Prepared byPrepared by

Prof.Dr Nefissa A. kaderProf.Dr Nefissa A. kaderVice Dean of education and Student Vice Dean of education and Student

AffairsAffairs

Faculty of Nursing – Cairo universityFaculty of Nursing – Cairo university

AnalysisAnalysis of conceptual model *origin of the model *unique focus and content of the

model EvaluationEvaluation of conceptual *Explication of origin *Comprehensiveness of the content *Generation of theory *logical congruence *Credibility *Contribution to the discipline of

nursing

The aim of the The aim of the analysisanalysis is to is to present an objective and present an objective and nonjudgmental description nonjudgmental description of the origins and content of the origins and content of the conceptual model. of the conceptual model.

Analysis is an objective Analysis is an objective breakdown of statements into breakdown of statements into component elementscomponent elements

To identify To identify To identify any concepts relationships relative hierarchy

between concepts of ideas contained

in the conceptual

model between concepts

Analysis of conceptual model of Analysis of conceptual model of nursing, requires a systematic, nursing, requires a systematic, detailed review of all available detailed review of all available publications and presentations publications and presentations

by the author of the model to by the author of the model to determine exactly what has determine exactly what has

been aid, rather than relying on been aid, rather than relying on inferences about what might inferences about what might

have been meant or by referring have been meant or by referring to other authors’ interpretations to other authors’ interpretations

of the conceptual model. of the conceptual model.

The first step in the The first step in the analysis of conceptual analysis of conceptual

models of nursing is models of nursing is examination of four examination of four

aspects of its origins.aspects of its origins.

TheThe historical evolutionhistorical evolution of the of the conceptual models is described, conceptual models is described, and the author’sand the author’s motivationmotivation for for

developing the conceptual developing the conceptual model is explicatedmodel is explicated..

The questions to ask are...The questions to ask are... WhatWhat are the origins of the are the origins of the

conceptual model?conceptual model? WhatWhat is the historical evolution is the historical evolution

of the conceptual model?of the conceptual model?

eg. eg. Model of Johnson over period of Model of Johnson over period of 20yrs. Beginning in early 1940, as she 20yrs. Beginning in early 1940, as she

developed baccalaureate nursing developed baccalaureate nursing course she motivated to ask several course she motivated to ask several

question..question.. What is explicit, ideal goal What is explicit, ideal goal of nursingof nursing? historical approach led ? historical approach led

her to accept fromher to accept from NightingalesNightingales nursing traditional concern with nursing traditional concern with

person who is ill, rather than with person who is ill, rather than with person disease." focus on basic person disease." focus on basic

human need of person and concern human need of person and concern for relationship between person & for relationship between person &

environment”environment”..

the author’s philosophical claims the author’s philosophical claims about nursing and the knowledge about nursing and the knowledge

development strategies used to development strategies used to formulate the conceptual models formulate the conceptual models

are examined.are examined.

**** Johnson underlying Johnson underlying behavioral system model in the behavioral system model in the form of beliefs, assumptions form of beliefs, assumptions and value system.and value system.

The questions to ask The questions to ask are...are...

OnOn what philosophical beliefs what philosophical beliefs and values about nursing is and values about nursing is the conceptual model based?the conceptual model based?

What What strategies for strategies for knowledge development were knowledge development were used to formulate the used to formulate the conceptual model?conceptual model?

the influences on the author’s the influences on the author’s thinking from nurse scholars thinking from nurse scholars

and scholars of adjunctive and scholars of adjunctive disciplines are identified disciplines are identified of a of a

concept & irrelevant concept & irrelevant attributes.attributes.

WhatWhat scholars influenced the scholars influenced the model author’s thinking?model author’s thinking?

e.g.. Starting with e.g.. Starting with Nightingale, Johnson Nightingale, Johnson

acknowledged the influence acknowledged the influence of many scholars on of many scholars on

development of behavioral development of behavioral system model. Johnson went system model. Johnson went

to explain that Nightingale to explain that Nightingale work “ provide direction to work “ provide direction to

herher “ “thinking”.thinking”.

the worldview reflected by the the worldview reflected by the conceptual model is specified. conceptual model is specified.

