NURS 8114: Exploring Middle Range Theories and Framing Practice Issues
Nursing is a rewarding but often challenging job. Nurses face various problems in their daily work, which can affect patient care, teamwork, and the overall functioning of healthcare organizations. To tackle these issues, nurses must use their education and experience to apply evidence-based practices. These problems can range from difficulties in patient care to issues with working together as a team or larger challenges within the organization. In this discussion, we will delve into my specific practice issue and look at middle-range theories that can help address it.
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Understanding the Practice Issue
Working in mental health care can be complicated due to the complex nature of mental health issues. Statistics show that nearly 50 million Americans have mental health problems, and these numbers continue to grow (Mental Health America, 2022). More people seeking mental health support means more work for nurses, which can lead to burnout. Research by Vincent-Höper et al. (2020) has found that nurse burnout is a major factor contributing to workplace violence among nurses. Therefore, our focus is on the impact of workplace violence on psychiatric mental health professionals. Currently, about 40%-65% of nurses in psychiatric care experience workplace violence (Konttila et al., 2020). Workplace violence has significant negative effects on the mental health and well-being of nurses. It can lead to exhaustion, depression, and insomnia, making it difficult for nurses to cope with the stress of their work (Konttila et al., 2020). Given these serious consequences, it’s essential to thoroughly investigate the effects of workplace violence in our current setting and propose effective, long-term solutions that match the severity of the issue.
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Relevant Middle-Range Theories
Nurses use various theories and concepts to address different practice issues. Theories provide a solid foundation of knowledge that guides nursing and healthcare processes. One middle-range theory that can help address workplace violence and aggressive behaviors among nurses is Katharine Kolcaba’s theory of comfort. Kolcaba’s theory suggests that the best outcomes in nursing care can be achieved when healthcare professionals prioritize the comfort of patients (Oliveira et al., 2020). This implies that nurses need to address patients’ comfort needs to provide relief and ease. But, nurses themselves also require comfort, which can be achieved by ensuring they work in environments free from violence and related behaviors.
Another valuable middle-range theory for addressing this practice issue is Imogene King’s theory of goal attainment. King’s theory views patient care as a collaborative effort in which nurses and patients work together to identify problems, set mutual goals, and achieve those goals as a team (Butts & Rich, 2021). Since goal setting and attainment involve collaboration, nurses must be in good health to effectively play their part. Middle-range theories like the theory of comfort and the goal attainment theory focus on specific aspects of nursing care. They provide concrete concepts and are well-suited to explore the practice problem in-depth, offering guidance on how to address it effectively.
In Conclusion
Practice problems in nursing require different solutions depending on their nature and scope. Workplace violence is a prevalent issue in nursing, especially for psychiatric mental health nurses, and it can have severe effects on their health, well-being, and ability to provide quality care. Middle-range theories like Katharine Kolcaba’s theory of comfort and Imogene King’s theory of goal attainment provide valuable tools for addressing this problem.
References
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 a crucial role in ensuring the health and well-being of the diverse populations they serve. In their practice, nurses often encounter issues that impact the quality of care they provide. One particular concern that has caught my attention is the low retention rates of nurses in intensive care units (ICUs). Existing evidence shows that ICU nurses work in a complex environment, tending to the needs of acutely ill patients. They also face occupational stress due to the critical decisions they must make to ensure their patients’ health. Additionally, high workload in ICUs increases the risk of burnout, leading to low job satisfaction and high turnover rates (Xu et al., 2023). I’m interested in understanding the factors contributing to this low retention rate among ICU nurses at my practice site. This information will help develop strategies to improve their retention rates, not only within the organization but also globally.
To investigate the issue of low retention rates among ICU nurses, I believe that middle-range theories can provide valuable insights. One such theory is the Health Belief Model. This model explains how individuals change their behaviors and posits that factors like the perceived severity of a situation, cues to action, and perceived barriers can influence behavioral change (Green et al., 2020). These factors may also play a role in the retention rates of nurses since their decisions to stay or leave may be influenced by their subjective experiences within the organization. For instance, ICU nurses might leave if they perceive an increased risk to their mental health due to the growing demands in their caregiving roles.
Another middle-range theory that could inform the investigation is the Behavioral System Model by Dorothy Johnson. This model emphasizes that individuals or systems have purposeful, individualized, and repetitive ways that influence behavior. It recognizes the importance of adopting strategies that promote effective and efficient functioning within healthcare organizations to achieve optimal outcomes. This model can help us understand the factors that determine an individual’s functioning, including motivation in healthcare systems (Alligood, 2021). For example, system considerations such as providing ICU nurses with a nurturing environment and opportunities for personal and professional growth can contribute to increased job satisfaction and reduced turnover rates.
In conclusion, ICU nurses play a vital role in healthcare, and understanding the reasons behind their low retention rates is essential. Middle-range theories like the Health Belief Model and the Behavioral System Model can provide valuable perspectives for investigating and addressing this issue, ultimately improving the retention rates of ICU nurses in various healthcare settings.
References
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
The nursing practice is greatly concerned with diabetes-related complications. Managing diabetes in many patients has proven to be quite challenging, leading to an increase in complications. Some of the most common complications include cataract-induced blindness, cardiovascular diseases, neuropathy, kidney diseases, and lower-extremity amputations (Papatheodorou et al., 2018). These complications have become a significant cause of higher illness and death rates among individuals with diabetes. Moreover, they impose a substantial economic burden on the US healthcare system.
Two middle-range theories that are particularly valuable in addressing complications related to diabetes are the Health Promotion Model and the Comfort Theory. The Health Promotion Model explains the various factors that determine whether a person engages in health-promoting behaviors. These factors include cognitive-perceptual elements, modifying factors, and cues to action (Peterson & Bredow, 2019). By applying the Health Promotion Model, we can understand the attitudes and beliefs of patients regarding diabetes and their perceived vulnerability. The model can also be used to modify the cognitive-perceptual factors of patients to enhance their health-promoting behaviors (Peterson & Bredow, 2019). This, in turn, can improve their self-management of diabetes and their inclination to seek healthcare, ultimately leading to better health outcomes.
On the other hand, the Comfort Theory involves nurses identifying the unmet needs of patients. These needs are influenced by dominant variables, which are factors that the nurse cannot change. With this understanding, nurses develop a comfort care plan to enhance comfort compared to a baseline measurement (Peterson & Bredow, 2019). When patients’ comfort is improved, they are more likely to engage in health-seeking behaviors. The Comfort Theory can address diabetes-related complications by enabling nurses to identify unmet needs among patients, such as education, nutrition, and exercise requirements (Peterson & Bredow, 2019). Nurses can then create a comfort care plan tailored to the specific needs of patients with diabetes. As comfort improves, patients are more likely to participate in healthy activities like physical exercise and attending diabetes clinics.
References
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.
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