RESEARCH METHODOLOGY: DISCUSSION PAPER –
METHODOLOGY
Concept analysis and the building blocks of theory: misconceptions
regarding theory development
Elisabeth Bergdahl & Carina M. Berter€
o
Accepted for publication 11 March 2016
Correspondence to E. Bergdahl:
e-mail: bergdahl_elisabeth@hotmail.com
Elisabeth Bergdahl MScN PhD RN
Project Leader/Affiliated Researcher
Research and Development Unit, FOU nu,
SLSO, Stockholm, Sweden
Faculty of Professional Studies, Nursing
Science, Nord University, Bod€o, Norway
Carina M. Berter€o BSc MScN PhD RNT
Professor
Division of Nursing Science, Department of
Medical and Health Sciences, Link€
oping
University, Sweden
2558
BERGDAHL E. & BERTERO € C . M . ( 2 0 1 6 ) Concept analysis and the building
blocks of theory: misconceptions regarding theory development. Journal of
Advanced Nursing 72(10), 2558–2566. doi: 10.1111/jan.13002
Abstract
Aim. The purpose of this article is to discuss the attempts to justify concepts
analysis as a way to construct theory – a notion often advocated in nursing.
Background. The notion that concepts are the building blocks or threads from
which theory is constructed is often repeated. It can be found in many articles
and well-known textbooks. However, this notion is seldom explained or
defended. The notion of concepts as building blocks has also been questioned by
several authors. However, most of these authors seem to agree to some degree
that concepts are essential components from which theory is built.
Design. Discussion paper.
Data sources. Literature was reviewed to synthesize and debate current
knowledge.
Implications for nursing. Our point is that theory is not built by concepts
analysis or clarification and we will show that this notion has its basis in some
serious misunderstandings. We argue that concept analysis is not a part of sound
scientific method and should be abandoned.
Conclusion. The current methods of concept analysis in nursing have no
foundation in philosophy of science or in language philosophy. The type of
concept analysis performed in nursing is not a way to ‘construct’ theory. Rather,
theories are formed by creative endeavour to propose a solution to a scientific
and/or practical problem. The bottom line is that the current style and form of
concept analysis in nursing should be abandoned in favour of methods in line
with modern theory of science.
Keywords: concept analysis, epistemology, nursing theory, philosophy, research
methods
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JAN: RESEARCH METHODOLOGY: DISCUSSION PAPER – METHODOLOGY
Why is this review needed?
• The debate around concept analysis in nursing seems to
concern the definition of ‘concepts’ and how to best clarify
them, rather than questioning if concept analysis is a sound
scientific endeavour.
• The notion of concepts as building blocks of theory is often
repeated. It can be found in many articles and well-known
textbooks. However, the statement is seldom explained or
defended.
• As a scientific discipline nursing science must discard inade-
quate methods, it has been questioned if concept analysis is
an adequate scientific procedure.
What are the key findings?
• The theory of concepts as building blocks, or threads, that
builds theory is based on a misunderstanding of philosophy
of science.
• Insights from the last decade of modern philosophy show
that the idea of defining all terms and concepts before for-
mulating a theory results in endless iterations of clarifica-
tions and cannot produce scientific theory.
• The use of concepts analysis in nursing research has no
foundation in the philosophy of science that is often
referred to when advocating concept analysis as a way to
construct science.
How should the findings be used to influence research/
practice?
• The type of concept analysis used in nursing science should
not be seen as proper scientific work.
• The idea of concepts as building blocks, or threads, from
which theory is constructed should be abandoned.
• There is a need to review the epistemic foundation of nurs-
ing science to embrace a hypothetical deductive view of
science where theory development is seen as a creative
endeavour.
