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From: McKenna H.P. (1997) Nursing Models and Theories. London, Routledge, p. 144-146. Like concepts theories may be classified by their levels of abstraction along a continuum from grand theories to practice theories. Grand theories are broad and abstract and do not easily lend themselves to application or testing. In contrast, narrow range theories are very precise and restricted in their focus. Moody (1990) argues that for a theory to be usefully generalised to other nursing situations, it needs to be abstract. But this means that it is difficult to operationalise the concepts within a theory and, without measurable indicators, how can the concepts and propositions be tested through systematic and rigorous research? Mid-range theories go some way to solving this problem. They are moderately abstract and inclusive but are composed of concepts and propositions that are measurable. Therefore, mid-range theories, at their best, balance the need for precision with the need to be sufficiently abstract. First advocated by the sociologist Robert Merton (1968), mid-range theories are more focused than grand theories. They have fewer concepts and variables within their structure, are presented in a more testable form, have a more limited scope and have a stronger relationship with research and practice. Merton (1968) maintained that mid-range theories were particularly important for practice disciplines. He stated that they identify a few key variables, present clear propositions, have limited scope and can easily lead to the derivation of testable hypotheses. They may be developed deductively and retroductively but more often they tend to be developed inductively using qualitative studies. Walker and Avant (1995) maintain that mid-range theories balance this specificity with the conceptual economy normally seen in grand theories. As a result mid-range theories provide nurses with the 'best of both worlds ' - easy applicability in practice and abstract enough to be scientifically interesting. Although only recently receiving increasing attention in UK, American metatheorists were calling for the development of mid-range theories concerning the management of pain and the promotion of sleep over twenty years ago (Jacox, 1974). Like branches of a plant that grow out of control, mid-range theories can sprout in all directions leading to fragmentation of the discipline's knowledge base. However, in the 1990s nursing has recognised the phenomena that specifically interest us, the importance of the metaparadigm, and the grand theories that help identify the boundaries of our discipline. As a result Meleis believes that the time is right for the development of mid-range theories. Mid-range theory deals with a relatively broad scope of phenomena but does not cover the full range of phenomena that are of concern within a discipline. A theory of pain alleviation represents a mid-range theory for nursing; it is broader than a theory of neural conduction of pain stimuli but narrower than the goal of achieving high level wellness. The phenomena of pain is a mid-range concept of concern for nursing because it is only one of many phenomena that comprise the global concern of the discipline (Chinn and Kramer, 1995, p 216). Mid-range theory tends to focus on concepts of interest to nurses. As well as pain, these include: empathy, grief, self esteem, hope, comfort, dignity, quality of life. Mid-range theory can also grow from concept analysis and is inextricably linked to research and practice. This triad of research-theory-practice helps to close both the theory-practice and the research-practice gaps and to provide knowledge which is more readily applicable in direct care situations. Some mid-range theories have their basis in grand theories. For example, the mid-range theory of 'self care deficit' grew out of Orem's (1980) grand theory of 'self care'. This supports Smith's assertion (1994) that a major function of grand theories is to act as a source for mid-range theory development. By doing so they ensure that the focus of mid-range theories remains a nursing one. Fawcett (cited in Smith 1994) agrees, believing that if a 'conceptual framework' (sic) is not related to mid-range theory then it is not absent but is really present in an implicit sense. However, other mid-range theories grow directly from practice. For example, Swanson's (1991) mid-range theory of 'caring in perinatal nursing' was inductively developed from studies in three perinatal settings. Similarly, Merle Mishel (1990) developed a mid-range theory of 'uncertainty' among patients. Chinn and Kramer (1995) discuss eight other mid-range theories which can be used to guide practice. These include: a theory of menstrual care, a theory of family care-giving, a theory of relapse among ex-smokers, a theory of uncertainty in illness, a theory of the peri-menopausal process, a theory of self-transcendence, a theory of personal risking and a theory of illness trajectory.

Submitted by Dr. Hugh McKenna