Peer Responses
Lucy Kelechi Ukachukwu
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: Peer Responses.
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 Penfold
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/
ORDER A PLAGIARISM-FREE PAPER HERE
We’ll write everything from scratch
Question 
Lucy Kelechi Ukachukwu
Initial Post:
Practice Issue: Medication Non-Adherence in Incarcerated Populations
One significant practice issue I’ve encountered as a psychiatric mental health nurse practitioner in correctional settings is medication non-adherence among incarcerated individuals with chronic mental illness. This issue is complex, influenced by factors such as mistrust in healthcare providers, stigma, cognitive impairment, side effects, and limited health literacy. Incarcerated patients often have co-occurring disorders and may
resist treatment due to past trauma, limited insight, or lack of engagement in care planning. Given the increased risk for relapse, self-harm, and recidivism, addressing medication adherence in this population is not only a clinical concern but a public health priority.
Selected Middle-Range Theories: To address this issue, I have selected Kolcaba’s Comfort Theory and the Middle-Range Theory of Self and Family Management of Chronic Illness by Schulman-Green et al. (2023). These theories offer practical frameworks to guide patient-centered interventions in mental health management within correctional environments.
Kolcaba’s Comfort Theory: Kolcaba’s theory defines comfort as the immediate experience of being strengthened through meeting the needs for relief, ease, and transcendence across physical, psychospiritual, sociocultural, and environmental contexts (McEwen & Wills, 2022). Although often applied in palliative care, the theory is versatile in guiding care for patients with persistent distress, such as those with untreated or poorly managed psychiatric symptoms.
Application Example: In correctional settings, improving comfort may involve managing side effects proactively (physical relief), addressing fears related to mental illness and stigma (psychospiritual ease), and creating therapeutic rapport despite environmental limitations (sociocultural and environmental comfort). For example, structured psychoeducation groups can help inmates understand the benefits and side effects of medications, enhancing perceived comfort and trust. Routine symptom check-ins and trauma-informed care practices may further alleviate anxiety and reinforce treatment engagement.
Theory of Self and Family Management of Chronic Illness
Schulman-Green et al. (2023) describe self-management as a dynamic and collaborative process involving the patient and often family or support networks in managing symptoms, treatment, and lifestyle changes. Although family involvement may be limited in correctional settings, the self-management concept still applies. This theory highlights contextual factors (e.g., environment, resources), process factors (e.g., decision-making, goal setting), and outcomes (e.g., symptom control, quality of life).
Application Example: Applying this theory, providers can use motivational interviewing to explore inmates’ beliefs about medications and co-create adherence goals.
Correctional nurses could facilitate brief one-on-one sessions focused on identifying barriers to adherence (e.g., side effects, distrust), then collaborate with the care team to tailor interventions. Even in isolated environments, digital mental health tools, journaling, or peer support groups could act as proxy “family systems,” fostering agency and accountability.
Conclusion: By combining Comfort Theory and the Self-Management Theory, clinicians can holistically address non-adherence by enhancing both comfort and autonomy.
These frameworks provide structure to assess barriers and implement strategies that are realistic within the constraints of correctional psychiatry. Ultimately, middle-range theories such as these bridge the gap between high-level nursing philosophy and real world clinical practice, offering nurse practitioners practical tools to promote sustainable patient outcomes.
References:
McEwen, M., & Wills, E. M. (2022). Theoretical basis for nursing (6th ed.). Wolters Kluwer.
Schulman-Green, D., Feder, S. L., David, D., Rada, L., Tesfai, D., & Grey, M. (2023). A middle range theory of self- and family management of chronic illness. Nursing Outlook, 71(3), Article 101985. https://doi.org/10.1016/j.outlook.2023.101985
Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort theory: A unifying framework to enhance the practice environment. The Journal of Nursing Administration, 36(11), 538– 544. https://doi.org/10.1097/00005110-200611000-00010
TP Terri-Ann Penfold
Practice issue
A significant practice issue I have noted in the catheterization lab (Cath lab) is the management of patients’ comfort during cardiac interventional procedures. Pain and anxiety are common experiences for patients undergoing procedures in the cath lab.
According to The American Society for Pain Management “nurses should advocate and intervene based on the needs of the patient, setting, and situation to provide optimal comfort management before, during, and after procedures” (Czarnecki et al., 2011).
