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:

1. 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?
2. What is the relationship between use of nursing theory in doctoral research and time periods between the 1970s and 2020s?
3. What is the relationship between type of degree and use of nursing theory?
4. What is the relationship between research methodology and use of nursing theory?
5. 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!

Sources

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.