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The differences between nursing grand and middle range theories

A theory is a set of propositions and concepts that deliver an organized way to understand phenomena. Nursing theory is systematic outline of the purposes and concepts developed to guide the nursing practice. They seek to describe the nursing practice, define the duties of nurses and present the goals or outcomes of care (McEwen & Wills, 2014). Nursing theories are classified according to their philosophical underpinnings, purpose, abstractness or generalization/scope/range.

In description, grand theories are broad and complex in scope. They
present a conceptual framework for identifying the key principles and concepts of the nursing practice. Even though they are known to provide intuitions useful for practice, they cannot be used for empirical testing. On the other hand, middle-range theories are focused on a particular
phenomenon or concept. They are limited in scope and deals with tangible and reasonably operative concepts. Their propositions and concepts are more specific to the nursing practice and they can be used for empirical testing.

Nursing theories are known to contribute greatly to the nursing practice. Particularly, Dorethea Orem’s Theory of Self-Care Deficit Nursing Theory (SCDNT) and Dorothy Johnson’s Theory of Behavioral System are some of the most applied theories in the nursing profession. These theoretical models developed by those celebrated theorists have been useful tools guiding the nursing practice. They both present nurses with a conceptual framework for an organized structure for practice, rationale for activities and reference (Green, 2013).

Generally, they seek to define the nursing practice while providing an efficient and consistent channel for communication within the profession. Orem’s SCDNT provides that all individuals have a right to access any or all essential materials required for the maintenance of human integrity, growth and sustenance of life (Hartweg, 2015). This theory guides nurses in helping patients to learn and maintain self-care.

Johnson’s theory of behavioral system maintains that for an effective and
efficient behavioral functioning in patients, balance and stability should be maintained. An imbalance in the system causes nursing problems. It is therefore the duty of the nurses to bring a state of equilibrium through protection from noxious stimuli, offering adequate environment, and
encouragement for growth and development (Smith & Parker, 2015). The theory stresses the need for research-based knowledge on the influences of nursing care to patients.


Green, R. (2013). Application of self-care deficit nursing theory: The community context. Self-
Care Dependent-Care & Nursing, 20(1), 5-15.
Hartweg, L. D. (2015). Dorothea Orem’s Self-Care Deficit Nursing Theory. In M. C. Smith &
M. E. Parker (Eds.). Nursing theories and nursing practice (4th ed., pp. 105-132).
Philadelphia, PA: F. A. Davis
McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA:
Wolters Klwuwer Health and Lippincott Williams & Wilkins.

Smith, Marlaine C., and Marilyn E. Parker. Nursing Theories and Nursing Practice. 4th ed.
Philadelphia: F.A. Davis, 2015.

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