This article covers Application of grand, mid-range and situation specific nurse theories in 21 st century – Clinical Theory Practice of the 21st Century.


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Clinical Theory Practice of the 21st Century

Nursing theories, models and philosophical concepts have been developing consistently in the last century. During the period, nursing practice and healthcare in general has been experiencing considerable challenges which have ultimately placed the applicability of the nursing theories in question. One of the role of theories in nursing is development of knowledge, which ultimately influences practice. In the current nursing practice, grand nurse theories, middle range and situation specific theories  continue playing an influential role not only in development of knowledge but also in informing the nursing practice in the 21st century. This paper is a critical reflection on grand theories, middle range and situation specific theories, with a view of exploring the most applicable of the given theories in the 21st nursing practice environment.

Nursing practice environment in the 21st century is characterized by various challenges and dynamics, which require application of the appropriate nursing interventions and theories to promote the quality of care delivered to the population.  Nursing practice in the 21st century is more diverse than ever before, thereby increasing the need for nurses to provide culturally competent care to the diverse groups in the population. Secondly, application of technology in provision of healthcare has become widespread in 21st century. This has necessitated the need for healthcare professionals to provide patients with adequate health education and information to enhance their ability for self-care in outpatient care settings (Curtis, 2014).

Twenty first century has also experienced an increasing population of people aged 65 years and above. The elderly population has one of the highest demands for healthcare services in the country, and hence it is important for nurses to be equipped with appropriate knowledge, skills and expertise to address the various health needs of this vulnerable group (Anazor, 2013).    Increasing prevalence of chronic disorders in the population is another challenge evident in the 21st century. Epidemiological studies indicate an increasing trend of chronic disorders such as diabetes, hypertension, asthma and HIV/AIDS in the national and global population (Gimbel, 2017; Curtis, 2014). Increased prevalence of chronic disorders has necessitated the application of situation specific approaches to address various health disorders in different clinical settings.   In the midst of the aforementioned dynamics in healthcare system, the demand for nurses to provide high quality and affordable care, which is also sensitive to individual needs of patients, is increasing. In this regard, it is crucial for nurses to not only be conversant with the various nurse theories but be knowledgeable about their application in nursing practice to address the healthcare challenges evident in the 21st century.

Research studies on the application of theories in nursing practice indicate an overlap of different philosophies, irrespective of the patient population and practice settings (Meleis, 2018). However the applicability of any given nurse theory in any given clinical setting is also determined by its scope   in terms of concepts and the targeted patient population.   Grand theories for instance have the broadest and widest scope compared to the middle range and situation specific theories (Parker, 2005). This enhances their application in diverse clinical settings and patient populations compared to the other two categories.  In the 21st century, a grand theory such as Henderson Need theory is applicable in promoting independence among diverse patient groups suffering from various health conditions, by addressing the 14 needs of patient (Nicely & DeLario, 2011). Similarly, Orem’s self-care deficit theory seeks to enhance health in the population by promoting self-care among individuals, families and communities. This includes vulnerable groups, such as the elderly, children and other groups demonstrating reduced capacity to take care of individual health needs.

Middle range nurse theories do not have as wide scope as grand theories. However, they focus on specific nursing phenomena and have limited conceptual framework (Meleis, 2018).  Just like grand theories, middle range theories are applicable in a wide range of clinical settings.  In 21st century for instance, Madeline Leininger theory of transcultural nursing is applicable in provision of culturally sensitive care in diverse patient populations. Similarly, Peplau’s theory of interpersonal relations is applicable due to its emphasis on development of patient-nurse relationships to help care provider to not only identify health needs of the patient, but also provide healthcare services tailored to individual needs of the client (Gimbel, 2017). Situation specific theories have the narrowest scope and they address a defined nursing field, a particular clinical condition and a defined patient population. Some of the situation specific theories include theory of barriers and facilitators, targeting patients with heart failure and Meleis Theory of care transition (Meleis, 2018).

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Clinical theory practice of the 21st century
Clinical Theory Practice of the 21st Century

From the analysis of the three types of theories, I think grand theories are the most applicable to clinical practice in the 21st century.  Grand theories have the widest scope among the three categories, enhancing their suitability in addressing the dynamics and diversity of the current healthcare system such as increased cultural diversity, diverse patient populations and the need to providing patient focused care.   In 21st century, nurse practitioners have a wider scope of practice and are increasingly playing the role of primary care providers in the healthcare system.

It is expected that nurse practitioners will continue playing a greater role in healthcare system, especially due to increased demand for healthcare services following the raising aging population and shortage of healthcare professionals (Gimbel, 2017).   In this case, grand theories are most appropriate in empowering nurses   with broad range of skills and knowledge to enhance their capacity to provide and cope with the increasing healthcare demands, across the population in the 21st century.  However, applying a combination of the three categories of theories in nursing practice is also relevant in the 21st century, to equip nurses with a holistic approach to healthcare, especially in addressing the emerging chronic diseases.


Anazor, C.(2013, December ). Preparing nurse leaders for global health reforms. Nursing   Management, 9(14):26-28.

Curtis, K, (2014, July). 21st century challenges faced by nursing faculty in educating for   compassionate practice: embodied interpretation of phenomenological data. Nurse Education Today, 33 (7): 746-750.

Gimbel, S.(2017,  March). Creating academic structures to promote nursing’s role in global health policy. International Nursing Review, 64(1): 117-125.

Meleis, A. I. (2018). Theoretical nursing: development and progress (6th ed). Philadelphia: Wolters Kluwer.

Nicely, B., & DeLario, G. (2011, March). Virginia Henderson’s principles and practice of nursing applied to organ donation after brain death. Progress in Transplantation, 21(1),  72-77. doi:10.7182/prtr.21.1.c7617103jug3466m

Parker, M.(2005). Nursing theories and nursing practice (2nd ed). Philadelphia: F.A. Davis Co.

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