Review one of the studies obtained from the reading list provided in the reading section of the module. Describe the theoretical framework in the study.

Mid-range Theories – Nursing Essay Assignment Papers
Mid-range Theories – Nursing Essay Assignment Papers

Search current nursing journals for examples of the development, analysis, or use of mid-range theories in the discipline of nursing. Debate trends in the development and use of mid-range theories in nursing research with colleagues. Mid-range Theories – Nursing Essay Assignment Papers.

Mid-range Theories
Introduction
Fig. 17: Nursing Theorists

Middle range, or mid-range, nursing theories lie between the most abstract theories, such as grand nursing theories, models, or conceptual frameworks, and more circumscribed, concrete theories, such as practice theories. Compared to grand theories, mid-range theories are more specific, have fewer concepts, and encompass a more limited aspect of the real world. Concepts are relatively concrete and can be operationally defined.

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Nursing has appeared to recognize mid-range theory as the latest step in knowledge development, and there is broad acceptance of the need to develop mid-range theories to support nursing practice. Mid-range theories are also increasingly used in nursing research studies. Many researchers prefer to work with mid-range theories rather than grand theories or conceptual frameworks because they provide a better basis for generating testable hypotheses and addressing particular client populations. A review of nursing research journals and dissertation abstracts indicates that nursing research is currently being used in the development and testing of a number of mid-range theories, and mid-range theories are frequently being used as frameworks for investigation. Mid-range Theories – Nursing Essay Assignment Papers.

Students will consider the relationship between nursing knowledge and nursing practice, with emphasis on the relationship of mid-range theories to aspects of nursing practice, research, education, and administration. Mid-range Theories – Nursing Essay Assignment Papers.

Several methods for development of mid-range theories have been identified in the nursing literature. Mid-range theories emerge from combining research and practice and building on the work of others. Sources used to generate mid-range theory include literature reviews, qualitative research, field studies, conceptual models, nursing practice, clinical practice guidelines, theories from other disciplines, and statistical analysis of empirical data. Liehr and Smith identified five approaches for mid-range theory generation. The purpose of this module is to examine the purposes, characteristics, and concepts of mid-range theory and to describe the source and development process of mid-range theories from these five approaches.

Outcomes
Upon completion of the module, students will be able to:

understand the purposes of mid-range theories.
discuss the characteristics and concepts of mid-range theories.
describe the sources and development of mid-range theories.
develop a concept of interest into a preliminary mid-range theory.
Topics Index
The following topics are covered in this module.

Purposes of Mid-range Theory
Characteristics of Mid-range Theory
Concepts and Relationships for Mid-range Theories
Theories from Research and Practice
Theories from a Grand Theory
Combining Theories
Theories from Non-Nursing Disciplines
Theories from Practice Guidelines
These topics are designed to direct your readings, assist you in the development of assignments, and prepare you for module discussions.

1. Purposes of Mid-range Theory
Nursing theories vary in scope, or the level of abstraction. Theories that are broader in scope are called grand range theories. These theories are abstract and give broad perspective to the goals and structures of nursing practice. They are not testable, rather, they are viewed as knowledge-generated models from which hypotheses can be derived and tested, and they are useful as a theoretical framework for the development of mid-range theories. Middle range theories are limited in scope and contain a limited number of variables; they involve abstractions that are close enough to observed data to be incorporated in propositions that permit empirical testing. Thus, they can easily be taken to the operational level. They are theories that describe, explain, and predict phenomena of concern to nursing as well as prescribe actions in response to those phenomena. Mid-range Theories – Nursing Essay Assignment Papers.

Both grand and mid-range theories are important for knowledge development in the discipline of nursing. Grand theories are important to provide a larger picture of the phenomena. However, a deeper understanding about the relationships among those phenomena is provided by mid-range theories. Thus, the discipline of nursing has been concentrating its efforts in developing more mid-range theories, which are able to direct research and practice as well as strengthen the linkage among areas of theory, research, and practice.

Mid-range theories were first suggested in the discipline of sociology in the 1960s, and were introduced to nursing in 1974. At that time, mid-range theories were useful for emerging disciplines because they were more readily operationalized and addressed through research than grand theories. However, more than fifteen years elapsed before there was a collaborative call for mid-range theory development in nursing.

Development of mid-range theories is supported by the frequent critique of the abstract nature of grand theories and the difficulty of their application to practice and research. The purpose of mid-range theories is to describe, explain, or predict phenomena, and unlike grand theory, they must be explicit and testable. Therefore, they are easier to apply in practice situations and as frameworks for research studies. In addition, mid-range theories have the potential to guide nursing interventions and change conditions of a situation to enhance nursing care. A major role of mid-range theory is to define or refine the substantive component of nursing science and practice.

