DNP 815 Conduct a literature search in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) using the terms middle range theory, mid-range theory, and nursing

According to Risjord (2019) a middle-range theory shows how the phenomenon is brought about by analyzing the phenomenon into parts and identifying their relationships. This means that to understand a middle-range theory what it tells us, how it might be tested, what interventions it might support we must identify: (a) the phenomenon modelled, (b) the elements of the model and their properties, and (c) the relationships it postulates .The author went on to posit that significant advantage of representing a middle-range theory as a model is that it highlights the ways that the model may be significantly tested. If the model is operationalized and reasonably precise, the relevant test would measure or otherwise observe whether the elements change in the way that the model predicts.

These concepts can be related and integrated with Orem’s theory of nursing of self-care in hypertensive patients. These theories and models are for behavioral change, counselling skills, patient advocacy, empowerment, professional knowledge, health education and support form the nursing system in hypertension care which the nurse brings into the encounter with the patient. The patient brings certain attitudes and beliefs, a view of health, need for autonomy, their own personality and traits, perceived vulnerability, hardiness, a sense of coherence, locus of control, self-efficacy, and social support and network into the encounter. All these factors affect behavior and thus the patients’ habits. (Drevenhorn, 2018). During these consultations these concepts are integrated with Orem’s theory of nursing of self-care, whereby nurses can apply the theories and models for behavioral change in the consultation and using counselling skills, patient advocacy, empowerment, professional knowledge and health education, to support the patient. The middle-range theory could be easily adopted to nursing research or practice in various but specific areas of focus. (Im E,2018). Because of inherent characteristics of middle-range theories that address specific phenomena or concepts, middle-range theories could easily provide directions for nursing research and practice.

References

Drevenhorn E. (2018). A Proposed Middle-Range Theory of Nursing in Hypertension Care. International journal of hypertension, 2018, 2858253. https://doi.org/10.1155/2018/2858253

Im E. O. (2018). Theory Development Strategies for Middle-Range Theories. ANS. Advances in nursing science, 41(3), 275–292. https://doi.org/10.1097/ANS.0000000000000215

Risjord M. (2019). Middle-range theories as models: New criteria for analysis and evaluation. Nursing philosophy : an international journal for healthcare professionals, 20(1), e12225. https://doi.org/10.1111/nup.12225

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS DNP 815 Conduct a literature search in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) using the terms middle range theory, mid-range theory, and nursing:

Using the middle range theory and nursing search in CINAHL, I found an article about hypertension care. A middle-range theory in hypertension care was developed to pilot and mentor nurses in their practice to improve patient care. The concepts of self-care, coping, adherence, communication, and shared decision-making are interlaced with Orem’s theory of nursing. Nursing in hypertension care involves measuring and monitoring blood pressure, lifestyle changes, patient counseling, and the provider’s translator. Medication compliance and lifestyle modification express self-care.

A middle-range theory is developed from practice and research, and other theories can also be incorporated. The development process includes a comprehensive review and literature search to look for concepts reflecting lifestyle change counseling and taking medications to assist an individual in self-care, including citing original literature. Self-care is an act of individuals who has the capability to take care of themselves in their environmental situations (Drevenhorn, 2018). Self-care for health promotion requires that individuals have the ability to take care, sustain and improve their own’s health. Orem’s self-care deficit theory of nursing is incorporated as a natural component in the proposed middle-range theory, and it arises when the capabilities of self-care are not meeting the demands due to existing limitations. The nursing supportive-educative system agencies help patients regain their self-care.

DNP 815 Conduct a literature search in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) using the terms middle range theory, mid-range theory, and nursing

Drevenhorn, E. (2018). A Proposed Middle-Range Theory of Nursing in Hypertension Care. International Journal of Hypertension, 1–11. https://doi-org.lopes.idm.oclc.org/10.1155/2018/2858253

