The foundation of any profession lies in its capacity to develop a specialized body of knowledge, usually encapsulated in theories. There are three classifications of theories based on the scope, range, abstractness, philosophical underpinnings, and purpose. Based on the scope or generalization and level of abstractness, there are three types of theories, middle-range, grand theories, and situation-specific theories. The grand theories are most complex and broadest in scope. They deal with nonspecific and relatively abstract components and lack operational definitions. On the other hand, situation-specific theories, as Im and Meleis (1999) articulate, are based on low level of abstraction, context, limits generalization, connects research to practice, incorporates diversities, and reflect specific nursing phenomena. According to Schmidt (2004), a science matures, knowledge development has moved from grand theories to middle-range theories that are practice-based, more empirical, and less abstract. Therefore, this makes them more useful in the 21st century. Middle range theories target specific concepts and phenomena, for example, pain and stress, are limited regarding scope and are general enough to encourage nursing research, thereby allowing for an opportunity to link to practice. Besides, it deals with operational and concrete concepts and is amenable to empirical testing. Since the theories are highly specific to the nursing practice, as well as relatively simple top understand, they are most useful and applicable to the clinical practice in the 21st Century.
In clinical practice, the middle range theory can be defined as a set of related concepts or ideas that are mainly focused on a limited dimension of the reality in nursing (Smith & Liehr, 2013). The theory was developed and grew at the intersection of research and practice to provide guidance for everyday scholarly research and practice rooted in the nursing discipline. The theories are characterized by the more limited scope and less abstraction compared to the grand theories (Meleis et al., 2000). The mid-range theory is important in clinical practice primarily because the credibility of any profession is usually based on its capability in creating and applying theory. In relation to nursing practice, the mid-range theory is important primarily because, for a long time, some aspects of the society have not been considered in healthcare, which is attributed to diversity. Essentially, the continual growth of diversity, as well as immigration are a reality that can no longer be ignored. Mid-range theories deal with these specific components in the nursing practice, thereby making them more effective compared to grand and situation-specific theories.
In essence, as Fitzpatrick and Whall (1996) articulates, middle range theories are readily operationalized compared to grand and situation-specific theories. Besides, it can be applied to many situations that range from individual, group, and community settings. As the writer asserts, depending on the application, its propositions can range from causal to associative. The assumptions that are used usually fit into theory, making the theory superior compared to the other two. Also, compared to the two, mid-range theories are relevant to potential users and are oriented towards achieving outcomes that are vital to patients, not merely describing what nurses do. Furthermore, Whall (1996) argues that mid-range theories describe nursing-sensitive phenomena that can be readily associated with deliberate actions of nurses.
While the grand theories provide a global viewpoint, the mid-range theories provide a middle view of reality, making them be less generalized compared to the grand theories. Therefore, they are more useful in the nursing practice in the 21st Century. Also, because the situation-specific theories are linked to special populations or an identified and specific field of practice, they do not take care of generalizability, which is important for research purposes. Therefore, because the mid-range theories encompass some generalizability, it makes them more efficient for nursing research and practice. Besides, mid-range theories are more specific compared to grand theories. Even though mid-range theories have limited number of concepts that are concrete, they can be operationally defined as opposed to grand theories and situation-specific theories whose concepts are abstract and single respectively. As the grand theories are abstract, they cannot be operationally defined. On the other hand, since the situation-specific theories are single, concrete concepts cannot be operationalized. Therefore, this makes the mid-range theories more useful and widely applicable compared to the two. For instance, Orlandos theory of deliberative nursing process, Watsons theory of human caring, and Peplaus theory of interpersonal relations, which are mid-range theories are narrower and concrete, making them even more useful compared to grand theories and situation-specific theories. Furthermore, the propositions used in middle-range theories are stated compared to grand theories, whose propositions are not always explicit. Besides, the hypotheses for mid-range theories are testable as opposed to those of grand theories, which are not testable. Besides, mid-range theories evolve from clinical practice, practice guidelines, and literature review, hence making them more applicable and useful in the nursing practice compared to situation-specific and grand theories.
According to Fawcett (1999), it can be derived that the product of every nursing study is a product of mid-range theories. Middle range theories cover the who nursing practice and include theories of pain, unpleasant symptoms, self-efficacy, reasoned action and planned behavior, empathy, chronic sorrow, social support, interpersonal relations , modelling and role modelling, comfort, health-related quality of life, health promotion, deliberative nursing practice, resilience, and planned change (Peterson & Bredow, 2004). These theories practically cover all aspects of nursing practice, thereby making middle-range theories most useful and applicable in the 21st Century nursing practice.
Furthermore, Smith and Liehr (2008 clarified that indeed the development of mid-range theories has necessitated the growth of knowledge development in the nursing practice. In light of this view, the professional nurse, even though he is not a master of everything, he is increasingly gaining knowledge and skill in various specialties areas, and this, middle range theories facilitate this. As Meleis (2012) articulates, middle range theories have a more limited scope compared to grand theories, less abstraction, and address specific phenomena while also reflecting the nursing practice. By adopting the mid-range theories, nurses will continue with knowledge development, which will lead to improvement of patient care outcomes and the quality of care, thereby allowing for the expansion on the phenomena of science and art of the nurse. In effect, this will provide an outline for practice within the nursing discipline. Therefore, it can be surmised that middle-range theories are more useful and applicable in the 21st Century.
References
Fawcett J. (1999). The relationship of theory and research. 3rd ed. Philadelphia: F. A: Davis.
Fitzpatrick, J. J., & Whall, A. L. (1996). Conceptual models of nursing: Analysis and application (3rd ed.). Stamford, CT: Appleton & Lange.
Im, E. O., & Meleis, A. I. (1999). Situation-specific theories: philosophical roots, properties, and approach. Advances in Nursing Science, 22(2), 11-24.
Meleis, A. I., Sawyer, L. M., Im, E. O., Messias, D. K. H., & Schumacher, K. (2000). Experiencing transitions: an emerging middle-range theory. Advances in nursing science, 23(1), 12-28.
Meleis, A. (2012). Theoretical nursing development and progress (5th ed.). Philadelphia, P.A.: Wolters Kluwer, Lippincott, Williams & Wilkins.
Peterson, S.J. & Bredow, T.S. (2004). Middle range theories: Application to nursing research. Philadelphia, PA.: Lippincott Williams and Wilkins.
Schmidt, N. (2004). Response to" The pediatric nurse-A societal need. Self-Care, Dependent-Care, and Nursing, 12(2), 7-9.
Smith, M. J., & Liehr, P. R. (Eds.). (2013). Middle range theory for nursing. 2nd Ed. New York, NY: Springer Publishing Company.
Smith, M. J. (2008). Middle range theory for nursing. New York, NY.: Spring House Publishing Company.
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