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The application of theory to triage decision-making

Gudrun Reay RN, BN (Doctoral Student) *,
James A. Rankin RN, NP, PhD (Professor and Nurse Practitioner)

Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4

Received 25 January 2012; received in revised form 22 March 2012; accepted 28 March 2012

KEYWORDS Abstract
Theory; Theory in nursing is frequently thought of as being a mainly academic exercise with little rel-
Triage;
evance to the everyday practice of nursing. In nursing there is disagreement about what theory
Decision-making;
is and what it is not. Scientific theory is an abstract systematic explanation of how concepts are
Recognition primed
decision model related to each other. Many nursing theories do not fit this description and should therefore, in
the opinion of the authors, be thought of as models. Nursing knowledge has been described as
the knowledge that is useful to nurses, whether it is derived from the discipline of nursing or
other disciplines.
Decision-making (DM) and triage nursing have been investigated by several nurse researchers,
however, most have not clearly articulated a theoretical or conceptual framework. The recog-
nition primed decision (RPD) model is based on research about DM under uncertain conditions
such as time pressure, limited time available, high stakes, and changing cues. The context of
emergency triage nursing DM is congruent with the RPD model. The authors propose that the
RPD model can serve as a foundation for research that seeks to understand DM by triage nurses
with the aim of yielding new knowledge that is useful for their practice.
ª 2012 Elsevier Ltd. All rights reserved.

Introduction
In nursing education students are exposed to nursing theo-
ries and are expected to integrate theory with practice.
The average staff nurse, on the other hand, would probably
maintain that theory is principally an academic exercise
with little relevance to the daily realities of ‘hands on’
* Corresponding author. Tel.: +1 403 220 4640; fax: +1 403 284
4803.
E-mail addresses: grmreay@ucalgary.ca (G. Reay), rankin@
ucalgary.ca (J.A. Rankin).
nursing (Doane and Varcoe, 2005). However, with the cur-
rent emphasis on evidenced based practice (Canadian
Nurses Association, 2007; DePalma, 2009; Sigma Theta Tau
International Honor Society of Nursing, 2005) it is important
that nurses have a sound understanding of theory and its
relationship to practice. The aim of this paper is not to offer
an exhaustive description of theory, but rather to present
an overview of how theory is commonly conceptualized.
The intent is to provide a description of the concept of
theory that is understandable and useful, and to discuss
theory development in relationship to emergency triage
nurse decision-making (DM).

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http://dx.doi.org/10.1016/j.ienj.2012.03.010

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Emergency Nursing (2012), http://dx.doi.org/10.1016/j.ienj.2012.03.010
2 G. Reay, J.A. Rankin
Theory in research
The word theory used in a colloquial sense is different from
the use of theory in science. Theory is often used in everyday
conversation in an informal manner. For instance, one might
say; ‘My theory is that the emergency department (ED) is
getting busier since we moved into a new building’. While
this statement may be based on empirical observation, the-
ory in this context is being used in relation to its everyday
usage, which contrasts with how theory is used in science.
Chinn and Kramer (2008) indicate that the definition of em-
piric theory is dependent on how it is conceptualized. Theory
can be viewed as a set of strictly connected hypotheses, a
set of loosely connected ideas, or theory can be a set of
philosophical based beliefs about our existence (Chinn and
Kramer, 2008). This pluralistic view of theory encompasses
theory from both quantitative and qualitative research.
