DNP 815 Compare and contrast a minimum of two middle range theories and describe how one of these middle range theories could serve as a foundation for direct practice improvement

DNP 815 Compare and contrast a minimum of two middle range theories and describe how one of these middle range theories could serve as a foundation for direct practice improvement

DNP 815 Compare and contrast a minimum of two middle range theories and describe how one of these middle range theories could serve as a foundation for direct practice improvement

Types of Nursing Theories

Dickoff and James (1968) described four types of theory: (1) descriptive, (2) explanatory, (3) predictive, and (4) prescriptive.

Descriptive theories are the first and most important level of theory development as they determine what will be perceived as the essence of the phenomenon under study. Descriptive theories describe, observe, and name concepts, properties, and dimensions but they don’t explain the interrelationships among concepts or propositions, and they don’t indicate how changes in one concept affect other concepts. There are two major types of descriptive theories. The first one is Naming Theories which describe the dimensions or characteristics of a phenomenon. The second type of descriptive theories is Classification Theories which describe dimensions or characteristics of a phenomenon that are structurally interrelated and are sometimes referred to as a typologies or taxonomies. Descriptive theories are generated and tested by descriptive or exploratory research.

Explanatory theories are the second level in theory development. They relate concepts to one another and describe and specify some of the associations or interrelations between and among the concept. This type of theories attempt to tell how or why the concepts are related and may deal with causality, correlations, and rules that regulate interactions.

Predictive theories intend to describe precise relationships between concepts and are the third level of theory development. Predictive theories are generated and tested by experimental research and are able to describe future outcomes

Prescriptive theories which are the highest level of theory development prescribe activities necessary to reach defined goals. In nursing, prescriptive theories address nursing therapeutics and predict the consequences of interventions. Prescriptive theories have three basic components: (1) specified goals or outcomes, (2) explicit activities to be taken to meet the goal, and (3) a survey list that articulates the conceptual basis of the theory.

Kolcaba’s Theory in Action: Optional Activity


Nursing theories are meant to stimulate and support knowledge development related to effectively exploring, predicating, describing, defining, and (sometimes) controlling nursing phenomena. 

Kolcaba’s work is ground breaking in that she created a theory to facilitate deepened understanding of a common, yet critical concept that is often unexamined because it is considered a by-product of good nursing care rather than end in itself. The two publications listed below, which are electronically accessible in the major database, demonstrate Kolcaba’s theory in action:

March, A. & McCormack, D. (2009). Modifying Kolcaba’s Comfort Theory as an institution-wide approach. Holistic Nursing Practice, 23(1), 75-80. Doi:10.1097/HNP.0b013e3181a1105b.

The authors of this article discuss how slightly modifying Kolcaba’s Comfort Theory could facilitate its interdisciplinary use to support continuity of care within one institution.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS DNP 815 Compare and contrast a minimum of two middle range theories and describe how one of these middle range theories could serve as a foundation for direct practice improvement:

Over the past 50 years, middle-range theories have been developed which are guiding nursing practice (Liehr & Smith, 2017). The push towards evidence-based practice in Magnet Hospitals and DNP programs has brought to light the importance of these theories. In looking at middle-range theories for a chronic illness or congestive heart failure (CHF|), Riegel’s Theory of Self-Care of Chronic illness describes how self-care is performed when someone is healthy and with chronic illness (Riegel et al., 2019). There are three concepts to Riegel’s theory which include self-care maintenance, self-care monitoring, and self-care management. Those who perform different self-care activities regardless of their health status will have a higher quality of life. For someone which a chronic illness such as CHF, self-care may be able to decrease any exacerbations and treat symptoms appropriately. This model aids nursing in assisting the patient in understanding that the decisions they make in their care will positively or negatively impact their quality of life. Riegel’s Theory of Self-Care of Chronic Illness can be a foundation for direct practice improvement for congestive heart failure, diabetes, and other chronic illnesses.

DNP 815 Compare and contrast a minimum of two middle range theories and describe how one of these middle range theories could serve as a foundation for direct practice improvement
DNP 815 Compare and contrast a minimum of two middle range theories and describe how one of these middle range theories could serve as a foundation for direct practice improvement

In contrast, Jean Watson’s Philosophy and Science of Caring is focused on the care that nursing gives to the patient and how caring interventions can be delivered to the patient through therapeutic communication and human touch (Wei et al., 2019). Using Watson’s theory in the daily practice of nursing benefits the patient and the nurse through nursing satisfaction, nursing practice, and patient safety. A foundation for a facility that provides quality patient care is an organization that provides a caring environment to colleagues and patients. The impact on patient safety comes from caring attitudes towards each other, confidence building, and maximizing teamwork and professionalism. As nursing turnover continues to increase, Watson’s Philosophy and Science of Caring needs to be incorporated into nursing programs, preceptor, and mentor programs to ensure that we care for our patients and each other.


