Middle-range nursing theories

11 Critical Middle-Range Nursing Theories

Posted: June 22nd, 2022

The middle-range theories are some of the vital theories in the nursing profession. Each one has its unique perspective on the role of nurses and the care they provide.

Some of the more well-known nursing theories, like Hildegard Peplau’s Interpersonal Nursing Theory, emphasize the importance of the nurse-patient relationship and how this can help promote healing.

Middle-range nursing theories are essential to every nurse that wants to stay ahead in their profession. They provide insights on patient care and support. Here is an in-depth look at nursing theories, including middle-range nursing theories. 

Classification of nursing theories

The classification of the theories follows a few methods. One way is to classify them according to their level of abstraction.

Grand Nursing Theories: These theories are broad in scope and provide a general framework for understanding nursing.

Middle-Range Nursing Theories: These theories are more specific and focus on a narrow aspect of nursing.

Nursing Practice Theories: These theories are even more specific and focus on how nurses can best care for their patients.

No matter what level of abstraction a nursing theory is, they share some commonalities. Nursing theories typically define nursing, the nurse-patient relationship, and an explication of how nurses can promote healing. Middle-range nursing theories, such as grand theories, can guide nurses in their practice and provide a framework for understanding the complex phenomena of nursing research. In this context, the concept of access to social support and networks becomes crucial for nurses in hypertension care. Nurses can better understand the patient’s overall well-being and provide appropriate care by considering the patient’s access to social support, network, and cognition.

Nursing meta-paradigm

The Nursing Meta-Paradigm consists of four concepts that define the scope of nursing. These concepts are person, environment, health, and nursing.

Person: The person is the focus of nursing care. It involves patients, families, communities, and populations.

Environment: The environment is everything that surrounds the person. It includes physical, social, cultural, and spiritual factors.

Health: Health is a state of being that is positive and dynamic. Nursing care promotes health and prevents illness.

Nursing: Nursing is the art and science of caring for people. Nurses use their knowledge, skills, and abilities to provide quality care for their patients.

Middle-range nursing theories provide a framework for nurses to understand and care for their patients. They help to guide nursing practice and research and can improve patient outcomes.

Importance of Middle-range Nursing theories

– Understand the patient’s experience of illness

– Plan and deliver individualized care to the patient’s needs

– Evaluate the effectiveness of nursing interventions

– Improve communication between nurses and other health care providers.

What is a nursing theory?

Nursing theory is a way of thinking about nursing and the role of nurses in providing care. Nursing theories have underlying assumptions about nursing, the role of nurses, and the relationship between nurses and patients. 

Middle-range nursing theories provide a framework for nurses to understand and care for their patients. 

Middle-range nursing concept

Middle-range theories are more specific than grand nursing theories but are not clinical Nursing models. These theories typically focus on a narrower scope of Nursing practice. Also, they guide nursing practice and research. Middle-range theories are easier to test and measure. 

Middle-Range Nursing Theories

Middle-range nursing theories provide a practical and tangible framework for nurses to better understand and care for their patients. These theories are more specific than grand nursing theories but not as extensive as clinical nursing models. They narrow down the scope of nursing practice and research, allowing nurses to focus on specific areas of patient care.

One of the key advantages of middle-range nursing theories is their testability and measurability. Nurses can use these theories to design interventions and evaluate their effectiveness in improving patient outcomes. By having a clear framework to guide their practice, nurses can ensure that their care is individualized and tailored to each patient’s unique needs.

Improving communication between nurses and other healthcare providers is an important aspect of middle-range nursing theory. Effective communication is crucial in ensuring coordinated and comprehensive care for patients. Nurses can collaborate more effectively with doctors, therapists, and other healthcare team members by enhancing communication.

Middle-range nursing theories emphasize the importance of clear, concise communication and active listening skills. Nurses are encouraged to engage in interdisciplinary discussions actively, share vital patient information, and ask questions when needed. This collaborative approach fosters better decision-making and improves the overall quality of care.

Moreover, middle-range nursing theories also highlight the significance of evidence-based practice. Nurses are encouraged to integrate the latest research findings into their clinical decision-making processes. By staying up-to-date with current evidence, nurses can provide the most effective and best possible care for their patients.

