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Development of middle-range theories in nursing

Desarrollo de las teorías de medio alcance en enfermería

ABSTRACT

Objective:

To identify in the literature how Middle-Range Theories (MRT) are being developed in Nursing.

Method:

Integrative review on the databases Lilacs (Latin American and Caribbean Literature in Health Sciences), Scopus, Cinahl (Cumulative Index to Nursing and Allied Health Literature), Web of Science and PubMed portal, using the keywords middle range theory and nursing, as well its Portuguese correspondents (Lilacs), and the Boolean operator AND. The sample included 25 articles.

Results:

All articles presented concepts related to MRT. Most developed a synthesis picture. Some theories have formulated specific propositions, hypotheses, and names. Only 16 articles cited the methodological framework, while 22 used theories or models for theoretical foundation and 11 carried out literature reviews.

Final considerations:

The development of MRT included the presentation of fundamental concepts, synthesis, propositions, hypotheses and specific name. The MRT is recognized as a way of developing knowledge to guide the nursing practice.

Descriptors:
Nursing; Nursing Theory; Review; Knowledge; Nursing Methodology Research

RESUMEN

Objetivo:

Identificar en la literatura cómo las Teorías de Medio Alcance (TMA) se están desarrollando en enfermería.

Método:

Revisión integrativa en las bases de datos: LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), Scopus, Cinahl (Cumulative Index to Nursing and Allied Health Literature), Web of Science y PubMed, utilizando la palabra clave middle range theory, el descriptor nursing y sus equivalentes en portugués (LILACS) y el operador booleano AND. La muestra constó de 25 artículos.

Resultados:

Todos los artículos presentaron conceptos relacionados con las TMA. La mayoría desarrolló un cuadro resumen. Algunas teorías presentaron proposiciones, plantearon hipótesis y nombres específicos. Solamente 16 artículos citaban el referencial metodológico, mientras que 22 utilizaban teorías o modelos en la fundamentación teórica y 11 hicieron revisión de la literatura.

Consideraciones finales:

El desarrollo de las TMA incluyó la presentación de conceptos fundamentales, de cuadro resumen, de proposiciones, hipótesis y nombre específico. Se reconocen las TMA como forma de desarrollar conocimiento para orientar la práctica en enfermería.

Descriptores:
Enfermería; Teoría de Enfermería; Revisión; Conocimiento; Construcción

RESUMO

Objetivo:

Identificar na literatura como as Teorias de Médio Alcance (TMA) têm sido desenvolvidas na enfermagem.

Método:

Revisão integrativa nas bases Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), Scopus, Cinahl (Cumulative Index to Nursing and Allied Health Literature), Web of Science e portal PubMed, utilizando a palavra-chave middle range theory, o descritor nursing, seus correspondentes em português (Lilacs) e o operador booleano AND. A amostra incluiu 25 artigos.

Resultados:

Todos os artigos apresentaram conceitos relacionados às TMA. A maioria desenvolveu quadro síntese. Algumas teorias formularam proposições, hipóteses e nomes específicos. Apenas 16 artigos citavam o referencial metodológico, enquanto 22 usavam teorias ou modelos para fundamentação teórica e 11 utilizavam revisão na literatura.

Considerações finais:

O desenvolvimento das TMA incluiu apresentação de conceitos fundamentais, quadro síntese, proposições, hipóteses e nome específico. Reconhece-se as TMA como forma de desenvolver conhecimento para orientar a prática de enfermagem.

Descritores:
Enfermagem; Teoria de Enfermagem; Revisão; Conhecimento; Construção

INTRODUCTION

Theories are sets of concepts that are less broad than conceptual models and that propose more specific results. However, these theories may vary according to their level of abstraction and scope; great theories are relatively broad, while the Middle-Range Theories (MRT) address a less abstract and more specific set of concepts for the details of the nursing practice(11 Alligood MR. Nursing theory: utilization & application. 5th ed. St. Louis: Mosby; 2013.).

MRTs are intermediate theories that arise due to the researchers’ need for developing a unified theory capable of explaining all the observed uniformities of behavior, organization, and social changes. They do not seek to explain the whole in a single theory, but seek to develop explanations for the parts that make up the whole, hence the term “middle range”(22 Merton RK. Sociologia: teoria e estrutura. São Paulo: Mestre Jou; 1970.).

The use of MRTs linking theoretical and empirical knowledge can be useful for the development of new knowledge. Based on larger theories or using part of a theory, MRTs are composed of concepts and suggest relationships between them that can be represented in a single model.

In Nursing, a MRT is defined as a set of related ideas that are focused on a specific dimension of a phenomenon, including a restricted number of concepts and propositions, described at a concrete level, that are directly linked to research and practice(33 Smith MJ, Liehr PR. Middle range theory for nursing. 3rd ed. New York: Springer; 2014.).

There are three types of MRT in Nursing, classified according to their purpose, namely: descriptive, explanatory and predictive(44 Fawcett J, Garity J. Evaluating research for evidence-based nursing practice. Philadelphia: Davis; 2009.). The first describes or classifies a phenomenon, such as the taxonomy of nursing diagnoses that organizes the phenomenon of nursing from a simple concept (nursing diagnosis). The explanatory one involves the relationship between many concepts that are concerned with the form and extension of the existing relations between them, which is exemplified in the Outcome-Present state-Test (OPT) clinical reasoning model. Finally, the predictive MRT seeks to establish the precise relationships between concepts or effects of one or more concepts in one or several concepts, with the purpose of describing how changes occur within a phenomenon (causality models)(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
).

The development of MRTs, both worldwide and nationally, is still limited. In Brazil, few studies have addressed the issue; however, some authors have already made important contributions to the construction of nursing MRTs and, thus, to guide the nurses’ practice(66 Primo CC, Brandão MAG. Interactive theory of breastfeeding: creation and application of a middle-range theory. Rev Bras Enferm. 2017;70(6):1191-8. doi: 10.1590/0034-7167-2016-0523
https://doi.org/10.1590/0034-7167-2016-0...
-77 Brandão MAG, Martins JSA, Peixoto MAP, Lopes ROP, Primo CC. Theoretical and methodological reflections for the construction of middle-range nursing theories. Texto Contexto Enferm. 2017;26(4):e1420017. doi: 10.1590/0104-07072017001420017
https://doi.org/10.1590/0104-07072017001...
). At the global level, there are specific research groups dealing with the development of MRTs based on grand theories and some journals specializing in studies on the use of specific theoretical approaches to Nursing(88 Roy C. Generating middle range theory: from evidence to practice. New York: Springer; 2013.). However, these journals include articles ranging from discussions on the Nursing meta-paradigm to the development of MRT. In addition, the approaches to building such theories seem to follow different patterns among different authors. In any case, MRTs have been proposed as a way to reduce the gap between nursing theory and practice and as an alternative to other movements, such as evidence-based practice and translational research.

