In March of 2022, at the Nursology Theory Conference, our research team presented a study that explored the use of theory, and specifically nursing theory, to guide nursing doctoral research. There was very little published research on this topic; therefore, a group of us decided to look into it.
The topic of theory-guided research comes up frequently in the Nursing Knowledge course in the doctoral program in Nursing Education at Teachers College Columbia University. At a school that is centered on education in general, nursing theories often take a back seat. More commonly, education theories are often used to guide doctoral research.
In our presentation, we talked about the importance of using nursing theory to guide nursing (education) research. Dr. Jacqueline Fawcett made an important point in the Q and A after our presentation last March: “if nursing theory is not used to guide the research, is it nursing research?” This is something we brought back to the classroom discussion and subsequently led to even further discussion and head scratching!
Drawing from four related studies, we found that 28% of citations in a sample of nursing publications were from the nursing discipline (Chinn, et al. 2019); 24% of PhD nursing theses referred to nursing theory (Jensen, 2019); 38% of nursing research articles identified theory, of which 21% were nursing theories (Bond et al., 2011); and 27% of nursing doctoral dissertation abstracts identified a nursing theory (Spear, 2007).
We set out to answer the following research questions:
- How often do nursing doctoral students use any theory, nursing-specific theory, or a combination of nursing and non-nursing theory to guide their doctoral research?
- What is the relationship between use of nursing theory in doctoral research and time periods between the 1970s and 2020s?
- What is the relationship between type of degree and use of nursing theory?
- What is the relationship between research methodology and use of nursing theory?
- What nursing theories are most frequently used to guide nursing doctoral research and where in the doctoral paper is the theory identified?
We used the Sigma Repository to access 747 doctoral papers. We included dissertations, theses, and capstone projects from authors identified as PhD, DNP, EdD and “doctoral – other” students. We did not include systematic reviews, meta analyses, master’s-level submissions, or papers submitted to the Repository after September 1, 2020.
We considered “theory” to include formal theories, conceptual or theoretical frameworks, and conceptual models. We used “non-nursing theory” to mean a theory from outside the nursing discipline and “nursing theory” to mean any formal theories, frameworks, or conceptual models developed by nurses and/or published in nursing journals.
Our sample comprised PhD papers, DNP papers, EdD papers, and “doctoral-other” papers. Methods used in the doctoral studies included quantitative, qualitative, and mixed/multi methods. We found that about 87% of doctoral papers included a theory of any kind, while only 22% used a nursing theory and 5% identified a combination of nursing and non-nursing theories being used to guide their study.
When looking at the use of nursing theory over the decades, we found no significant differences among the 1990s, 2000s, and 2010s; however, there was a significant difference between the 1980s and 1990s. We also found that doctoral students using quantitative research approaches were significantly more likely to use a nursing theory than those using qualitative approaches. The most frequently identified nursing theories were Roy, Watson, King, and Pender.
This exploration, based on classroom curiosity, showed that most doctoral nursing students are using theory to guide their research; however, most of those did not choose a nursing theory. We were left wondering how nursing theory is being taught and/or emphasized in doctoral nursing programs. It is possible that students are likely to use the theories they are most familiar with, and if nursing theory is not being taught in a timely and effective manner, this could create the type of gap we saw in our study.
While it may be unavoidable for theories from other disciplines to inform nursing science, these non-nursing theories should not be used at the expense of nursing theories to guide doctoral research and the development and further use of nursing knowledge.
Next week there will be a follow-up article by my two co-investigators, who will discuss ideas for future research, education, and what we learned from the study. Stay tuned!
Bond, E.A., Eshah, N.F., Bani-Khaled, M., Hamad, A.O., Habashneh, S., Kataua, H., Al-Jarrah, I., Kamal, A.A., Hamdan, F.R., & Maabreh, R. (2011). Who uses nursing theory? A univariate descriptive analysis of five years’ research articles. Scandinavian Journal of Caring Science, 25(2), 404-409.
Chinn, P.L., Nicoll, L.H., Carter-Templeton, H.D., & Oermann, M.H. (2019). An analysis of nursing citations and disciplinary characteristics in 79 articles that represent excellence in nursing publication. Nursing Inquiry, 26(3), e12996.
