Borrowed Theory in Nursing Theory Development

Borrowed Theory = Different Worldviews

Borrowed Theory = Different Worldviews
Photo by Casey Horner on Unsplash

Nursing theory is not that old. Other than Florence Nightingale’s Notes on Nursing in 1860, nursing theories only started to be developed in the 1950s. So was nursing atheoretical until then? No. Nurses “borrowed” theories from other disciplines to inform nursing practice. Nurses borrowed theories from psychology, physiology, sociology, medicine, physics, and organizational systems, for example, and then used those concepts and frameworks to develop theories specific to nursing practice. 

In this post, I will discuss the history of borrowed or shared theories in nursing and identify common theories used to inform and guide nursing practice, education, and research. 

Discipline-Specific Theory

One hallmark of a profession is a unique body of knowledge. Nursing theory development is part of that unique body of knowledge. A lot of nursing theories have been developed since 1860, with a proliferation of theories in the 1960s and 1970s; of course, nursing theories continue to be developed today. 

A discipline-specific theory is defined as organized knowledge that is unique to a discipline (Johnson & Webber, 2015). Knowledge considered “owned” by one discipline can have significance to another discipline and is “shared … when answers to questions, solutions to problems, or explanations of phenomena fall into another discipline’s knowledge domain” (p. 20).

According to Johnson and Webber (2015), the point of a discipline-specific theory is to identify the knowledge that is exclusive (to a point) to a particular specialty or branch of learning. Its purpose is also to provide a database that can be used to “answer questions, solve problems, and describe and explain discipline-specific phenomena” (p. 78). In the case of nursing theory, the questions, problems, and discipline-specific phenomena are related to nursing care designed to improve and promote health and well-being of persons under their care. 

Borrowed Theory in Nursing

Borrowed theory is simply theoretical or conceptual models/frameworks from disciplines other than nursing that are used in the nursing domain (Villaruel et al., 2001). Nurses may use borrowed theories in conjunction with nursing theories to inform and guide practice (though theories should be examined for congruence with nursing ideals and situations) (Thompson, 2016). Borrowed theories have formed the basis of much nursing theory development. 

Johnson and Webber (2015) call this supporting theory instead of borrowed theory and explain that nurses don’t “give back” the borrowed concepts, as they are part of a “theoretical DNA” of many nursing theories (p. 79). I like this explanation because it supposes that there are no pure theories, but all have seeds of thoughts that have come before. 

But you have to start somewhere when developing a unique body of knowledge. Nightingale’s Notes is considered a nursing model that, while it speaks about the four nursing metaparadigm concepts, focused on environmental rules for nursing practice. It did not cover all possible phenomena that nurses manage. 

Nurses, therefore, borrowed theories developed by other disciplines to inform and influence nursing practice. The internal framework (e.g., definitions, concepts, propositions) was then used to form the foundation and/or influence the development of nursing-specific theories. 

Even though there are many nursing theories that could be used to guide research studies, many nursing studies use non-nursing theories. A review of nursing dissertations found that over 45% of nursing dissertations used non-nursing theories as the frameworks for their work (Spear, 2007).

However, “knowledge developed within other disciplines could fail to address the problems that nurses confront and that are important to their work” (Rodgers, 2018, p. 28). Nurses need to be encouraged to use nursing theories to frame their research studies if “nurses are to “have an understanding of their discipline” (p. 28). 

Borrowing theory from other disciplines is not unique to the nursing profession (Masters, 2015; Rodgers, 2018; Spear, 2007; Villaruel et al., 2001). General systems theory, social cognitive theory, stress and coping theory, general adaptation theories, and developmental theories are just some of the commonly “borrowed” theories and frameworks that have influenced the development of nursing theory (Masters, 2015). 

How to Decide if a Borrowed Theory “Fits” the Nursing Profession 

Remember that nursing theories describe, explain, or predict nursing phenomena. For a theory to be useful to nursing practice — it has to fit. Nurses shouldn’t assume that theory from non-nursing disciplines, even if related to healthcare, will work in a shared capacity as a theory for nursing care (Villaruel et al., 2001).

For example, in a discussion about the concept of empathy, borrowed from the discipline of psychology, Walker and Alligood (2001) pointed out that fit is often assumed because concepts in healthcare seem to transcend discipline. But if this premise is critically examined, one could find contradictions or challenges to those assumptions. “The direct application of borrowed theories of empathy assumed that context and content applicable to the psychotherapist-patient relationship were directly transferable to the nurse-patient relationship” (p. 141). I think you can see that it makes sense that there might be differences between the psychotherapist-patient relationship and the nurse-patient relationship?

Many papers have been written on how to evaluate borrowed theories for fit in nursing (Villaruel et al., 2001). “The linkage of a nursing conceptual model and a borrowed theory must first take into consideration the logical congruence of worldviews that undergird the conceptual model and the theory” (p. 160). Remember that a worldview is someone’s (the theorist’s) perspective of the world. So though theories from non-nursing disciplines may seem to fit within the overall nursing paradigm, to be valid for nursing practice they really need to be critically examined to see if the worldviews between the selected theories are really congruent. What you really want to look at is if the borrowed theory can be applied to nursing situations (Villaruel et al., 2001).

