Theories are essential for guiding nursing practice and improving patient outcomes. There are three different categories of nursing theories you will encounter in school: Grand nursing theory, practice-level nursing theories, and middle-range nursing theories. The level of abstraction and specificity differentiates each of these.
Middle-range theory nursing examples were developed in the mid-1990s and held the most sway in understanding a particular concept. Mainly, they are more specific and help bridge the gap between nursing practice and grand theories.
The following guide provides a comprehensive overview of middle-range theory nursing examples you will come across as part of assignments in nursing school.
When faced with a complex situation in nursing, having the backing of a specific and focused theory is vital to ensuring success.
Middle-range theories provide a simple description of a phenomenon compared to the grand theory. These theories provide a practical framework for a particular aspect of nursing care.
Furthermore, they provide a clear description and prediction that answers questions not addressed in other nursing practice theories.
Middle-range theories are derived from empirical evidence and developed through research studies.
Nurses can use them to address and understand clinical practices since they address specific nursing phenomena such as patient satisfaction or self-care. They can be categorized as follows: high, low, and middle range.
High-range theories: These are general and abstract, explaining a broad phenomenon. They provide a comprehensive framework for understanding different aspects of nursing care. These theories are applied in the psychiatric and mental health field of nursing for the following purposes:
Middle-range theories are essential in nursing for several reasons. Firstly, they set a clear foundation for nurses to offer care efficiently by understanding the underlying issues that affect healthcare. Secondly, they provide evidence-based approaches and interventions to improve patient outcomes. When nurses utilize these interventions, they can effectively care for their patients. Lastly, these theories generate new ideas and information used to advance the nursing profession.
Low-range theories are more specific compared to middle-range theories. They aim to explain a specific phenomenon occurring within a very specific context.
The following are key characteristics of middle-range theory nursing examples that distinguish them from other nursing theories.
Specificity- Middle-range theories are specific as they focus on a particular aspect of nursing. They offer a more targeted approach to addressing specific healthcare issues.
Reliable and relevant- These nursing theories are based on an empirical basis, which means they are developed through extensive research and observation.
Applicability- They are more applicable to nursing care since they offer evidence-based practices and interventions.
As we noted before, the middle-range nursing theories are narrower in scope than the grand nursing theories. They majorly deal with a part of a concern of a discipline related to specific topics. Middle-range theories can readily be used and tested in research projects thanks to their narrower scope and specificity. Some of the theories include:
The framework for system organization; theory of group power within organizations; theory of comfort, theory of maternal role attainment, nurse as a wounded healer; synergy model, quality of nursing care theory, theory of unpleasant symptoms; Barker’s triad model; psychological adaptation theory; Toward a Theory of Diversity of Human Field Pattern; A Relationship-Based Model for Psychiatric Nursing Practice ; Comfort Care: A Framework for Hospice Nursing; theory of uncertainty in illness, advancing technology, caring, and nursing (Rozzano C Locsin); theory of empathy; theory of social support, theory of health-related quality of life; theory of resilience; theory of self-efficacy, theory of pain; theory of chronic sorrow; theory of interpersonal relations; theory of reasoned action and planned behavior; theory of health promotion, theory of the deliberative nursing process, etc.
The following are middle-range nursing theories examples nurses can apply in healthcare.
Pain management and patient education are crucial in an acute care setting. Several studies have shown that pain management tools could be ineffective in minimizing patient pain. Acute pain management theory thus describes the relationship between nurses and patients and how they relate to patients’ pain in acute care.
Good and Moore developed this theory as a framework to manage acute postoperative pain among patients. These guidelines aim to help caregivers reduce pain, prevent complications and length of hospital stay, and encourage and teach patients to communicate unrelieved pain to ensure patient satisfaction. Some of the recommendations put forward to nurses and other healthcare providers include the administration of medication, educating patients, and providing attentive care.
Research shows that nearly 50% of adults suffer from a chronic illness. Self-care is considered an essential measure in managing chronic illness. Adaptation of the chronic illness model was developed to understand and support patients living with chronic illnesses. It recognizes that chronic illnesses are enduring conditions that require ongoing treatment and adaptation by their healthcare providers. The theory encourages patients to be proactive and make better decisions about their health.
Adaptation of the chronic illness model is also based on the premise that patients with chronic illnesses physically, emotionally, and socially adapt to every challenge associated with illness. This means that right from the onset of the disease, they accept their condition and learn ways to live with it.