Dickinson, J.K., Quay, C., & Dolen, E. (accepted for publication). Use of nursing theory to guide doctoral research: An exploratory study. Nursing Science Quarterly.
Jensen, K.T. (2019). Nursing research: A marriage of theoretical influence. Nursing Open, 6(3), 1205-1217.
Spear, H. (2007). Nursing theory and knowledge development: A descriptive review of doctoral dissertations, 2000-2004. In: Scholars Crossing.
10 thoughts on “Is Nursing Theory Guiding Nursing Doctoral Research?”
Thank you for this post! 🙂
I will be waiting for the next week to see your article!
Thank you, Sara from Lisbon! I will be in Sevilla in a few weeks 🙂
Thanks for doing this important research. I look fed to your next blog!
I totally agree that „….…non-nursing theories should not be used at the expense of nursing theories to guide doctoral research and the development and further use of nursing knowledge.“
Indeed, we see a backlash in the last 20 years and it seems teachers and scholars believe more into other disciplines than nursing, which is a pity that brought research back into the medical model.
A drum I’ve been beating since 1993:
Schoenhofer, S. (l993). Research Issues Column: What constitutes nursing research? Nursing Science Quarterly, 6, 2.
Nursing faculty aren’t being (and haven’t been) educated with the perspective that Nursing as a discipline – thus nursing theory is little known and its purpose is not understood by many (most?) nursing faculty – so unless doctoral students of Nursing stumble onto the idea, or figure it out for themselves, there is no reasonable expectation that what is intended to be nursing science most often is not.
Thank you for having the insight and courage to pursue this work!
Thank you! In fact, a colleague is (as I write this) working on a grant proposal for a study she designed. She “was told that I need to include a nursing theory” and she has been trying to find that theory for over a month now. To me, this is a clear example of ‘not having been educated with the perspective of Nursing as a discipline’ and now having to force theory into her study after the fact (but before the study 🙂 ). This colleague has been out of school for several years and teaches nursing students herself. The silver lining is that she is now learning a lot about nursing theory and will hopefully pass it on to her students.
PS Based on what I learn from doctoral nursing students, nursing theory is at least sometimes, if not often, taught; however, the approaches to teaching nursing theory are not always effective so it “doesn’t stick.”
The inclusion of a theory of nursing more often within quantitative studies is interesting, but not surprising as the goal of such studies may be to test the theory or aspects of it; to better understand its utility for describing, explaining, or predicting some phenomenon. Theories of nursing (or borrowed theories) may not be explicit in qualitative research but are likely woven throughout these studies. I am reminded of a terrific paper by Dr. M. Sandelowski (reference below), in which the ways theories are used and appear in qualitative research are discussed. In addition, some qualitative researchers endorse not using a theory at the outset of a study, and only look to the existing literature after data collection and analysis are complete. I do think that faculty have varying degrees of knowledge about (including how to use) theories of nursing and this influences decisions about using theories among doctoral students. That is why this blog is so important; it is a forum for discussing these issues. Thank You!
Sandelowski M. Theory unmasked: the uses and guises of theory in qualitative research. Res Nurs Health. 1993 Jun;16(3):213-8. doi: 10.1002/nur.4770160308. PMID: 8497673.
Thank you for adding this important perspective! My dissertation research was a qualitative (phenomenology) study and the “theory” was actually the methodology (Van Manen). We often found that to be the case in this study.
Thank you, Jane, for your blog. I continue to be astounded that nursologists who are enrolled in so-called nursing PhD programs are allowed to graduate without conducting research guided by nursology knowledge. I cannot imagine a similar situation in another discipline. For example, would a person enrolled in a PhD program in sociology be allowed to graduate if the research was guided by a nursology conceptual model or theory?
We who teach in PhD Nursing programs and guide supposedly nursology dissertations must stand firm in requiring that nursology knowledge be used to guide dissertation research–I have always done that and strongly encourage everyone else to do the same.
Thank you for your comment and for encouraging doctoral nursing students to use our discipline’s knowledge to guide their work!!