Liehr, P., & Smith, M. J. (2017). Middle range theories. In J. Fitzpatrick (Ed.), Encyclopedia of nursing research (4th ed.). Springer Publishing Company. Credo Reference:

Riegel, B., Jaarsma, T., Lee, C. & Strömberg, A. (2019). Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science, 42 (3), 206-215. 

Wei, H., Fazzone, P. A., Sitzman, K., & Hardin, S. R. (2019). The Current Intervention Studies Based on Watson’s Theory of Human Caring: A Systematic Review. International Journal for Human Caring, 23(1), 4–22.

Middle range theory focused on the defined elements of the reality of nursing wherein these theories are composed of concepts that can be illustrated in a model and developed in the circle of research and practice to maintain guidance for daily practice, and the discipline of nursing is rooted into research (Liehr & Smith, 2017).

One of the middle-range theories that could serve as a foundation for direct practice improvement is Orem’s self-care deficit theory of nursing which consists of three parts: theory of nursing systems, self-care, and theory of self-care deficit (Drevenhorn, 2018). Hypotheses for the theory are that individuals should manage to care for themselves needed to maintain continuing daily care by developing and exercising practical and intellectual abilities. Self-care is the capability to take care of themselves which affects their health, interests, and well-being, while self-care deficit is not meeting the components of therapeutic self-care (Drevenhorn, 2018). In hypertension, the self-care deficit means an individual is not willing to perform lifestyle changes or medication compliance. In order to meet the self-care deficit of an individual, nurses developed nursing actions based on patient-centered communication, shared decision-making, and goal setting of what was agreed upon. It is a big challenge for the nurse to help the patient understand the seriousness of the illness. The integration of Orem’s self-care theory is pertinent to patient education.

Newcomb’s Symptom Management Theory (SMT) is another deductive, middle-range theory composed of three factors within the domain of nursing care consisting of symptom experience, symptom management strategies, and status outcomes (Shankel & Wofford, 2016).

Patients with chronic conditions such as hypertension deal with persistent and contributing symptoms for a long period of time between visits to their primary provider and are left to interpret their own symptoms through the lens of their knowledge and previous actions, and maybe symptom management strategies that are not evidence-based. Chronic disease telemonitoring is a symptom management strategy itself to fill a needed gap where it recognizes symptom experiences, applying timely and cost-effective leadership strategies for an improved outcome (Shankel & Wofford, 2016). The demand for chronic diseases is rising, and the costs exceed the government’s ability to pay. The adaptation to SMT can provide a structure to meet the needs of a patient in a timely manner, decrease the utilization of healthcare and overall costs, and make sure that it is established in a strong theoretical framework.


Drevenhorn, E. (2018). A proposed middle-range theory of nursing in hypertension care. International Journal of Hypertension, 2018, 1-11.

Liehr, P. & Smith, M. J. (2017). Middle range theories. In J. Fitzpatrick (Ed). Encyclopedia of Nursing Research (4th ed.). Springer Publishing Company. Credo Reference.

Shankel, E.C., & Wofford, L. G. (2016). Symptom management theory as a clinical practice model for symptom telemonitoring in chronic disease. Journal of Theory Construction &

Testing, 10 (1), 31-38.

Mid-range nursing theories are less broader than grand nursing theories and present a worthwhile link between grand nursing theories and nursing practice. They offer ideas with a lesser degree of speculation and guided principles and nursing practice methodologies. The concepts of Middle-Range theories are less abstract and are more verifiable through testing. Theory can also be defined as a systematic set of statements in response to specific questions communicated in an organized manner. Theory is however, used to convey some observed facts while summarizing different evidences and proposing explanations while yielding testable hypothesis in presence of particular hypothesis and limitations. However, the two middle range theories used as foundation of direct practice improvement are social influence theory and stage theory. According to social influence theory the individual pay special attention towards the significance of shared beliefs and propositions, haring group norms and culture of the organization as the element to determine the professional attitude of an individual.

