Frameworks

Concept

A concept is a term that abstractly describes and names an object, a phenomenon, or an idea, thus providing it with a separate identity or meaning. An example of a concept is the term anxiety. At high levels of abstraction, such as is found in conceptual models, concepts have general meanings and are sometimes referred to as constructs. For example, a construct associated with the concept of anxiety might be “emotional responses.”

At a more concrete level, terms are referred to as variables and have narrow definitions. A variable is more specific than a concept and implies that the term is defined so that it is measurable. The word variable implies that the numerical values associated with the term vary from one instance to another. A variable related to anxiety might be “palmar sweating,” which the researcher can measure by assigning numerical values to different amounts of sweat on the subject’s palm. The links among constructs, concepts, and variables are illustrated here:

Defining concepts allows us to be consistent in the way we use a term in the discipline, apply it to a theory, and incorporate it in a field of study. A conceptual definition differs from the denotative (or dictionary) definition of a word. A conceptual definition (connotative meaning) is more comprehensive than a denotative definition because it includes associated meanings the word may have. For example, we may connotatively associate the term “fireplace” with images of hospitality and warm comfort, whereas the dictionary definition would be more concrete and narrower. A conceptual definition can be established through concept synthesis, concept derivation, or concept analysis.

Relational Statements

A relational statement declares that a relationship of some kind exists between or among two or more concepts (Walker & Avant, 2004). Relational statements form the core of a framework. Skills in expressing statements are essential for constructing an integrated framework that will, in turn, lead to a well-designed study. The statements expressed in your framework will determine (1) your objective, question, or hypothesis; (2) your study’s design; (3) the statistical analyses you will perform; and (4) the type of findings you can expect. Frameworks developed with inadequate expression of statements provide only a broad orientation for the study and do not guide the research process.

Understanding relational statements is essential also for appraising frameworks. Being able to evaluate the links among the hypotheses, the design, and the framework is also an essential part of determining the quality of a study. Judging whether the study was successful depends, in part, on identifying the statements in the framework and tracking their examination by the study.

Conceptual Models

A conceptual model is a set of highly abstract, related constructs. It broadly explains phenomena of interest, expresses assumptions, and reflects a philosophical stance. A number of conceptual models have been developed in nursing. For example, Roy’s (1984, 1988, 1990) model describes adaptation as the primary phenomenon of interest to nursing. This model identifies the constructs she considers essential to adaptation and how these constructs interact to produce adaptation. Orem (2001) considered self-care to be the phenomenon central to nursing. Her model explains how nurses facilitate the self-care of clients. Rogers (1970, 1980, 1983, 1986, 1988) regarded human beings as the central phenomenon of interest to nursing, and her model is designed to explain the nature of human beings. A conceptual model may use the same or similar constructs as other models but define them in different ways. Thus, Roy, Orem, and Rogers may all use the construct health but define it in different ways.

Most disciplines have several conceptual models, each with a distinctive vocabulary. Table 7-6 lists some of the conceptual models or grand theories in nursing. These philosophical and theoretical statements of nursing vary in their level of abstraction and the breadth of phenomena they explain. However, each provides an overall picture, a gestalt of the phenomena they explain. It is not their purpose to provide detail or to be specific. Most are not directly testable through research and thus cannot be used alone as the framework for a study (Fawcett, 1999; Walker & Avant, 2004). However, a framework can include a combination of a more abstract conceptualization of nursing and a theory.

An organized program of research is important for building a body of knowledge related to the phenomena explained by a particular conceptual model. This program of research is referred to as a research tradition. To develop a research tradition for a particular model, a group of scholars must be willing to dedicate time and energy to this endeavor. Middle-range theories compatible with the model must be developed. The research tradition for the conceptual model must be defined. The definition must (1) identify acceptable strategies for developing and testing theory on the basis of the model, (2) define the phenomena to be studied, (3) establish priorities for testing theory statements, (4) develop research methods and measurement techniques, (5) describe data collection strategies, and (6) select acceptable approaches to data analyses (Fawcett, 1999). These research traditions should include the advanced practice roles in nursing and their phenomena.