This theory proposes that by implementing self-care maintenance, monitoring, and self-care management, patients can actively participate in managing their illnesses. Healthcare providers will facilitate patient adaptation by providing education, support, and resources.
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Attentively embracing a story is connecting with the self through intentional dialogue. This theory encourages patients to intentionally describe their health issues in detail so they can receive help. Developed by Smith, M.J. and Liehr, P, states that effective nurse-client dialogue encourages human development. By encouraging patients to be more open and nurses to listen attentively, there will be significant improvement in the healthcare settings, thus positively impacting patient care and overall well-being.
Attentively embracing stories encourages patients to share their experiences, emotions, and concerns with their nurses, who will better understand their needs, values, and perspectives. This understanding will then help them provide more personalized and patient-centered care.
Furthermore, this middle-range theory nursing example emphasizes the significance of incorporating storytelling in nursing research. It proposes that qualitative research methods, for example, phenomenology, can be applied to explore patients' stories and unique experiences. By conducting extensive research in this area, healthcare providers can contribute to developing interventions that promote effective care and patient well-being.
This middle-range theory nursing example was developed after research was conducted on postpartum depression. It was applied to help midwives, nurses, and caregivers help mothers dealing with postpartum depression. The primary purpose of the theory was to help improve patient care. Beck identified postpartum depression as biological and suggested specific interventions to help. Part of these interventions include informing nurses about the consequences of postpartum depression.
Beck identified four stages that mothers with postpartum depression go through: (1) encountering terror, (2) dying of self, (3) struggling to survive, and (4) regaining control. Since biological factors cause postpartum depression, Beck suggested changing how symptoms are treated and managed. Beck stresses that even though postpartum depression is a biological problem, it can still be worsened by other factors (social, economic, and emotional).
The client experience model is focused on enhancing patients' overall experience in a healthcare setting. The theory is based on the premise that patients are not just recipients of medical interventions but active participants in their healthcare journey.
The client experience model is a powerful framework focusing on patients' holistic well-being. It aims to do the following: guide nursing practice, improve healthcare outcomes, and promote positive healthcare outcomes. The theory recognizes distinct needs, preferences, and expectations; thus, care should be tailored accordingly. Nurses can offer more personalized care when this model is adopted in healthcare.
This theory offers various benefits, including enhancing patient satisfaction by ensuring they are well taken of. Studies have shown that satisfied patients adhere to their treatment plans and have better health outcomes.
The provision of compassionate and holistic care is key in the hospice setting. Comfort care theory, developed by Vendlinski and Kolcaba, provides a comprehensive approach to addressing all patients' needs during their final moments.
Comfort care theory is focused on ensuring that hospice nurses enhance the quality of life for individuals in hospice care by prioritizing their health and well-being.
It acknowledges that people in hospice need more than traditional medical interventions to alleviate their physical pain, manage symptoms, and provide emotional, psychological, and spiritual support to patients and their families.
Comfort Care recognizes that by doing all this, nurses can enhance the quality of patient life and give them a dignified end-of-life experience.
Developed by nursing theorist Katharine Kolcaba, comfort theory proposes the holistic understanding and promotion of comfort as an essential need in healthcare.
The theory recognizes that comfort brings relief, ease, or transcendence to patients, healthcare providers, and families in highly stressful healthcare situations.
Comfort theory touches on all the elements of the nursing metaparadigm (person, environment, health, and nursing). Comfort should be provided in physical (pain management), psychospiritual (emotional support), sociocultural (respecting people’s cultural beliefs), and environmental aspects to reduce and possibly prevent harmful tension. Nurses will enhance patients' overall well-being and promote healing by providing comfort.
The theory shows that nurses are key in providing holistic care and improved health outcomes.
Created by DR. jane Georges, the emancipatory theory of compassion suggests the universality of suffering and how it can be alleviated through compassion. The theory assumes that nurses have the power to create environments that promote suffering among patients. It states that oppressive structures that promote inequality and suffering should be challenged.
The emancipatory theory of compassion acknowledges that acts alone are not enough to deal with injustices in the healthcare setting. It encourages stakeholders to gain a deeper understanding of all the factors (social, economic, and political) that contribute to disparities in healthcare access and outcomes. The theory suggests that healthcare providers should advocate for marginalized individuals and implement measures that ensure a compassionate society. When nurses put this theory into practice, they can better provide care at an individual level.
