NURS 8114 Exploring Middle Range Theories and Framing Practice Issues
NURS 8114 Exploring Middle Range Theories and Framing Practice Issues
Middle range theories are theories that are less comprehensive and more specific than the broader grand theory. They have a limited number of concepts and will usually produce a testable hypothesis (McEwen & Ellis, 2019, p. 210). These middle range theories can be used to address a multitude of issues in most, if not all, nursing practices.
An issue I’ve faced in my practice as a psychiatric registered nurse is performance of the least intrusive physical restraint to subdue aggressive patients as well as limiting its use. This is an issue because many patients, some with a history of physical and sexual abuse, can be triggered and behaviors escalated through physical touch and/or invasion of personal space.
A middle range theory that is valuable in addressing this issue is The Tidal Model. The Tidal Model “emphasizes the
fluid nature of human experience characterized by change and unpredictability” (McEwen & Ellis, 2019, p. 225). It focuses on self-empowerment and focused risk assessments. This is particularly beneficial to the issues of restrictions in mental health patients because it initiates an active role in patients to identify and vocalize triggers through self-awareness. Focused risk assessments also provide staff with the tools needed to identify patients of abuse who may need modified forms of physical restriction or restricted use. For example, a risk assessment to identify patients of physical abuse may be gathered for each new admit.
Another middle range theory that could be useful to my physical restriction issue is The Transitions Theory. A major concept of this theory is the transfer of experiences between nurse and patient and the development of safety interventions during this transfer (McEwen & Elis, 2019, p. 231). This is important to my issue because of the need for a dynamic transfer of educational experiences and therapeutic flow of communication between patient and nurse in order to identify proper safety interventions in times of stress. This will minimize the need for physical restraints and present alternative methods for sensitive patient populations. For example, it may be found through the transfer of experiences between nurse and patient that the patient is calmed through soft music. Soft music can then be utilized as a safety intervention when and if the patient becomes aggressive.
McEwen, M., & Willis, E. M. (2019). Theoretical basis for nursing. (5th ed.). Wolters Kluwer.
Diabetes-related complications are a clinical issue of concern in nursing practice. Management of diabetes in most patients has been a challenge resulting in increased complications. The most common complications include blindness secondary to cataracts, cardiovascular disease, neuropathy, kidney disease, and lower-extremity amputation (Papatheodorou et al., 2018). These complications have been a major cause of increased morbidity and mortality among individuals with diabetes. They have also placed a heavy economic burden on the US health care system.
Middle-range theories most valuable in addressing diabetes-related complications include the Health Promotion Model and Comfort Theory. The Health Promotion Model explains the variables that determine the chances that a person will engage in health-promoting behavior, including cognitive-perceptual factors, modifying factors, and cues to action (Peterson & Bredow, 2019). The Health promotion model can help address the practice issue by understanding patients’ attitudes and beliefs regarding diabetes and perceived vulnerability. The model can be used to modify patients’ cognitive-perceptual factors in order to increase their health-promoting behaviors (Peterson & Bredow, 2019). This can improve their diabetes self-management and health-seeking attitude and ultimately improve health outcomes.
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In the Comfort theory, the nurse identifies patients’ needs that have not been met. The needs are modified by dominant variables, which are factors that the nurse cannot change. With this in mind, the nurse develops a comfort care plan, which aims to enhance comfort over a measurement of baseline comfort (Peterson & Bredow, 2019). When patients’ comfort is improved, they can engage more in health-seeking behaviors. The Comfort theory can address the diabetes issue by having nurses identify patients’ needs that have not been met, such as education, nutrition, and exercise needs (Peterson & Bredow, 2019). Nurses can then develop a comfort care plan for patients with diabetes. When the comfort is improved, patients can engage more in healthy behaviors such as physical exercises and attending diabetes clinics.
Papatheodorou, K., Banach, M., Bekiari, E., Rizzo, M., & Edmonds, M. (2018). Complications of Diabetes 2017. Journal of diabetes research, 2018, 3086167. https://doi.org/10.1155/2018/3086167
Peterson, S., & Bredow, T. S. (2019). Middle range theories: Application to nursing research and practice. Lippincott Williams & Wilkins.
Inconsistent clinical care of vulnerable populations in the Emergency Department is the practice issue. One identified vulnerable population is the homeless. “Homeless patients are a unique patient population with high occurrence of inappropriate emergency department utilizations” (Holmes et al., 2020). Lack of knowledge base can be identified as one reason for the gaps in the patient care received. Brown and Steinman (2013) concluded the ED care of the older homeless adult differ from the ED care of the younger homeless adult.
The American Association of Critical Care Nurses Synergy Model of Patient Care and Benner’s Professional Advancement Model are the two middle range theories that are most valuable in addressing this issue. The Synergy model basic concept is that the patient’s needs and their level of need will determine the competencies the nurse needs to develop a synergistic patient-nurse relationship. The more competent the nurse the more valuable the relationship and patient outcomes. The synergy model characteristic of patient vulnerability requires the nurse to be competent as a moral agent and advocate for the patient. Benner’s competency based theory of professional advancement describes the stages of the nurse knowledge based on the skills that the nurse has achieved. The more advices the knowledge and practice of the nurse helps to prepare the nurse to collaborate and advocate for the homeless patient in the community and within the health care system.
American Association of Critical-Care Nurses. Appendix C: the synergy model. In: Standards for Acute and Critical Care Nursing Practice. Aliso Viejo, CA: American Association of CriticalCare Nurses; 2000: 47-55.
Brown, R. T., & Steinman, M. A. (2013). Characteristics of Emergency Department Visits by Older Versus Younger Homeless Adults in the United States. American Journal of Public Health, 103(6), 1046–1051. https://doi-org.ezp.waldenulibrary.org/10.2105/AJPH.2012.301006
Holmes, C. T., Holmes, K. A., MacDonald, A., Lonergan, F. R., Hunt, J. J., Shaikh, S., Cheeti, R., D’Etienne, J. P., Zenarosa, N. R., & Wang, H. (2020). Dedicated homeless clinics reduce inappropriate emergency department utilization. Journal of the American College of Emergency