Across the country each day people, health care providers and others, are engulfed in the reality and uncertainty of an on-going process for changing how health care is financed. We all seem to agree that change was needed; certain changes have been put in motion. Still we hear from every formal and informal media source both the positive outcomes and the potential pitfalls. Nurse leaders are clear that changes in nursing practice lie ahead as larger system changes occur. In recent decades nursing as a profession has developed the knowledge needed for these new roles for themselves and for the populations we work with.
The book Generating Middle-Range Theory: From Evidence to Practice was created to bring together the best of this knowledge in a way that nurses can make immediate applications to the increasingly important nurse-patient transforming relationships. I am someone who cares deeply about opportunities and the eventual success of this era. The times dictate an increasing imperative that nurses partner with people to bring about real improvements in the health of the nation. I recognize the significant efforts in place to put nursing knowledge at the forefront of advancing a health agenda. In particular, the national movement toward translational research, led by the National Institute of Nursing Research is making strides and secondly, the evidence-based practice (EBP) movement has had some success in closing the gap between research and practice. Still I felt there was room for deriving another approach that can quickly enhance the mutual roles of nurses and patients and families in being accountable for improving health.
The large reservoir of research published in the last 15 years on the Roy adaptation model (RAM) cried out to be synthesized as evidence for practice. In addition, I have the extraordinary talent of the Roy Adaptation Association Fellows and Board Members to conceptualize and carry out such a project. Thus this book was born out of absolute need within the profession and timely opportunity for one theorist and her colleagues.
The work is based on an earlier project, introduced to the Board of the RAA by its founder, Dr. Susan Pollock, and published by STTI in 1999. Collecting and critiquing the RAM-based research was patterned after that project. What was added was using the studies to create middle range theories with concepts that are closer to practice and can be used across settings. In this case, the evidence for practice included in the studies was summarized by way of Roy’s description of levels of readiness for practice. After the studies are described and evaluated, the authors describe exemplars for practice. The middle range theories are created by using a six-step process with a cluster of studies related to significant themes in nursing practice: coping, adapting to life events, adapting to loss, adapting in chronic conditions and the adapting family.
The major vehicle for nurses to take greater roles in using their full potential to help people be more active in managing their health promotion, maintenance and restoration is the proposal of a nurse/patient alliance portal infrastructure based on RAM EPB. Since this sophisticated information technology approach was conceptualized, similar ideas have been proposed in related projects to enhance the nursing role in patients assuming responsibility for their health. What seems novel then is part of a movement. However, it is still innovative in the depth and breadth of nursing knowledge that was synthesized from theory-based research, to generating the middle-range theories with the evidence provided. We offer this approach with hope that it can be part of the contributions to changing practice now.