Each mid-range theory addresses relatively concrete and specific phenomena by stating what the phenomena are, why they occur, and how they occur. In addition, mid-range theories can provide structure for the interpretation of behavior, situations, and events. They support understanding of the connections between diagnosis and outcomes, and understanding of the connections between interventions and outcomes. Mid-range Theories – Nursing Essay Assignment Papers.

Overall, mid-range theories:

are more useful in research than grand theories because of their low level of abstraction and ease of operationalization
tend to support prediction better than grand theories due to circumscribed range and specificity of the concepts
are more likely to be adopted in practice because their relative simplicity eases the process of developing interventions for identified health problems.
Like theory in general, mid-range theory has three functions in nursing knowledge development:

Mid-range theories are used as theoretical frameworks for research studies.
Mid-range theories are open to use in practice and should be tested by research.
Mid-range theories can be the scientific end product that expresses nursing knowledge.
2. Characteristic of Mid-range Theory
Several characteristics identify nursing theories as mid-range. First, the principal ideas of mid-range theories are relatively simple, straightforward, and general, Second, mid-range theories consider a limited number of variables or concepts; they have a particular focus and consider a limited aspect of reality. In addition, they are receptive to empirical testing and can be consolidated into more wide-ranging theories. Third, mid-range theories focus primarily on client problems and outcomes, as well as the effects of nursing interventions on client outcomes. Finally, mid-range theories are specific to nursing and may specify an area of practice, age range of the client, nursing actions or interventions, and proposed outcomes. Mid-range Theories – Nursing Essay Assignment Papers.

The more frequently cited mid-range theories tend to be those that are clearly stated, easy to understand, internally consistent, and coherent. They deal with current nursing perspectives and address socially relevant topics that solve meaningful and persistent problems. Overall, mid-range theories for nursing combine proposed relationships between specific, well-defined concepts with the ability to measure or objectively code concepts. Therefore, mid-range theories contain concepts and statements from which hypotheses may be logically derived and empirically tested, and easily adopted to guide nursing practice. Mid-range Theories – Nursing Essay Assignment Papers.

The characteristics of middle range nursing theory are:

not comprehensive, but not narrowly focused
some generalizations across settings and specialties
limited number of concepts
clearly stated propositions
may generate testable hypotheses.
3. Concepts and Relationships for Mid-range Theories
Mid-range theories consist of two or more concepts and a specified relationship between the concepts. They address concepts that are toward the middle of the continuum with the metaparadigm concepts (nursing, person, health, and environment) at one end and specific concrete actions or events (i.e., medications, preoperative teaching, and electrolyte management) at the other. The concepts should be discrete, observable, and sufficiently abstract to be applied across multiple settings and used with clients with differing problems. Examples from the nursing literature include theories describing health promotion, comfort, coping, resilience, uncertainty, pain, grief, fatigue, self-care, adaptation, self-transcendence, and transitions. Mid-range Theories – Nursing Essay Assignment Papers.

Mid-range theories link discrete and observable phenomena or concepts in relationship statements. In mid-range theory, relationships are explicitly stated and, preferably, they are unidirectional. Relationships can be of several types. The most common are causal relationships that state a change in the value of one variable or concept is associated with a change in the value of another variable or concept.

4. Theories from Research and Practice
The current emphasis of nursing theory development focuses on efforts to construct, test, refine, and evaluate mid-range theories. To help advance the discipline, nurses are encouraged to write and publish articles that describe mid-range theories and report research studies in which a mid-range theory was used. This process of mid-range theory generation and refinement may further develop the discipline’s knowledge base. Therefore, nurses in all settings need to strive to learn about existing or emerging mid-range theories, or seek to develop and describe theories that will explain phenomena they observe in practice. Mid-range Theories – Nursing Essay Assignment Papers.

Nursing has the knowledge, skills, manpower, and resources to move beyond delineation of conceptual models and domain concepts to emphasize development and application of mid-range theory. Mid-range theory holds much promise for the evolution of the discipline’s science and practice. But, as Liehr and Smith point out, the challenge is developing mid-range theories that are empirically sound, coherent, meaningful, useful, and illuminating.

