1. Chapter 10 Introduction to Middle Range Nursing Theories

2. Middle Range Theory Middle range theories
Lie between grand theories and practice theories
Have fewer concepts and encompass a more limited aspect of reality
Concepts are relatively concrete and often operationally defined.
Propositions are relatively concrete and can be empirically tested.

3. Middle Range Theory—(cont.)
Middle range theories are used by “emerging disciplines” because they are readily operationalized.
Easier to apply in practice
Easier to apply as frameworks for research studies

4. Middle Range Theory—(cont.)
Nursing has recognized middle range theory development as the latest step in knowledge development.
There is broad acceptance of the need to develop middle range theories to support nursing practice.
This is consistent with the desire to legitimatize nursing as a profession.

5. 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.

6. Answer
True Rationale: Middle range theories are increasingly being used by nurses because they are readily operationalized and easy to apply in clinical settings.

7. Middle Range Theory—(cont.)
Many researchers prefer to work with middle range theories.
They provide a better basis for generating testable hypotheses.
They address particular client populations and situations.
Nursing research is currently being conducted to develop and test many middle range theories.
Middle range theories were first introduced into nursing in the early 1974 but are now being used increasingly as frameworks for investigation.

8. Characteristics of Middle Range Theories
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

9. 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

10. Concepts and Relationship Statements
Middle range theories consist of two or more concepts and specified relationship(s) between the concepts.
Concepts should be discrete, observable, and sufficiently abstract to be applied across multiple settings.
Examples of middle range concepts
Health promotion
Comfort
Coping
Resilience
Pain
Self-transcendence

11. Comparison of Grand, Middle Range, and Practice Theories
Complexity/
abstractness
Comprehensive, global
Middle view of reality
Narrow view; simple
Generalizability/ specificity
Nonspecific to setting or specialty
May be generalized to multiple settings
Linked to special groups or type of practice
Concepts
Abstract, not operationalized
Limited number of concrete
Single, concrete concept
Testability
Not testable
May generate testable hypotheses
Goals and outcomes testable
Source of development
Thoughtful appraisal; many years
Evolve from grand theories, practice, and literature
Derived from practice or middle range theories

12. Development of Middle Range Theory
Research
Practice
Literature review
Conceptual models or grand theories
Taxonomies (interventions, diagnosis)
Guidelines or standards
Other disciplines

13. Middle Range Theories Developed From Practice or Research
Includes those developed from grounded theory research and other qualitative methods
Theory of chronic sorrow (Eakes et al.)
Theory of transitions (Meleis et al.)
Theory of caring (Swanson)
Theories from practice are less common.

14. Question
Tell whether the following statement is true or false: Middle range nursing theories are often developed from quantitative research studies but rarely from qualitative or grounded theory research studies.

15. Answer
False Qualitative research studies—particularly grounded theory studies—often contribute to the development of middle range nursing theories.

16. Middle Range Theories Developed From Grand Nursing Theories
Many scholars suggest development of middle range theories from grand theories because of their abstract nature.
Some examples
Nurse-expressed empathy (Olson & Hanchett)— Orlando’s Model
Theory of self-care (Rew)—Orem’s self-care
Prevention as intervention (August-Brady)—Neuman Systems Model

17. 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

18. 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

19. Middle Range Theories That Combine Nursing and Non-Nursing Theories
Combining concepts or elements of multiple theories is very common in middle range theory development.
Examples
Theory of exercise as self-care (Ulbrich, 1999)— Orem’s + transtheoretical model + concept of risk
Self-transcendence (Reed, 1991)—Rogers’ Unitary Human Beings + developmental psychology
Theory of adaptation to chronic pain (Dunn, 2004)— Roy adaptation model + gate control theory, stress and coping (Lazarus) + relaxation theory

20. 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

21. Development of Middle Range Theory—Guidelines
Articulate the theory name (identify it as a middle range theory).
Describe approach used to develop the theory.
Clarify the conceptual linkages in a diagram or model.
Describe the research–practice links of the theory.
Explain the association between the theory and the discipline of nursing.

22. Levels of Middle Range Theory
May be categorized as “high,” “middle,” and “low” middle range theories
High middle range theories include broad, fairly abstract concepts.
Caring, transcendence, adaptation, culture
Middle range theories generally consist of theoretically defined, fairly specific constructs.
Uncertainty in illness, unpleasant symptoms, chronic sorrow
Low middle range theories are more defined and specific.
Women’s anger, acute pain management, intervention for postsurgical pain

23. Middle Range Theory—Future Directions
Middle range theory development and application will and should be increasingly emphasized in nursing.
Attention to middle range theory in practice and research in particular will assist evolution of the discipline’s science.