What is a Theoretical Framework or Conceptual Model?

hands painted with map of the worldI’ve gotten several requests to explain what a theoretical framework really is and how it’s different than a conceptual model. This post will cover why theoretical frameworks and conceptual models are important in nursing, explain the difference between the two, and provide a simple example of how research is used to test theoretical propositions.

Before we get started, I want to remind you of a free resource I have waiting for you. The Nursing Theory and Philosophy: Terms & Concepts Guide will assist you to understand the many concepts and language specific to the study of theory and philosophy. Click Here for Your Free Nursing Theory and Philosophy: Terms & Concepts Guide!

Theory in Nursing Programs

Every nursing student in a baccalaureate degree program gets introduced to nursing theory. Usually, the undergraduate class teaches you the basic concepts of theory, differentiates between theories and models, introduces the steps to critique a theory, and presents an overview of selected nursing theories – usually from the first grand theories to practical middle-range theories to conceptual models. Non-nursing or borrowed theories may be discussed — these are theories that are supportive to nursing practice but are not theories describing nursing as a phenomenon specifically. (An overview of basic concepts of nursing theory is found in a previous blog post. The podcast that accompanies this post elaborates on the notes provided, so be sure to scroll down to the podcast player!)

Graduate theory courses should build on the theory foundation laid in the undergraduate course. A graduate theory course should assume the student knows the basics (even if they don’t remember it all) and usually delves deeper into theoretical frameworks and nursing philosophies.  Students may learn to do a concept analysis to analyze and synthesize the meanings and nuances of a selected concept so that the concept may be tested through research and used in practice. The grad school course should promote a deeper level of thinking about theory and practice-based phenomena and set the stage for the student’s research or capstone project. 

Why is Nursing Theory Important?

Nursing theory describes what nurses do and what outcomes can be expected as a result. They explain what the phenomenon of nursing is all about. Nursing theory provides a way to “organize the nurse’s thinking by providing decision-making structures to guide the reasoning required for quality professional nursing practice” (Alligood, 2010, p. 47, emphasis added).

The benefits of nursing theory include improved patient care based on deliberate theory-guided interventions; a theoretical basis for practice decisions; professional status and nursing power; a recognition of nursing’s values and unique contribution to health care; enhanced communication between nurses; and a roadmap for research and education (Alligood, 2010; Colley, 2003;  Masters, 2015). 

Having taught nursing theory at the graduate level, my purpose was to get nursing students to value nursing theory as a unique, essential, part of our professional nursing practice.  To appreciate how nurses describe, explain, predict, and understand phenomena that are important to the practice of nursing is a building block of expert nursing knowledge. 

The title of an article by Gonzalez (2008) conveys the gestalt of theory-driven practice: Practice with Meaning. When nurses consciously or deliberately use nursing theory to guide nursing practice, nurses have a means to improve practice and build the science of nursing. Theory-guided practice provides a systematic way of practicing that helps us predict patient outcomes. There’s a clear relationship between what theory-guided nurses do and the outcomes they attain. Deliberate action and professional autonomy go hand-in-hand. 

In addition to using theory to guide practice, to build the science of nursing, nursing research should be guided by theory, as well as teaching practice

I’m going to quote from one of my previous posts about nursing theory for you to think about: 

The major reason for learning philosophy and nursing theory is for you to USE the content in your basic and advanced practice to become a better nurse, promote positive outcomes for your patients,  and ultimately move the profession of nursing forward.”  

 
What is the Difference between a Conceptual Model and a Theory?
graphic of continuum from abstract to concrete

The Nursing Knowledge Continuum from most abstract to most concrete

One of the characteristics of a profession is to have a unique, specialized body of knowledge. Nursing knowledge can be viewed as a continuum that moves from a high level of abstraction to a practical and concrete level of abstraction (Alligood, 2010; Fawcett, 2013; Masters, 2015). The nursing metaparadigm (consisting of the four central concepts: person, health, environment, nursing) is the most abstract, followed by philosophies, conceptual models, grand theory, middle-range theory, and situation-specific theory.

