¶ … Range Nursing Theory A clinical nurse is generally involved with specialized research; for example, a clinical nurse specializing in oncology would likely be heavily involved in the treatment of patients with cancer, according to Andrea Santiago. That clinical nurse specialist (CNS) working with cancer patients may also create helpful protocols or other strategies to improve the delivery of services in a hospital (Santiago, 2013). This paper delves into the reasons why the CNS can (and will) benefit from the use of the middle range theory.

What are middle range theories?

Judy Davidson (RN, DNP, CNS) explains that middle range theories are designed to "guide practice" for nurses (including clinical nurse specialists) and are "more focused than grand theories" because they zero in on a "single aspect of practice" and are not as general as grand theories (Davidson, 2010, p. 28). Moreover, because grand theories only offer a framework in terms of descriptions and prescribing within the nursing practice -- and middle range theories are "directly applicable to patient care and more prescriptive" -- middle range theories are easier to test (Davidson, 29).

Why would a CNS embrace the middle range theory?

The middle range theory has proven to be useful "…in both research and practice," according to the book Middle Range Theories: Application to Nursing Research (Peterson, et al., 2009, p. 36). The middle range theory can serve a "heuristic function" [a way of ranking various alternatives] in order to "…stimulate and provide rationale for studies" (Peterson, 35). Also the selection of the most important research questions can be guided through the use of the middle range theory, Peterson explains.

Through use of the theory a clinical nurse specialist can gain a deeper understanding of the patient's behavior, and from that deeper understanding the clinical nurse specialist can make suggestions as regards possible interventions along with an understanding as to how effective the intervention turned out to be (Peterson, 35). Peterson aims to show how valuable the use of the middle range theory is; hence, she has done the meta-research and reports that of 173 studies published...

And of those 173 studies, 79 included the use of a theory; of those 79 studies that "identified a theory," 25 were nursing theories and 54 were "middle range theories borrowed from other disciplines, most frequently from psychology" (Peterson, 25).
Peterson asserts that notwithstanding the "great potential for guiding nursing practice" that middle range theories present, that potential goes underutilized. And moreover, Peterson points out that nurse researchers have been "…denounced for making use of middle range theories from disciplines other than nursing," in particular, from psychology (37).

Testing the middle range theory for the self-care of home-bound elderly

A peer-reviewed article in the Scandinavian Journal of Caring Sciences describes the process of "…developing an instrument to test the middle range nursing theory" as to how effective it would be vis-a-vis the self-care of home-dwelling elderly people (Rasanen, et al., 2007, p. 397). Also, this research sought to determine how effective the middle range theory would be in a clinical setting with reference to evaluating the self-care of home-bound older people.

The authors used four phases to test the middle range theory: a) the first phase was set in motion based on the theory; b) next, two home-bound elderly people were interviewed as a pilot program, and 20 elderly people completed a questionnaire and "…commented upon its ease of use"; the results from the questionnaire responses were used for the 2nd phase; c) using the results from the 2nd phase, data was collected from 200 home-bound seniors aged 75 and up from various locations in Finland; and d) the "content validity of the third version was assessed by three home-dwelling elders" (Rasanen, 397).

The authors learned through this test that the instrument used in a middle range theory context must be "…explicit and short enough" to be completed without taking a long time; and moreover, collecting data may require "structured interviews" due to the difficulty some elderly people will have in completing a questionnaire (Rasanen,…