Furthermore, middle-range nursing theories recognize the importance of holistic care. Nurses treat physical ailments and address the emotional, psychological, and social aspects of a patient’s well-being. This comprehensive approach allows nurses to provide personalized care that takes into account all dimensions of a patient’s health.

In conclusion, middle-range nursing theories play a crucial role in guiding nursing practice and improving patient outcomes. By emphasizing effective communication, evidence-based practice, and holistic care, nurses can provide their patients with the highest quality of care. As the field of nursing continues to evolve, middle-range theories will continue to shape and enhance nursing practice, ultimately benefiting patients and healthcare systems as a whole.

Some well-known middle-range nursing theories include:

Roy’s Adaptation Model

Sister Calister L. Roy is a professor, nursing theorist, and author. The adaptation model theory focuses on people and society. The healthcare provider’s role is to promote health to the people and society at large.

This theory focuses on how people adapt to changes in their environment. The nurse should adjust and manipulate the stimuli to promote healing. 

Everett Rogers’s diffusion of innovation theory

The diffusion of innovation theory has five different categories that describe how people adopt new things. These are:

Innovators (2.5%): These people are the first to try new things. They’re risk-takers and are usually very knowledgeable about the subject matter.

Early Adopters (13.5%): They adopt new things before others do. They’re usually opinion leaders and have a lot of influence over others.

Early Majority (34%): These people adopt new things after the Early adopters but before the Late Majority. They’re usually well-educated and have a lot of resources available to them.

Late Majority (34%): These people adopt new things after the Early Majority but before the Laggards. They’re usually more skeptical of new things and take their time before adopting them.

Laggards (16%): These people are the last to adopt new things. They’re usually resistant to change and may not have the same resources or knowledge as the other adopters.

Comfort care- Kolcaba’s Theory of Comfort

Kolcaba’s Theory of Comfort is a middle-range nursing theory that focuses on comfort as a fundamental aspect of patient care. According to this theory, comfort can be achieved through the relief of physical, emotional, and spiritual distress.

Comfort care emphasizes the provision of a supportive environment that promotes relaxation, reduces anxiety, and enhances overall well-being. Nurses play a crucial role in assessing and meeting patients’ comfort needs, whether it be through pain management techniques, therapeutic communication, or creating a soothing atmosphere.

By implementing Kolcaba’s Theory of Comfort, nurses strive to enhance the quality of care provided to patients by prioritizing their comfort and promoting holistic healing. This theory recognizes that patients have different comfort needs and preferences, and it encourages nurses to individualize care to meet those needs.

Understanding the adoption process is essential when introducing new theories or approaches like Kolcaba’s Theory of Comfort. Geoffrey Moore’s Technology Adoption Curve provides insights into how individuals or groups may respond to such innovations.

In the context of nursing, we can apply this curve to understand how different healthcare professionals may embrace and integrate Kolcaba’s Theory of Comfort into their practice.

The innovators, who represent a small percentage of nurses or healthcare professionals, are often the first to adopt new theories or approaches like Kolcaba’s Theory of Comfort. These individuals are highly knowledgeable and open to change, constantly seeking opportunities for improvement in patient care.

Next on the curve are the early adopters. They are also open-minded and willing to try new approaches but may require more evidence of the theory’s effectiveness before fully integrating it into their practice. These healthcare professionals can serve as influencers, sharing their positive experiences with others and encouraging them to adopt Kolcaba’s Theory of Comfort.

The early majority represents a larger group of healthcare professionals who may hesitate to adopt new theories or approaches initially but are willing to do so if they see the benefits and evidence of their effectiveness. They may take a more cautious approach, conducting their own research and seeking out success stories from their peers before fully embracing Kolcaba’s Theory of Comfort.

The late majority consists of healthcare professionals who are typically skeptical of change and may resist adopting new theories or approaches until they feel it is necessary or unavoidable. They may require significant evidence and convincing arguments to overcome their resistance.

Lastly, we have the laggards, who are hesitant to embrace any change and prefer to stick to traditional approaches in their practice. These healthcare professionals may be resistant to adopting Kolcaba’s Theory of Comfort, viewing it as unnecessary or incompatible with their established methods.

Integrating Kolcaba’s Theory of Comfort into practice requires a strategic approach that recognizes each group’s different attitudes and behaviors. Education and training programs can play a vital role in informing nurses and healthcare professionals about the theory’s benefits and providing them with the necessary tools to implement it effectively.

