Three Levels of Nursing Theory

Grand nursing theories are the broadest category. They’re the most abstract and complex concepts and propositions that provide a general nursing care framework. A grand nursing theory can apply to a variety of nursing care environments and situations.

An example of a grand nursing theory is Ida Jean Orlando-Pelletier’s Deliberative Nursing Process TheoryExternal link:open_in_new. This theory examines the definition of the function of nursing and the interaction between the nurse and the patient. It explains how to use the nursing process to improve patient outcomes.

Using a broad theory like this one, nurses, nurse educators and nurse researchers can apply the theory in a variety of patient settings and use it with other more specific nursing theories to determine the most optimal outcomes.

Middle-range nursing theories are more specific in focus compared to grand nursing theories, but they’re broader than the more specific practice-level nursing theories. Middle-range nursing theories may derive from theories of similar disciplines, nursing research or nursing practice.

Since they’re less abstract than grand nursing theories, middle-range theories tend to be more verifiable through testing. These theories attempt to explain, describe or predict specific issues in clinical nursing practice.

An example of a middle-range nursing theory is Imogene King’s Theory of Goal AttainmentExternal link:open_in_new. This theory focuses on the factors that affect the attainment of certain life goals and explains how a nurse and a patient can communicate, set goals together and take actions to achieve goals. The theory examines how the personal system, the interpersonal system and the social system affect goal attainment.

Practice-level nursing theories are situation-specific. They’re the most narrow in scope and focus of the three levels of nursing theories. They may be based on concepts from grand nursing theories and middle-range nursing theory but provide specific frameworks for specific nursing interventions.

Nurses and nurse researchers may apply a practice-level nursing theory when it relates to a defined patient population at a specific time. Since these theories are more specific and unique, they may draw upon multiple theories to create the optimal recommended practice for that particular patient group.

For example, a nurse who is working with a patient who is a mother may draw upon elements of middle-range nursing theories like the Maternal Role Attainment TheoryExternal link:open_in_new by Ramona Mercer and the Life Perspective Rhythm ModelExternal link:open_in_new by Dr. Joyce Fitzpatrick to provide optimal maternal patient care.