Theoretical substruction: a guide for theory testing research

Theoretical Substruction of Resilience Theory: Dementia Caregivers' Burden and Their Care Recipients' Behavior

Theoretical substruction is vital in clarifying models and guiding research. In this article, the process of theoretical substruction was examined through resilience theory to provide an example of the congruence between theoretical and operational definitions in nursing research. The author examines the significance of resilience theory in the context of dementia caregivers' burden and their care recipients' behavioral problems. The steps of theoretical substruction are included, and a model of resilience is presented that includes middle-range concepts, relational statements, and propositions derived from the research literature. The rigorous process of theoretical substruction provides an example of a theoretically sound basis for exploring the role of positive thinking in the lives of dementia caregivers and their care recipients. Geropsychiatric nurses working with dementia patients and their caregivers should consider the role of positive thinking in decreasing caregivers' burden.

A Substruction Approach to Assessing the Theoretical Validity of Measures

BACKGROUND

Validity is about the logic, meaningfulness, and evidence used to defend inferences made when interpreting results. Substruction is a heuristic or process that visually represent the hierarchical structure between theory and measures.

PURPOSE

To describe substruction as a method for assessing the toretical validity of research measures.

METHODS

Using Fawcett's Conceptual-Theoretical-Empirical Structure. an exemplar is presented of substruction from the Individual and Family Self-Management Theory to the Striving to be strong study concepts and empirical measures.

RESULTS

Substruction tables display evidence supporting theoretical validity of the instruments used in the study.

CONCLUSION

A high degree of congruence between theory and measure is critical to support the validity of the theory and to support attributions made about moderating, mediating, causal relationships, and intervention effects.

Theories of Health Care Decision Making at the End of Life: A Meta-Ethnography

The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015. Forty-three articles were included. The most common theories included decision-making models ( n = 14) followed by family-centered ( n = 11) and behavioral change models ( n = 7). A conceptual framework was developed using themes including context of decision making, communication and negotiation of decision making, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes. Future research should enhance and apply these theories to guide research to develop patient-centered decision-making programs that facilitate informed and shared decision making at the end of life among patients with advanced illness and their caregivers.

The Nursing Knowledge Pyramid: A Theory of the Structure of Nursing Knowledge

A theory of the structure of nursing knowledge is proposed. Using retroductive reasoning to build upon an existing theory, the goal of the Nursing Knowledge Pyramid is to integrate disparate forms of nursing knowledge into a comprehensive, coherent, and useful structure to enhance the learning, development, automation, and accessibility of nursing knowledge. Education uses are discussed.

Uso Del Condón en Adolescentes Nahuas, un Modelo Explicativo

En México, la población indígena supera los siete millones de habitantes, en Puebla el grupo más representativo es el Náhuatl. Sin embargo, las condiciones de vida, salud, educación y transporte son precarias para esta población. En los adolescentes, las responsabilidades como el matrimonio, la familia y los compromisos ante la comunidad, favorecen conductas de riesgo sexual que dificultan su desarrollo económico, social y reproductivo. El objetivo fue proponer un modelo explicativo del uso del condón en adolescentes nahuas. Método. Bajo el marco de la teoría social cognitiva, el concepto de valores culturales de Leininger y el proceso de la sustracción teórica, se desarrolló este artículo. Se muestran las relaciones del modelo con las proposiciones y los factores que influyen en el uso del condón para este grupo específico. Finalmente, el modelo explica las variables de interés, los niveles de abstracción y las relaciones entre sí en el contexto náhuatl. El siguiente paso será implementar los indicadores empíricos para conocer el grado de influencia de los factores personales y ambientales hacia el uso del condón en adolescentes nahuas. Resultados que aportarán información para el desarrollo del conocimiento en enfermería y la reducción de riesgo sexual de esta población.

Predictors of Depression Among Community-Dwelling Older Women Living Alone in Korea

This study examined the prevalence and predicting factors of depression among community-dwelling older women living alone in Korea. Of the 2054 older women living alone in this study, 42.9% (881) were experiencing depression. Factors associated with a higher prevalence of depression were overall difficulty with living alone, taking more than six medications, limitations of instrumental activities of daily living, limitations of muscle strength, limitations of exercise performance in upper extremities, trouble with hearing, and perceptions of poor health status. These results provide a basis for designing preventive interventional programs to decrease depression among older women living alone in Korea.

