The credibility of a profession is based upon its ability to create and apply theory. Nursing as a whole has not been at the forefront of theoretical research being much more practical or hands-on in nature. Unless nurses increase the value placed on research and the body of knowledge that establishes the legitimacy of their practice then nursing will remain in a subordinate position in the medical environment.
Theorists anticipated that by conceptualizing models of nursing, practitioners would be able to become more autonomous in their clinical settings while increasing the visibility and authority of nursing as a discipline. It would therefore be anticipated that nurses being able to comprehend and use theory will continue to grow with more master degree nurses and with the development of advanced practice nurses. Theoretical development is imperative as nursing progresses into care management, prescribing rights and specialist arenas traditionally held solely by physicians.
Current embodiments such as the Magnet Recognition Program have encouraged theoretical research in nursing (McCrae, 2012) Definition Middle range theory as defined by Smith and Liehr (2008) is a set of related ideas associated with the defined reality of nursing. These theories are developed at the level where research and nursing practice intersect. Nursing is a professional discipline and as such middle range theories are part of this structure.
Middle range theories and thusly the knowledge base of nursing is growing and theories are useful to both the nursing profession nut also other disciplines involved in the care of individuals and populations. On the Ladder of Abstraction, middle range theories are the middle rung; below the abstract philosophical rung of symbols and concepts, and above the empirical or concrete level or that which can be observed. Current Trends In the evolving nursing profession, nursing theories have set the stage for nursing research and practice.
The current trends in nursing theories as noted by Im and Chang (2012) were categorized into six major groupings: (a) “foci on specifics” where the researchers rather than further developing nursing theory focused their energies on details of the previous work and in testing associations among those concepts; (b) “coexistence of various types of theories” where it was identified the most prevalent trend in nursing research was that particular theories were cited predominantly, where 257 articles were about grand theories, 84 were about middle range theory, 13 were related to situation-specific theory, etc. (c) “close links to research “where it was noted that most of the articles published in the last 10 years were based on multiple areas of theorizing including research findings; (d) “international collaborative works” whereby much of the work reviewed was written by international authors coauthored by authors in the United States, where the US author was the senior author. This may be related to an increasing number of international nurse scholar exchanges in nursing academia; (e) “integration to practice” where nurses attempt to integrate theory into practice in their clinical practice.
Occasionally two or more theories were combined to explain a particular practice setting phenomenon; and finally (f) “selective evolution” where most of the research noted related to the four grand theories: Neuman’s system model, Orem’s self-care theory, Rogers’ history of unitary human beings and Roys’ adaptation model. Im and Chang titled it such because only those four selective theories had been further developed through additional research in the past 10 years. They postulated that these particular theories were further developed because they are more closely linked to nursing practice.
Examples An example of the “coexistence of various types of theories” is demonstrated by Andershed and Olsson’s (2009) research review of the existing middle range theory of caring by Kristen Swanson. Her theory was developed from separate experiential studies and has been used by multiple authors referring to her theory, applying it in practice or validating and testing the theory. The authors concluded that if people are guided through discussions about their experiences and “feel understood, informed, provided for, validated and believed in” (p. 609), they were better able to integrate ifficult events into their lives in a positive manner. The middle range intellectual capital theory conceptualizes nursing knowledge within health care organizations and how it relates to patient and organizational outcomes. This incorporates two concepts: nursing human capital and nursing structural capital. These are influenced by nurse staffing and employer support for continuing professional development. Magnet hospital nursing staff and nurse executives deem educational support to be necessary for higher quality patient care (Covell, 2008) Conclusion
Overall it is important for the profession of nursing to formalize and expand upon middle range theories as they relate to nursing to advance the profession and validate the expanded roles being seen in today’s nursing field. While building upon existing research is beneficial it is also important to conduct new research and expand the knowledge base for all nurses. As the role of the nurse is advanced so must the research that validates the nursing profession.
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