For the innovators, providing them with opportunities to explore further and understand the theory will fuel their enthusiasm for implementing it.

There are three types of comfort that this theory addresses: physical, psychological, and social.

– Physical comfort is the relief of pain and other physical symptoms.

– Psychological comfort is bursting anxiety and other mental/emotional symptoms.

– Social comfort is providing support and belonging from positive interactions with others.

The four modes of comfort that this theory addresses are:

Nursing interventions: These are things nurses do to comfort their patients.

Environmental manipulations: These are things like changing the lighting or temperature in a room to make it more comfortable.

Distraction techniques are things like providing entertainment or diversion to take a person’s mind off their discomfort.

Relaxation techniques: These are things like breathing exercises or progressive muscle relaxation.

Emancipatory Theory of Compassion

The Emancipatory Theory of Compassion, developed by nursing scholar Cheryl Beck, seeks to empower both the patient and the nurse in the healing process. It recognizes that compassion is not a one-way street but rather a reciprocal exchange of empathy and understanding.

At its core, the theory emphasizes the importance of fostering a collaborative relationship between patients and nurses. This means that both parties are actively involved in decision-making and goal-setting, working together towards optimal health outcomes.

Unlike traditional models of nursing care, which often place the nurse in a position of authority, the Emancipatory Theory of Compassion shifts the power dynamic to a more equal footing. It acknowledges that patients have unique knowledge and experiences essential to their healing journey. Conversely, nurses serve as facilitators and partners, providing guidance and support based on their expertise.

The theory also recognizes the significance of social and cultural factors in healthcare. It emphasizes the importance of understanding individual beliefs, values, and preferences when delivering care. By doing so, nurses can tailor their interventions to align with the patient’s needs, ultimately enhancing their sense of comfort and well-being.

In terms of comfort, the Emancipatory Theory of Compassion acknowledges that physical and emotional comfort are intertwined. It highlights the importance of addressing both aspects to promote overall well-being.

To promote physical comfort, nurses can utilize various interventions such as pain management techniques or providing a soothing environment. This may include adjusting lighting and temperature, providing comfortable bedding, or using relaxation techniques like breathing exercises.

On the other hand, emotional comfort can be achieved through empathetic communication and active listening. Nurses can create a safe space for patients to express their fears and concerns without judgment. Nurses can help alleviate distress and instill a sense of emotional well-being by validating their emotions and demonstrating genuine empathy.

The Emancipatory Theory of Compassion also emphasizes the importance of patient autonomy and empowerment. It recognizes that patients have the right to make informed decisions about their own healthcare. Nurses play a crucial role in supporting this by providing clear and accurate information, facilitating discussions about treatment options, and respecting the patient’s choices.

Furthermore, this theory highlights the need for cultural humility in nursing practice. It encourages nurses to continuously educate themselves about different cultures and traditions and approach each patient with respect and openness. By doing so, nurses can build trust and strengthen therapeutic relationships with patients, ultimately enhancing the quality of care provided.

Middle-range theory in nursing is a valuable framework that helps nurses bridge the gap between abstract concepts and practical applications. It provides a foundation for understanding and addressing the complex needs of patients, promoting holistic care that considers both physical and emotional well-being.

In conclusion, the Theory of Compassion and the Emancipatory Theory of Compassion offers valuable insights into promoting comfort, autonomy, and cultural humility in nursing practice. By incorporating these theories into everyday patient interactions, nurses can provide compassionate and patient-centered care that enhances overall well-being.

Nursing is a process that liberates both the nurse and the patient. It is an act of compassion that allows for the recognition and embrace of human suffering.

The theory also states that nursing is a process of liberation that enables both the nurse and the patient to reach their fullest potential.

Madeleine Leininger: Cultural Care Diversity and Universality Theory

Nursing is a culturally based profession that should be responsive to the needs of all cultures.

Nursing care should have a basis on an understanding of the cultural beliefs and practices of the patient.

Nursing care should be universal in its provision. Also, it should be culturally specific when necessary.

Peplau’s Nursing Process Theory

Peplau’s nursing process is a four-step process that includes:

Assessment: This is the first step in which the nurse collects information about the patient’s health condition.

Diagnosis: This is the second step in which the nurse judges the patient’s health condition.

Planning: This is the third step in which the nurse develops a care plan for the patient.