Illnesses bring a lot of changes in an individual’s life, thus creating transitions. Those in transition are extremely vulnerable to risks that may put them at more health risks. Experiencing transitions theory by Afaf Ibrahim Meleis was developed to understand and address any challenges patients may face during transitions. It consists of the following:
Meleis states that these transitions can occur at any stage, including when diagnosed with a chronic illness. The theory states that transitions are about moving from one stage to another, and patients go through multiple stages at this point. It proposes that individuals going through these transitions should be offered the necessary support to deal with the challenges.
Overall, experiencing transitions theory should offer a model for guiding nursing practice in assisting patients through various stages of transitions in their health and lives.
Developed by Dorothy E. Johnson, the behavior system model stresses the importance of fostering efficient and effective behavioral functioning in patients to prevent diseases.
The theory considers a person as a behavioral system composed of seven subsystems, each comprising different structural characteristics.
Any imbalance that occurs in any of the subsystems leads to an imbalance. Therefore, the main role of nurses is to help patients maintain their balance.
The health behaviors system model identifies three major concepts:
Nursing in hypertension is part of middle-range theory nursing examples that guide nurses in managing and caring for patients suffering from hypertension. It states that when nurses understand the complexities of hypertension and develop ways of ensuring optimal health, there will be significant patient outcomes.
Nursing in hypertension theory agrees that high blood pressure is a chronic illness that requires continued treatments and lifestyle changes. It proposes the following interventions:
This theory suggests that a successful psychiatric nurse-patient relationship is key to promoting healing and eliminating elements of the psychotherapeutic relationship. It suggests that nurses should establish trust empathy and mutual trust with their patients.
The theory suggests that psychiatric nurses can provide support, guidance, and interventions that promote the patient's recovery and well-being by encouraging therapeutic alliance.
The relationship-based model for psychiatric nursing practice similarly suggests the significance of healthcare givers being more self-aware, practicing self-reflection, and continuously developing themselves professionally to promote patients' recovery and healing.
Nurses can provide patient-centered care When they continuously examine their values and beliefs. This theory states that psychiatric nurses should foster a therapeutic environment to enhance open communication. Doing this will promote patient recovery and improve the overall quality of psychiatric care.
Self-care theory suggests the importance of caring for oneself to promote good health and well-being. It states that individuals have the power and ability to care for their health. This theory sees individuals as agents who can actively participate in their health. On the other hand, nurses can play a key role in supporting individuals by assessing their self-care abilities and providing appropriate interventions to enhance their care.
The selected papers of Dorothea Orem describe self-care as activities that individuals perform independently to promote and maintain their health and well-being. This theory is composed of three interrelated theories: (1) theory of self-care, (2) self-care deficit theory, and (3) theory of nursing systems.
Self-care theory highlights when nursing is needed. Nursing is needed if an adult cannot provide continuous care. Orem states that these people can be helped through various methods, including guiding and teaching others.
Story Theory in Nursing (Smith & Liehr)
Story theory focuses on how a nurse and patient communicate with each other. It proposes that healing occurs through sharing stories. The purpose of the theory is to enable patients to communicate the health challenges they are experiencing by participating in the intentional nurse-patient dialogue.
Story theory is composed of the following interrelated concepts:
Intentional dialogue is about clarifying unclear aspects of the narrative to make sense of the origin. The nurse and the patient sharing the story will focus on the narrative of a difficult health challenge. During this dialogue, the nurse will try to understand the challenge from the patient's perspective.
Connecting with self-in-relation is all about personal history and self-awareness. The personal history will emerge as the patient ponders where they come from, their present situation and where they see their future. As the nurse listens to the story, they will use the past to understand the present and predict the future. While doing this, they will encourage the patient to make peace with the past.
Creating ease brings everything together to make the story intelligible and reveals certain aspects that could lead to solving a complicated health challenge.
Successful aging describes the aging process and the expected activities older adults should participate in for successful aging. The successful aging theory is based on the classic concept developed by Rowe and Kahn in 1987.
According to the concept, successful aging is high functioning without experiencing any major illnesses. Rowe and Khan stated that successful aging involves the following: (1) being free of disability or illness, (2) having high cognitive and physical abilities, and (3) relating with others in a productive and meaningful way.
By identifying activities and behaviors that older adults should engage in, nurses can help them age successfully. Meaningful aging is not about winning or losing in relation to longevity but the need to focus on what is important in a person's life, especially in old age.
Chronic sorrow is a long-term sadness faced by the chronically ill and their caregivers when faced with continued losses. Chronic sorrow theory originated from Olshansky and provides a framework for nurses to understand and work with patients who have suffered or are undergoing losses. It is essential for analyzing individual responses for patients going through ongoing disparity brought about by a chronic illness.
