Theoretical Framework
In nursing research, a conceptual or theoretical model serves as a framework for guiding nurses to identify evidence-based or best practices by building upon the previous theories corresponding with the research (McEwen & Wills, 2014). The paper discusses the various ways in which the is used in research and evaluates how the theory was used as a conceptual framework in the nursing study discussed in the article “The Influence of Work-Related Fatigue, Work Conditions, and Personal Characteristics on Intent to Leave among New Nurses” by Yi Liu, Li-Min Wu, Pi-Ling Chou, Mei-Hsin Chen, Li-Chien Yang and Hsin-Tien Hsu.
Theory Use in Research
Theories are used in research in three significant ways, namely: research-testing theory, research-generating theory, and theory as the context of a study or conceptual framework. Theory-generating research is commonly referred to as descriptive research, and according to McEwen & Willis (2014), researchers use it to “describe relationships between and among phenomena without imposing preconceived notations of what these phenomena mean” (p. 437). The model enables researchers to convert abstract ideas into concepts and categories that build established relationships from observations. There is a conventional five-step process that the theory-generating research follows: (1) recognition of commonly occurring themes; (2) conceptualization of observed elements into abstract concepts; (3) identification of patterns that build on relationship patterns; (4) using the abstract concepts to formulate propositional statements; and (5) combining the propositional statements and concepts into a model or theory (McEwen & Wills, 2014).
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According to McEwen and Willis (2014), this type of research is not common, but it involves the formulation of a hypothesis from a section of theory. Taking a part of a theory helps to determine whether the model could be used in explaining a particular phenomenon of the subject under discussion, in this case, nursing practice. They are used by researchers trying to determine the usability or applicability of a theory in a specific situation to make logical conclusions. McEwen & Willis (2014) came up with four steps in using the theory-testing research approach as follows: (1) identification of propositional statements from the theory of interest; (2) coming up with hypotheses from the abstract statement that have measurable variables; (3) carrying out the study using the identified variables; and (4) making conclusions on the present guidelines and future recommendations.
The third way that theory is used in research is as a conceptual framework. McEwen & Willis (2014) recognize that this approach is the most commonly used whereby the researcher(s) conduct a literature-based analysis of the available models or frameworks to determine the most applicable conceptual framework. The identified model(s) create a platform for assessing the observable items or experimental findings (Yamauchi et al., 2017). The steps followed when using theory as a conceptual framework include: (1) identification of a model applicable as a variable to the study; (2) understanding the conceptual definitions of the model; (3) linking the data of the study to the theory for congruency; (4) linking study findings to the framework; (5) identification of whether the findings challenge or support the model; and (6) formulation of recommendations for current and future practice (McEwen & Wills, 2014).
Theory as a Conceptual Framework
Liu et al. (2016) utilized a conceptual framework in their study to describe the influence of work conditions, work-related fatigue, and personal characteristics on the intent among new nurses to quit work in Taiwan. McEwen & Willis (2014) describe seven criteria that would be used in this section to explain how Liu et al. (2016) incorporated theory as a conceptual framework at various levels of their research study.
Study Variables
The model of study adopted by Liu et al. (2016) had four identified variables. Out of the four, one was a measurable variable: the intent of Taiwan nurses to leave and three were latent variables: work-related fatigue, work conditions, personal characteristics.
Conceptual Definitions
The defined concepts in Liu et al. (2016) study are work-related fatigue, work conditions, personal characteristics, and the intent to leave scale.
Work-Related Fatigue
Using the occupational fatigue exhaustion recovery scale, Liu et al. (2016) divided fatigue into three subscales: chronic fatigue, acute fatigue, and inter-shift recovery. The study rated each subscale having five items on a 7-point Likert scale.
Work Conditions
Work conditions involved workload measured on a scale of 1 to 10 and self-reported working hours per day in the previous week before the study (Liu et al., 2016).
Personal Characteristics
Personal characteristics included educational level, age, work experience, and overall health status rated on a scale of 1 to 5 (Liu et al., 2016).
Intent to Leave Scale
Liu et al. (2016) measured intent to leave using three items: how likely the participants want to continue working as a nurse, leave nursing, and leave the hospital on a scale of 1 to 7.
