Connelly__L._M.__2014_._Use_of_theoretical_frameworks_in_research._MEDSURG_Nursing__23_3___187_188…pdf

R esearch
R o u n d ta b le Lynne M . C o n n e lly

Use o f Theoretical Frameworks
in Research

R eaders of research reports probably have noticed some studies explicitly name a theory that guided the research and some do not. It is not always clear
in reports what role the theory or theoretical framework
played (or did not play) in the research. In this issue,
Parker (2014) outlined a study about decision making by
medical-surgical nurses when they activate rapid response
teams. In the report, in the section called “Nurse Decision
Making,” the author concisely discussed theories of deci­
sion making and the models of decision making that oth­
ers have used to examine the topic with nurses. In addi­
tion, Parker used an instrument to measure decision mak­
ing based on these various decision-making models. This
report is a useful example of how theory guides research
and also makes sense of the subsequent findings.

W hat Is a theory?
First, various terms are used to refer to the theoretic

basis of a study, including theory, theoretical framework,
conceptual framework, and models. Theory is a set of inter­
related concepts (or variables) and definitions that are
formed into propositions or hypotheses to specify the
relationship among the constructs (Creswell, 2013). A for­
mal theory is well-developed and is useful to predict
behavior or outcomes. A theoretical framework or con­
ceptual framework is less formal and typically less devel­
oped than a formal theory. Such a framework often is use­
ful when exploratory work is being done to expand the
theoretical ideas. A conceptual model usually is focused
more narrowly and structured more loosely than theories,
and does not link concepts (Polit & Beck, 2014). For
example, the Lauri and Salantera (2002) instrum ent is
based on a model that describes how nurses make deci­
sions but does not predict how effective each type is in
making decisions. For the purposes of this column, I use
the general word theory to encompass all these terms.

In simple terms, a theory is a representation of a por­
tion of reality that helps us make sense of complex phe­
nomena. It is not the reality itself; it is a tool for better
understanding. Theories are not right or wrong but some
theories offer a better fit for particular situations. Each
theory can provide a different lens for looking at a prob­
lem, allowing it to be examined from different perspec­
tives for full understanding of all its facets (Reeves, Albert,
Kuper, & Hodges, 2008).

Lynne M. Connelly, PhD, RN, is Associate Professor and Director of
Nursing, Benedictine College, Atchison, KS. She is Research Editor for
MEDSURG Nursing.

MEDSURG n u r s in g . May-june 2014 • Vol. 23/No. 3

Theory in a study can be stated clearly or it can be
implied (Bond et al., 2011). For example, in physiological
studies, the framework usually is drawn from current
understanding of physiology and pathophysiology. It
often is presented as the state of science in a particular
area. In more abstract areas of research, specific theory
can be useful to frame the problem, develop an interven­
tion, and guide the research study.

A theory about a phenom enon, such as nurse decision
making, parsimoniously explains how nurses make deci­
sions in the practice setting. Each theory will have a num ­
ber of interrelated concepts. Concepts are abstract repre­
sentations of specific parts of the theory (Polit & Beck,
2014). In the Parker (2014) study, the decision-making
models described how different people have different
ways of making decisions. Some people are intuitive deci­
sion makers, some are analytical decision makers, and
others use both types of decision making. While it can
seem even more complex, this concise depiction helps us
understand the process of making a decision and measure
how each nurse in a study normally makes decisions.

Guiding Research
A theory should not be added to a study because the

researcher was told in school that a theory is needed for a
research study. A clear connection should exist among
the theory, the problem or phenom enon being studied,
and the research method. For example, Parker (2014)
used an instm m ent developed by Lauri and Salantera
(2002) based on the various models of decision making.
Using a valid instm m ent based on theory allows the
researcher to make comparisons between the results of
different studies that otherwise could not be made if the
researcher used a separate instm ment. In addition, when
conducting the study, the researcher also is testing the
theory to determine if it works in the study population.

In Parker’s (2014) study, a factor analysis showed items
measuring analytic decision making correlated with each
other and intuitive decision-making items correlated
with each other; however, each of these did not correlate
significantly with the other type. In other words, intuitive
items were connected with other intuitive items, but not
with analytic items. The same is tm e for analytic items.
This supports the validity of the instm m ent and also sup­
ports the theory that guided development of this instru­
ment. W hen we review the results, then, we can have
some confidence they are measuring aspects of the theo­
ry appropriately. In addition, investigators should make
connections between their results and the theory clear in

187

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R esearch R o u n d ta b le

their discussion of the findings. They should relate their
results to other research in which the theory was used.
Parker compared his results to results by Lauri and
Salantera (2002).

In another example, Yoder (2005) described how the
Roy Adaption Model was used in several studies: a study
of quality of life in patients with cancer, a study of exer­
cise intervention in patients with cancer, and another
study of clinical outcomes in patients with burns. Yoder
presented figures outlining each aspect of the theory and
how each aspect was measured. Each of the studies pro­
vided results helpful to patients, but they also provided
support for the Roy Adaptation Model. The figures in this
article are useful examples of how to make clear connec­
tions between concepts within a theory or model and the
measurement instruments. This can be particularly useful
in research proposals.

