Conceptual-Theoretical-Empirical Structure Evaluation


The health care industry is the most efficient when there are robust links between theory and practice. That is why advanced-practice nurses should understand these links since this fact has the potential to improve the quality of care and patient outcomes. Nurses need a structure to test how it is possible to apply theory to practice. Thus, the principal purpose of the given paper is to examine how the conceptual-theoretical-empirical (CTE) structure translates into nursing practice based on a middle-range theory of nursing in hypertension care.

Evaluation of the CTE Linkages

According to the information above, the conceptual-theoretical-empirical (CTE) structure consists of three components, and each of them is of specific meaning. The first of them, the conceptual model, stands for “an overall umbrella or disciplinary frame of reference for the study and guides middle-range theory development” (Garvey et al., 2019, p. 231). It is the most abstract element of the structure under consideration. That is why a middle-range theory, the second element, should be incorporated. This term means a set of related ideas that describe a limited phenomenon in the nursing practice (Liehr & Smith, 2017). Empirical indicators represent the final element of the CTE structure, and they include the data and the ways or instruments of how these data can be obtained. The indicators are necessary to receive information that can help researchers prove their theory. These elements are placed in inverse relation to their abstractness level, meaning that the empirical indicators are the most specific phenomenon. When the three are combined, it becomes possible to identify whether a theory under analysis can improve nursing practice and lead to better outcomes.

Evaluation of the Selected Theory

As has been mentioned, the paper focuses on a middle-range theory of nursing in hypertension care, which is offered by Drevenhorn (2018). Elevated blood pressure is a severe disease in the modern world, while the prevalence of the health condition in the United States was 29.1% (Khademain et al., 2020, p. 141). When it comes to hypertension care, the significant phenomena are blood pressure measurement, motivating lifestyle changes that should include self-care, and organizing a dialogue between the patient and the medical professional. This theory contains clearly defined “concepts related to the patient, nursing in hypertension care, the encounter between the patient and the nurse, the expected outcomes of this encounter,” and others (Drevenhorn, 2018, p. 2). All these concepts should be used jointly to provide patients with improved nursing care by increasing the quality of nursing practice. For example, it is not a surprise that hypertensive patients should stop smoking if they want to improve their health. The middle-range theory under consideration means that the concepts of the patients’ autonomy and nurses’ counseling skills are significant for achieving positive outcomes in this case.

The given theory has appeared based on Orem’s conceptual model of self-care. According to Khademian et al. (2020), this model states that self-care is the activities that “people engage in to maintain, restore, or improve their health” (p. 141). Consequently, Orem believes that patients are active and responsive agents who actively influence health outcomes rather than recipients of health services. Khademain et al. (2020) admit that Orem’s model has proved its efficiency regarding patients with chronic disease. That is why the studies by Khademian et al. (2020) and Drevenhorn (2018) have used the model as a basis of their research to analyze whether self-care can enhance outcomes of hypertensive patients.

Evaluation of the Empirical Indicators

As has been stated above, the empirical component is the most specific element of the CTE structure. These indicators represent whether the middle-range theory under consideration has real-world manifestations. That is why it is not a surprise that this component should include actual data. Thus, the article by Drevenhorn (2018) is a cohort study that examines how self-care can improve the health of hypertensive patients. The researcher used the databases “PubMed, Cinahl, PsychINFO, SocSci, and Eric” to identify the relevant articles (Drevenhorn, 2018, p. 2). The search strategy relied on numerous keywords, including nurse-patient relations, nursing, self-care, and others, that were used separately and in combination with one another. Over longitudinal data collection procedures in 2001, 2005, and 2014, the author managed to identify 1,347 studies in total (Drevenhorn, 2018, p. 3). Consequently, content analysis was the leading data analysis technique that was used by Drevenhorn (2018). These theoretical indicators demonstrate that the middle-range theory under consideration has sufficient academic information to result in a practical application.

Evaluation of Research Findings

The findings of the middle-range theory of nursing in hypertension care are explicit. The study by Drevenhorn (2018) shows that every patient is unique, and it is necessary to engage them in their treatment. The researcher stipulates that patients’ self-perception can be a significant challenge for achieving positive outcomes. It relates to the fact that individuals can believe that living a healthy life is not for them because they will be subject to a disease for the rest of their life. In this case, nurses should use their counseling skills to make the patient change their opinion. In addition to that, Drevenhorn (2018) states that patients’ self-care skills become worsened when they do not have acute symptoms that can relate to the diagnosis.

Evaluation of the Utility and Soundness of the Practice Theory

The information above stipulates that the proposed middle-range theory of nursing in hypertension care can be useful in some cases when nurses manage to engage patients in their self-care. However, it is impossible to state that the practice theory is universally sound. It is so because Drevenhorn (2018) admits that “the proposed theory is work in progress and further development is needed” (p. 2). This limitation means that the middle-range theory’s outcomes can significantly depend on external factors, including patient and nurses’ personal skills. That is why the researcher should take additional efforts to improve the theory and make it work under all conditions, irrespective of how resistant patients are.


The conceptual-theoretical-empirical structure is used to test various medical theories. This phenomenon draws attention to the theoretical background and analyzes the instruments and strategies used to find specific data. That is why this structure is useful to examine the middle-range theory of nursing in hypertension care offered by Drevenhorn (2018). According to the evaluation, the approach under analysis is based on Orem’s conceptual model of self-care, which means that the patients’ engagement is crucial for improving their health. Drevenhorn (2018) has selected 1,347 studies that allowed her to identify that the nurses’ counseling skills can be sufficient to enhance the patients’ self-care. However, the author admits that the study has a limitation, which means that additional research is required to prove the universal efficiency of the middle-range theory under consideration.


Drevenhorn, E. (2018). A proposed middle-range theory of nursing in hypertension care. International Journal of Hypertension, 1-11.

Garvey, J. M., Dalton, J. M., & Magny-Normilus, C. (2019). A conceptual-theoretical-empirical structure for the study of Alzheimer informal caregivers and home health care nursing services. Home Health Care Management & Practice, 31(4), 231-238.

Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The effect of self-care education based on Orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: A quasi-experimental study. International Journal of Community Based Nursing and Midwifery, 8(2), 140-149.

Liehr, P., & Smith, M. J. (2017). Middle-range theories. In J. Fitzpatrick (Ed.), Encyclopedia of nursing research (4th ed.). Springer.