Theory Development in Community Health Nursing: Issues and Recommendations
Hamilton, Patricia A. Rn, PhD, Bush, Helen A. Rn, PhD, Scholarly Inquiry for Nursing Practice
Although community health nursing celebrated its centennial in this country in 1986, a lack of conceptual clarity and a relative paucity of theory development persist in this field of nursing. Without conceptual clarity regarding the nature of community health nursing, progress in theory development in the field will encounter significant barriers.
Progress can be aided by systematic analysis and critique of a variety of strategies for developing community health nursing theory. This article focuses on the consequences of initiating community health nursing theory development from the points of view of theory, practice, or research. In addition, eight sources of ideas and data relevant to community health nursing are proposed.
Although community health nursing celebrated its centennial in this country in 1986, a lack of conceptual clarity and relative paucity of theory development persist in this field of nursing. While research has been conducted that has relevance for community health nursing, the research to date is diverse and lacks an explicit focus on development of theory specific to the field. Sills and Goeppinger (1985), in the Annual Review of Nursing Research, report only two studies appearing in the nursing literature between 1952 and 1983 in which investigators delimited the community as the target of the practice of nursing. Their finding is particularly disturbing when one considers that many experts propose that to consider the community as client is the distinguishing feature setting community health nursing apart as a unique field of nursing (American Public Health Association, 1982; Freeman, 1970; Robischon, 1975; Spradley, 1986; Watson, 1984; Williams, 1981).
The development of community health nursing has been influenced by social conditions, political changes, economic contingencies, war, and human need. Many public health, and later community health nursing, care practices were based on common sense, intuition, ritual, and tradition, as well as on medical and environmental science.
Efforts of community health nurses, along with progress in medical treatment, immunizations, sanitary conditions, and nutrition, have dramatically improved public health in the U.S. during the past 100 years. Many of the illnesses and health concerns of Americans today, however, are not easily prevented, treated, or ameliorated. Community health nurses face complex health problems such as childhood pregnancy, AIDS, cancer, and heart disease, all with multiple causalities. In addition, community health nurses find themselves in an uncertain economic environment. Shifts in government appropriations and private health care financing arrangements greatly influence the structure, process, and outcomes of community health nursing practice. A sound theoretical foundation for practice is needed if these health concerns are to be adequately addressed. Sills and Goeppinger (1985) warn, however, that the "American society in its present state seems less likely than it was in the 1970s to be willing to invest in the research needed to develop this field" (p. 20).
Efficient, cost-effective, and focused research in community health nursing is a priority need at this time in the U.S. This article presents a variety of strategies for developing community health nursing theory. Researchers are challenged to focus their attention on the generation of sound community health nursing theory and to do so with the most efficient use of the limited resources available for the task. This article does not advocate a singular strategy for theory development in community health nursing, but instead considers the wide range of research strategies and data sources that hold promise in community health nursing theory development.
The term community health nursing is used throughout the paper. It is acknowledged, however, that the term public health nursing was most often utilized prior to 1970. In addition, the term generic nursing refers to all types of nursing other than community health nursing. …