Theory also is used to guide the development of effec­
tive interventions for patient care. In this case, theorists
may use both theory and empirical results to suggest one
variable (the intervention) can have a positive effect on
another variable (e.g., a person’s behavior or physical
outcome). If a theory indicates, for example, that teach­
ing a patient about his or her disease will improve self­
management, th en we could conduct an intervention
study to test that proposition. Theory also may provide
us with other variables that can moderate this effect
(Polit & Beck, 2014).

O t h e r Is s u e s

W hen research results are not what were expected, two
reasons are possible: either the research design or measure­
m ent of variables was flawed, or the theory guiding the
research did not fit the situation or population. In the case
of an inappropriate theory, the researcher may be able to
suggest modifications to the theory. The modifications
then would need to be tested. Useful theory is refined by
this iterative process (Johnson & Webber, 2010).

In qualitative research, theory can have several purpos­
es. General theories, such as interactionism and critical
theory, can be used to guide qualitative research (Reeves
et al., 2008). These are theories that conceptualize how
we should study phenom ena (Polit & Beck, 2014;
Sandelowski, 1993). On the other hand, qualitative inves­
tigators often want to generate rather than test theory
based on what they find with their particular informants.
Prior to and during data collection, researchers often
avoid substantive theory about the specific phenom ena
to prevent being influenced by prior theorizing about the
topic. Thus, the theory generated in qualitative research
is grounded in data that come from directly observing
and talking to the participants (Creswell, 2013).

This short column can not cover all the nuances of
theory and research. Readers can refer to the references
cited or to a good research textbook to obtain more infor­
mation. Because theory is im portant to conducting and
understanding research findings, readers should under­
stand what theory is and how a researcher can use it effec­
tively to guide a study. i ’»:i

REFERENCES
Bond, A., Eshah, N., Bani-Khaled, M., Hamad, A., Habashneh, S.,

Kataua’, H….. Maabreh, R. (2011). Who uses nursing theory? A
univariate descriptive analysis of five years’ research articles.
Scandinavian Journal o f Caring Sciences, 25(2), 404-409.

Creswell, J.W. (2013). The use of theory. In J.W. Creswell (Ed.) Research
design: Qualitative, quantitative, and mixed methods approaches
(4th ed.) (pp. 51-76). Los Angeles, CA: Sage.

Johnson, B.M., & Webber, P.B. (2010). An introduction to theory and rea­
soning in nursing. Philadelphia, PA: Wolters Kluwer/Lippincott
Williams & Wilkins.

Lauri, S., & Salantera, S. (2002). Developing an instrument to measure
and describe clinical decision-making in different nursing fields.
Journal o f Professional Nursing, 18(30), 93-100.

Parker, C.G. (2014). Decision making models used by medical-surgical
nurses to activate rapid response teams. MEDSURG Nursing,
23(3), 159-164.

Polit, D.F., & Beck, C.T. (2014). Essentials o f nursing research:
Appraising evidence for nursing practice. Philadelphia, PA: Wolter
Kluwer/Lippincott Williams & Wilkins.

Reeves, S„ Albert, M., Kuper, A., & Hodges, B.D. (2008). Why use theo­
ries in qualitative research? BMJ, 337, 631-634.

Sandelowski, M. (1993). Theory unmasked: The uses and guises of the­
ory in qualitative research. Research in Nursing and Health, 16,
213-218.

Yoder, L.H. (2005). Using the Roy Adaptation Model: A program of
research in a military research service. Nursing Science Quarterly,
18(A), 321-323.

M
E
D
S
u
R
G

P ersistent D iffe re n c e s Found in
P re v e n tiv e Services Use w ith in th e
U.S. P o p u la tio n

Large differences in adult use of preventive serv­
ices persisted from 1996 through 2008 across popu­
lation groups defined by poverty, race/ethnicity,
insurance coverage, and geography. Researchers
examined trends in five preventive services: general
checkups, blood pressure screening, blood choles­
terol screening, Pap smears, and mammograms.

Among the population of nonelderly adults
(ages 19-64 years), the proportion of the population
having a general checkup increased 1.1% from
1996/1998 to 2007/2008; the proportion of those
with blood cholesterol screening within the prior 5
years increased by 8.2%. In contrast, the percentage
of the population having blood pressure screening
or mammograms (among women) increased mod­
estly between the first pair of time points, but
remained essentially constant thereafter. Finally,
the percentage of women having Pap smears
increased modestly (by 2.1%) from 1996/1998 to
2002/2003, but decreased by about a percentage
point subsequently to the end of the study period.

More details are in Abdus & Selden (2013).
Preventive services for adults: How have differences
across subgroups changed over the past decade?
Medical Care, 51(11), 999-1007. EB3I

188 MayJune 2014 • Vol. 23/No. 3 MEDSURG UXJHSIMG,
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