Research testing nursing theory: state of the art

Martha Rogers' science of unitary human beings in relation to workers health and well-being: A scoping review

BACKGROUND

Workers' health and well-being are topics on the rise within occupational research. Rogers' science of unitary human beings can potentially contribute to increased knowledge in the area. However, no previous review has investigated how the theory has been used in relation to workers in working life.

OBJECTIVE

The aim of this scoping review was to provide an overview of studies that have used Rogers' science of unitary human beings to study workers health and well-being in working life.

METHODS

A literature search was conducted in CINAHL and PubMed, and other relevant sources in May-June 2022.

RESULTS

The results showed that there seems to be a lack of use of Rogers' science of unitary human beings regarding workers health and well-being in working life. The overarching theme was: Well-being as an essential phenomenon in working life in all dimensions of existing.

CONCLUSION

The theory has potential to contribute more to research regarding workers' health and well-being in working life.

Symptom Management Theory: Analysis, Evaluation, and Implications for Caring for Adults With Cancer

A detailed analysis of Symptom Management Theory (SMT) along with its extent of use and implications for adults with cancer as demonstrated in 20 oncology research studies is reported. SMT provides useful guidance for adult oncology research and nursing practice. Theory dimension most researched in cancer was symptom experience. Although theory assertions were demonstrated in 80% of the studies, it was used to an adequate extent only in 35% of them. Comparisons between cancer-related clinical outcomes with and without use of SMT, certain theory modifications, and future SMT-based studies involving longitudinal designs in this population are warranted.

Theory Description, Critical Reflection, and Theory Evaluation of the Transitions Theory of Meleis et al according to Chinn and Kramer (2011)

Transitions Theory (TT) states that change and transition are phenomena that make humans more vulnerable to health risks. Transitions Theory was evaluated through a text analysis of 4 publications, 3 nursing expert focus group interviews in Switzerland, and a mapping review of the transition literature of the last 5 years. Although the implementation of TT into Swiss nursing practice seems problematic due to conceptual deficiencies, transition is a meaningful nursing topic. The connection between TT, research, and practice is weak. Yet guidelines for theory description, theory analysis, and theory actualization could enhance and strengthen the body of knowledge in nursing.

An Analysis and Evaluation of the Theory of Unpleasant Symptoms

The Theory of Unpleasant Symptoms was developed to enhance understanding of relationships among multiple symptoms and symptom experiences. Although the theory has been used to guide research, no formal critique of the theory has been published since 2000. This article comprehensively analyzes and evaluates the theory using Fawcett and DeSanto-Madeya's framework. Although its semantic clarity, semantic and structural consistency, and parsimony could be improved, the theory demonstrates good social and theoretical significance, testability, and empirical and pragmatic adequacy. Understanding multiple patient symptoms is essential, and the theory demonstrates that nurses should focus on multiple rather than individual symptoms.

Qualitative theory testing as mixed-method research

While the concept of mixed-methods research is more usually associated with combining quantitative and qualitative approaches, this paper outlines a study that mixed methods by undertaking qualitative theory testing and derivation when examining the relationship between health promotion theory and hospital nursing practice. Thus, it is concerned with relating the metatheoretical aspects of the debate and not with the pragmatic aspects of the research and concomitant methods. A deductive–inductive–deductive design, based on the theory–research–theory strategy of Meleis (1985), tested, revised and developed for nursing established health promotion theory using theory-testing criteria. To complement the methodological mix, the study also used the theory (i.e. a health-promotion taxonomy) as a framework to contextualise the findings rather than generate theory in the way associated with interpretative inquiry. While inconsistent with the traditional view linking theory testing with quantitative, objective epistemology, the process enabled a theoretically robust health-promotion taxonomy to be synthesised and advanced for use in nursing in relation to a paradigm of social thought.

Using Theory Integration to Explore Complex Health Problems

Although nursing leaders call for theory utilization in research, use remains low within the discipline. The purpose of this article is to explore the application of interdisciplinary integration of models and theories to nursing research. An example of theory integration for the purposes of guiding a study relevant to school nursing is described. A conceptual-theoretical-empirical structure based on the Neuman's systems model, a nursing theory, integrated with the social communication model of pain, a psychology model, was developed to guide the study to examine pain assessment for schoolchildren with intellectual and developmental disabilities.