Introduction
The purpose of this article was to show that the attempts
to justify concept analysis (CA) as described in nursing
science (Morse et al. 1996b, Rodgers 2000, Penrod & Hup-
cey 2005, Walker & Avant 2005) are based on misunder-
standing of the philosophy of science. To do this, we will
discuss the notion of concepts as the building blocks of the-
ory – a notion often advocated in nursing (Chinn & Jacobs
1983, Morse et al. 1996b, Rodgers & Knafl 2000, Walker
& Avant 2005, 2011) and that is used to justify different
approaches of concept analysis. Our standpoint is that con-
cepts are not building blocks of theory. We will also
© 2016 John Wiley & Sons Ltd
Concept analysis and the building blocks of theory
analyse some other attempts to justify concept analysis and
show that those also are based on misunderstandings. We
argue that the misconceptions regarding concepts and the
need for concept analyses argued for by Walker and Avant
(2011), Morse et al. (1996a,b), Morse (2012), Rodgers
(1989), Penrod & Hupcey 2005 and Fawcett (2012) can
lead researchers in the wrong direction and limit their abil-
ity to create nursing theory, much like other misconceptions
and rhetoric around positivism, the philosophy of science
(Persson 2009) and phenomenology (Paley 1998, 2005).
Our standpoint is that the concept analysis methods com-
monly used in nursing should be abandoned and we will
not suggest any replacement. Instead, we argue for creating
theories and using qualitative and/or quantitative methods
in combination or separately to test them.
Background
Rodgers (2000) tries to give a philosophical foundation for
concept development and states that:
In theory development literature, concepts are widely recognized as
the ‘building blocks’ from which theories are constructed. (p. 2)
If Rodgers had written that it was in nursing theory
development, her statement would have been correct. In
theory development literature from well-known philoso-
phers of science, such as Popper (2001), Kuhn (1970),
Quine (1998) and Toulmin (1972), there is no trace of the
idea of concepts as building blocks or any discussion of
concept analysis methods. The closest parallel, which will
be discussed below, is the positivist idea of primitive terms
as building blocks to define all other terms.
The notion of concepts as building blocks has been ques-
tioned by several authors, including Paley (1996), Penrod
and Hupcey (2005), Duncan et al. (2007) and Risjord
(2009). However, most of these authors, with the exception
of Paley (1996), seem to agree that concepts are essential
components from which theory is built. The debate seems
to concern the definition of ‘concepts’ and how best to clar-
ify them, not so much questioning if theory is actually built
on concepts. Duncan et al. (2007) state that the ‘philosoph-
ical foundation’ of concepts and its epistemological and
ontological basis are not identified in the different frame-
works of concept analysis. Of the aforementioned authors,
Paley (1996) and Hupcey and Penrod (2005) are those who
explicitly criticize the notion of concepts as building blocks,
Paley prefers to see concepts as ‘niches’ in theory and Hup-
cey and Penrod see them as knots in a tapestry. For Paley,
concepts are defined within the context of a theory. If Paley
is right, there is no justification to first analysing concepts
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E. Bergdahl et al.
and then building theory – in fact concept analysis cannot be
seen as an activity in theory creation. When a theory is devel-
oped, the concepts – or rather terms – are developed and given
their position in the theory (Paley 1996), this view is consistent
with influential philosophers of science (Kuhn 1970, Toulmin
1972, Quine 1998, Popper 2001).
A new debate around the legitimacy of concept analysis
has recently emerged in nursing. Draper (2014) states that:
. . .there is no place for concept analysis in the scholarship of mod-
ern nursing. (p. 1207)
To which Morse (2014) adds:
Inadequate or insufficient methods of concept analysis must be dis-
carded and appropriate, productive methods used. (p. 2969)
We agree with Morse that inadequate methods must be
discarded. This paper aims to show why the concept analy-
sis as method, including approaches suggested by Walker
and Avant (2011) and Rodgers (1989) does not have any
justification in the philosophy of science and cannot be seen
as a proper scientific endeavour. By showing that concepts
are not building blocks of theory or ‘the foundation of our
discipline’ (Morse 2012, p. 151), we argue that the idea of
‘Delineation and description of the anatomy of the concept’
(Morse 2012, p. 152) as an activity that is needed before
theories can be formulated is wrong. The notion we are
going to defend here is in line with Paley’s (1996) view,
that concepts (or terms) as such do not have any specific
meaning outside the context where they are defined.
