Ch. 11-Overview of Selected Middle-Range Nursing Theories
Introduction
-Theories are divided into sections based on whether they appear to be
“high,” “middle,” or “low” middle-range theories
-High middle-range theories being the most abstract and nearest to the
grand theories
-Low middle-range theories, on the other hand, are the least abstract, and
they are similar to practice or situation-specific theories
-Middle-range theory is vital for the ongoing development of the nursing
profession
-Nursing science frames the development of middle-range theories and
concepts to guide nursing practice”
High Middle-Range Theories
Benner’s Model of Skill Acquisition in Nursing
-Theoretical model was first published in 1984
-Applies the Dreyfus model of skill acquisition to nursing
-Five stages of skill acquisition: novice, advanced beginner, competent,
proficient, and expert
Purpose and Major Concepts
-Importance of retaining and rewarding nurse clinicians for their clinical
expertise in practice settings bc it describes the evolution of “excellent
caring practices”
-Practice grows “through experiential learning and through transmitting that
learning in practical settings”
-Expertise develops when the clinician tests and refines propositions,
hypotheses, and principle-based expectations in actual practice situations
-Six areas of practical knowledge—graded qualitative distinctions; common
meanings; assumptions, expectations, and sets; paradigm cases and
personal knowledge; maxims; and unplanned practices
-Central concepts of Benner’s model are those of competence, skill
acquisition, experience, clinical knowledge, and practical knowledge
-Seven domains of nursing practice:
Helping role
Teaching or coaching function
Diagnostic client-monitoring function
Effective management of rapidly changing situations
Administering and monitoring therapeutic interventions and regimens
, Monitoring and ensuring quality of health care practices
Organizational and work-role competencies
Context for Use and Nursing Implications
-Career development and continuing education
-Cited for utilization include nursing management, career enhancement,
clinical specialization, staff development programs, staffing, evaluation,
clinical internships, and precepting students and novice nurses
Evidence of Empirical Testing and Application in Practice
- Wilson et al. (2015) examined the “perpetual novice phenomenon,”
-Cates et al. (2015) employed a Delphi method to develop a simulation-
based competency assessment instrument for neonatal nurse practitioners,
both based on Benner’s model
- Miller and Hille (2018) used Benner’s model in their research examining the
relationship between proficiency and intuition on clinical decision-making
among practicing nurses
- Smith et al. (2019) described the process they went through to develop and
test an evaluation tool to study the level of care provided by newly licensed
RNs
- Process that can be used by faculty and preceptors to develop clinical
reasoning in nursing students
-Improve clinical preceptorships for nurse practitioner student
Leininger’s Cultural Care Diversity and Universality Theory
-Demonstrating to nurses the importance of considering the impact of
culture on health and healing
- Conceptualized transcultural nursing as a distinct area of nursing practice
in the late 1950s
-Mid-1970s, she presented a transcultural health model that was expanded in
1978 and 1980; the Leininger Sunrise Model was first described as such in
1984 and depicts the transcultural dimensions of culturologic interviews,
assessments, and therapies
Purpose and Major Concepts
-Generate knowledge related to the nursing care of people who value their
cultural heritage and lifeways
-Major concepts of the model are culture, culture care, and culture care
differences (diversities) and similarities (universals) pertaining to
transcultural human care
Introduction
-Theories are divided into sections based on whether they appear to be
“high,” “middle,” or “low” middle-range theories
-High middle-range theories being the most abstract and nearest to the
grand theories
-Low middle-range theories, on the other hand, are the least abstract, and
they are similar to practice or situation-specific theories
-Middle-range theory is vital for the ongoing development of the nursing
profession
-Nursing science frames the development of middle-range theories and
concepts to guide nursing practice”
High Middle-Range Theories
Benner’s Model of Skill Acquisition in Nursing
-Theoretical model was first published in 1984
-Applies the Dreyfus model of skill acquisition to nursing
-Five stages of skill acquisition: novice, advanced beginner, competent,
proficient, and expert
Purpose and Major Concepts
-Importance of retaining and rewarding nurse clinicians for their clinical
expertise in practice settings bc it describes the evolution of “excellent
caring practices”
-Practice grows “through experiential learning and through transmitting that
learning in practical settings”
-Expertise develops when the clinician tests and refines propositions,
hypotheses, and principle-based expectations in actual practice situations
-Six areas of practical knowledge—graded qualitative distinctions; common
meanings; assumptions, expectations, and sets; paradigm cases and
personal knowledge; maxims; and unplanned practices
-Central concepts of Benner’s model are those of competence, skill
acquisition, experience, clinical knowledge, and practical knowledge
-Seven domains of nursing practice:
Helping role
Teaching or coaching function
Diagnostic client-monitoring function
Effective management of rapidly changing situations
Administering and monitoring therapeutic interventions and regimens
, Monitoring and ensuring quality of health care practices
Organizational and work-role competencies
Context for Use and Nursing Implications
-Career development and continuing education
-Cited for utilization include nursing management, career enhancement,
clinical specialization, staff development programs, staffing, evaluation,
clinical internships, and precepting students and novice nurses
Evidence of Empirical Testing and Application in Practice
- Wilson et al. (2015) examined the “perpetual novice phenomenon,”
-Cates et al. (2015) employed a Delphi method to develop a simulation-
based competency assessment instrument for neonatal nurse practitioners,
both based on Benner’s model
- Miller and Hille (2018) used Benner’s model in their research examining the
relationship between proficiency and intuition on clinical decision-making
among practicing nurses
- Smith et al. (2019) described the process they went through to develop and
test an evaluation tool to study the level of care provided by newly licensed
RNs
- Process that can be used by faculty and preceptors to develop clinical
reasoning in nursing students
-Improve clinical preceptorships for nurse practitioner student
Leininger’s Cultural Care Diversity and Universality Theory
-Demonstrating to nurses the importance of considering the impact of
culture on health and healing
- Conceptualized transcultural nursing as a distinct area of nursing practice
in the late 1950s
-Mid-1970s, she presented a transcultural health model that was expanded in
1978 and 1980; the Leininger Sunrise Model was first described as such in
1984 and depicts the transcultural dimensions of culturologic interviews,
assessments, and therapies
Purpose and Major Concepts
-Generate knowledge related to the nursing care of people who value their
cultural heritage and lifeways
-Major concepts of the model are culture, culture care, and culture care
differences (diversities) and similarities (universals) pertaining to
transcultural human care