Development and psychometric testing of the Nursing Research Self-Efficacy Scale (NURSES)

BACKGROUND AND PURPOSE

The Nursing Research Self-Efficacy Scale (NURSES) was designed to measure individual nurses' degree of research self-efficacy and their perceptions regarding their unit's collective support of research use. Development for the NURSES instrument spanned a 4-year period, which included initial development, revisions, and psychometric evaluations.

METHOD

The NURSES is a 38-item Likert-scale instrument developed through ongoing instrument validation that included content validation and exploratory and confirmatory analysis. The 5 subscales include obtaining science-based knowledge resources, critically reading and evaluating quantitative research literature, critically reading and evaluating qualitative research literature, understanding and applying theory, and collective research efficacy.

RESULTS

Over a 4-year period, approximately 1000 practicing nurses from multiple hospitals responded to the instrument. Exploratory and confirmatory factor analyses supported the existence of four subscales for research self-efficacy and one subscale for collective research efficacy. Reliability for the subscales was excellent, ranging from .94 to .97.

CONCLUSIONS

Hospitals may wish to use the NURSES instrument as an orientation tool, or to examine relationships between research efficacy and nurses' professional development. Health care facilities on a Magnet journey might also use the NURSES instrument to assess their nursing staff as they pursue evidence-based practice and conduct research.

Testing the integrated theory of health behaviour change for postpartum weight management

AIM

This is a report of a correlational study to test the Integrated Theory of Health Behaviour Change within the context of postpartum weight self-management including the impact of race/ethnicity and weight classification.

BACKGROUND

Women experiencing childbirth face increasing challenges to manage their weight postpartum. Little is known about women's weight self-management during the complex physiological and psychosocial transition of the postpartum period.

METHODS

Data were collected during the birth hospitalization and 4 months postbirth during 2005 and 2006. A quota sample of 250 postpartum women using two strata, race/ethnicity and prepregnant weight classification, were enrolled; 179 women completed the follow-up survey. A survey questionnaire measured concepts from the Integrated Theory of Health Behaviour Change concepts, including knowledge and beliefs (self-efficacy, outcome expectancy and goal congruence), self-regulation skills and abilities, and social facilitation (social support and social influence) and the proximal outcome of weight retention. Factor analysis identified 5 factors consistent with the theoretical concepts that accounted for 47·1% of total survey variance.

RESULTS

Model testing using path analysis explored the relationship among factors. The final model explained 25·7% of the variance in self regulation at 4 months, but did not explain weight retention. The contribution of select concepts to total variance was different for Caucasian and African American women, but not by weight classification.

CONCLUSIONS

Findings support use of theoretical concepts and relationships to understand postpartum weight self-management. The different relationships among concepts in Caucasian and African American women should be considered in planning targeted postpartum weight self-management interventions.

Making the Case for a Nurse-Led Vascular Access Team Utilizing a Quality Assurance Conceptual Framework

The cost of complications of central venous access devices (CVADs) in today's health care setting is creating a financial burden, increasing the expenditures of resources, and consuming the time of health care providers to resolve. As the roles of nurses continue to evolve, nurses may be in a position to recognize and prevent many of these complications. This paper proposes a conceptual model to address the issues related to caring for and monitoring CVADs, while reducing complications and increasing quality of patient care.

Theoretical substruction: establishing links between theory and measurement of military women's attitudes towards menstrual suppression during military operations

AIM

The aim of this paper is to establish a theoretical model for the exploration of the phenomenon of menstruation and women's attitudes towards menstrual suppression during military operations.

BACKGROUND

In the emerging field of literature that explores menstruation among military women, there are indications that menstrual symptoms and hygiene are problematic under the circumstances of deployment to military operations. While menstrual suppression may be a solution to problems that women encounter with menstruation during deployment, there is little research exploring the phenomenon.

DATA SOURCES

CINAHL and Medline were used to locate peer reviewed journal papers published from 1977 to 2007. International military reports were obtained through an internet search engine (Google).

DISCUSSION

Issues that military women encounter surrounding menstruation during deployment are framed according to components of human ecology and social ecology theories, creating a theoretical model for the study of military women's menstrual health. Theoretical substruction is then used to evaluate the proposed theoretical and operational systems for measuring military women's attitudes during deployment. The process of theoretical substruction validates the model and the theoretical integrity of the proposed research on women's attitudes towards suppression.

CONCLUSION

A theory-based model for women's health under challenging environmental conditions will enhance the holistic consideration of women's health issues by care providers. The theoretical model clearly explicates the phenomenon of menstruation during deployment and the theoretical and operational systems are soundly linked in the proposed measurement model of military women's attitudes towards menstrual suppression.

