Middle-range theories refer to the sets of interrelated ideas about specific dimensions of nursing care. Such theories advance the science of nursing by illuminating new concepts peculiar to care delivery and proposing the models that outline conceptual relationships relevant to everyday practice. The purpose of this discussion is to review these theories’ contributions to concept clarification and outline my potential role in theory evaluation and development.
Middle-Range Theory and Concepts in Health and Care Delivery
Middle-range theories are significant for nursing professionals since they offer non-abstract guidelines and reference points that support care quality and can be adapted to different clinical situations to promote health and quicker recoveries. Their central role is to structure the available nursing knowledge, thus enhancing and supplementing grand nursing theories that represent the disciplinary roots of the nursing profession. By elucidating and clarifying concepts pertaining to health and recovery, such as self-care, adaptation, or goal attainment, theories at the middle-range level serve as the interlink between overly broad theoretical assumptions and minor hypotheses of daily research (Liehr & Smith, 2017; Younas & Quennell, 2019). Current reviews report theory-guided nursing practice’s increased effectiveness compared to traditional practice, which suggests the accuracy, clarity, and practice-orientedness of concepts in well-recognized middle-range theories (Younas & Quennell, 2019). Considering their potential in hypothesizing conceptual links and putting this knowledge into practice, theories at this level of abstraction deserve close attention in the context of a scientific approach to nursing and the practice of caring.
Modern peer-reviewed studies illustrate middle-range theories’ contributions to concept illumination and practice improvement. Particularly, Swanson’s middle-range theory of caring explains caring through five equisignificant concepts that represent nonlinear processes, including the maintenance of productive philosophical attitudes and emotional presence, thus offering a model for person-centered care (Miller & Wojnar, 2019). As of now, the theory and its concepts find use in diverse clinical contexts globally, and its potential applications have recently been expanded to include the prevention of lapses in care during breastfeeding support interventions in postpartum nursing (Miller & Wojnar, 2019). The promise of mid-range theories in understanding the peculiarities of caring in mental health settings also deserves consideration. For instance, Peplau’s theory applies three phases of developing relationships (orientation, working, and termination) to nursing processes to outline the psychodynamic dimension of care (Younas & Quennell, 2019). The conceptual links in her theory have been shown to support therapeutic processes in the cases of psychotic patients with substance abuse disorders by reinforcing trust-based nurse-patient interaction (Ogoncho et al., 2017). Thus, theory-based nursing interventions are not uncommon, which highlights the usefulness of concepts in middle-range theories.
DNP-Prepared Nurses’ Role in Theory Development/Evaluation
As a mental health nurse that seeks to pursue doctoral preparation in the nearest future, I assume the organization of efforts to help novice and inexperienced nurses to develop a more complete and sophisticated understanding of productive theory-guided therapeutic interactions as my particular role in evaluating mid-range theories or even proposing theoretical improvements. Being a professional that provides supervision regarding care individualization and the administration of care to those with complex mental health needs, including both therapy and medications, I have a passion for disseminating knowledge that maximizes the chances of smooth recovery and resocialization. Middle-range theories applied to nursing can be incorporated into the realization of my nurse teaching tasks. Potentially, it can increase care providers’ knowledge peculiar to the establishment of a healthy climate in therapeutic nurse-patient relationships when caring for problematic psychiatric clients, such as those with poor response to treatment or comorbid disorders. In particular, by teaching middle-range theories, for instance, Swanson’s theory of caring, I can contribute to the exploration of their applicability to psychiatric contexts, thus supporting theory evaluation endeavors.
Advancing Nursing Science and Improving Clinical Practice
By adding the explanations of theory-based interventions to nurse teaching plans, I would encourage other specialists in the workplace to make observations regarding the peculiarities of maintaining belief and other components of caring when supporting individuals with diagnoses that severely affect thinking, reasoning, and self-control. As a result, the presence of similar or consistent observations from different sources would shed light on whether the theory is universal or even suggest the existence of previously unexplored concepts that surround offering hope-filled attitudes to those with irrational thought patterns, thus laying the groundwork for new theoretical developments (Younas & Quennell, 2019). The implementation of these efforts might be important to advancing nursing science by supporting at least some preliminary conclusions about middle-range theories’ limits to applicability in inpatient mental health settings and unique concepts that surround caring for the mentally ill but find little representation in the current scientific literature. After thorough checking and testing, the resulting theoretical propositions might give rise to practice changes related to therapeutic communication techniques for particular conditions or patients with multiple diseases.
Conclusion
Finally, the potential of middle-range nursing theories cannot be overstated since they clarify important concepts in care and maintain the balance between case-specific hypotheses with limited generalizability and the global nursing science paradigms. As a professional, I associate my role in theory development and evaluation with the distribution of information regarding mid-range theories and theory-based interventions among mental health nurses. Potentially, this activity might lead to knowledge generation in the field of therapeutic communication with the mentally ill.
References
Liehr, P., & Smith, M. J. (2017). Middle range theory: A perspective on development and use. Advances in Nursing Science, 40(1), 51-63.
Miller, C. W., & Wojnar, D. (2019). Breastfeeding support guided by Swansonʼs theory of caring. The American Journal of Maternal/Child Nursing, 44(6), 351-356.
Ogoncho, I. M., Sanga, P., & Halake, D. G. (2017). Case management of substance-induced psychosis using Peplau’s theory of interpersonal relations. Clinical Practice, 6(2), 33-36.
Younas, A., & Quennell, S. (2019). Usefulness of nursing theory-guided practice: An integrative review. Scandinavian Journal of Caring Sciences, 1-16.