Policy With or Without Theory: Questions to be Answered

Chantal Cara, Jacqueline Fawcett,
Deanna Gray-Miceli, M. Lindell Joseph, and
Maya Zumstein-Shaha

We maintain that health policies of interest to nursologists must be based on explicit nursology knowledge, thereby providing the necessary specific perspective that helps distinguish nursology from other scientific disciplines. We know, however, that not all nursologists agree with our position. Therefore, the purpose of this blog is to initiate a discussion about the connection between nursology knowledge and health policy and to ask questions that we invite readers to answer in the comments section of this blog.

Moving forward in our discipline of nursology, all nursologists need to contemplate nursology knowledge, its components and development, as well as its application in research, practice, and health policy development. Doing so will make it possible to determine the distinctive nursology perspective to collectively shape the future of nursology. Therefore, in developing and proposing health policies with a nursology knowledge informed lens, each of us ultimately and collectively contributes to the advancement of the discipline.

Utilization of nursing knowledge, in the form, for example, of conceptual models and theories, as well as theory guided practice approaches for clinical excellence, is central to the advancement of the discipline. Health policies, defined as “The purposeful, general plan of action developed to respond to a concern … or matter in either the public or private sector … that includes authoritative guidelines. This plan directs human behavior toward specific goals” (Sudduth, 1999, pp. 219, 221), undergird development and implementation of evidence-based practice innovations. When development of these health policies is guided by explicit nursology knowledge, the outcomes of the innovations, we contend, will be the highest quality of patient care possible.

We ask that you submit answers to the questions listed here in the comments section of the blog. We look forward to your comments reflecting debate about our position. We will compile the comments and report a summary in a future blog. Thank you for your important contributions.

  • What explicit conceptual model or theory have you used as the basis for health policy development?
  • How is this conceptual model or theory linked to the nursology metaparadigm concepts: human beings, human wholeness, environment, human-environment-health relationships, health/well-being, nursing goals and activities and caring?
  • How does this conceptual model or theory advance nursology discipline-specific knowledge?
  • If you do not use a conceptual model or theory to guide health policy development, what approach do you use?

Please note: If you are trying to locate an appropriate theory and/or model, consider conducting an evidence-based search of the literature or search the Nursing Models and Theories Gallery of Nursology.net.


Kuehnert, P., Fawcett, J., DePriest, K. Chinn, P. Cousin, L., Ervin, N., Flanagan, J., Fry-Bowers, E., Killion, C., Maliski, S. Maughan. E. D., Meade, C., Murray, T., Schenk, B., & Waite, R. (2022). Defining the social determinants of health for nursing action to achieve health equity. A consensus paper from the American Academy of Nursing. Nursing Outlook, 70(1), 10-27. doi: 10.1016/j.outlook.2021.08.003

Sudduth, A. L. (1999). Policy evaluation. In J. A. Milstead (Ed.), Health policy and politics: A nurse’s guide (pp. 219-256). Aspen.

About the contributors

Chantal Cara, RN, BSN, MSN, PhD, FAAN, FCAN

Professor at the Université de Montréal, in Québec, Canada for more than 30 years, Dr. Chantal Cara is a renowned bilingual expert in the field of Caring Sciences. She is a researcher at the Quebec Network on Nursing Intervention Research for humanistic practices. She is also a Visiting Caring Science Scholar/Professor at the University of Colorado and at the Haute École LaSource in Switzerland. Her numerous publications and conferences reflect her commitment to advance humanization in both, nursing education and healthcare. She is an international renowned scholar for creating and implementing the French Humanistic Model of Nursing Care, and the Relational Caring Inquiry research methodology, both being used in several countries. She first authored the book: A Nurse Educator’s Guide to Humanizing Nursing Education: Grounded in Caring Science. She received the following honorific titles: Fellow of the American Academy of Nursing, Charter Fellow of the Canadian Academy of Nursing and Distinguished Caring Science Scholar.

Jacqueline Fawcett, RN: PhD; ScD (hon); FAAN; ANEF
Jacqueline Fawcett

Dr. Fawcett is Professor, Department of Nursing, University of Massachusetts Boston where she has taught undergraduate nursing research courses emphasizing conceptual-theoretical-empirical structures, and currently teaches a PhD program nursing course addressing contemporary disciplinary knowledge. She is a member of the Nursology.net management team, and a member of the planning/management team for the Nursing Theory Conference. Dr. Fawcett provides consultation about the use of nursing conceptual models. She is author, with Susan DeSanto-Madeya, of the 3rd edition of Contemporary Nursing Knowledge and author or co-author of numerous Essays in Nursing Science, published in Nursing Science Quarterly since 2012. She is the author or co author of three nursology conceptual models:

