Middle Range Theories In Nursing Care

Afza.Malik GDA

Nursing Care and Middle Range Theories

Middle Range Theories In Nursing Care

What are Middle-Range Theories,Nursing Literature,Other Theories,Scope of Theories,Middle Range Theories and Progress.

What are Middle-Range Theories

     Middle-range theories are described by Merton (1968, p. 9) as those "that lie between the minor but necessary working hypotheses that evolve in abundance during day-to-day research and the all-inclusive systematic efforts to develop unified theory." 

    He goes on to say that the principal ideas of middle-range theories are relatively simple. Simple here means rudimentary, straightforward ideas that stem from the focus of the discipline. Thus middle-range theory is a basic, usable structure of ideas, less abstract than grand theory and more abstract than empirical generalizations or micro-range theory. 

    Middle- range theory is a set of related ideas that are focused on a limited dimension of the reality of nursing. These theories are composed of concepts and suggested relationships among the concepts that can be depicted in a model. 

    Middle range theories are developed and grown at the intersection of practice and research to provide guidance for everyday practice and scholarly research rooted in the discipline of nursing.

Nursing Literature 

    In 1999, a review of a decade of nursing literature identified the existing foundation of middle-range nursing theory (Lichr & Smith, 1999). To locate this literature, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) was searched using the terms "middle-range theory," "mid-range theory," and "nursing." 

    All papers written in English were evaluated according to four inclusion criteria: 

1) the theory's author identified it as middle-range in the paper

2) the theory name was accessible in the paper

3) concepts of the theory were explicitly or implicitly identified

4) the development of the theory was the major focus of the paper (Licht & Smith, p. 83)

Other Theories

    Twenty-two theories, published from 1988 to 1998, met these criteria and were addressed. Seven were published between 1988 and 1992, and 15 were published be tween 1994 and 1998 (Licht & Smith, 1999). 

    The 22 middle-range theories were grouped as high, middle, and low relative to each other based on the generality or scope of the theory as determined by the name of the theory. Six of the 22 were high-middle, 7 were at the middle range, and 9 were grouped as low middle (Liehr & Smith). 

    It was recommended that persons creating middle-range theory: 

(a) describe clearly the theory name and how it was generated

(b) clarify conceptual linkages with a model

(c) articulate the research-practice links

(d) tie the theory to the disciplinary perspective of nursing

    A 2001 CINAHL. search using the same search terms and the same criteria for inclusion resulted in identification of 14 new middle-range theories published from 1998 through 2001. 

    Two of the theories on the list of 14 (Precarious Ordering: Theory of Women's Caring and Experiencing Transitions) are referred to as "emerging" by their authors, indicating that they are in early stages of development (Smith, M. J., & Lichr, 2003). 

    Four of the theories (Enlightenment, Family Health, Urine Control, and Pathway to Chemical Dependency in Nurses) were de rived from grand theories of nursing or other middle-range theories (Smith, M. J., & Lichr).

Scope of Theories

    The 14 middle-range theories were grouped as high, middle, and low relative to each other based on the generality or scope of the theory as determined by the name of the theory. One theory (Enlightenment) was high-middle; 7 were at the middle range (Attentively Embracing Story, Comfort, Cultural Negotiation.

    Experiencing Transitions, Family Health, Investing in Self-Care, and Truthful Self-Nurturing); and 6 were grouped as low-middle (Caring Through Relation and Dialogue for Patient Education, Family Dynamics of Persons with Chronic Pain, Pathway to Chemical Dependency in Nurses, Precarious Ordering: Theory of Women's Caring, Prevention as Intervention, and Urine Control Theory) (Smith, M. J., & Liehr, 2003, pp. 11-17).

Middle Range Theories and Progress

    All middle-range theories are works in progress. It is to be expected that middle- range theories change over time as they are applied to guide practice and research. Theories are published so that others can critique, test, revise, and use them as a source of scholarly productivity in research and practice. 

    The 8 middle-range theories that follow cover a broad spectrum, including ones that were proposed decades ago and have been used extensively, to those that are newly developed and just beginning to be used. Some of the theories were originated by nurses and some were originally created by persons outside of nursing. 

    Middle-range theories are offered as starting points for nurses wishing to structure their practice and research. With these theories comes a challenge to stretch the boundaries of thinking, consider the rub between each theory and what is known from experience, and apply the theories so that the body of nursing knowledge remains a vibrant, relevant foundation for guiding practice and re- search.

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