Robinson, Trans.). New York: Harper & Row.
- Kohlberg, L. (1976). Moral stages and moralization. In T. Lickona (Ed.), Moral development and behavior: Theory, research and social issues. New York: Holt, Rinehart & Winston.
- Kramer, M. (1974). Reality shock: Why nurses leave nursing. St. Louis: C.V. Mosby.
- Leininger, M. (1981). Caring; An essential human need. Proceedings from the three national caring conferences. Thorofare, NJ: Charles B. Slack Incorporated.
- Leininger, M. (1984). Care: The essence of nursing and health. Thorofare, NJ: Charles B. Slack Incorporated.
- Murphy, C.P. (1978). The moral situation in nursing. In E. Sandman & B. Bandman (Eds.) Bioethics and human rights. Boston: Little Brown Co.
- Paterson, J. & Zderad, L. (1976). Humanistic nursing. New York: John Wiley & Sons.
- Walker, L.O. & Avant, K.C. (1983). Strategies for theory construction in nursing. Norwalk, CT: Appleton-Century-Crofts.
- Watson, J. (1979). Nursing: The philosophy and science of caring. Boston: Little Brown Co.
PARALLEL STRUCTURE OF PARENT THEORY AND DERIVED THEORY