Deanna Gray-Miceli, PhD, GNP-BC, FGSA, FNAP, FAANP, FAAN

A gerontological nurse health care expert who has focused on reducing the incidence of recurrent falls among the older adults with chronic disease, Deanna Gray-Miceli serves as a Professor in the Jefferson College of Nursing. Dr. Gray-Miceli’s research- and practice-based-and educational innovations – developed during more than three decades of work – have helped reduce the number falls among older adults in long-term care, where more than 60 percent of America’s 1.53 million older adult’s reside. She has developed and tested a practice-based process of care measure for use by registered nurses with older patients who fall in long-term care. As part of a 2002-2005 Post Doctoral Fellowship funded by the John A Hartford Foundation, Dr. Gray-Miceli was the Principal Investigator who led development and psychometric testing of her innovative 30-item comprehensive post-fall assessment and clinical decision support tool, called the Post-Fall IndexTM. The PFITM has been shown effective in reducing total and recurrent falls among older adults in long-term care when used by trained nurses. Dr. Gray-Miceli has also led large scale educational interventions in acute-care hospitals within state government to reduce falls by creating novel nurse driven, theory guided educational interdisciplinary falls prevention programs shown to significantly impact fall outcomes. Her interdisciplinary work is stellar and she translates her work to the long-term care staff so they can implement the strategies and improve documented care—with fall prevention being a prime example.

Dr. Gray-Miceli’s research-educational-and practice-based innovations are based on her program of translational research guided by humanistic care and the older adult’s worldview evidenced through interpretive hermeneutic phenomenology. In her pioneering research, Dr. Gray-Miceli explored the lived experience and meaning of “serious falls” to independent older adults residing in long-term care. Findings led to the development of person-derived action steps to reduce recurrent falls; development of an evidenced based practice approach to comprehensive post fall assessment of older adults who fall titled, “Stepwise Approach to Comprehensive Post-Fall Assessment”; creation of the Post-Fall IndexTM innovation; development of a balance app; development of an evidenced based categorization of fall typology used by nurses; a clinical manual to assist nurses titled “ Five Easy Steps to Prevent Falls Among All Ages” (American Nurses Association, 2014); numerous evidence-based fall prevention educational interventions shown to reduce falls in hospital systems; and development of a situation specific theory to guide practice related to caring for older adults who have experienced a serious fall. Dr. Gray-Miceli’s interest in aging began as a teenager when she volunteered at a nursing home. Her first- hand experiences led to her professional practice career as a nationally certified master’s prepared Gerontological Nurse Practitioner. For more than 14 years, she collaborated with an interdisciplinary geriatric team managing the care of older adults and their family caregivers through an ambulatory Dementia Evaluation Program (DEP) and Falls Assessment Program (FAPP), in addition to work within numerous long term care facilities. She has created and taught several innovative undergraduate and graduate courses to teach students best practice care of older adults. Dr. Gray-Miceli is a Fellow of four prestigious associations of health care professionals – the American Academy of Nursing, the American Academy of Nurse Practitioners, the National Academies of Practice, and the Gerontological Society of America. Since 2017, she has been an active member of the American Academy of Nursing’s Expert Panel on Theory Guided Practice.

M. Lindell Joseph, PhD, RN, FAAN, FAONL

Dr. Joseph is a Distinguished Scholar in Nursing, Clinical Professor, and the Director of the Health Systems/Administration and Clinical Nurse Leader Programs at the University of Iowa College of Nursing. She currently serves on the American Organization for Nursing Leadership (AONL) Foundation Board of Directors and on the Advisory Council for the International Society for Professional Identity in Nursing (ISPIN) where she chairs the committee, All Nurses are Leaders. She is a fellow in both the American Academy of Nursing and The American Organization for Nursing Leadership. Dr. Joseph’s areas of expertise are innovativeness, leadership effectiveness, and the General Effectiveness Multilevel Theory for Shared Governance (GEMS), the only theory-based program for shared governance in nursing practice.

Maya Zumstein-Shaha, PhD, MSCN, RN, FAAN

Maya Zumstein-Shaha is the adjunct head of the Master of Science in Nursing program at the Bern University of Applied Sciences, Department of Health, in Switzerland. In this position, she teaches a module on philosophy of science and to accompany the Master thesis elaboration. In addition, she conducts research into new roles such as the Advanced Practice Nurse and the experience of being diagnosed with a life-limiting disease. She has obtained various grants and published widely.

One thought on “Policy With or Without Theory: Questions to be Answered

  1. Thank you for opening the discussion on this important topic! My name is Cameron Albright, I am a registered nurse in Nova Scotia, Canada. I currently work as a clinician at my local hospital and I am in my last year of my MN.

    As part of our policies where I work, all initial nursing assessments and ongoing assessments are informed by Gordon’s Functional Health Patterns. This is reflected in our documentation and how we organize care for the patients on each unit. To my understanding, this is more of a middle-range theory or empirical indicator.

    I’ve worked in other hospitals that don’t use this format and assessments were prioritized in a more bio-medical fashion, in documentation practices anyway. I found this to be quite limiting, in that the outcomes of assessing and caring for someone in the context of Gordon’s Health Patterns was more easily “looked over”.

    I would love to learn more about the conceptual origins to Gordon’s work. I’ve tried to find out more in the past, but was unable to find anything specific that explains where this theory fits in a C-T-E structure. Nevertheless, I appreciate its value that it has for my practice and, ultimately, the outcomes for our patients.

    I think that being able to note clearly identify which conceptual model the Functional Health Patterns are associated with might help advance discipline-specific policy innovations in my workplace given that most nurses are already immersed in this context.

    Cameron Albright BScN, RN, CMSN(C)

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