Data sources
This discussion is based on some of the most influential
papers in nursing on concept analysis and the notion of
concepts as building blocks of nursing science. The roots
of this notion are traced and the influential philosophy of
science is used to problematize the idea of concepts as
building blocks of theory and the types of concept analysis
most often seen in nursing science.
Discussion
Is concept analysis a good idea?
Intuitively, trying to find the ‘correct’ definition of all con-
cepts or terms and then combine these into a theory seems
like a good idea. Certainly, good theorists make sure they
define the terms they use in a theory or hypothesis, but
usually these definitions are stipulated by the theorists; the
terms are explicated in the theory by the theorists, not
2560
found ‘out there’. An underlying assumption by the advo-
cates of concept analysis seems to be that there is a
‘proper’ definition to be found, at least in a particular
context, an idea at odds with findings from the philosophy
of language.
Morse et al. (1996b) are aware that many philosophers
regard efforts to assess or evaluate concepts as unnecessary
or impossible and they also regard it as ‘remarkable’ that
‘texts on logic ignore concepts in favour of arguments.’ (p.
385). However, since Plato and Aristotle, philosophers and
logicians have been concerned with how words in the lan-
guage can ‘point’ to things in the external world and how
they can ‘mean’ something. As Goertz (2012) points out,
the first part of J.S. Mills ‘A System of Logic’ is dedicated
to this problem. Another logician who carried out ground-
breaking work on logic and language in the early 20th
century was Gottlieb Frege, who was a driving force behind
what is often called the ‘linguistic turn’ in philosophy.
In fact, leading philosophers and logicians, such as
Wittgenstein (1922, 1953/2001) and Quine (1998), put
great effort into investigating how words, terms and con-
cepts acquire meaning.
The meaning of a word, according to Wittgenstein
(1953/2001), is connected to the ability to use it in some
language game. Wittgenstein’s point is that a specific word
does not need, nor have, one specific definition since we
can use it successfully in language games without defining
it. Furthermore, concepts get their meaning through use in
a language game, i.e. a context (Wittgenstein 1953/2001).
Quine (1998) had a similar view. A parallel is that both
Hempel (1952) and Popper (2001) are clear that a term
acquires meaning by its use and definition in a theory and
those terms are introduced as abbreviations for longer state-
ments in a theoretical context.
A term is just an abbreviation that can be used instead of
a longer sentence is also true for everyday language use. To
analyse what ‘puppy’ means, is to analyse the sentence or
proposition ‘a young dog’. ‘Puppy’ is shorthand for the
statement ‘a young dog’. To get a clearer understanding,
we might also need to understand and investigate the defini-
tion of ‘young’ and ‘dog’. We will then find that a dog is a
mammal, but all of this does not really give a clearer
understanding of what a person means when uttering the
word ‘puppy’ or what ‘puppy’ means to that particular
language user.
