The Essence of the Middle-Range Theoretical Model

The middle-range theory should be comprehended as several interrelated ideas grounded on a limited aspect of nursing reality. Their elaboration and development occur at the intersection of research and practice (Smith & Liehr, 2018). Thus, the qualitative combination of science and its application is a significant cause of the theory’s emergence. Its basis is founded on the discipline of nursing, and the logic of the approach is centered on mid-range ideas. Furthermore, the middle-range theory can be derived explicitly from the grand concept or can be directly related to the paradigm (Smith & Liehr, 2018). The process of its development is lengthy and requires multiple trials, but they are all justified by efficacy for patient health.

The most crucial idea is that practice underlies the structure of the nursing discipline. Nowadays, a significant number of theories have been developed to provide a framework for patient care. Nevertheless, all concepts have no significance without practice, as they are merely ideas that help define nursing as a separate and distinct discipline. Therefore, it is evident that every approach is established on theory, but the practice is central to the structure of nursing (Smith & Liehr, 2018). With a constant shift to methodology and research guided by ideas, productive partnerships between academics and practitioners emerge. The doctors are dedicated to applying knowledge to improve the quality of life of patients and their families.

Middle-range theories directly correlate with research and practice, and each of these variables cannot exist independently. Their development can be inductive, established on qualitative research and practice. However, it can also be deductive, founded on logical synthesis. As scholarly work expands mid-range theories, research and practice traditions persist to evolve (Smith & Liehr, 2018). Using middle-range approaches to structure research and practice develops the discipline’s content, organization, and integration.

The Ladder of Abstraction is a vision and a concept that indicates how reasoning develops from the concrete to the conceptual. Its point is to connect the levels of address or ideas that describe and explain a middle-range theory of discourse (Smith & Liehr, 2018). The Ladder of Abstraction can be comprehended as a qualitative explanation and guide for the intern to understand the idea and its subsequent practical application. Therefore, it is a logical system, the purpose of which is to locate and relate the various levels of discourse. A qualitative understanding of all three levels and their differences contributes to a sense of the middle-range theory and its proper application.

The three rungs of the ladder symbolize levels of discourse or distinct patterns of defining ideas. The philosophical level is the highest, representing the beliefs and assumptions that are tolerated as valid and fundamental to theory (Smith & Liehr, 2018). The theoretical level denotes the belief systems necessary for reasoning, which can be encountered in academic and empirical expressions of middle-range views. Its essence is in the abstract realm, consisting of symbols, ideas, and concepts that enable the continued development of an idea. The empirical is the lowest rung on the ladder, the concrete class of discourse (Smith & Liehr, 2018). It represents what can be observed through the senses, including perception, symbolic meanings, self-reports, observed behavior, biological indicators, and personal histories.

This way of thinking promotes a qualitative logical process, provides clarity, and facilitates the use of theory in research and practice. Moving up the ladder allows one to make sense of phenomena through inductive and deductive reasoning. Substantive disciplinary knowledge structured by logic guides thinking in nursing research and advanced nursing practice (Smith & Liehr, 2018). Theory ceases to be confusing, and its logic is straightforward to comprehend and apply. Therefore, it becomes easier to create patient care protocols and expand the evidence of practice while contributing to theory development.


Smith, M. J., & Liehr, P. R. (2018). Middle range theory for nursing. Springer Publishing Company.

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