"Models, Theories and Concepts" c/o Smith (1994). Plus ça change ...

"Whilst the impracticality of unified approaches has been noted for some time (McFarlane, 1976), it is still considered that many theories, in their efforts to explain everything, succeed only in explaining nothing (Draper, 1990). Therefore, as Kenny (1992) points out, the use of theories and models in nursing has resulted in sweeping generalizations which 'are not always personally, culturally or contextually appropriate'.

In overcoming this difficulty many authors advocate that theories of lesser scope and abstraction are considered (McFarlane, 1976; Clarke, 1986; Draper, 1990; Moore, 1990; Ingram, 1991; Reid & Bond, 1991). Such theories have been termed 'mid-range' and address a more limited number of variables in particular situations (scope), whilst being empirically grounded and focusing on practical problems (abstraction) (Rogers & Shoemaker, 1971; Walker & Avant, 1983; Fawcett, 1984; Lowenberg, 1984). According to Clarke (1986), mid-range theories should appeal to practitioners as being more directly accessible conceptually and linguistically. Reed & Robinson (1991) contend that, given the diversity of nursing practice, the search for grand theory is inappropriate and nursing would be better served by developing mid-range theories that are 'more precisely stated, more easily treated and produce more specific indications for practice'." pp. 59-60.

Smith, J.P. (1994) Advanced Nursing Series - Models, Theories and Concepts. Oxford: Blackwell Scientific Publications.

While the structure of Hodges' model is global - 'grand' in scope, the model, as a template is blank and open to whatever conceptual content follows in the practice situation, or context. 'Precision' can be assured using Hodges' model as it can facilitate person-centred care, integrated care, reflection, critical thinking and conceptual development. 

Delivery of high-quality health care is not a given. 

Safe, effective and equitable care is variously dependent upon staffing, the skills and attitudes of individual nurses, staff numbers, skill-mix, team effectiveness and resource allocation. Hodges' model can also assist users to recognise and call-out unmet needs, deficits in the quality of care, and risks to the safety of patients, the public, staff and the profession.

At risk of sounding grand if not grandiose ...

Change will and must follow - in respect of models and theories, not just of and for nursing but health and care at scale.