Theories guide all fields and disciplines. Theories explain how and why things happen or work the way they do. They are derived from observations, experiments, and other empirical evidence. Theories are used in many ways, but primarily, they are used for predicting future outcomes and providing a more thorough understanding of different phenomena. In nursing specifically, theories must have undergone extensive testing and review before they become widely accepted explanations with solid evidential support. It is essential to examine the grand, middle-range, and practice-level nursing theories to advance the discipline of nursing.
Grand theories are vast, all-encompassing theoretical models that aim to explain the core elements of human existence, behavior, and experience. These theories might be challenging to evaluate empirically because they are frequently complex and abstract. Grand theories frequently have high goals and try to offer a thorough justification for various occurrences. In nursing, these theories have helped organize and synthesize knowledge and provide a starting point for more focused research and theory development (Higgins & Shirley,2000). These theories include General Systems Theory by Imogene King, Modeling and Role Modeling Theory by Erickson, Tomlin, and Swain, Transcultural Nursing (formerly Culture-Care) by Madeleine Leininger, and Conservation Model by Myra Estrine Levine.
Unlike grand theories, middle-range theories are more focused and specific in a particular field of nursing. They are intended to guide nursing practice and research. Moreover, they help guide caregivers’ clinical choices and formulate research questions. They offer a framework for synthesizing existing data and creating interventions that meet the specific needs of patients or healthcare settings. These models rely on empirical evidence to explain and predict phenomena related to nursing practice (Liehr & Smith, 2017). Through their application, medical professionals can effectively address health concerns with tailored strategies. Middle-range nursing theories are more practical and can be tested than grand theories, making them helpful in guiding particular practices and treatments. These theories include the comfort theory, which states that if the patient’s specific comfort needs are met, then the patient will recover quickly, both emotionally and physically (Kolcaba, 2001). Another theory is Orem’s self-care deficit theory, which states that patients who retain autonomy over their self-care are more likely to recover. In doctor of nursing practice (DNP) programs, students learn about this idea, which is frequently implemented in the nursing sector.
Lastly, we have the nursing practice theories. Nursing practice theories concentrate on particular situations. They have the narrowest scope and the most limited focus of all three levels of nursing theory. Because they are so specific, these theories often draw upon multiple sources to develop an ideal approach for a given set of patients at any one time. This may include concepts from grand nursing theories and mid-level nursing ideas. Practice-level nurse theorists use such evidence to construct frameworks that can be used as precise models for interventions in those patient populations.
In their study, Jean-François Desbiens, J. Gagnon, and L. Fillion use grand nursing theory to create a theoretical framework tailored for palliative care that would encourage nurses to develop skills and competencies. To build this framework, they conducted an extensive survey of existing theories related to the topic, such as Katharine Kolcaba’s Theory of Comfort and Sister Callista Roy’s Adaptation Model, as well as other relevant ones like Dorothea Orem’s Self-Care Deficit Theory or Neuman Systems Model. Their goal was to generate a shared theory that could improve knowledge among health practitioners regarding palliative care practices (Naz & Muhammad, 2018). The authors use insights from interviews with expert nurses in palliative care and elements of grand nursing theories to create a shared theory for enhancing nursing competence. This has been designed to promote holistic care, communication, and collaboration among healthcare professionals when caring for patients nearing the end of their lives. Key concepts from existing models are incorporated into this new shared understanding. Comfort is drawn from The Theory of Comfort as an illustration to emphasize physical, emotional, and spiritual well-being, while adaptation was taken from the Roy Adaptation Model to assist those affected by severe illness adapt during times of transition. The shared theory developed by the authors provides a practical framework for enhancing nursing competence in palliative care. It incorporates critical concepts from grand nursing theories and emphasizes the importance of communication and collaboration in providing holistic care. The authors conclude that the shared theory can guide nursing practice and education in palliative care.
The article “A Theoretical Lens Through Which to View the Facilitators and Disruptors of Nurse-Promoted Engagement With Families in the ICU” delves into the intricacies of nurse-promoted engagement with families in intensive care units (ICUs). It examines the facilitators and disruptors that influence such interactions through a theoretical lens. Utilizing the Conceptual Model of Family Systems Nursing as its foundation, this text outlines various tactics for augmenting nurse-family connection within ICUs.Family-focused attention is essential to guarantee the involvement of nurses and families in the ICU (McAndrew et al., 2020). The research used the Conceptual Model of Family Systems Nursing as a prescriptive theory to guide interventions that enhance nurse-family engagement in intensive care units. The key factors impacting this relationship were identified, and practical strategies for improving family-centered care were proposed. Addressing facilitators and disruptors could improve patient outcomes by fostering more meaningful engagements between nurses and families. Although descriptive and explanatory theories were also employed to analyze the situation at hand, with more emphasis on suggesting ways to intervene practically, it is clear that the primary purpose behind utilizing this model was prescriptive.
As a nurse, I recognize the importance of understanding and applying nursing theory to ensure high-quality patient care. The theory provides an essential framework that allows me to comprehend complex relationships between myself, the patient, their family members, and other healthcare professionals. It also helps provide effective interventions tailored to each individual’s unique needs. As an advanced practice nurse, I must stay current on current research so that evidence-based practices can be implemented within my clinical decisions. This is important for continuing advancement within our field; by staying informed about new theories and research findings, we can identify potential gaps in our knowledge base, encouraging us to develop better models and approaches when caring for patients in future settings. By doing this, we can provide higher-quality care while improving overall outcomes at all care delivery levels.
In conclusion, theories are essential in every field, including nursing, as they explain how and why things happen. In nursing, grand, middle-range, and practice-level theories guide the discipline and provide a framework for organizing and synthesizing knowledge, predicting outcomes, and tailoring interventions to meet the specific needs of patients. The use of theories such as the Conceptual Model of Family Systems Nursing in enhancing nurse-family engagement in the ICU and the development of a shared theory for enhancing nursing competence in palliative care illustrate the practical applications of nursing theories. As a nurse, understanding and applying nursing theories is crucial in ensuring high-quality patient care.
References
Higgins, P. A., & Shirley, M. M. (2000). Levels of theoretical thinking in nursing. Nursing Outlook, 48(4), 179–183.
Kolcaba, K. (2001). Evolution of the mid-range theory of comfort for outcomes research. Nursing Outlook, 49(2), 86–92.
Liehr, P., & Smith, M. J. (2017). Middle Range Theory: A perspective on development and use. Advances in Nursing Science, 40(1), 51-63.
McAndrew, N.S., Schiffman, R.F., & Leske, J.S. (2020). A Theoretical Lens Through Which to View the Facilitators and Disruptors of Nurse-Promoted Engagement With Families in the ICU. Journal of Family Nursing, 26, 190 – 212.
Naz, S., & Muhammad, D. (2018). Integration of grand and middle-range nursing theories into clinical practice. Journal of Rehman Medical Institute, 4(1), 29-33.
write