Implementation: This is the fourth step in which the nurse carries out the care plan.

Merle H. Mishel Nursing Theory

The uncertainty on illness theory by Merle H. Mishel focuses on the strain and struggle when one gets an acute and chronic illness. It provides ways a patient or nurse can adjust to the change. 

The theory follows three themes: antecedents of uncertainty, coping with uncertainty, and the process of the uncertainty appraisal. 

Evelyn Adam’s Nursing Theory of Goal Attainment

The theory upholds the thought that nursing is a process of helping people to achieve their goals. It is a process of assisting people to reach their potential.

Nursing is a process of supporting people to achieve their dreams. Additionally, it involves professional interventions and the consequences of help. 

Orlando’s Nursing Process Theory- Deliberative nursing process theory

Ida Jean Orlando-Pelletier founded the theory. She was a theorist and a psychiatric nurse. The deliberative nursing process theory allows nurses to create a care plan for undertaking their duties if and when complications arise.

The theory also states that patients have their own understanding and interpretation of situations. That prompts nurses to understand before they make conclusions.

The middle range theory defines a mental health-inclusive approach to nursing. Healthcare providers and their patients need to create a reciprocal relationship where their actions are interconnected.

Phil Barker

Barker’s Tidal Model emphasizes best care policies for people with mental health struggles. Also, the nursing theory talks about caring and empathy for people going through difficulties in life.

The tidal model has ten commitments. They include valuing the voice, respecting the language, becoming the apprentice, developing genuine curiosity, Using the available toolkit, giving time, revealing wisdom, acknowledging change, and embracing transparency.

– Nursing is a process of caring for people in a state of flux.

– Nursing is a process of helping people to cope with change.

– Nursing is a process of supporting people through transitions.

Ramona T. Mercer- Maternal role attainment theory

The Maternal role attainment theory focuses on the journey of helping mothers attain their maternal roles. It focuses on supporting mothers to bond with their children and build confidence in their mothering skills. 

The maternal role theory advocates for a non-traditional approach to providing proper healthcare interventions for new mothers as they attain their maternal identity. 

Dorothea Orem’s Self-Care Deficit Nursing Theory

Nursing is a process of assisting people by offering self-care services. The assistance improves human function at the home level. It sheds light on someone’s ability to take care of themselves. 

More theories from the self-care theory include the self-care deficit theory, the theory of self-care, and the nursing system theories. 

Each of these theories has its strengths and weaknesses, and no one ‘right’ theory exists. Nurses need to be aware of the different theories and select the one that best fits their practice.


What are some examples of middle-range theory?

Some examples of middle-range theory are the self-care deficit nursing theory, Orlando’s Nursing Process Theory, and the Tidal Model.

What is the goal of Nursing?

The goal of Nursing is to help people achieve their potential. Nursing, as a profession, is rooted in the belief that individuals are in a constant state of flux. It is a process that goes beyond the traditional approach of providing healthcare interventions. Middle-range theories in nursing play a crucial role in guiding nurses to fulfill their goal of helping people achieve their potential.

What is a key feature of Nursing?

A key feature of Nursing is that it is a process of caring for people in a state of flux. As a profession, nursing recognizes the ever-changing nature of individuals and their health. A key feature of Nursing is the understanding that people are in a constant state of flux, and it is through this lens that nurses approach their practice.

By embracing this concept, nurses are able to provide holistic care that goes beyond mere healthcare interventions. They become advocates for their patients, empowering them to take charge of their own well-being and achieve their full potential.

Middle-range theories in nursing play a pivotal role in guiding nurses toward fulfilling this goal. These theories, such as Dorothea Orem ‘s self-care deficit nursing theory and Orlando’s Nursing Process Theory, provide frameworks for nurses to understand and address the unique needs of individuals in various healthcare settings.

For example, the self-care deficit nursing theory by Dorothea Orem emphasizes the importance of self-care in maintaining optimal health. According to this theory, individuals possess the ability and responsibility to care for themselves but may require assistance when they are unable to meet their self-care needs. Nurses who apply this theory assess a patient’s ability to perform self-care activities and intervene to promote independence or provide support as needed.

What is a middle-range concept in nursing?

A middle-range concept in nursing is a Nursing theory that falls somewhere between the grand Nursing theories and the specific Nursing interventions.

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