Middle Range Theories Are At The Frontier Of Nursing Science Essay

Middle range theories “lie between the grand nursing models and more circumscribed, concrete ideas” (McEwen & Wills, 2014, p. 37). There are numerous middle range theories specifically created for the nursing profession. These theories serve to guide nurses in their nursing duties, offering insight into an abundance of topics ranging from objective, fact-based data to the more subjective, personalized material. Each middle range theory can be further grouped into four subgroups; descriptive, explanatory, predictive, and prescriptive. Descriptive theories describe and examine major ideas. The purpose of a descriptive theory is not to link one concept to another, but rather to simply study the perceivable philosophy. In comparison, explanatory

“Caring through Relation and Dialogue: A Middle-Range Theory for Patient Education is derived from the two

Theory development stems from personal experiences, intuition, and knowledge of the theorist (Burns et al., 2013). When a scholar develops a theory, it has to be tested through research. The findings of the study are then presented to experts in the area of academics and the field of practice (Burns et al., 2013). The presentation of the findings allows experts to provide constructive criticism, highlight the pros and cons of the theory, and acknowledge whether or not the theory can be accepted as a guide to practice. This theory evaluation paper will give the reader a theory description, theory analysis, and an assessment of Dorothea Orem’s self-care deficit theory of nursing (Alligood et al., 2010).

The symptom management theory (SMT) of the University of California, San Francisco (UCSF), was revised by its faculty and students in 2001 (Smith & Liehr, 2014). According to Dodd et al. (2001), the subjective experience that suggests alterations in an individual’s functioning, sensation, and cognition is called a symptom. Dodd et al. state that their theory provides a nonspecific symptom management model to guide nursing practice and research. The SMT has three overlapping circles which contain the three domains of nursing science, also known as concepts of metaparadigm of nursing. The three nursing science domains are the person, the environment, and health & illness. In the theory’s model, the dimensions are affected by the three nursing science domains (Dodd et al., 2001).

Middle range nursing theories are abstract, testable theories that contain a limited number of variables. According to Chinn and Kramer (2011), middle range nursing theories can lead to new practice approaches as well as examine factors that influence the desired outcomes in nursing practice. One beneficial and widely used middle range nursing theory is the theory of unpleasant symptoms, developed collaboratively by Lenz, Pugh, Milligan, Gift, and Suppe in 1995.

The metaparadigm of nursing consists of four parts comprised by Jacqueline Fawcett, in 1984, in her seminal work (Alligood, 2014). The metaparadigm she developed served to provide direction and guidance for the nursing framework already in use and became an organization tool for theories already in use (Alligood, 2014). The four parts being person, health, environment, and nursing. The four components of the metaparadigm concept of nursing is important to nursing theory because they are the key areas of focus of patient care, and the metaparadigm is designed to differentiate nursing from other specialties (Alligood, 2014). It is this use of theories that makes nursing a profession and guides professional nursing practice, research, and education (Alligood, 2014).

Consequently, one nursing theory does not fit every individual’s need. However, while nursing theories encompass many different beliefs, policies, and procedures, nurses can choose from many theories and can utilize some, all, or none of the concepts of each theory.

In the 21st century, one can see that nursing is a profession that is ever-changing and nurses rely on knowledge development to implement care to their patients. With the use of middle-range theories, nurses can easily implement research into their care since they are easily tested and can be

The middle-range theories for nursing as I understood are a part of the structure of discipline. These theories are mainly concerned with well-being, and conditions of people rather sick or well. Not only are middle-range theories concerned with well-being of people, but also human behavior as it relates to interactions in daily life situations. Lastly, middle-range theory is concerned with the steps taken by which positive changes in health status are affected.

To this end, I believe middle-range theories are best suited to advance nursing knowledge and practice in the 21st century. “Middle-range theories are at those levels of conceptualization that could inform nursing practice and research, and thus continue the cycle of advancing foundational knowledge and enhancing quality care”, (Meleis, 2012). Middle-range theories were created to help the nursing profession realize its overall mission and goal, now and in the future; to alleviate pain, suffering and distress, as well as promote health-seeking behaviors which will lead to improved health outcomes and attainable goals. Because middle-range theories lie in the middle of grand theories and situation specific theories, they are directed more toward specific interventions that can be implemented at the ‘bedside’. As such, they are designed to provide frameworks to manage patients’ experiences with symptoms, as well as the ability to understand responses to health and illness phenomenon.

From my search I have noted that middle range theories are being used to develop valid instruments and processes for care of both specific and general populations. An example of theory developments and comparisons for a specific population include topics like unpleasant symptoms of chemotherapy relating to changes in cognitive status (Myers, 2009). An example of a more general theory would be, a practical application of Katharine Kolcaba's comfort theory to cardiac patients (Krinsky, Murillo & Johnson, 2014). These are just two of the many theories that I reviewed.

The importance of nursing theory to practice of nursing should not be overlooked or underrated. That is because, it’s understanding and application are essential in enhancing patient 's care, improving communication between nurses, providing education’ and guidance in research, (Robert T. Croyle (2005). It is equally important to know that currently, there are many theories that guide the practice of nursing. Two of the most prominent ones will be compared and will form the subject of this this discussion.

As part of the theme for the theory development for my nurse practitioner career, I chose the Nurse Practitioner Practice Model and the Symptom Management Theory. Each of these theories is unique, but have different aspects that appeal to the overall trend of my theory development. As a nurse practitioner, I see the end goal as helping people achieve their goal of health, by integrating medicine and nursing. The Nurse Practitioner Practice Model helps by giving a framework to mesh nursing and medicine together (Shuler & Davis, 1993) The Symptom Management Theory gives a framework to manage symptoms, not only by the symptoms themselves, but take in consideration the individuals characteristics (Linder, 2010). As a nurse practitioner, I feel the two coexist together perfectly. Since every patient expresses a symptom or the lack of symptoms, when seeing a nurse practitioner, these middle range theories are congruent with everyday practice at the nurse clinician level.

In 1970s and 1980s the scholars and practicing nurses started to incorporate nursing theories into their research and clinical practices. The most of the early theories fell into category of “grand theory”. While nursing researchers initially tried to utilize the grand theory in to their research, due to its wide range of information it made the effort difficult. The development of middle range theory started to emerge in attempt to incorporate in nursing research and practice. Middle range theory extend the understanding of nursing practice relevant to evidence based research and nursing practice. In this paper, I am going focus on two middle range theory chronic sorrow and unpleasant symptoms. I will discuss the brief historical background on each theory, compare and contrast internal and external criticism of each theory and finally which theory will I choose in clinical settings by providing reasons for my selection

Imogene King is a very influential nursing theorist. King was a master’s prepared registered nurse and she also received an honorary doctorate from Southern Illinois University (Messmer, 2000). She worked many years as a nurse educator; preparing the future of nurses for their profession. During her time working as an educator, she also wrote three books relating to her nursing theory (Alligood, 2014, pp.261-263). It is my belief that her work will be used for many more years in nursing practice.