in search of applications of nursing theories: the nursing citation index

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In search of applications of nursing theories:the Nursing Citation IndexBy E. Diane Johnson, M.A.L.S.Head, Information Services

J. Otto Lottes Health Sciences LibraryUniversity of Missouri-ColumbiaColumbia, Missouri 65212

Cited author searches were conducted in Nursing Citation Index todetermine its utility in locating clinical studies that apply theconceptual frameworks of Dorothea Orem, Callista Roy, MarthaRogers, Betty Neuman, and Dorothy Johnson. Fully 75 percent of therelevant papers would have been missed by a conventional subject/textword search in the MEDLINE or CINAHL databases. Had NursingCitation Index not been available, only 22 percent of relevant paperscould have been retrieved by cited author searches of Social ScienceCitation Index. In summary, Nursing Citation Index provides animportant indexing link between nursing theory and nursingresearch.

THE PROBLEM

Several years ago, the staff of the J. Otto Lottes HealthSciences Library at the University of Missouri-Co-lumbia noticed that they were receiving a large num-ber of queries from nursing students seeking appli-cations of the work of various nursing theorists.Traditional bibliographic search techniques-bothcomputerized and manual-proved to uncover onlya small fraction of the universe of relevant literature.Many appropriate articles failed to mention their con-nection to the theorist in the title or, for that matter,in the abstract if one was available online. In additionthe controlled vocabularies used by the AJN Inter-national Nursing Index (INI) and the Cumulative Indexto Nursing and Allied Health Literature (CINAHL) didnot permit direct subject access for theory application.After attempting to locate applications of Orem's SelfCare Deficit Theory (SCDT), one nursing scholar la-mented:

In reviewing the literature related to Orem's SCDT, twomajor problems were noted. The term 'self care' is used ina variety of ways, so that literature searches are not exclu-sive to SCDT and not all reports based on SCDT are soreferenced and retrievable [1].

Other authors share her concern [2-3]. In fact, it isnot unheard of for nurse researchers to report paging

through ten to thirty years worth of Nursing Researchand similar titles to locate research related to nursingmodels [4-5].An alternative to a conventional subject/textword

search for this type of information was a cited authorsearch of the theorist in question. Frequently, how-ever, these searches proved unsatisfactory because ofscanty nursing journal coverage. As of 1985, SocialScience Citation Index (SSCI) covered only eleven ofthe major nursing journals, while Science Citation Index(SCI) included only two.With the introduction of a Nursing Citation Index

(NCI) section of INI in 1986, cited author access tothe nursing literature was greatly expanded. It nowappears that the researcher will have a powerful aidin tracking down much of this elusive literature. Thisindex permits cited author searching for 157 of themajor nursing journals worldwide.

This study began with the working hypothesis thatNCI would prove useful in locating research that ap-plies the work of the various nursing theorists, andfurther, that many articles so retrieved would not beaccessible by other methods.

WHY A CITED AUTHOR APPROACH?

Librarians have long recognized the usefulness of acited author search to enhance the results of a con-ventional subject or keyword approach [6]. In theory,

Bull Med Libr Assoc 77(2) April 1989176

Nursing Citation Index

each time an author's work is cited by another, aconceptual link is established between the two. Thislink is not affected by changes in the terminology ofa discipline over time; neither is it dependent on theuse of a controlled vocabulary term as applied by anindexer [7].With citation indexing, each cited reference serves

as an access point. On the average, a scientific journalarticle has a bibliography containing fifteen refer-ences to previous works [8]. Therefore, using the citedreferences of a document as "content indicators" [9]provides a greater depth of subject access than is usu-ally afforded through conventional indexing, sincefew conventional indexes provide as many as fifteendescriptors.There have been some attempts to codify the re-

lationship between a citing paper and the items inits bibliography, that is, to classify cited papers bythe reasons they were referenced [10-11]. Garfield hasmentioned fifteen possible reasons for citing, two ofwhich are relevant to this investigation: "Identifyingoriginal publications in which an idea or concept isdiscussed," and "Identifying original publication orother work describing an eponymic concept or termas, e.g., Hodgkin's disease, Pareto's Law, Friedel-CraftsReaction, etc." [12].