OBJECTIVE

To identify, in the literature, how MRTs are being developed in Nursing.

METHOD

This is an integrative review based on six steps: 1) identification of the theme and elaboration of the guiding question; 2) establishment of criteria for the inclusion and exclusion of studies/sampling or literature search; 3) definition of the information to be extracted from the selected studies/categorization of the studies; 4) evaluation of studies included in the integrative review; 5) interpretation of results, and 6) presentation of the knowledge review/synthesis(99 Mendes KDS, Silveira RCCP, Galvão CM. Integrative literature review: a research method to incorporate evidence in health care and nursing. Texto Contexto Enferm. 2008;17(4):758-64. doi: 10.1590/S0104-07072008000400018
https://doi.org/10.1590/S0104-0707200800...
).

For the first stage of the review, the following research question was elaborated: how are MRTs being developed in Nursing?

The search in the databases Lilacs (Latin American and Caribbean Literature in Health Sciences), Scopus, Cinahl (Cumulative Index to Nursing and Allied Health Literature), Web of Science and PubMed was carried out by two members of the research team from May to June 2016, using the keyword middle-range theory, the descriptor nursing, and the Boolean operator AND. The selection of this keyword occurred due to the inexistence of a controlled descriptor that specifically represented the MRT. For the Lilacs database, the corresponding terms in Portuguese (teoria de médio alcance; enfermagem) were used. The inclusion criteria adopted were: articles published in full and electronically available, in Spanish, English or Portuguese, and that answered the research question. Repeated articles were excluded. Searches description and article selection were based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (Prisma), according to the following flowchart (Figure 1).

Figure 1
Articles selected for review, based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (Prisma)

Articles were selected by reading the title and abstracts and, then, the full article. The final selection included 25 articles that met the inclusion criteria – 20 of them in the Scopus database, one in the Web of Science, one in Cinahl and three in the PubMed portal. No articles were identified during the search on Lilacs. As most articles were theoretical, they were not classified according to the level of scientific evidence.

The following information was extracted from the selected studies: journal; language; year of publication; contributions; study object; main results and how the theory was developed. Finally, the results identified were compiled in a chart and later discussed.

RESULTS

In this study, we analyzed the 25 scientific articles on MRT that strictly followed the previously mentioned sample selection and, following, a summary table of those articles will be presented, according to year of publication, authorship, object of study, main results and theory development (Chart 1).

Chart 1
Synthesis of articles selected in the review according to year of publication, authorship, object of study, main results and theory development

The articles analyzed were published between 1989 and 2016. Of these, 24 were published in English(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
,1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...

11 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...

12 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...

13 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...

14 Elo S, Kääriäinen M, Isola A, Kyngäs H. Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. Sci World J. 2013;2013:945635. doi: 10.1155/2013/945635
https://doi.org/10.1155/2013/945635...

15 Phillippi JC, Roman MW. The motivation-facilitation theory of prenatal care access. J Midwifery Women's Health. 2013;58(5):509-15. doi: 10.1111/jmwh.12041
https://doi.org/10.1111/jmwh.12041...
-1616 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...
,1818 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...

19 Davidson JE. Facilitated sensemaking: a strategy and new middle-range theory to support families of intensive care unit patients. Crit Care Nurse. 2010;30(6):28-39. doi: 10.4037/ccn2010410
https://doi.org/10.4037/ccn2010410...

20 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...

21 Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249-57. doi: 10.1111/j.1365-2648.2009.05108.x
https://doi.org/10.1111/j.1365-2648.2009...

22 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...

23 Noiseux S, Ricard N. Recovery as perceived by people with schizophrenia, family members and health professionals: a grounded theory. Int J Nurs Stud. 2008;45(8):1148-62. doi: 10.1016/j.ijnurstu.2007.07.008
https://doi.org/10.1016/j.ijnurstu.2007....

24 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...

25 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...

26 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...

27 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...

28 Sanford RC. Caring through relation and dialogue: a nursing perspective for patient education. ANS Adv Nurs Sci. 2000;22(3):1-15. doi: 10.1097/00012272-200003000-00002
https://doi.org/10.1097/00012272-2000030...

29 Jirovec MM, Jenkins J, Isenberg M, Baiardi J. Urine control theory derived from Roy's conceptual framework. Nurs Sci Q. 1999;12(3):251-5. doi: 10.1177/08943189922106828
https://doi.org/10.1177/0894318992210682...

30 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...

31 Olson J, Hanchett E. Nurse-expressed empathy, patient outcomes, and development of a middle-range theory. Image J Nurs Sch. 1997;29(1):71-6. doi: 10.1111/j.1547-5069.1997.tb01143.x
https://doi.org/10.1111/j.1547-5069.1997...

32 Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996;44(2):74-9. doi: 10.1016/S0029-6554(96)80053-4
https://doi.org/10.1016/S0029-6554(96)80...
-3333 Thompson JE, Oakley D, Burke M, Jay S, Conklin M. Theory building in nurse-midwifery: the care process. J Nurse Midwifery. 1989;34(3):120-30. doi: 10.1016/0091-2182(89)90056-6
https://doi.org/10.1016/0091-2182(89)900...
) and only one in Spanish(1717 Castillo-Arcos L, Benevides-Torres R. Model of sexual resilience in the adolescent: middle range theory. Aquichan [Internet]. 2012 [cited 2016 May 30];12(2):169-82. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-59972012000200008&lng=en
http://www.scielo.org.co/scielo.php?scri...
). Most of the articles were published in general nursing journals(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
,1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...

11 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...

12 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...
-1313 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...
,1616 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...

17 Castillo-Arcos L, Benevides-Torres R. Model of sexual resilience in the adolescent: middle range theory. Aquichan [Internet]. 2012 [cited 2016 May 30];12(2):169-82. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-59972012000200008&lng=en
http://www.scielo.org.co/scielo.php?scri...

18 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...

19 Davidson JE. Facilitated sensemaking: a strategy and new middle-range theory to support families of intensive care unit patients. Crit Care Nurse. 2010;30(6):28-39. doi: 10.4037/ccn2010410
https://doi.org/10.4037/ccn2010410...

20 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...

21 Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249-57. doi: 10.1111/j.1365-2648.2009.05108.x
https://doi.org/10.1111/j.1365-2648.2009...

22 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...

23 Noiseux S, Ricard N. Recovery as perceived by people with schizophrenia, family members and health professionals: a grounded theory. Int J Nurs Stud. 2008;45(8):1148-62. doi: 10.1016/j.ijnurstu.2007.07.008
https://doi.org/10.1016/j.ijnurstu.2007....

24 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...

25 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...

26 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...

27 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...

28 Sanford RC. Caring through relation and dialogue: a nursing perspective for patient education. ANS Adv Nurs Sci. 2000;22(3):1-15. doi: 10.1097/00012272-200003000-00002
https://doi.org/10.1097/00012272-2000030...
-2929 Jirovec MM, Jenkins J, Isenberg M, Baiardi J. Urine control theory derived from Roy's conceptual framework. Nurs Sci Q. 1999;12(3):251-5. doi: 10.1177/08943189922106828
https://doi.org/10.1177/0894318992210682...
,3131 Olson J, Hanchett E. Nurse-expressed empathy, patient outcomes, and development of a middle-range theory. Image J Nurs Sch. 1997;29(1):71-6. doi: 10.1111/j.1547-5069.1997.tb01143.x
https://doi.org/10.1111/j.1547-5069.1997...
-3232 Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996;44(2):74-9. doi: 10.1016/S0029-6554(96)80053-4
https://doi.org/10.1016/S0029-6554(96)80...
), in nursing journals related to a specific context(1515 Phillippi JC, Roman MW. The motivation-facilitation theory of prenatal care access. J Midwifery Women's Health. 2013;58(5):509-15. doi: 10.1111/jmwh.12041
https://doi.org/10.1111/jmwh.12041...
,3030 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...
,3333 Thompson JE, Oakley D, Burke M, Jay S, Conklin M. Theory building in nurse-midwifery: the care process. J Nurse Midwifery. 1989;34(3):120-30. doi: 10.1016/0091-2182(89)90056-6
https://doi.org/10.1016/0091-2182(89)900...
) and in medical journals(1414 Elo S, Kääriäinen M, Isola A, Kyngäs H. Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. Sci World J. 2013;2013:945635. doi: 10.1155/2013/945635
https://doi.org/10.1155/2013/945635...
). As to the place where the studies were developed, we identified 19 in the United States(1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...

11 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...

12 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...
-1313 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...
,1515 Phillippi JC, Roman MW. The motivation-facilitation theory of prenatal care access. J Midwifery Women's Health. 2013;58(5):509-15. doi: 10.1111/jmwh.12041
https://doi.org/10.1111/jmwh.12041...
-1616 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...
,1818 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...

19 Davidson JE. Facilitated sensemaking: a strategy and new middle-range theory to support families of intensive care unit patients. Crit Care Nurse. 2010;30(6):28-39. doi: 10.4037/ccn2010410
https://doi.org/10.4037/ccn2010410...

20 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...
-2121 Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249-57. doi: 10.1111/j.1365-2648.2009.05108.x
https://doi.org/10.1111/j.1365-2648.2009...
,2424 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...

25 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...

26 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...

27 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...

28 Sanford RC. Caring through relation and dialogue: a nursing perspective for patient education. ANS Adv Nurs Sci. 2000;22(3):1-15. doi: 10.1097/00012272-200003000-00002
https://doi.org/10.1097/00012272-2000030...

29 Jirovec MM, Jenkins J, Isenberg M, Baiardi J. Urine control theory derived from Roy's conceptual framework. Nurs Sci Q. 1999;12(3):251-5. doi: 10.1177/08943189922106828
https://doi.org/10.1177/0894318992210682...
-3030 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...
,3232 Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996;44(2):74-9. doi: 10.1016/S0029-6554(96)80053-4
https://doi.org/10.1016/S0029-6554(96)80...
-3333 Thompson JE, Oakley D, Burke M, Jay S, Conklin M. Theory building in nurse-midwifery: the care process. J Nurse Midwifery. 1989;34(3):120-30. doi: 10.1016/0091-2182(89)90056-6
https://doi.org/10.1016/0091-2182(89)900...
), three in Canada(2222 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...
-2323 Noiseux S, Ricard N. Recovery as perceived by people with schizophrenia, family members and health professionals: a grounded theory. Int J Nurs Stud. 2008;45(8):1148-62. doi: 10.1016/j.ijnurstu.2007.07.008
https://doi.org/10.1016/j.ijnurstu.2007....
,3131 Olson J, Hanchett E. Nurse-expressed empathy, patient outcomes, and development of a middle-range theory. Image J Nurs Sch. 1997;29(1):71-6. doi: 10.1111/j.1547-5069.1997.tb01143.x
https://doi.org/10.1111/j.1547-5069.1997...
) and only one in Brazil(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
), Mexico(1717 Castillo-Arcos L, Benevides-Torres R. Model of sexual resilience in the adolescent: middle range theory. Aquichan [Internet]. 2012 [cited 2016 May 30];12(2):169-82. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-59972012000200008&lng=en
http://www.scielo.org.co/scielo.php?scri...
) and Finland(1414 Elo S, Kääriäinen M, Isola A, Kyngäs H. Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. Sci World J. 2013;2013:945635. doi: 10.1155/2013/945635
https://doi.org/10.1155/2013/945635...
).

Regarding the development of MRT in nursing, the studies point out their contributions. All the studies analyzed emphasize that theories can contribute to the nursing practice. In 16 theories, it was mentioned its importance for the development of research(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
,1111 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...

12 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...

13 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...

14 Elo S, Kääriäinen M, Isola A, Kyngäs H. Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. Sci World J. 2013;2013:945635. doi: 10.1155/2013/945635
https://doi.org/10.1155/2013/945635...

15 Phillippi JC, Roman MW. The motivation-facilitation theory of prenatal care access. J Midwifery Women's Health. 2013;58(5):509-15. doi: 10.1111/jmwh.12041
https://doi.org/10.1111/jmwh.12041...
-1616 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...
,2020 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...
-2121 Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249-57. doi: 10.1111/j.1365-2648.2009.05108.x
https://doi.org/10.1111/j.1365-2648.2009...
,2323 Noiseux S, Ricard N. Recovery as perceived by people with schizophrenia, family members and health professionals: a grounded theory. Int J Nurs Stud. 2008;45(8):1148-62. doi: 10.1016/j.ijnurstu.2007.07.008
https://doi.org/10.1016/j.ijnurstu.2007....

24 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...
-2525 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...
,2727 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...

28 Sanford RC. Caring through relation and dialogue: a nursing perspective for patient education. ANS Adv Nurs Sci. 2000;22(3):1-15. doi: 10.1097/00012272-200003000-00002
https://doi.org/10.1097/00012272-2000030...

29 Jirovec MM, Jenkins J, Isenberg M, Baiardi J. Urine control theory derived from Roy's conceptual framework. Nurs Sci Q. 1999;12(3):251-5. doi: 10.1177/08943189922106828
https://doi.org/10.1177/0894318992210682...
-3030 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...
) and only two were referred to as important for nursing teaching(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
,1212 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...
).

Some MRTs (n = 18) are directed to specific groups, such as: older adults, adolescents, children, adults, pregnant women, families, obstetrics nurses, flight nurses, hospitalized people, people with chronic illnesses and specific diseases (diabetes, obesity, chronic pain, acute pain and schizophrenia)(1111 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...
,1313 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...

14 Elo S, Kääriäinen M, Isola A, Kyngäs H. Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. Sci World J. 2013;2013:945635. doi: 10.1155/2013/945635
https://doi.org/10.1155/2013/945635...

15 Phillippi JC, Roman MW. The motivation-facilitation theory of prenatal care access. J Midwifery Women's Health. 2013;58(5):509-15. doi: 10.1111/jmwh.12041
https://doi.org/10.1111/jmwh.12041...

16 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...
-1717 Castillo-Arcos L, Benevides-Torres R. Model of sexual resilience in the adolescent: middle range theory. Aquichan [Internet]. 2012 [cited 2016 May 30];12(2):169-82. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-59972012000200008&lng=en
http://www.scielo.org.co/scielo.php?scri...
,1919 Davidson JE. Facilitated sensemaking: a strategy and new middle-range theory to support families of intensive care unit patients. Crit Care Nurse. 2010;30(6):28-39. doi: 10.4037/ccn2010410
https://doi.org/10.4037/ccn2010410...

20 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...

21 Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249-57. doi: 10.1111/j.1365-2648.2009.05108.x
https://doi.org/10.1111/j.1365-2648.2009...

22 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...

23 Noiseux S, Ricard N. Recovery as perceived by people with schizophrenia, family members and health professionals: a grounded theory. Int J Nurs Stud. 2008;45(8):1148-62. doi: 10.1016/j.ijnurstu.2007.07.008
https://doi.org/10.1016/j.ijnurstu.2007....

24 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...

25 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...

26 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...
-2727 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...
,3030 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...
,3232 Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996;44(2):74-9. doi: 10.1016/S0029-6554(96)80053-4
https://doi.org/10.1016/S0029-6554(96)80...
-3333 Thompson JE, Oakley D, Burke M, Jay S, Conklin M. Theory building in nurse-midwifery: the care process. J Nurse Midwifery. 1989;34(3):120-30. doi: 10.1016/0091-2182(89)90056-6
https://doi.org/10.1016/0091-2182(89)900...
).

The main results found in the developed MRTs included: presentation of fundamental concepts, synthesis picture, propositions, hypotheses and specific name for theories. Of the analyzed articles, most (n = 22) developed a synthesis picture with the conceptual framework, presenting the relationships between the main concepts involved in the theories(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
,1111 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...

12 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...

13 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...

14 Elo S, Kääriäinen M, Isola A, Kyngäs H. Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. Sci World J. 2013;2013:945635. doi: 10.1155/2013/945635
https://doi.org/10.1155/2013/945635...

15 Phillippi JC, Roman MW. The motivation-facilitation theory of prenatal care access. J Midwifery Women's Health. 2013;58(5):509-15. doi: 10.1111/jmwh.12041
https://doi.org/10.1111/jmwh.12041...

16 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...

17 Castillo-Arcos L, Benevides-Torres R. Model of sexual resilience in the adolescent: middle range theory. Aquichan [Internet]. 2012 [cited 2016 May 30];12(2):169-82. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-59972012000200008&lng=en
http://www.scielo.org.co/scielo.php?scri...

18 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...

19 Davidson JE. Facilitated sensemaking: a strategy and new middle-range theory to support families of intensive care unit patients. Crit Care Nurse. 2010;30(6):28-39. doi: 10.4037/ccn2010410
https://doi.org/10.4037/ccn2010410...

20 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...

21 Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249-57. doi: 10.1111/j.1365-2648.2009.05108.x
https://doi.org/10.1111/j.1365-2648.2009...
-2222 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...
,2424 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...

25 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...

26 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...

27 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...

28 Sanford RC. Caring through relation and dialogue: a nursing perspective for patient education. ANS Adv Nurs Sci. 2000;22(3):1-15. doi: 10.1097/00012272-200003000-00002
https://doi.org/10.1097/00012272-2000030...

29 Jirovec MM, Jenkins J, Isenberg M, Baiardi J. Urine control theory derived from Roy's conceptual framework. Nurs Sci Q. 1999;12(3):251-5. doi: 10.1177/08943189922106828
https://doi.org/10.1177/0894318992210682...

30 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...

31 Olson J, Hanchett E. Nurse-expressed empathy, patient outcomes, and development of a middle-range theory. Image J Nurs Sch. 1997;29(1):71-6. doi: 10.1111/j.1547-5069.1997.tb01143.x
https://doi.org/10.1111/j.1547-5069.1997...
-3232 Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996;44(2):74-9. doi: 10.1016/S0029-6554(96)80053-4
https://doi.org/10.1016/S0029-6554(96)80...
). Some theories formulated specific propositions (n = 18), whose number ranged from 11 to three(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
,1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...

11 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...

12 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...
-1313 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...
,1616 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...

17 Castillo-Arcos L, Benevides-Torres R. Model of sexual resilience in the adolescent: middle range theory. Aquichan [Internet]. 2012 [cited 2016 May 30];12(2):169-82. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-59972012000200008&lng=en
http://www.scielo.org.co/scielo.php?scri...
-1818 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...
,2020 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...
,2222 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...
,2424 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...

25 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...

26 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...

27 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...
-2828 Sanford RC. Caring through relation and dialogue: a nursing perspective for patient education. ANS Adv Nurs Sci. 2000;22(3):1-15. doi: 10.1097/00012272-200003000-00002
https://doi.org/10.1097/00012272-2000030...
,3030 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...

31 Olson J, Hanchett E. Nurse-expressed empathy, patient outcomes, and development of a middle-range theory. Image J Nurs Sch. 1997;29(1):71-6. doi: 10.1111/j.1547-5069.1997.tb01143.x
https://doi.org/10.1111/j.1547-5069.1997...
-3232 Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996;44(2):74-9. doi: 10.1016/S0029-6554(96)80053-4
https://doi.org/10.1016/S0029-6554(96)80...
). Regarding the hypotheses formulated (n = 8), we identified that they are usually presented at the end of the articles, and the number of hypotheses for each theory ranged from three to eight(1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...
,1313 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...
-1414 Elo S, Kääriäinen M, Isola A, Kyngäs H. Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. Sci World J. 2013;2013:945635. doi: 10.1155/2013/945635
https://doi.org/10.1155/2013/945635...
,1616 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...
,1818 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...
,2424 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...
,2626 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...
,3131 Olson J, Hanchett E. Nurse-expressed empathy, patient outcomes, and development of a middle-range theory. Image J Nurs Sch. 1997;29(1):71-6. doi: 10.1111/j.1547-5069.1997.tb01143.x
https://doi.org/10.1111/j.1547-5069.1997...
).

After their development, the MRTs were named or directed to a specific context, namely: nursing diagnosis(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
); intuitive decision-making in Nursing(1212 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...
); weight management(1313 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...
); physical environment to support the well-being of older adults(1414 Elo S, Kääriäinen M, Isola A, Kyngäs H. Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. Sci World J. 2013;2013:945635. doi: 10.1155/2013/945635
https://doi.org/10.1155/2013/945635...
); family coping(1919 Davidson JE. Facilitated sensemaking: a strategy and new middle-range theory to support families of intensive care unit patients. Crit Care Nurse. 2010;30(6):28-39. doi: 10.4037/ccn2010410
https://doi.org/10.4037/ccn2010410...
); in-flight nursing experience(2020 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...
); music, humor and movement(2121 Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249-57. doi: 10.1111/j.1365-2648.2009.05108.x
https://doi.org/10.1111/j.1365-2648.2009...
); intellectual capital of nursing(2222 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...
); health promotion for preterm infants(2525 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...
); patient education(2828 Sanford RC. Caring through relation and dialogue: a nursing perspective for patient education. ANS Adv Nurs Sci. 2000;22(3):1-15. doi: 10.1097/00012272-200003000-00002
https://doi.org/10.1097/00012272-2000030...
); urine control(2929 Jirovec MM, Jenkins J, Isenberg M, Baiardi J. Urine control theory derived from Roy's conceptual framework. Nurs Sci Q. 1999;12(3):251-5. doi: 10.1177/08943189922106828
https://doi.org/10.1177/0894318992210682...
); nurse-patient empathy(3131 Olson J, Hanchett E. Nurse-expressed empathy, patient outcomes, and development of a middle-range theory. Image J Nurs Sch. 1997;29(1):71-6. doi: 10.1111/j.1547-5069.1997.tb01143.x
https://doi.org/10.1111/j.1547-5069.1997...
); obstetric nursing(1515 Phillippi JC, Roman MW. The motivation-facilitation theory of prenatal care access. J Midwifery Women's Health. 2013;58(5):509-15. doi: 10.1111/jmwh.12041
https://doi.org/10.1111/jmwh.12041...
,3333 Thompson JE, Oakley D, Burke M, Jay S, Conklin M. Theory building in nurse-midwifery: the care process. J Nurse Midwifery. 1989;34(3):120-30. doi: 10.1016/0091-2182(89)90056-6
https://doi.org/10.1016/0091-2182(89)900...
); chronic diseases(1111 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...
,1616 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...
,2323 Noiseux S, Ricard N. Recovery as perceived by people with schizophrenia, family members and health professionals: a grounded theory. Int J Nurs Stud. 2008;45(8):1148-62. doi: 10.1016/j.ijnurstu.2007.07.008
https://doi.org/10.1016/j.ijnurstu.2007....
,2727 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...
); pain(2424 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...
,3030 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...
,3232 Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996;44(2):74-9. doi: 10.1016/S0029-6554(96)80053-4
https://doi.org/10.1016/S0029-6554(96)80...
), and psychological aspects(1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...
,1717 Castillo-Arcos L, Benevides-Torres R. Model of sexual resilience in the adolescent: middle range theory. Aquichan [Internet]. 2012 [cited 2016 May 30];12(2):169-82. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-59972012000200008&lng=en
http://www.scielo.org.co/scielo.php?scri...
-1818 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...
,2626 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...
).

Finally, we identified that 16 articles cited the methodological framework that had been followed(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
,1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...

11 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...
-1212 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...
,1414 Elo S, Kääriäinen M, Isola A, Kyngäs H. Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. Sci World J. 2013;2013:945635. doi: 10.1155/2013/945635
https://doi.org/10.1155/2013/945635...
,1717 Castillo-Arcos L, Benevides-Torres R. Model of sexual resilience in the adolescent: middle range theory. Aquichan [Internet]. 2012 [cited 2016 May 30];12(2):169-82. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-59972012000200008&lng=en
http://www.scielo.org.co/scielo.php?scri...
,2020 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...

21 Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249-57. doi: 10.1111/j.1365-2648.2009.05108.x
https://doi.org/10.1111/j.1365-2648.2009...

22 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...

23 Noiseux S, Ricard N. Recovery as perceived by people with schizophrenia, family members and health professionals: a grounded theory. Int J Nurs Stud. 2008;45(8):1148-62. doi: 10.1016/j.ijnurstu.2007.07.008
https://doi.org/10.1016/j.ijnurstu.2007....

24 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...
-2525 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...
,2828 Sanford RC. Caring through relation and dialogue: a nursing perspective for patient education. ANS Adv Nurs Sci. 2000;22(3):1-15. doi: 10.1097/00012272-200003000-00002
https://doi.org/10.1097/00012272-2000030...
,3030 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...
,3232 Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996;44(2):74-9. doi: 10.1016/S0029-6554(96)80053-4
https://doi.org/10.1016/S0029-6554(96)80...
-3333 Thompson JE, Oakley D, Burke M, Jay S, Conklin M. Theory building in nurse-midwifery: the care process. J Nurse Midwifery. 1989;34(3):120-30. doi: 10.1016/0091-2182(89)90056-6
https://doi.org/10.1016/0091-2182(89)900...
), 22 used theories or models for theoretical foundation(1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...

11 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...

12 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...
-1313 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...
,1515 Phillippi JC, Roman MW. The motivation-facilitation theory of prenatal care access. J Midwifery Women's Health. 2013;58(5):509-15. doi: 10.1111/jmwh.12041
https://doi.org/10.1111/jmwh.12041...

16 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...

17 Castillo-Arcos L, Benevides-Torres R. Model of sexual resilience in the adolescent: middle range theory. Aquichan [Internet]. 2012 [cited 2016 May 30];12(2):169-82. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-59972012000200008&lng=en
http://www.scielo.org.co/scielo.php?scri...

18 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...
-1919 Davidson JE. Facilitated sensemaking: a strategy and new middle-range theory to support families of intensive care unit patients. Crit Care Nurse. 2010;30(6):28-39. doi: 10.4037/ccn2010410
https://doi.org/10.4037/ccn2010410...
,2121 Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249-57. doi: 10.1111/j.1365-2648.2009.05108.x
https://doi.org/10.1111/j.1365-2648.2009...

22 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...

23 Noiseux S, Ricard N. Recovery as perceived by people with schizophrenia, family members and health professionals: a grounded theory. Int J Nurs Stud. 2008;45(8):1148-62. doi: 10.1016/j.ijnurstu.2007.07.008
https://doi.org/10.1016/j.ijnurstu.2007....

24 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...

25 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...

26 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...

27 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...

28 Sanford RC. Caring through relation and dialogue: a nursing perspective for patient education. ANS Adv Nurs Sci. 2000;22(3):1-15. doi: 10.1097/00012272-200003000-00002
https://doi.org/10.1097/00012272-2000030...

29 Jirovec MM, Jenkins J, Isenberg M, Baiardi J. Urine control theory derived from Roy's conceptual framework. Nurs Sci Q. 1999;12(3):251-5. doi: 10.1177/08943189922106828
https://doi.org/10.1177/0894318992210682...

30 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...

31 Olson J, Hanchett E. Nurse-expressed empathy, patient outcomes, and development of a middle-range theory. Image J Nurs Sch. 1997;29(1):71-6. doi: 10.1111/j.1547-5069.1997.tb01143.x
https://doi.org/10.1111/j.1547-5069.1997...

32 Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996;44(2):74-9. doi: 10.1016/S0029-6554(96)80053-4
https://doi.org/10.1016/S0029-6554(96)80...
-3333 Thompson JE, Oakley D, Burke M, Jay S, Conklin M. Theory building in nurse-midwifery: the care process. J Nurse Midwifery. 1989;34(3):120-30. doi: 10.1016/0091-2182(89)90056-6
https://doi.org/10.1016/0091-2182(89)900...
) and 11 used literature review for the development of MRT(1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...
,1313 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...
,1515 Phillippi JC, Roman MW. The motivation-facilitation theory of prenatal care access. J Midwifery Women's Health. 2013;58(5):509-15. doi: 10.1111/jmwh.12041
https://doi.org/10.1111/jmwh.12041...
-1616 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...
,1818 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...

19 Davidson JE. Facilitated sensemaking: a strategy and new middle-range theory to support families of intensive care unit patients. Crit Care Nurse. 2010;30(6):28-39. doi: 10.4037/ccn2010410
https://doi.org/10.4037/ccn2010410...

20 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...

21 Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249-57. doi: 10.1111/j.1365-2648.2009.05108.x
https://doi.org/10.1111/j.1365-2648.2009...
-2222 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...
,2424 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...
,2727 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...
). Among the authors used as a methodological reference, Walker and Avant (1995; 2005; 2011) were the most frequent(1111 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...
-1212 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...
,2020 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...

21 Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249-57. doi: 10.1111/j.1365-2648.2009.05108.x
https://doi.org/10.1111/j.1365-2648.2009...
-2222 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...
,2525 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...
,3030 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...
,3232 Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996;44(2):74-9. doi: 10.1016/S0029-6554(96)80053-4
https://doi.org/10.1016/S0029-6554(96)80...
), followed by the methodology described by Roy (2013)(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
,1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...
) and by Fawcett (1986)(1717 Castillo-Arcos L, Benevides-Torres R. Model of sexual resilience in the adolescent: middle range theory. Aquichan [Internet]. 2012 [cited 2016 May 30];12(2):169-82. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-59972012000200008&lng=en
http://www.scielo.org.co/scielo.php?scri...
,3333 Thompson JE, Oakley D, Burke M, Jay S, Conklin M. Theory building in nurse-midwifery: the care process. J Nurse Midwifery. 1989;34(3):120-30. doi: 10.1016/0091-2182(89)90056-6
https://doi.org/10.1016/0091-2182(89)900...
). Roy’s Model of Adaptation was the most adopted for theoretical basis(1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...
,1818 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...
-1919 Davidson JE. Facilitated sensemaking: a strategy and new middle-range theory to support families of intensive care unit patients. Crit Care Nurse. 2010;30(6):28-39. doi: 10.4037/ccn2010410
https://doi.org/10.4037/ccn2010410...
,2424 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...
,2626 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...
-2727 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...
,2929 Jirovec MM, Jenkins J, Isenberg M, Baiardi J. Urine control theory derived from Roy's conceptual framework. Nurs Sci Q. 1999;12(3):251-5. doi: 10.1177/08943189922106828
https://doi.org/10.1177/0894318992210682...
), followed by Orem’s theory of self-care(1313 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...
,1616 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...
).

DISCUSSION

Middle-range theories are understood by many nursing researchers as a theoretical framework that connects grand theories to the nursing practice(3434 Meleis AI. Theoretical nursing: development and progress. Philadelphia: Lippincott Williams & Wilkins; 2007.). They started to be developed in the mid-1980s ─ one of the first MRTs in nursing was the Theory of Obstetric Nursing Care, which identified seven original concepts to describe the process of obstetric nursing care(3333 Thompson JE, Oakley D, Burke M, Jay S, Conklin M. Theory building in nurse-midwifery: the care process. J Nurse Midwifery. 1989;34(3):120-30. doi: 10.1016/0091-2182(89)90056-6
https://doi.org/10.1016/0091-2182(89)900...
).

All the analyzed articles clearly presented the main concepts involved in the theories. It should be emphasized that the concepts and their definitions are the main components that should be explained during the development of a theory, regardless of its level(33 Smith MJ, Liehr PR. Middle range theory for nursing. 3rd ed. New York: Springer; 2014.). Therefore, the description of the terms used to write a phenomenon is essential during the MRT development since the inclusion of concepts will provide the nurses with a concise summary of the thoughts related to the phenomena of interest(3434 Meleis AI. Theoretical nursing: development and progress. Philadelphia: Lippincott Williams & Wilkins; 2007.).

The presentation of the synthesis picture developed in most of the studies(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
,1111 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...

12 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...

13 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...

14 Elo S, Kääriäinen M, Isola A, Kyngäs H. Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. Sci World J. 2013;2013:945635. doi: 10.1155/2013/945635
https://doi.org/10.1155/2013/945635...

15 Phillippi JC, Roman MW. The motivation-facilitation theory of prenatal care access. J Midwifery Women's Health. 2013;58(5):509-15. doi: 10.1111/jmwh.12041
https://doi.org/10.1111/jmwh.12041...

16 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...

17 Castillo-Arcos L, Benevides-Torres R. Model of sexual resilience in the adolescent: middle range theory. Aquichan [Internet]. 2012 [cited 2016 May 30];12(2):169-82. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-59972012000200008&lng=en
http://www.scielo.org.co/scielo.php?scri...

18 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...

19 Davidson JE. Facilitated sensemaking: a strategy and new middle-range theory to support families of intensive care unit patients. Crit Care Nurse. 2010;30(6):28-39. doi: 10.4037/ccn2010410
https://doi.org/10.4037/ccn2010410...

20 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...

21 Murrock CJ, Higgins PA. The theory of music, mood and movement to improve health outcomes. J Adv Nurs. 2009;65(10):2249-57. doi: 10.1111/j.1365-2648.2009.05108.x
https://doi.org/10.1111/j.1365-2648.2009...
-2222 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...
,2424 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...

25 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...

26 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...

27 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...

28 Sanford RC. Caring through relation and dialogue: a nursing perspective for patient education. ANS Adv Nurs Sci. 2000;22(3):1-15. doi: 10.1097/00012272-200003000-00002
https://doi.org/10.1097/00012272-2000030...

29 Jirovec MM, Jenkins J, Isenberg M, Baiardi J. Urine control theory derived from Roy's conceptual framework. Nurs Sci Q. 1999;12(3):251-5. doi: 10.1177/08943189922106828
https://doi.org/10.1177/0894318992210682...

30 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...

31 Olson J, Hanchett E. Nurse-expressed empathy, patient outcomes, and development of a middle-range theory. Image J Nurs Sch. 1997;29(1):71-6. doi: 10.1111/j.1547-5069.1997.tb01143.x
https://doi.org/10.1111/j.1547-5069.1997...
-3232 Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996;44(2):74-9. doi: 10.1016/S0029-6554(96)80053-4
https://doi.org/10.1016/S0029-6554(96)80...
) is an intellectual construction, a picture of reference that allows organizing observations, interpreting them and suggesting research hypotheses(3535 Verhaeghe M, Bracke P, Christiaens W. Stigma and client satisfaction in mental health services. J Appl Soc Psychol. 2010 ;40(9):2295-318. doi : 10.1111/j.1559-1816.2010.00659.x
https://doi.org/10.1111/j.1559-1816.2010...
). Such model incorporates a set of specific, coherently organized and interrelated terms that serve for nurses to guide care in practice. Thus, the caregiving actions is developed around a structure based on critical thinking or on the problem-solving process(3636 Pepin J, Ducharme F, Kérouac S. La pensée infirmière. 3rd ed. Montréal: Chenelière; 2010.).

Therefore, it is perceived that, in developing an MRT, the synthesis picture is an important item because its presentation allows nurses to understand what is happening in practice, critically organizing information, in addition to elucidating the relationships between the main concepts of theories. It is worth mentioning the graphic representation of the main elements of MRT can be called synthesis picture, pictogram, figure or diagram.

Another important aspect in developing a theory is the establishment of its propositions. Hence, we noticed that most MRTs developed in Nursing present propositions(55 Oliveira Lopes MV, Silva VM, Herdman TH. Causation and validation of nursing diagnoses: a middle range theory. Int J Nurs Knowl. 2017;28(1):53-9. doi: 10.1111/2047-3095.12104
https://doi.org/10.1111/2047-3095.12104...
,1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...

11 Fearon-Lynch JA, Stover CM. A middle-range theory for diabetes self-management mastery. ANS Adv Nurs Sci. 2015;38(4):330-46. doi: 10.1097/ANS.0000000000000087
https://doi.org/10.1097/ANS.000000000000...

12 Payne LK. Toward a theory of intuitive decision-making in nursing. Nurs Sci Q. 2015;28(3):223-8. doi: 10.1177/0894318415585618
https://doi.org/10.1177/0894318415585618...
-1313 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...
,1616 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...

17 Castillo-Arcos L, Benevides-Torres R. Model of sexual resilience in the adolescent: middle range theory. Aquichan [Internet]. 2012 [cited 2016 May 30];12(2):169-82. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-59972012000200008&lng=en
http://www.scielo.org.co/scielo.php?scri...
-1818 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...
,2020 Reimer AP, Moore SM. Flight nursing expertise: towards a middle-range theory. J Adv Nurs. 2010;66(5):1183-92. doi: 10.1111/j.1365-2648.2010.05269.x
https://doi.org/10.1111/j.1365-2648.2010...
,2222 Covell CL. The middle-range theory of nursing intellectual capital. J Adv Nurs. 2008;63(1):94-103. doi: 10.1111/j.1365-2648.2008.04626.x
https://doi.org/10.1111/j.1365-2648.2008...
,2424 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...

25 Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
https://doi.org/10.1177/0894318404266327...

26 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...

27 Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
https://doi.org/10.1177/089431802236796...
-2828 Sanford RC. Caring through relation and dialogue: a nursing perspective for patient education. ANS Adv Nurs Sci. 2000;22(3):1-15. doi: 10.1097/00012272-200003000-00002
https://doi.org/10.1097/00012272-2000030...
,3030 Huth MM, Moore SM. Prescriptive theory of acute pain management in infants and children. J Soc Pediatr Nurs. 1998;3(1):23-32. doi: 10.1111/j.1744-6155.1998.tb00206.x
https://doi.org/10.1111/j.1744-6155.1998...

31 Olson J, Hanchett E. Nurse-expressed empathy, patient outcomes, and development of a middle-range theory. Image J Nurs Sch. 1997;29(1):71-6. doi: 10.1111/j.1547-5069.1997.tb01143.x
https://doi.org/10.1111/j.1547-5069.1997...
-3232 Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996;44(2):74-9. doi: 10.1016/S0029-6554(96)80053-4
https://doi.org/10.1016/S0029-6554(96)80...
). These are important elements of a theory because they compose the descriptive statement of the properties and dimensions of a concept or statement that links two or more concepts. They provide the theory with the power to describe, predict or explain(3434 Meleis AI. Theoretical nursing: development and progress. Philadelphia: Lippincott Williams & Wilkins; 2007.). Overall, propositions present what the theory concludes.

After propositions, the hypotheses of a theory can be presented. MRTs work with the establishment of hypotheses to present how previously established propositions can be tested, as identified in some studies(1010 Dobratz MC. Building a middle-range theory of adaptive spirituality. Nurs Sci Q. 2016;29(2):146-53. doi: 10.1177/0894318416630090
https://doi.org/10.1177/0894318416630090...
,1313 Pickett S, Peters RM, Jarosz PA. Toward a middle-range theory of weight management. Nurs Sci Q. 2014;27(3):242-7. doi: 10.1177/0894318414534486
https://doi.org/10.1177/0894318414534486...
-1414 Elo S, Kääriäinen M, Isola A, Kyngäs H. Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. Sci World J. 2013;2013:945635. doi: 10.1155/2013/945635
https://doi.org/10.1155/2013/945635...
,1616 Riegel B, Jaarsma T, Strömberg A. A middle-range theory of self-care of chronic illness. ANS Adv Nurs Sci. 2012;35(3):194-204. doi: 10.1097/ANS.0b013e318261b1ba
https://doi.org/10.1097/ANS.0b013e318261...
,1818 Dobratz MC. Toward development of a middle-range theory of psychological adaptation in death and dying. Nurs Sci Q. 2011;24(4):370-6. doi: 10.1177/0894318411419212
https://doi.org/10.1177/0894318411419212...
,2424 Dunn KS. Toward a middle-range theory of adaptation to chronic pain. Nurs Sci Q. 2004;17(1):78-84. doi: 10.1177/0894318403260474
https://doi.org/10.1177/0894318403260474...
,2626 Tsai PF. A middle-range theory of caregiver stress. Nurs Sci Q. 2003;16(2):137-45. doi: 10.1177/0894318403251789
https://doi.org/10.1177/0894318403251789...
,3131 Olson J, Hanchett E. Nurse-expressed empathy, patient outcomes, and development of a middle-range theory. Image J Nurs Sch. 1997;29(1):71-6. doi: 10.1111/j.1547-5069.1997.tb01143.x
https://doi.org/10.1111/j.1547-5069.1997...
).

We identified that most authors of the articles under analysis gave a name to the developed theory, although some did not present it directly. The attribution of a name to the theory is important since it facilitates the identification of the MRT by professionals and researchers. Naming a theory is a challenge, as it is the etiquette of research orientation. However, it is essential that MRTs be named in the context of the proposed disciplinary approach.

Thus, MRTs can be applied to a variety of subpopulations. For example, a middle-range theory can be applied in urban or rural centers, in native or immigrant groups(3737 Higgins PA, Moore SM. Levels of theoretical thinking in nursing. Nurs Outlook. 2000;48(4):179-83. doi: 10.1067/mno.2000.105248
https://doi.org/10.1067/mno.2000.105248...
). Therefore, it is believed the authors did not develop specific names for the MRTs in their research because these are nursing theories geared towards the general public and/or nurses, thus not having a specific population for the theory created.

Regarding the use of theoretical framework, methodological basis and/or literature review in the development of MRT, we noticed the authors of the articles under analysis were supported by different references. However, the form of elaboration and the main results are similar between them. On this, it is emphasized that, based on the description and analysis of the MRT construction, some recommendations were identified for its development: one should try to explain the name of the theory and the method used to generate it; try to clarify the conceptual links of the theory in a diagrammed model; to articulate the research links to the practice of theory, and to create an association between the proposed theory and a disciplinary perspective in Nursing, seeking that the MRT is ahead of nursing practice and research for a more in-depth and critical analysis(3838 Peterson SJ, Bredow TS. Middle range theories: application to nursing research. 3rd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013.). It is worth emphasizing that the development of propositions are also important results of a theory.

Given the items presented, one can noticed the first three recommendations were followed by the authors when developing their theories, as all articles analyzed described the method used to generate them, as well as presented the fundamental concepts; 22 articles explained the conceptual links of theory in a diagrammed model, and some showed the relationship of the research with the practice of the theory. However, we noticed the association between the proposed theory and a disciplinary perspective in nursing is still deficient, and the MRT is not ahead of the nursing practice and research.

Therefore, a unique methodology was not identified among the analyzed articles with specific recommendations on the mandatory items for the creation of a MRT. Each researcher selects their theoretical and methodological foundation to build a specific theory. However, it is recommended that at least three important elements be presented: main concepts, diagram model and propositions, considering these items were frequently shown in the studies analyzed.

Only two studies tested the developed theories(1414 Elo S, Kääriäinen M, Isola A, Kyngäs H. Developing and testing a middle-range theory of the well-being supportive physical environment of home-dwelling elderly. Sci World J. 2013;2013:945635. doi: 10.1155/2013/945635
https://doi.org/10.1155/2013/945635...
,3131 Olson J, Hanchett E. Nurse-expressed empathy, patient outcomes, and development of a middle-range theory. Image J Nurs Sch. 1997;29(1):71-6. doi: 10.1111/j.1547-5069.1997.tb01143.x
https://doi.org/10.1111/j.1547-5069.1997...
), while most research suggests that theories are subsequently tested on specific populations. It should be noted that the authors may have tested the theories and published the results in other manuscripts. Therefore, the conduction of a study to identify which theories were further tested and what were their results is suggested.

This study becomes important because it synthesizes in the results how the MRT are developed in the field of Nursing. Thus, the essential components that should compose the structure of a theory and the main methods used in research were clarified.

Study limitations

As a limitation of the study, we have the number of databases used, given the possibility of identifying complementary information in studies indexed in other databases.

Contributions to the field of Nursing, Health or public policy

Knowing the structure of a MRT can contribute to the advancement of nursing as an academic discipline and profession, as the main characteristic of this type of theory is the provision of substantive knowledge to practice.

FINAL CONSIDERATIONS

Overall, the development of MRTs identified in the studies analyzed included: presentation of fundamental concepts, synthesis picture, propositions, hypotheses and specific names for theories. Therefore, the MRT is recognized as a means to face the challenge of developing a substantial body of knowledge to guide the nursing practice.

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    Mefford LC. A theory of health promotion for preterm infants based on Levine's conservation model of nursing. Nurs Sci Q. 2004;17(3):260-6. doi: 10.1177/0894318404266327
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  • 27
    Whittemore R, Roy C. Adapting to diabetes mellitus: a theory synthesis. Nurs Sci Q. 2002;15(4):311-7. doi: 10.1177/089431802236796
    » https://doi.org/10.1177/089431802236796
  • 28
    Sanford RC. Caring through relation and dialogue: a nursing perspective for patient education. ANS Adv Nurs Sci. 2000;22(3):1-15. doi: 10.1097/00012272-200003000-00002
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    » https://doi.org/10.1177/08943189922106828
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    » https://doi.org/10.1111/j.1547-5069.1997.tb01143.x
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Edited by

EDITOR IN CHIEF: Antonio José de Almeida Filho
ASSOCIATE EDITOR: Margarida Vieira

Publication Dates

  • Publication in this collection
    10 Feb 2020
  • Date of issue
    2020

History

  • Received
    15 Feb 2018
  • Accepted
    29 Nov 2018
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