WhatWhat worldview is reflected in worldview is reflected in the conceptual model?the conceptual model?

e.g. Reciprocal interaction e.g. Reciprocal interaction worldview also is reflected inworldview also is reflected in JohnsonJohnson description of the person description of the person as actively seeking new as actively seeking new experience.experience.

The second step in the The second step in the analysis of a conceptual analysis of a conceptual model of nursing is model of nursing is examination of its unique examination of its unique focus and its content. focus and its content.

The question isThe question is

What What is the unique focus of is the unique focus of the conceptual model?the conceptual model?

eg. The unique focus of the behavioral eg. The unique focus of the behavioral system model is the person as system model is the person as behavioral system.behavioral system.

““ Person is primary component Person is primary component of this nursing modelof this nursing model””

Therefore, this part of the analysis Therefore, this part of the analysis is most readily accomplished first is most readily accomplished first

by This part categorizing the by This part categorizing the content of the model into content of the model into

definitions and descriptions of definitions and descriptions of person, environment, health, and person, environment, health, and

nursing. Then , in the language of nursing. Then , in the language of conceptual model, statement conceptual model, statement

reflecting the linkage of reflecting the linkage of metaparadigm concept can be metaparadigm concept can be

extracted. extracted.

HowHow are nursing’s four are nursing’s four metaparadigm concepts metaparadigm concepts explicated in the model?explicated in the model?

HowHow is person defined and is person defined and described?described?

HowHow is environment defined and is environment defined and described?described?

HowHow is health defined? How are is health defined? How are wellness and illness differentiatedwellness and illness differentiated

HowHow is nursing defined? is nursing defined? What is the goal of nursing? What is the goal of nursing?

How How is the nursing process is the nursing process described?described?

WhatWhat statements are made statements are made about the relationships about the relationships among the four among the four metaparadigm concepts?metaparadigm concepts?

The evaluation, in contrast The evaluation, in contrast of analysis of conceptual of analysis of conceptual model requires judgments model requires judgments to be made about the to be made about the conceptual model with conceptual model with regard to the extent to regard to the extent to which it satisfies specific which it satisfies specific external criteria.external criteria.

The evaluation is based on The evaluation is based on the results of the analysis, as the results of the analysis, as well as on a review of well as on a review of previously published previously published critiques, research reports, critiques, research reports, and reports of the and reports of the application of the conceptual application of the conceptual model in nursing education, model in nursing education, administration and practice.administration and practice.

Evaluation of a conceptual model of Evaluation of a conceptual model of nursing is accomplished by nursing is accomplished by

comparing its content with criteria comparing its content with criteria that addressthat address

ExplicationExplication of origins.of origins. ComprehensivenessComprehensiveness of focus and of focus and

content.content. Logical Logical congruence.congruence. theory-generating theory-generating capabilities.capabilities. Credibility.Credibility. contributions tocontributions to nursing discipline.nursing discipline.

The first step of evaluation The first step of evaluation concerns the origins of the concerns the origins of the conceptual model. Identification conceptual model. Identification of the author’s beliefs and of the author’s beliefs and values yields information about values yields information about the philosophical foundations of the philosophical foundations of the model and helps to identify the model and helps to identify special points of emphasis in special points of emphasis in the view of nursing. the view of nursing.

AreAre the philosophical claims the philosophical claims on which the conceptual on which the conceptual model is based explicit?model is based explicit?

AreAre the scholars who the scholars who influenced the model author’s influenced the model author’s thinking acknowledged, and thinking acknowledged, and are bibliographical ?are bibliographical ?

e.g. e.g. Johnson Johnson explicated the origins explicated the origins of the Behavioral System Model of the Behavioral System Model clearly and concisely. clearly and concisely.

• her philosophical claims in the form of beliefs about the profession of nursing, assumptions and value system. acknowledge other scholars She was especially informative with regard to the influence of Nightingale's work and general system theory on the development of the Behavioral system model.

The second step of The second step of evaluation deals with theevaluation deals with the comprehensivenesscomprehensiveness of the of the content of the model, content of the model, with with emphasis placed on the depth emphasis placed on the depth and breadth of the content. and breadth of the content.