Each time an author's work is cited by another, aconceptual link is established between the two.

Herein we find the relationship between applica-tion and theory that we are seeking. When a nurseconducts research by using the concepts, assump-tions, and theoretical framework of a given nursingmodel, it seems safe to assume that credit will begiven to the model and its creator through a referenceto the original work.Hence, the cited author approach would seem to

have two added advantages over a conventional ap-proach for identifying applications of nursing theo-ries. First, by virtue of the number of citations typi-cally found in the bibliography of an article, we areafforded additional access points, or what amounts toa greater depth of indexing. Second, cited referencescan serve to establish a conceptual or eponymic linkbetween two sources that is either elusive or absentwhen a search is conducted through conventionalaccess points.

DEFINITIONS

Many authors in nursing have attempted to distin-guish among the terms "theory," "model," and "con-ceptual framework," but much confusion and dissentremains as to the meaning of these terms. Most nurs-

ing scholars agree that models differ from theories intheir "level of abstraction" [13]. Models are not ame-nable to testing [14]; however, the theories which arederived from them are. Models provide the basic as-sumptions to guide research and aid in the creationof testable theories [15-16].

Despite this basic consensus, the terms continue tobe used almost interchangeably in the literature [17-18]. To add further fuel to the fire, the creators ofthese models, theories, and frameworks are univer-sally referred to as nursing "theorists." For the pur-poses of this paper, "theory," "model," and "frame-work" will be used interchangeably to refer to thewritten descriptions of the overall view of the nurs-ing process set forth by each of the nursing theorists.How, then, are models applied in nursing research,

and what constitutes a clinical application of a model?Nurse researchers tend to utilize models in three ways:1) studies in which the model is named and described,but not actually integrated into the research itself; 2)descriptive studies in which the model is used as anorganizing framework; and 3) research in which atheory is tested through scientific method [19]. Dis-tinguishing among these three uses is difficult [20],and perhaps is best left to nursing scholars. For thepurposes of this investigation, any of these three usesof models was considered an "application" if the ar-ticle so stated, and to be "clinical" if it dealt withsome aspect of patient care.

BACKGROUND

The quest for a model to conceptualize the nursingprocess actually dates back to Florence Nightingale'sNotes on Nursing [21]. However, it was with the for-mation of the Nursing Development ConferenceGroup in 1973 [22] that the nursing profession firstbegan an effort to identify an organized frameworkof nursing practice and label it as such. Since then,nursing models have proliferated, and they have hadan ever-increasing impact on research, education, andpractice. Many nursing schools now base their entirecurriculum on one or more models [23-24], and stu-dents are therefore required not only to learn aboutthe various models, but also to "examine others' use"[25] of them; that is, to see how they are applied tonursing research and practice.As time passes, there will be more and more uses

of the models to examine. Beck, in a 1985 study oftheoretical frameworks used in the articles publishedin the journal Nursing Research from January 1974 toJune 1985, noted a recent trend away from borrowingmodels from related disciplines in favor of usingmodels unique to nursing [26]. Riehl and Roy concurthat theory-based nursing research "will undoubt-edly continue," because "the ultimate criteria of atheory's usefulness, and hence a model's, are whether

Bull Med Libr Assoc 77(2) April 1989 177

Johnson

it stimulates new observations and insights, and gen-erates predictions of relevant events that are subse-quently confirmed" [27].

NCI were searched for any authors citing the keypapers (Appendix 1) of the following nursing theor-ists:

RESEARCH QUESTIONS

The study was designed to answer the followingquestions:

1. How many source papers can be located by con-ducting cited author searches in NCI using the keypapers of five prominent nursing theorists? Of these,what percentage of the source papers identified inthis manner actually describe clinical applications ofthe various models?

2. How many of the citing papers identified in theNCI search could have been retrieved through "tra-ditional" textword searches of MEDLINE and NAHL(Nursing and Allied Health Literature)? Statedanother way, how many unique references were re-trieved by the NCI cited author searches that wouldhave been missed had an NCI cited author search notbeen conducted?

