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From the Editor: Rehabilitation Nursing is introducing a new intermittent feature, Research Insights. The purpose is to participate in the education process of readers who are less acquainted with essential elements of the research process. Every day nurses are reminded of the importance of using evidence-based practice that results in better patient outcomes. However, an integral aspect of evaluating the quality of the literature is understanding the research process and being able to critically appraise the scientific evidence and its validity, relevance, and applicability. Part of this appraisal process includes a rating system for the hierarchy of evidence and the quality of the research. The Research Insights feature will help to expand your capability in performing this essential step, the critical appraisal of the research pertaining to your practice area.
Theoretical Framework and the Review of the Literature
This is the second part of a four-part series focusing on sections of an experimental or quasi-experimental quantitative research study. The purpose of this article will be: (1) to present two sections of a research study and (2) to offer guidelines to critique and evaluate these sections of the research article for use in clinical practice.
Theories explain the phenomena which are important to rehabilitation nurses. A theory is composed of defined concepts, relationships among concepts or proposed relationships among concepts (Burns & Grove, 2005). Prior testing of theory propositions of conceptual relationships is needed to establish usefulness in research. The purpose of the theoretical framework is to provide a basis for the hypothesis or study question. An example is when the theorist Seyle (1976) defined the concept of stress being “the nonspecific response of the body to any demand made upon it” (p.36). An example of relationships between concepts is that stressors are associated with biological stress responses (Seyle). An example of a directional hypothesis using Seyle’s theory: There will be less stress- associated symptoms for persons receiving mental health therapy as compared with those who do not receive such therapy. An example of the null or non-directional hypothesis using Seyle’s theory: There will be no difference in stress-associated symptoms with personal injuries as compared with family injuries. Theoretical frameworks usually used as a basis for nursing may also be from the disciplines of business, education, psychology, physiology, and sociology.
Nursing researchers with rehabilitation often use the work of nursing theorists such as Orem and Roy to develop the theoretical basis for their studies. For example, Orem states that decreases in self-care agency (defined as the client’s ability to care for the self) has an association with need for nursing agency (defined as the professional nurses’ abilities to care for clients) (Orem, 1995). Roy’s Adaptation Theory supports the subsystems as adaptation modes including the physiological, self-concept, role function, and interdependence systems (Roy & Andrews, 1991). The concepts have conceptual definitions (word definitions) as well as operational definitions (measurement definitions) for use with the hypothesis or study question. The conceptual and operational definitions help make a theory/conceptual framework that is abstract more concrete and testable in a real-world situation. Nursing research using a theoretical base continues to build the body of knowledge in nursing.
The conceptual framework may be used instead of the theory in nursing research. The conceptual framework is an organization of concepts with the purpose of providing a focus for the study (Burns & Grove, 2005). The conceptual framework clarifies and defines the study concepts and can provide relationships among concepts. However, compared to the formal theory, conceptual frameworks tend to be less well developed and not as easily testable (Burns & Grove). Examples of conceptual frameworks include the Transtheoretical Model of Change and the Health Belief Model.
Review of the Literature
The review of the literature presents the background for the problem of the study. There are two forms of literature review. The theoretical literature review presents conceptual analyses and theories supporting the research problem. The empirical literature review presents prior research studies within the problem focus. Computerized databases such as CINAHL or Medline expedite the search for pertinent studies. There are multiple sources for the literature search including professional journals, monographs, books, dissertations, theses, and professional Web sites. One caution in using Web site information is the lack of professional review or editorial review of the articles. Ideally, the review of the literature presents studies, which present many views, opinions, and study outcomes for the identified problem.
References should be current within the last 5–10 years, unless important past initial study results are presented.
Critique of the Theoretical Framework and the Review of Literature
The nurse evaluates these two sections when reading the research article. In examining the theoretical/conceptual framework and the review of the literature, the reader can use the following guidelines.
In any research study, the literature review and the theoretical or conceptual framework guide the development of the subsequent research questions and hypotheses. Both professional nurses and researchers evaluate the research article and its applicability to practice. This article presented the purpose of the theoretical framework or conceptual framework in a study, plus the purpose for the review of the literature.
About the Author
Barbara Brillhart, PhD RN CRRN, is an associate professor at the Arizona State University, College of Nursing. Direct correspondence to her at firstname.lastname@example.org.
Burns, N., & Grove, S. K. (2005). The practice of nursing research conduct, critique, & utilization (5th ed.). Philadelphia: Saunders.
Orem, D. (1995). Nursing concepts of practice (5th ed.) St. Louis: Mosby.
Roy, C., & Andrews, H. A. (1991). The Roy Adaptation model. Norwalk, CT: Appleton & Lange.
Seyle, H. (1976). The stress of life. New York: McGraw-Hill Book Co.
Pilot, D. F., & Beck, C. T. (2004). Nursing research: Principles and methods (7th ed.). Philadelphia: Lippincott Williams & Wilkins.