Chapter 5Components and

Levels of Abstraction in Nursing Knowledge

Introduction

• Graduate students and advanced practice nurses must be familiar with the components and levels of abstraction in nursing knowledge.

• One way to conceptualize this information is by using the structural holarchy developed by Jacqueline Fawcett.

Components of Nursing Knowledge

• Nursing knowledge is the cumulative, ever-evolving result of prior learning, experience, theory, and research.

• Fawcett (2005) places nursing knowledge into a structural holarchy with five components: – Metaparadigm– Philosophy– Conceptual model

– Theory– Empirical indicator

Knowledge Holarchies• A holarchy is a hierarchy in which each level is a

whole but is also part of a larger whole.• Each holon or node functions independently but

also interacts with other holons or nodes.• Within a holarchy, holons coordinate and include

holons on subordinate levels.• Some holons also interact with other holons of the

same level.• Can be viewed through either testing theory or

generating theory.

Metaparadigms• A metaparadigm is the most abstract view of a

discipline, and it consists of the concepts that define that discipline.

• In nursing, the most common metaparadigm concepts are human beings, environment, health, and nursing.

• Because it has a metaparadigm, nursing is accurately classified as a discipline, or “a distinct way of viewing all phenomena.”

Philosophies (1 of 3)

• Broadly speaking, a philosophy is the search for and communication of a viewpoint.

• According to Fawcett (2005), the function of a philosophy is “to communicate what the members of a discipline believe to be true in relation to the phenomena of interest to that discipline.”

Philosophies (2 of 3)

• There are four areas of philosophical inquiry:– Ontological area: Involves the study of reality and what

the members of a discipline believe to exist.– Epistemology area: Involves the study of knowledge,

including how it can be created, disseminated, and categorized.

– Ethics area: Involves inquiry about what is valued by a discipline in terms of actions and practices.

– Logic area: Is a method of inquiry through which arguments are presented and evaluated.

Philosophies (3 of 3)

• Nursing scholars use three main philosophies:– Reaction world view: States that humans react to stimuli in a

linear, causal manner and change only when necessary for survival.

– Reciprocal interaction world view: States that humans are active, have reciprocal reactions with the environment, and may or may not change under certain circumstances.

– Simultaneous action world view: States that humans change continuously and are in mutual rhythmical interchange with the environment.

Conceptual Models (1 of 3)

• Also called conceptual framework, conceptual system, paradigm, and disciplinary matrix.

• Fawcett (2005) defines a conceptual model as a “set of relatively abstract and general concepts that address the phenomena of central interest to a discipline, the propositions that broadly describe those concepts, and the propositions that state relatively abstract and general relations between two or more of the concepts.”

Conceptual Models (2 of 3)

• Conceptual models characterize relationships among phenomena to shape a distinctive frame of reference.

• Individuals can interpret and characterize the same reality in different ways using different conceptual models.

• These models have practical value because they guide research and practice.

Conceptual Models (3 of 3)

• Fawcett recognizes seven conceptual models of nursing.

• According to Fawcett, these models are the foundation of nursing as a discipline.

• Conceptual models are more abstract than theories, and they can be distinguished from theories using a series of if-then determinations.

Theories (1 of 2)

• According to Fawcett (2005), a theory is “one or more relatively concrete and specific concepts that are derived from a conceptual model, the propositions that narrowly describe those concepts, and the propositions that state relatively concrete and specific relations between two or more concepts.”

Theories (2 of 2)

• Theories can be defined in different ways:– Based on structure– Based on practice goals– Based on tentativeness– Based on research– Based on creativity in developing and connecting

concepts– Based on progression from conceptual models to

theory

Functions of Theory: Theory to Practice

• The usefulness of a theory is closely connected to “how good” the theory is.

• Theory development serves two functions:– Testing and generating theories drives research– Finding research-based evidence for theories drives

changes in practice

• The relationship of theory development to practice is called the conceptual-theoretical-empirical (C-T-E) formalization.

Theory by Levels of Abstractions (1 of 2)

• Theories can be categorized as follows based on their levels of abstraction and scope:– Metatheory: A philosophical stance about theory

and its methods for generating knowledge– Grand theory: A set of concepts that is less broad

than a conceptual model but too abstract to state relationships or hypotheses in empirical terms

Theory by Levels of Abstractions (2 of 2)

– Middle-range theory: A set of concepts that is not as broad as a grand theory and is strongly supported by empirical data.

– Practice theory: A narrow theory that results from empirical testing; sometimes called situation-specific theory or micro theory.

Middle-Range Theory and Nursing

• Middle-range theories are important because they have specificity for nursing practice.

• A middle-range theory may be categorized as:– Descriptive: “Information presenting”– Explanatory: “Knowledge building”– Predictive: “Knowledge confirming”– Prescriptive: “Knowledge utilizing”

• Good middle-range theories are closely linked to specific conceptual models.

Empirical Indicators

• Defined by Fawcett (2005) as “an actual instrument, experimental condition, or procedure that is used to observe or measure a middle-range theory concept.”

• Information derived from these indicators is commonly known as data.

• Empirical indicators provide a way to test or generate middle-range theories.

Using the Components in Practice (1 of 2)

• As mentioned, the C-T-E system can be used to connect theory and practice.

• When applying the system, three elements must be considered:– Translation of the metaparadigm of nursing into practice

(e.g., via hospital mission statements)– Translation of philosophies into practice (e.g., via codes

of ethics , patient bills of rights, and statements of nursing philosophy)

Using the Components in Practice (2 of 2)

– Translation of conceptual models, theories, and empirical indictors into a “formal nursing knowledge system” (e.g., via practice standards, assessment designs, intervention protocols, and evaluation programs).

Summary• Fawcett’s holography connects five main

components of nursing knowledge: metaparadigm, philosophy, conceptual model, theory, and empirical indicator.

• Middle-range theories must be closely linked to conceptual models if nursing is to retain its status as a discipline.

• The C-T-E system is necessary for translating nursing models and theories into practice.