3. SCI and SSCI have provided cited author accessto thirteen of the main nursing journals for a numberof years. Do clinical applications appear primarily inthe source journals already covered by SCI and SSCI?If the clinical applications appear only in this coregroup of thirteen journals, then NCI, its source cov-erage of 157 nursing journals notwithstanding, is con-tributing nothing unique toward locating applica-tions studies. Does NCI provide unique cited authoraccess to applications papers published in source jour-nals outside the purview of SCI and SSCI?

4. How complete a list of applications papers canbe compiled with an NCI cited author search? Doesa traditional subject/textword search yield relevantitems which a cited author search does not? A closelyrelated question would be: do authors of clinical ap-plications papers routinely cite the frameworks theyare applying in their bibliographies? Finally, if a "tra-ditional" search is undertaken, is a textword searchfor the name of the theory and its creator sufficient,or should broader controlled vocabulary terms thatapproximate the content of the theory (such as "selfcare" or "adaptation, psychological") be incorporatedinto the search to enhance recall?

5. What are the strengths and weaknesses of a citedauthor search versus conventional subject and text-word searches with regard to precision and compre-hensiveness of retrieval?

6. Finally, which of the theories is generating themost clinical research today?

METHODS

1. NCI cited author search; percentage of clinicalapplications. The first three 1986 quarterly issues from

Dorothea OremBetty Neuman

Dorothy Johnson

Martha Rogers

Callista Roy

Self Care Deficit TheoryNeuman's Health CareSystems ModelJohnson's Behavioral Sys-tems ModelRoger's Life Process Mod-el/Science of Unitary Hu-man BeingsRoy Adaptation Model

The key papers of each theorist were identified withthe aid of a textbook on nursing theory, chosen be-cause of its extensive bibliographies [28]. These par-ticular theorists were selected for two reasons. First,their models are widely used in various nursing cur-ricula [29-30]. Second, they are the ones most heavilyused in clinical nursing research today [31].

After the cited author searches were completed,source journals in foreign languages were immedi-ately eliminated, because the time and expense ofobtaining full-text translations in order to determinewhich among them reported clinical applicationswould have been prohibitive. The article titles for theremaining references were obtained from the authorsection in the main body of INI and inspected. Withfive of the references, it was obvious from the titlethat the article was not a clinical study. The full textof the remaining seventy-nine articles was obtainedand examined to judge if the paper described a clin-ical application. As stated earlier, even nursing schol-ars disagree on what qualifies as a clinical applicationstudy. Since no objective criteria have yet been de-veloped that could be used here to identify clinicalapplications, an operational definition had to be de-vised. For the purpose of this investigation, the textof the article had to state explicitly that the study wasdrawing on the model for its theoretical frameworkin order for it to be counted as an "application" ofthe model.

2. Analysis of NAHL and MEDLINE access pointsin the clinical applications located with NCI. Ci-tations that passed the relevancy test were thensearched in the MEDLINE and NAHL databases. Ti-tles, subject headings, and abstracts (where available)were printed for each. Each reference was then ana-lyzed to determine if it contained the name of themodel or its creator, making it accessible through a"traditional" textword approach.

3. Remaining unique NCI coverage after compari-son with SSCI and SCI source journal lists. Cited



author access to some of the NCI journal titles hasbeen available for a number of years through SCI andSSCI. To determine how many of the relevant appli-cations could have been located through a cited au-thor search of those indexes, the journal titles whichcontained application articles were compared to theSSCI and SCI source lists for 1986. Next, these itemswere compared against the NCI applications retriev-able in MEDLINE and NAHL to calculate coverageoverlap among SCI, SSCI, MEDLINE, and NAHL rel-ative to NCI.

