Middle-Range Theories and Nursing Practice Issues
Identified Practice Issue: Nurse Burnout
One of the most critical and long-standing practice issues in modern healthcare is nurse burnout, more specifically for nurses working in high-stress environments like intensive care units, emergency departments, and COVID-19 units. Li et al. (2024) state that nurse burnout, characterized by emotional exhaustion, depersonalization, and lowered personal accomplishment, results in high turnover rates, low job satisfaction, and compromised patient safety: Middle-Range Theories and Nursing Practice Issues.
This matter matters to me personally since I have observed a number of skilled colleagues depart from their careers early because of excessive workplace stress. Among organizations, burnout results in labor shortages and higher healthcare expenses. Tackling this concern is key to supporting a strong and lasting nursing workforce.
Selected Theories
In order to create a strategy for this prevalent issue, I chose two middle-range nursing theories that suit this issue most: Kolcaba’s Comfort Theory and Mishel’s Uncertainty in Illness Theory. Kolcaba’s Comfort Theory is intended to help meet physical, psychospiritual, environmental, and sociocultural comfort needs to facilitate well-being. The intervention is based on three forms of comfort, relief, ease, and transcendence, which make it highly suitable for leading interventions that could help nurses in a holistic way (Lin et al., 2023).
Originally developed to explain patient response to illness, Mishel’s Uncertainty in Illness Theory is also applicable to the nursing staff facing uncertainty in clinical practice. It looks at the stress and psychological distress that comes from a lack of information, unpredictability, or inconclusive cues, as Reinken and Reed (2022) note. With worldwide health crises come evolving guidelines and organizational changes that leave nurses bewildered and unsupported, and the relevance of this work has grown.
Application of the Comfort Theory
Kolcaba’s theory is applicable to the creation of workplace interventions that could help reduce nurse burnout by increasing holistic comfort. Physical interventions may include making sure there are sufficient break rooms where employees can sit comfortably in ergonomic seating and have easy access to healthy refreshments (Lin et al., 2023). Psychospiritual comfort can be promoted through mindfulness sessions or on‐site counseling.
Optimizing lighting, noise control and aesthetic aspects of nurse workspaces may enhance environmental comfort. There is potential in fostering an inclusive work culture and providing diversity training to support sociocultural comfort. For instance, I have worked in several units in which implementing a “comfort cart” with snacks, stress relief tools, and encouragement messages during long shifts has had positive effects.
Application of the Uncertainty in Illness Theory
Mishel’s theory offers a framework for managing the cognitive stress that arises when nurses face uncertainty about clinical decisions, changing protocols, or administrative expectations. By increasing informational support and decreasing ambiguity, organizations can reduce the psychological toll associated with this uncertainty. Practical applications include conducting daily briefings to clarify updates, using clear and consistent communication during organizational changes, and involving nurses in policy-making processes.
For example, during the COVID-19 pandemic, nursing teams that received consistent updates from leadership and had input into PPE policies reported lower levels of distress and greater confidence in their roles (Reinken & Reed, 2022). By addressing the sources of uncertainty, this theory promotes a more informed and psychologically secure workforce.
Conclusion
Nurse burnout is a significant issue that undermines both individual well-being and organizational effectiveness. Applying the Comfort Theory and the Uncertainty in Illness Theory provides a comprehensive, evidence-based approach to addressing this challenge. Kolcaba’s theory supports the emotional and physical aspects of nurse well-being, while Mishel’s theory targets the cognitive and informational stressors that contribute to burnout. Together, these theories can guide nurse leaders in creating sustainable strategies that improve staff satisfaction, enhance retention, and ultimately lead to better patient care.
References
Li, L. Z., Yang, P., Singer, S. J., Pfeffer, J., Mathur, M. B., & Shanafelt, T. (2024). Nurse burnout and patient safety, satisfaction, and quality of care: A systematic review and meta-analysis. JAMA Network Open, 7(11), e2443059. https://doi.org/10.1001/jamanetworkopen.2024.43059
Lin, Y., Zhou, Y., & Chen, C. (2023). Interventions and practices using comfort theory of Kolcaba to promote adults’ comfort: An evidence and gap map protocol of international effectiveness studies. Systematic Reviews, 12(1). https://doi.org/10.1186/s13643-023-02202-8
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
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Question 
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.
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.
Middle-Range Theories and Nursing Practice Issues
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.