The current status of theory evaluation in nursing

AIMS

To identify the current status of theory evaluation in nursing and provide directions for theory evaluation for future development of theoretical bases of nursing discipline.

BACKGROUND

Theory evaluation is an essential component in development of nursing knowledge, which is a critical element in development of nursing discipline. Despite earlier significant efforts for theory evaluation in nursing, a recent decline in the number of theory evaluation articles was noted and there have been few updates on theory evaluation in nursing.

DESIGN

Discussion paper.

DATA SOURCES

A total of 58 articles published from 2003-2014 were retrieved through searches using the PUBMED, PsyInfo and CINAHL. The articles were sorted by the area of evaluation and analysed to identify themes reflecting the theory evaluation process.

IMPLICATIONS FOR NURSING

Diverse ways of theory evaluation need to be continuously used in future theory evaluation efforts.

CONCLUSION

Six themes reflecting the theory evaluation process were identified: (a) rarely using existing theory evaluation criteria; (b) evaluating specifics; (c) using various statistical analysis methods; (d) developing instruments; (e) adopting in practice and education; and (f) evaluating mainly middle-range theories and situation-specific theories.

A Roy model study of adapting to being HIV positive

Roy's adaptation model outlines a generic process of adaptation useful to nurses in any situation where a patient is facing change. To advance nursing practice, nursing theories and frameworks must be constantly tested and developed through research. This article describes how the results of a qualitative grounded theory study have been used to test components of the Roy adaptation model. A framework for "negotiating uncertainty" was the result of a grounded theory study exploring adaptation to HIV. This framework has been compared to the Roy adaptation model, strengthening concepts such as focal and contextual stimuli, Roy's definition of adaptation and her description of adaptive modes, while suggesting areas for further development including the role of perception. The comparison described in this article demonstrates the usefulness of qualitative research in developing nursing models, specifically highlighting opportunities to continue refining Roy's work.

Who uses nursing theory? A univariate descriptive analysis of five years' research articles

BACKGROUND

Since the early 1950s, nursing leaders have worked diligently to build the Scientific Discipline of Nursing, integrating Theory, Research and Practice. Recently, the role of theory has again come into question, with some scientists claiming nurses are not using theory to guide their research, with which to improve practice.

AIMS

The purposes of this descriptive study were to determine: (i) Were nursing scientists' research articles in leading nursing journals based on theory? (ii) If so, were the theories nursing theories or borrowed theories? (iii) Were the theories integrated into the studies, or were they used as organizing frameworks?

METHODS

Research articles from seven top ISI journals were analysed, excluding regularly featured columns, meta-analyses, secondary analysis, case studies and literature reviews. The authors used King's dynamic Interacting system and Goal Attainment Theory as an organizing framework. They developed consensus on how to identify the integration of theory, searching the Title, Abstract, Aims, Methods, Discussion and Conclusion sections of each research article, whether quantitative or qualitative.

RESULTS

Of 2857 articles published in the seven journals from 2002 to, and including, 2006, 2184 (76%) were research articles. Of the 837 (38%) authors who used theories, 460 (55%) used nursing theories, 377 (45%) used other theories: 776 (93%) of those who used theory integrated it into their studies, including qualitative studies, while 51 (7%) reported they used theory as an organizing framework for their studies. Closer analysis revealed theory principles were implicitly implied, even in research reports that did not explicitly report theory usage.

CONCLUSIONS

Increasing numbers of nursing research articles (though not percentagewise) continue to be guided by theory, and not always by nursing theory. Newer nursing research methods may not explicitly state the use of nursing theory, though it is implicitly implied.