4. Test for recall on NCI cited author search. Next,an attempt was made to assess the comprehensivenessof the cited author search. After all, if a relevant paperdid not include one of the theorist's key papers in itsbibliography, it would be overlooked in a cited authorsearch even though it might show up on a traditionalsubject/textword search. A broad MEDLINE searchfor English language citations indexed from Januarythrough October 1986 yielded forty-five references.The search strategy incorporated a free-text searchfor the names of the theorists and their models, andalso included MeSH terms such as "nursing theory"and "models, theoretical", as well as MeSH terms thatapproximate the content of the theories where avail-able, such as "adaptation, psychological" (Roy) and"self care" (Orem) (Appendix 2). Citations that didnot appear in the three 1986 quarterly INI indexesunder study were then eliminated; this left thirty-eight references for review. The full text for each ofthese items was examined to determine which qual-ified as clinical applications. Then the citation foreach relevant application was analyzed to determineif it could be retrieved with a narrow textword searchfor the model name or its creator, or whether it wasretrieved solely by the use of the broader controlledvocabulary terms such as "self care" or "adaptation,psychological."

5. Comparison of comprehensiveness and precision:cited author vs. conventional methods. Combiningall relevant applications studies identified by the broadMEDLINE and NCI cited author searches made it pos-sible to calculate comprehensiveness for the broadand narrow MEDLINE approaches and for the NCIcited author search. Comprehensiveness is definedhere as the percentage of all relevant application stud-ies retrieved by a cited author search, a broad con-ventional search (as conducted in MEDLINE using acombination of subject headings and textwords), anda narrow conventional search (as determined by ex-amining access points in the broad MEDLINE resultsto identify a subset that could be retrieved solely bysearching on textwords). It was arrived at by usingthe formula:

# of relevant applications retrieved by the method(# of NCI relevant applications

+ additional applications found in MEDLINE)

Precision for each retrieval method was calculated inthe following manner:

4 of relevant applications retrieved by the methodtotal # of references retrieved by the method

A table was prepared to permit comparison of com-prehensiveness and precision for all three retrievalmethods.

6. Percentage of clinical applications using each the-ory. The applications papers were then grouped bytheory used, and the number of times each theorywas cited was calculated as a percentage of the totalrelevant applications.

RESULTS AND CONCLUSIONS

1. NCI cited author search; percentage of clinicalapplications. The NCI cited author searches identi-fied a total of 109 references to eighty-four distinctciting papers. Of these, twenty-seven, or 32 percent,qualified as relevant applications of one of the nurs-ing models, while 68 percent (fifty-seven) of the ci-tations were not relevant (Figure 1). Therefore, a citedauthor search can prove fruitful for locating clinicalapplications of nursing theories. However, this typeof search will provide a substantial number of irrel-evant citations.

2. Analysis of MEDLINE and CINAHL access pointsin the clinical applications located with NCI. Al-though the NCI search was low in precision, it scoredhigh on recall. In fact, the analysis of MEDLINE andCINAHL access points revealed that twenty, or fully74 percent of the twenty-seven applications papersfound in the NCI search, would not have been re-trieved through a textword search of those files, sinceneither the name of the theorist nor the name of themodel appeared in the title or abstract (Figure 2).Seven of the remaining clinical applications papers

were retrievable by a NAHL textword search for eitherthe theory or its creator. Three of these articles werenot accessible in MEDLINE. They were retrieved inthe NAHL search because an indexer had enrichedthe title by adding the name of the model in paren-theses.

Four of the twenty-seven applications containedaccess points making them retrievable in MEDLINE,but all of these references would also have appearedin searches of NAHL. Since 74 percent of the relevant


Johnson

Figure 1Proportion of relevant clinical applications papers retrieved in NCIsearch (n = 84).

Clinical Applications (27 papers)

Other (57 papers)

Figure 2Accessibility of relevant NCI applications via textwords inMEDLINE & NAHL (n = 27).

LEGEND

citations would have gone undetected had an NCIcited author search not been conducted, NCI appearsto offer much in locating clinical applications as com-pared to a traditional bibliographic textword ap-proach.

-4I NCI & NAHL Only (3 papers) 11 %- NCI, NAHL, & MEDLINE (4 papers) 15%

<C NCI Only (20 papers) 74%

3. Remaining unique NCI coverage after compari-son with SSCI and SCI source journal lists. Next thejournal titles containing applications papers werechecked for coverage against the SSCI and SCI sourcejournal lists. Six of the applications papers (22 per-cent) could have been retrieved through a SSCI citedauthor search. Of these, two papers contained accesspoints that would also render them retrievable inMEDLINE and NAHL. The remaining four papers,representing 15 percent of the total applications,would have been missed using the conventional text-word approach available in MEDLINE and NAHL.None of the relevant applications papers appeared inthe SCI source journals.