Furthermore, Quine (1998) concludes that we have an
indeterminacy of translation; there are several correct ways
to translate a word or a sentence into another language. It
seems that Morse et al. (1996b) also misunderstand that in
logic, as exemplified above, a term is usually seen as defined
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JAN: RESEARCH METHODOLOGY: DISCUSSION PAPER – METHODOLOGY
by a statement and therefore a concept/term can be under-
stood by analysing the statement defining the term. One
philosopher of science well versed in logic, Karl Popper
(2011), also quite clearly explains why we should not start
out by defining terms/concepts:
For a definition cannot establish the meaning of a term any more
than a logical derivation can establish the truth of a statement;
both can only shift this problem back. The derivation shifts the
problem of truth back to the premises, the definition shifts the
problem of meaning back to the defining terms (i.e., the terms that
make up the defining formula). But these, for many reasons, are
likely to be just as vague and confusing as the terms we started
with; and in any case, we should have to go on to define them in
turn; which leads to new terms which too must be defined. And so
on, to infinity. (p. 276)
Many concept analyses in nursing are quite good exam-
ples of the issue Popper (2011) presents: the defining attri-
butes are on a higher level of abstraction than the concept
that is supposed to be defined. Examples can be found in
the most important books on concept analysis, such as
Rodgers (1989), or Cowles and Rodgers (2000), which
analyses the ‘concept’ of grief and finds that it has five attri-
butes: dynamic, process, individualized, pervasive and nor-
mative. Each of these attributes is at least as complex and
undefined as grief. In any attempt to find a definition, be it
in the form of dictionary definition or with a set of ‘at-
tributes’, ‘properties’ or ‘dimensions’ (Fawcett 2012), the
attributes and definition will contain other concepts that
are undefined that lead to the next analysis and so on. In
this way, an endless stream of analysis can be published
without actually adding any proper knowledge to the
discipline.
In social science, there are a few theorists (Collier and
Levitsky 1997, Sartori 2009, Goertz 2012) that have gone
deeper into the problem of concepts and the possibility to
use them in qualitative studies. In this context, the main
focus is to avoid conceptual stretching and to create a con-
ceptual system that can aid empirical research. And, again,
it is important to remember that the created conceptual
classification system is a classification of what these con-
cepts are, not what causes something or what the effects of
something are. The conceptual classification system allows
us to investigate causes and effects but the causes and
effects are not a part of the definition.
The greatest problem might be that many concept analy-
ses are made without investigating whether there is a con-
ceptual problem, the first step Wilson recommends for
students so they do not waste time conducting a conceptual
analysis when there is no conceptual problem.
© 2016 John Wiley & Sons Ltd
Concept analysis and the building blocks of theory
For example, Toulmin (1972) shows that some concepts
are invented and are not abstracted from reality at all.
Toulmin (1972) uses the example of particle physics. Sub-
atomic particles were invented by theorists in a creative
endeavour to solve a scientific problem, not by observation.
Later, the validity of these conceptualizations (theories) was
deductively tested against reality. The idea (conception) of
‘atoms’ has gone through tremendous changes throughout
the history of physics, as have many ideas or concepts in all
sciences, but these changes are not a problem to scientists.
Scientific endeavours cannot start with concept clarification
and move towards theories: it is the other way around.
First, theories are proposed and in the formulation of the
theory the needed concepts are given a definition, which
can be unique for a given theory (c.f. Popper 2011). In fact,
most philosophers of science since the early 20th century
separated the creation of theory from theory justification
(Putnam 1992, p193). Theory creation is seen as a creative,
artistic, endeavour and theory justification and testing is
seen as more like a craft.
The lesson we should learn from the philosophy of lan-
guage and science is that the ‘true’ meaning of a term or
‘concept’, cannot be found and that the effort to find
such meanings is an endless and fruitless endeavour (c.f.
Paley 1996).
How concepts became building blocks
Most authors in nursing who state that concepts are build-
ing blocks do not argue their case; they merely use a refer-
ence to justify this idea. For example, Morse et al. (1996b)
refers to Chinn and Jacobs (1983) and the first edition of
their book Theory and Nursing: A Systematic Approach. In
this edition, Chinn and Jacobs just state it as a fact, without
reference or explanation. Interestingly, in later editions of
this book (Chinn and Kramer 1991), there is no mention of
concepts as building blocks. Another source of the notion
of concepts as building blocks is Walker and Avant; they
state this notion as fact and it appears in the 1995, 2005
and 2011 editions of their book Strategies for Theory Con-
struction in Nursing. Walker and Avant use a reference, i.e.
