Peer Responses: Middle-Range Nursing Theories

Peer Responses: Middle-Range Nursing Theories

Response to Lucy 

Hi Lucy,

I appreciate your detailed and insightful conversation about people not taking their medications in correctional mental health settings. Your approach, which combines Kolcaba’s Comfort Theory and the Theory of Self- and Family Management of Chronic Illness, balances emotional care and behavioral involvement well. Considering Mishel’s Uncertainty in Illness Theory (UIT) as an extra middle-range theory could help you strengthen your approach.

UIT points out that patients react and interpret situations differently when they do not have enough information, trust, or predictability about their illness (Reinken & Reed, 2022). This theory matters most in correctional settings, where those who are incarcerated have little say in their care, must deal with different providers, and could feel unsure or confused about their treatment. UIT allows correctional nurses and mental health providers to actively reduce uncertainty by speaking, checking in regularly, and teaching about medicine’s effects and aims.

UIT’s main principles match what you mentioned about psychoeducation and trauma-informed care. Supporting inmates to think of their illness as something they can handle and predict can lower emotional stress and help them stick to their treatment. According to Bose et al., (2024)

, giving marginalized and high-risk individuals structured care helps them become more involved and improves their health.

Using UIT may also help shape policies in correctional systems by supporting consistent, reliable, and trust-building actions. These improvements can result in better patient outcomes, fewer people returning to jail, and improved relationships between nurses and patients. Since your framework is already strong, this new perspective could improve it.

References

Bose, D., Bhattacharya, R., Kaur, T., Banerjee, R., Bhatia, T., Ray, A., Batra, B., Mondal, A., Ghosh, P., & Mondal, S. (2024). Overcoming water, sanitation, and hygiene challenges in critical regions of the global community. Water-Energy Nexus, 7(56), 277–296. https://doi.org/10.1016/j.wen.2024.11.003

Reinken, D. N., & Reed, S. M. (2022). Mishel’s uncertainty in illness theory: Informing nursing diagnoses and care planning. International Journal of Nursing Knowledge, 34(4). https://doi.org/10.1111/2047-3095.12406

Response to Terri-Ann

Hi Terri-Ann,

Thank you for pointing out the significance of making patients comfortable during cardiac catheterization. Kolcaba’s Comfort Theory and Good and Moore’s Acute Pain Management Theory are practical approaches you can use to deal with both pain and anxiety. These theories prove that you focus on giving your patients personal attention and treatment based on evidence. Another way to improve your clinical framework is by including Lenz and Pugh’s Theory of Unpleasant Symptoms (TOUS).

Since TOUS views the relationships between pain, anxiety, nausea, and fatigue, it helps manage them better in hospitals (Chukwurah et al., 2020). It underlines that many factors affect discomfort, so clinicians should also look at the person’s mind, body, and surroundings.

TOUS suggests using music, blankets, and therapy for relief, and this is what you are already doing. Manda & Baradhi, (2023) found that using a symptom cluster approach made patients more comfortable and satisfied when they underwent invasive procedures. Using TOUS in the cath lab could help nurses assess patients more fully and act immediately when numerous discomforts are reported.

To further help, TOUS recommends assessing how symptoms impact a patient’s activities and abilities over time to decide on post-procedure guidance and educational strategies. This approach helps interventions during the procedure and also supports recovery and satisfaction over the long term. To include TOUS in your practice would mean changing from only addressing one symptom at a time to managing symptoms in a wider, theory-based way.

References

Chukwurah, J. N., Voss, J., Mazanec, S. R., Avery, A., & Webel, A. (2020). Associations Between Influencing Factors, Perceived Symptom Burden, and Perceived Overall Function Among Adults Living With HIV. Journal of the Association of Nurses in AIDS Care, 31(3), 325–336. https://doi.org/10.1097/jnc.0000000000000166

Manda, Y. R., & Baradhi, K. M. (2023, June 5). Cardiac Catheterization Risks and Complications. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK531461/

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Peer Responses: Middle-Range Nursing Theories

There are several different types of theories in nursing. Grand theories look at nursing from a broad perspective of human needs. In contrast, middle-range theories are narrower in focus, and look at specific aspects of the nursing profession. Due to their narrower scope, middle-range theories are more applicable for use in actual nursing practice.

Peer Responses – Middle-Range Nursing Theories

High level middle-range theories can be quite complex (for example, Benner’s “Novice to Expert Theory” and Leininger’s “Theory of Culture Care Diversity and Universality”). Less complex middle-range theories include Mishel’s “Uncertainty in Illness Theory,” Kolcaba’s “Comfort Theory,” and Lenz and Pugh’s “Theory of Unpleasant Symptoms.” Some middle-range theories are even more specifically focused. For example, Beck’s “Postpartum Depression Theory” or Eakes et al.’s “Theory of Chronic Sorrow.”

For this Discussion, you will identify a practice or organization issue of importance to you. Then, you select two middle-range theories and apply them to address the practice or organization issue.

Note: The practice issue you select will also inform your work in Week 3 (and can potentially be utilized throughout the remainder of this course).

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare
Reflect on your nursing practice to identify issues of particular interest or concern to you and/or your organization.
Select one practice or organization issue on which to focus for this Discussion.
Review the Learning Resources for this week, focusing on specific middle-range theories that may apply to the practice or organization issue that you selected.
Select two middle-range theories that you believe are relevant and valuable in addressing the practice or organization issue you selected.
By Day 3 Of Week 2
Post the following:

Identify the practice or organization issue you selected. Explain why you chose it.
Describe the two middle-range theories that you selected. Explain why you chose them.
Explain how you would apply each middle-range theory to the practice or organization issue. Be specific and provide examples.
Note: Your posts should be substantial (500 words minimum), supported with scholarly evidence from your research and/or the Learning Resources, and properly cited using APA Style. Personal anecdotes are acceptable as part of a meaningful post but cannot stand alone as the entire post.

Read a selection of your colleagues’ posts.

By Day 6 of Week 2
Respond to at least two of your colleagues, on different days, by suggesting at least one additional middle-range theory for each to consider. Support your recommendation with at least one scholarly resource illustrating why you think that middle-range theory might be relevant and valuable to the practice issue they selected.

Note: Your responses to colleagues should be substantial (250 words minimum), supported with scholarly evidence from your research and/or the Learning Resources, and properly cited using APA Style. Personal anecdotes are acceptable as part of a meaningful response but cannot stand alone as a response. Your responses should enrich the initial post by supporting and/or adding a fresh viewpoint and be constructive, enhancing the learning experience for all students.

Return to this Discussion in a few days to read the responses to your initial posting. Note what you have learned and/or any insights that you have gained because of your colleagues’ comments.

Including 2 Responses