Instruments
Liu et al. (2016) used questionnaire as the data collection instrument and they had to obtain the consent of the participants, handed them the questionnaire, and picked up upon completion.
Findings
In the study, Liu et al. (2016) found out that there were direct relationships among work conditions, work-related fatigue and overall health status of the participants. Education level, work experience, and the age of the new nurses did not have a direct relationship to their intent to leave (Liu et al., 2016).
Relationship of Findings to Framework
According to the initial conceptual framework, Liu et al. (2016) hypothesized personal characteristics such as education, age, overall health status, and work experience to affect new nurses’ intent to leave. However, their findings showed that there was no direct relationship between the personal characteristics and intent to leave apart from self-reported health status. Therefore, Liu et al. (2016) modified the original conceptual model to reflect the study findings.
Implications for Nursing Practice
Using the findings by Liu et al. (2016), the study makes significant contributions to the current knowledge of factors that drive nurses into leaving their work station. The findings show that personal characteristics do not have a direct relationship with the intent to leave among new nurses. However, work-related fatigue and work conditions influenced the nurses’ intent to leave. On further analysis, work conditions only contributed to the intent to leave through work-related fatigue. From the findings, Liu et al. (2016) recommend that nurse leaders should pay attention to the working hours of nurses, especially those working overtime to improve on job satisfaction and reduce employee turnover rate. With the new findings, Liu et al. (2016) recommend the following strategies for enhancing the intent to stay for new nurses: monthly evaluation of the level of work-related fatigue and workload, especially for those nurses that have a day shift of more than ten hours in a day.
Recommendations for Further Research
In the study, Liu et al. (2016) recommend future studies to focus on change in the pattern of work-related fatigue overtime to come up with an observable trend and mitigation strategies to improve the work environment, mediate fatigue, and promote the nurses’ intention to remain at the current work.
Nursing versus Non-Nursing: Should Nursing Research Utilize Nursing Theories, Non-Nursing Theories, or a Combination of the Two?
McEwen & Willis (2014) state that there is ongoing research and debate on whether nursing research should utilize nursing, non-nursing, or both theories. In the book, proponents of the utilization of nursing theories argue that they are relevant to the discipline hence provide a better-focused scope in the provision of nursing interventions. However, those opposed to nursing theories, bring forth a counterargument that non-nursing models that are more detailed and extensive are more useful if their scope addresses issues relevant to nursing research. McEwen & Willis (2014) propose a combination of the two models to arrive at more informed and comprehensive findings.
Several theories came about as a result of research using nursing, non-nursing, and combination of both approaches. For example, Pamela Reed derived her theory of Self-Transcendence from Martha Rogers’s nursing model of the urinary system. Imogene King derived her theory of goal attainment and transactional process from von Bertalanffy’s non-nursing model, general systems. Lastly, Madeleine Leininger derived her theory of culture care diversity and universality from a combination of two disciplines: nursing and non-nursing. The ultimate goal of the research is an expansion of the existing knowledge. I believe that non-nursing theories relevant to a particular sector of the nursing research field are equally important. Arguably, nursing is a discipline that significantly depends on others such as philosophy, social sciences, and anthropology, among others. Therefore, the best approach is combining both nursing and non-nursing theories with the primary objective of expanding nursing knowledge.
References
Liu, Y., Wu, L., Chou, P., Chen, M., Yang, L., & Hsu, H. (2016). The influence of work-related fatigue, work conditions, and personal characteristics on intent to leave among new nurses. Journal of Nursing Scholarship , 48 (1), 66-73. https://pubmed.ncbi.nlm.nih.gov/26641770/
McEwen, M., & Wills, E. M. (2014). The theoretical basis of nursing (5 th ed.). Philadelphia, PA: Wolters Kluwer Health.
Yamauchi, L. A., Ponte, E., Ratliffe, K. T., & Traynor, K. (2017). Theoretical and Conceptual Frameworks Used in Research on Family-School Partnerships. School Community Journal , 27 (2), 9-34. http://www.schoolcommunitynetwork.org/SCJ.aspx
