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of nursing over time. Nursing theorists who have
worked at this level have had insights guided by
nursing and related metaparadigms and sometimes
have experienced leaps of knowing grounded in
these insights. Although there is debate about
which nursing theories are grand in scope, the fol-
lowing are usually considered to be at this level:
Leininger’s Theory of Culture Care Diversity and
Universality, Newman’s Theory of Health as
Expanding Consciousness, Rogers’ Science of
Unitary Human Beings, Orem’s Self-Care Deficit
Nursing Theory, and Parse’s Theory of Human
Becoming. These theories are presented in the third
section of this book.

MIDDLE-RANGE NURSING THEORY

Middle-range theory was proposed by Robert
Merton (1968) in the field of sociology to provide
theories that are both broad enough to be useful in
complex situations and appropriate for empirical
testing. Nursing scholars proposed using this level
of theory because of the difficulty in testing grand
theory (Jacox, 1974). Middle-range theories are
more narrow in scope than grand theories and offer
an effective bridge between grand theories and
nursing practice. They present concepts and propo-
sitions at a lower level of abstraction and hold great
promise for increasing theory-based research and
nursing practice strategies.
The literature presents a growing number of re-
ports of nurses’ experiences of developing and
using middle-range theory. A wide range of nursing
practice situations and nursing issues are being ad-
dressed by middle-range theory. The methods used
for developing middle-range theories are many and
represent some of the most exciting work being
published in nursing today. Many of these new the-
ories are built on content from related disciplines
and are brought into nursing practice and research
(Lenz, Suppe, Gift, Pugh, & Milligan, 1995; Polk,
1997; Eakes, Burke, & Hainsworth, 1998). The liter-
ature also offers middle-range nursing theories that
are directly related to grand theories of nursing
(Olson & Hanchett, 1997; Ducharme, Ricard,
Duquette, Levesque, & Lachance, 1998; Dunn,
2004). Reports of nursing theory developed at this
level include implications for instrument develop-
ment, theory testing through research, and nursing
practice strategies. Illustrations of the process and

CHAPTER 1 Introduction to Nursing Theory 7

product of nursing theory developed at the middle

range are presented in Section IV of this book.

NURSING PRACTICE THEORY

Nursing practice theoryhas the most limited scope

and level of abstraction and is developed for use

within a specific range of nursing situations.

Theories developed at this level have a more direct

impact on nursing practice than do theories that

are more abstract. Nursing practice theories pro-

vide frameworks for nursing interventions and pre-

dict outcomes and the impact of nursing practice.

At the same time, nursing questions, actions, and

procedures may be described or developed as nurs-

ing practice theories. Ideally, nursing practice theo-

ries are interrelated with concepts from

middle-range theories or may be deduced from

theories at the middle range. Practice theories

should also reflect concepts and propositions of

more abstract levels of nursing theory. Theory de-

veloped at this level is also termed prescriptive the-

ory (Dickoff, James, & Wiedenbach, 1968; Crowley,

1968), situation-specific theory (Meleis, 1997), and

micro theory (Chinn & Kramer, 2004).

The day-to-day experience of nurses is a major

source of nursing practice theory. The depth and

complexity of nursing practice may be fully appre-

ciated as nursing phenomena and relations among

aspects of particular nursing situations are de-

scribed and explained. Benner (1984) demon-

The day-to-day experience of nurses is a

major source of nursing practice theory.

strated that dialogue with expert nurses in practice

is fruitful for discovery and development of prac-

tice theory. Research findings on various nursing

problems offer data to develop nursing practice

theories as nursing engages in research-based de-

velopment of theory and practice. Nursing practice

theory has been articulated using multiple ways of

knowing through reflective practice (Johns &

Freshwater, 1998). The process includes quiet re-

flection on practice, remembering and noting fea-

tures of nursing situations, attending to one’s own

feelings, reevaluating the experience, and integrat-

ing new knowing with other experience (Gray &

Forsstrom, 1991).