Abstract
The connection between theory and research is vital. In this paper, Dr. Fawcett presents her views of her life as a researcher. The importance of early mentoring is addressed as is the impact of her research on nursing science.
In a previous paper (Fawcett, 2013), Dr. Fawcett described her life as a metatheorist. In this dialogue, she expands on her life and the application to research. The dialogue should be particularly interesting to future researchers who are developing their careers in nursing science.
In today’s world it is sometimes difficult to get young professionals interested in a life of research. Tell me what stimulated your interest in research and the key factors in making decisions about your career. Was it the mentorship you received or something else?
I have been a researcher for more than 40 years. My primary mentors were Florence Downs and Martha Rogers, who catalyzed my thinking about research and helped me to appreciate that a nurse could focus on research as a major career goal. Specifically, I found what I regard my “place” in nursing in 1969 when I was taking Florence Downs’ nursing research course as part of my master’s degree studies at New York University. My commitment to living the life of a nurse researcher came as I began to plan my doctoral dissertation in 1975, also at New York University. With increasing certainty, I realized that research was what I wanted to do. The qualitative and quantitative elements of research guided by a nursing conceptual model became more and more stimulating and satisfying as I progressed toward attainment of my goal of being a nurse researcher.
I regard research as a formal, systematic, and rigorous process of inquiry used to generate and test the concepts and propositions that comprise middle-range theories and situation-specific theories, which are derived from or linked with a conceptual model. All modes of inquiry in all disciplines—whether empirical or nonempirical or qualitative or quantitative—are conducted for the purpose of developing middle-range theories and situation-specific theories, that is, discovering or generating new theories and testing existing theories. Every theory development effort is based on a more abstract frame of reference, that is, a conceptual model. Consequently, all research is conducted to not only determine the empirical adequacy of the middle-range or situation-specific theory that was generated or tested but also the legitimacy of the parent conceptual model. I realized the centrality of middle-range and situation-specific theory development in all research after repeated readings, beginning in 1969, of Fred Kirlinger’s classic text, Foundations of Behavioral Research. Kerlinger (1964) stated very simply that the aim of research is theory. My understanding of the centrality of theory development as the focus of research, and the role of a conceptual model in guiding the research, was strengthened by reading Sir Karl Popper’s 1965 book, Conjectures and Refutations, as well as many journal articles that focus on the explication of the postpositivist philosophy of science. Popper (1965), a physicist turned philosopher of science, told us:
The belief that science proceeds from observation to theory is still so widely and so firmly held that my denial of it is often met with incredulity. I have even been suspected of being insincere—of denying what nobody in his senses can doubt. But in fact the belief that we can start with pure observations alone, without anything in the nature of a [framework], is absurd… Observation is always selective. It needs a chosen object, a definite task, an interest, a point of view, a problem. And its description presupposes a descriptive language, with property words; it presupposes similarity and classification, which in its turn presupposes interests, points of view, and problems… A point of view is provided . . . for… scientist[s] by [their] theoretical interests, the special problems under investigation, [their] conjectures and anticipations, and the [conceptual model that they] accept as a kind of background: [that is, their] frame of reference, [their] horizon of expectations. (pp. 46-47)
Every theory is shaped by an a priori frame of reference, that is, a conceptual model that guides theory-generating and theory-testing research by directing the questions that are asked and how they are asked. In particular, each conceptual model functions as an umbrella, the fabric and ribs of which are concepts and propositions that guide theory- generating and theory-testing research. As the philosopher, Carl Hempel (1970) explained, “The specification of the [conceptual] model determines in part what consequences may be derived from the theory and, hence, what the theory can [describe,] explain or predict” (p. 157). Educational psychologist Ronald Serlin (1987) extended discussion to the role of conceptual models and middle-range theories as guides for selection of statistical procedures. He pointed out that “statistics and theory inform each other . . . [such that] any statistical analysis whose purpose is not determined by theory, whose hypothesis and methods are not theoretically specified, or whose results are not related back to theory must be considered . . . [a] hobb[y]” (p. 371).
Would you describe your programs of research, specifically focusing on the knowledge gained and support for the theories?
My understanding about the influence of explicit nursing conceptual models on nursing theory development was formed after course work and discussions with Martha Rogers, which has been strengthened by my own research and that of my students since 1976. Given my understanding of how conceptual models guide theory development through empirical research, it is not surprising that my programs of research have been based on explicit conceptual models of nursing and are made up of theory-generating or theory-testing studies.
