Theory-guided Research Research Articles

Advancing Nursing Science: Deriving a Middle-Range Theory for System-Level Communication Research in Complex Hospital Environments.

Background: Millions of injuries and deaths occur yearly from preventable errors, despite interventions applied at the point of care. Although evidence suggests that system-level factors are responsible for hospital system health and patient safety, research has largely not accounted for hospital complexity. Prior to the authors' research regarding the communication of system-level events that influence hospital system health and patient safety, no nursing-specific communication theories that accounted for hospital complexity were identified. However, theory-guided research holds the potential to boost scientific knowledge through the provision of a robust foundational understanding of phenomena. Purpose: The purpose of this article is to discuss the concept derivation used to create a middle-range theory for the guidance of research involving system-level communication in complex healthcare environments as it relates to hospital system health and patient safety. Methods: Concept derivation as described by Walker and Avant (2018) was conducted using parent concepts from the Effective Nurse-to-Nurse Communication Framework, Symbolic Interactionism, Information Theory, Gerbner's Communication Model, and Complexity Theory. Results: Authentication of the derived Effective System-to-System Communication Theory (ESSCT) was confirmed through identification of coherent relationships between the concepts and conceptual statements, alignment with the nursing metaparadigm, and peer review by a subject matter expert from the nursing discipline. Additionally, research revealed an overall congruency between the research findings and the ESSCT's theoretical statements. Implications: The current healthcare climate necessitates that research involving communication be optimized by a germane theoretical underpinning that accounts for hospital complexity. The authors contend that the use of the derived theory may assist such endeavors.

Expanding the Health Belief Model for exploring inpatient fall risk perceptions: A methodology paper.

Inpatient falls among older adults are a relentless problem, and extant inpatient fall prevention research and interventions lack the older adults' perspectives and experiences of their own fall risk in the hospital. Theory-guided research is essential in nursing, and the purpose of this paper was to describe the process of developing a theoretical framework for a phenomenological nursing study exploring older adults' lived experiences of being at risk for falling in the hospital. Based on philosophical nursing underpinnings, the Health Belief Model (HBM) was selected as the theoretical model. The limitations of the model led to expansion of the model with established concepts associated with accidental falls among older adults. The HBM was selected as the guiding model due to its ability to capture a broad range of perceptions of a health threat. The HBM was expanded with the concepts of embarrassment, independence, fear of falling, dignity and positivity effect. The addition of these concepts made the theoretical framework more applicable to age-related developmental behaviours of older adult and more applicable to nursing research. The Expanded HBM theoretical framework may guide future nursing research to develop fall prevention interventions to decrease fall rates among hospitalized older adults. No Patient or Public Contribution.

Concepts from behavioral theories can guide clinicians in coaching for behavior change

ObjectivesMany patients do not engage in health behaviors that can control common, chronic illnesses. Clinicians have opportunities to promote health behaviors yet may lack skills for coaching effectively about health behaviors. Our aims are to: present definitions of coaching, propose concepts for coaching about behavior change from two theories, share theory-guided research on behavior change relevant to ambulatory care settings, and delineate how concepts from these theories can guide coaching. MethodsIn our discussion, we explain how two behavioral theories are complementary and applicable to coaching, present empirical support for these theories, and describe applications of these concepts for practice. Conclusions and practice implicationsSelf-determination theory can guide clinicians in how to interact with patients to meet patients’ psychological needs, to promote health behaviors, and subsequent health status. Self-regulation theory can guide coaches in what concepts to address for behavior change. These complementary theories have been supported in rigorous research with adult populations in ambulatory care settings.

The Pyschoactive Politics Framework and the Beginning of Coca Eradication in Peru

Objective/Context: The present article develops a theoretical tool to explain drug policy decisions called the Psychoactive Politics Framework. It is built on the assumption that the design and implementation of drug policies affect several political goals, such as popularity, winning elections, material benefits, and international reputation. Therefore, the framework expects these policies to be the result of national and international incentives that will help policy makers achieve those goals. These are incentives related to public opinion, policy advocacy, crises, pressure, standing, and leadership. Methodology: The second part of the article applies the Psychoactive Politics Framework to explain Peru’s first legislation to eradicate illicit coca crops: the Decree Law 22095 of 1978. Through examining diplomatic cables, protocols of international meetings, and media sources, the analysis gathers evidence in favor and against each of the incentives outlined in the framework. Conclusions: While Peru’s drug policy reform took place in an increasingly prohibitionist international environment, its primary driver was the advocacy of national actors, such as the Ministry of the Interior, the Investigative Police, and the attorney general. Originality: The findings question the popular notion that prohibitionist drug policies in South America resulted exclusively from US pressure. Furthermore, the article presents a coherent tool to carry out theory-guided research about past and present drug policy decisions.