In direct practice improvement the significance of social influence theory can be considered in context to promoting change while influencing group perceptions while promoting change in behavior. For this purpose the theorists have provided classified schemes for potential social influence intervention to practice and guideline for the distribution and application of ideas in accordance to the size and demand of the intervention while including educational outreach and opinion of the leaders (Risjord, 2018). On the other hand, the stage theory deals with change in behavior of an individual at a given point in time while leading the individual in linear progression towards change in behavior and accounting different stages of behavior in progression. For instance, the theory effectively explained the trans – theoretical and perception adoption processes. Another important aspect of the theory is the development of intervention in behavior of an individual which is very important thing in dealing different situations in direct practice improvement. It is further explored that interventions in conjunction to stage theories can be more workable as compared to non-stage theory interventions.

Hence, the comparison of social influence and stage theory presents that in direct practice improvement the most important thing is to bring change in behavior in demand of the situation. In nursing practice the positive change in behavior is the need of time to meet the demand of the patients and to provide the quality healthcare services. The adaptation in nursing practice as per the need of time helps in brining change in nursing research. The most influential aspect in this context can be the evidence based research work that can be effective in molding the nursing practice in addition to picking interventions best explained the fundamental need of the profession. For example, organization and dissemination of clear information and selection of intervention with clarity of applicability of the strategies can be observed effectively in context to reviewing the two theories (Mgbekem and Neji, 2018). 


Lor, M., Backonja, U., & Lauver, D. R. (2017). How Could Nurse Researchers Apply Theory to Generate Knowledge More Efficiently?. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing49(5), 580–589.

Mgbekem,M. and Neji,O. (2018). Middle range theory evaluation: bridging the theory-practice gap. Global Journal of Pure and Applied Sciences, 249-254.

Risjord, M. (2018). Middle-range theories as models: New criteria for analysis and evaluation. Nursing Philosophy, 1-10.

Nursing Practice: 

Change is an integral part of growth, development, and healing; hence the recognition and application of transition theories to practice should be considered (Gill, 2018). Examples of transition or change that can readily be applied to nursing care include the Theory of transition and cultural marginalization (Smith & Liehr, 2014). First, let us consider the Theory of transition in its context, nurses applying this to practice consider their client’s experiences, developmental stages, illness, and support system when recognizing the probability of positive coping mechanisms (Smith & Liehr, 2014). Thus, by doing so, care plans are patient-specific, providing a more holistic outlook. Ideas of holistic care are also noted in the Cultural Marginalization theory, as this Theory explores America’s changing demographics and the nurse’s role in diversity and inclusion promotion (Smith & Liehr, 2014). In summary, the theories proposed by Im and Choi are guidelines for executing competent nursing care necessary to achieve desired patient outcomes (Gill, 2018). 

Im’s Theory of Transitions (Smith & Liehr, 2014):  

  •  It explains differing nursing care situations affected by illness, life situations, developmental stages, health, and organizations.
  • Considers transition types, patterns, properties of the transitional experiences, and outcomes of transitions. 
  • Transition types: developmental, health and illness, and situational
  • Patterns: multiple and complex
  • properties: awareness (perception), engagement (involvement), changes (level of comfort with transition), time-span, critical points (markers), conditions (circumstances influencing transition), personal conditions (meaning, cultural beliefs, attitudes), community
  • Patterns of Response: process and outcome indicators, feelings of connection, interactions, coping, confidence
  • Nursing therapeutics: assessment of readiness, preparation, and roles supplementation

The Theory of transition recognizes that transitions or change is a complex, multifaceted phenomenon resulting in alterations of identities, relationships, roles, and behaviors (Smith & Liehr, 2014). In addition, the Theory considers the number of transitions the person is experiencing and their perceptions of the changes; thus, a successful transition considers both process and outcomes and depends upon the nurse-patient relationship (Smith & Liehr, 2014). The Theory of transition resembles the Theory of cultural marginality as both theories recognize the impact of change as it relates to the client’s mental and physical health (Smith & Liehr, 2014). 

