High Middle Range Theories
The high middle range theories presented here are some of the more well known and most widely used theories in nursing. Included are the works of Benner, Leininger, Pender, and Meleis. These theories may be considered grand theories or conceptual frameworks by other nursing scholars and possibly by the author of the theory. These theories, however, do not totally fit with the criteria for grand theories as outlined in this text and therefore are not covered in the chapters dealing with that content. In addition, the Synergy Model, a nursing model that is widely used in research and practice, particularly in critical care, will be discussed. Table 11-1 lists other high middle range theories or conceptual models, their purposes, and major concepts.
Table 11-1: High Middle Range Nursing Theories
|Tidal model (psychiatric and mental health nursing) (Barker, 2001a, 2001b)||Describes psychiatric nursing practice focusing on three care processes; emphasizes the fluid nature of human experience characterized by change and unpredictability||Personhood (dimensions—world, self, others), discrete holistic (exploratory) assessment; focused (risk) assessment, empowerment, narrative as the medium of self|
|Parish nursing (Bergquist & King, 1994)||Describes the integration of physical, emotional, and spiritual components in provision of holistic health care in a faith community||Client (spiritual, physical, emotional components), parish nurse (spiritual maturity, pastoral team member, autonomy, caring, effective communication), health (physical, emotional, and spiritual wellness and wholeness), environment (faith community)|
|Parish nursing (Miller, 1997)||Integrates the concepts of evangelical Christianity with application of parish nursing interventions||Person/parishioner, health, nurse/parish nurse, community/parish, the triune God|
|Neal theory of home health nursing (Neal, 1999a, 1999b)||Describes the practice of home health nurses as they use process of adaptation to attain autonomy||Autonomy, three stages (dependence, moderate dependence, and autonomy), logistics, client’s home, client’s resources, client’s needs, and learning capacity|
|Occupational health nursing (Rogers, 1994)||Shows how the occupational health nurse works to improve, protect, maintain, and restore the health of the worker/workforce and depicts how practice is affected by both external and internal work setting influences||Work setting influences (corporate culture/mission, resources, work hazards, workforce characteristics), external factors (economics, population/health trends, legislation/politics, technology), occupational health nursing practice (health promotion, workplace hazard detection, case management/primary care, counseling, management, research, legal/ethical monitoring, community orientation)|
|Omaha System (Martin, 2005)||Comprehensive classification system that promotes documentation of client care, generally in community and home health nursing practice||Depicts the nursing process as circular rather than linear; steps are: collect and assess data, state problems, identify admission problem rating, plan and intervene, identify interim/dismissal problem rating, and evaluate problem outcomes.|
|Schuler Nurse Practitioner Practice Model (Schuler & Davis, 1993).||Integrates essential nursing and medical orientations to provide a framework for holistic practice for nurse practitioners (NP)||Patient and NP inputs (noted as episodic and comprehensive with and without health problem); data gathering/role modeling; patient and NP throughputs include identification of problems and diagnosing, contracting, and planning and implementing of the plan of care. Outputs involve comprehensive evaluation of patient and NP outcomes.|
|Public health nursing practice (Smith & Bazini-Barakat, 2003)||Guides public health nurses to improve the health of communities and target populations||Interdisciplinary public health team, standards of public health nursing practice, essential public health services, health indicators, population-based practice (systems, community, individual, and family focus), healthy people in health communities|
|Rural nursing (Weinert & Long, 1991)||Guides rural nursing practice, research, and education by understanding and addressing the unique health care needs and preferences of rural persons||Health (health as ability to work), environment (distance and isolation), person (self-reliance and independence), nursing (lack of anonymity, outsider/insider, and old-timer/newcomer)|
Benner’s Model of Skill Acquisition in Nursing
Patricia Benner’s theoretical model was first published in 1984. The model, which applies the Dreyfus model of skill acquisition to nursing, outlines five stages of skill acquisition: novice, advanced beginner, competent, proficient, and expert. Although her work is much more encompassing in regard to nursing domains and specific functions and interventions, it is the five stages of skill acquisition that has received the most attention with regard to application in administration, education, practice, and research.
Purpose and Major Concepts
Benner’s model delineates the importance of retaining and rewarding nurse clinicians for their clinical expertise in practice settings because it describes the evolution of “excellent caring practices.” She notes that research demonstrates that practice