The nursing theory is defined as a rigorous and creative structuring of ideas for the purposes of a systematic view of an occurrence. The types of nursing theories include; nursing practice theories, mid-range nursing theories, and grand nursing theories. Mid-range nursing theories tend to be narrow in scope than the grand nursing and, in addition, it offers an effective link between the nursing practice and grand nursing theories. Consequently, mid-range theories offer propositions and concepts, nursing strategies, and an increasing theory-based approach. In this light, this paper will describe the development of the mid-range theory by applying an inductive-deductive approach. The inductive-deductive theory can be explained in four phases; Creating concepts inductively through synthesis, examining the relationship in order to set up a model, verifying the concepts through the hypothesis and testing the model, and presentation of the theory. Most commonly used mid-range nursing theories include Peplau’s theory that relates with interpersonal relations, Orlando’s theory of a deliberate nursing process, and Watson’s theory of human caring. Many mid-range theories exist (O’Brien, 2008). The aim of this study is to describe, evaluate, and discuss the application of mid-range theory.
Types of Mid-Range Theories
There are three common types of mid-range theories. The mid-range descriptive theory is the most basic type. It identifies the commonalities in groups, individuals, events, or situations. The mid-range descriptive theory is also known as taxonomy or typology. They are created and tested through descriptive research methods which may be either quantitative or qualitative. A good example of a mid-range descriptive theory is Peplau’s theory of inter-personal relations. The second type is the mid-range explanatory theories. They identify relations between concepts. Mid-range explanatory theories explain the extent to which a concept is related to the other. They are created and tested through correlation research which is commonly quantitative in nature. A good example of this theory is Watson’s theory of human caring and affection. The third type of mid-range theory is predictive theories. These theories move beyond the descriptive and explanatory. This theory addresses how changes occur in a phenomenon. Mid-range predictive theories are created and tested through experimentation. The research is quantitative in design and a good example of this theory is Orlando’s theory of a deliberative nursing process (Fawcett, 2005).
Background of Theory Development
Professional nursing began with a philosopher called Florence Nightingale. She envisioned and pioneered nursing practices and she became a guide for development of nursing schools and hospitals in the U.S in the 20th century (Parker, 2005). In the 1970s, practicing nurses and academicians began to integrate theories of nursing into research. However, majority of these nursing models fell into the category of grand theories. This conceptual model presented a way of understanding professional nursing. The exploration of the concepts under the model included: nursing, health, person, and the environment. A number of nursing conferences were organized to discuss and analyze the practicality of these theories in research. The presentations included key nursing theorists such as Callista Roy, Betty Neuman, Dorothea Orem, and Martha Rogers. Frequent conceptual model used are Orem’s self-care in nursing, Neuman’s system model, Rogers model, and Roy’s adaptation model. The works of theorists of the 20th century and nurse meta-theorists, Nightingale is regarded as the first nursing theorist with her works well described in her book Notes on Nursing. In the professional literature, a number of mid-range theories have begun to develop. Some of these include models dealing with chronic illness, pain control, and acquiring skills. Robert Merton is acknowledged for developing the concept of mid-range theory in 1957. Early in the 21st century, Watson stated that nursing practices is at stake at the moment in the reality of modern health care practices. It is important to realize that theorists like Roy and his conceptual model provide the ground for the survival of nursing (O’Brien, 2008).
Roberts and Roy have pioneered and paved way for the roots of other mid-range nursing theories. Roy has widened the theory of self-concept and interdependence mode through middle-range theories. In addition, Roy’s adaptation model has integrated other mid-range theories such as;
- Caregiver stress
- Adaptation during childbearing
- Adapting to diabetes
- Adaptation to illnesses
- Walking exercises
Nursing theories can be developed using a deductive or inductive approach. The inductive approach in developing a theory is applied when the information is available. Observations are commonly used at this basis. In deductive approach, quantitative study is used in developing the theory. The middle range theory of well-being or holistic care is useful in orienting the practice of a nurse performing holistic healthcare; this includes attention to the mind, body, and spirit; this is important for nurses and medical practitioners for those providing care to individuals’ with life threatening illnesses. Patients coping with such illnesses strive to become self-aware of the state they are in. the mid-range theory of wellbeing in illness helps nurses to assess the patients’ needs (spiritual) and further to institute health care interventions (O’Brien, 2008).