In order to develop mid-range theories, one needs to be aware of the sources for the process of mid-range theory development. Liehr and Smith (1999) identified five approaches for mid-range theory generation. The five approaches are:

Induction through research and practice.
Deduction from research and practice or application of grand theories.
Combination of existing nursing and non-nursing mid-range theories.
Derivation from theories of other disciplines that relate to nursing.
Derivation from practice guidelines and standards rooted in research.
This module is an overview of the five approaches for mid-range theory generation.
One of the most common sources for development of mid-range theories is nursing research or nursing practice. Qualitative research methods are frequently noted as sources for mid-range theory development. Variations in the idea of mid-range theory development from research are fairly common. Theorists often combine qualitative research with literature review, concept analysis, concept synthesis, and other techniques in the process of developing a mid-range theory. For example, Eakes, Burke, and Hainsworth developed the mid-range theory Theory of Chronic Sorrow from an extensive review of the literature, and data gathered through ten qualitative research studies. Mid-range Theories – Nursing Essay Assignment Papers.

Identification of mid-range theories and models derived primarily from practice is more difficult. One example is the Theory of Unpleasant Symptoms, which was reportedly developed by integrating existing practice and research information about a variety of symptoms. Some models that describe areas of specialty nursing practice were developed from combination of practice and another source, typically research or practice standards.

5. Theories from a Grand Theory
Many nursing theorists and scholars found grand theories difficult to apply in research and practice and suggested the development of mid-range theories derived from the grand theories. During the past decade or so, a number of theories developed from grand theories have been published in nursing literature. Several mid-range theories were developed from Roy’s Adaptation Model. One example is Whittemore and Roy’s concept syntheses to integrate concepts and assumptions in order to theoretically describe “adapting to diabetes mellitus” (Whittemore & Roy, 2002, p. 311-317). Mid-range Theories – Nursing Essay Assignment Papers.

Exemplar of a mid-range theory derived from a grand theory:

Jirovec, Jenkins, Isenberg, and Baiardi (1999) detailed their work substructing The Urine Control Theory from Roy’s Adaptation Model. In this case, the theory was used as a framework for addressing problems of urine control.

Theory development process: To develop the Theory of Urine Control, the theorists first described elements of Roy’s Adaptation Model (input stimuli, coping mechanism and adaptive modes), then inserted the variables affecting urinary tract functioning into each of the elements. For example, bladder distention was identified as a component of “focal stimuli”, accessible facilities were seen as “contextual stimuli,” and socialization of sanitary habits was described as “residual stimuli” (Figure 2). Mid-range Theories – Nursing Essay Assignment Papers.

Following development of the model, a research program was developed to decrease incontinence in 119 elders. The intervention was to manipulate contextual stimuli to compensate for the elder’s memory impairment. Variables were measured in the study and several relationships outlined. For example, the researchers looked at the relationship between urine control and mobility, and urine control and accessible facilities by manipulating elements of the residents’ environment to improve accessibility. They determined that cognitive abilities may be compensated for by changes in contextual stimuli. Also, when cognitive ability or mobility is decreased, environmental manipulations can be increased to compensate. It was noted that the derived mid-range theory supported Roy’s work. Mid-range Theories – Nursing Essay Assignment Papers.

Fig. 18: Conceptual Model of Urine Control.

6. Combining Theories
Combining concepts or elements of multiple theories is very common in mid-range theory development. In many cases found in recent literature, the author(s) of a mid-range theory reported that they derived their theory from both nursing and non-nursing theories. For example, Ulbrich developed the Theory of Exercise as Self-Care through “triangulation of Orem’s self-care deficit theory of nursing, the trans-theoretical model of exercise, behavior, and characteristics of a population at risk for cardiovascular disease” (Ulbrich,1999, p. 65-70).

Exemplar of a mid-range theory combining existing nursing and non-nursing theories:

Dunn provided an excellent example of combining existing nursing and non-nursing theories in development of a mid-range Theory of Adaptation to Chronic Pain. The theorist’s intention was to describe coping and pain control in elders with the purpose of maintaining their quality of life and functional ability.

Theory development process: Dunn wrote that the first step in developing her theory was to review and synthesize the theoretical knowledge related to pain in elders, coping with pain, religious coping, and spirituality. She reported identification of three theoretical models that addressed concepts related to pain and coping in elders. There were: Melzak & Wall’s gate control theory of pain, Lazarus & Folman’s stress and coping theory, and Wallace, Benson, and Wilson relaxation response. To ensure that the final model was applicable to nursing, Dunn selected the Roy Adaptation Model to guide the theory development process. Mid-range Theories – Nursing Essay Assignment Papers.