Quantitative research derives its philosophical underpin-
nings from positivism and the positivist research tradition
has strongly influenced how theory is traditionally conceptu-
alized in science (Risjord, 2010; Rodgers, 2005). Theory de-
fined from a positivist perspective is often referred to as the
received view of theory (Risjord, 2010). The purpose of the-
ory developed from this perspective is to explain and predict
events (Rodgers, 2005). If events can be predicted then
there is also the possibility of attempting to control the out-
come by introducing a causative event. The cause and effect
relationship forms the basis for experimental research meth-
ods (Rodgers, 2005). Powers and Knapp (1995) define scien-
tific theory as ‘a set of statements that tentatively describe,
explain, or predict relationships among concepts that have
been systematically selected and organized as an abstract
representation of some phenomenon’ (pp. 170–171). A the-
ory in this sense contains concepts, definitions, and proposi-
tions about relationships (Chinn and Kramer, 2008; Fawcett,
1978; Polit and Beck, 2012). Concepts, which are the build-
ing blocks of theory, need to be carefully defined (Chinn
and Kramer, 2008; Liehr et al., 2009). Two types of defini-
tions are necessary in order to define a concept: conceptual
and operational. Conceptual definition refers to the specific
meaning of the concept that is being studied, and is derived
from theoretical literature and experience (Chinn and Kra-
mer, 2008; Liehr et al., 2009). An operational definition oc-
curs when a researcher defines something, such as a variable
or a concept, with respect to the specific process or instru-
ments used to measure the variable (Bridgman, 1959; Liehr
et al., 2009). Moreover, the operational definition refers to
the observable effects of a concept and represents the con-
nection to the empirical world (Fawcett, 1978; Rodgers,
2005). Empirical refers to that which is observable and mea-
surable. For example, accuracy in DM by emergency regis-
tered nurses (RNs) could be operationalized as the level of
agreement between their actual triage decisions in compar-
ison with a triage scale such as the Canadian Triage and Acu-
ity Scale (Rankin et al., 2011). In a theory concepts are
linked by propositions about their relationship (Fawcett,
1978; Chinn and Kramer, 2008). Commonly terms such as,
‘is associated with’ or ‘varies with’ are used to describe
these relationships (Polit and Beck, 2012). An example would
be, ‘The amount of the triage nurse’s experience is associ-
ated with a higher number of accurate triage decisions’.
Please cite this article in press as: Reay, G, Rankin, JA, , The application of theory to triage decision-making, International
Emergency Nursing (2012), http://dx.doi.org/10.1016/j.ienj.2012.03.010
Relationship between theories and hypothesis
As stated earlier theories are abstract generalizations about
the relationship between at least two concepts. In order to
test theories researchers commonly develop hypotheses,
which are testable, as links to the empirical world (Higgins
and Moore, 2000). A hypothesis is a prediction derived from
a theory about the manner in which variables are related if
the theory were true (Chinn and Kramer, 2008). The hypoth-
esis is developed deductively from the general to the partic-
ular (Fawcett, 1978). Concepts are operationalized as
variables and the variables are stated in empirical, testable
terms (Liehr et al., 2009). The simplest form of a hypothesis
contains an independent variable (the cause) and a depen-
dent variable (the effect) with a statement expressing the
expected relationship between the two variables (Chinn
and Kramer, 2008; Polit and Beck, 2012).
A hypothesis can also be developed inductively from an
observed empirical relationship, in other words from the
particular to the general (Chinn and Kramer, 2008; Fawcett,
1978; Liehr et al., 2009). For instance, an emergency nurse
may observe that an experienced triage nurse is better at
recognizing patients at risk for adverse events compared
with an inexperienced nurse. Based on this observation
the nurse inductively develops the following hypothesis,
‘‘Triage nurses with more than 5 years of triage experience
are more likely to triage patients correctly according to the
Canadian Triage and Acuity Scale than triage nurses with
less than 5 years of triage experience’’. This hypothesis is
not based on any particular theory. Another emergency
nurse may have conducted a literature review of DM and
developed the same hypothesis deductively from Klein’s
recognition primed decision (RPD) model (Klein, 1998). In
this case, the hypothesis is derived from, if not a theory
at least a model. According to Klein (1998) experts are able
to quickly recognize a situation and reach a high number of
correct decisions. The nurse can then develop a research
plan and test the hypothesis. Findings never prove a hypoth-
esis; instead they are said to support or not support a
hypothesis. If several hypotheses, which are derived from
the same theory are supported through testing the credibil-
ity of the theory is strengthened (Polit and Beck, 2012).
Types of theories
Theories can be viewed according to their purpose or based
on their level of abstraction. Theories that are sub-divided
according to their purpose can be thought of as explanatory,
predictive, or descriptive (Polit and Beck, 2012; Powers and
Knapp, 1995). Explanatory theories aim to explain a rela-
tionship or association between two variables. For instance,
Thompson et al. (2008) used signal detection theory to ex-
plain how critical care experience and time pressure im-
pacted the ability of nurses to correctly identify and
intervene for patients at risk for an adverse event. Nurses
(n = 241) from the United Kingdom, Netherlands, Australia,
and Canada were presented with power point vignettes of
patient scenarios either while under time pressure, or while
not under time pressure. Thompson et al. (2008) found that
when experienced critical care nurses were presented with
patient scenarios under time pressure their DM ability was
The application of theory to triage decision-making
negatively impacted. According to signal detection theory
an individual has to decide whether a stimulus actually rep-
resents a true signal, or whether the stimulus is irrelevant
(Wickens and Carswell, 2006). Individuals have a threshold
for when they will initiate action and this threshold is influ-
enced by both perceived costs of false responses and bene-
fits of correct responses. Thompson et al. (2008) suggested
that signal detection theory can be a useful way of concep-
tualizing why nurses vary in their decisions to intervene in
similar clinical scenarios.
