¶ … range theory nursing. If accepts premise grand theories nursing longer, implications nursing education, practice, research? Question 2: due 11/29/11 There controversy nursing direction development nursing knowledge . There is an emphasis at present on the development and use of mid-range theory in nursing. If one accepts the premise that grand theories of nursing are no longer necessary, what are the implications for nursing education, practice, and research?

Nursing theories can be classified in many different ways, but one of the most common methods is to group them into grand and middle range theories. A grand theory "provides a conceptual framework under which the key concepts and principles of the discipline can be identified," while, in contrast, a "middle range theory is more precise and only analyzes a particular situation with a limited number of variables" (Nursing theories: An overview, 2011, Nursing Theories). Mid-range theories of nursing do not attempt to define what 'nursing' is as a concept in a universal fashion. Rather they tend to give more practical, hands-on guidelines for nurses in the field dealing with specific medical issues, spanning from eldercare to obesity prevention.

Nursing as a profession takes many different forms -- the duties of a nurse in a small doctor's office may be very different from a nurse-midwife in private practice, a nurse at a busy hospital, or a nurse dealing with mainly geriatric patients. Examples of mid-range theories include "Huth and Moore's Pain Management (Children); Barnard's Child Interaction; Ruland and Moore's End of Life Care; Ulbrich's Exercise as Self-Care" (Nursing theory, 2011, Nursing theory). Simply listing the range and diversity of these theories highlights the need for mid-range theories in the manner in which they show the many contexts in which nurses operate today.

For example, 'exercise as self-care' stresses the healing power of exercise and self-empowerment and the possibilities of change. These theories have a very different emphasis than theories dealing with end-of-life care, which stress the need for privacy and respect for the cultural and religious beliefs of the patient and the family (End of life care, 2005, Nursing theory.). However, even mid-range theories have connections to broader 'grand' theories. For example, Ulbrich's Exercise as Self-Care was developed using the mid-range theories of Pender's Health Promotion, and Younger's Mastery of Stress models along with the grand theory of Orem's self-care deficit theory of nursing with "the transtheoretical model of exercise behavior, and characteristics of a population at risk for CVD" (Ulbrich 1999).

Grand theories of nursing such as Leininger's Cultural Care Diversity; Newman's Health as Expanding Consciousness, and Parse's Theory of Human Becoming are necessary to broadly define the nature and purpose of nursing, as distinct from other healthcare professions. As nursing takes on different forms, including assuming some of the roles and responsibilities previously only accorded to physicians, there is even more of a need to define what makes nursing special, and to understand the special gifts nurses can give to their patients. Grand theories stress aspects of nursing care, such as the importance of acknowledging the patient's environment and cultural context, which have implications for all aspects of nursing. In contrast, the concerns of mid-range theories are particular to situations and may not be generalized to all areas. For example, some patients may not have sufficient physical mobility to engage in exercise, so Ulbrich's Exercise as Self-Care theory is not appropriate for all patients.

Nursing has fought long and hard to be acknowledged as its own profession within the 'academy.' Without grand, overarching theories it would lose its legitimacy, and be forced to 'borrow' other theories from other disciplines, which would devalue the profession. Nursing is both practical and theoretical in its orientation, much like the law, where there may sometimes be a discrepancy in the immediate priorities of teachers and practitioners, even though the work of both 'informs' one another. Grand theories also create a sense of continuity between the different eras of nursing. Many of the concerns of mid-range theories are highly specific in a manner that does not define nursing in all contexts....

Thus, to do away with grand theories would make nursing education, in many respects.
However, it may be that there will be a distinct shift to favoring mid-range nursing theories when engaging in research about the nursing profession. Empirical research is usually specific and focused in nature, and dealing with relatively enclosed patient populations' needs is one of the strengths of mid-range nursing. It is difficult to imagine a world in which grand theories are done away with entirely, but as mid-range theories become more popular, and as empirical nursing research in general becomes more widely used, mid-range theories are more likely to proliferate than grand theories.

References

End of life care. (2005). Nursing Theory. Retrieved September 25, 2011 at http://www.nursingtheory.net/mr_endoflifecare.html

Nursing theory. (2005). Nursing Theory. Retrieved September 25, 2011 at http://www.nursingtheory.net/

Nursing theories: An overview. (2011). Nursing Theories. Nursing theories: An overview.

Retrieved September 25, 2011 at http://www.currentnursing.com/nursing_theory/nursing_theories_overview.html

Ulbrich, S.L. (1999). Nursing practice theory of exercise as self-care.

Image J. Nurs Sch, 31(1):65-70.

Question 2:

Discuss the issue of entry level into practice for nurses and the impact it has on the understanding of theory and use of theory at the bedside. What do you believe the entry level into practice should be for the professional registered nurse?

According to one nursing standards board: "Entry-level RNs have a strong base in nursing theory, concepts and knowledge; the sciences; the humanities; research and ethics (e.g., pathophysiology, pharmacology, microbiology, epidemiology, human growth and development, role transitions for people of all ages, nutrition, genetics)" (Entry-to-practice competencies, 2011, College & Association of Registered Nurses of Alberta). The presumption is that new nursing graduates have a sound grounding in theory as well as technical knowledge of how to perform their tasks. However, many new nurses feel that abstract theory is irrelevant for them, given the actual duties they must perform on a daily basis, and view learning theory in school as merely one in several succession of 'hoops' they must jump through to gain employment. This sentiment, articulated by one nurse, is common: "We teach theory wrong. It should only get a mention in undergrad nursing education. The average nursing student doesn't have the framework to really understand, integrate, synthesize the concepts. (can you tell I'm in grad school?) Nursing theory is probably best delivered at higher levels of education" (Is nursing theory important, 2009, All Nurses).

However, as abstract as some of the concepts may be in higher level nursing theory, it is important to remember that nurses at patient's bedsides must often make split-second decisions. They cannot consult a textbook for every action, and patients, by virtue of being human, present nurses with problems that require critical thinking, including critical ethical thinking. Having a grounding of theory to use enables nurses to develop a consistent philosophy that can guide them through long hours and stressful emotional situations.

For most nurses, it is true that understanding the technical requirements of their job is more important than being able to parse and compare grand theories of nursing. However, it is also very true that statistically speaking there is a very high dissatisfaction rating amongst new nurses for their profession. These nurses may have the technical capabilities to perform as nurses, but they still find themselves stressed and unable to cope. A recent survey of new nurses suggested that these were the most problems are manifest amongst new nurses: "colliding expectations...the nurses expected the workplace to be more in keeping with what they were taught in nursing school;" "the need for speed...nurses felt there should have been more time for them to transition to carrying full responsibilities for patient care;" "there were many complaints about the heavy workload, with little time to do it and little time to spend with patients;" and "nurses felt they were mistreated by nurse and physician colleagues and management" (Kennedy 2009).

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