Nursing in hypertension care comprises counseling about lifestyle changes, blood pressure measurement, and being a translator for the physician. My literature search in CINAHL using the terms middle range theory and nursing resulted in many articles from which I chose an article written by Drevenhorn, E. (2018) on A Proposed Middle-Range Theory of Nursing in Hypertension Care. This study aimed to determine the effectiveness of a nurse’s caring relationship according to Watson’s Caring Model of blood pressure and quality of life and Orem’s self-care deficit theory. According to Drevenhorn, E. (2018), there are not many guidelines available to nursing; therefore, the development of a middle-range theory of nursing in hypertension care was developed to guide nurses in their practice, improve the nursing of patients, and design studies for investigating nursing in hypertension care. Patients’ attitudes and beliefs toward health and sickness, autonomy, personality and traits, level of perceived vulnerability, hardiness, sense of coherence, locus of control, self-efficacy, and access to social support and network were presented. Use of counseling skills, patient advocacy, empowerment, professional knowledge, health education, and support of patients was discussed as the nursing application of theories and models for behavioral change. Orem’s nursing theory was integrated with the concepts of consultation, including communication, shared decision-making, concordance, coping, adherence, and self-care Drevenhorn, E. (2018). The results support the middle-range hypothesis of self-care for chronic illness. Strategies and education to improve self-efficacy, health motivation and knowledge must be incorporated when designing self-care programs. Patients can participate in nursing interventions with their family members might facilitate improving self-care. Self-care was significantly correlated with learning, health motivation, self-efficacy, social support, and access to care. The studies showed that self-efficacy, health motivation, and knowledge influenced blood pressure. For patients, changing their lifestyle includes performing activities of daily living, including performing self-care.

Drevenhorn, E. (2018). A Proposed Middle-Range Theory of Nursing in Hypertension Care. International Journal of Hypertension, 1–11. https://doi-org.lopes.idm.oclc.org/10.1155/2018/2858253

As the struggle continues to reduce the readmission rates for heart failure patients, it was great to be able to use an article that highlights heart failure. My literature search in CINAHL using the terms middle range theory and nursing resulted an article written by da Silva et al, (2022), this article explains how Heart Failure has become a major health problem and has over 2millions cases diagnosed each year. A study done in Europe shared the main caused is lack of medication compliance, poor control of appropriate diet intake and infection. The article suggest that nursing theories were developed to aid in the understanding of nursing phenomenon. Also, that middle age theories are founded from the construction of knowledge and practice strength. It defines middle age theory as focused concepts and gave Sister Callista Roy Adaptation Theory as an example. The objective was to develop a middle range theory that would address the lack of knowledge surrounding heart failure patients. One they were able to define the Adaptation model as an approach that looks at the person in an wholistic way, they say how it individualized the input, output, trigger and controls of the elements that cause heart failure. They concluded with the support of the theoretical approach to guiding nursing judgment required for knowledge gain. This knowledge will improve heart failures quality of life through individualized interventions.

da Silva, C. G., Santana de Araújo, S., Ramalho Vasconcelos Morais, S. C., & Farias de Queiroz Frazão, C. M. (2022). Impaired knowledge in individuals with heart failure: a middle range nursing theory. Revista Brasileira de Enfermagem, 75(2), 1–6. https://doi-org.lopes.idm.oclc.org/10.1590/0034-7167-2020-0855

According to Jacqueline Fawcett (2015) Middle range nursing theories are necessary for the advancement of the discipline and the development of middle range theory is based on the need of dealing with compulsory phenomena in context to any conceptual model while dealing with limited aspect of the reality. That is why middle range theories are particular of dealing with conceptual models containing some aspects of the reality.

In the development process, three different approaches are described in this article. For instance, the first approach regarding the development of mid – range theories were the identification of the conceptual model and the need of mid-range theory. To better understand the connection approach between the conceptual model and the mid-range theory the Kings’ conceptual system can be considered. This system devised a logical connectivity between the concept and the need of mid-range theory. The logic is based on the world view dealing with reactions, reciprocal interactions and actions taken simultaneously (Fawcett, 2015).

The second approach adopted in the development of mid-range theories is linking of an existing mid-range theory with the conceptual model. For instance, the need to create link between nursing theory of uncertainty in disease and the behavioral system model of Johnson can serve as an example of the approach. In this developmental approach the problematic area is the lack of logical congruent between the conceptual model and the world view related to nursing theory. It is because of the fact the appearance of logical congruence would result when there appears similarity between the conceptual model and the selected nursing theory (Fawcett, 2015).

The third effective approach adopted in the development of mid-range nursing theories deals with the development of link between the existing mid-range theory adopted from non-nursing discipline and the conceptual model of nursing. For instance, the connectivity between the famous theories of planned behavior from social philosophy and Orem self-care model. The problem in this approach is the lack of logical congruence in terms of reviewing the conceptual model in accordance to world view and the derivation of the theory.

