NURS 8114 Exploring Middle Range Theories and Framing Practice Issues
NURS 8114 Exploring Middle Range Theories and Framing Practice Issues
Nursing is a gratifying profession, but the benefits are not straightforward. Typically, nursing care is awash with practice issues that nurses working in different specialties must overcome to achieve their performance targets. They must also understand the evidence-based practice (EBP) essentials and adopt practices that are based on evidence. Among many obligations, nurses should use their educational knowledge and clinical expertise to address practice issues. These issues range from problems hampering patient care, interprofessional collaboration hitches, and organization-wide challenges. The purpose of this discussion is to explore my practice issues and middle-range theories valuable in addressing the issue.
Explanation of the Practice Issue
Mental health practice is complex due to the multifaceted nature of mental health problems among patients and nursing practitioners. Statistics show that nearly 50 million Americans have a mental health problem, and the rates continue to rise over time (Mental Health America, 2022). The high rates of mental health problems lead to a proportional increase in patients seeking mental health support in health care settings. Increased hospital visits increase nurses’ workload leading to burnout. Vincent-Höper et al. (2020) found that nurse burnout is a leading cause of workplace violence among nurses. As a result, the focus problem is the impact of workplace violence among psychiatric mental health professionals. In the current practice, about 40%-65% of nurses in psychiatric care experience workplace violence (Konttila et al., 2020). From a practice viewpoint, workplace violence among nurses has detrimental effects on nurses’ mental health and well-being. It leads to exhaustion, depression, and insomnia and reduces nurses’ ability to cope with workplace stress (Konttila et al., 2020). Due to the far-reaching effects of workplace violence, it is crucial to investigate its effects in the current setting and suggest practical, lasting solutions that match its severity.
Valuable Middle-Range Theories
Nurses apply many theoretical concepts to address different practice issues. Theories provide widely researched knowledge-based concepts that define nursing and health care processes. A suitable middle-range theory to address workplace violence and aggressive behaviors among nurses is Katharine Kolcaba’s theory of comfort. Kolcaba conjectured that the desirable outcomes of nursing care could only be achieved when health care professionals place comfort at the center of nursing care (Oliveira et al., 2020). The implication is that nurses must meet patients’ comfort needs to enable them to experience relief and ease. In the same view, nurses cannot provide optimal care if they do not work in environments that guarantee comfort. Like patients, nurses need comfort, which can be achieved by ensuring they work in environments free from violence and related behaviors.
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Imogene King’s theory of goal attainment is another middle-range theory valuable for addressing the practice issue. King depicted patient care as a collaborative practice where nurses and patients identify problems together, set mutual goals, and work together to achieve these goals (Butts & Rich, 2021). Since goal setting and attainment require collaboration, nurses must be optimally healthy to play their part effectively. As middle-range theories, the theory of comfort and goal attainment theory focuses on a limited dimension of nursing. They illustrate how nursing care can be improved through concrete and specific concepts hence their suitability in exploring the practice problem in-depth and providing a guidance on how to address it.
Practice problems necessitate different solutions depending on their scope and intensity. Workplace violence is prevalent in nursing and hampers psychiatric mental health nurses’ health, well-being, and ability to provide optimal care. Middle-range theories suitable for addressing the problem include Katharine Kolcaba’s theory of comfort and Imogene King’s goal attainment theory.
Butts, J. B., & Rich, K. L. (2021). Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning.
Konttila, J., Kähkönen, O., & Tuomikoski, A. M. (2020). Nurses’ experiences of workplace violence in psychiatric nursing: A qualitative review protocol. JBI Evidence Synthesis, 18(9), 2025-2030. doi: 10.11124/JBISRIR-D-19-00254
Mental Health America. (2022). The state of mental health in America. https://mhanational.org/issues/state-mental-health-america
Oliveira, S. M. D., Costa, K. N. D. F. M., Santos, K. F. O. D., Oliveira, J. D. S., Pereira, M. A., & Fernandes, M. D. G. M. (2020). Comfort needs as perceived by hospitalized elders: An analysis under the light of Kolcaba’s theory. Revista Brasileira de Enfermagem, 73. https://doi.org/10.1590/0034-7167-2019-0501
Vincent-Höper, S., Stein, M., Nienhaus, A., & Schablon, A. (2020). Workplace aggression and burnout in nursing-the moderating role of follow-up counseling. International Journal of Environmental Research and Public Health, 17(9), 3152. https://doi.org/10.3390/ijerph17093152
Nurses play an important role in the promotion of optimum health and wellbeing of the diverse populations that they serve. Nurses constantly explore issues in their practice that influence care outcome. An issue of interest for me is the low retention rates of nurses that work in the intensive care units. The existing evidence shows that most ICU nurses experience work in a complex environment characterized by the increased need to address the care needs of acutely ill patients. The nurses are also predisposed to occupational stress because of the decisions they must make regularly to promote the health of their patients. There is also the issue of high workload among the ICU nurses, which increase their risk of burnout, low job dissatisfaction, and high turnover rates (Xu et al., 2023). I am interested in learning about the factors that contribute to low retention rate among ICU nurses in the practice site. The information will inform the strategies adopted to improve their retention rates in the organization as well as other institutions globally.
Middle range theories may help me investigate the issue of low retention rate among ICU nurses. One of the middle range theories that may inform the investigation of the topic is the health belief model. The health belief model is a framework that explains how individuals change their behaviors. It asserts that factors such as perceived severity, cues to action, and perceived barriers may affect behavioral change (Green et al., 2020). These factors may also influence the retention rates among nurses since they are likely to engage in specific behaviors based on their subjective experiences in their organizations. For example, ICU nurses leave their organizations if they perceive an increased risk to poor mental health status due to increasing demands in their caring roles.
The other middle range model that may influence the investigation is the behavioral system model by Dorothy Johnson. The behavioral system model asserts that individuals or systems have purposeful, individualized, and repetitive ways that influence behaviors. The model recognizes the need for the adoption of strategies that promote effective and efficient functioning in health organizations to achieve optimum outcomes. The model can enable the understanding of determining factors for individual’s functioning, including motivation in healthcare systems (Alligood, 2021). For example, system considerations such as providing ICU nurses with a nurturing environment and stimulating their personal and professional growth contribute to their increased job satisfaction and reduction in reduction in their turnover rates.
Alligood, M. R. (2021). Nursing Theorists and Their Work E-Book. Elsevier Health Sciences.
Green, E. C., Murphy, E. M., & Gryboski, K. (2020). The Health Belief Model. In The Wiley Encyclopedia of Health Psychology (pp. 211–214). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781119057840.ch68
Xu, G., Zeng, X., & Wu, X. (2023). Global prevalence of turnover intention among intensive care nurses: A meta-analysis. Nursing in Critical Care, 28(2), 159–166. https://doi.org/10.1111/nicc.12679
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.
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.