The Development Of Middle Range Theory

For centuries the development of nursing knowledge has been influenced by numerous theorists and their respective theories. These theories have influenced, and continue to influence, nursing education, practice and research. (Johnson & Webber, 2005)

The purpose of this paper is to compare and contrast nursing theorists from the four categories which are identified by Meleis as: Needs, Interaction, Outcome and Caring. (Meleis, 2012, Chapter 9) I have chosen Faye Abdellah, Imogene King, Myra Levine and Jean Watson as the grand theorists that I would like to explore for this study in contrast and comparison. This decision was made, in part, due to the fact that all of these theorists were born and educated in the twentieth century and I felt that their theories might be more applicable to my nursing practice. The information contained in the tables was obtained from several sources in an

Nursing theories have been a fundamental tool used to explain, guide and improve the practice of nursing. Theorists have contributed enormously to the growth of nursing as a profession. The four grand theorists I chose are Virginia Henderson, Peplau, Myra Levine and Jean Watson. These theorists have contributed tremendously in the field of nursing through their theories, and research. One thing the theorists have in common is that they are patient centered. They are all concerned on ways we can improve our responsibility to the patients, their families and the environment. They have different ideas but they are all aiming towards achieving the same goal, which is patient satisfaction and safety. Their differences are in their areas of

The profession of nursing has, in recent years, been trying to further develop, test and use proposed nursing theory. To utilize theory appropriately, in all domains of practice, education and research, it is important to know how to describe, analyze and evaluate

There are many concepts in nursing theory that need further clarification. A concept analysis can provide a thorough explanation of a term in nursing theory that will help healthcare professionals better communicate. The Walker and Avant approach to perform a concept analysis was specifically formulated with nurses in mind (McEwen & Wills, 2014). Walker and Avant proposed a concept analysis be used to further understand the meaning of a term or concept in anticipation that those using the term would have the same understanding (McEwen & Wills, 2014). When a term or concept is in question or needs further questioning in any field of nursing, a concept analysis is indicated (McEwen & Wills, 2014). Walker and Avant’s concept analysis is comprised of eight steps; select a concept, determine the aim of the concept, list all possible uses of concept, defining attributes, model case, alterative case (borderline, related, contrary, invented, and illegitimate), list antecedents and consequences, and lastly list empirical referents (McEwen & Wills, 2014). The defining attributes are deemed most beneficial in obtaining comprehension due to the fact that these attributes show which show up in regularity when relating to the concept (Linda & Judith, 2011). Using the Walker and Avant concept analysis model a formal concept analysis will be performed on the term “pain”. Middle range nursing theory gave the example of pain as one of many concepts used in nursing (McEwen & Wills, 2014).

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.

Conceptual analysis is integral in understanding nursing theory. According to Walker and Avant (1995), concept analysis allows nursing scholars to examine the attributes or characteristics of a concept. It can be used to evaluate a nursing theory and allows for examination of concepts for relevance and fit within the theory. The phenomena of pain will be discussed in this paper and how it relates to the comfort theory.

Nursing care incorporates not only a compassionate attitude but passion for care of patients. The caring component of nursing cannot be measured, rather dissected through theory within the clarification of what nurses do. Systemically this is all supported through abundant theories and theorist. The nursing profession emphasizes on holistic care which is defined as treatment of the whole person. Within this skill is the admittance of problems that are biomedical but also opportune clarification of the well-being and health of a human that introduces added indicators of disease that are non-visualized (Powers, 2011).

Nursing revolves, not merely about looking after patients, but creating awareness in the society about self care nursing and prevention strategies and to communicate with their patients in a holistic manner, so as to satisfy their physical, mental and spiritual health needs. Various nursing theorists have repeatedly

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.

Practicing as a nurse, I realize I follow my own metaparadigm of nursing. In this paper, I relate my own personal beliefs with that of a popular nursing theorist. Though my research on theory is just beginning, I feel my metaparadigm most relates to that of Katharine Kolcaba and her theory of comfort. I will seek to illustrate my philosophy with the knowledge and nursing experience I have.

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.

Research in the professional practice of nursing was built upon a wide variety of theories that were presented by many well-known nursing theorists. Nursing theories that may be recognized today include Florence Nightingale’s Environmental Theory, Dorothea Orem’s Self-Care Deficit Theory, Madeleine Leininger’s Cultural Care Theory, and Hildegard Peplau’s Interpersonal Process Theory. These individuals and their respective theories

Nursing theories are the support of nursing practice today. They are significant to nursing practice, education and scientific research because they help to determine, what is already known, and what additional knowledge and skills are needed. Nurses are usually first exposed to nursing theories during nursing education and further exposure comes from hands on training. The gained knowledge, about nursing theories, through education and training enhances better outcomes for patients and caregivers, allows application of professional boundaries, and assists in decision making. In this paper I will attempt to analyze, in general, the importance of nursing theory to the nursing profession; discuss middle-range theory, furthermore Benner’s