Figure 3 depicts the twenty-seven applications pa-pers again; this time accounting for cited author ac-cess of those journals covered by SSCI. After SSCI,MEDLINE and NAHL accessibility was determined,there still remained sixteen papers, or 60 percent ofthe relevant applications located in NCI, which werenot accessible by any other means. Therefore, it seemssafe to conclude that the minimal coverage of nursingjournals available via SSCI and SCI prior to the debutof NCI did not provide adequate cited author accessto locate available clinical applications, and the NCI'senhanced source nursing journal coverage is helpfulin identifying clinical applications which could notpreviously have been identified by either cited authoror textword access.

4. Test for recall on NCI cited author search. Thebroad MeSH subject/textword search of MEDLINEyielded thirty-eight references which were also cov-

ered in the INI test issues. When these articles wereexamined, thirteen (34 percent) were deemed to berelevant applications papers (Table 1). A closer in-spection of these relevant papers revealed that of

Figure 3Accessibility of relevant NCI applications via SSCI, MEDLINE, &NAHL (n = 27).

LEGEND

-II NCI Only (16 papers) 60%

4 NCI & SSCI Only (4 papers) 15%

<C NCI, NAHL, MEDUNE & SSCI (2 papers) 7%-'4I NCI, NAHL, & MEDUNE (2 papers) 7%

<U NCI & NAHL Only (3 papers) 11%



Figure 4Distribution of all relevant clinical applications by theory used (n =32).

Orem (18 papers)

Rogers (2 papers) 6%

Neuman (3 papers) 9.5%Roy (6 papers)

Johnson (3 papers) 9.5%

these, eight, or 61 percent had also been retrieved inthe NCI cited author searches. Five, or 39 percent hadnot been identified with NCI. All five of these paperscame from a single publication from the NationalLeague for Nursing (NLN). (NLN publications do notappear in NCI.)

Since all of these papers came from a single pub-lication excluded explicitly from NCI, these resultsindicate that clinical nurse researchers can indeed berelied on to cite the model which they are applyingin their bibliographies, and an NCI cited author searchis liable to yield virtually complete recall for clinicalapplications published in the nursing journal litera-ture. It is less clear whether NCI should extend itsindexing to the nursing association publications toensure complete coverage, since all five unique rel-evant papers came from only one NLN publication.

5. Comparison of comprehensiveness and precision:cited author vs. conventional search methods. Ananalysis of the access points on the thirteen relevantclinical applications retrieved in MEDLINE revealedthat nine, or 69 percent, mentioned explicitly thetheorist or the model in the title or abstract. Mean-while, four, or 31 percent, of the relevant applications,

were retrievable only by broadening the search strat-egy to include such MeSH headings as "self care" and"nursing theory." However, the inclusion of MeSHheadings accounted for the low precision on theMEDLINE search. Had the search been restricted tofree-text occurrences of the names of the theorists ortheir models, precision would have been increasedfrom 34 percent to 47 percent overall.

It is interesting to note that the precision of thebroad MEDLINE search, at 34 percent, was compa-rable to the 32 percent precision on the NCI search.However, there was a marked difference in compre-hensiveness (Table 1). A total of thirty-two relevantapplications papers were located: twenty-three uniqueto NCI and five unique to MEDLINE. Using thesethirty-two papers as a yardstick to measure the com-prehensiveness of each method, NCI's performance,with twenty-seven relevant applications papers, stoodat 84 percent. Meanwhile, the broad MEDLINE searchyielded 41 percent comprehensiveness with thirteenrelevant applications papers (eight overlapping withNCI, plus five unique). These figures indicate thatwhen using NCI to locate applications studies likethese, the slightly lower precision achieved in a NCIcited author search is more than offset by a vast im-provement in comprehensiveness.