Researchers conducting studies consistent with a particular tradition may be scattered across the country (or the world), but they often maintain a network of communication about their work. In some cases, they hold annual conferences that focus on the model. These gatherings give researchers the opportunity to share findings, discuss methods, explore theoretical ideas, identify priorities for future research, and maintain network contacts. The organizations of advanced practice nurses should interface with organizations that conduct studies according to a particular tradition; this type of interaction will facilitate studies relevant to advanced nursing practice.

One example of a conceptual nursing model with an emerging research tradition is Orem’s model of self-care. Orem’s (2001) model focuses on the domain of nursing practice and on what nurses actually do. She proposed that individuals generally know how to take care of themselves (self-care). If they are dependent in some way, as are children, the aged, or the handicapped, family members take on this responsibility (dependent care). If individuals are ill or have some health problem (such as diabetes or a colostomy), they or their family members acquire special skills to provide that care (therapeutic self-care). An individual’s capacity to provide self-care is referred to as self-care agency. A self-care deficit occurs when self-care demand exceeds self-care agency (Hartweg & Orem, 1991).

An individual obtains nursing care only when there is a deficit in the self-care or dependent care that the individual and his or her family can provide (self-care deficit). In this case, the nurse or nurses develop a system to provide the needed care. This system involves prescribing, designing, and providing care. The goal of nursing care is to help the individual resume self-care independently or with family assistance. There are three types of nursing systems: wholly compensatory, partly compensatory, and supportive-educative. The system chosen is based on the person’s capacity to perform self-care.

A research tradition related to the testing of propositions of the theory requires a commitment to develop valid and reliable scales to measure the concepts of the theory. Instruments based on Orem’s model are shown in Table 7-7. Orem (2001) has developed three theories related to her model: the theory of self-care deficits, the theory of self-care, and the theory of nursing systems (also referred to as the general theory of nursing). Studies testing statements that have emerged from Orem’s theories appear in the literature (Table 7-8). Research methodologies acceptable for testing Orem’s theories have not been specified in the literature. Orem has suggested that researchers examine the qualitative characteristics of self-care, as well as its presence or absence. She also recommended studying the phases in which individuals (1) investigate the possibility of caring for themselves, (2) make the decision to do so, and (3) begin to engage in self-care behaviors. The focus of self-care in Orem’s work should provide a basis for research by nurse practitioners who, in most cases, must depend on the client’s self-care abilities to implement the instructions provided during primary care. Are there strategies that nurse practitioners could use to increase the self-care capabilities of their clients? Could the effectiveness of a new strategy be tested through research and published to guide other nurse practitioners?

Theory

A theory is more narrow and specific than a conceptual model and is directly testable. A theory consists of an integrated set of defined concepts, existence statements, and relational statements that can be used to describe, explain, predict, or control that phenomenon. Existence statements declare that a given concept exists or that a given relationship occurs. For example, an existence statement might claim that a condition referred to as stress exists and that there is a relationship between stress and health.

Relational statements clarify the relationship that exists between or among concepts. For example, a relational statement might propose that high levels of stress are related to declining levels of health. It is the statements of a theory that are tested through research, not the theory itself. Thus, identifying statements within the theory is critical to the research endeavor and forms the basis of the study’s framework. The types of theory discussed here are scientific, substantive, and tentative.

Conceptual Maps

One strategy for expressing a framework is a conceptual map that diagrams the interrelationships of the concepts and statements (Artinian, 1982; Fawcett, 1999; Moody, 1989; Newman, 1979, 1999; Silva, 1981). Figures 7-3 through 7-7 are examples of conceptual maps. A conceptual map summarizes and integrates what we know about a phenomenon more succinctly and clearly than a literary explanation and allows us to grasp the gestalt of a phenomenon. A conceptual map should be supported by references from the literature.

A conceptual map explains which concepts contribute to or partially cause an outcome. Conditions, both direct and indirect, that may produce the outcome are specified. A conceptual map illustrates the process in which factors must cumulatively interact over time in some sequence to have a causal effect. Conceptual maps vary in complexity and accuracy, depending on the available body of knowledge related to the phenomenon. Mapping can also identify gaps in the logic of the theory being used as a framework and reveals inconsistencies, incompleteness, and errors.

