Middle Range Theories
Week 4 School resources
Grand Theories
Theories can be classified based on their levels of abstraction. The scope of grand theories is very broad and, therefore, they don’t lend themselves easily to application and testing. Grand theories are less abstract than conceptual models, but the concepts that compose them are still relatively abstract and general, and the relationships cannot be tested empirically (Fawcett, 1995)1.
Let’s begin our exploration of grand theories with Sr. Callista Roy’s adaptation model. The principal premise behind this model is that individuals are adaptive systems that cope with change through adaptation, and nursing helps to facilitate this adaptation of individuals during health and illness.
Middle Range Theories
Middle-range theories originate from grand theories. They are less abstract and comparatively more focused and narrower in scope, which implies that they are made up of concepts and propositions that are testable. The development of the concept of caring as the central concept to nursing gave rise to several theories focused on caring. The most prominent of these caring theories is Madeleine Leininger’s theory of culture care.
Madeleine Leininger: Culture Care: Diversity and Universality Theory
Culture plays an important role in every healthcare setting. Integrating culture with care is an effective way of guiding thought processes, actions, and decisions within that culture.
Leininger’s theory takes into account the cultural beliefs and values of individuals and groups to provide satisfying and culturally congruent nursing care. Culture exhibits both diversity and universality. While diversity includes different ways of practicing care, universality refers to the common elements in care. While adopting this model, it is important to incorporate cultural differences into nursing assessments, interventions, and care plans.
The culture care theory stresses the importance of cultural care and the need to be sensitive to the role of culture in health and healing. Consider this case. A South East Asian female patient admitted to a U.S. hospital for gynecological complaints felt that she was in a hostile healthcare environment, in the midst of caregivers who were not friendly or sensitive to her needs. Everything, starting from the admission procedure, routine questioning, and physical assessment to the diet she was served, sent out negative signals to the patient. Had the attending nursing and other healthcare professionals been sensitive to her cultural differences and taken the trouble to make her feel comfortable, this turn of events could easily have been avoided. Culturally competent nurses can create positive environments where patients feel accepted and their cultural norms, beliefs, and practices are respected.
This model is relevant to education, research and practice.
Education
Research
Practice
Leininger’s model is helpful to nurse educators to teach the importance of transcultural nursing to students and function as ambassadors of a culturally competent nursing force.
Further research will guide the discovery of new knowledge, which may transform the way nursing is taught and practiced.
It helps to meet the needs of culturally diverse people.
Leininger’s theory presumes that human beings are inherently social and concerned about the well-being and survival of others. Nursing actions, therefore, need to be culture specific so as to reflect an understanding of and respect for the client’s values, beliefs, and practices.
What are some of the cultural factors that you should consider in patient care? Can you recollect instances from your personal experience where this theory could have been effectively applied to achieve better patient outcomes?
Nola Pender’s Model
Nola J. Pender: Health Promotion Model (HPM)
The fundamental aim of every healthcare professional is health promotion and disease prevention. This shift in focus has taken place because of the high costs involved in healthcare. Pender’s health promotion model was developed to provide a framework for predicting health promoting behaviors.
The factors that influence health behaviors are multidimensional. All factors are interrelated and, therefore, produce results that exert both direct and indirect influences on health promoting behaviors. These factors cooperatively support the processes that influence individuals to make informed decisions and participate in health promoting behaviors. Identification of the interrelationships and an understanding of the dynamics that facilitate health specific behaviors provide insight into both health compromising and health enhancing behaviors, and is what makes the model useful to researchers (Pender,1996)2.
Consider this example. Lack of physical activity and sedentary life styles are emerging as major health risks today. Populations across the world require regular physical activity to maintain good health and prevent diseases. Pender’s HPM model can be used as a framework to examine the necessity of continued research in this important area of health behavior, as this will facilitate the identification of the most effective interventions to promote physical activity among diverse populations
The HPM model is relevant to education, research, and practice.
