Development Of Middle-range Theory Research Articles

Adapting to diabetes mellitus: a theory synthesis.

One priority in nursing research is the development of middle-range theories that are applicable to nursing practice. The purpose of this article is to describe the development of a middle-range theory, adapting to diabetes mellitus, through theory and concept synthesis. The adaptation to chronic illness model explicates the conceptual relationships of the Roy adaptation model in a theory specific to chronic illness. Several concepts in the diabetes literature, self-management, integration, and health-within-illness were synthesized with the theory through examination of empirical evidence. This method of theory development increases the specificity of the existing theory and informs the application to nursing practice.

Adapting to Diabetes Mellitus: A Theory Synthesis

One priority in nursing research is the development of middle-range theories that are applicable to nursing practice. The purpose of this article is to describe the development of a middle-range theory, adapting to diabetes mellitus, through theory and concept synthesis. The adaptation to chronic illness model explicates the conceptual relationships of the Roy adaptation model in a theory specific to chronic illness. Several concepts in the diabetes literature, self-management, integration, and health-within-illness were synthesized with the theory through examination of empirical evidence. This method of theory development increases the specificity of the existing theory and informs the application to nursing practice.

An integrative framework for conceptualizing clients: a proposal for a nursing perspective in the new century.

It is exciting to view the year 2000 as the beginning for a new century and a new millennium that can be based on a new resolve and a refreshing insight. In thinking and reflecting about what aspects of nursing and nursing knowledge development that should be the focus for formulating such a new resolve or a refreshing insight, pluralism comes to mind as one of the critical issues that is both important and troublesome. Nursing has pursued multiple paths to develop knowledge with different commitments to philosophies and epistemological orientations during the past three decades. The resulting pluralism is evident not only in philosophical orientations regarding human nature and nursing, but also in theories, scientific explanations, and methods of inquiry adopted in nursing science. During the past three decades we have put a great deal of our scientific effort into developing nursing knowledge in terms of (a) conceptualizing the key and essential phenomena of concern, (b) identifying the nature of nursing problems and different ways of solving such problems, (c) understanding fundamental human processes associated with health and illness through development of multiple theories, (d) identifying the impact of environment on human functioning and health, and (e) advancing technical supports that enhance human health. These efforts have resulted in truly pluralistic knowledge development in nursing in terms of theories, empirical findings, and practical approaches, along with differences in philosophical and value orientations. A rich array of scientific results has provided the foundation to move nursing practice to be grounded in scientific knowledge. On the other hand, multiple theories, conflicting findings, and competing approaches to patient care have created confusion as well as a heightened sense of separation and schism between science and practice in nursing. One of the most critical aspects of such pluralism is in regard to theories and conceptualizations about phenomena in the client domain. Client domain, identified as one of the four domains of nursing’s subject matter (Kim, 1987), refers to the key area of nursing’s concern for knowledge development. There has been a long-standing presumption that through the understanding and explanation about client phenomena, nursing could develop its approaches, that is, therapeutics and strategies of care regarding clients’problems. The conceptual works of early nurse scholars helped to shift nursing’s orientation from medicine and pathologies to human needs. In the ensuing decades, the relevance of these frameworks as a basis for the practice of nursing became apparent, and a series of grand theories concerned with the knowledge domain of the client were proposed and studied. Rogers’s (1970, 1992) science of unitary human beings, Roy’s (Roy & Andrews, 1997) adaptation model, Orem’s (1995) self-care model, Neuman’s (1995) systems model, and Parse’s (1998) theory of human becoming are the major grand frameworks in nursing that try to formulate and explain client domain phenomena from generalized conceptualizations of humanity and health. These and related nursing models can be categorized into six major types according to their views on humanity and health: (a) holistic processes as the modes through which humans coexist within their environment, (b) balance as the essential human characteristic that expresses human condition, (c) configuration of structural and functional aspects as an integrative basis for human functioning, (d) aggregation of parts as revealing states of the human condition, (e) experiencing as the basic form of human existence, and (f) meaning-making as the essential feature of human life. This categorization suggests that in nursing there is diversity in the way clients and client phenomena are conceptualized and that there is no generally endorsed unified perspective regarding humans. It would be quite premature to state that nursing has firmly established specific paradigms or schools of thought based on these differing conceptualizations of humans and grand theories. However, these grand theories persist as the bases for empirical work and research, middle-range theory development, nursing curricula, and Editor’s Note: Send abstracts, outlines, or query letters about ideas for this column to Marilyn M. Rawnsley, RN, DNSc, P.O. Box 2188, Flagler Beach, FL 32136; phone/fax: (904) 439-3406; e-mail: mrawnsley2@aol.com. Persons interested in being critical respondents should forward curriculum vitae and a statement indicating areas of expertise and interest.

