Conceptual Framework or Theory Introduction: Conceptual frameworks or theories are used to guide scholarship and research. These terms are often used interchangeably, however, there are some differences. Here we present an overview of conceptual frameworks and theories and how they are applied to guide scholarship and research. Concepts or Construct Concepts are the building blocks of conceptual frameworks and theories. Concepts are abstract and are defined by the application of the concept to the framework or theory. Consider the following: The concept is “chair”. What does that mean? Chair could be defined as an apparatus to sit on, wooden or leather, or even by location against the wall or middle of room. We generally associate the concept “chair” to any item that supports sitting within a physical space. What about the concept “patient”? Each of you would define this differently based on your experiences and emphasis in practice. The definition would be very broad, as someone seeking care. Notice, the specific location of care is left open. This is because the patient definition could be attached to where care is provided. For example, a pediatric patient wouldn’t seek care in a long-term care setting. Concept and construct are often used together. True nurse theorists will disagree that they are different. Others disagree and use them interchangeably. Conceptual Framework Connecting concepts is the beginning of a framework. In a very simple example, connect “patient” with “provider” is a start. Each of you would also define “provider” differently, by the way. Now, we have two concepts. Now we need a relationship and context. If a direct relationship, that is an arrow pointing one way or bidirectional between the two concepts. And the context could be something like “blood pressure management”, “weight management”, or whatever would connect these two concepts. Perhaps the final concept for this example could be “outcome” as this is what comes from the patient and provider relationship. This is a very basic (too much so to be useful) framework. To add usefulness to the framework, several additions and clarifications could be made. For example, more concepts could be added, and the context could be made more complex. The framework could also be developed based on existing theories. Theory Theories have been tested and have empirical evidence for their explanation of phenomenon. Theories explain and predict and help us to increase our understanding of phenomenon. In nursing, we have three levels of theory. Highest level is the meta- theory, grand theory, middle range, and micro-range theory. Table 1. Range of level of theory Theory Levels Description Meta Theory Most abstract, used for theory of inquiry, based on analytic reasoning and logic Grand Theory Little to no predictive strength, lack elements for testing Middle Range Theory Explains empirical phenomenon in nursing, measurable, guides research Micro Range Theory Set of hypotheses, used to categorize, least formal of theories Adapted from Higgins, P. A., & Moore, S. M. (2000), Levels of theoretical thinking in nursing. Nursing Outlook, 48(4), 179-183. Grand theories are often taught in nursing theory courses in undergraduate nursing programs for example, Watson Caring Theory, Orem Self Deficit Nursing Theory, Rogers Science of Unitary Human Beings and more. A middle range theory can be constructed from a grand theory or from elevation of a micro theory. How do frameworks and theories differ or are they the same thing? Table 2 provides a comparison of frameworks and theories. Table 2. Framework vs. Theory Framework Theory Consists of theories Set of related constructs or concepts of phenomena Summarizes concepts based on research Three key elements: 1) set of defined and related constructs; 2) constructs are interrelated; 3) Explains a phenomenon Represents current thinking of Predictive phenomenon Adapted from Kivunja, C. (2018). Distinguishing between theory, theoretical framework, and conceptual framework: A systematic review of lessons from the field. International Journal of Higher Education, 7(6), 45-53. Conceptual Frameworks and Theories for Quality Improvement Nearly any theory or framework could be applied to a project. Here is a process used to determine selection of framework or theory: 1. The key is to first determine the constructs, relationships or how they relate for the project. 