Villaruel and colleagues argued that borrowed theories “can be placed within a nursing context only if [they are] linked with a nursing frame of reference, that is, a conceptual model of nursing” (p. 160). Failure to link the borrowed theory within a nursing framework “and be considered a theory shared with nursing … is a missed opportunity to advance nursing knowledge” (p. 160), as well as a missed opportunity to link the borrowed theory with nursing interventions — predicted from a nursing theory or model. 

What’s the downside of using another discipline’s theory to guide nursing practice? Well, again, the borrowed theory may not “fit” nursing practice and mislead the nurse to think that theoretical interventions may work, when in reality they may not (Villaruel et al., 2001; Walker & Alligood, 2001). When we borrow theory — that theory was created based on another discipline’s practice. So the borrowed theory has to make sense with nursing’s ideals and science. 

Questions to ask about borrowed theories before using them in nursing practice:

  • Do the concepts of the theory resonate with/make sense to nursing practice/profession?
  • How developed is the concept under review? (Is there a precise definition? Research testing the propositions? methodological rigor of the research studies? measurement tools? etc.)
  • Are the theory’s assumptions, concepts/constructs, propositions congruent with the philosophy of nursing?
Borrowed Theory or Supporting Theoretical Frameworks Used in Nursing
Multiple Borrowed Theories are like Multiple Perspectives of the World

Multiple Borrowed Theories are like Multiple Perspectives of the World
Photo by João Silas on Unsplash

The link between nursing theories and supporting or borrowed theories is sometimes obvious because you can see the shared concepts explicit in both theories (e.g., Selye’s General Adaptation Theory/Stress and Adaptation Theory with Roy’s Adaption Model) and sometimes not as explicit (Kohut’s Model of Self-Psychology with Theory of Chronic Sorrow).

There are many theories from which nursing has borrowed ideas for use in nursing practice. I organized the theories into categories, but realize that multiple categories may apply to each theory.

Commonly borrowed theories include:

General Systems Theory

  • Von Bertalanffy’s General Systems Theory/Open Systems Theory (systems theories are “helpful in understanding organic systems, or systems involving living beings” (Cordon, 2013, p. 21).
  • Senge’s The Learning Organization (leadership, systems thinking)
  • Family Systems Theory

Stress, Adaptation, and Coping Theories

  • Lazarus and Folkman’s Stress and Coping Model 
  • Selye’s General Adaptation Theory

Developmental Theories

  • Erik Erikson’s Psychosocial Development Theory
  • Piaget’s Theory of Cognitive Development
  • Freud’s Psychosexual Development Theory
  • Freud’s Theory of Personality
  • Bowlby’s Attachment Theory
  • Kohlberg’s Moral Development
  • Kohut’s Model of Self-Psychology

Motivation Theories

  • Maslow’s Theory of Human Motivation and Hierarchy of Basic Human Needs
  • Hertzberg’s Two-Factor Theory of Motivation
  • Expectancy Theory

Physiologic Frameworks

  • Germ theory
  • Infectious disease transmission
  • Immunity theories
  • Homoeostasis
  • Gate control theory (pain transmission and management)
  • Genetic principles and theories
  • Chaos and Complexity theories

Educational and Learning Theories are the basis for many theories and frameworks about learning theory in education. It can be applied to students and to patients (i.e., health teaching and behavior change).

  • Bandura’s Social Learning Theory AKA Social Cognitive Theory
  • Behaviorist Learning Theory (Classical and Operant Conditioning)
  • Social Constructivism (e.g., Ausubel’s Meaningful Learning Model)
  • Cognitive Development Theory (e.g., Piaget’s Theory of Cognitive Development)
  • Human Capital Theory 

Health Promotion and Disease Prevention Theories useful for describing, explaining, or predicting behaviors would be useful for teaching about health promotion and disease prevention and encouraging behavior change. Nurse practitioners and health educators could use these theories to encourage and measure behavior change. 

  • Rosenstock’s Health Belief Model 
  • Azjen & Fishbein’s Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB)
  • Ecological Systems Theory
  • Self-Determination Theory
  • Prochaska & DiClemente’s Transtheoretical Model or Stages of Change Model 
  • Expanded Chronic Care Model
  • Rosenbaum’s Learned Resourcefulness Theory

Planning and Evaluation Models (Logic Models)

  • The PRECEDE-PROCEED MODEL
  • The RE-AIM Framework
  • Practical Robust Implementation and Sustainability Model
  • Practice Change Model

Organizational Change/Culture

  • Kanter’s Structural Theory of Organizational Behavior
  • Prochaska & DiClemente’s Transtheoretical Model or Stages of Change Model 
  • Rogers’ Diffusion of Innovations Theory
  • Lewin’s Change Theory
  • Deming’s Healthcare Process Improvement Model
  • Kotter & Cohen’s Change Theory
  • Practice Change Model

Leadership

  • Transformational Leadership
  • Hersey-Blanchard Situational Leadership Theory

How to Cite this Blogpost in APA*: 

Thompson, C. J. (2017, October 17). Borrowed theory in nursing theory development. [Blogpost]. Retrieved from https://nursingeducationexpert.com/borrowed-theory/

 

*Citation should have hanging indent

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