MIDDLE RANGE NURSING
THEORIES
GROUP DISCUSSION
Level of nursing theory
INTRODECTION TO MIDDLE RANGE NURSING THEORIES
As discussed in Chapter 2, middle range nursing
theories
Lie between grand theories and practice theories
Have fewer concepts and encompass a more limited aspect of reality
Easier to apply in practice
Easier to apply as frameworks for research studies
Middle-range nursing theories
Definition
arenarrower in scope than grand nursing
theories and offer an effective bridge between
grand nursing theories and nursing practice
Focus on more specific phenomena than grand
theories
Characteristics of middle range theory
Ideas are relatively simple and general.
Consider a limited number of variables or concepts
Have a substantive focus
Consider a limited aspect of reality
Can be tested empirically
Focus on client problems and outcomes
May specify an area of practice, client age range, nursing actions or
interventions, and outcomes
Frequently Used Middle Range
Theories
Are clearly stated and easy to understand
Consistent and coherent
Deal with current nursing perspectives
Address relevant topics that solve persistent problems
Can easily be adopted to guide nursing practice
question
Tell whether the following statement is true or false
Compared with grand nursing theories,
middle range theories are easy to apply in
practice and can readily be used for
research.
answer
True
Rationale: Middle range theories are
increasingly being used by nurses because
they are readily operationalized and easy to
apply in clinical settings.
Categorizing Middle Range Theory
Middle range theory is more specific than grand theory
but abstract enough to support both generalization and
operationalization across a range of populations; this sets
it apart from practice or situation-specific theory.
Level of middle range theory
: based on their abstraction or degree of specificity
3- Low-middle
1- High-middle theories 2- Middle theories theories
included concepts such as included concepts those that are closer to
such as uncertainty in practice or situation-
caring, growth and specific theories, included
illness, unpleasant
development, self- hazardous secrets,
symptoms, chronic women’s anger, nurse
transcendence, resilience, sorrow, peaceful end midwifery care, acute pain
and psychological of life, cultural management, helplessness,
adaptation. brokering, and nurse- and intervention for
postsurgical pain.
expressed empathy.
Development of Middle Range Theory
Sources used to generate middle range theory
:include
Literature reviews
Qualitative research
Field studies
Conceptual models
Taxonomies of nursing diagnoses and interventions
Clinical practice guidelines
Theories from other disciplines
Statistical analysis of empirical data
Approaches for Middle Range
Theory Generation
1.Induction through research and practice
2.Deduction from research and practice or application of grand theories
3.Combination of existing nursing and non-nursing middle range
theories
4. Derivation from theories of other disciplines that relate to nursing
5. Derivation from practice guidelines and standards rooted in research
Middle Range Theories Derived From
Research and/or Practice
Theprocess used to develop a middle range Theory of
Family Vigilance was described by Carr
Purpose:
toprovide an explanation of “the meanings, patterns and
day-to-day experience of family members staying with
hospitalized relatives”
Theory Development Process of Family
Vigilance
Second, described how she
The first study among employed the strategies of Finally, through
family members of patients concept synthesis and
the process of
in a neurology unit, yielded statement synthesis to
define than illustrate the theory synthesis,
five categories of meaning:-
#commitment to care
relationships between and she constructed the
among the different
defining characteristics of information into a
#resilience
the categories that formalized theory.
# emotional upheaval comprise family vigilance.
# dynamic nexus
# transition
QUSTION
How many Level of middle range theory
based on their abstraction or degree of
specificity?
- Two level
- Four level
- Three level
:ANSWER
- THREE LEVEL
- RATIONAL: There is three level of middle
range theory based on their abstraction or degree
of specificity which is high middle theory ,
middle theory, and low middle theory.
