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Running head: DEVELOPMENT OF MIDDLE RANGE NURSING THEORIES

Development of Middle-Range Nursing Theories

Kristen Eden

Bethel College
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DEVELOPMENT OF MIDDLE RANGE NURSING THEORIES

There are four levels of theories in the nursing profession: metatheory, grand-theory,

middle-range, and practice-theory. Each level of nursing theory is developed differently and used

in different practice settings for different purposes. Middle-range and practice theories tend to

have more narrow focuses. These types of theories are found being used in their specific area of

nursing as being practical and applicable to direct nursing practice. Middle-range theories are

used to bridge the gap between grand theories and specific practice theories. They can be

applicable to multiple areas of practice within the nursing field (McEwen & Wills, 2014).

Development of middle-range theories begins with research. Middle-range theories must

be able to be tested in a clinical research setting (McEwen & Wills, 2014). Merton states that

middle-range theories lie between the minor but necessary working hypotheses that evolve in

abundance during day-to-day research and the all-inclusive systematic efforts to develop unified

theory that will explain all the observed uniformities of social behavior, social organization and

social change (as sited in Liehr & Smith, 1999, pp. 81-91).

There are specific qualifications for a nursing theory to be classified as a middle range

theory. The middle-range theory must be testable and intermediate in scope, adequate in

empirical foundations, neither too broad nor too narrow, circumscribed and substantively

specific, and more circumscribed that grand theory but not as concrete as practice theory (Liehr

& Smith, 1999). According to Lenz, Suppe, Gift, Pugh, & Milligan (1995), Middle-range

theories have greater potential to guide research and provide the basis for effective intervention

(p. 2).

The middle-range theory foundation consists of 22 middle range theories. Uncertainty in

Illness by Mishel, Self-Transcendence by Reed, and Caring by Swanson are three examples of

the middle-range theory foundation. The naming of middle-range theories is important because
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DEVELOPMENT OF MIDDLE RANGE NURSING THEORIES

the context where the theory will be practiced must be defined and referred to within the name of

the middle-range theory (Liehr & Smith, 1999).

Three levels of abstraction also exist that further classify middle range theories. Middle

range theories can be classified as high-middle, middle, or low-middle theories. The level of

abstraction of a middle range theory is used to describe its generality of scope of theory. The

conceptual structure of the theory also determines the level of abstraction of the middle-range

theory (Liehr & Smith, 1999).

Middle-range nursing theories can be better understood by comparing them to grand

nursing theories. While grand nursing theories are developed to define and evaluate the nursing

profession as a whole, middle-range theories are developed to be put into practice in the

healthcare setting. Middle-range nursing theories are meant to be used by nurses to determine

practice, not simply to define and understand it (Liehr & Smith, 1999).

Middle-range nursing theories tend to be used to develop research questions and

hypotheses (Lenz et al., 1995). The middle-range theory used in research must have descriptors

that are measurable and identifiable. Qualitative research, field studies, and statistical analysis of

empirical data must be included when developing a new middle-range nursing theory. Theories

can also be developed from observing nursing practice. But the best middle-range nursing

theories will be developed using research and existing nursing practice (McEwen & Wills, 2014).
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DEVELOPMENT OF MIDDLE RANGE NURSING THEORIES

References

Lenz, E.R., Suppe, F., Gift, A.G., Pugh, L.C., & Milligan, R.A. (1995). Collaborative

development of middle-range nursing theories: Toward a theory of unpleasant symptoms.

Advanced Nursing Science, 17(3), 1-13.

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(4), 81-91.

McEwen, M. & Wills, E.M. (2014). Theoretical Basis for Nursing, 4th ed. Philadelphia, PA:

Wolters Kluwer Health.