Beyond Statistical Ritual: Theory in Psychological Science

More than 40 years ago, Paul Meehl (1978) published a seminal critique of the state of theorizing in psychological science. According to Meehl, the quality of theories had diminished in the preceding decades, resulting in statistical methods standing in for theoretical rigor. In this introduction to the special issue Theory in Psychological Science, we apply Meehl’s account to contemporary psychological science. We suggest that by the time of Meehl’s writing, psychology found itself in the midst of a crisis that is typical of maturing sciences, in which the theories that had been guiding research were gradually cast into doubt. Psychologists were faced with the same general choice when worldviews fail: Face reality and pursue knowledge in the absence of certainty, or shift emphasis toward sources of synthetic certainty. We suggest that psychologists have too often chosen the latter option, substituting synthetic certainties for theory-guided research, in much the same manner as Scholastic scholars did centuries ago. Drawing from our contributors, we go on to make recommendations for how psychological science may fully reengage with theory-based science.

Claiming the Narrative Wave With Story Theory.

Over the past few decades, there has been a narrative wave that has advanced and subsided but consistently moved toward acceptance in health care circles. Despite the importance of narrative to nursing practice and research, the discipline has been slow to claim the narrative wave as its own. The purpose of this article is to claim the narrative wave for the discipline of nursing with story theory-guided research and practice and to describe dimensions of the narrative movement in health-related literature. Practical application of story theory is described for both nursing practice and nursing research.

Establishing a generalized polyepigenetic biomarker for tobacco smoking

Large-scale epigenome-wide association meta-analyses have identified multiple ‘signatures’’ of smoking. Drawing on these findings, we describe the construction of a polyepigenetic DNA methylation score that indexes smoking behavior and that can be utilized for multiple purposes in population health research. To validate the score, we use data from two birth cohort studies: The Dunedin Longitudinal Study, followed to age-38 years, and the Environmental Risk Study, followed to age-18 years. Longitudinal data show that changes in DNA methylation accumulate with increased exposure to tobacco smoking and attenuate with quitting. Data from twins discordant for smoking behavior show that smoking influences DNA methylation independently of genetic and environmental risk factors. Physiological data show that changes in DNA methylation track smoking-related changes in lung function and gum health over time. Moreover, DNA methylation changes predict corresponding changes in gene expression in pathways related to inflammation, immune response, and cellular trafficking. Finally, we present prospective data about the link between adverse childhood experiences (ACEs) and epigenetic modifications; these findings document the importance of controlling for smoking-related DNA methylation changes when studying biological embedding of stress in life-course research. We introduce the polyepigenetic DNA methylation score as a tool both for discovery and theory-guided research in epigenetic epidemiology.

How Could Nurse Researchers Apply Theory to Generate Knowledge More Efficiently?

Reports of nursing research often do not provide adequate information about whether, and how, researchers applied theory when conducting their studies. Unfortunately, the lack of adequate application and explication of theory in research impedes development of knowledge to guide nursing practice. To clarify and exemplify how to apply theory in research. First we describe how researchers can apply theory in phases of research. Then we share examples of how three research teams applied one theory to these phases of research in three different studies of preventive behaviors. Nurse researchers can review and refine ways in which they apply theory in guiding research and writing publications. Scholars can appreciate how one theory can guide researchers in building knowledge about a given condition such as preventive behaviors. Clinicians and researchers can collaborate to apply and examine the usefulness of theory. If nurses had improved understanding of theory-guided research, they could better assess, select, and apply theory-guided interventions in their practices.

A Mixed-Methods Approach Examining Illicit Prescription Stimulant Use: Findings From a Northern California University.

Preventing the illicit use of prescription stimulants, a particularly high-risk form of substance use, requires approaches that utilize theory-guided research. We examined this behavior within the context of a random sample of 554 undergraduate students attending a university in northern California. Approximately 17% of students self-reported engaging in this behavior during college; frequency of misuse per academic term ranged from less than once to 40 or more times. Although most misusers reported oral ingestion, a small proportion reported snorting and smoking the drug. The majority of misusers reported receiving the drug at no cost, and the primary source of the drug was friends. Misusers were motivated by both academic (e.g., to improve focus) and non-academic (e.g., to experiment) reasons. Our thematic analyses of an open-end question revealed that students abstaining from illicit use of prescription stimulants did so primarily for reasons related to health risks, ethics, and adherence regulations. Results from adjusted logistic regression analyses showed that correlates of the behavior were intrapersonal, interpersonal, and environmental in nature. We conclude that characteristics of misuse are a cause for concern, and correlates of the behavior are multifaceted. These findings, in addition to insights provided by students who choose not to engage in this behavior, suggest that a number of prevention approaches are plausible, such as a social norms campaign that simultaneously corrects exaggerated beliefs about prevalence while also illustrating why abstainers, in their own words, choose to abstain.