Conceptual maps are useful beyond the study for which they were developed. A conceptual map may suggest hypotheses that can be tested in future studies. In addition, through map development, the researcher may gain insight about different situations in which the same process may be occurring. Publication of the map may stimulate the interest of other researchers, who may then use it in their own studies. Thus, a well-developed conceptual map may help to build a body of knowledge related to a particular theory. In addition to conceptual maps included as the framework for a study, more maps are being published that are outcomes of extensive reviews of the literature expressed as tentative theories.

Selecting and Defining Concepts

Concepts are selected for a framework on the basis of their relevance to the phenomenon you are studying. Thus, the problem statement, which describes the phenomenon, is a rich source of concepts for the framework. If you begin from a concrete clinical perspective, the ideas may be first identified as variables and then translated to concepts. Every major variable included in the study should reflect a concept included in the framework. You may modify the framework as you develop the rest of the study. As you gain additional insight into the phenomenon through a thorough search of theoretical, research, and clinical publications, you may identify additional relevant concepts or propose new relationships. While incorporating these new elements into the framework, consider their implications for the study design.

The framework presented here was developed by researchers from the public health field, not nursing, but it is imminently relevant for nursing research. As Kamphuis and colleagues indicated:

Their framework “specifies the pathways between socioeconomic status (SES), environmental factors, personal level factors (constructs from the Theory of Planned Behaviour: see Ajzen, 1991) and health behaviours” (p. 494).

Each concept included in a framework must be defined conceptually. When available and appropriate, use conceptual definitions from existing theoretical works, with definitions quoted and sources cited. If theories that define the concept are not available, you will need to develop the definition. Conceptual definitions may be available in the literature in the absence of theories that use the concept. For an example of the extraction of conceptual definitions from the literature, see Chapter 6 in Understanding Nursing Research (Burns & Grove, 2007).

One source of conceptual definitions is published concept analyses. Previous studies using the concept may also provide a conceptual definition. Another source of a conceptual definition is literature associated with instrument development related to the concept. Although the instrument itself is an operational definition of the concept, the author will often provide a conceptual definition on which the instrument development was based. The general literature can sometimes provide a conceptual definition. Although it may not have been as carefully thought out as the definitions in a theory or a concept analysis, this conceptual definition may reflect the only definition available in the discipline.

When acceptable conceptual definitions are not available, perform concept synthesis or concept analysis to develop the definition. You must present various definitions of the concept from the literature to validate the conceptual definition you selected for the study.

Kamphuis et al. (2007) provided the conceptual definitions in the following excerpts.

Developing Relational Statements

The next step in framework development is to link all of the concepts through relational statements. Whenever possible, obtain relational statements from theoretical works and the sources cited. If such statements are unavailable, propose the relationships. Provide evidence from the literature for the validity of each relational statement whenever available. This support must include a discussion of previous quantitative or qualitative studies (or both) that have examined the proposed relationship and published observations from the clinical practice perspective.

As you develop the framework, you may have to extract statements that are embedded in the literary text of an existing theory, published research, or clinical literature. When you first begin extracting statements, the task can be overwhelming because every sentence in the text seems to be a relational statement. A little practice makes the task easier. The steps in the process of extracting statements are as follows:

This process is illustrated in greater detail in Chapter 6 of Understanding Nursing Research (Burns & Grove, 2007).

If statements relating the concepts of interest are not available in the literature, statement synthesis is necessary. Develop statements that propose specific relationships among the concepts you are studying. You may gain the knowledge for your statement synthesis through clinical observation and integrative literature review (Walker & Avant, 2004).

In descriptive studies, theoretical statements related to the phenomenon may be sparse. In this case, developing a framework requires more synthesis and has a higher level of uncertainty. You may note in the statement that a relationship between A and B is proposed but the type of relationship is unknown. Follow this statement with a research question based on this relationship rather than a hypothesis. For example, ask, “What is the nature of the relationship between A and B?” An objective might be to examine the nature of the relationship between A and B.

Kamphuis et al. (2007) offered the relational statements shown in the following excerpts, each of which is followed by a diagram of the relationship.

Developing Hierarchical Statement Sets

A hierarchical statement set is composed of a specific proposition and a hypothesis or research question. If a conceptual model is included in the framework, the statement set may also contain a general proposition. The proposition is listed first, with the hypothesis or research question immediately following. In some cases, more than one hypothesis may be related to a particular proposition. However, there must be a proposition for each hypothesis stated. This statement set indicates the link between the framework and the methodology.