Management of comfort during procedures is important as it reduces stress and anxiety, enhances satisfaction, and improves patient outcomes, leading to better recovery and treatment compliance.
Middle-range theories
Middle-range theories are nursing theories that provide practical, specific guidelines to instruct the practice of nursing. Two middle-range theories I have selected to address the issue of patient comfort during procedures are Kolcaba’s theory of comfort (McEwen & Wills, 2022) and Good and Moore’s theory of acute pain management (Good & Moore, 1996).
Kolcaba’s theory of comfort focuses on how to provide patient comfort by addressing their physical, psychological, and environmental needs. The theory suggests that when patients’ comfort is addressed, they are more likely to participate in their healthcare and experience satisfaction with their care (Lin et al., 2023). Comfort is a primary objective for most patients and is often the personal focus of their procedure. Regardless of
outcome, patients will express satisfaction with their procedure if their comfort needs are addressed.
Cath lab nurses can apply this theory to develop care plans that incorporate comfort-enhancing interventions tailored to meet the needs of patients.
Comfort interventions can include sedation or non-pharmacological measures such as explanation of procedures, therapeutic communication, warm blankets, or music choices to help alleviate patient fear and anxiety. The advantage of Kolcaba’s theory is that it is measurable and attainable. Through verbal rating scales and patient satisfaction surveys, comfort interventions can be analyzed and modified as needed to
ensure patients’ needs are met.
The second theory cath lab nurses can use to address patients’ comfort during procedures is Good and Moore’s theory of acute pain management. The theory of acute pain management focuses on achieving a balance between analgesia and side effects.
This theory, derived from practice guidelines, emphasizes a multi-faceted approach to pain management strategies that include medication, physical and psychological interventions” (Good & Moore, 1996). An integral part of utilizing the theory and assessing the effectiveness is to frequently assess the patient’s pain levels and side effects from medication.
The use of middle-range nursing theories is helpful because they provide a framework for addressing issues in nursing practice from real-world situations. By applying middle range nursing theories to the issue of patient comfort during procedures, nurses in cath labs can enhance their ability to provide safe, individualized care, leading to improved patient outcomes and satisfaction.
Peer Responses
References
Czarnecki ML, Turner HN, Collins PM, Doellman D, Wrona S, Reynolds J. Procedural pain management: a position statement with clinical practice recommendations. Pain Manag Nurs. 2011 Jun;12(2):95-111. doi: 10.1016/j.pmn.2011.02.003. Epub 2011 Apr 29. PMID: 21620311.
Good M, Moore SM. Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nurs Outlook. 1996 Mar-Apr;44(2):74-9. doi: 10.1016/s0029-6554(96)80053-4. PMID: 8722673.
Lin, Y., Zhou, Y. & Chen, C. Interventions and practices using Comfort Theory of Kolcaba to promote adults’ comfort: an evidence and gap map protocol of international effectiveness studies. Syst Rev 12, 33 (2023). https://doi.org/10.1186/s13643-023-02202-8
McEwen, M., & Wills, E. M. (2022). Theoretical basis for nursing (6th ed.). Wolters
Kluwer.
Ronak Delewi , Wieneke Vlastra , Wim J. Rohling , Tineke C. Wagenaar , Max Zwemstra , Martin G. Meesterman , Marije M. Vis , Joanna J Wykrzykowska , Karel T. Koch , Robbert J. de Winter , Jan Baan Jr. , Jan
J. Piek , Mirjam A.G. Sprangers , José P.S. Henriques. Anxiety levels of patients undergoing coronary procedures in the catheterization laboratory. International Journal of Cardiology 228 (2017) 926-930. https://doi.org/10.1016/j.ijcard.2016.11.043
SX Satyne Kiara Xu
6/3/25, 9:38 PM Topic: Week 2: Discussion
Jun 3 6:21pm
Practice Issue: Gaps in Continuity of Care for Homeless Individuals with Co-Occurring Mental Illness and Substance Use Disorders
In my work on an inpatient behavioral health unit, I’ve seen a persistent issue that continues to impact outcomes for homeless patients with both mental illness and substance use disorders: the lack of continuity of care after discharge. These patients are often stabilized temporarily in the hospital, only to be discharged without secure housing, medication management, or access to community resources. This leads to
repeated hospitalizations and worsening health. I chose this issue because I’ve seen firsthand how damaging it is—and how preventable it could be with better systems and more intentional, theory-driven interventions.