Dunn reports that the second step is to define assumptions for the theory that are based on assumptions from the four models. To lay the theoretical foundation, Dunn took concepts, relational statements, and propositions from the existing theories, and arranged them into a diagram to represent the theoretical and operational systems. Finally, the concepts from the Adaptation to Chronic Pain model were linked to empirical indicators to provide a logical and consistent connection.

7. Theories from Non-Nursing Disciplines
A significant number of mid-range nursing theories are developed from one-or-more non-nursing theories. Non-nursing theories, including those from the behavioral sciences, sociology, and physiology, appear to be the most common source for theory development. For example, Kolcaba’s Theory of Comfort was reportedly derived from a review of literature from medicine, psychiatry, ergonomics, and psychology, as well as from nursing literature and history. Benner explained that the Dreyfus model of skill acquisition, developed by a mathematician and a philosopher, was the primary source for her work. Mishel and Clayton’s Uncertainty in Illness Theory incorporated elements of chaos theory. In addition, several mid-range nursing theories have been derived from theories or models of behavioral change. Frequently cited are: Becker’s Health Belief Model, Pender’s Health Promotion Model, and Bandura’s Social Learning and Social Cognitive Theory. Mid-range Theories – Nursing Essay Assignment Papers.

8. Theories from Practice Guidelines
Practice guidelines or standards of care appear to be the least common source for the development of mid-range theories, as only a few examples could be found. In one example, the Public Health Nursing Practice Model was developed by “melding of nationally recognized components” (Smith & Bazini-Barakat, 2003, p. 44) of public health nursing practice (PHN). The identified components were the Standards of PHN practice, the 10 Essential Services of Public Health, Healthy People 2010’s 10 Leading Health Indicators, and Minnesota’s Public Health Interventions Model.

Another example is Ruland and Moore’s use of the standards of care to develop the Theory of the Peaceful End of Life from standards of care for terminally ill patients. In this work, the theorists observed the relational statements of the standards needed to be more specifically defined to make them applicable for empirical testing. Because the standards were too specific, they were too detailed to illustrate the major themes succinctly. Mid-range Theories – Nursing Essay Assignment Papers.

The first step in Ruland and Moore’s theory development process was to define the theory’s assumptions based on the standards of care. The second step was to perform a “statement synthesis,” whereby they developed five outcome criteria that contributed to a peaceful end of life (not being in pain, experiencing comfort, experiencing dignity and respect, being at peace and closeness to significant others or another caring person). In the third step, conceptual definitions for each of the outcome indicators were determined, and the fourth step involved defining relational statements between the outcome indicators and the nursing interventions. In this step, all the process criteria from the standard were examined and combined into “prescriptors” to facilitate the desired outcome. The process of theory synthesis was then used to combine the relational statements into an integrated structure or theory. The final step was to draw a diagram of the relationships as a model (Figure 3). Mid-range Theories – Nursing Essay Assignment Papers.

Fig. 19: Theory of Peaceful End of Life: Relationships Between the Concepts of the Theory.

Mid-range Theories – Nursing Essay Assignment Papers Assignments
Post a response to the following question and respond to one of your classmate’s postings for each question. Your initial response and responses to others should be 100-200 words. Respond to your classmate’s requests for feedback. In addition, follow the guidelines provided in the Grading Rubric for Online Discussions-500 Level.

Module IX
Readings
Chinn & Kramer, Review Chapters 2, 7
Walker & Avant, Review Chapters 1, 2
Chinn, P. L. (1997). Why middle range theory? Advances in Nursing Science, 19 (3), viii.
Kolcaba, K. (2001). Evolution of the middle range theory of comfort for outcomes research. Nursing Outlook, 49, 86-92.
Liehr, P., & Smith, M. J. (1999). Middle range theory: Spinning research and practice to create knowledge for the new millennium. Advances in Nursing Science, 21, 81-91.
Ruland, C. M., & Moore, S. M. (1998). Theory construction based on standards of care: A proposed theory of the peaceful end of life. Nursing Outlook, 46, 169-175.
Discussion 1 .
Review one of the studies obtained from the reading list provided in the reading section of the module. Describe the theoretical framework in the study. Post your description and discuss your findings with your colleagues. Mid-range Theories – Nursing Essay Assignment Papers.

Module IX: Discussion 1

Discussion 2 Search current nursing journals for examples of the development, analysis, or use of mid-range theories in the discipline of nursing. Debate trends in the development and use of mid-range theories in nursing research with colleagues. Mid-range Theories – Nursing Essay Assignment Papers.
Module IX: Discussion 2