A model of consensus formation for reconciling nursing's disciplinary matrix

With questions raised as to whether or not nursing knowledge should be developed from extant conceptual/theoretical models or from practice-based environments, this paper utilizes Kuhn's disciplinary matrix and Laudan's model of consensus formation to explore the changing nature of the discipline's structural matrix. Kuhn's notion that a discipline's structural matrix includes symbolic generalizations, models and exemplars, and Laudan's view that a maturing discipline embraces factual, methodological, and axiological (goals and aims) knowledge, and that context and discourse are also involved in advancing a discipline is described as a means for reconciling the source of nursing knowledge. This paper posits that shared axiological goals connect both theorists and practitioners, and resolve potential conflicts as to viable sources of nursing knowledge. Through shared goals that include humanization, meaning, quality of life, caring, consciousness, transcendence, and presence, which bridge both theoretical and practice approaches, nursing's charge to contribute to the good of society is fulfilled.

Predictors of self-care in adolescents with cystic fibrosis: a test of Orem's theories of self-care and self-care deficit

Pediatric nurses often struggle to find ways to encourage adolescents with cystic fibrosis (CF) to engage in self-care that is essential to their health and life. A study of predictors of self-care was conducted to provide a stronger evidence base for nursing practice with these youth. Orem's theories of self-care and self-care deficit were tested to explain and predict the universal and health deviation self-care of 123 adolescents with CF. Four dimensions of self-care agency emerged as predictors of universal self-care, two of which were also predictive of health deviation self-care. Seventy percent of the variance or change in universal self-care scores and 40% of health deviation self-care variance were explained. Clarification and extension of Orem's theories were also an important outcome. Development of nursing interventions designed to strengthen predictors of universal and health deviation-specific self-care identified in this research holds the potential to improve length and quality of life for adolescents with CF.

Criteria for evaluation of theory

This column presents criteria for evaluation of nursing theories specified by Jacqueline Fawcett and Rosemarie Rizzo Parse. Fawcett's criteria are significance, internal consistency, parsimony, testability, empirical adequacy, and pragmatic adequacy. Some of those criteria are differentiated for grand theories and middle-range theories but are not differentiated by type of data-qualitative or quantitative-used to develop the theory. Parse's criteria are structure and process. Structure encompasses historical evolution, foundational elements, and relational statements. Process encompasses correspondence, coherence, and pragmatics. Parse's criteria are appropriate for the critical appraisal of all frameworks and theories, regardless of level of abstraction. Parse also presents a comparison of her own and Fawcett's criteria.

The Neuman Systems Model Institute: testing middle-range theories

The credibility of the Neuman systems model can only be established through the generation and testing of Neuman systems model-derived middle-range theories. However, due to the number and complexity of Neuman systems model concepts/concept interrelations and the diversity of middle-range theory concepts linked to these Neuman systems model concepts by researchers, no explicit middle-range theories have yet been derived from the Neuman systems model. This article describes the development of an organized program for the systematic study of the Neuman systems model. Preliminary work, already accomplished, is detailed, and a tentative plan for the completion of further preliminary work as well as beginning the actual research conduction phase is proposed.

Adaptation as a mediator of intimate abuse and traumatic stress in battered women

The purpose of this research was to test one aspect of a proposed middle-range theory synthesized from the Roy adaptation model and linked with the framework of post-traumatic stress. A predictive-correlational design was used to examine adaptation as a mediator of traumatic stress in battered women. Analysis included regression and path analytic procedures. Results indicated (a) direct relationships between the focal stimuli of abuse and the response of post-traumatic stress disorder and (b) adaptation in the physiologic, self-concept, and interdependence modes partially mediated the relationship between the focal stimuli of abuse and the response of post-traumatic stress disorder in battered women.

Empirical tests of the Neuman systems model: relational statement analysis

To be a valid test of the Neuman systems model, researchers' relational statements must be congruent with Neuman's axioms and must also be congruent at the conceptual, theoretical, and operational levels. Guided by Cooper's five-stage integrative review method, 92 quantitative research studies (dissertations and journal articles) were collected and categorized according to an expanded version of Silva's levels of theory testing. Nine studies, with explicit relational statements, were analyzed at three levels of abstraction, and interpretations of the studies' results were explored. Recommendations are made for the establishment of a program of research.