Predictive theories are used to predict an expected out-
come of an event (Dickoff et al., 1968). Dakin (2006) used
Bandura’s social cognitive theory as the theoretical founda-
tion to study the effect of self-efficacy and outcome beliefs
in emergency patients as predictors of adherence to dis-
charge instructions regarding laceration care and suture re-
moval. Bandura (1977) proposed that an individual’s belief
about his or her ability to successfully complete a task
(self-efficacy) determines how much effort the individual
will utilize in attempting to complete the task. Dakin
(2006) developed a wound care questionnaire, which was
based on Bandura’s theory, to measure self-efficacy and
outcome beliefs in emergency patients who were sutured
in the ED. Findings indicated that high self-efficacy beliefs
correlated positively with adherence to discharge instruc-
tions and return to the ED for suture removal. In other
words, in this particular setting it was found that Bandura’s
social cognitive theory could be used to predict future
behavior of a certain subset of patients.
The aim of descriptive theories is to depict phenomena as
they occur (Oberle and Raffin Bouchal, 2009) with a view to
extract common themes (Rodgers, 2005). Descriptive theo-
ries are often used when little is known about the area of
interest. In a descriptive theory concepts are more loosely
connected than in predictive or explanatory theories. The in-
tent is not to determine causal relationships but to try and
understand what is going on in a particular context (Rodgers,
2005). Qualitative researchers often use descriptive theories
(Rodgers, 2005). An example is Edwards and Sines (2008)
grounded theory study of how emergency triage nurses con-
duct the process of initial assessment. Edwards and Sines
(2008) developed a theory of initial assessment at triage.
They concluded that triage may be viewed as a socially con-
structed interactive process in which both nurses and pa-
tients participate to create meaning of the situation. As can
be seen from the preceding description there is no attempt
to determine that a particular cause leads to a certain effect.
Theories may be classified as grand, middle range, or mi-
cro-range theories (Chinn and Kramer, 2008; Higgins and
Moore, 2000; Risjord, 2010; Rodgers, 2005); the latter are
also known as situation specific theories (Liehr et al.,
2009; Risjord, 2010).
Grand theories represent the most abstract level of the-
ory. These theories are broad in scope and according to
some authors aim to provide broad explanations of nursing,
see Table 1 (Higgins and Moore, 2000; Im and Meleis, 1999;
Rodgers, 2005). According to Rodgers (2005) the high level
of abstraction in grand theory means that they are difficult
to test, and the theories do not provide specific direction
for actions to be taken (Im and Meleis, 1999). Fawcett
(2005) maintains that grand theories cannot be tested
empirically because their concepts cannot be operationally
Please cite this article in press as: Reay, G, Rankin, JA, , The application of theory to triage decision-making, International
Emergency Nursing (2012), http://dx.doi.org/10.1016/j.ienj.2012.03.010
3
defined. An example of a grand theory would be Rogers’ Sci-
ence of Unitary Human Beings in which ‘human beings are
dynamic energy fields integral with environmental fields’
(Gunther, 2006, pp. 246). Human energy fields and environ-
mental fields are not concepts that can be operationalized
and tested. According to Gunther (2006), Rogers’ so called
theory is an abstract system that does not identify empiri-
cally testable concepts.
Middle range theories provide the link between abstract
concepts and practice (Liehr et al., 2009). Middle range the-
ories can be generalized across fields of nursing, but are not
as broad in scope as grand theories (Higgins and Moore,
2000; Im and Meleis, 1999). The more specific nature of mid-
dle range theories make it possible to operationalize their
concepts and subject the theories to empirical testing (Hig-
gins and Moore, 2000). Micro-theories, or situation specific
theories, are the most specific theories and are narrow in
scope. They are limited to certain populations and contexts,
and are often used to test working hypotheses about specific
relationships (Higgins and Moore, 2000; Im and Meleis,
1999).