Middle Range Theory Derived From a Grand
Theory
many nursing theorists and scholars agree that grand theories are difficult to apply in research and practice
.And suggest development of middle range theories derived from them
.During the last two decades, several theories developed from grand theories have been published in the nursing literature
:Examples
Nurse express empathy (Orlando’s model )
Theory of self care (Orem’s self care theory)
middle range theory of health promotion for preterm infants
Prevention as intervention (Neuman system model)
Middle Range Theory
Combining Existing
Nursing and Non-Nursing Theories
Combining concepts or elements of multiple theories is common in middle range theory development.
In many cases found in recent nursing literature, the authors of a middle range theory reported that
.they had derived their theory from both nursing and non-nursing theories
:Examples
Theory of exercise as Self Care ( ulbrich, 1999) - to improve the health of individuals at risk for cardiovascular disease
Theory of Adaption to Chronic Pain (Dunn, 2004)
theory was to review and synthesize the theoretical knowledge related to pain in older adults, coping with pain, religious coping, and spirit
.uality
, Roy adaptation model (To Promote Physical Activity )
.gate control theory (The 'gate' is the mechanism where pain signals can be let through or restricted)
:Examples
Self transcendence(reed, 1991)
provide a framework for inquiry and practice regarding promotion of well-being in
the midst of difficult life situations
stress and coping ( Lazarus)
Relaxation theory
Developmental psychology
Rogers’ Unitary human beings- views nursing as both a science and an art
Middle Range Theories Derived From
Non-Nursing Theories
A very significant number of middle range theories are developed from non-
nursing theories.
Most commonly used are theories from behavioral sciences, sociology, and
anthropology.
Health Belief Model (behavioral sociology)
Theory of Reasoned Action (behavioral psychology)
Social Learning/Social Cognitive Theory
Middle Range Theories Derived From
Non-Nursing Theories (CONT.)
Examples of nursing theories:
Theory of comfort (Kolcaba,1994)—medicine, psychiatry, ergonomics, and
psychology
Theory of skill acquisition (Benner, 2001)—Dreyfus model of skill acquisition
(mathematician and philosopher)
Uncertainty in illness theory (Mishel & Clayton, 2003)—chaos theory
Other examples:
Middle Range Theories Derived From
Practice Guidelines and Standards
Appear to be the least common source for middle range theory development in
nursing
Examples:
Public Health Nursing Practice Model (Smith & Bazini-Barakat, 2003)—
several sources including Healthy People 2010, Standards of PHN Practice, and
10 Essential Services of Public health
Theory of Peaceful End of Life (Ruland & Moore, 1998)—standards of care
for terminally ill
Questions
1. A few number of middle range theories are developed from non-nursing
theories. (T or F )?
2. A few examples could be found in middle range theories derived from practice
guidelines and standards. (T or F )?
3. All these examples are middle range theories are developed from non-nursing
theories. Except:
A. Theory of skill acquisition
B. Theory of Peaceful End of Life
C. Theory of comfort
D. Uncertainty in illness theory
Answer
1. A few number of middle range theories are developed from non-nursing
theories. (T or F )?
2. A few examples could be found in middle range theories derived from practice
guidelines and standards. (T or F )?
3. All these examples are middle range theories are developed from non-nursing
theories. Except:
A. Theory of skill acquisition
B. Theory of Peaceful End of Life
C. Theory of comfort
D. Uncertainty in illness theory
Final thoughts
Theories vary in their level of abstraction and scope. The more
abstract and broader type of theory is called grand theory.
The more concrete and narrower theory is referred to as a
.middle-range theory
Middle-range theories are narrower in scope than grand theories.
They are composed of a limited number of concepts and propositions.
A nurse’s activity is an example of a middle-range theory concept (Orlando, 1961).
Links the concepts of nurse’s reaction and nurse’s activity
Middle-range explanatory theories specify relations between two or more
concepts.
Explain why and the extent to which one concept is related to another concept.
Middle-range predictive theories addresses how changes in a phenomenon occur.
Analysis and Evaluation
Questions
Do you agree with presence of middle range theory for all
nursing services ( such as use MRT for maternity, adult,
pediatric) or do you like one mega theory that suitable for all
and why?