A meta-analysis of the interrelationships between the modes in Roy's adaptation model

A meta-analysis of nine empirical studies based on Roy's adaptation model was conducted to determine the magnitudes of the interrelationships of the four modes: physiological, self-concept, role function, and interdependence. Small to medium effect sizes between each two modes do support the proposition of Roy's model that the four modes are interrelated. The only exception is the relationship between interdependence and physiological modes, as shown by the non-significant effect size of .04. The present study also discusses several limitations that should be considered when interpreting the findings of this meta-analysis. This study does provide a useful compilation of the Roy model's credible studies and proposes a direction for further research. The results indicate a need for further study to explore the relationship in all response modes to have a clearer understanding of the credibility of Roy's model.

Nursing models: extant or extinct?

Although nursing models have always had their sceptics, they are now being subjected to more sustained criticism. Critiques have tended to focus mostly on the value of models for nursing practice but, increasingly, their place in nursing science is also being questioned. Reed believes that the growing disparagement of nursing models is symptomatic of the tensions between modernist and postmodernist perspectives on nursing. Drawing its title from Reed's discussion, this paper--from the opposite side of the Atlantic--reflects on the original purpose of nursing models and critically examines their relevance now, using the first and best-known British nursing model (the Roper-Logan-Tierney model for nursing) as the particular example for scrutiny. Although the popularity of this model is acknowledged, Fraser highlights the concern that it has not been tested. Can, and should, models be tested? This question is addressed in view of its apparent importance to the debate about whether or not nursing models have any continuing, legitimate role in theory or in practice.

Theory and research: a linkage to benefit practice

This paper begins with a critical overview of what the extant literature sees as the relationship between research, theory and practice. Most scholars maintain that there are two main viewpoints: research exists to build theory from practice and/or research exists to test existing theory in practice. It will be argued that is too simplistic a view and four specific linkages will be proffered: Theory Testing Research, Theory Generating Research, Theory Evaluating Research and Theory Framed Research. All four will be discussed and their contribution to the knowledge base of nursing practice explored. In concluding, an argument will be put forward proposing the view that undertaking research without considering theory is an empty and non-productive exercise.

Theoretical substruction: a guide for theory testing research

This article demonstrates how theoretical substruction with its various levels of abstraction can be used as a guide for theory testing research. The article describes a method for substructing research hypotheses as well as an entire study. Substruction and its benefits, including assuring the internal consistency of model testing, are discussed as applied to a study testing hypotheses derived from proposition two of Orem's self-care deficit theory of nursing. This approach to theory testing is congruent with the coherence theory of truth and promises to contribute to the advancement of nursing epistemology.

A case for theory triangulation

Although theory triangulation has not received much attention in the nursing literature, its deliberate, strategic use can be an invaluable guide to reviewing literature and designing research. It can enlarge the framing of questions for orderly data collection and analysis, and can lay out a route for rational, coherent study-clustering. An example is presented that triangulates two nursing theories to address a frequently studied problem--nurses' attitudes about AIDS care. The absence of firm theoretical footing in exploring this problem has limited the application of a large, continuously growing body of empirical data. Triangulation is suggested to organize these data, to clarify apparently inconsistent findings, and to guide research. The example demonstrates how the exploration of related questions not addressed by a single theory may be aided by searching for linkages among mid-range theories, including theories from other disciplines.

The evaluation of nursing theory: a method for our madness

The profession of nursing has, in recent years, been trying to further develop, test and use proposed nursing theory. To utilize theory appropriately, in all domains of practice, education and research, it is important to know how to describe, analyze and evaluate theory. Evaluation of theory both within and among cultures should be a goal for the future of nursing to further advance the science of nursing. From a philosophical and historical standpoint, this paper attempts to define theory, including nursing theory, and then analyze criteria for the evaluation of theory. Finally, a more comprehensive set of criteria for the evaluation of theory is proposed, which may stimulate more informed decisions regarding the choice of nursing theory for use in practice, education and research, and from which may emerge new theories for and of nursing consistent with the 90s, and beyond.

