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Posts tagged ‘middle-range theory’

Middle range theory in the making: You gotta’ stay with it and you gotta’ pass it on

Our latest featured article from the current ANS issue is titled “Middle Range Theory: A Perspective on Development and Use” by Patricia Liehr, PhD, RN and Mary Jane Smith, PhD, RN, FAAN. Both authors are long-time contributors to ANS and in this article they examine the journey of developing middle range theory that is solidly situated within nursing’s disciplinary persepective and ultimately bringing it to the interdisciplinary table. This article is available for download at no cost on the ANS website while it is featured.  Here is a message that the authors provided for ANS blog readers, followed by a short video that Dr. Liehr and her doctoral students created, talking about the nature of middle-range theory:

We are going to tell you our story as it relates to this paper. Often when we use a story path that focuses on the present…the past….and the future.

At PRESENT, we invite you to read and share your thoughts about “Middle range theory: A perspective on development

Mary Jane Smith (L) & Patricia Liehr (R)

Mary Jane Smith (L) and Patricia Liehr (R)

and use” in the current issue of ANS. We are honored to be in this retrospective issue.

Moving to PAST, we first met and engaged with each other in 1979-1980 as teacher (Smith) – student (Liehr) while Liehr was in her Masters program at Duquesne University in Pittsburgh, Pennsylvania.

During a period of about 20 years, as we began to learn more about middle range theory as a guide for practice and research, we saw the need for a state of the science manuscript. This was the impetus for the 1999 paper published in ANS “Middle range theory: Spinning research and practice to create knowledge for the new millennium.”

The 1999 paper in ANS was the impetus for our textbook, Middle Range Theory for Nursing, first published in 2003. The book was written to create a resource for scholars wishing to use middle range theory in practice and research.

The 1999 paper was also the impetus for this 2017 paper, allowing us to consider middle range theory through the lens set forth nearly 20 years ago.

And now, the FUTURE….the 4th edition of Middle Range Theory for Nursing is in the works and we continue to teach students about the usefulness of middle range theory. We are offering a short video recording of current PhD students at Florida Atlantic University, Christine E. Lynn College of Nursing who are considering the relevance of middle range theory as they immerse in developing ideas to guide their research.

The foremost recommendation in “Middle range theory: A perspective on development and use” is to “stay with the theory”. We believe that persistence and scholarly engagement over time has the potential to effectively shape disciplinary knowledge. Our story highlights and brings to life this belief. Thank you for sharing blog-time with us.

Patricia Liehr and Mary Jane Smith


Nursing Practice Inspires Theory for Diabetes Self-management Theory

The current ANS featured article is titled, “A middle range theory for diabetes self-management mastery.”  It is authored by Jennifer A. Fearon-Lynch, MSN, RN, doctoral student at the University of Massachusetts Dartmouth and Caitlin M. Stover, PhD, RN, Assistant Professor, Chairperson of Community Nursing Department, University of Massachusetts Dartmouth.

Ms. Fearon-Lynch shared this background of her work, which originated from her clinical practice with people who are living with diabetes:


Jennifer A. Fearon-Lynch

The middle range theory being featured in our article evolved from a theory class assignment during year one of doctoral studies. As a clinical nurse, I have concentrated much of her practice in the area of medical surgical nursing and currently works at an acute care facility in southeastern Massachusetts. The high prevalence of diabetes within this geographic location and varied patients’ responses to self-management captured my attention and interest.

Observation during nurse-patient encounters revealed that the complexity of diabetes self-management often produced stressful experiences such as chaos, distress, and disturbances in routine. Despite diabetes-related stresses, some patients gained mastery over stress, accepted their chronic illness, and engaged in health protective behaviors while others demonstrated little or no motivation to self-manage and were frequently admitted to the hospital with abnormally high blood glucose levels and diabetes associated health problems. An attempt to understand why people choose not to engage in positive lifestyle practices associated with desirable diabetes management outcomes generated several questions that became the genesis of the theoretical inquiry. These are, “Why do some people with diabetes gain mastery over the illness-related stress and emerge with positive attitudes and fortitude and some do not?” Furthermore, “Why do some people exhibit motivation to engage in health care behaviors associated with desirable outcomes and others express little or no desire to participate?” How can people be assisted to handle the experience of stress accompanying diabetes related events that have important effects on their life?

As interest in the phenomenon grew stronger, literature from nursing and psychology were reviewed on mastery and motivation. Despite application of theories to bolster human’s response to effectively self-manage, no single theory adequately addressed the issue. Two theories appeared to best describe the phenomenon of interest: The theory of Mastery (TM) from nursing and Organismic Integration Theory (OIT) (extrinsic motivation) from psychology. However, examination of the theoretical properties of TM showed it did not completely fit the problem at hand since it did not explain the role of motives as a stimulus to moderate the direction and strength of the theory’s variables: certainty, change, acceptance, and growth. In addition, it lacked clarity in relation to how the theoretical variables are strengthened and supported. Lastly, distal factors triggering TM proximal variables were not explicit. As a result, TM was modified by integrating concepts from OIT to act as distal factors impacting the TM fundamental variables to produce mastery over stress and consequently more energy to effectively self-manage diabetes. The integrated theory better explains the phenomenon and is not only applicable to people with diabetes, but any chronic illness condition that is impacted by stressful experiences.