Application of Mid-Range Theory of Holistic Care
Holistic care is the modern nursing practice that expresses the total patient’s care involving care of the body, mind and spirit. It is well done by realizing a person’s health and well-being. It is achieved by providing the physical, mental and spiritual health care of a patient. This helps improve the quality of life of the patient and that of his or her family. This care is provided to ensure a balanced lifestyle, to prevent and cure any illness a patient could be suffering from so as to ensure a healthy life. According to Beebe et al., (2012), nursing involves helping someone through a difficult moment. Therefore, people seek professional counseling when they need support or cannot cope with a situation alone. McLeod (2007), also coins that nursing is an interaction between the counseling expert and the client or patient who needs help.
Doka (2009) indicates that holistic health counseling or Holism refers to a practice of counseling by identifying and analyzing an illness and providing healthcare that recognizes and responds to the well-being of the patient and his or her general health. The approach is usually perceived as morally better, by this it means an alternative approach to the traditional biomedical use of medicines in treating diseases or illnesses. The biomedical approach to the treatment of diseases assumes that all disease begin with a disorder in the body causing bodily harm thus leading to disability, impairment of the normal functions of the body and restrictions on social life. The process of holistic counseling considers the physical, economic, social, emotional and spiritual needs of the patient, his or her response to the illness and the effect of the illness on the person’s ability to meet self-care needs.
Batie (2003) coins that to integrate a holistic healing program; energy based such healing techniques such as Transformation Therapy and inner light consciousness meditation are essential in the healing process of patients.
This may include government bodies like hospitals that help in the facilitation of medical services to the community. Different hospitals have different levels of services depending with the hospitals capability. For these agencies to operate efficiently, they are governed by laws, acts and legislation. These laws ensure the health sector offers services to patients without any favors and with full professionalism. The agencies get their funds directly from the government. In case there is need to improve the health facilities, the government takes control. At times doctors and nurses become reluctant and in this case issues of negligence are experienced. The governments in its stated laws take charge to punish the law breakers. These cases are mostly experienced in the government health centers. Health issues are very critical therefore tight measures should be put in place. The government has ensured enough health care facilities in the community to help in the provision of health services. This has been made possible by providing proper services by qualified specialists and assistants who have helped in the facilitation process. Equipped tools and machines have been put in place to guarantee quality service. Qualified specialists like nurses play a vital role in the healing process of a patient (Batie, 2013).
According to Dossey (2005), nurses who are committed to ‘Holism’ are compassionate, kind and emphasize a balance between safe care skills, analytic and intuitive skills and have the ability to care for a patient using the integration of the body mind and spirit. The holistic nursing practices dwell on creativity, knowledge, expertise, theories and intuition, all these five elements are essential for the nurse to function in a proper way.
These are non-governmental agencies that are not profit making and derive their revenue from voluntary contribution from the general public for the support in the health, welfare and community service. An example of a voluntary organization may include Red Cross and other clubs that purpose to contribute funds that would help to treat patients with certain diseases like cancer, diabetes, heart diseases among others. This is normally done by organizing activities like marathon which is sponsored by specified companies whose main aim is to raise funds that goes to the needy people. Patients through sensitive care should strive to get well soon and succeed in their goal which is to recover. This is by not giving up and allowing the inner energy through transformation healing and inner consciousness. With a combination of hard work and a drive towards excellence then the invisible power of success is achieved (Dyer, 2004).
The human body’s organs can act as series of interacting energy fields. In holistic health today, the mind and body language has been very much appreciated as a channel to healing processes. Therefore, if diseases can be detected at the etheric level they can be protected. The etheric level is the first layer in the human energy body rather a vital body or aura. Gerber (2001) argues that we, human organisms are a series of dimension energy systems that when they become imbalanced they may result in physical, mental, emotional and spiritual problems. This can then be solved only by rebalancing the energy with the right frequency of vibrational medicine. Vibrational medicine plays a role of balancing the energy system of an individual when one cannot be able to control his energy mode to a normal level. This is a system of medicine which accepts its existence, the spirit, mind and body to heal. Health does not depend on vibrational medicine or spiritual healing, but on people living as a community, harmony and loving one another in every aspect of life.