The Roy Adaptation Model: a consideration of its properties as a conceptual framework for an intervention study

The underlying premise of this paper is the belief that one of the core values of nursing research is its ability to demonstrate that nursing interventions influence care outcomes. From this perspective the contribution offered by the Roy Adaptation Model for Nursing within an intervention study is evaluated. Although it was believed that the model enriched the study in several ways, its overall contribution was likened to a "conceptual stepping stone', used by the researcher en route back towards its underlying theories and classical intervention design methodologies.

Preliminary testing of a proposition from the Roy Adaptation Model

OBJECTIVE

To test a framework based on a proposition of the Roy Adaptation Model predicting the relationships of severity of illness, perceived control over visitation (PCV), hardiness, state anxiety, and length of stay in an intensive care unit (ICU).

DESIGN

Descriptive-correlational.

POPULATION, SAMPLE, SETTING

Convenience sample was 60 general medical-surgical ICU patients admitted to one regional medical center in the Southeastern U.S.A. Patients completed data collection instruments after a minimum of 20 hours in the ICU during January-March 1994.

METHODS

Instruments included the PCV Scale, the State Anxiety Inventory, the Health Related Hardiness Scale, and the Acute Physiologic and Chronic Health Evaluation II. Model testing and path analysis were done.

FINDINGS

The study variables explained 18% of the variance in length of stay in the ICU, with anxiety and hardiness being the major contributing variables. The path between hardiness and PCV was the only path in the model supported by the data.

CONCLUSIONS

The proposed model had inadequate support in this preliminary testing. However, interventions that increase a patient's feelings of control and hardiness could decrease length of stay in ICU's.

Use of nursing models in pediatric nursing research: a decade of review

Systematic analysis of published nursing research is not new, but the incorporation of theory into research has not been separately evaluated, and pediatric nursing research has not been evaluated in its entirety for nearly two decades. A review of the use of nursing models in 302 pediatric nursing research articles published between 1980 and 1989 was conducted. Criteria developed by Silva (1986) to examine the theoretical basis of nursing practice research were used for this analysis. Nursing models were used as the theoretical framework in 17 investigations. According to Silva's criteria, the use of nursing models in these studies could be classified as follows: 6 minimal, 8 insufficient, and 3 adequate. This analysis produced results similar to those of previous analyses, finding that scant numbers of studies actually test nursing theory.

Stress mediation in caregivers of cognitively impaired adults: theoretical model testing

The purpose of the study was to test a midrange model of caregiver stress mediation based on Modeling and Role-Modeling theory. Perceived support and self-worth were examined to determine if these self-care resources had a mediating effect between stress and well-being in caregivers of cognitively impaired adults. The sample of 117 caregivers completed measures of basic need status, perceived support, self-worth, stress, and well-being. There were significant correlations among the study variables in the expected directions. Resources mediated the relationship between stress and well-being, providing tentative support for theoretically proposed linkages.

Continuing the dialogue: a response to Draper's critique of Fawcett's 'Conceptual models and nursing practice: the reciprocal relationship'

In their response to Draper's (1993) critique of Fawcett's (1992) paper 'Conceptual models and nursing practice: the reciprocal relationship', the authors argue that Draper's critique is flawed. They point out that Draper fails to acknowledge the diversity within the positivist movement, makes logical leaps, and fails to acknowledge Fawcett's long-standing distinction between middle-range theories and conceptual models and her discussions of the differences in the criteria to be used when evaluating conceptual models and theories.

King's framework and theory in Japan, Sweden, and the United States

In this article, we present our work in extending and testing Imogene King's conceptual framework and theory in Japan, Sweden, and the United States. Comparing and contrasting cultural relevance, methodology, and issues of validity provide examples of international scholarship and knowledge development that result from networking and collaboration.

Survey and critique of studies related to shift length variations in nursing from 1970 to 1993

The purpose of this study was to describe the current status, stage of staffing change, and findings of research relating to shift length variations in nursing. This was accomplished through a review of the literature to (a) evaluate the quality of the research, (b) summarize and draw conclusions related to variations in nursing shift length, and (c) identify gaps in the literature for the purpose of making recommendations for future studies related to nursing shift length variations. Multiple methods were utilized for locating potential studies to include in this project. Smith and Stullenbarger's (1991) Quality of Study instrument was used to rate the studies. None of the research reviewed explicitly identified a conceptual or theoretical framework or model, and few studies could be classified as scientifically rigorous. This study illuminates the state of the art and findings related to length of shift variations in nursing, and as such has implications for practice and research in nursing service administration.