Constructing a Conceptual Map

Conceptual maps are initiated early in the development of the framework, but refining the map will probably be one of your last steps. Before you can complete the map, the following information must be available:

Some nursing scholars believe that the map should be limited to those concepts included in the study (Fawcett, 1999). However, Artinian (1982) recommended that the map include all the concepts necessary to explain the phenomenon, plainly delineating that portion of the map to be studied. We agree with Artinian. It is important that the map be a full expression of the phenomenon of concern. This strategy is illustrated by Artinian’s map of the conceptualization of the effects of role supplementation, presented in Figure 7-3. In this map, the scope of the study is enclosed by a yellow box.

Developing your own concept map entails the following steps. First, arrange the concepts on the page in sequence of occurrence (or causal linkage) from left to right, with the concepts reflecting the outcomes located on the far right. Concepts that are elements of a more abstract construct can be placed in a frame or box. Sets of closely interrelated concepts can be linked by enclosing them in a frame or circle. Second, using arrows, link the concepts in a way that is consistent with the statement diagrams you previously developed. For some studies, at some point on the map, the path of relationships may diverge, so that there are then two or more paths of concepts. The paths may converge at a later point. Every concept should be linked to at least one other concept. Third, examine the map for completeness by asking yourself the following questions:

Developing a well-constructed conceptual map requires repeated tries, but persistence pays off. You may need to reexamine the statements identified. Are there some missing links? Are some of the links inaccurately expressed?

As the map takes shape and begins to seem right, show it to trusted colleagues. Can they follow your logic? Do they agree with your links? Can they identify missing elements? Can you explain the map to them? Seek out individuals who have experienced the phenomenon you are mapping. Does the process depicted seem valid to them? Find someone more experienced than you in conceptual mapping to examine your map closely and critically.

Continue to revise your conceptual map until you achieve some degree of consensus with the people you have consulted and you feel a sense of rightness about it. Examine the conceptual map by Kamphuis et al. that is presented in Figure 7-4. Is it consistent with their concepts and statements? Does the process described seem valid to you?

Constructing a Study Framework from Substantive Theory

Developing a framework designed to test statements in a substantive theory requires that all concepts in the framework be obtained from the substantive theory. These concepts must be defined as the theorist defines them. If the theorist has failed to define a concept, develop one that is consistent with the theorist’s perspective. Operational definitions must be consistent with the conceptual definitions and should be accepted methods of measurement used for testing the selected theory. Statements (propositions) from the substantive theory must be identified. In a substantive theory, previous studies will have tested at least some of the relational statements. Findings from these studies must be discussed in the literature review or in the presentation of the framework in terms of evidence validating or refuting the relational statements. Hypotheses for the present study must be designed to test one or more statements from the substantive theory.

Hoffman, Given, von Eye, Gift, and Given (2007) developed a study to test the theory of unpleasant symptoms (Lenz, Pugh, Milligan, Gift, & Suppe, 1997). The framework for the theory of unpleasant symptoms is shown in Figure 7-5. The authors described the theory as follows.

Constructing a Study Framework on the Basis of a Conceptual Model

Although the testing of extant nursing models is a critical need within nursing, few published studies have been designed for this purpose. One reason is the level of complexity required for such testing. Because conceptual models cannot be tested directly, a middle-range theory based on the conceptual model must be available (or must be developed as a tentative theory). The framework must include both the conceptual model and the middle-range theory. Thus, the conceptual map for the study must illustrate relationships among the constructs of the model, the concepts of the middle-range theory, and the link between the concepts and relationships in the model and the concepts and relationships in the middle-range theory. Because of this complexity, in our opinion, master’s-level students should not attempt the process unless they are collaborating with doctorally prepared nurses. However, master’s-level students will be involved in critiquing published studies with such frameworks and applying them in practice situations.

A framework that includes a conceptual model has the following elements:

In some cases, rather than beginning with the choice of a model, the researcher begins developing the framework by identifying concepts relevant to a particular nursing problem. The researcher identifies or develops a theory related to the phenomenon of interest; simultaneously, or perhaps later, the researcher selects all or a portion of a conceptual model compatible with his or her interests. The important issue is not where the development of the framework begins but rather how logically the various elements of the framework are linked and how complete the end product is.