Chronic sorrow theory identified the following critical attributes: (1) cyclic sadness occurs over time in a situation with no predictable end. (2) External and internal stimuli that trigger those feelings of disappointment and loss. (3) progression and intensification of the sadness and disappointment over time.
Chronic sorrow theory suggests nurses play a key role in recognizing and diagnosing chronic sorrow. They can then come up with interventions to help suffering patients. Chronic sorrow theory also suggests that nurses can come up with anticipatory guidance to help patients at risk of chronic sorrow. Chronic sorrow theory acknowledges that the role of nurses comprises an empathetic presence, teacher-expert, and caring and competent caregiver.
The theory of interpersonal relations was developed by Hildegard E. Peplau in 1952 to emphasize the need for a good nurse-patient relationship.
According to Peplau, nurses are professionals who engage in therapeutic relations with people needing health services.
He theorized that for this relationship to be successful, it must pass through the following stages: (1) orientation, (2) working, and (3) termination.
Patients will realize their health situation and need help in the orientation stage. At the same time, nurses will collect essential information from patients because they have unique needs and priorities.
During the working stage, nurses spend a lot of time with the patients by assessing their health, which they can use to teach and contribute to creating a management care plan. Patients and nurses become closer to each other as they spend more time together; thus, a therapeutic relationship develops.
In the termination stage, the patient is expected to have accomplished all the activities put together by the patient. The patients can now make their decisions without depending on the nurse. It's important to ensure that care should be taken so that the patients don't become overly dependent on the nurse. The therapeutic relationship ends at this stage since the patient can decide.
Reed's theory of self-transcendence was derived from inquiry into the well-being of older adults’ Self-transcendence is defined as an individual’s capacity to expand their boundaries inwardly (introspective experiences), outwardly (connecting with others) and temporarily (in cases where the past and the future are integrated in the present moment) to connect within self, others, and nature.
Later, Reed added another transpersonal expansion, which refers to individuals connecting” dimensions beyond the typically discernible world."
According to Reed, human beings are open systems capable of talking about new information. The only obstacle between them and self-transcendence is those they impose on themselves.
The theory highlights three major concepts that describe how human beings attempt to connect with self: self-transcendence, well-being, and vulnerability. It embraces the dynamic connection between a person, environment, health, and nursing.
Much of what nurses do during their practice is to measure and assess patients' symptoms and assess factors that may influence changes. They are also responsible for developing prevention and management strategies and guiding patients on monitoring and self-management. The middle range theory of unpleasant symptoms developed by Elizabeth R. Lenz and Linda C.
Pugh recognizes that symptoms share various similarities and consist of four measurable dimensions: timing, intensity, quality, and distress. It suggests that two or more symptoms can occur simultaneously in a symptom cluster.
Even though multiple symptoms could occur simultaneously, they could have different causes and result in cumulative or multiplicative effects.
When the unpleasant symptoms theory is implemented, it results in positive outcomes.
Please note that these applications include various components, including educating patients and their caregivers.
Resilience is transforming an uncomfortable situation into a growth experience and moving forward. According to Polk, nursing's role is to help individuals through adversity.
Resilience theory was developed to tackle burnout among healthcare workers experiencing emotional and psychological adversity when caring for patients.
It argues that it is not the adversity that matters but how to deal with it.
Nurses care for patients going through a traumatic experience and help them recover. The theory proposes that nurses must understand the concept of resilience and how it is applied to be successful.
Polk identified characteristics that could be grouped into different categories, each helping support a patient going through a traumatic experience. These four categories are dispositional patterns, situational patterns, philosophical patterns, and relational patterns.
Joanne Duffy, Ph.D., a nursing theorist, developed this middle-range theory nursing example. It combines both the art and science of nursing and highlights their importance.
Duffy highlights that caring relationships are always lacking in nursing because of the overwhelming responsibilities.
Health is a dynamic state involving physical, emotional, and spiritual factors, thus resulting in value-based methods to establish connections.
Studies have shown that nurses who apply the quality-caring model theory in their practice will have better work perceptions and patient relationships than those who don't.
The theory states that if nurses show kindness and compassion, their patients are more likely to be pleased with healthcare services.
Theory-based nursing sets the foundation for nursing practice and education. They help design and develop interventions that address patients’ health problems.
Middle-range theory nursing examples can help nurses identify the contributions that can help improve healthcare practice and the patient's health.
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