Measuring constructs accurately: a prerequisite to theory testing

Accurate identification and measurement of constructs is particularly relevant to mental health nurses, who often have to work with clients that have intangible needs and problems. In this paper, the measurement of constructs, the relevance of construct validity to nursing research and, in particular, to theory testing will be discussed. Constructs within the health belief model are used to illustrate the discussion and procedure of factor analysis. Analysis of data based on a survey of health beliefs of 276 adults with the chronic condition of insulin-dependent diabetes is presented, interpreted and discussed. Whilst the paper focuses upon specific constructs and study population in order to provide a worked example, the issues raised and principles outlined relate to an analytical model that can be applied to other research problems and settings.

The orientation phase of the nurse-client relationship: testing Peplau's theory

This investigation used a prospective design to examine the orientation phase of the nurse-client relationship. A total of 124 newly formed nurse-client dyads constituted the sample. Preconceptions of both clients and nurses were related to the duration of the orientation phase and development of the therapeutic alliance. There was support for the importance of other interpersonal relationships for clients but not for nurses. Anxiety was not found to be significantly related to the development of the therapeutic relationship. The explanatory power resulting from including both nurse and client variables was considerably greater than client factors alone or the nurse factors alone as predictors of the therapeutic relationship. The current investigation validates the need for research specifically testing nursing theory.

Testing a theoretical proposition for modeling and role-modeling: basic need and adaptive potential status

The purpose of this research was to test the validity of a propositional statement within the Modeling and Role-Modeling theory and paradigm (Erickson, Tomlin, & Swain, 1988). The Adaptive Potential Assessment Model (APAM) is part of a multidimensional assessment strategy used by nurses to determine ability to mobilize coping resources. This study tested the theoretical proposition that basic need satisfaction and adaptive potential status are directly related. Three study hypotheses were deduced from the identified theoretical proposition. A simple linear relationship between basic need satisfaction and adaptive potential status was not supported. Multidimensional representations of the relationships contained important findings. Understanding more about the relationships between basic need status and adaptive potential will contribute to refining this theory for use in practice.

Studies exploring self-care for the person coping with cancer treatment: a review

Individuals living with an illness such as cancer and receiving chemotherapy must often meet a new set of demands, that are not amongst their usual repertoire of skills and knowledge. Little is known about how patients manage the illness of cancer and in particular what self-care actions they develop and perform to cope with the side-effects of treatment. This paper outlines Orem's theory of self-care and describes its utilization in the design of a number of research studies in the cancer patient population. In particular, work which has explored the role of self-care in relationship to the control of chemotherapy induced nausea and vomiting is reviewed. The role of manipulating food and fluid intake, exercise and sleep and diversionary activities are explored; self-care is considered a vital part of the battle against combating nausea and vomiting induced by chemotherapy and further studies are urged.

Conceptual models and nursing practice: the reciprocal relationship

There is a reciprocal relationship between conceptual models of nursing and nursing practice. Conceptual models influence clinical nursing practice by specifying standards for and purposes of practice; identifying relevant clinical problems, settings for practice, legitimate recipients of nursing care, and the content for the nursing process; suggesting methods for delivery of nursing services; and by providing frameworks for clinical information systems, patient classifications systems and quality assurance programmes. Nursing practice, in turn, provides data that can be used to determine the credibility of the conceptual models. Sources of data from clinical practice for credibility determination include evaluations of nursing interventions, the recipient's perspective of nursing care and quality assurance reviews.