Hardy (1974), as a source of the notion of concepts as
building blocks of theory. It is therefore of interest to see
how Hardy (1974) refers to ‘primitive terms’ as primary
building blocks of theory:
. . .the primitive terms (or concepts) are primary building blocks of
theories from which new terms are defined. (p. 101)
Hardy also refers to Hempel (1952) in stating that the
‘derived terms’ are built on ‘primitive terms’. To clarify this
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statement and why it is not correct to justify the ‘building constitute virtually two different aspects of the same procedure.
block’ dogma using Hempel, we need to see what Hempel (pp. 1–2)
actually writes in Fundamentals of Concept Formation in
Hempel himself advocates a deductive view of theory
Empirical Science in 1952. First of all, Hempel never states
where the terms acquire meaning by being seen as knots in
that primitive terms have been seen as the building blocks
a ‘complex spatial network’ (Hempel 1952, p. 36) where
of ‘defined terms’. The expression ‘derived terms’ is not
the threads are their theoretical definitions that are funda-
used by Hempel (1952) at all. Hempel explains:
mental and derivative hypothesis of the network.
Thus the vocabulary of a theory falls into two classes, the defined When Hardy (1974) sets ‘concepts’ in parentheses after
terms, i.e. those which are introduced by definition in terms of ‘primitive terms’, it can be seen as a mistake. Readers that
other expressions of the vocabulary and the so-called primitive are not familiar with Hempel’s work can interpret this as
terms, or primitives, by means of which all other terms of the theo- Hempel seeing ‘primitive terms’ and ‘concepts’ as syn-
retical vocabulary are ultimately defined. (p. 15) onyms, which is not at all consistent with Hempel’s use of
these two terms. In other words, the notion of ‘concepts as
Primitive terms are a positivist idea and are supposed to
building blocks of theory’, which is still advocated widely
be applicable to those terms that could be defined by direct
in nursing science, seems to be based on a misunderstand-
correlation with an empirical observation, often called ‘ob-
ing or mistake by Hardy (1974) and the notion does not
servation terms’ (Hempel 1952). Defined terms are made of
have support in Hempel or any theory of science we know
several primitive terms – linguistic labels on possible direct
of outside nursing. Nor is there any argument to support
sense data or empirical observation according to Hempel
the notion of ‘building blocks’ in the writing of Walker and
(1952). So in some ways, Hempel could be said to describe
Avant, Morse or any of the other proponents of the view
and criticize, how the logical positivists saw scientific theo-
that concepts need to be analysed before theory can be cre-
ries as built on terms (or at least containing terms), but not
ated.
necessarily concepts and where defined terms can be
The conclusion has to be that the notion of concepts as
reduced to primitive terms. Hempel regarded the distinction
building blocks is not supported by the references to
between defined and primitive terms as deeply problematic.
Walker and Avant or Chinn and Jacobs; nor is the reference
Hempel does not have an inductive view of science and
that Walker and Avant (1995, 2005, 2011) give to Hardy a
points out those concepts, which he regards as ‘theoretical
support for that notion. On the contrary, Hempel – who is
constructs’, are invented:
referred to by Hardy (1974) – has a view of concepts as
Guided by his knowledge of observational data, the scientist has to defined within theory.
invent a set of concepts, theoretical constructs, which lack immedi-
ate experiential significance, a system of hypotheses couched in
Concepts as building blocks in grounded theory
terms of them and an interpretation for the resulting theoretical
network; and all this in a manner which will establish explana- Another source of this notion can be found in Straussian
tory and predictive connections between the data or direct grounded theory, where it is declared that ‘concepts that
observation. (p. 37) are the building blocks of theory’ (Strauss & Corbin 1998,
p. 13). In the analysis phase of the method, categories are
This is a very different view of concepts to the plethora
developed and these form the concepts of the theory that is
of definitions offered by nursing theorists. Hempel even
created with grounded theory as a tool. However, Strauss
points out those concepts may lack ‘experiential signifi-
and Corbin (1998) make an effort to point out that con-
cance’, again a sharp contrast to the notion of concepts as
cepts are contextual and that the same phenomena may get
inductive building blocks. Hempel (1952) advocates a view
different labels in different theories.