According to Layte (2011), one of the most studied energy forms of healing is the Healing Touch (HT). Many science disciplines have turned to this concept to understanding the energy therapy of the Healing Touch. Research has been carried out and studied on the impact of the Healing Touch to diseases like cancer, heart diseases, headaches and symptoms like fatigue, anxiety and stress. The studies support the use of the technique in reducing fatigue, pain, anxiety, tension and stress to patients.
A study conducted in the year 2000, suggested that there were 4.5million people with Alzheimer in the United States, and that the older age group from 85 years and above were mostly affected. The research concluded that the number of infected people will increase significantly unless new discoveries are implemented to prevent the disease. The assessment method of cognitive deficit in controlling Alzheimer disease in patients allows a detailed examination of self-awareness in relation to the disease. Results show the screening of ‘anosogonosia’ in Alzheimer disease is useful to assess for amnesia both before and after the memory test (Barrett, 2005). A pre-clinical diagnosis in controlling Alzheimer is therefore necessary in self-assessment and awareness. Magnetic Resonance Imaging (MRI) can have therapeutic importance to a patient and importance as current imaging techniques develop. Neuroimaging provides measure of a pre-clinical state of the disease and change, and this is relevant in prevention Some studies target a more clinical treatment approach of the disease Dementia, using behavior variation and language variation to present a combination of behavior and languages problems In effect to Alzheimer (Hodges, 2006).
Holistic care or practice is comprehensive in nature and covers the patient’s total well-being; it is also called comprehensive counseling. A holistic approach means that a counselor is informed about the patient’s whole life.
According to Elo (2013), the formulation of concepts in the mid-range theory in this context was selected because of the notion of well-being. In this study, the analysis is done to describe the well-being or holistic care. Applying the mid-range theory in practice is widely used in evaluating the theory. These theories may be used in nursing education and for health practitioners. The concept can be further used to support the well-being of people. The theory of well-being in illnesses is a mid-range theory as discussed above and can be applied to other studies. For instance, other studies may research on how the environment contributes to the health (holism) of the patient. This theory can be used to as a guideline for practicing nurses in order to develop the practice. According to a research by Elo (2013), the mid-range theory was tested with analysis showing that reliability and validity of the nursing theory was good. Through qualitative analysis, it confirmed the hypothetical framework by the researcher.
Explicit and Implicit Assumptions (Hypothesis) from the Theory
Based on the mid-range theory of holistic care as described in this study, many hypotheses can be derived that links to spiritual well-being and quality of life for patients. The first assumption is that it can be noted that there is a relationship between the patient’s faith and his quality of life or well-being. Second, there is a relationship between the patient’s religious practices and well-being during the illness. Third, there is a relationship between the patient’s feelings of spiritual fulfillment and the quality of life in his holistic experience. The overall assumption can be defined as; there is a relationship between holistic care and quality of life or well-being among sick people. It is suggested in the findings presented in this study, nursing researches to test the mid-range theory of holistic care is employed in the collection of both quantitative and qualitative data that explores the connection of well-being in coping with disability and illnesses. According to Fawcett (2005), the mid-range theory as applied to holistic care incorporates the metaparadigm of four relational and non-relational propositions. Fawcett identifies the four non-relational propositions of metaparadigm and the relational propositions as to what nursing concerns.
The primary purpose is to enable nurses, theorists, practitioners, and researchers to develop and enhance the business of nursing. The metaparadigm is used in the analysis and framework for comparing nursing theorists (Fawcett, 2005). More nurse scientists continue to recommend the development of the theory in the disciplinary perspective of nursing. In addition, the mid-range theories have fulfilled the crucial functions of distinguishing nursing from other health professions. The mid-range theory has been found to be helpful in practice and research to nurse scientists. It has assisted nurses by aiding the understanding of patient’s behavior, providing interventions, and possible strategies for its effectiveness (Peterson and Bredow, 2013).