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Middle Range Theories, Internal, and External Criticism

Alicia Piedra

Miami Regional University

MSN5270 Advanced Theoretical Perspectives for Nursing.  

Leanne Trigoura, DNP-C, FNP-BC, MSN, APRN



Middle-range theories play a crucial role in nursing practice. For instance, the theories significantly brig the gap between abstract grand theories and specific nursing interventions. As such, it Tamati important to provide the theoretical framework and rationale for the critical scrutiny of internal criticisms of theory and external criticism (George et al., 2019). Medically managed patients are physically and mentally ill individuals with lifesaving treatments that have been applied to have maximum effect with minimum risks. Physician influence, patient decisions, nursing care delivery, and outcome are all influenced by choice of a unique “middle range” theory (TM et al., 2021). The application of this theory is supported by current scientific research. They provide a framework for understanding and explaining phenomena in nursing practice. However, like any other scientific theory, middle-range theories are subject to internal and external criticism. Middle-range theories are subject to internal criticism. This means that the theory is subjected to close analysis and evaluation in relation to its own assumptions. The evaluation considers how well the theory explains its findings, whether contrary evidence can be found, and whether it generalizes to outcomes other than those it was designed for.

Explanation of Middle-Range Theories

Middle-range theories are more specific and concrete than grand theories but still provide a level of abstraction that can be applied across various nursing contexts. They focus on a particular aspect of nursing phenomena, such as pain management, patient satisfaction, or stress reduction (Northoff and Tumati, 2019). These theories rely on patient-centered approaches and humanistic theory, focusing on practice and patient experience. Internal criticism is consistent with the theoretical rationale for middle-range theories and is considered a very important component of the theory. Middle-range theories are often derived from grand theories developed through research and empirical evidence. Internal criticism is considered a rigorous process of evaluating assumptions underlying a middle-range theory. The significance of middle range theories lies in their ability to guide nursing practice, research, and education (Derakhshan et al., 2019). They provide a theoretical foundation for developing interventions, assessing outcomes, and promoting evidence-based nursing care. Middle-range theories are often derived from grand theories and developed through research and empirical evidence. The internal criticism is consistent with the theoretical rationale for middle-range theories and is considered a very important component of the theory. Middle-range theories can also facilitate communication and collaboration among nurses, as they provide a common language and understanding of nursing concepts.

Internal Criticism of Middle-Range Theories

Internal criticism involves evaluating the logical consistency, clarity, and coherence of a theory’s concepts, propositions, and assumptions. It ensures that the theory is internally valid and free from contradictions. Internal criticism helps identify any logical gaps, inconsistencies, or ambiguities that may undermine the credibility and utility of a middle-range theory (Tamilmani et al. 2021). For example, suppose a middle-range theory proposes that educating patients with diabetes improves self-management behaviors and glycemic control. Internal criticism would involve examining the clarity of concepts such as defining “education” and “self-management behaviors” and assessing the logical consistency of propositions (Jabbour et al., 2019). Examples include the causal relationship between education and glycemic control. Researchers and clinicians can refine and strengthen middle-range theories through internal criticism, ensuring their relevance and applicability in nursing practice.

External Criticism of Middle-Range Theories

External criticism is useful in determining whether the middle range theory has been accepted in nursing practice and if it provides useful insights into nursing phenomena. External criticism helps ensure that a middle-range theory has empirical grounding and is supported by scientific research. For instance, if a middle-range theory proposes that nurse-led interventions improve patient satisfaction, external criticism would involve reviewing studies investigating the relationship between nurse-led interventions and patient satisfaction (TM et al., 2021). A small-to-moderate amount of empirical evidence may support a middle-range theory, but a large amount of low quality or biased research could also support it. If a middle-range theory is deemed to have strong theoretical and empirical underpinnings, then external criticism can help guide practice and research in nursing. In addition to internal and external criticism, certain areas in nursing are more prone to scrutiny than others. This can be significant when evaluating a theoretical perspective. By assessing the quality and consistency of empirical evidence, external criticism allows researchers and practitioners to determine the strength of support for a middle-range theory and its potential relevance in different clinical contexts.

Application of Student Learning Outcomes

Internal and external criticism requires students to evaluate the empirical evidence supporting middle-range theories. This process fosters critical thinking and the ability to judge the quality and relevance of research findings. After investigating theories and concepts in nursing, students could determine their applicability in practice. Through analyzing middle-range theories, students could develop an understanding of the various concepts and relationships among them. Demonstrating critical thinking and analysis is the other issue. Discussing internal and external criticism encourages students to think critically about middle-range theories’ logical consistency and empirical support. Students were encouraged to critically appraise the strengths and weaknesses of theories and concepts in nursing, which is essential in maintaining a high standard of critical thinking. This critical thinking is essential to research-based assessment. Theoretical perspectives in the nursing curriculum have changed over time. The pedagogical approaches have become more complex as educators are increasingly aware of the impact of studying theories on students’ learning. It prompts them to analyze the strengths and weaknesses of theories and develop a deeper understanding of their implications for nursing practice.


Derakhshan, R., Turner, R., & Mancini, M. (2019). Project governance and stakeholders: a literature review. International Journal of Project Management37(1), 98-116.

Jabbour, C. J. C., Sarkis, J., de Sousa Jabbour, A. B. L., Renwick, D. W. S., Singh, S. K., Grebinevych, O., … & Godinho Filho, M. (2019). Who is in charge? A review and a research agenda on the ‘human side’of the circular economy. Journal of cleaner production222, 793-801.

Tamilmani, K., Rana, N. P., Wamba, S. F., & Dwivedi, R. (2021). The extended Unified Theory of Acceptance and Use of Technology (UTAUT2): A systematic literature review and theory evaluation. International Journal of Information Management57, 102269.

TM, A., Kaur, P., Ferraris, A., & Dhir, A. (2021). What motivates the adoption of green restaurant products and services? A systematic review and future research agenda. Business Strategy and the Environment30(4), 2224-2240.

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