As can be seen from the above discussion the level of
theory reflects its purpose. For instance, a middle range
or micro-range theory can be explanatory, predictive or
descriptive; whereas grand theory is neither explanatory
nor predictive. It could be argued that grand theory is
descriptive in the sense that the aim is to provide a high le-
vel description of nursing. However, nursing is complex in
which knowledge is used from diverse fields such as, for
example, biology, sociology, psychology and neurosciences.
It is not plausible that one theory can describe the complex-
ities of nursing. Risjord (2010) argues that grand theories
are not theories at all, but rather philosophical conceptual-
izations of nursing. If grand theories are thought of in these
terms it might be more useful to refer to them as models.
Theories and models
Any exploration of theory must also include a discussion of
the relationship between theories, models, and frame-
works. As previously stated theories are abstract systematic
generalizations of concepts and how these concepts are re-
lated. Researchers deductively derive hypotheses from the-
ories and test them. Conceptual models are at a higher level
of abstraction than theories. The models are not as rigid as
theories and the aim is to convey a broad understanding of
the phenomenon of interest (Polit and Beck, 2012; Rodgers,
2005). A model is not directly testable, but the model can
guide theorizing by providing a framework (Risjord, 2010).
Researchers commonly refer to theoretical frameworks
and conceptual frameworks. Frameworks provide guidance
and road maps for a study. In the nursing literature the
terms theoretical framework and conceptual framework
are often used interchangeably (Chinn and Kramer, 2008).
To confuse matters further some authors suggest that the
terms theoretical framework and conceptual framework
have been used with reference to grand theories (Rodgers,
2005).
The authors’ purpose is not to get entangled in a theoret-
ical discussion about the differences between conceptual
models, levels of theories, and frameworks; rather the
4 G. Reay, J.A. Rankin
intent is to discuss emergency triage nursing DM in relation
to theory development.
Emergency triage nursing
The term triage stems from the French verb trier, meaning
to separate, sort, sift or select. Triage first became known
during the First World War as a process of sorting patients
according to who should be treated first (Andersson et al.,
2006). The essence of emergency triage is a rapid focused
assessment with the objective of identifying patients who
require immediate attention, and to prioritize other pa-
tients according to acuity (Cone and Murray, 2002; Cioff,
1998).
Triage is traditionally conducted by emergency nurses
and has been described as a dynamic DM process (Gerdtz
and Bucknall, 2001; Patel et al., 2008). Triage nurses assess
emergency patients, assign an acuity score, prioritize pa-
tients in order to be examined by a physician, and determine
an appropriate treatment space in the ED. These multiple,
simultaneous decisions occur in an environment of uncer-
tainty (Cioff, 1998). The triage nurse is required to formu-
late a decision based on limited information regarding the
patient and the DM process often occurs under pressure of
time in a stressful environment (Edwards and Sines, 2008).
An incorrect triage decision has the potential to adversely
affect the health of the patient if a serious condition is over-
looked. Therefore an understanding of the processes and
strategies that triage nurses use to formulate decisions is
an important component in enhancing patient safety.
Theory and decision-making
Decision-making and triage nursing has been studied by sev-
eral researchers, but few have conducted the research using
an explicitly stated theory or model. Goransson et al. (2008)
provided a brief overview of information processing theory,
cognitive continuum theory, and intuitive approach to DM in
relation to their study of DM processes of Swedish triage
nurses (n = 16). They used, what is termed, the think-aloud
method. The participants were presented with patient sce-
narios and encouraged to think aloud as they reasoned to
reach a triage decision. Goransson et al. (2008) reported
that they did not find any support for the intuitive approach.
However, they did suggest that an individual’s ability to ad-
just to large amounts of information, and information pro-
cessing theory may offer an explanation for the variety in
triage decisions.