Reflections on Leadership

Reflections on Leadership

Dating Violence Victimization, Interpersonal Needs, and Suicidal Ideation Among College Students.

Victims of dating violence experience suicidal ideation at a higher rate than the general population. However, very few studies have examined the relationship between dating violence and suicidal ideation within an empirically supported theory of suicide. The interpersonal-psychological theory of suicide posits that thwarted interpersonal needs (i.e., thwarted belongingness and perceived burdensomeness) are proximal antecedents to suicidal ideation. The experience of dating violence may thwart such interpersonal needs, thus increasing risk for suicidal ideation. We aimed to examine the relationships among dating violence, thwarted interpersonal needs, and suicidal ideation and test the interpersonal-psychological theory of suicide. We conducted two cross-sectional studies on college students in dating relationships to examine these research questions. Study 1 indicated positive correlations among dating violence (i.e., physical and psychological), thwarted belongingness, and perceived burdensomeness. Study 2 generally replicated the bivariate relationships of Study 1 and demonstrated that, at high levels of thwarted belongingness, perceived burdensomeness was correlated with suicidal ideation, while accounting for the effects of depressive symptoms and drug use. These results highlight the importance of using theory-guided research to understand the relationship between dating violence and suicidal ideation.

New Directions in Reactance Research

According to reactance theory, formulated by Jack Brehm in 1966, the motivational state of psychological reactance is aroused when an individual perceives any of her or his free behaviors she or he can engage in to be threatened (Brehm, 1966). Reactance theory does not hold that people believe that they have freedom in all daily life situations but that they perceive themselves as having specific freedoms. The amount of reactance experienced when a perceived freedom is threatened depends on the intensity of the threat as well as the importance of the restricted freedom (Brehm, 1966; Brehm & Brehm, 1981; Miron & Brehm, 2006; Worchel & Brehm, 1971). Reactance as research topic has attracted attention in both basic and applied research in areas such as health, marketing, politics, and education. Nevertheless, Miron and Brehm pointed out several research gaps in their review paper on reactance research 40 years later. This review article inspired us to develop this special issue in order to highlight new insightful theory and research concerning reactance processes. ‘‘Reactance’’ is often used as an ex post explanation for different phenomena occurring in applied research, such as research in workor health-related contexts. Yet, interesting new theory-guided research has also been testing a priori hypotheses in different domains over the last decade. And there are still remaining open questions in understanding basic theoretical assumptions concerning the classic social psychology theory of reactance. The purpose of this issue is therefore to present recent research and developments in reactance theory that both offer new knowledge and illuminate issues still in need of resolution. This special issue contains one review article, five empirical articles, and a research spotlight. The review article by Steindl, Jonas, Sittenthaler, TrautMattausch, and Greenberg (2015) introduces the special issue with an overview of research that has been conducted since Miron and Brehm’s review article from 2006. The article presents new developments concerning the measurement of reactance, research on cultural differences in the experience of self-experienced and vicarious reactance, and research revealing different processes involved in reactance. Furthermore, the authors encourage future research to gain a better understanding of the state of psychological reactance per se and to also look at the positive motivational side of reactance. In the empirical paper by Bessarabova, Turner, Fink, and Beary Blustein (2015) data showed that guilt had a direct effect on the affective component of reactance, anger, whereas guilt influenced the cognitive component of reactance via awareness that a message was a guilt appeal. This is an interesting approach in extending reactance theory by relating reactance to guilt appeals and examining the process by which reactance translates into action. The next contribution in persuasion research by Shen and Coles (2015) investigates fear-reactance processes. Results showed that a within-individuals perspective instead of the between-individuals perspective might help to increase our understanding of fear-reactance processes. In the third empirical contribution, De Lemus, Bukowski, Spears, and Telga (2015) found out that the motivational state of reactance can also result from perceived threats to one’s group norms and social identities. More precisely, the authors show that examples of stereotypic women arouse reactance responses in progressive women (feminist identifiers) and examples of counterstereotypic women arouse reactance in more traditional women. The article by Ungar, Sieverding, Schweizer, and Stadnitski (2015) addresses the question of whether an intervention designed to increase the consumption of fruits and vegetables could elicit reactance. Results indicated that even a relatively brief intervention (i.e., eating according to a 5 a day or just 1 more goal for one week) led to reactance that persisted on the same level 1 week later, with effects on attitude, intention, and behavior lasting as much as 4 months later. The final empirical paper presents the validation of a state reactance scale, the Salzburger State Reactance Scale