of science where theories could be formulated by invented
There are several similarities between the way that
concepts used as descriptions of a possible phenomenon,
Strauss and Corbin express themselves and how theories
often not yet observed by empirical science but put forward
are regarded in post-positivistic philosophy of science; all
as a hypothesis. Hempel further sees concept and theory
theory is regarded as provisional and subject to change
formation as closely related or aspects of the same activity:
when confronted with new data. In grounded theory, the
This analysis will lead to a close examination of the function of finding is ‘theoretical constructs’, which is in agreement
concepts in scientific theories and will show that concept formation with Hempel’s (1952) idea that theory is invented. Strauss
and theory formation in science are so closely interrelated as to and Corbin (1998) seem to have a conception of concepts

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JAN: RESEARCH METHODOLOGY: DISCUSSION PAPER – METHODOLOGY
and theory as being contextual and provisional, which is in
contrast with the way Morse et al. (1996b) and Morse
(2012) views concepts and theory.
Short analysis of Wilson’s ‘Thinking with Concepts’
Wilson wrote Thinking with Concepts (1963) as an aid to
high school students to prepare for university and be able
to grasp how words (concepts) are used in ordinary lan-
guage and academic texts. (c.f. Hupcey & Penrod 2005).
Wilson was heavily influenced by the Oxford and Cam-
bridge language philosophy of that time; in particular, there
was a heavy influence from Wittgenstein’s ‘philosophical
investigations’ and the then debate and development of
Wittgenstein’s thoughts in Oxford and Cambridge. The
book was not intended to be used in theory development
and the method described is not a scientific method. This is
evident when Walker and Avant (2011) try to develop Wil-
son’s text into some sort of scientific method. We believe
the method could be used in a literature review, but as used
in nursing currently it is only contributing to increased frus-
tration and confusion and is not in any way advancing
science.
When we look at Wilson’s (1963) examples, we also see
that the techniques are mainly used for two purposes: ana-
lysing rather long and complex texts and answering ques-
tions such as ‘Is astrology a science?’ There is no attempt
to give one clear answer and definition of ‘concepts’ with
attributes or antecedents. It is worth noting that Wilson
does not give any example that resembles the concept anal-
yses that in nursing are said to be ‘Wilsonian’.
It can also be noted that the only thing that Walker and
Avant have in common with Wilson (1963) is the idea to
describe typical cases and also extend them to contrary and
borderline cases. None of the other five steps of Walker
and Avant have anything in common with Wilson.
As we see it, all approaches derived from Wilson lack
foundation in scientific methods and should not be seen as
methods suitable to provide a foundation for research to be
published in peer-reviewed scientific journals.
Further misunderstandings and attempts to justify
concept analysis
Penrod and Hupcey abandon the building block analogy in
their two papers from 2005; instead they adopt a tapestry
analogy. Interestingly, they refer to Hempel, whose name
they misspell as ‘Hemple’, where they see concepts as the
strand or threads that build the tapestry. They quote
Hempel to give emphasis to their argument:
© 2016 John Wiley & Sons Ltd
Concept analysis and the building blocks of theory
Hemple (1966) offers a different concept-theory analogy in his
work in natural science, describing concepts as the ‘knots in a net-
work of systematic interrelationships (p. 94).’ (Hupcey & Penrod
2005)
They only quote a part of Hempel’s sentence; in its com-
plete form it is as follows:
Thus, the concepts of science are the knots in a network of system-
atic interrelationships in which laws and theoretical principles form
the threads. (Hempel 1966, p. 94)
What Penrod and Hupcey do is to substitute blocks with
strand and wall with tapestry but ultimately they keep the
same view, that concepts build well integrated supported
theory. Penrod and Hupcey (2005) do however acknowl-
edge that ‘. . .concepts cannot be analysed irrespective of
their theoretical frame.’ (p 199), but they believe, without
support from Hempel or other philosophy of science, that
it is possible ‘to tie and retie the conceptual knots to form
a stronger, more coherent tapestry of nursing theory’ (pp.
