Differences between Grand and Middle-Range Nursing Theories

Nursing theories are organized frameworks of concepts and purposes that guide nursing practices. Ideally, there are two nursing theories; grand theories and middle-range ones.

The grand nursing theories provide a general worldview but are too abstract to guide practice effectively. On the other hand, middle-range theories are less abstract and are more linked to nursing practice. Below is a comprehensive guide to help you differentiate between these nursing theories.

Grand Nursing Theories

Grand nursing theories have a broader scope and are related to larger areas of nursing, such as health promotion, across all members of society. Nonetheless, the grand nursing theories help to integrate all the aspects of human experience, which makes them effective in general situations.

Although they are non-specific and broad, these theories provide several implications for advanced nursing practice. First, with increased changes in healthcare, they can help address the complex issues related to nursing, such as complex diseases and aging populations.

In this case, the grand theories can highlight the complexities of these issues. Thus health providers can apply this theory in advanced nursing practice to meet the needs of the global society. In addition, the theories view patients as individual beings but also part of a larger community. Therefore, serving an individual patient can provide insights into how to improve health for the global community.

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Examples of Grand Nursing Theories

Neuman’s System Model

Neuman’s system model is one of the grand theories focusing on preventive measures for health promotion. It provides a comprehensive and holistic approach to improving health outcomes by focusing on the stresses that influence the relationship between a patient and the respective environments.

The environment comprises different components, including mental, biological, environmental, social, and spiritual aspects. These components are interrelated and influence the health outcomes of an individual. Therefore, nurses have a primary role in enhancing the environment’s stability using the three prevention levels. 

First, primary prevention takes place before a patient experiences a reaction to a stressor. Moreover, secondary prevention occurs when the patient experiences a reaction to a stressor. Lastly, tertiary prevention occurs after a patient has been treated for specific stressors through secondary prevention measures. 

Using this theory, advanced practice nurses can identify the necessary interventions at different disease development levels by creating partnerships with a common goal of preventing these diseases. Additionally, advanced practice nurses can also utilize client education and counseling to prevent disease prevention.

Orem’s Self-Care Deficit Theory

Orem’s self-care deficit model is also an example of a grand theory involving three factors: self-care, self-care deficit, and the theory of the nursing system. This theory explains why and how patients should care for themselves to improve health outcomes.

Grand nursing theories are mainly common concepts of nursing practice that may be difficult to test empirically but can solve complex situations. In this case, these grand theories present conceptual models and have higher levels of abstraction.

Orem’s self-care deficit theory is highly abstract. It focuses on energy domains to explain the interaction between the environment and the patients and its influence on health outcomes. Nonetheless, the grand theory contains non-operationalized elements. In this case, it is difficult to apply across different healthcare settings. 

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In this case,  grand theories are mainly limited to directing, explaining, and forecasting in nursing practice, especially in specified practice environments. 

Middle-Range Theories

Ideally, the middle-range theories act as a link between the research and practice. They can be exploratory, descriptive, or predictive, but they all help guide advanced nursing practice. Unlike the grand theories, the middle-range theories have a smaller scope, greater ease of application, and specificity, which makes them more effective in the application. 

Examples of Middle Range Theories

Theory of Optimal Client System Stability

The theory of optimal client system stability is a middle-range theory that insists on the need for stability to enhance the client’s health. Moreover, nurses use this theory for interventions linked to patient outcomes. Therefore, it is effectively applied when nurses have identified several factors, including health status, age, and stressors, to provide interventions that improve patient outcomes.

Rosemary Parse’s Human Becoming Theory

Rosemary Parse’s human becoming model is an example of a middle-level theory that uses scopes such as rhythmicity, transcendence, and meaning. Nurses can easily test these concepts empirically to assess how nurses present themselves to patients through attention and mention.

Contrary to the grand theories, middle-level theories are more straightforward. For instance, the human becoming model helps demonstrate the different scopes that help develop life patterns and how these patterns influence their meaning and values. In addition, middle-level theories are highly operationalized, making them easier to apply in several practice settings to achieve the required patient outcomes.

Application of Nursing Theories

As earlier identified, the grand theories have a broader scope than middle-range nursing theories. For instance, nurses can apply the Henderson need theory to promote independence among patients suffering from a range of health conditions by addressing the 14 needs of a patient.

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Additionally, Orem’s self-care deficit theory can be used to promote self-care among individuals, families, and communities to enhance population health. Specifically, it can be applied to vulnerable groups, such as the elderly and children, with a reduced capacity to care for their health needs. 

The middle-range nursing theories can be applied across different clinical settings. For instance, the Madeleine Leininger Theory of transcultural nursing can be applied across different settings to provide culturally sensitive care to patients with diverse backgrounds.

Moreover,  the theory of interpersonal relations can help emphasize the need for patient-nurse relationships in identifying the patient’s health needs and providing tailored care to meet these needs.

From this comparison, the grand theories are the most applicable in clinical practice as they have the broadest scope, enhancing their suitability in dynamic healthcare environments. 

Video Guide


What is the difference between grand theories and middle-range theories?

The grand theories have a broader scope than the middle-range theories.

How are the grand theories and middle-range theories related?

The middle-range theories provide testable propositions which can inform grand theories in nursing.

What is the limitation of grand theories?

Grand theories are inadequate in addressing the emotional needs of an individual as they focus on the suppression of emotions to achieve positive outcomes for the general population.

What are the most common healthcare theories used today?

  • Social cognitive theory
  • The Health Belief model
  • Theory of planned behavior

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