References

Fawcett, J. (2015). Middle range nursing theories are necessary for the advancement of the discipline. SCiELO, 1657-5997.

Mgbekem,M. and Neji,O. (2018). Middle range theory evaluation: bridging the theory-practice gap. Global Journal of Pure and Applied Sciences, 249-254.

Risjord, M. (2018). Middle-range theories as models: New criteria for analysis and evaluation. Nursing Philosophy, 1-10.

As said by Brandão et al. in 2019, middle-range nursing theories are theories derived from the manipulation and translation of concepts from other parent theories to best fit the current ideology or topic at the time (Brandão et al., 2019). This learner found an article done by Paul in 2020 that went over the development of a theory regarding wound itch. In this article, Paul stated that theory derivation was the process utilized in the development of this theory, which is described as a method to arrive at an explanation regarding a phenomenon with very little priorly found information from literature or studies. There is a process for this though. The author had to become very acquainted with the topic, studying various theories to pick a parent theory for derivation, and taking those concepts and altering them to fit the current topic. The author mentioned that taking a parent theory and redefining the concepts to build a middle-range theory is termed subconstruction. The author goes on to talk about how statement derivation was also utilized to create the theoretical propositions, which means developing statements utilizing analogies. After this, there was the concept synthesis and derivation in which the author had to be well-versed in the existing literature and understand the qualitative approach to itching wounds. The author determined in this that the concepts of skin integrity disruptions, protection, and continuity were the main points that affected wound itch. The theory boiled down to the protection, regulation, and continuity of wounds helps to prevent and control wound itch, which will further protect the client from furthering the disruption of skin integrity, thus stopping the cycle of wound degradation (Paul, 2020).

References

Brandão, G., Mercês, M., Lopes, O., Martins, S., Souza, A., & Primo, C. (2019). Concept Analysis Strategies for the Development of Middle-Range Nursing Theories. Texto & Contexto Enfermagem, 28, 1–12. https://doi-org.lopes.idm.oclc.org/10.1590/1980-265X-TCE-2018-0390

Paul, J. C. (2020). Development of the middle-range theory of wound itch. British Journal of Nursing, 29(20), S32–S37. https://doi-org.lopes.idm.oclc.org/10.12968/bjon.2020.29.20.S32

Nurses in all aspects of patient care deal with patients who have hypertension. Even though there are theories based on chronic illness and self-care, there is not a framework for hypertension specifically. In a study by Drevenhorn (2018), it was determined that even though some models could be used as a reference, a middle-range theory in hypertension was needed to help guide nursing practice. A literature search was the first step to finding concepts on lifestyle change and how to help patients perform self-care and take medications appropriately for hypertension. Multiple concepts were determined:

· Attitudes and beliefs on health and illness: This concept is about the patient’s ability and wiliness to make necessary changes to their lifestyle and medical needs.

o Autonomy

o Personality and traits

o Vulnerability

o Hardiness

o Sense of Coherence

o Loss of Control

o Self-Efficacy

o Social Support and Network

· Concepts Related to Nursing in Hypertension Care: This concept discusses what is essential in the nursing care of patients with hypertension.

o Theories and Models for Behavioral Change

o Counselling Skills

o Patient Advocacy

o Empowerment

o Professional Knowledge

o Health Education

o Support

· Concepts related to Consultation and the Expected Outcome: This concept discusses the importance of communication from the nurse to the patient and then the patient’s decision to follow through with the self-care elements necessary to make necessary changes.

o Communication

o Shared Decision-Making and Concordance

o Coping

o Adherence

o Self-Care

· Integration with existing theory of nursing: Orem’s Self Care Deficit Theory of nursing was used as a basis for this theory of Nursing in Hypertension Care and is relevant in teaching the patient the skills needed for self-care.

This proposed theory would provide a framework for all nurses caring for patients. It allows the nurse to have the ability to work with a patient with hypertension to determine their ability and willingness to change, their support systems, and their determination to make positive change. As a nurse dealing with patients, we must have the knowledge needed to provide education, support, and empower our patients to have the courage for self-care and success while incorporating current nursing theories on self-care.

References

Drevenhorn, E. (2018). A Proposed Middle-Range Theory of Nursing in Hypertension Care. International Journal of Hypertension, 1–11. https://doi-org.lopes.idm.oclc.org/10.1155/2018/2858253

DNP 815 Conduct a literature search in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) using the terms middle range theory, mid-range theory, and nursing