199–200). By stating this, they disregard that a particular
term can have very different definitions in different theo-
ries that are all part of nursing science. Trying to create
an understating of ‘concepts’ by tying and retying terms/
concepts from different theories does not seem to be a fea-
sible way to create knowledge. In fact, the tapestry anal-
ogy is no better than the building block analogy in our
opinion.
There are also some misconceptions in the foundation
for concept development that Rodgers claims to find in
the philosophy of Toulmin. Rodgers claims that ‘Toulmin
failed to define the term concept. . .’ (Rodgers 2000, p.
28). This statement is untrue in two ways. First, Toulmin
(1972) clearly states that, like many other terms or con-
cepts, the term ‘concept’ might not need a comprehensive
definition since scientists use it without problems. Second,
in the case of the term ‘concept’, Toulmin does give a def-
inition of concepts, albeit in the form of a question, as
follows:
What are the skills or traditions, the activities, procedures or
instruments of Man0 s intellectual life and imagination – in a word
the concepts – through which that human understanding is
achieved and expressed? (p. 11)
Toulmin’s definition of concepts is clearly very different
than something that is ‘. . .cognitive in nature and com-
prised of attributes abstracted from reality, expressed in
some form. . .’ (Rodgers 2000, p33) or ‘. . .abstractions
expressed in some way’ (Rodgers 1989, p. 78). To analyse
‘concepts’ of the sort Toulmin speaks of, the strategies
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E. Bergdahl et al.
proposed by Rodgers are clearly not applicable. An impor-
tant consequence is that the alleged support Rodgers claims
to find in the writings of Toulmin is not at all a support for
Rodgers evolutionary view of concept analysis. Instead, we
can see that Toulmin is rather close to Hempel (1952) in
that he sees concepts and theories development as virtually
the same activity.
It is also very hard to understand how Wittgenstein’s
‘family resemblance’ ideas for natural language are applica-
ble for analysis of scientific terms or concepts. In fact, it
seems that Rodgers is guilty of ‘the language-in-use fallacy’
mentioned by Sartori (2009). Furthermore, all inductive
methods of concept analysis are automatically guilty of this
fallacy. The argument is that science is a practice of con-
structing a more exact language to describe some aspect of
reality; therefore, to quote or refer to Wittgenstein (1953/
2001) theories regarding ordinary language when discussing
scientific language is to interpret Wittgenstein out of con-
text (c.f. Sartori 2009).
Fawcett (2012) regards herself as a post-positivist, but
post-positivist philosophers such as Popper or Hempel
would not, as we have seen, conduct concept analysis as
advocated in nursing and they would also object to the
notion of the essence of a phenomenon, which is central to
Fawcett’s (2012) definition of concepts as:
. . .a label, expressed as a word or phrase that summarizes the
essence of a phenomenon.
Fawcett (2012) regards the result of a concept analysis as
a middle-range theory:
. . .which should be linked explicitly with the conceptual model that
guided the analysis.
The statement above repeats the view that concept analy-
sis could be a way to construct theory, a view that is not
supported be post-positivist or other philosophies of
science. The only difference is that Fawcett thinks that a
concept analysis is of more value if it is confined to a con-
ceptual model.
Implications for nursing – a way forward?
From time to time, there is a need to analyse the way lan-
guage is used in a professional academic discipline. One
might then perform an analysis of existing knowledge and
clarify how terms are used in the discipline and what the
most important theories and ideas are. However, the
methods used in nursing regarding concept analysis men-
tioned in this paper have no foundation in theory of science
nor in language philosophy; rather it is built on the
2564
misinterpretation of these areas. If analysis of language use,
terms and conceptualization is needed, this should not be
done by junior nursing scholars in their thesis work, other
than as a step in the needed background research. If such
an analysis is to be published as an academic paper, it
should either be done by senior nursing researchers with
sound competence in semiotics and language philosophy, or
be done together with specialists from these fields. When
we want to analyse what theorists and researchers have
published on a particular subject, a literature review can be
performed, just as Draper (2014) suggests, or a meta-synth-
esis might be applicable.
