HOW IS THE MIDDLE-RANGE THEORY IDENTIFIED?
We believe that generating or testing a middle-range theory is the main reason for research. Consequently, a vast number of middle-range theories exist. Sometimes, the name of the middle-range theory is stated explicitly in the research report, but sometimes the middle-range theory is not stated explicitly and is only implied.
Explicit Middle-Range Theories
A review of research guided by seven different nursing conceptual models yielded more than 50 explicitly named middle-range theories that were directly derived from the conceptual models. The theories and the conceptual models from which they were derived are listed in Table 6–1 on the CD that comes with this book.
The conceptual frames of reference for three other explicit middle-range nursing theories were extracted from publications about the theories (Fawcett, 2005b). Although none of the theories were derived from a nursing conceptual model, statements reflecting some of the nursing metaparadigm concepts—human beings, environment, health, and nursing—were identified. The theories and relevant citations are:
1. Orlando’s Theory of the Deliberative Nursing Process (Orlando, 1961; Schmieding, 2006)
2. Peplau’s Theory of Interpersonal Relations (Peplau, 1952, 1997) 3. Watson’s Theory of Human Caring (Watson, 1985, 2006)
The conceptual origins of many other explicitly named middle-range nursing theories are not yet clear; examples are listed in Table 6–2, which is included on the CD that comes with this book. Some explicitly named middle-range theories that are tested by nurse researchers come from other disciplines; examples are given in Table 6–3 on the CD. Additional information about the theories listed in Tables 6–2 and 6–3 can be found in Marriner Tomey and Alligood (2006), Peterson and Bredow (2004), Smith and Liehr (2003), and/or Ziegler (2005).
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Although the conceptual frame of reference for the theories listed in Table 6–3 typically is not mentioned in the published research report, one such theory—the Theory of Planned Behavior (TPB)—was linked with Neuman’s Systems Model and with Orem’s Self-Care Framework by Villarruel and her colleagues (2001). They explained that the linkage placed the TPB within a nursing context and provided direction for a program of nursing research that could progress from “an explanation of the antecedents of behavioral actions to a prediction of the effects of nursing interventions on behavioral actions that are directed toward health promotion and dis- ease prevention” (p. 160). They also explained that linkage of the TPB to a nursing conceptual model is needed if effects of interventions are to be studied, because interventions are not part of the TPB.
Implicit Middle-Range Theories
When the middle-range theory is implicit—that is, when it is not explicitly named—you may want to make up a name to increase your understanding of the theory. Finding the information
Chapter 6 ■ Evaluation of Middle-Range Theories 75
BOX 6-3
Naming an Implicit Middle-Range Theory
Example from a Theory-Generating Research Report
Study purpose
The purpose of this descriptive study was to identify patients’ perceptions of fatigue during chemotherapy for Hodgkin’s disease.
Results
Analysis of the patients’ responses to an open-ended questionnaire revealed three categories of fatigue—exhausted, sleepy, and tired.
Possible names for the middle-range theory
• Perceptions of Fatigue Theory
• Theory of Categories of Chemotherapy Fatigue
Example from a Theory-Testing Research Report
Study purpose
The purpose of this experimental study was to determine the effect of exercise on chemotherapy- related fatigue.
Hypothesis
An increase in exercise will decrease chemotherapy-related fatigue.
Possible names for the middle-range theory
• Theory of the Effects of Exercise on Fatigue
• Exercise and Fatigue Theory
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76 Part 2 ■ Evaluation of Conceptual Models and Theories
in a research report that may be used to identify a name for the theory can be challenging or even frustrating. Sometimes, the statement of the study purpose or aims can be used as the basis for the name of the theory. Or, you may have to rely on the categories or themes and their defini- tions in reports of theory-generating research and the study variables, definitions of variables, and hypotheses in reports of theory-testing research. Examples from fictitious studies are given in Box 6–3. (Recall that we discussed categories, themes, variables, definitions, and hypotheses in Chapter 2, and we identified where to look for the content of the T compo- nent in Chapters 3 and 4.)