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32 UNIT I Evolution of Nursing Theories

medicine, clinical exercise physiology, or sociology. In the discipline of nursing, the earlier focus on
Fawcett (2005) proposed that a metaparadigm defines theory development has evolved to an emphasis
the totality of phenomena inherent in the discipline on theory utilization with development and use of
in a parsimonious way, as well as being perspective- middle-range theories focused at the practice level
neutral and international in scope. Her definition of (Acton, Irvin, Jensen, Hopkins, & Miller, 1997; Good,
perspective-neutral is that the metaparadigm con- 1998; Im & Meleis, 1999; Lawson, 2003; Liehr &
cepts reflect nursing but not any particular nursing Smith, 1999; Smith & Liehr, 2008; Smith & Liehr,
conceptual model or paradigm. This criterion is 2002). Situation-specific theories (the term preferred
clearly illustrated as the nursing models and para- by Meleis, 2007) are applicable to a nursing problem
digms include the metaparadigm concepts but define or specific group of patients. An integrative approach to
each in distinctly different ways. This supports their situation-specific theories is summarized as involving
generic nature as broad metaparadigm concepts but four broad interrelated steps: checking assumptions
with specificity within each conceptual theory or for theory development, exploring the phenomenon
paradigm. It is important to grasp the significance of through multiple sources, theorizing, and reporting/
Fawcett’s point. Since the metaparadigm is the highly validating (Im, 2005, 2006).
philosophical level in the structure of knowledge, Middle-range theory was described very early in
models and theories define the terms specifically the nursing literature by a sociologist (Merton, 1967).
within each of their works, and differences among He proposed that it focused on specific phenomena
them is anticipated. Thorne and colleagues (1998) pro- (rather than attempting to address a broader range of
posed that it was not productive to continue metapara- phenomena) and was comprised of hypotheses with
digm debates about which conceptual system should two or more concepts that are linked together in a
define these concepts, and that each conceptual model conceptual system. Today in the nursing literature,
is labeled as a nursing conceptual model because it many middle-range theories are developed qualita-
clearly addresses each metaparadigm concept, though tively from practice observations and interviews and
from different philosophical perspectives. Scholarly quantitatively from nursing conceptual models or
debates are expected to continue among doctoral stu- theories. Middle-range theory is pragmatic at the
dents and communities of scholars engaged in scholar- practice level and contains specific aspects about the
ship and inquiry. Discussions in the nursing discipline practice situation as follows:
and approaches to nursing knowledge are anticipated • The situation or health condition involved
as nurses address dynamic social obligations, tentative- • Client population or age-group
ness of theory, and new developments as the discipline • Location or area of practice (such as community)
advances (Monti & Tingen, 1999). • Action of the nurse or the intervention
Viewing the metaparadigm from different cultural It is these specifics that make middle-range theory
perspectives enhances our understanding and expands so applicable to nursing practice (Alligood, 2010,
our ideas as the discipline develops globally. For p. 482). Therefore, the development of middle-range
example, the work conducted by Kao, Reeder, Hsu, & theory facilitates conceptions of relationships be-
Cheng (2006) proposes a Chinese view of the western tween theory, nursing practice, and patient outcomes
nursing paradigm through the lens of Confucianism in focused areas. In 1996, Lenz (in Liehr & Smith, 1999)
and Taoism. The concept of person is more than a bio- identified the following six approaches for devising
psycho-social spiritual being, but also encompasses middle-range theories:
being responsibility bound. Health includes the flow of 1. Inductive approach through research
qi, yin-yang, and the five phases: wood, water, fire, 2. Deductive approach from grand nursing theories
metal, and earth. The challenge in knowledge develop- 3. Integration of nursing and non-nursing theories
ment is to learn how to consider nursing phenomena 4. Derivative (retroductive) approach from non-nursing
through many lenses and to enhance the development theories
of knowledge and improve nursing of people around 5. Theories devised from guidelines for clinical practice
the globe. 6. Synthesis approach from research findings