DoesDoes the conceptual model the conceptual model provide adequate descriptions provide adequate descriptions of all four concepts of of all four concepts of nursing’s metaparadigm?nursing’s metaparadigm?

DoDo the relational propositions the relational propositions of the conceptual model of the conceptual model completely links the four-completely links the four-metaparadigm concepts?metaparadigm concepts?

The criterion forThe criterion for the breadththe breadth of of the content of the conceptual the content of the conceptual model requires that it is model requires that it is

sufficiently broad in scope to provide sufficiently broad in scope to provide guidance in clinical situations of guidance in clinical situations of normalcy, risk, crisis, and morbidity, normalcy, risk, crisis, and morbidity, as a basis for research, education, as a basis for research, education, and administration. and administration.

  

The questions to ask when The questions to ask when evaluating the breadth of the evaluating the breadth of the content of the conceptual model content of the conceptual model are:are:

ls the researcher given sufficient ls the researcher given sufficient direction about what questions to ask direction about what questions to ask and what methodology to use?and what methodology to use?

Does the educator have sufficient Does the educator have sufficient guidelines to construct a curriculum?guidelines to construct a curriculum?

Does the administrator have sufficient Does the administrator have sufficient guidelines to organize and deliver guidelines to organize and deliver nursing services?nursing services?

logic of its internal logic of its internal structure. structure. Logical Logical congruencecongruence is evaluated is evaluated through the intellectual through the intellectual process of critical reasoning, process of critical reasoning, which “highlights strength which “highlights strength and explores problem and explores problem inherent in a line of inherent in a line of reasoning”. reasoning”.

The questions to be asked when The questions to be asked when evaluating logical congruence areevaluating logical congruence are

Is the internal structure of the conceptual model Logically congruent?

Does the model reflect more than one contrasting worldview?

Does the model reflect characteristics of more than one category of nursing knowledge?

eg. eg. Content of model Content of model clearly flow from Johnson clearly flow from Johnson philosophical claim and it philosophical claim and it reflects reciprocal reflects reciprocal interaction worldview.interaction worldview.

theories. The need for theories. The need for logically logically conceptual- theoretical conceptual- theoretical systemssystems of nursing knowledge of nursing knowledge for nursing activities mandates for nursing activities mandates that at least some theories be that at least some theories be derived from each conceptual derived from each conceptual model. model.

The question isThe question is

What theories have beenWhat theories have been generated from the generated from the conceptual model?conceptual model?

Social utilitySocial utility Social congruenceSocial congruence Social significanceSocial significance

The ultimate aim of The ultimate aim of credibility determination is credibility determination is

to ascertain which to ascertain which conceptual models are conceptual models are appropriate for use inappropriate for use in

Social utility..Social utility.. addresses the special education addresses the special education

required to apply the required to apply the conceptual model; the conceptual model; the feasibility of implementing the feasibility of implementing the conceptual model in nursing conceptual model in nursing practice; and the extent to practice; and the extent to which the conceptual model is which the conceptual model is actually used to guide nursing actually used to guide nursing research, education, research, education, administration and practice. administration and practice.

The question to be asked when The question to be asked when evaluating the social utility of a evaluating the social utility of a conceptual model is:conceptual model is:

Are education and skill training required prior Are education and skill training required prior to application of the conceptual model in to application of the conceptual model in nursing practice?nursing practice?

eg.eg. Johnson (1980Johnson (1980) ) claimed that the behavioral system claimed that the behavioral system model “has already proved its utilty in providing clear model “has already proved its utilty in providing clear direction for practice, education, and research.direction for practice, education, and research.

Social congruenceSocial congruence.. .. refers to refers to the compatibility of conceptual the compatibility of conceptual model-based nursing activities model-based nursing activities with the expectations of the with the expectations of the patient, the community, and the patient, the community, and the health care system for nursing health care system for nursing practice. practice.

Dee (1990) added, “The Dee (1990) added, “The Johnson Model has provided Johnson Model has provided nurses with a framework not nurses with a framework not only to describe phenomena only to describe phenomena but also to explain, predict and but also to explain, predict and control clinical phenomena for control clinical phenomena for the purpose of achieving the purpose of achieving desired patient out comes. desired patient out comes.

