Grand and Middle Nursing Theories

Topic: Nursing
Words: 1184 Pages: 4
Table of Contents


This paper analyzes research articles on applying various grand and middle nursing theories and their impact on the usefulness of nursing within the research and in general. Grand theories tend to touch on the nurse’s role in the big picture of medicine, exploring the more fundamental aspects of her work in patient care. Middle theories are more practice-oriented and provide more specific guidance for clinical decisions (Younas & Quennell, 2019). Practical theories are a different type of classification of nursing theories, highlighting those that can be applied in clinical practice in various models of use (Fawcett, 2021). Both grand and middle theories have a particular share of implementation in practice, differing in mechanisms, the scope of research, and the aspects involved. This paper will analyze Orem’s self-care theory and Orlando’s theory of the deliberative nursing process. The practical application of these theories differs due to the need for an individual approach to the patient and the lack of need for interaction in activities with the other. However, this paper explains the importance of both theories in the cases considered and their specificity for the advanced nursing role as a Family Nurse Practitioner.


Research articles often analyze various aspects of nursing theories. For example, Yip highlighted a shortcoming of other studies: Orem’s self-care deficit theory tends to be studied in isolation rather than as a whole (2021). In this paper, a comprehensive assessment was applied to the work of a nurse in a primary care setting. A case study was conducted by observing the APN at the Asthma Clinic of the Hong Kong Government Hospital (Yip, 2021). Emphasis on patient self-care has shown positive results, making it clear that the study was successful. The nurse structured her care so that patients could best take care of themselves in her absence. However, the main practical consequence that expands the theory is the identification of indicators by which the nurse herself can evaluate her performance during clinical practice.

This grand theory suggests that the purpose of its application is to provide the patient with the most appropriate care for himself through the invocation of responsibility, behavior change, and other interventions that fill the gap between care and attention. In this study, all of the listed measures were applied to one degree or another in a particular case. The patient was assigned to monitor their health and asthma using special devices, a specific goal was set with the patient, and specific steps were identified to change the patient’s behavior, as well as providing him with knowledge and instructions for action in various cases (Yip, 2021). The peculiarity of the study was also that the nurse’s activity was assessed by assessing the patient’s condition. The experiment participants made it possible, within the framework of a specific situation, to identify generalizing signals from the nurse’s side, which indicate specific instructions for action.

The deliberative nursing process has a reasonably versatile model that can be applied to many different aspects of medical interventions. Nopriyanto’s article explores the impact of this Orlando theory on implementing performance documents (Nopriyanto et al., 2019). The aim was to test whether this middle theory could improve patient record outcomes after an intervention to empower head nurses (Nopriyanto et al., 2019). In fact, the documentation was put under state control in the form of the Orlando model. Senior nurses were given additional authority in using assessment, diagnosis, planning, implementation, and evaluation. However, despite the increase in responsibility, the results are positive; the recordings are better quality and faster.

The theory, in this case, is prescriptive, as it prescribes a specific plan of action for the nursing unit. As a result, the theory model makes it possible to improve one of the bureaucratic aspects of nurses’ clinical practice. This theory, unlike grand, affects one specific stage in medical activity and carries practical advice without going beyond theory. Oresme’s self-care deficit theory, in contrast, is broader in scope and practical application is not always so specific. The case discussed above may be relevant for a patient with asthma in a similar life situation, while the Orlando model can be adapted to almost any medical institution and any patient. This fact is partly explained by the fact that this middle theory is used as prescriptive, while descriptive and other theories in this classification may not impact practice.


For nursing, both theories are essential due to the fact that they affect different aspects of an activity. Orem’s theory is more related to treatment, and interacting directly with the patients themself requires an individual approach governed by the framework and ideas within the theory. Orlando’s model is more generalized while also addressing the bureaucratic aspect of clinical practice, which is almost entirely independent of the patient. However, efficiency is required in both designated stages of activity, and therefore both theories in such a context of application are of high importance. The advanced nursing role as a Family Nurse Practitioner can be changed for the better by these theories. It is also possible to adapt patient records to the Orlando model and, if possible, to supervise the head nurses. After this stage, an assessment of the activity will be required since applying this theory does not guarantee a 100% result and may depend on many other external factors.

Grand theories help nurses understand the fundamentals and values ​​on which all clinical practice is based. In this case, the whole approach to treatment was based on Orem’s theory. Middle theories reveal the essence of a particular aspect of clinical practice, giving specific instructions for action. In fact, with implementation, both kinds of theories are practical. The bureaucratic aspect of activity has improved thanks to the considered middle theory of Orlando. Therefore, such studies are needed to determine the specific issues of applying these theories at the practical level, moving from theoretical and value models.

Second, Oresme’s theory often addresses family relationships either as a reason for use, as in the case of maternal self-care in the early postpartum period, or as a tool to help maintain a patient’s planned activities (Lambermon et al., 2020). In this regard, the study of cases of application of Orem’s theory can open from new perspectives numerous aspects of family relations, which in practical medicine concerning the patient are always especially important.


This paper analyzed the practical aspects of applying Orlando’s deliberative theory and Oresme’s self-care deficit theory in the research. Both theories have yielded positive results and are essential to the Family Nurse Practitioner as they can help improve the efficiency and professionalism of the nurse. Improving efficiency in bureaucratic activities can save time for more critical practical activities related to diagnosis or treatment. The self-care deficit theory provides a more fundamental understanding of family relationships, which is found as an essential regulatory aspect in many studies. Oresme’s broader grand theory has found application in a narrower and more specific case, while Orlando’s middle theory has shown promising results in fairly comprehensive practice. However, both theories are essential for medical practice and should be applied in cases where research has already proven their effectiveness.


Fawcett, J. (2021). Thoughts about models of nursing practice delivery. Nursing Science Quarterly, 34(3), 328-330. Web.

Lambermon, F., Vandenbussche, F., Dedding, C., & van Duijnhoven, N. (2020). Maternal self-care in the early postpartum period: An integrative review. Midwifery, 102799. Web.

Nopriyanto, D., Hariyati, R. T. S., & Ungsianik, T. (2019). Improving documentation of patient progress note through role empowerment of head nurse by Orlando theory approach. Enfermeria Clinica, 29, 182-188. Web.

Yip, J. Y. C. (2021). Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem’s Self-Care Deficit Nursing Theory. SAGE Open Nursing, 7, 23779608211011993. Web.

Younas, A., & Quennell, S. (2019). The usefulness of nursing theory‐guided practice: An integrative review. Scandinavian Journal of Caring Sciences, 33(3), 540-555. Web.

Theory of Needs in Nursing Practice
Roles in Advanced Practice Nursing