Dimensions of International Negotiation: A Test of Iklé's Typology

Results from statistical analyses of 30 cases of international negotiations supported Ikle's typology of negotiating objectives. The cases, sampled from the collection of Pew Case Studies in International Affairs, were distinguished in terms of five objectives: innovation, redistribution, extension, normalization, and side effects. In addition, a sixth objective was identified: negotiations concerning the creation of multilateral regimes. These cases focused on issues that surfaced on the international agenda during the 1980s. Each type had a relatively distinct profile based on such aspects of negotiation as the number of parties and issues, bargaining strategies, media exposure, stability of the process, and types of outcomes. The methodology contributes to the state-of-the art in comparative analysis and the results have implications for the development of middle-range theories of negotiation. They also contribute to practice, by enabling negotiators to evaluate future cases in terms of knowledge about past cases.

The nursing outcomes taxonomy: development and coding.

Interest in the theoretical knowledgebase of nursing has increased over the last 25 years and has led to the current interest in middle-range theory development to describe the essence of nursing. This article describes the creation of a three-level taxonomy and coding structure for the Nursing Outcomes Classification (NOC) based on methods developed by the Nursing Interventions Classification (NIC) work. A model is presented depicting the importance of standardized nursing diagnoses, interventions, and outcomes in the development of the substantive component of nursing practice and to enable nurses to be accountable for care of their clients.

The authors respond

The authors respond: We welcome the opportunity to engage in discourse about middle-range theory. In our article we advocated the development of middle-range theories in addition to, not in opposition to or as a substitute for, the development of more specific theories. Empirically based concept development regarding the individual symptoms of dyspnea and fatigue provided the basis for moving to the broader scope and higher level of abstraction represented by the Theory of Unpleasant Symptoms. As Brown notes, such concept development yields valuable information about patients' symptom experiences. It is needed to guide symptom-specific measures and interventions. Continued empirical work and concept and theory development at the level of individual symptoms also provides the basis for continued amplification and refinement of the middle-range theory. We agree that it should continue. Brown feels that a middle-range theory that encompasses several similar phenomena-in this case, unpleasant symptoms-may be less clinically useful than separate theories. Our experience has been that symptom-specific theory is too restrictive to be the sole focus of knowledge development. In keeping with nursing's holistic focus, clinical practice with ill patients almost always involves attending to more than one symptom at a time. The middle-range theory is clinically applicable because it goes beyond symptom-specific concepts and theories to stimulate thinking about common factors that may influence more than one symptom, the ways in which multiple symptoms interact with one another and affect performance, and interventions that would mitigate multiple symptoms. To underscore the usefulness of theories that encompass multiple symptoms, we point out that while we were developing our Theory of Unpleasant Symptoms, another group of nurse scientists, the University of California, San Francisco, School of Nursing Symptom Management Faculty Group, [1] was developing a model to guide clinical practice in the management of a variety of symptoms. Nursing theories are evaluated by several criteria, of which clinical usefulness is only one. Also important is a theory's ability to explain relevant phenomena in a parsimonious manner and to generate interesting scientific questions for study. It is our experience that a middle-range theory that highlights commonalities among symptoms and provides for the simultaneous experience of multiple symptoms (this aspect of the Theory of Unpleasant Symptoms is evolving) generates more interesting researchable questions than single-symptom approaches. The latter represent untapped scientific potential that can be most effectively maximized through the development of higher-level middle-range theories. Elizabeth R. Lenz, PhD, RN, FAAN Pennsylvania State University; Hershey Medical Center; Hershey, Pennsylvania Frederick Suppe, PhD University of Maryland, College Park; College Park, Maryland Audrey G. Gift, PhD, RN, FAAN University of Pennsylvania; Philadelphia, Pennsylvania Linda C. Pugh, PhD, RN Johns Hopkins University; Baltimore, Maryland Renee A. Milligan, PhD Georgetown University; Washington, DC

Collaborative development of middle-range nursing theories

One promising approach to strengthening theory-research and theory-practice linkages is to place greater emphasis on developing and using theories of the middle range to underpin nursing research and practice. In this article, a postpositivistic definition of middle-range theory is advanced, an argument is made for shifting nursing's theory development activities from discipline-defining grand theories to middle-range theories, and a collaborative and incremental approach to middle-range theory development is described and illustrated. A sustained substantive example is provided by the beginning development of a theory of unpleasant symptoms.

Professional oligarchy in medical group practice: toward the development of a middle-range theory.

The article presents the findings from a study of 27 large, multi-specialty medical groups that suggests a new middle range theory that the governance of medical groups is evolving away from professional autonomy due to environmental changes resulting from the expansion of managed care. The article takes a contingency theory approach to the governance of medical groups to determine the locus-of-control for strategic and management decision making. The findings support the contention that successful medical groups limit decision making at the highest level in the organization to a small number of physician leaders, thereby creating a new organizational form, professional oligarchy.

The Resurrection of Taxonomy to Aid the Development of Middle Range Theories of Organizational Behavior

The Resurrection of Taxonomy to Aid the Development of Middle Range Theories of Organizational Behavior