The effect of nurse champions on compliance with Keystone Intensive Care Unit Sepsis-screening protocol

Sepsis poses a major threat to patient safety in intensive care units (ICU) across the country. An accumulating body of evidence supports using established protocols to screen ICU patients regularly for sepsis indicators; however, there often is a gap between what is known and what is practiced. Compliance with sepsis screening was noted to be less than acceptable at one Regional Michigan Medical Center. The 2-fold purpose of this study was to evaluate the effect of introducing nurse champions into an ICU environment on (1) ICU nurses' compliance with Michigan Health and Hospital Association Keystone ICU sepsis screening protocols and (2) patient safety outcomes. A 1-group pretest-posttest quasi-experimental design was used for the study. A nonprobability, convenience sample of patient charts from a 16-bed ICU in a 352-bed regional referral center was used for the study. Findings from this study demonstrated that the introduction of nurse champions significantly improved compliance with ICU sepsis screening, from 23% preintroduction to 74% postintroduction, but had virtually no effect on patient outcomes related to percentage of patients treated for sepsis.

Re-thinking family-centred care across the continuum of children's healthcare

BACKGROUND

The terms family-centred care (FCC) and family-centred services (FCS) are used interchangeably across the continuum of children's healthcare to encompass concepts of: parental participation in children's healthcare; partnership and collaboration between the healthcare team and parents in decision-making; family-friendly environments that normalize as much as possible family functioning within the healthcare setting; and care of family members as well as of children. However, authors from different professional and policy perspectives have used different definitions and literatures when arguing the evidence for FCC and FCS.

METHOD

A critical literature review and theoretical discussion exploring common concepts and issues forming the basis for a research agenda further strengthening of the evidence base for FCC. A systematic identification of constructs, concepts and empirical indicators is developed and applied to exemplars in pain and asthma that span the continuum of children's healthcare across acute and community settings.

CONCLUSIONS

The extent to which the concepts are supported by research and applied in practice remains unclear. We propose that re-thinking of FCC is required in order to develop a more coherent programme of research into the application of FCC theory in children's healthcare.

King's conceptual system and theory of goal attainment: past, present, and future

Imogene King is universally recognized as a pioneer of nursing theory development. Her interacting conceptual system for nursing and her theory of goal attainment have been included in every major nursing theory text, are taught to thousands of nursing students, form the basis of nursing education programs, and are implemented in a variety of service settings.

Sexual prevention of HIV: a model for Latinos

Despite reductions in AIDS deaths in the general population, Latino AIDS deaths in the United States have been increasing. The underlying cause of the rising HIV infection rates in the U.S. Latino population is not fully understood. Focus groups among Mexicans in North Carolina revealed methods of prevention that were different from those recommended by the Centers for Disease Control and Prevention (CDC). A research-based Mexican model of HIV prevention is proposed and contrasted with a model deducted from CDC prevention strategies. Recently immigrated Mexicans may be unlikely to adopt the CDC model of HIV prevention due to their culturally specific views of prevention.

Caregiving effectiveness in families managing complex technology at home: replication of a model

BACKGROUND

Original testing of the Caregiving Effectiveness Model, in a randomly drawn national sample (n = 111) of family caregivers, explained variance in the home care outcomes of patient physical condition, technology side effects, and quality of life. The variables in the resulting model reflected the challenges specific to family caregivers managing complex home care for the growing populations of technology-dependent patients.

OBJECTIVE

To seek further empirical verification of the relationships among home care outcomes and the variables in the original trimmed model.

METHOD

Data were collected from family caregivers (n = 31) and adult patients (n = 31) requiring lifelong daily total parenteral nutrition (TPN) infusion technology for nonmalignant bowel disease. Hierarchical regression was used with variables entered in the two stages that coincided with the model configuration of Caregiving and Adaptive concepts, with a criteria of alpha = .05 at a power of > .80.

RESULTS

The model variables explained variance in all four outcomes. Specifically, Caregiving and Adaptive concept variables contributed to the explained variance in quality of life of both caregivers (R2 = .559, F = 4.65, p = .003) and patients (R2 = .464, F = 5.17, p = .04). Variance in patients' physical condition (R2 = .345, F = 6.37, p = .032) and the technological side effects outcomes (R2 = .357, F = 3.60, p = .018) were accounted for by variables in the model.

CONCLUSIONS

In this sample, the Caregiving Effectiveness Model concepts accounted for significant variance in home care outcomes (quality in patients' and caregivers' lives, patients' physical condition, and technological side effect). Longitudinal study of this sample will determine if variables explain variance over time, as in the original model testing.