This issue of Nursing Research is focused on theory in nursing, including how theories historically developed in nursing and how they have evolved over time. Also included in this issue are new thoughts on theory development as well as emergent theoretical ideas. But to what end is theory in the rapidly changing scientific world? Do theories and, particularly, “grand” theories of the sort that many of us of a “certain age” were required to “use” in our own first efforts at research lead to scientific advancement? Is theory useful in today’s seemingly atheoretical age where new scientific “discoveries” are announced daily on social media? Do we need theory to advance science?
Like most scientists, I was taught very early in my training that a theory is a set of interrelated concepts and propositions that explains or predicts events or situations. But I also learned that what “counts” as theory could be many different things depending on who you ask. A theory could be “grand” or macro level, setting forth the phenomena of interest to the discipline using rather abstract concepts. A theory could be “grounded,” addressing contextual explanations of very specific phenomena experienced by select people. Or a theory could be “middle range” or meso level, aimed at integrating empirical research and focused on linking macro and micro level concepts and theories. Clear in all of this was the idea that theories are abstract, varying in the extent to which they are conceptually developed and empirically tested. However, in the end, theory development and testing were deemed to be critically important to advancing science.
Scientific advancement is of course critical to any discipline, and nursing is no different; science is generally thought to advance when theories exist that explain and predict phenomena. A full discussion of how science advances is beyond the scope of this editorial. However, whether you think science advances only when current theories fail to explain the phenomena of interest—resulting in a paradigm shift—or at the other extreme that science advances by a steady accumulation of knowledge that occurs with rigorous and repeated theory testing, theory and scientific advancement would appear to interact. But is theory necessary to science? More importantly, should all science or research within a scientific field be focused on theoretical development and testing. I certainly consider myself a scientist. Am I also a theorist?
The answers to these questions, I believe is, “perhaps.” Indeed, perhaps theory is necessary for scientific advancement. This would particularly be the case if theories for nursing science were focused on understanding, explaining, and predicting those phenomena that are of interest to our discipline and, by extension, to our practice. Our conundrum here is that the phenomena of interest in nursing science and practice are highly varied and—importantly—not agreed upon by the discipline. Many years ago, the historically important grand theories identified broad phenomena of interest—person, environment, health, and nursing. In the ensuing years, these broad phenomena have been challenged, modified, or even discounted as meaningless because of their broadness. And yet, it seems that much of what we study as nurse scientists does fall into one or more of these broad categories of phenomena. That begs a further question about the utility of grand theories: Have grand theories resulted in a clear definition of nursing science? However, from an historical perspective, the grand theories have helped advance nursing science by articulating these phenomena, even if we choose to let the phenomena represent almost anything we wish to study.
Thus, we acknowledge the importance of grand theories to explication of phenomena of interest to nursing science. Regrettably, grand theories do not particularly help us to understand relationships among these broad phenomena. Rather, we need middle range or grounded theories to explicate relationships among concepts embedded within these phenomena in order that scientists can test those proposed relationships. But should all our research be focused on the development and testing of these theories? Perhaps. Certainly it would be hard to document that our science is advancing in this way; many research papers do not name a theory upon which the work is based nor identify a theoretical model being tested. Most rare of all are papers reporting on a theory that has been developed. If theory is necessary for scientific advancement, nurse scientists need to pay greater attention to theory use in their research and their research reports. Certainly if theory has been used to inform research, that use should be clearly articulated. And if theories are tested, then scientists should report on how the theory actually performed.
Rather than clear delineation of theory use, much reported nursing science is a collection of empirical studies on many phenomena of interest. Rarely do we have clear understanding of how or why the results of these studies contribute to scientific advancement within the discipline. Perhaps as a scientific community, we do not think this is necessary. Or perhaps we need to encourage theory development using the empirical evidence we have collected over many years and many studies. I might hazard a guess that many of us who have been studying very specific phenomena over a long period of time have sufficient data accumulated from which theories could be developed and tested. Certainly we need more “basic” research to develop and test theories, particularly those that may lead to interventions designed to improve patient outcomes. Greater rigor and precision in theory development and testing is much needed.
Science advances because of and sometimes in spite of our efforts. Theory should help that advancement, providing explanations of phenomena and their relationships. Using theory in research allows us to refine the definitions and scope of the discipline of nursing. Theories may change and the way that they are interpreted may change, but these changes and interpretations based on observations are most likely to result in advancements because they occur within the context of theory. In nursing science, given the broad scope of our interests, we are likely to need many theories to describe, explain, and predict the complexity in the relationships among those concepts.
Theories have long been thought to be the foundations for furthering scientific knowledge and for putting the information gathered through empirical research into practice. Indeed, perhaps more than ever, clear use of theory in research may be even more important to further advance nursing science. Thus, the question is not: should we use theory in our scientific work? The question is: are we making explicit the theories we are using? The papers collected in this issue will hopefully advance science by reminding us of important past theoretical work and providing guidance for the way forward. To each of us engaged in nursing science, our challenge is to carefully consider the function of theory in our own work and to further advance nursing science by making theory use more evident in our research reports.