6. Percentage of clinical applications using each the-ory. A breakdown showing how many times eachtheorist was cited in the thirty-two "applications"papers appears in Figure 4. With eighteen papers cit-ing it, Orem's self care deficit theory was by far themost widely used framework.

SUMMARY AND SUGGESTIONS FORFUTURE RESEARCH

These results indicate that NCI is unique in the levelof access it provides to clinical applications testingnursing theory. It identifies studies which were pre-viously inaccessible either by textword approaches orby the limited cited author access to nursing literatureprovided by SCI and SSCI.The retrieval on MEDLINE suggests that a tradi-

tional subject/textword search for this type of appli-

Table 1Comparison of precision and comprehensiveness for cited author search and broad and narrow (textword) conventional searches: applicationstudies

Relevant and Comprehen-unique to siveness

Total retrieval Relevant Not relevant source Precision (n = 32)

Broad MEDLINE search 38 13 25 5 34% 41%

Narrow MEDLINE search 19 9 10 5 47% 28%NCI cited author search 84 27 57 23 32% 84%


Johnson

cation paper is at best an adjunct to a cited authorsearch, even when precision is more important thancomprehensiveness.However, before discarding the subject/textword

approach entirely in this context, librarians will wantto monitor a recent enhancement to the NAHL the-saurus. Beginning in 1988, the NAHL producers for-malized the indexing of nursing models by addingdescriptors for each. It remains to be seen how theseheadings will be used: will they be attached to theoryapplication papers as well as to simple descriptionsand critiques of the models? A recent study of depthof indexing in NAHL revealed that on the average,NAHL indexers assign only five descriptors per doc-ument, including checktags and geographics [32]. Isthe depth of indexing in NAHL sufficient to permitassigning a descriptor for the model applied oncedescriptors have been assigned to cover the subjectof the study? An exploration of now NAHL performsversus NCI once these descriptors are in place wouldanswer these questions.

Since this study was made to gauge the utility ofNCI, it was by necessity restricted to applicationsstudies published in the journal literature. DissertationAbstracts International, with its long and informativeabstracts, might warrant a closer look as an aid tolocating this type of nursing research.

Finally, there is much potential for investigatingthe utility of NCI for locating other types of elusiveliterature; for example, the use of various psycholog-ical tests in nursing research. For the time being,though, it can be concluded that NCI is providing amuch-needed link between nursing theory and theresearch it generates.

REFERENCES

1. OREM DE, TAYLOR SE. Orem's general theory ofnursing. In: Winstead-Fry P, ed. Case studies in nurs-ing theory. New York: National League for Nursing,1986:58. (NLN Publication 15-2152.)

2. DAHLEN R, BRUNDAGE CA, ROTH CB. Guidelines fordoing a computerized literature search. Nurse Educ1987 Mar/Apr;12(2):20.3. SILVA MC. Conceptual models of nursing. AnnuRev Nurs Res 1987;5:230, 242.

4. BECK CT. Theoretical frameworks cited in NursingResearch from January 1974-June 1985. Nurse Educ1986 Nov-Dec;10(6):137.

5. SILVA MC. Research testing nursing theory: stateof the art. ANS 1986 Oct;9(1):10.6. SMITH LC. Citation analysis. Libr Trends 1981 Sum-mer;30(1):83-106.

7. GARFIELD E. Can citation indexing be automated?In: Stevens ME, Giuliano VE, Heilprin LB, eds. Sta-tistical association methods for mechanized docu-mentation. Washington DC: National Bureau of Stan-dards, 1965:189. (NBS Misc. Pub 269)8. GARFIELD E. Citation indexing: its theory and ap-plication in science, technology, and humanities. NewYork: Wiley, 1979:2.

9. SALTON G. Associative document retrieval tech-niques using bibliographic information. J Assoc Com-put Machinery 1963 Oct;10:445.

10. MORAVCSIK MJ, MURUGESAN P. Some results onthe function and quality of citations. Soc Stud Sci 1975Feb;5(1):86-92.

11. SPIEGEL-RosING I. Science studies: bibliometric andcontent analysis. Soc Stud Sci 1977 Feb;7(1):97-113.12. GARFIELD E. Can citation indexing be automated?189.

