Strategies of Middle - range Theory Development in Nursing

Theory development in nursing can be viewed to have progressed during the last 50 years in three periods: (a) the era of specifying theoretical orientations for nursing that occurred during the period of 1950s and 1960s, (b) the era of grand theorizing during the 1970s and 1980s, and (c) the era of middle-range theory development in the last two decades. The first era was characterized by the attempts of several nursing leaders and scholars to identify specific nursing orientations in an effort to disassociate and differentiate nursing from medicine. There were two distinct directions with which theoretical orientations for nursing were specified: one was the specification of what the focus of nursing is in relation to clients, namely what has been identified as the patients' needs orientation advanced by Henderson, Abdellah, and others, and the other was the focus on nursing's unique nature from the interaction perspective as was done by such scholars as Peplau, Orlando, Travelbee, and Widenbach. By specifying the theoretical and professional orientation of nursing in terms of patients' needs as with the 14 basic needs of patients by Henderson and the system of 21 nursing problems by Abdellah, nursing leaders and scholars were attempting to shift from disease-orientation to nursing-specific problem orientation. On the other hand, the interaction perspective was an attempt to provide theoretical approaches regarding how nursing is done rather than what sorts of problems in patients nursing is oriented to solving. These two groups of theoretical work in nursing during this initial period were oriented to providing general frameworks and systems of terminologies rather than in advancing specific theoretical systems. However, these proposals and developments were the impetus and foundation from which the second era of theoretical efforts emerged. The second era of grand theorizing was a critical development for nursing in several respects: (a) it provided unique nursing perspectives and frameworks; (b) it placed the idea of theory firmly into the nursing culture especially in relation to education and research, and