Sustainability in shipper-logistics service provider relationships: A tentative taxonomy based on agency theory and stimulus-response analysis

The paper contributes to research on sustainability in dyadic buyer–supplier relationships of logistics services. It presents deeper knowledge on why and how suppliers choose to behave sustainably. The research analyzes how shippers stimulate their LSPs and how LSPs respond by conducting sustainability activities. Agency theory and the stimulus–organism–response model are applied as the theoretical foundations for an explorative case study analysis of three large and five small and medium-sized European logistics service providers (LSPs) active in road transport services. Significant differences are found between the sustainability efforts of SMEs and large LSPs and a tentative taxonomy of the sustainability response types of LSPs is derived. The taxonomy contributes to theory-guided research in sustainable supply chain management and procurement. Thereby, mismatches of stimuli and responses are identified and related agency problems in dyadic relationships in terms of sustainability are discussed. From a managerial point of view, the findings may serve as a starting point for purchasers of logistics services to develop adequate sustainability selection criteria and incentives.

Nursing Theory-Guided Research

Theory-guided research has a long tradition in nursing that spans at least 50 years. Yet the use of nursing theory with qualitative research approaches continues to raise questions. Grounded theory is selected by nurses as a research methodology to address research questions that are aimed at understanding the nuances of nursing communication processes. Nurse theorist Margaret Newman is recognized in this issue for her theoretical contributions to practice and research, and a Newman scholar is introduced who explains her use of grounded theory research methodology guided by Newman's theory of health as expanding consciousness.

Understanding Social Capital and HIV Risk in Rural African American Communities

African Americans (AA) and rural communities often suffer disproportionately from poorer health. Theory-guided research examining how individual- and community-level factors influence health behaviors and contribute to disparities is needed. To understand how a social network model that captures the interplay between individual and community factors might inform community-based interventions to reduce HIV risk in rural AA communities. Qualitative study. Eleven focus groups with 38 AA 16-24 year olds, 42 adults over age 25, and 13 formerly incarcerated individuals held in community settings in two rural, predominantly AA counties in North Carolina. Thirty-seven semi-structured interviews with multiethnic key informants. Semi-structured interviews and focus groups with open-ended questions assessed a) perceptions of multi-level HIV risk determinants from a social network model (individual, interpersonal, social, economic, political and structural) identified through literature review and b) community needs and assets affecting local HIV rates. Qualitative data was analyzed using directive content analysis guided by a social network model. We identified four themes regarding the interaction between individuals and their communities that mediate HIV risk: interpersonal processes, community structural environment, social disorder, and civic engagement. Communities were characterized as having a high degree of cohesiveness, tension, and HIV-related stigma. The community structural environment-characterized by neighborhood poverty, lack of skilled jobs, segregation, political disenfranchisement and institutional racism-was felt to reduce the availability and accessibility of resources to combat HIV. Adults noted an inability to combat social problems due to social disorder, which fuels HIV risk behaviors. Civic engagement as a means of identifying community concerns and developing solutions is limited by churches' reluctance to address HIV-related issues. To combat HIV-related stigma, physicians should follow recommendations for universal HIV testing. Besides asking about individual health behaviors, physicians should ask about the availability of support and local community resources. Physicians might consider tailoring their treatment recommendations based on available community resources. This strategy may potentially improve patient adherence and clinical outcomes.

Issues pertaining to the theoretical framework of a study: Reflections from some Universities in three African Countries

This paper derives from the review of some postgraduate theses completed in the Faculties of Education of some selected universities in three African countries. The review casts doubts over the understanding of the place of theory in the conduct of educational research amongst researchers within the African research tradition. In this paper, the meanings and relevance of theories within the context of educational research with a primary focus on the self-evidenced misconceptions regarding the application of theories by research-students and their supervisors were examined. The paper, while noting that the application of theory to research within African research tradition is far from being established, highlights the implications of such epistemological neglect on the growth and relevance of educational research within the continent. Consequently, an attempt is made to set out the framework within which students and researchers alike may conduct theory-guided educational research.

Summary of Issues and Challenges in the Use of New Technologies in Clinical Care and With Children and Adolescents With Chronic Illness

New technologies such as telehealth and Internet-based interventions provide powerful methods of clinical intervention and research with pediatric populations, especially children with chronic health conditions. Barriers to utilization of these technologies include the experiences and attitudes of professionals and families, ethical concerns about privacy and confidentiality resources, and control. The utilization of new technologies will be promoted by addressing resistance toward and discomfort of new technology, enhancing ways of providing information via technology, and facilitating education efforts within the general population. Recommendations to advance research concerning new technologies include the following: (a) develop benchmarks for evaluations, (b) use quantitative and qualitative approaches, (c) conduct theory-guided research, (d) study the cost benefits of different technologies, (e) document the impact of technologies on comprehensive outcomes, and (f) facilitate multisite research collaboration.

Corporate Emotions and Emotions in Corporations

Although sociology of organizations never banned emotions from its field of inquiry, first the sociology of emotions elevated them to central research objects. Disparate research on various types of enterprises shows that both managers and employees are much more emotional than most scientists would care to admit. Under constant pressure not to display their fears, anxieties or worries, they have to balance a mixture of emotions attending solidarity and competition with their peers. Whereas managerial roles actually call for occasional displays of anger at subordinates, anger is beyond the pale for subordinates who are supposed to swallow anger, humiliation or fear. Capitalist labour, no matter whether this of managers or that of workers, exacts a heavy emotional toll. While in handling their work managers rely heavily on the emotional support of their peers and secretaries, employees spin nostalgic stories or take to subversive workplace humour. Against this broader perspective, Arlie Hochschild's research and its critique have focused exclusively on the workers' emotional toll. In centre of interest is emotional labour exacted by employers and the many ways of managing undesired feelings which this labour requires. Hochschild's critics stress that subordinates often find ways of evading supervision and playing with rules for emotional display, so that they are much less subject to emotion management than her research agenda implies. Although Hochschild's research and its echo produced the only coherent body of theory-guided research to emerge so far within the sociology of organizations under the influence of the sociology of emotions, the chapter ends with an argument that her valuable yet work-focused approach has become constraining in times of disjointed, turbulent capitalism. Social change demands that we enlarge our scope of inquiry to include the experience of lay-off and unemployment as well as work-unrelated emotions and the broader society into our purview.

Transferable Training as a Collective Good

The potential significance of employers' collective action for economic performance is widely acknowledged, but has not been complemented with corresponding theory-guided research on the probability of collective action and the conditions for effective action. This article examines the nature of, the conditions for, and the consequences of employers' collective action on further training, a crucial component of a successful high-skill strategy for industries and nations. The collective action perspective shares the core assumptions of human-capital theory, but integrates the possibility of collective action as a solution to some of the market failures associated with investment in transferable human capital. This alternative view also predicts in what labour-market settings such action is likely to occur, building on Olson's work and theories of employers' collective action. We suggest that employers' collective action is more likely to succeed in ensuring transferability and encouraging employee investment than is the use of sanctions against employers to promote employer-financed transferable training

Religion, Psychopathology and Coping

Introduction. Section. 1. [Theoretical Overviews]. J.A. van BELZEN: Methodological perspectives on psychopathology and religion: a historical review. M.H.F. van UDEN & J.Z.T. PIEPER: Mental health and religion: a theoretical survey. Jozef CORVELEYN: The psychological explanation of religion as wish-fulfilment. A test-case: The belief in immortality. Benjamin BEIT-HALLAHMI: Religion as psychopathology: Exploring a metaphor. Halina GRZYMALA-MOSZCZYNSKA: Religion as transgression: Psychological mechanisms involved in religion and mental illness. Jan van der LANS: Religion as a meaning system: A conceptual model for research and counseling. James T. RICHARDSON: Religion, mental health and the law: Assessing the cult controversy. Section 2. [Theory-guided Research] Pawel SOCHA: A model of sequential development of religious orientation. L.B. BROWN: An experimental perspective on religion as a therapeutic resource. Kenneth I. PARGAMENT: Religious contributions to the process of coping with stress. Antoon GEELS: Religious visions in contemporary Sweden. Section 3. [Clinical Research] Eystein KALDESTAD: Religious orientation, religious activity and mental health. Hans STIFOSS-HANSSEN: A Norwegian religiosity scale based on quest theory - development and application. Dorota KUBACKA-JASIECKA, Roman DORCZAK, Malgorzata OPOCZYNSKA: The role of religious values in functioning and mental health. H. Newton MALONY: How counselors can help people become more spiritual through religious assessment. Section 4. [Case Studies] Nils G. HOLM and Pertti JARVINEN: Psychosis and religion. Gustaf STAHLBERG: Two cases of loss of faith in depressed female patients and some questions concerning theoretical and clinical validity. Krzysztof CIESLAK: Religious involvement and mental health: A case of depression