A more comprehensive discussion of DM theories was of-
fered by Cioff (1998) who conducted a study of Australian
triage nurses (n = 20) using the think-aloud method in order
to investigate the effects of experience and uncertainty on
DM. Cioff (1998) identified the heuristics and biases per-
spective as conceptualized by Tversky and Kahneman
(1974) as the underlying theoretical foundation for the
study, in combination with Benner’s (1984) work on intui-
tion. Heuristics are mental shortcuts that individuals use
when making complex decisions. Heuristics are generally
helpful, but can lead to systematic errors, which are called
biases (Tversky and Kahneman, 1974). One example of a
heuristic is, anchoring, the ease with which a recent event
Please cite this article in press as: Reay, G, Rankin, JA, , The application of theory to triage decision-making, International
Emergency Nursing (2012), http://dx.doi.org/10.1016/j.ienj.2012.03.010
comes to mind and then influences subsequent decisions
(Tversky and Kahneman, 1974). For instance, a triage nurse
who has just triaged a patient with a myocardial infarction
will be more likely to think that the next patient who pre-
sents with chest pain is infarcting. Cioff (1998) reported
that experienced nurses used more heuristics than inexperi-
enced nurses, and that in conditions of uncertainty both
inexperienced and experienced nurses used more probabil-
ity judgments.
The most clearly stated use of theory in DM research in
the context of triage nursing was provided by Arslanian-Eng-
roen (2009). Arslanian-Engroen (2009) used Hammond’s
(1964) lens model and Evans’ (1984) 2-stage reasoning pro-
cess to develop a 7-stage conceptual model to guide her fo-
cus group study of triage nurses’ cardiac DM (n = 12). Simply
stated lens models are conceptual representations of how
on one hand, multiple cues in the environment are related
to a certain outcome (criterion) and how on the other hand,
inferences made by the individuals about these cues are
used in making a judgment (Hammond, 1964; Karelaia and
Hogarth, 2008).
The accuracy of a decision depends on how well the cues
actually predict a certain outcome and if the decision maker
relies on the most valid cues (Hammond, 1964; Karelaia and
Hogarth, 2008). Evans (1984) proposed a theoretical frame-
work for DM in which the individual first attends to those
features that are perceived as relevant and then proceeds
to reason analytically about these features. Arslanian-Eng-
roen (2009) used the synthesized conceptual model of emer-
gency nurses’ cardiac triage decisions which she developed
based on Hammond’s (1964) and Evan’s (1984) theories to
guide the development of questions for three focus groups.
The participants were asked to describe how they deter-
mined the cause of a patient’s chief complaint, how they
determined relevant cues, collected data, and decided on
actions. Findings indicated that nurses rely on empirical
data, personal beliefs and attitudes, nursing knowledge,
and ED experience when making cardiac triage decisions.
The recognition primed decision model
As described earlier emergency triage nurses make decisions
in an environment of uncertainty, under time pressure, and
with limited information available. Naturalistic decision
making (NDM) is a branch of cognitive psychology that
emerged in the 1980s in which researchers sought to under-
stand how skilled decision makers reach decisions in real
world settings (Klein, 2008). Naturalistic decision making
researchers are interested in dynamic contexts with time
pressure, uncertainty, high stakes, ill defined goals, incom-
plete information, cues that are changing, and decisions
that involve multiple persons. (Kahneman and Klein, 2009;
Klein, 1998; Lehto and Nah, 2006; Lipshitz et al., 2001).
Individuals from a variety of fields such as navy command-
ers, nuclear power plant operators, airline pilots, nurses, and
anesthesiologist have been studied by NDM researchers
(Klein, 2008). Klein and associates developed the recognition
primed decision (RPD) model based on their early work with
fire ground commanders in 1986 (Kahneman and Klein, 2009;
Klein, 1998). Lipshitz et al. (2001) describe the RPD model as
the ‘prototypical’ NDM model (p. 335).
The application of theory to triage decision-making
Table 1 Levels of theory.
Characteristics Grand theory Middle range theory
Level of abstraction High Medium
Aim Describe nature Explain concepts across
and goal of nursing patient populations
Testable No Yes
Guide for clinical action No Some
Level of context Low Medium
Higgins and Moore (2000), Im and Meleis (1999) and Rodgers (2005).
The RPD model is a conceptualization of the processes
used by experienced decision makers to formulate deci-
sions. The model describes how people use their experience
to make rapid decisions in time-pressured settings under
conditions of uncertainty (Klein, 2008, 1998; Lipshitz
et al., 2001). Klein (1998) argues that in situations with lim-
ited time available individuals do not carefully evaluate all
the options and then make a decision, instead they follow a
process that is more closely aligned with the RPD model.