The middle range theory has the potential to masterfully influence individuals’ response to diabetes-related stress, thus resulting in better diabetes self-management behaviors. Nursing science could benefit from the feasible translation of the theory in diverse clinical settings to generate health-promoting behavioral interventions for individuals with diabetes and other chronic health conditions. The theory has not yet been tested. However, since components of the theory were synthesized using constructs from extant, reputable theories it is likely to have a robust impact on the chronic illness population. The authors welcome anyone who wishes to apply the theory in research and practice to do so and disseminate the result through scholarly dialogue.

Download this article at no charge now, while it is featured!  We would be delighted to hear from you – read the article and come back to share your ideas in the comments on this blog!


Focus on transitions from a nursing perspective

Eun-Ok Im, PhD, MPH, RN, CNS, FAAN is the author of our latest featured article titled “Situation-Specific Theories From the Middle-Range Transitions Theory.”  She begins her article is a concise overview of nursing’s theoretical evolution, placing the emergence of situation-specific theory in an historical context.  Dr. Im and Dr. Afaf Meleis first introduced the concept of situation-specific theory in their 1999 ANS article titled “Situation-specific theories: philosophical roots, properties, and approach” (ANS 22:2, p 11-24).  This current article provides, in addition to the historical overview, an analysis of 6 situation-specific theories and themes reflecting commonalities and variances in the theory development process.  Dr. Im shared this message about her work:

As you can see in the picture, we had lots of snow here in Philly, and hope all of you would stay warm and safe!  🙂snow

First of all, thanks a million for this opportunity to discuss my article with my respectable colleagues and students.  This article was originally initiated because of doctoral students in my theory class in Spring, 2013.  The students wanted to know about how a situation specific theory could be developed from a middle-range theory.  Although I previously wrote about the integrative approach to development of situation specific theories, the paper might not be adequate to address the students’ questions. The students were eager to learn about the exact theory development process that had been taken in previous development of situation specific theories. Also, since our original paper on situation specific theories was written in 1999, I thought this might be the right time to evaluate how situation specific theories have been developed.  Especially, I was wondering how situation specific theories were derived from middle range theories and further developed as “ready-to-wear” theories.

As the article illustrates, the development of situation specific theories from the middle-range Transitions theory were on the same directions that were originally proposed, and I could extract several themes reflecting the commonalities and differences in the theory development process.  The reviewed situation specific theories derived from Transitions theory focused on specific phenomenon of interests with narrow foci and provided clear implications for nursing practice. They were developed using multiple sources of theorizing, but mainly based on research-evidence. They

Dr. Eun-Ok Im

Dr. Eun-Ok Im

specified, added and combined major concepts and/or sub-concepts, and they had been developed to advance nursing theory toward forms of theory applicable to specific practice situations.

In the article, based on these findings, I proposed two implications for future development of situation specific theories: (a) to continue our efforts to further develop, specify, and modify the concepts and sub-concepts of situation specific theories through “integrative approaches”; and (b) to support the situation specific theories with strong collective evidence from nursing practice and apply and evaluate the situation specific theories in practice settings. From this stance, I would like to work on further recommendations for future development of situation specific theories.

Through this blog, I hope to open a conversation on the directions for future development of situation specific theories, which would be essential for future nursing knowledge development. Any thoughts would be greatly appreciated.

I join Dr. Im in encouraging you to respond to her article, and participate in a conversation here about these ideas!  This kind of conversation is vital for the future development of our discipline!  You can download your copy of her article while it is featured at no cost, so read it today, and come back here to join the conversation!


“Editor’s Picks” available now!

We have added a new feature to the ANS web site … Editor’s Picks from the current issue.  The Editor’s Picks will change every couple of weeks, and while an article is featured, it will be available for a free download!  Each week I will post information on this blog about one of the articles on the current “Editor’s Picks” list, giving some background and information about the article that I believe makes the article important for our readers.

Barbara Reigel (University of Pennsylvania), with her colleagues from Sweden Tiny Jaarsma and Anna Strömberg (Linköping University) are the authors of one of our first features, titled “A Middle-Range Theory of Self-Care of Chronic Illness.”  The theory was developed from self-care studies that the authors have conducted in several countries around the world; the article cites the studies so that you can trace the specific evidence on which the theory is based.

The authors address a central concern of nursing practice – the nature of the relationship between a nurse and a patient.  They explain the connection between that relationship and self-care of chronic illness as follows:   “When providers interact with patients their intention is that the partnership they form will motivate patients to engage in self-care that can be incorporated into their lifestyle. It is within this context of a mutually rewarding relationship that the self-care of chronic illness takes place.”

This theory was developed from sound research evidence, and in turn it provides an important resource to guide nursing practice.  It is based on deep analysis and clarification of some of the most persistent challenges that nurses face in building relationships with people living with chronic illness. This article  is an exemplar of one approach to the development of nursing theory that serves to guide nursing practice.

Check out the article now and add your ideas and thoughts about this article by replying to this post!  I look forward to hearing from you!

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