A conceptual model is a starting point for many theories – though not all theories started out as conceptual models nor do all conceptual models become theories. A conceptual model also can be derived from a theory.

A conceptual model or a conceptual framework represents abstract and general work that can guide research and practice. A conceptual model may be thought of as an early-stage of theory development. 

Conceptual models are frequently presented as a picture or diagram to show the components of the model and to link the concepts through symbols. The visual representation of the model is helpful to see how the components are related and fit the phenomenon of interest. 

A theory, in general, is used to describe, explain, predict, and understand a specific phenomenon. Nursing theories define phenomena of interest to the nursing profession. Because a theory has a structure in terms of assumptions, concepts, and propositions, it can also be called a theoretical framework

Theories range from “very abstract and general conceptual models to less abstract and general grand theories, to relatively concrete and specific middle-range theories, to very concrete and specific narrow-range, situation-specific theories” (Fawcett, 2013, p. 593).

The major difference between a conceptual model/framework and a theory is the level of specificity and practical use (Alligood, 2010; Fawcett, 2013; Masters, 2015).

Testing a Theory Proposition: A Simple Example

Theories (and conceptual models) are used to guide the design of research studies, clinical practice, and education practices because they provide the rationale for the relationships between the variables of interest. 

Imogene King (1981) developed a conceptual framework she called the Dynamic Interacting Systems Framework (personal, interpersonal, social). She also described multiple models, including a Transaction Model – a series of interactions between the nurse and patient to attain goals.  These frameworks are integral parts of her Theory of Goal Attainment (TGA). The theory guides the nurse to positive outcomes for patients/clients by describing how the nurse interacts and communicates with the patient for the purpose of setting goals that lead to the transaction of the goal outcome. We can test this theory by validating the propositions in a research study.

For example, one of the propositions of King’s theory is that when nurses and clients interact to mutually set goals, positive outcomes will occur. A research study can be designed based on this TGA proposition.

Basically, we could take two similar med-surg units  – in one, the TGA would be taught to the nurses and they would practice according to this theory and mutually set goals with their patients. In the control unit, practice would not change – it would be “business as usual.” At the end of the study, the researcher would measure the attainment of the goals in both units.  If the TGA unit (the experimental unit) had more positive outcomes than the control unit, it could be said that King’s proposition for this theory was true – it worked. The more research that is conducted on a theory’s propositions, the better.  As we are able to build evidence for the validity of the theory propositions, we can have confidence in the use of theory in practice.   

Remember: Theories are NEVER proved, only tested: Research only strengthens, refutes, or refines the theory tested.

What questions do you have about theories or conceptual models? Let me know in the comments!

References

Alligood, M. R. (2010). Nursing theory: Utilization and application (4th ed.). Maryland Heights, MO: Mosby Elsevier. 

Colley, S. (2003) Nursing theory: Its importance to practice. Nursing Standard,17(46), 33-37.

Fawcett, J. (2015). Theory testing and theory evaluation. In J. B. Butts and K. L. Rich (Eds.), Philosophies and theories for advanced nursing practice (2nd ed., pp. 593-611).   Burlington, MA: Jones & Bartlett Learning.

Gonzalez, R. (2008). Practice with meaning. Advance for Nurses, 10(16), 20. Retrieved from http://nursing.advanceweb.com/Article/Practice-With-Meaning-5.aspx

Johnson, B. M., & Webber, P. B. (2001). An introduction to theory and reasoning in nursing. Philadelphia: PA: Lippincott.  (I have an old edition – the 4th edition has a publication date of 2013, FYI)

King, I. M. (1981). A theory for nursing: Systems, concepts, process. New York, NY: John Wiley & Sons.

Masters, K. (2015). Nursing theories: A framework for professional practice (2nd ed.). Burlington, MA: Jones & Bartlett Learning. 

NOTE: There is a lot of information on the Internet regarding nursing theories.  Let me caution you to always check the About page of any online website you visit and find out who is posting the information you are interested in! Use these sites for information only – don’t cut-and-paste (you don’t know if the author copied info from a text or article or another website). Also make sure to cite the websites correctly in your class papers according to the style manual you are required to use in your nursing program (e.g., APA, AMA).