We agree with Beckwith et al. (2008) that there is:
. . . little evidence to show that the CA (concept analysis) frame-
works discussed add rigour to our research or facilitate deep
enough understanding of concepts to enable and justify the theory
developments which they underpin. (p. 1840)
In our view, the underlying problem is that the idea
that the proper definition or essence of a concept/term can
be found or that a meaning can be revealed through any
sort of concept analysis is flawed. Important concepts will
always be ambiguous and have several uses even in a dis-
cipline. This is not a problem since concepts are not the
‘building blocks of science’, nor do they ‘form the founda-
tion of our discipline’, nor are they ‘threads in a tapestry’.
Rather, science is built on hypotheses that are systemati-
cally tested and then rejected, modified or tentatively
accepted, not on concepts. In our view, nursing theory, as
with all theories, starts with ideas that are formulated in a
hypothetical manner. There is no formula or strict method
to be found for theory creation, no more than there is a
formula on how to write books, be a great painter or
compose music. In our view, all theories should start as
creative interpretations of some aspect or reality, the the-
ory is regarded as true when it has been rigorously tested.
What we find perplexing is the willingness by many quali-
tative method theorists to emphasize almost mechanical
structure that should generate or construct theory. For us,
the way forward is to open up for creative and free think-
ing in formulating theories, conjectures and that the future
of qualitative methods is depending on clarifications of
how qualitative methods contribute both to creative for-
mulation of theory and to rigorous testing of theory. In
this discussion, there is a need to question many of the
foundation of our discipline to ensure that nursing ontol-
ogy and epistemology is well grounded. The most impor-
tant lesson that should be learnt is that, as a scientific
discipline, we need to retain and value critical thinking
and creative ideas.
© 2016 John Wiley & Sons Ltd
JAN: RESEARCH METHODOLOGY: DISCUSSION PAPER – METHODOLOGY
Conclusion
We have shown that the attempts to justify concept analysis
as a way to construct theory lack sound foundation in the
philosophy of science and are to a large extent argued for
with some serious misinterpretations of the philosophy of
science. Although Rodgers (2000), Penrod and Hupcey
(2005) and Fawcett (2012) do not use the building block
analogy, they nevertheless share the same view, that theory
is constructed from concepts and as a consequence, concept
analysis and development is a vital part of theory construc-
tion. It seems as if authors that are critical towards the
building block analogy still cling to the notion that con-
cepts build theory, but when they try to justify that notion
by referring to philosophers of science that are against term
and concept clarifications and the notion that one can gen-
erate theory, the lack of foundation for the concept clarifi-
cation notion becomes obvious.
As we have shown, the type of concept analysis per-
formed in nursing is not a way to ‘construct’ theory; theo-
ries are formed by creative endeavour to propose a solution
to a scientific and/or practical problem. The focus on con-
cept development and analysis also cripples theory develop-
ment and empirical research, both quantitative and even
more so qualitative research. It is important that we aban-
don this concept focus and start to create and test theories
instead. To get an overview on a specific subject existing lit-
erature reviews and knowledge synthesises methods are suf-
ficient. The bottom line is that concept analysis in nursing
should be abandoned in favour of sound scientific methods
in line with modern theory of science.
Funding
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
No conflict of interest has been declared by the authors.
Author contributions
All authors have agreed on the final version and meet at
least one of the following criteria [recommended by the
ICMJE (http://www.icmje.org/recommendations/)]:
• substantial contributions to conception and design,
acquisition of data, or analysis and interpretation of
data;
© 2016 John Wiley & Sons Ltd
Concept analysis and the building blocks of theory
• drafting the article or revising it critically for important
intellectual content.
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