2. Determine the nature of the project, change in practice, education, improve process 3. Once you have these, then search through the internet or books to find the best fit 4. Play with the selected framework or theory, remember, this framework or theory will be bigger than your project. These will guide your scholarship well beyond your project. 5. Draw it out and label and define everything and work with faculty to improve the framework or theory 6. Be sure to cite the sources-each theory involved in the framework and they must be primary sources (as usual for all citations). To be clear, the conceptual framework or theory is not the PDSA (Plan, Do, Study, Act) model for quality improvement. This is different. The PDSA guides on rapid cycle process for change in practice. Some will use the PDSA to implement the project while guided by a conceptual framework or theory. Here is a partial list of common theories and frameworks used for QI. This is not a complete list. 1. Stetler Model of Research Utilization and Evidence Based Practice (Stetler, 2001) Stetler, C. B. (2001). Updating the Stetler model of research utilization to facilitate evidence-based practice. Nursing Outlook, 49(6), 272-279. 2. The IOWA model guides the translation of evidence-based project showing the organization at every level from the top to the bottom should support the project (Titler, 2001). Titler, M. G., Kleiber, C., Steelman, V. J., Rakel, B. A., Budreau, G., Everett, L. Q., ... & Goode, C. J. (2001). The Iowa model of evidence-based practice to promote quality care. Critical care nursing clinics of North America, 13(4), 497-509. 3. Rosswurm and Larabee Model Rosswurm, M. A., & Larrabee, J. H. (1999). A model for change to evidence‐based practice. Image: The Journal of Nursing Scholarship, 31(4), 317-322. 4. Advancing Research And Clinical practice through close collaboration (ARCC) Melynk, B.M.& Fineout-Overholt, E. (2002b). Putting research into practice. Reflections on Nursing Leadership. 28(2), 22-25. 5. Lewin’s Theory of Planned Change Lewin, K. (1951). Field theory and learning. In D. Cartwright (Ed.) Field theory in social science (pp. 60-86). New York, NY: Harper & Row. 6. Roger’s Diffusion of Innovations Theory Rogers, E.M. (2003). Diffusion of Innovation. (5th ed.). New York, NY: Free Press. 7. Ottawa Model of Research Logan, J. & Graham, I.D. (1998). Toward a comprehensive interdisciplinary model of health care research use. Science Communication, 20(2), 227-246. 8. Promoting Action on Research Implementation in Health Services (PARIHS) Kitson, A.L. & Harvey, G. (2016). Methods to succeed in effecrtive knowledge translation in clinical practice. Journal of Nursing Scholarship. 48(3), 294-302. Doi:10.1111/jnu.12206 9. The Knowledge to Action Framework Graham, L.D., Logan, J., Harrison, M.B., Straus, S.E., Tetroe, J., Caswell, W., & Robinsonm, N. (2006). Lost in knowledge translation: Time for a map? Journal of Continuing Education in the Health Professions, 26(1), 13-24 10. Health Belief Model (HBM) Champion, V. L., & Skinner, C. S. The Health Belief Model. https://d1wqtxts1xzle7.cloudfront.net/49289960/Health_Behavior___Health_Education_ book_4th_Ed.pdf?1475413105=&response-content- disposition=inline%3B+filename%3DHealth_Behavior_and_Health_Education_boo.pdf& Expires=1593623104&Signature=We0D7FxG8BMdGc6w0liA~blLdhK1hNSIP8oWgWb UdUZsCouHln9Q30piYteGi6jJ2MA5zF6Zp2FaBOBpMSaK-M6lbiBSinVd- UGjxKXfYoNRiYe1cFaz6j70I6~q6EfFyQMZmsB1tTa- RtWL6iV4ZO7sqa3Zjm3F~ocmmj- uSr71n57eYI2q9c5FTJ5fCImeEglH0sV0VQDQrMmJPX6Kep5q1XXOyeFS~vLBBfOeM WkWRLKr76mM3usMZtvEkITd5z9TiLWLsKrPZauiD97pdLZ0TtdZt1DK1JVy3fTM4KZ0~ oV4iBsRPu21NBoUAoBvZ2wQpIkY62uIvxR5AGatVw__&Key-Pair- Id=APKAJLOHF5GGSLRBV4ZA#page=83 11. Translating Research into Practice Model (TRIP) https://journals.lww.com/ajnonline/FullText/2007/06001/Translating_Research_into_Pra ctice.10.aspx https://www.ahrq.gov/topics/translating-research-practice-trip.html 12. Synergy Model of Patient Care (AACN) https://nursology.net/nurse-theorists-and-their-work/the-synergy-model/ 13. AHRQ's Framework for the "Transfer of Patient Safety Research into Practice https://www.ncbi.nlm.nih.gov/books/NBK20521/ 14. John's Hopkins Nursing Evidence Based Practice Model (JHNEBP) https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html 15. Health Promotion Model http://currentnursing.com/nursing_theory/health_promotion_model.html 16. Theory of Human Caring-Jean Watson 17. Conceptual Model for Community Needs Assessment Type in google and you will find several related to children, African Americans, Palliative Care, Mental Health 18. Tannehill Model of Health Promotion https://journals.sagepub.com/doi/abs/10.1177/001789698504400402?journalCode=heja .