Selected Middle-Range Theories
To address this, I selected Pender’s Health Promotion Model and Peplau’s Theory of Interpersonal Relations. Pender’s theory is valuable because it encourages a proactive, strengths-based approach to health. It recognizes that individuals can be motivated to change if they believe the benefits outweigh the barriers (Pender et al.,2019). This is particularly important for patients dealing with both addiction and chronic
psychiatric conditions who often feel disempowered.
Peplau’s theory focuses on building a therapeutic nurse-patient relationship, moving through four key phases: orientation, identification, exploitation, and resolution (Rasmussen et al., 2021). I chose it because trust is often a huge barrier with this population—many have experienced trauma, discrimination, and institutional neglect. Without trust, care plans often fail.
Application of Theories to Practice
Using Pender’s Health Promotion Model, I’ve learned to explore what actually motivates each patient. For instance, a recent patient with schizoaffective disorder and a long history of heroin use didn’t initially want to engage in rehab. But when I asked about his goals, he said he missed his daughter.
That emotional motivator allowed us to frame sobriety as a means to an end. I connected him with a peer support coach and a housing application service—both steps that aligned with Pender’s emphasis on increasing self-efficacy and removing barriers (Knight et al., 2022).
Peplau’s theory played a role even earlier in the process. When the same patient first arrived, he refused treatment and was highly paranoid. Through consistent, empathetic communication, I helped him move from orientation into the identification phase, where he began to trust me and other team members. That relationship became a foundation for collaborative care planning—something that would’ve been impossible without
applying Peplau’s principles (Taylor et al., 2023).
Interestingly, Kaur and Saini (2023) expand on how middle-range theories help reduce uncertainty in illness, particularly for vulnerable populations. Their analysis shows that when patients feel more in control and informed, their engagement and outcomes improve. This insight aligns directly with both theories I’ve chosen— emphasizing clear communication, predictability, and empowerment.
Supporting Research and Broader Implications
Research consistently shows that theory-informed care improves outcomes for structurally vulnerable patients. McNeil et al. (2021) found that harm-reduction models grounded in relationship-based care significantly reduced emergency visits among unhoused individuals.
Miller et al. (2020) emphasized the need for trauma-informed approaches to build trust in clinical settings—validating Peplau’s model. And while Pender’s model is often applied to chronic illness, it’s increasingly being used in behavioral health for populations with low health literacy and high social complexity.
Together, these theories provide not only structure but meaning to my work. They help bridge the gap between compassion and effectiveness—something every patient deserves.
References
Kaur, G., & Saini, M. (2023). Application of middle-range theory of Uncertainty in Illness: A concept analysis. Nursing and Midwifery Studies, 12(3), 167–172. https://doi.org/10.4103/nms.nms_32_23
Knight, K. R., Kushel, M., Abramovitz, D., & Moss, A. R. (2022). Housing and harm reduction: What is the role of supportive housing in reducing opioid overdose risk? International Journal on Drug Policy, 103, 103625.
https://doi.org/10.1016/j.drugpo.2022.103625
McNeil, R., Kerr, T., Pauly, B., Wood, E., & Small, W. (2021). Advancing patient-centered care for structurally vulnerable drug-using populations: A qualitative study. BMC Health Services Research, 21(1), 1–11. https://doi.org/10.1186/s12913-021-06031-z
Miller, V., Fields, B., & Spencer, M. (2020). Building trust through trauma-informed care: A strategy for supporting marginalized populations in clinical settings. Journal of Psychosocial Nursing and Mental Health Services, 58(7), 28–34. https://doi.org/10.3928/02793695-20200616-04
Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2019). Health promotion in nursing practice (8th ed.). Pearson.
Rasmussen, D. H., Høgsbro, K., & Kristiansen, C. B. (2021). Recovery-oriented intersectoral care for people with severe mental illness: A realist review. International Journal of Integrated Care, 21(3), 1–13. https://doi.org/10.5334/ijic.5620
Taylor, M. E., Brekke, J. S., & Simpson, G. (2023). Advancing equity in mental health care for individuals experiencing homelessness. Psychiatric Services, 74(1), 6–12. https://doi.org/10.1176/appi.ps.202200073