Middle-Range Theory Utilization and Application


Nursing is a profession in which specialists must always renew their awareness about theoretical concepts to satisfy challenging health care requirements. Nursing specialists have to understand the unique variety of information necessary for training and subsequent practice. Nursing science is connected to the theories of what it is, what healthcare specialists do, and why they do it. Middle-range theories, in particular, connect research with nursing practice. The Health-Related Quality of Life theory is based on the idea that a patient’s conditions and recovery rely on more than just biological indicators. This middle-range theory considers other concepts inherent in patients, such as their psychological and social status, as well as their perception of their condition. Moreover, the evaluation showed that the theory suffers from the complexity because it involves trying to comprehend the interconnectivity of environmental factors with patients’ personal physical and psychological condition. Lastly, in clinical practice, the Health-Related Quality of Life theory suggests that care should include five concepts: physical aspects, symptoms, ability to function, overall health perceptions, and quality of life.

Keywords: middle-range theory, health-related quality of life, clinical practice.


The middle-range theory is recognized as vital to the formation of nursing education. The middle-range level is beneath metaphysical principles and above practical concepts outlined as hypotheses (Liehr & Smith, 2017). The middle-range theory is the extent of nursing science with a promise of leading practice and analysis. The transition to middle-range theory advancement has been stimulated by the increase of nursing training programs that highlight the importance of evidence-based projects. Moreover, the trend is connected to a recent hospital emphasis on obtaining Magnet status that necessitates the study of theories to guide practices (Liehr & Smith, 2017). Such theories are included in the nursing knowledge foundation structure, along with grand principles, as representations of disciplinary origins for conducting research and practice.

The existing use of middle-range theories proposes the potential for experimentation and development to improve the relevance in the health care field. Furthermore, they make efficient contributions to nursing education and support growth over the following decades. Overall, there is a growing demand for nursing theories, and, particularly, for middle-range ones. Scholars developed various middle-range theories, including the concepts of Uncertainty, Caring, Transitions, Comfort, Self-Care, and more (Liehr & Smith, 2017). One of the most influential ones is the middle-range theory of Health-Related Quality of Life. Therefore, the purpose of this paper is to identify its application to nursing practice through analysis and evaluation.


The fundamental building blocks of the Health-Related Quality of Life theory are the environment in which the patient resides and the characteristics of an individual. Notably, the theory highlights the interplay of the patient’s various health conditions and the status of their symptoms. This helps to measure and understand the patient’s behavior and feelings, which provides valuable data for analyzing the patient’s well-being. The theory assumes the patient’s actions, beliefs, and expectations will change along with their circumstances (Honaker, 2017). Furthermore, the patient’s interpretation of their symptoms creates a tolerance threshold. The theory allows health care providers to assess the condition of the patient beyond just biological indicators. It uses five health concepts to describe the patient’s condition, including biological factors, symptoms, functioning, general health perceptions, and quality of life (Ojelabi et al., 2017). Overall, the theory allows for a more holistic view of the patient’s condition.

Furthermore, the theory also asserts that individual characteristics of the patient, ranging from behavior to cultural and spiritual factors, may influence their vitality. Health-Related Quality of Life theory also assumes the interconnectivity of the various practices and characteristics of the patient. For example, the loss of mechanical skills caused by an arm injury can negatively affect a patient reliant on the mechanical ability for employment more than a patient not as dependent upon their arm, hence, potentially limiting recovery for the former (Ojelabi et al., 2017). Therefore, the patient’s perception of their condition is an essential component of their recovery, according to Health-Related Quality of Life middle-range theory. Overall, this theory posits that health is a combination of the patient’s biological indicators with the patient’s psychology, primarily, the individual’s perception of their condition (Andela et al., 2018). The patient’s social well-being is also essential, as it influences their psychological state.


Assumptions and propositions of the Health-Related Quality of Life theory help to determine possible factors that affect it; however, there are still challenges with this middle-range theory in both research and practice. The theory model statements do not happen consistently in all unique situations; thus, they are highly contextual. For instance, a patient with arthritis increases their social, psychical, and functional state by applying new body techniques or movement assistance tools, generally improving their health-related quality of life (Honaker, 2017). Their quality of life developed because of positive changes in the functional status, although no alteration of the modified biological state occurred. Therefore, change in the biological aspect of the theory does not affect the improvement of health-related quality of life. Therefore, this middle-range theory can have a notable impact on the health care industry; however, the application of individual perceptions change over time.

Another challenge with Health-Related Quality of Life middle-range theory is the non-linear correlations between different variables because of its unique inter-individual components. A patient’s quality of life is determined by personal and environmental characteristics, biological capacities, observed symptoms, functional state, and perceived health conditions (Honaker, 2017). Therefore, the variety of linear and non-linear interplay of these parts ends in the generation of an individualized outlook on each patient’s health-related quality of life. Consequently, finding interconnected variables that impact this middle-range theory is challenging. The theory is still developing; therefore, its many aspects have not yet been clearly determined. However, due to the significant interest of medical scholars, its value to healthcare professionals is indisputable.