Rogerian Science-Based Research
The first program of research, which started with my doctoral dissertation, was guided by the framework of the family as a living open system (Fawcett, 1975), which is an extension to the family of what we now call Rogers’ science of unitary human beings. That program of research focused on testing a theory that asserted spouses’ strength of identification is positively related to similarities in their patterns of change in body image and physical and psychological symptoms during and after pregnancy. I tested the theory in a series of studies of childbearing families, some of which were conducted with colleagues in the United States and in Canada, and with much help from master’s and doctoral student research assistants. The findings of our studies revealed that the theory as tested was not empirically adequate. However, we did find some similarities in spouses’ physical and psychological symptoms during and after pregnancy. These findings indicate that nurses should include men in their discussions with women about pregnancy and postpartum, to better prepare both genders for the many changes that occur during the childbearing period of life.
The products of that research are my doctoral dissertation and many journal articles, including one methodological issues article and several reports of the research. Examples of the publications are Fawcett (1977), Fawcett, Bliss-Holtz, Haas, Leventhal, and Rubin (1986), and Drake, Verhulst, Fawcett, and Barger (1988).
Roy Adaptation Model-Based Research
The second program of research, which began in 1979, was derived from Callista Roy’s adaptation model. The first component of that research program focused on generating and then testing a predictive theory asserting that comprehensive antenatal preparation for unplanned cesarean birth diminishes new mothers’ pain intensity and distress, and enhances self-esteem, functional status, positive feelings about the baby, and positive changes in the quality of the marital relationship. That study was conducted with the assistance of a nursing practitioner, a statistician, and baccalaureate, master’s, and doctoral student research assistants. Our theory was not supported. Instead, we found that the outcomes of our experimental antenatal childbirth preparation intervention did not differ from standard antenatal childbirth preparation. We speculated that the lack of differences was due to the inclusion of content about cesarean birth, which had begun at about the same time as our study began, in standard childbirth preparation classes. The products of that research are reports published as a book chapter and journal articles. An example of the publications is Fawcett et al. (1993).
The cesarean birth research continued for more than 30 years, with studies focused on testing an explanatory theory of women’s perceptions of and responses to cesarean birth. The studies were conducted with colleagues from the University of Massachusetts Boston and other universities and a healthcare agency in the United States, as well as with colleagues from Finland and Australia, with a master’s degree student at Hampton University, and with graduate student research assistants. A hallmark of the studies was the integration of teaching, research, and practice, especially by undergraduate students who conducted assessments of women who had experienced a cesarean birth. The information gathered during the assessments was, with the permission of the women and Institutional Review Board approval, used as data for our research. In addition, nurse practitioners at one healthcare agency collected data for one of the studies. The products of this research are several journal articles, with the culmination of this component of the Roy adaptation model-based program of research the publication of a report of a multisite international study of women’s perceptions of and responses to cesarean birth (Fawcett et al., 2011). The findings of all of these studies indicate that some women continue to regard cesarean delivery birth less favorably than vaginal delivery, although negative perceptions and responses have decreased over the years as the cesarean birth rate has increased. The high rate may be due to women now viewing cesarean birth as a “normal” mode of delivery.
The second component of the Roy adaptation model-based research program focused on functional status during normal life transitions and serious illness. I shared that research program with my University of Pennsylvania colleague, Dr. Lorraine Tulman. Lorraine and I, along with doctoral students and a postdoctoral fellow, focused some of our work on the development and psychometric testing of instruments to measure changes in functional status experienced by individuals with various life events and health conditions, including childbearing, aging, cancer, multiple sclerosis, end-stage kidney disease, cardiovascular disease, chronic pain, and orthopedic problems. Each instrument reflects a test of a theory derived from the Roy adaptation model role function mode asserting that functional status is a multidimensional concept addressing the extent to which an individual actually performs usual activities associated with his or her primary, secondary, and tertiary roles. The theory was expanded in later research to include the extent to which an individual not only actually performs usual activities, but also the extent to which the individual would like to perform those activities. Our first instrument development study was reported in Fawcett, Tulman, and Myers (1988). Additional products of the instrument development work are book chapters and several other journal articles.
Other Roy adaptation model-guided instrument development work, conducted with my University of Pennsylvania colleague, Ann Burgess, was development of the Comprehensive Sexual Assault Assessment Tool. The product of that work is a journal article in which we reported the development of the tool, including how the Roy adaptation model guided selection of tool items (Burgess & Fawcett, 1996).
Concurrent with our instrument development research was our Roy adaptation model-based normal life transitions research that focused on testing a theory asserting that demographic, individual psychosocial, and family variables are related to women’s functional status during pregnancy and the postpartum. Lorraine Tulman and I conducted two major longitudinal studies of correlates of changes in functional status during childbearing, with much help from master’s and doctoral student research assistants. Lorraine and I were particularly interested in following up our initial cross-sectional research with longitudinal studies to track changes in women’s functional status and the variables that influence those changes. From a policy perspective, we were particularly concerned about data-based decisions regarding length of maternity leave. We found that inasmuch as the women do not return to full functional status even by six months postpartum, the typical six-week maternity leave in the United States is not sufficient. The products of that research are a book (Tulman & Fawcett, 2003) as well as journal articles and a book chapter.