13. FAWCETT J. Analysis and evaluation of conceptualmodels of nursing. Philadelphia: Davis, 1984:25.

14. LONG GE. Professional advancement: theory de-velopment through practice and research. Am Ne-phrol Nurs Assoc J 1985 Feb;12(1):35-8.

15. RIEHL JP, Roy C. Nursing models in education,research, and service. In: Riehl JP, Roy C, eds. Con-ceptual models for nursing practice. 2d ed. NewYork: Appleton-Century-Crofts, 1980:14.

16. HARRELL JS. Needed: nurse engineers to link the-ory and practice. Nurs Outlook 1986 Jul-Aug;34(4):196-8.

17. SANTORA D. Conceptual frameworks used in bac-calaureate and master's degree curricula. New York:National League for Nursing, 1980:6. (NLN Publi-cation No. 15-1828) (League Exchange No. 126).18. WINSTEAD-FRY P. Case studies in nursing theory,iv.

19. SILVA MC. Research testing nursing theory, 3-4.

20. Ibid.

21. NIGHTINGALE F. Notes on nursing: what it is, andwhat it is not. London: Harrison, 1860.

22. NURSING DEVELOPMENT CONFERENCE GROUP. Con-cept formalization in nursing: process and product.Boston: Little, Brown, 1973.

23. FAWCETT J. Analysis and evaluation of conceptualmodels of nursing. Philadelphia: Davis, 1984.

24. RIEHL JP. Nursing models in current use. In: RiehlJP, Roy C, eds. Conceptual models for nursing prac-



tice. 2d ed. New York: Appleton-Century-Crofts, 1980:393-8.

25. CAPERS CF. Some basic facts about models, nursingconceptualizations, and nursing theories. J ContinEduc Nurs 1986 Sep-Oct;17(5):149-54.

26. Beck CT. Theoretical frameworks cited in NursingResearch from January 1974-June 1985. Nurse Educ1986 Nov-Dec;10(6):37.

27. RIEHL JP, Roy C. Nursing models in education,research, and service, 13.

28. FAWCETT J. Analysis and evaluation of conceptualmodels of nursing.

29. Ibid.

30. RIEHL JP, Roy C. Conceptual models for nursingpractice.

31. SILVA MC. Conceptual models of nursing. AnnuRev Nurs Res 1987;5:230.

32. BRENNER S. CINAHL and MEDLINE: A compari-son of indexing practices (paper presented at Eighty-seventh Annual Meeting, Medical Library Associa-tion, Portland, Oregon, May 1987).

Received May 1988; accepted August 1988

APPENDIX 1

Cited references searched for each theoristDorothy Johnson1. JOHNSON DE. The nature of a science of nursing.Nurs Outlook 1959 Apr;7(4):198-200.2. JOHNSON DE. The significance of nursing care. AmJ Nurs 1961 Nov;61(11):63-6.3. JOHNSON DE. One conceptual model of nursing(paper presented at Vanderbilt University, Nashville,Tennessee, April 1968).

4. JOHNSON DE. Application of theory in educationand service. Chicago: Teach em Inc., 1978. Audiocas-settes.

Betty Neuman5. NEUMAN B, YOUNG RJ. A model for teaching thetotal person approach to patient problems. Nurs Res1972 May-Jun;21(3):264-9.6. NEUMAN B. The Betty Neuman health care systemsmodel: a total patient approach to patient problems.In: Riehl JP, Roy C, eds. Conceptual models for nurs-ing practice. New York: Appleton-Century Crofts,1974:99-114.

7. NEUMAN B. The Betty Neuman health care systemsmodel: a total person approach to patient problems.

In: Riehl JP, Roy C, eds. Conceptual models for nurs-ing practice. 2d ed. New York: Appleton-Century-Crofts, 1980:119-34.

8. NEUMAN B. The Neuman systems model: applica-tion to nursing education and practice. New York:Appleton-Century-Crofts, 1982.

Dorothea Orem

9. OREM DE. Guides for developing curricula for theeducation of practical nurses. Washington DC: Gov-ernment Printing Office, 1959.

