Story Middle Range Theory Introduction to Story Middle Range Theory
Story Middle Range Theory, initially termed “Attentively Embracing Story” (Smith, M. J., & Liehr, 1999), represents a conceptual framework in nursing practice that emphasizes the importance of narrative and storytelling. This theory posits that story is not merely an exchange of information but a dynamic and evolving dialogue between the nurse and the patient. Through intentional dialogue, nurses engage with patients’ stories to create a sense of ease and understanding. The core idea behind this theory is that every nursing encounter happens within the context of a story — whether it be the story of the patient, their family, or other healthcare providers — woven together to form a narrative around a health challenge (Smith, M. J., & Liehr, 2003b).
This theory recognizes story as a fundamental dimension of human experience and a critical element of nursing practice. The concept of story is not new in nursing; it has long been used implicitly or explicitly in various forms, such as theoretical models, interventions, or as a source of research data (Smith, M. J., & Liehr, 2003b). However, Story Middle Range Theory explicitly places story at the center of nursing practice, offering a structured way to understand its role in health promotion.
Assumptions of Story Middle Range Theory
Story Middle Range Theory is grounded in three core assumptions that underpin its conceptual framework:
- Interrelation and Change: People change as they interrelate with their world in a vast array of flowing, connected dimensions. This assumption emphasizes the dynamic nature of human experience, where every interaction and relationship contributes to personal growth and transformation.
- Expanded Present Moment: Individuals live in an expanded present moment where past and future events are transformed into the here and now. This assumption highlights the importance of understanding the patient’s experience in the current moment while considering their past and potential future.
- Meaning as Resonating Awareness: People experience meaning as a resonating awareness in the creative unfolding of human potential. This idea suggests that individuals find meaning in their experiences, which unfolds over time through interactions with others and their environment (Smith, M. J., & Liehr, 2003b).
The three core concepts of this theory are connecting with self-in-relation, intentional dialogue, and creating ease. Intentional dialogue is the primary activity that brings the story to life as a health-promoting endeavor. This dialogue involves a purposeful engagement between the nurse and the patient to explore the story of a health challenge. Intentional dialogue requires the nurse to be fully present, abandon preexisting assumptions, and respect the storyteller as the expert of their own experience (Smith, M. J., & Liehr, 2003b).
Relationship with Person History
Connecting with self-in-relation is a process of reflective awareness on personal history. This involves recognizing oneself as related to others within a developing story plot uncovered through intentional dialogue (Smith, M. J., & Liehr, 2003b).
People see themselves not as isolated individuals but as existing and evolving within a context that includes an awareness of others, sensitivity to bodily expression, and a sense of history and future within the present moment. This concept of self-in-relation highlights the interconnectedness of human experience, emphasizing the importance of understanding a patient’s narrative in relation to their social and historical context.
Nursing Care and History Theory
In Story Middle Range Theory, the nurse plays a crucial role in guiding the patient through their story. By encouraging patients to explore their personal history, the nurse helps them move from the past to the future while remaining in the present moment. This process involves delving deep into the story to uncover unique meanings that may be hidden within the ambiguity of complex dilemmas (Smith, M. J., & Liehr, p. 171).
Creating ease involves recalling disjointed story moments to experience flow amidst anchoring (Smith, M. J., & Liehr, 2003b). This process allows for a moment of stability, even if temporary. Paradoxically, anchoring is accompanied by flowing, as energy surfaces when story moments coalesce into a comprehensible whole, moving towards resolving the complicating health challenge.
Story Theory and Nursing Research
Story Middle Range Theory finds its application in both research and practice through three essential processes: complicating, developmental, and resolving. Each of these processes is a fundamental element of storytelling:
- Complicating Process: This involves identifying a health challenge that emerges when there is a change in the person’s life.
- Developmental Process: This comprises the story plot that links to the health challenge, infusing it with meaning.
- Resolving Process: This is a shift in perspective that enables progress with a new understanding (Smith, M. J., & Liehr, 2003b, p. 173).
Every time a nurse engages a patient to learn about their concerns or what matters most to them, Story Middle Range Theory is applicable. By abandoning preexisting assumptions, respecting the storyteller as the expert, and clarifying vague story directions, the nurse fosters an intentional engagement that enables connecting with self-in-relation to create ease.
When the primary intention of the nurse is caring-healing, the nurse explores the story to understand “what matters” to the individual, culminating in a distinct narrative of how that person is dealing with a particular health challenge. This distinct narrative allows for nursing care that is tailored to the patient’s unique needs, addressing their most important concerns.
Purpose of Story Theory in Research
The purpose of using Story Middle Range Theory in research is to gather health stories with the intent of scholarly inquiry. When the goal is scholarly inquiry, the nurse poses a research question about a specific health challenge, and the participant’s experience is explored to understand how they have lived through that challenge.
Regardless of the intention — whether caring-healing or scholarly inquiry — stories are collected with a focus on essential story processes: complicating health challenges, developing the story plot, and moving toward resolving the issue. The only distinguishing factor between caring-healing and scholarly inquiry is where the intentional dialogue begins — either with what matters most to the patient or with a phenomenon outlined in the research question formulated by the nurse.
Story plots can be explored using structures like family trees or story paths (Smith, M. J., & Liehr, 2003b, p. 175). In both cases, movement toward resolving the health challenge is possible as the storyteller immerses themselves in sharing their experience with someone who genuinely listens. “Finding a center of stillness and letting go of busyness and distractions energizes mindful attention to the story and propels movement toward resolving” (Smith, M. J., & Liehr, p. 176).
A health story gathered for scholarly inquiry requires a research strategy based on a research question. Smith and Liehr (2003b) propose using both qualitative and quantitative methods for analyzing story data. They advocate for dual analyses, suggesting that combining qualitative and quantitative approaches may provide the most meaningful direction for practice, further theory development, and continued research.
Methodological Approaches in Story Theory Research
Qualitative approaches for dual analyses can include any method where stories are gathered and audio-recorded for transcription. For quantitative analysis, narrative analysis software, such as Linguistic Inquiry and Word Count (LIWC), is used to analyze the transcriptions prepared for qualitative analysis (Smith, M. J., & Liehr).
Research and practice have significantly contributed to the development of Story Middle Range Theory, establishing its foundation as a middle-range theory. Since its inception in 1999, the theory’s authors have been refining methods guided by this framework. The ultimate test of any theory, particularly a middle-range theory, lies in its application to guide practice and research.
By this measure, Story Middle Range Theory is still in its early growth stages but holds significant promise for use by nurses who believe in the central role of narrative in nursing. It is also well-suited for use with undergraduate and graduate students seeking guidance on how to engage patients in meaningful conversations about health challenges.
Conclusion
Story Middle Range Theory offers a compelling framework for understanding and utilizing narrative in nursing practice. By focusing on intentional dialogue and recognizing the interconnectedness of human experience, this theory provides a valuable approach for nurses to engage patients, promote health, and contribute to research. It emphasizes the importance of understanding each patient’s unique story, which can guide personalized and effective nursing care. As research and practice continue to evolve, Story Middle Range Theory will likely become a cornerstone in the broader field of nursing, fostering deeper connections and understanding between nurses and patients.