Concurrent with our normal life transitions research, Lorraine Tulman and I launched a parallel pilot study focusing on functional status during serious illness. That research was designed to test a theory asserting that demographic, physiologic, and individual psychosocial variables are related to women’s functional status following diagnosis of breast cancer. We conducted the study with help from a doctoral student research assistant. Our pilot study sample was too small to draw any definitive conclusions about the theory, although the calculated effect sizes indicated that the theory should be much more parsimonious. The products of that work are two brief reports published in journals; see, for example, Tulman and Fawcett (1996).
Other Roy adaptation model-based research focused on adaptation during serious illness. Lorraine Tulman and I collaborated with Dr. Nelda Samarel, who was particularly interested in testing a theory asserting that cancer support groups have a positive effect on adaptation to breast cancer. We completed two major clinical trials. We were surprised to find that cancer support groups do not always have the positive effects so often cited in the literature. The products are several reports published as journal articles, examples of which are Samarel, Fawcett, and Tulman (1997) and Samarel, Tulman, and Fawcett (2002).
In addition, an acquaintance who has multiple sclerosis, two doctoral students, and I conducted two studies of individuals’ adaptation to multiple sclerosis, including their functional status. Our findings suggested that functional status is compromised even in the early stages of multiple sclerosis although our study participants indicated willingness to continue their usual pre-disease activities of daily living as much, and as often, as possible. The products of that work are three reports published as journal articles. An example of the publications is Fawcett, Sidney, Riley-Lawless, and Hanson (1996). Noteworthy is that the desire to continue usual activities of daily living has been a common finding across our studies of functional status reported by people experiencing various life events and health conditions.
Another study of adaptation to serious illness focused on young adults’ health-related quality of life after treatment for Hodgkin’s lymphoma. My University of Massachusetts Boston colleague, Mary Cooley, and I served as mentors for a group of nurses working at a comprehensive cancer center who had observed that young adults with Hodgkin’s lymphoma appeared anxious as treatment ended; the nurses speculated that end of treatment was a time of feeling abandoned by the healthcare system. Our longitudinal data indicated that the research participants reported improved quality of life during the first six months after treatment ended, and that they used a variety of support services to assist them with continuing improvement in their quality of life after active treatment ended. Noteworthy was that although support services initially focused on economic issues, by six months following end of treatment, nutrition and fitness support services were most commonly used. Our findings suggest that the support services mitigated feelings of abandonment. The products of that work are two journal articles, one of which is Roper, McDermott, Cooley, and Fawcett (in press).
Conceptual Model of Nursing and Health Policy-Based Research
An emerging program of research is being guided by the conceptual model of nursing and health policy (Russell & Fawcett, 2005). This conceptual model already has been used to guide several doctoral dissertations by University of Massachusetts Boston nursing students. To date, the products of that research are the students’ dissertations and their journal articles. In addition, the conceptual model of nursing and health policy has been used to guide a study of the work of nurse case managers that I conducted with my University of Massachusetts Boston Department of Sociology colleague, Russell Schutt, with assistance from master’s and doctoral student research assistants. The report of that study was published as a journal article (Fawcett, Schutt, Gall, Riley-Cruz, & Woodford, 2007). Currently, Russell and I are completing data analysis for a study of the work of case managers and patient navigators.
To what extent have you been able to obtain funding for your research?
Yes. Indeed, lest you doubt that research that is guided by an explicit conceptual model of nursing can be funded or published, I am pleased to tell you that my colleagues and I have received more than $1,000,000 in funding from federal agencies, clinical specialty organizations, Sigma Theta Tau International, university foundations, and schools of nursing. In addition, we have published more than 50 reports of our research in peer-reviewed journals. We have been very pleased to have such a positive response to our grant applications and paper submissions, especially since so many nurses claim that conceptual models of nursing are not a necessary component of research and that articulation of the theories that are represented by research findings is not the purpose of research.
Clearly your research has been very fulfilling in your life. Would you describe what all of the research meant to you personally?
The research has been both challenging and a source of joy. Although designing rigorous good research is always a challenge, joy comes from the privilege of developing new knowledge that has the potential to enhance people’s lives. It is an honor to be a member of a discipline whose research findings (the theories that were generated or tested) serve as the evidence for evidence-based nursing practice. Working with colleagues and students is stimulating. Running computer programs yields satisfying, concrete answers in the midst of an otherwise abstract and never-ending enterprise. Interpreting the findings in light of the theory that was generated or tested and the parent conceptual model is, for me, the best part, the part that brings me back to metatheory (Fawcett, 2013). Although at this time in my career I am moving away from the conduct of research and focusing most of my scholarly work on metatheory, I continue to work with colleagues and students who are interested in the focus of these programs of research.
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the authorship and/or publication of this column.
Funding
The author received no financial support for the authorship and/or publication of this column.