Empirical evidence supporting the Empirical evidence supporting the claims made by Johnson, Grubbs, claims made by Johnson, Grubbs, (1990), who reported a statistically (1990), who reported a statistically significant increase in both cancer significant increase in both cancer patients’ and nurses’ satisfaction patients’ and nurses’ satisfaction with nursing process, including the with nursing process, including the comprehensiveness of assessment, comprehensiveness of assessment, the interventions, and the the interventions, and the effectiveness of outcomes, according effectiveness of outcomes, according to the Behavioral System Model to the Behavioral System Model compared with routine clinical compared with routine clinical assessment.assessment.

Social significanceSocial significance.. .. the criterion the criterion of social significance requires a of social significance requires a judgment to be made with regard to judgment to be made with regard to the social value of the conceptual the social value of the conceptual model, with emphasis placed on the model, with emphasis placed on the effect of use of a conceptual model effect of use of a conceptual model on patients’ health status. on patients’ health status. Social Social significance of a conceptual model significance of a conceptual model can be determined by informal and can be determined by informal and formal methods.formal methods.

The informal methodThe informal method of determining social of determining social significance is accomplished in three phases. significance is accomplished in three phases. First, First, prototype conceptual-theoretical system of prototype conceptual-theoretical system of nursing knowledge is developednursing knowledge is developed for each clinical for each clinical specialty areas or each nursing department and specialty areas or each nursing department and for various patient populations. for various patient populations. Next,Next, each nurse each nurse for each patient develops an individualized for each patient develops an individualized system of knowledge. Nursing care then is system of knowledge. Nursing care then is carried out in accordance with the nursing carried out in accordance with the nursing process of the selected conceptual model, which process of the selected conceptual model, which is amplified by logically congruent middle-range is amplified by logically congruent middle-range theories. theories.

The formal methodThe formal method of determining social of determining social significance is accomplished by examining the significance is accomplished by examining the findings of research guided by conceptual- findings of research guided by conceptual- theoretical-empirical systems of nursing theoretical-empirical systems of nursing knowledge. knowledge.

  

eg. eg. Poster (1989)Poster (1989) provided initial provided initial empirical evidence of the social empirical evidence of the social significance of the Behavioral significance of the Behavioral System Model. Using the Patient System Model. Using the Patient Classification Instrument developed Classification Instrument developed by by Auger and Dee (1983),Auger and Dee (1983), she found she found that 90 percent of the 38 adolescent that 90 percent of the 38 adolescent psychiatric inpatients studied had an psychiatric inpatients studied had an adaptive change in at least one adaptive change in at least one behavioral category after I week of behavioral category after I week of Behavioral System ModelBehavioral System Model based based nursing care.nursing care.

The judgment is made The judgment is made following a thorough review following a thorough review of all of the literature of all of the literature dealing with the conceptual dealing with the conceptual model. model.

Judgments should not be made on the Judgments should not be made on the basis of the comparison of one basis of the comparison of one conceptual model with another. Each conceptual model with another. Each conceptual model should be judged on conceptual model should be judged on its own merits and in accord with its its own merits and in accord with its own philosophical claims.own philosophical claims.

The expectation is that the conceptual The expectation is that the conceptual model enhances understanding of model enhances understanding of phenomena of interest to nursingphenomena of interest to nursing

The question is:The question is: WhatWhat is the overall contribution of the is the overall contribution of the

conceptual model to the discipline of nursing?conceptual model to the discipline of nursing?  

eg.eg. Johnson behavioral model Johnson behavioral model system system

The modelThe model offers a reasonably precise offers a reasonably precise and limited ideal goal for nursing by and limited ideal goal for nursing by stating the end product desired.stating the end product desired.

The modelThe model directs our attention to directs our attention to those aspect of the patient, in all his those aspect of the patient, in all his complex reality.complex reality.

It offersIt offers a focus for intervention and a focus for intervention and suggests the major modes of suggests the major modes of intervention which will be required.intervention which will be required.