Characteristics of Grand, Middle-Range and Practice Theories Based on McEwen and Wills Table 10-1

  Grand Theories Middle-Range (Text calls High-Middle and Middle-Middle) Practice (text calls Low-Middle and Microrange)

Comprehensive, global covering all aspects of the human experience

Middle view reality Focused on a narrow view of reality, simple and straightforward



Non-specific, general application irrespective of setting or area More specific to practice areas Linked to special populations or an identified field of practice
Characteristics of concepts Concepts abstract and not operationally defined Limited number of concepts that are fairly concrete Single, concrete concept that is operationalized
Characteristics of propositions Propositions are not always explicit Propositions are clearly stated Propositions defined
Testability Not generally testable May generate testable hypotheses Goals or outcomes defined and testable
Source of development Developed through thoughtful appraisal and careful consideration over many years Evolve from grand theories, clinical practice, literature review, practice guidelines Derived from practice or deduced from middle-range or grand theories
Examples Martha Rogers, Margaret Newman, Parse, Systems theory, Feminist theory

Benner's Model of Skill Acquisition, Leninger's Cultural Care, Pender's Health Promotion Model, Health Belief Model

Theories used for direct patient care such as theories of caring, pain, empowerment, clinical decision-making, describe patient outcomes such as parent-infant bonding or pain management. They tend to be developed from grounded theory studies
Jeanette Koshar, RN, MSN, NP, PhD
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