The underlying assumption is that skilled decision makers
are usually able to select a viable option as the first option
selected. Three variations of DM are described in the model
(Klein, 1998). The first variation involves recognition of a
situation as typical with pattern recognition and selection
of a course of action. The decision maker understands what
the goals are, is able to select the pertinent cues, knows
what to expect next, and can implement the typical ways
of responding. In the second variation the situation is atyp-
ical and the decision maker responds to the ambiguity of the
situation by trying to build a story of events leading up to
the incident. The story building is an attempt to account
for the unexpected in the situation. The third variation in-
volves mentally simulating a course of action and either
selecting the course of action, adapting it, or rejecting it
according to how it plays out. If the course of action is re-
jected, the decision maker proceeds to mentally simulate
the next option (Klein, 1998). Klein (2008) writes that the
RPD model is a combination of intuition and analysis. Pat-
tern matching involves intuition, and mentally simulating
an option involves analytical reasoning. Both are necessary
according to Klein (2008), because pattern matching based
on intuition alone may lead to faulty options, and using only
analytical reasoning would be too slow in time pressured sit-
uations. For example, a triage nurse who relies on intuition
alone may neglect to obtain qualifying factors with regards
to a patient’s chest pain and simply triage all cases based on
a previous serious patient presentation, which may lead to
inappropriate utilizing of ED space. On the other hand, a tri-
age nurse who spends a long time assessing and analyzing
the presentation of a patient with obvious cardiac chest
pain delays necessary treatment.
Summary
The intent of this article has been to offer a description of
the concept of theory that is understandable and useful.
Scientific theories are abstract statements that offer a sys-
tematic explanation of how concepts are related (Polit and
Please cite this article in press as: Reay, G, Rankin, JA, , The application of theory to triage decision-making, International
Emergency Nursing (2012), http://dx.doi.org/10.1016/j.ienj.2012.03.010
5
Situation specific theory
Low
Explain specific phenomena
limited to a certain patient
population within a particular context
Yes
Yes
High
Beck, 2012). Risjord (2010) argues that theory can be
thought of in terms of questions and answers, and that sci-
entific theories answer questions that arise either from
other theories or from experience. According to Risjord
(2010) the discipline of nursing must also answer questions
that arise from practice. Doane and Varcoe (2005) argue
that practice and theory development is an integral action
orientated process. Furthermore Risjord (2010), writes that
nursing knowledge is the knowledge that is useful for
nurses, whether the knowledge is derived from the disci-
pline of nursing or other disciplines.
It has also been argued that many, so called, nursing the-
ories are abstract and offer little concrete guidance for prac-
tice (Lundh et al., 1988). Lundh et al. (1988) question the
utility of nursing theories arguing that most nursing theories
are too abstract with complicated jargon offering limited
guidance in real life situations. Furthermore they argue that
many nursing theories are a complicated way of stating the
obvious. Theory in order to be useful for practicing RNs,
needs to be anchored in practice, based on sound scientific
principles, address issues that are relevant to everyday nurs-
ing practice, and lead to a meaningful change in practice.
One of the authors (G.R.) intends to explore the pro-
cesses and strategies that expert triage RNs use when mak-
ing triage decisions for her doctoral research. The question
of how nurses formulate triage decisions arose from the
author’s own practice as a triage nurse in an overcrowded
ED in Western Canada with long wait times for patients. It
is expected that an understanding of how triage decisions
are formulated may lead to a change in practice to increase
patient safety. Few studies exist in which triage nursing and
DM have been investigated using either a clearly stated the-
ory of DM, or a conceptual model.
The RPD model has been developed based on how skilled
decision makers formulate decisions in real life situations
under uncertain and stressful conditions with limited time
available, high stakes, incomplete information, shifting
goals, and changing cues (Klein, 1998). The triage environ-
ment is a context that is congruent with the RPD model.
To date the authors have not been able to identify any stud-
ies of triage nurse DM in which the RPD model has been used
as a framework. The RPD model could offer a foundation for
research that aims to develop a theory of triage nurse DM.
Conclusion
Theory should not be thought of as an abstract entity, instead
theory needs to be understood and used in everyday nursing
6 G. Reay, J.A. Rankin
practice. A better understanding of what theory is, and what
theory is not may contribute to an increased use of theory in
clinical nursing practice. Research that is conducted using
questions that arise in actual practice situations, and that
is based on previous theoretical knowledge and experience,
can provide an avenue for theory development that is useful
and meaningful in everyday nursing practice.
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