Effects of promoting patients' participation in self-care on postoperative recovery and satisfaction with care

The effectiveness of patients' participation in self-care aimed at expediting the rate of recovery from surgery and increasing satisfaction with care received was tested with adult patients undergoing pyelolithotomy and nephrolithotomy. Forty subjects participating in the study were randomly assigned to either an experimental (n = 20) or a control group (n = 20). Patients in the experimental group participated in their self-care through nurse-patient interaction in addition to the usual care received in the setting. Results of the study indicated that patients in the experimental group had significantly less pain sensation and distress, used fewer analgesics, ambulated more, had fewer complications, and had higher satisfaction with care than patients in the control group. Since the experimental intervention was based on Orem's and King's theories, these findings support the value of application of these two nursing theories in practice.

Guidelines for the application of ARIMA models in time series

Time series analysis has been suggested as a valuable approach to evaluating the effectiveness of nursing interventions. Time series analysis techniques provide the tools for analyzing unique behavioral fluctuations through time and a framework for predicting future changes in the individual. Because of its newness, time series modeling has not been used widely in nursing research, but it can provide information about processes in nursing practice. Despite the utility of the interrupted time series design, a number of problems frequently arise in view of the practical and inferential difficulties in conducting interrupted time series research. The inherent limitations of time series analysis procedures are discussed in application to research problems.

Application of Orem's Self-Care Deficit Theory to the pediatric chronically ill population

The conditions under which children with long-term chronic health problems are cared for have changed dramatically in the past decade. These children are more often living longer and being cared for at home by their families and nursing supports. An effective tool allowing nurses to systematically assess, plan, implement, and evaluate the care needs of these children is a nursing theory. Orem's (1985) self- or dependent-care deficit theory is a useful basis from which the care of the chronically ill pediatric population can be planned. Attention is given to a caring relationship in which there is a dependent person in need of care and an individual who serves as that dependent person's agent of care. This article discusses several of the major concepts of the self- or dependent-care deficit theory and how it can be applied to guide clinical nursing practice aimed at meeting the care demands of the pediatric chronically ill population and their families.

The congruence of elderly client and nurse perceptions of the clients' self-care agency

Congruence of client and nurse perceptions is vital to mutual goal-setting as a means of achieving self-care in the elderly. The purpose of this descriptive, correlational study was to explore the relationship between nurse and elderly client perceptions of the clients' self-care agency. A sample of 40 elderly client subjects and registered nurses' selected from two community health agencies, completed a questionnaire consisting of three instruments: (a) a demographic sheet; (b) the appraisal of Self-Care Agency Scale; and (c) the Perceived Health Status. Pearson product moment correlation coefficients were significant for the relationships between: (a) client and nurse perceptions of clients' self-care agency (r = 0.42, P less than 0.01); (b) client and nurse perceptions of clients' health status (r = 0.38, P less than 0.01; and (c) nurse perceptions of clients' self-care agency and nurse perceptions of clients' health status (r = 0.44, P less than 0.01). With increasing emphasis on health promotion of the elderly in the community, identified relationships may have potential implications for gerontological and community nursing practice.

Building a programme of research from the Roy Adaptation Model of Nursing

This paper describes a series of methodological and substantive studies derived from the Roy Adaptation Model of Nursing. The research encompassed development of an instrument to measure functional status after childbirth and retrospective and longitudinal studies of variables associated with functional status during the postpartum period. The conceptual model proved to be a useful guide for the design and conduct of these studies as well as ongoing investigations of functional status during pregnancy and following diagnosis of breast cancer. Findings from completed studies support the credibility of Roy's conceptual model.

Social support and health: a theoretical formulation derived from King's conceptual framework

This article describes the development and initial empirical testing of a theoretical formulation of social support, family, health, and child health derived from Imogene King's conceptual framework for nursing. A correlational design was used to test the formulation with 103 families who have children with diabetes mellitus. Three hypotheses were supported: parents' social support had a direct and positive effect on family health, parents' social support and child's social support were positively related, and illness factors had a direct and negative effect on child health. Both the supported and unsupported hypotheses are discussed in terms of the present substantive knowledge base and evidence of validity for King's framework. Direction for further theory development and research are identified.

Structuring nursing knowledge: a priority for creating nursing's future

Nursing's future will be created only as the discipline underlying nursing practices is identified, structured, and continuously updated by systematic inquiry. The kinds of knowledge contained within the disci pline are identified and an approach to its structure is proposed.