Available scholarship demonstrates that the contemporary nursing profession is increasingly relying on theories and conceptual frameworks to not only guide practice through describing and predicting specific behavior but also to expand concepts through research and ultimately advance knowledge for optimal nursing outcomes (Parker & Smith, 2010). Indeed, various nursing theories have shown immense capacity in assisting professionals to use the concrete and specific theoretical structures to interpret phenomena and provide effective recommendations for practice (Peterson & Bredow, 2013). The present paper expands the knowledge of contemporary nursing theory by illuminating the differences between grand theories and middle-range theories.
According to Parker and Smith (2010), grand theories have the widest scope and present common concepts and propositions for nursing practice, implying that these theories may reflect and avail insights useful for practice but are not in any way intended for empirical testing or research verification. Consequently, as postulated by these authors, the use of grand theories and models is predominantly limited to directing, explaining, and forecasting nursing practice in specific practice environments. In contrast, middle-range theories are not only expansive enough to be employed in complex contexts but can be exposed to rigorous empirical testing or research verification (Parker & Smith, 2010).
Drawing from this description, it is evident that grand and middle-range theories can be successfully employed in practice settings to solve complex situations or phenomena; however, middle-range theories are more focused in scope than grand theories and appropriate for empirical testing by researchers, not mentioning that they provide an effective conduit between grand theories and nursing practice (Parker & Smith, 2010).
For example, Dorothea Orem’s Self-care Deficit Model is a classic grand theory in that it presents a broad scope of three interrelated theories (theory of self-care, theory of self-care deficit, and theory of nursing systems) to explain why and how individuals care for themselves. However, these nursing theories are merely common concepts and propositions for nursing practice that can be used to solve complex situations irrespective of the fact that it may be difficult to empirically test them (Fiorczak, Poradzisz, & Hampson, 2012).
In contrast, Rosemary Parse’s Humanbecoming Model is a classic middle-level theory that is focused in scope (uses themes of meaning, rhythmicity, and transcendence) and can be empirically tested to measure or assess how nursing professionals become truly present with others through focused attentiveness and immersion (Duteau, 2013).
Additionally, while grand theories are known to present conceptual models and propositions at an extremely higher level of abstraction, middle-range theories avail conceptual models and propositions at a lower level of abstraction and hence hold immense promise for enhancing theory-based research as well as nursing practice strategies (Parker & Smith, 2010). For example, Orem’s Self-Care Deficit Model is highly abstracted in using the concept of energy domains to explain how individuals and the environment operate as a unitary unit (Fiorczak et al., 2012). In contrast, Parse’s Humanbecoming Model is straightforward in its attempt to demonstrate how rhythmicity, for example, helps individuals to develop patterns in life and how these patterns influence personal meanings and values (Duteau, 2013).
Lastly, while most grand theories contain elements that cannot be readily operationalized and applied to many practice settings, middle-level theories are readily operationalized and can be applied to a multiplicity of practice settings to achieve important care and treatment outcomes for patients (Peterson & Bredow, 2013). This particular difference is informed by the high abstraction levels that characterize grand theories as opposed to the lower abstraction levels typifying middle-level theories.
Duteau, J. (2013). Improving the uptake of independent dialysis using the human being theoretical approach. Seminars in Dialysis, 26(2), 180-183.
Fiorczak, K., Poradzisz, M., & Hampson, S. (2012). Nursing in a complex world: A case for grand theory. Nursing Science Quarterly, 25(4), 307-312.
Parker, M., & Smith, M.C. (2010). Nursing theories and nursing practices (3rd ed.). Philadelphia, PA: F.A. Davis.
Peterson, S.J., & Bredow, T.S. (2013). Middle range theories: Application to nursing research (3rd. ed). Philadelphia, PA: Lippincott Williams & Wilkins.