Nursing Theory, as Nolan and Grant (1992,

Nursing theory, as Nolan and Grant (1992, p. 217) correctly state, cannot be separated from the practice of the profession. On the other hand, theories that have become known collectively as "grand theory" have become so fraught with terminology discrepancies and idealistic representation that it has become impossible for practitioners to use. This has created what Nolan and Grant (1992, p. 217) refer to as the "theory-practice gap," where there is a lack of basic communication and collaboration among nursing theorists and practitioners in the field.

To remedy this, a new approach to nursing theory and its relationship to practice arose, known as "mid-range theory." This approach was first suggested by Hildegard Peplau at the end of the 1960s (Peden, 1998). Recently, there has been a revisitation of the merits of mid-range theories as a more effective approach not only to the practice of nursing, but also to research in the field, as well as education of both nurses and families making use of nursing care.

Indeed, mid-range theory has opened the field to better communication between nursing practitioners and their patients in terms of inclusive education as well. In the field of mental health nursing, for example, the current approach focuses on the inclusion of families in nursing education, especially where conditions such as schizophrenia or physical disability creates a need for extensive family support. According to Goldenberg and Goldenberg (p. 381), mental health and other caregiving practitioners have increasingly realized the importance of collaborative therapist-family relationships in order to provide optimal care to clients.

This creates a network of care for the disabled and mentally challenged, which is far more effective than placing the burden of care exclusively upon an already burdened nursing profession. Hence, education extends not only to the nursing profession itself, but also to families who are faced with caregiving challenges daily. In this, communication is also of the greatest importance, as made evident in the work by Xu and Jezewski (2007).

In focusing on the nurse's role in terms of patient advocacy, the authors provide for the public demand for greater control over their health care. In this, not only public education, but also collaborative communication is of the utmost importance. One might therefore say that grand theory is no longer relevant in this domain, while the importance of mid-range theory has heightened. This is particularly important in view of current technological and medical advances.

Without the necessary communication and education, these can leave health care clients with a sense of bewilderment and loss of control. Here, the role of the nursing practitioner is of vital importance; he or she is the mediator between the client and the intricacies of the profession. The advocating role is therefore not only one of communication, but also of public education. Another function of mid-range theory in nursing is to promote effective and practically applicable theories to cater for the current nursing needs of humanity.

In other words, this type of theory observes the function and status of humanity in the world today and devises theories that focus on the improvement of these. This includes the aging population that has been one of the nursing realities in the world today. Flood (n.d., p. 35), for example, notes that 2011 will see the 65th birthday of the oldest members of the baby boom generation.

The practical reality of this is that comprehensive care for older people has increased, especially with medical advances resulting in people generally reaching a higher age during their lifetime. For this reason, nurses who work with older people have themselves entered the theoretical field in order to devise effective and consistent theories that can provide a basis for caring for this generation. According to Flood (n.d., p. 35), what currently lacks in the nursing theory that relates to older persons is practical direction.

This practicality is what nurses are currently pursuing by devising mid-range theories. One practical element that is missing from current theory is a description of human aging. The author notes that there is a notable discrepancy between the practical experiences of older people and the findings of researchers in terms of the aging process. This indicates a need for research that includes the views of those who are directly involved.

The same is true of the above-mentioned families who are challenged by the medical and care needs of mentally and physically disabled family members. One might therefore draw the conclusion that, whereas grand theory tends to focus exclusively on the theoretical aspects of nursing, mid-range theory not only focuses on practical applicability, but also on how research and practical need collaborate in creating new theoretical approaches.

Mid-range theory is therefore the result of collaborative and communicative research, involving not only nursing professionals and researchers, but also the clients who receive nursing care. One of the main differences between the two types of theory is therefore the direct involvement of the client in dictating the direction of the research. In mid-range theory, the theoretical aspect is at least as important as its practical roots and applicability. Xu and Jezewski (2006, p.

108), for example, note that a mid-range theory of patient advocacy both conceptualizes this aspect of nursing practice, as well as providing an operational definition of its function in terms of practice and research. In this way, a patient-centered approach can be taken when researching advocacy and its effectiveness in terms of the experience of clients with the medical profession. While a practical aspect is regarded as highly important in the mid-range theoretical approach, this is not to say that the theoretical, empirical aspect should be neglected.

Indeed, this aspect is fortified by mid-range theory, as it proves the applicability, necessity, and soundness of the findings obtained. In addressing the communication gap between research and practice, for example, Nolan and Grant (1992, p. 217) suggest that those involved in the practical aspect of nursing care should also be involved in the research of these concerns. A case in point is the research regarding the aging process as reported by Flood (n.d.), where the theory and practice show remarkable discrepancies.

This emphasizes the necessity of increasing the theoretical focus on the practical aspects of nursing in order to improve both the theoretical and practical aspects of the profession. Perhaps a sound suggestion is a return to Hildegard Pelau's practice-based theory, as described by Peden (1998). While this theory acknowledges the vital importance of theory in advancing the knowledge about nursing practice, it is also.