10. OREM DE. Nursing: concepts of practice. New York:McGraw-Hill, 1971.

11. OREM DE. Nursing: concepts of practice. 2d ed.New York: McGraw Hill, 1980.

Martha Rogers

12. ROGERS ME. An introduction to the theoreticalbasis of nursing. Philadelphia: Davis, 1970.

13. ROGERS ME. Nursing: a science of unitary man.In: Riehl JP, Roy C, eds. Conceptual models for nurs-ing practice. 2d ed. New York: Appleton-Century-Crofts, 1980:329-37.

Callista Roy14. Roy C. Adaptation: a conceptual framework basisfor nursing. Nurs Outlook 1970 Mar;18(3):42-5.15. Roy C. Adaptation: a basis for nursing practice.Nurs Outlook 1971 Apr;19(4):254-7.16. Roy C. The Roy adaptation model. In: Riehl JP,Roy C, eds. Conceptual models for nursing practice.New York: Appleton-Century-Crofts, 1974:135-44.

17. Roy C. Introduction to nursing: an adaptationmodel. Englewood Cliffs, NJ: Prentice-Hall, 1976.

18. Roy C. The Roy adaptation model. In: Riehl JP,Roy C, eds. Conceptual models for nursing practice.2d ed. New York: Appleton-Century-Crofts, 1980:179-88.

19. Roy C, ROBERTS SL. Theory construction in nurs-ing: an adaptation model. Englewood Cliffs, NJ: Pren-tice-Hall, 1981.

20. Roy C, ED. Introduction to nursing: an adaptationmodel. 2d ed. Englewood Cliffs, NJ: Prentice-Hall,1984.

APPENDIX 2Broad MEDLINE Search Strategy

1-: PHILOSOPHY-NURSING OR NURS-ING-THEORY


Johnson

2 : MODELS-THEORETICAL OR MODELS-PSYCHOLOGICAL OR MODEL$1.TI,AB. ORFRAMEWORK$1.TI,AB. OR THEOR$.TI,AB.

3-: N.LI. OR NURS$3.TI,AB,DE.4 : (NEUMAN$1 OR OREM$1 OR JOHN-

SON$1 OR ROGERS$1 OR ROY$1).TI,AB.5-: 4AND (3 OR 1)6-: 1 OR (2 AND 3)7-: SELF ADJ CARE AND (DEFICIT$1 OR

AGENCY OR OREM$1.TI,AB. OR 6)8-: LIFE ADJ PROCESS AND

(ROGER$1.TI,AB. OR 6)9-: (BEHAVIORAL OR BEHAVIOURAL) ADJ

SYSTEM$110-: 9 AND (JOHNSON$1.TI,AB. OR 6)1 L: ADAPTATION AND (ROY$1.TI,AB. OR 6)12-: (SCIENCE WITH UNITARY WITH (MAN

OR BEINGS)).TI,AB.13-: 5 OR 7 OR 8 OR 10 OR 11 OR 1214 : 13 AND LGEN15: ..L/ 14 IM>851216.: L/15 IM<8611


FROM THE BULLETIN-25 YEARS AGO

Mechanization of Library Procedures in the Medium-sized Medical Library: II. Records

By Irwin H. Pizer, Associate Librarian and Research Associate in Machine Methods; Isabelle T. Anderson, AssistantLibrarian for Technical Services; and Estelle Brodman, Ph.D., Librarian and Associate Professor of Medical History,Washington University School of Medicine Library, St. Louis, Missouri

In deciding to do the work on a daily basis in order to get a better end result, we are reminded of theanalogy of the peas and the potatoes. As any child at the conundrum age knows, it is possible to place apeck of peas in a bushel basket of potatoes without requiring a larger container, because the peas settlein the interstices between the potatoes. Similarly, a certain amount of extra work can be absorbed by astaff without dislocation, if it can be interspersed among other duties. Daily keypunching is an exampleof this; keypunching the entire file at one time would not be so.

Bull Med Libr Assoc 1964 Apr;52(2):381

184

in search of applications of nursing theories: the nursing citation index

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