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CHAPTER 3 Theory Development Process 33

Liehr and Smith (1999) reviewed 10 years of nurs- theory, research, and practice. Their recommenda-
ing literature on middle-range theories from 1985 tions include the following:
and 1995 and located 22 middle-range theories that • Continued development of nursing theories that
could be categorized in five approaches to theory are relevant to nurses’ specialty practice
building. They did not identify any theories devised • Increased collaboration between scientists and
by simply synthesizing research findings. practitioners (Lorentzon, 1998)
The nursing literature abounds with a range of • Encouraging nurse researchers to communicate
different approaches to middle-range theory build- research findings to practitioners
ing and development. The recent nursing literature • Increased efforts to relate middle-range theories to
emphasizes the importance of relating middle-range nursing paradigms
theories to broader nursing theories and paradigms • Increased emphasis on clinical research
and continuing to pursue empirical testing and the • Increased use of nursing theories for theory-based
replication of studies to advance nursing knowledge. practice and clinical decision making
Fahs, Morgan, and Kalman (2003) have called for (See Chinn and Kramer, 2011; Cody, 1999; Hoffman
the replication of research studies to ensure that and Bertus, 1991; Liehr and Smith, 1999; Lutz, Jones, &
nursing scholars can provide “a (reliable) research- Kendall, 1997; Reed, 2000; and Sparacino, 1991.)
to-practice link” . . . that (provides) “safe, effective, Within education, some use one theory guiding nurs-
quality care to consumers” (p. 70). Middle-range ing curricula, however others utilize a framework of the
theories have essentially grown over the last 10 years metaparadigm. Malinski (2000) and others have urged
with textbooks into their second editions (Peterson, increased attention to nursing theory–based research
2008; Sieloff & Frey, 2007; Smith & Liehr, 2008) and and strengthening of nursing theory–based curricula,
being taught in graduate education for theory-based especially in master’s and doctoral programs.
practice. Regarding the use of nursing knowledge in clinical
Numerous authors have proposed criteria to evalu- practice, Cody asserted, “It is a professional nurse’s
ate theories (Chinn & Kramer, 2011; Fawcett, 2005; ethical responsibility to utilize the knowledge base
Meleis, 2007; Parker, 2006). They reflect the importance of her or his discipline” (1997, p. 4). In 1992, in the
of nursing knowledge to the future of the discipline and first issue of the journal Clinical Nursing Research,
some diversity in approaches. Is the theory relevant, Schlotfeldt stated the following:
significant, or functional to the discipline of nursing? “It will be nursing’s clinical scholars . . . that will
Chapter 1 presents the criteria used for analysis of the- identify the human phenomena that are central
ory in this text (Chinn & Kramer, 2011).
to nurses’ practice . . . and that provoke consider-
Nursing Theory, Practice, and Research ation of the practice problems about which
Theory-testing research may lead one nursing theory knowledge is needed but is not yet available. It is
nursing’s clinical scholarship that must be de-
to fall aside as new theory is developed that explains pended on to generate promising theories for
nursing phenomena more adequately. Therefore, it is testing that will advance nursing knowledge and
critical that theory-testing research continues to ad- ensure nursing’s continued essential services to
vance the discipline. Nursing scholars have presented humankind.”
criteria for evaluating theory-testing research in (Schlotfeldt, 1992, p. 9)
nursing (Silva, 1986; Acton, Irvin, & Hopkins, 1991).
These criteria emphasize the importance of using a In summary, contemporary nursing scholars are
nursing framework to design the purpose and focus emphasizing the following in theory-building processes:
of the study, to derive hypotheses, and to relate the • Continued development of theoretical inquiry in
significance of the findings back to nursing. In addi- nursing
tion to the call for more rigorous theory-testing re- • Continued scholarship with middle-range theories
search in nursing, nursing scholars and practitioners and situation-specific theories, including efforts to
call for increased attention to the relationships among relate to nursing theories and paradigms