Application of Nursing Theories into Clinical Practice

The key to accommodating skilled cost-effective care delivery is connected to nurses’ knowledge of medical research and the capacity to connect theories to clinical practice. This is crucial because patients ask for services based on evidence, particularly, with a change to the model of health promotion. Nursing is a practical discipline; therefore, its theory is inevitably connected to clinical action. Both nursing and practice emerged symbiotically because of specific needs within society. The middle-range theory is a part of nursing education with the potential for guiding clinical practice and scientific research. Nursing is a participatory field with a mission to make a positive difference in society’s quality of life. The utilization of middle-range theories in practice usually starts with an individual focus.

The use of these theories to manage practice is significant for improving society through the action-focused approach. Thus, some middle-range theories are used in practice, including Caring, Unpleasant Symptoms, and Comfort (Liehr & Smith, 2017). For instance, caring is the method of “knowing, being with, doing for, enabling, and maintaining belief” (Liehr & Smith, 2017, p. 57). This theory helps to connect individuals who share feelings of commitment and loyalty towards one another. The Comfort theory has been applied to manage clinical action at the unit level with pediatric patients. Additionally, it was used at the hospital-wide level within the Veterans setting and by a hospital seeking Magnet status. Moreover, in clinical settings, it is vital to examine nurses’ opinions on implementing the middle-range theory of Self-Care of Chronic Illness in their practice as well as patients’ perception of their experiences. The suitable setting for this clinical practice is acute care. Moreover, practical research could be conducted where nursing care is theory-based (Drevenhorn, 2018). This can help to comprehend if self-care makes any difference for patients’ well-being.

The application of Health-Related Quality of Life theory in clinical practice must start with assessing the patient along the lines of the five health concepts outlined by the theory. For example, a woman at risk of heart disease (a biological factor) could be introduced to a female support group (social concept) that would assist in keeping her physically active. This would influence the patient’s perception of their condition in a beneficial way, as they would be more likely to keep up with any exercises or treatment prescribed to them. To implement this sort of strategy, the health care provider must understand the patient’s non-biological conditions, which, in this example, is the sedentary lifestyle of the patient. Furthermore, the health care provider must be aware of the resources available in the community and health care facility to treat the patient best.


In conclusion, the Health-Related Quality of Life theory seeks to include non-biological conditions, factors, and concepts into the health care providers’ assessment of how to treat the patient. The theory posits that a relationship exists between several aspects, ranging from biological factors and symptoms to general health perceptions and quality of life. These must be identified by the health care provider to treat the patient accordingly, as the interconnectivity of each element does not allow certain concepts to be ignored. This identification gives the health care provider a detailed idea of the patient’s mental and physical conditions. However, the Health-Related Quality of Life theory suffers from reliance on patients’ perception of their conditions, which may be challenging to assess and address adequately.

Furthermore, the theory assumes interconnectivity of varying aspects ranging from the patient’s biological status to their social assessment, making it difficult to gauge the factors that influence outcomes. Several interplays of linear and non-linear concepts necessitate the creation of an individualized outlook on each patient’s health-related quality of life. This can be complicated and time-consuming. A level of comfort between the health care provider and the patient is vital to evaluating the patient’s conditions against the five concepts specified by the theory. Additionally, comfort may improve the patient’s perception of their condition. To conclude, for the Health-Related Quality of Life theory to work in a clinical setting, the health care provider must be informed about relevant resources. This practice facilitates the patient’s access to these resources, which can subsequently improve their health-related quality of life.


Andela, C. D., Lobatto, D. J., Pereira, A. M., van Furth, W. R., & Biermasz, N. R. (2018). How non-functioning pituitary adenomas can affect health-related quality of life: A conceptual model and literature review. Pituitary, 21(2), 208–216. Web.

Drevenhorn, E. (2018). A proposed middle-range theory of nursing in hypertension care. International Journal of Hypertension, 2018, 1-11. Web.

Honaker, J. (2017). Predictors of wound healing in lower extremity wounds [Doctoral Dissertation, Case Western Reserve University]. Ohio Library and Information Network.

Liehr, P., & Smith, M. J. (2017). Middle range theory: A perspective on development and use. Advances in Nursing Science, 40(1), 51–63. Web.

Ojelabi, A. O., Graham, Y., Haighton, C., & Ling, J. (2017). A systematic review of the application of Wilson and Cleary health-related quality of life model in chronic diseases. Health and Quality of Life Outcomes, 15(1), 241. Web.

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"Middle-Range Theory Utilization and Application." NursingBird, 15 Feb. 2022, nursingbird.com/middle-range-theory-utilization-and-application/.


NursingBird. (2022) 'Middle-Range Theory Utilization and Application'. 15 February.


NursingBird. 2022. "Middle-Range Theory Utilization and Application." February 15, 2022. https://nursingbird.com/middle-range-theory-utilization-and-application/.

1. NursingBird. "Middle-Range Theory Utilization and Application." February 15, 2022. https://nursingbird.com/middle-range-theory-utilization-and-application/.


NursingBird. "Middle-Range Theory Utilization and Application." February 15, 2022. https://nursingbird.com/middle-range-theory-utilization-and-application/.