Choi’s Theory of Cultural Marginality (Smith & Liehr, 2014):

  • recognition of cross-cultural conflicts (reaction to perceptions, responses, and mental health outcomes associated with marginal living)
  • marginal living (living in two worlds; yet feeling you belong in neither)
  • Assimilation: cultural tension eases the client assumes the characteristics of the new or dominant cultural outcomes, including self-denial, self-hatred, or guilt
  • Reconstructed return: client returns or remains in their culture outcomes include overidentification of their culture
  • Poise: tentatively fits within the culture without an attachment to a particular culture. “homeless in a cultural sense” outcomes include personal crisis, which leads to poor mental health, personality changes, substance abuse, and stress
  • Integration: individual assumes some characteristics of the new culture but merges or integrates personal culture
  • Cross-cultural conflict resolution: dominant culture’s openness to diversity and inclusion
  • nurse care: continual assessment of contextual and personal influences, education, health promotion, recognizing and modifying influences,

Theoretical differences:

 The Theory of transition and cultural marginalization are alike in that they recognize the client’s fluid and vulnerable mental and physical health when experiencing change (Smith & Liehr, 2014). In addition, both theories recognize the importance of considering the environment, culture, and interactions when caring for patients; however, unlike the Theory of cultural marginalization, the Theory of transition broadens the population by applying the Theory of care to include health, illness, developmental stages and recovery process of the patient(Smith & Liehr, 2014). 


Gill. (2018). Applying Transition Theory to Preparation of Experienced Nurses for New Clinical Roles [Unpublished doctoral dissertation]. University of North Dakota.

Smith, & Liehr. (2014). Middle Range Theory for Nursing (3rd ed.). Springer.

Middle range theories have understandably emerged as the focus of knowledge development in nursing with a “broad acceptance of the need to develop middle range theories to support nursing practice” (Liehr, P., et. Al., 2017).  Middle-range theories are more concrete and narrower than grand theories; they are made up of a limited number of concepts and propositions that are written at a relatively concrete and specific level. Widely used middle-range nursing theories include Orlando’s theory of the deliberative nursing process, Peplau’s theory of interpersonal relations, and Watson’s theory of human caring.   One can argue that every nursing study represents a middle-range theory. Middle-range descriptive theories are the most basic type of middle-range theory. Each descriptive theory describes or classifies a phenomenon and, therefore, may encompass just one concept. When a middle-range descriptive theory describes a phenomenon, it simply names the commonalities found in discrete observations of individuals, groups, situations, or events (Leandro, T., et., al., (2020).  When a middle-range descriptive theory classifies a phenomenon, it categorizes the described commonalities into mutually exclusive, overlapping, hierarchical, or sequential dimensions (Leandro, T., et., al., (2020). Middle-range descriptive theories are generated and tested by means of descriptive research, which may be qualitative or quantitative in design. Peplau’s theory of interpersonal relations is an example of a middle-range descriptive classification theory (Leandro, T., et., al., (2020). Middle-range explanatory theories specify relations between two or more concepts. Each explanatory theory explains why and the extent to which one concept is related to another concept. Middle-range explanatory theories are generated and tested by means of correlational research, which typically is quantitative in design (Leandro, T., et., al., (2020). Watson’s theory of human caring is an example of a middle-range explanatory theory. Middle-range predictive theories move beyond explanation to the prediction of precise relations between concepts or the effects of one or more concepts on one or more other concepts (Leandro, T., et., al., (2020). This type of middle-range theory addresses how changes in a phenomenon occur. Middle-range predictive theories are generated and tested by means of experimental research, which typically is quantitative in design. Orlando’s theory of the deliberative nursing process is an example of a middle-range predictive theory.

Middle range nursing theories guides the nurse to considerations when making clinical decisions (lligood, M. R., & Fawcett, J., 2017). With increasing frequency, middle range theories are being generated and tested through practice-oriented nursing research. There is a dynamic relationship between theory, research, and practice. Research is a source of theory development and theory is a source of research questions. Theory is used to improve practice and practice is used to shape and refine theories. According to Leandro, T., et., al., (2020) because middle range theories are narrower in scope and are a bridge between grand theories and nursing practice, it is very useful for direct process improvement projects. Because middle range theories are less abstract, and their concepts are more easily operationalized they allow for hypothesis testing. Middle range theories are often evolved from grand theories, literature reviews, and clinical practice making them more specific to nursing practice (Liehr, P., et. Al., 2017).

Leandro, T., Nunes, M. M., Teixeira, I. X., Lopes, M. V. d. O., de Araújo, T. L., Lima, F. E. T., & da Silva, V. M. (2020). Development of middle-range theories in nursing. Revista Brasileira De Enfermagem, 73(1), 1-7. doi:

lligood, M. R., & Fawcett, J. (2017). The Theory of the Art of Nursing and the Practice of Human Care Quality. Visions: The Journal of Rogerian Nursing Science23(1), 4–12.

Liehr, P., & Smith, M. J. (2017). Middle range theories. In J. Fitzpatrick (Ed.), Encyclopedia of nursing research (4th ed.). Springer Publishing Company. Credo Reference: