The future of health care is causing rise to much uncertainty in the delivery of care to clients in need both directly and indirectly. With continued rise of overhead costs on an upward spiral, the nurse finds herself or himself caught in the midst of administrative decisions that involve staffing and direct care delivery decisions all the while providing quality of care to the patient. Additionally, the demands of technological advancement will directly affect the future delivery of care and how that care is delivered to those in need.
So, where does nursing theory fit in the future of nursing and what theory is most applicable to usage by the professional nurse in this changing health care market? It appears little attention has been given to grand theory in recent years. The goal has been achieved and the nurse is finally accepted as a profession. However, the quest remains to develop the discipline to expand in knowledge growth. With this search to cement a knowledge base to the professional nurse, it is apparent that middle range theories will blossom in the 21st
century. In the text, Middle Range Theory for Nursing, 2nd
Edition, authors Mary Jane Smith and Patricia Liehr state, Nursing remains on the margin of the professional disciplines and is in danger of being consumed or ignored if sufficient attention is not given to the uniqueness of nursing’s field of inquiry and practice. (Smith & Liehr, 2008) The authors state that with the development of middle range theories, there is evidence of a growth of knowledge development. (Smith & Liehr, 2008) Additionally, as the nursing profession continues to evolve there is a specialization occurring within the profession as theories move ever closer to the bedside and the nurse expands his or her practice knowledge within their specialty.
The professional nurse is no longer master of everything but rather has and continues to gain knowledge and skill within his or her area of specialty. Therefore the future research aim will be towards middle range theory. These theories, have more limited scope, less abstraction, address specific phenomena or concepts, and reflect practice. (Meleis, 2012. p.33) The development of middle range theories will further lead the way for situation specific theories that will, focus on specific nursing phenomena that reflect clinical practice and are limited to a specific population or a particular field of practice. (Meleis, 2012. p.34) The nurse must continue knowledge development that continually improves patient care outcome and quality of care that will expand on the phenomena of the art and science of the nurse and thereby provide an outline for practice within the discipline.
The future of health care has only one constant and that is, health care is in constant change. The focus on improved patient outcome and patient satisfaction will be the future development in nurse theory and middle range theories lend to this development. Evidence based practice developed through the use of research studies and theory will lead the nurse in to the future. Middle range theories are applicable to each aspect of the nurse profession from administration, education, and direct patient care. Though the future is uncertain regarding many aspects of health care, the nurse will remain intact; steady and strong; persevering through the changes to emerge with not only applicable theories by which to practice by, but also a stronger knowledge base that will enhance the nurse and develop a firm discipline whereby to provide quality of care through skills learned, knowledge gained, and art applied.
- Meleis, A. (2012). Theoretical nursing development and progress (5th ed.). Philadelphia,: Wolters Kluwer, Lippincott, Williams & Wilkins.
- Smith, M. J. (2008). Middle range theory for nursing. New York: Spring House Publishing Company.