Whittemore and Roy (2002) have developed a middle-range theory of adapting to diabetes mellitus that is derived from the Roy adaptation model, developed through theory and concept synthesis using relevant empirical evidence. The following excerpt contains their description of the process of developing the theoretical model:

The researchers conducted an extensive literature review to identify concepts within the nursing literature that are relevant to chronic illness. They selected Pollock’s middle-range theory of chronic illness (1986, 1993), based on Roy’s adaptation model (Figure 7-6), because it captured key aspects of adapting to DM. The authors analyzed the theory in terms of its origin, meaning, logical adequacy, usefulness, and testability. Several concepts in the DM literature were identified that had the potential to enhance the understanding of the theory—namely, self-management, integration, and health-within-illness. Analyzing the concepts from the Pollock model and from the literature review provided new insights into adapting to DM. A synthesis of Roy’s model, Pollock’s chronic illness theory, and findings from existing diabetes research were used to develop a new middle-range theory—adapting to DM.

Definitions of adaptation and health from Roy’s model and Pollock’s theory were expanded, and assumptions of individual creativity and human potential have been added. These additions are consistent with the relationships and propositions from Roy’s model and Pollock’s middle-range theory.

The goal of nursing in Pollock’s theory and the newly developed theory of adapting to diabetes mellitus, consistent with Roy’s model, is to facilitate this adaptation. The conceptual map of the newly developed theory of adapting to diabetes mellitus is shown in Figure 7-7. Examine the progression of ideas expressed in the maps illustrating Roy’s conceptual map, Pollock’s map, and the map of the new theory.

• Concepts (and constructs if included)

• Conceptual definitions (and construct definitions if used)

• Operational definitions of concepts

• Conceptual sets linking constructs, concepts, and variables

• General propositions linking the constructs

• Specific propositions linking the concepts

• Hypotheses, research questions, or objectives

• Statement sets linking (a) general propositions, (b) specific propositions, and (c) hypotheses, questions, or objectives

• A conceptual map

• Sampling method and size

• Design

• Data analysis performed in relation to each hypothesis, question, or objective

• Findings related to each hypothesis, question, or objective

• Author’s interpretation of findings in relation to the framework

1. Is the framework based on a substantive theory or a tentative theory?

2. Was a conceptual model included in the framework?

3. Are the definitions of constructs consistent with the theorist’s definitions?

4. Do the concepts reflect the constructs identified in the framework?

5. Do the variables reflect the concepts identified in the framework?

6. Are the conceptual definitions validated by references to the literature?

7. Do the operational definitions reflect the conceptual definitions?

8. Are the reliability and validity of the operational definitions adequate?

9. Are the propositions logical and defensible?

10. Is evidence from the literature used to validate the propositions?

11. Are the hypotheses, questions, or objectives logically linked to the propositions?

12. Can diagrams of the propositions be linked to the conceptual map?

13. Does the conceptual map adequately explain the phenomenon of concern?

14. Is the design appropriate to test the propositions?

15. Is the sample size adequate to avoid a type II error? (Type II errors are discussed in Chapter 18.)

16. Are the data analyses appropriate for the hypotheses, questions, or objectives?

17. Are the findings for each hypothesis, question, or objective consistent with that proposed by the framework? If not, was the methodology adequate to test the hypothesis, question, or objective?

18. Did the author interpret the findings in terms of the framework?

19. Do the findings validate the framework?

20. Are the findings consistent with those of other studies using the same framework (or testing the same propositions)?

• A framework is the abstract, logical structure of meaning that guides the development of the study and enables the researcher to link the findings to the body of knowledge used in nursing.

• Every study has a framework.

• The framework should be well integrated with the methodology, carefully structured, and clearly presented, whether the study is physiological or psychosocial.

• If a well-established theory is being tested, the framework is derived deductively from the theory.

• A concept is a term that abstractly describes and names an object or a phenomenon, thus providing it with a separate identity or meaning.

• A relational statement declares that a relationship of some kind exists between two or more concepts.

• Relational statements are the core of the framework; it is these statements that are tested through research.

• Developing a framework for a study is one of the most important steps in the research process.

• The steps of the process are (1) selecting and defining concepts, (2) developing statements relating the concepts, (3) expressing the statements in hierarchical fashion, and (4) developing a conceptual map.

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