Chapter 13 Models, Mechanisms, & Middle-Range Theory April Jennings BEF 644 Philosophy of Science in Relation to Nurse Educational Research

Middle-Range Theory Developed to address the relevance gap between grand theory and nursing practice. Followed “received view”-hierarchical chain, which middle-range theory should be derived from grand theory- making them more applicable in practice and measurable through research. Philosophers who critique this view, follow the "semantic view”-Should develop middle-range theories that replace, not supplement, grand theories. Argument is that “relevance gap is closed by thinking differently about nursing science” (Risjord, 2010).

Theoretical Models In the 1980’s and 1990’s theorists worked to develop middle-range theories, which are distinguished by generality and testability. Lenz, Suppe, and collaborators argue that theorists should develop models of phenomena relative to nursing science and focus on their content, rather than their form. In recent times, philosophers have abandoned term “theory” entirely, replacing them with models and mechanisms. Not same as conceptual models used in nursing, but theoretical models developed from scientific theory. The argument is that middle-range theories should be referred to as theoretical models, because the term “middle-range” misrepresents their purpose and intent, and still classifies them as part of the hierarchy of grand theory.

Theoretical Model Cont’ Theoretical models sacrifice some scope and depth, but gain precision. They are able to explain more precisely how something works. This makes them more testable through research and more applicable to practice. Interlevel models focus on causal mechanisms that underlie a phenomena. The Gate Control Theory, which relates feelings of pain to underlying neurology. Interlevel models take into account the theoretical and observational factors and focus on relationships among laws. considered an important ways of building scientific theory. They aim to show how psychological, social, and biological features of the patient are related to each other. Interlevel model development bring theories together.

Synthesizing Domains Nursing phenomena are complex and multifaceted; therefore, since quantitative research (Interlevel model building) reduces complexity, in cannot produce nursing knowledge. –FALSE! A patient has complex, interdependent, and inseparable characteristics that require multiple perspectives. To provide holistic nursing, different theories must be synthesized…. Interlevel models synthesize theories; therefore, support the synthesis required in providing holistic patient care. Nursing science must embrace both quantitative and qualitative methodologies to construct theoretical models that continue to advance nursing science in way that is meaningful and applicable to nursing education and practice.

Synthesizing Domains Cont’. Natural Scientific methods cannot be ignored, because their causal process must be manipulated and recognized as part of the process of providing holistic nursing care. Risjord (2010) asserts that “the practical commitment to the whole patient, unique person is supported, not threatened by knowledge of causal generalities and subsystems” (p. 151). Knowledge of causes that underlie health phenomena is sought to help enhance patient autonomy, not to control of the patient. Example: Discovering nursing interventions that reduce the need for medications, makes more options available for the patient.

Reference Risford, M. (2010). Models, mechanisms, middle-range theory. Nursing knowledge. pp.141-153. West Sussex, UK: Wiley- Blackwell.