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Nursing Theory – An Introduction

Nursing theory is essentially a group of general ideas and doctrines put forth as a framework for the further acquisition of knowledge within the field. They are needed as much as theory in many other fields, such as math, philosophy, and literature. Perhaps nursing theory is needed more than theory within those other fields because few mathematical, philosophical, or literary theorists have ever had followers whose decisions, framed by theory, were actual matters of life and death. Nursing theory gives nurses a scaffold upon which to build the knowledge necessary for higher level decisions, organizing methods of inquiry, description, prediction, and prescription. It is split into four disciplines of thought: meta-theory, grand theory, middle range theory and practice theory. Nursing theories are learned during your nursing education either an RN program or an LPN program.


Meta-theory is essentially a theory about nursing theory. Basically, it is a discipline centered on how to further the discipline, a theory with the main goal of determining what types of theories are needed as nursing evolves, how theories are built, and how to determine the validity and practicality of a theory.

Of course, this type of thought can be difficult to wrap your head around, so perhaps it is best to think of it in another way. Try drawing the following parallel when trying to recall what it is meta-theory does. As a nursing student, it is not a stretch to imagine you have had to study. Imagine there was a test you studied for which you studied weeks and still received a poor grade. Imagine that test was the beginning of a string of tests for which you received a sub-par mark. You would have to think about the way you think about studying. Maybe you always thought study groups were the single best method for studying. All your study mates might feel the same way. You and your community have been convinced for years that because of a substantial body of evidence, group study was the only viable option for the serious student. Now you decide to think about why you thought that way. What was it about group study that you thought helped? Upon reflection (in this case you would be doing something called metacognition) you decide that the thing you thought helped your study was the social atmosphere. The fun helped you relax. Now that the topic is difficult to comprehend, you might think the social atmosphere allows for an increased frequency in a loss of focus.

Meta-theory is by no means easy to understand, but it is through this discipline that all other schools of thought within nursing are advanced, so its importance cannot be overstated.

Grand Theory

It is important to remember, when discussing theory, that theory is actually an umbrella under which many other related theories can be referenced. In the instance of grand theory, the theories are related in the fact that they try to refer to the entirety of nursing as a field of study. Whereas meta-theory was the study of thinking about how we think about nursing, grand theory peels away one of those layers, and can be considered a way of thinking about nursing. They consider nursing as a whole and develop theories through observation and the insights of the observing theorist.

There are many benefits to grand theories. One of the most important of these is that they serve the theorist and the student by allowing for a break from tradition and intuition. Within the framework of grand theory, a student or practitioner has the opportunity to consider the whole of nursing and address the area he or she has observed in need. It is a break from constant practice, which, when done daily for a long period of time, can lead to complacency. The desire to improve the nursing profession begins to take a back seat to the very real and legitimate desire to make it through the day.

Middle-Range Theory

A middle-range theory is one that is more specific and more narrowly focused on a specific aspect of the profession or the medical world. As opposed to grand theory, which attempts to come up with ideas to improve the entirety of nursing, middle-range theory seeks to improve certain smaller aspects of nursing. Interestingly enough, middle-range theories could accomplish the aspirations of a grand theory, but by their nature would still be considered middle-range.

Middle-range theories are delineated into three subsections: high, middle, and low middle-range theory and the amount of theories published each year continues to grow with no sign of stopping. As technologies increase, so too do the intricacies and idiosyncrasies involved in handling them, thus providing a fertile ground for the cultivation of new and interesting theories.

Practice Theory

Practice theory is the theory in nursing which is the most focused on one topic. In fact, some textbooks simply include practice theory in low middle-range theory. Most, however, recognize that practice theory as a discipline has such a limited scope as to be considered its own category of theory. Practice theories are best used for predicting the impact of aspects of the nursing profession. It can be said that most nursing decisions made throughout the course of a day or a career are either results or examples of nursing practice theory.

There are recommended methods for the conceiving of nursing practice theories and the first is to be on the front lines. Nursing is not a profession which can be understood from a distance, in order to start a nursing career; you need to understand nursing theories. It is not something which can be analyzed by numbers alone, and this is especially true for the aspiring practice theorist. Much of what is done in practice theory that is not done to improve the experience of the patient is done to improve the experience of the nurse. One of the suggested means of coming up with good practice theory is by allowing time for quiet reflection. Of course, know the first rule of being on the front lines on a daily basis, this may be difficult to do, but it is believed that allowing for this time will be beneficial when attempting to come up with new ideas. Also, noting the issues and features of nursing occupations as they occur can help.

Resources and Further Reading

What is a Mid-Range Theory?
Nursing Theorists
US National Library of Medicine
National Institute of Nursing Research
An Example of Grand Nursing Theory
The Mother of Nursing Theory – Florence Nightingale
A Practical Application of Theory
How a Hospital Uses Nursing Theory
Why Nursing?