NURS 8114 Discussion Exploring Middle Range Theories and Framing Practice Issues

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NURS 8114 Discussion Exploring Middle Range Theories and Framing Practice Issues

Week 2 Discussion: Exploring Middle Range Theories and Framing Practice Issues Attachment

Nursing Practice Issue

Compassion fatigue (CF) has increased in our organization over the last year, resulting in burnout (BO) and discontent on the part of patients. A group of healthcare workers who are dedicated to helping others but neglect their own well-being work in a high-stress, complex setting. The COVID-19 pandemic has brought a number of factors that are causing concern among medical specialists. As the frontline caregivers and communicators for patients, family members, and friends, healthcare professionals face situations that make it difficult to retain personal compassion and self-care in their work. A large number of patients have been admitted to the hospital’s emergency room and inpatient units. There has been a severe lack of hospital beds, medical supplies, and patient resources. Overwhelmed, weary, scared of shortages of supplies and employees, self-care and pleasure of their job are all issues for healthcare workers with CF and BO (Watts & Thorne-Odem, 2020). Between 22% and 60% of nurses had been affected by CF or BO prior to the COVID-19 epidemic. Nearly 40% of front-line workers in the pandemic had moderate to high levels of CF, and the pandemic’s impact was 70%. (Labrague & de los Santos, 2021).

Middle Range Nursing Theories

Middle-range theories are a combination of nursing practice with nursing research. More nurses use this theory in research, they are abstract, cover a broad spectrum of nursing, and specify relations between two or more concepts (McEwen & Willis, 2019).

NURS 8114 Discussion Exploring Middle Range Theories and Framing Practice Issues Slayers

NURS 8114 Discussion Exploring Middle Range Theories and Framing Practice Issues Slayers

The theory of human caring by Jean Watson, the theory of holistic comfort by Kolcaba, and the Roy adaptation model are theories and models that will help address the issue for CF and BO.

Jean Watson’s theory of human caring focuses on both the patient and the healthcare provider; Watson believes that self-care, self-compassion, and respect are variables that must be addressed within oneself and others. This theory assesses the healthcare provider on both a personal and professional level (Durgun Ozan et al., 2020). Many hospitals, such as the magnet hospital program, are using her theory as a guide to establishing professional nursing practice change and promoting quality of care (Watson, 2009). Durgun Ozan et al. (2020) conducted a study using the theory of human caring to investigate the effect of clinical education on students’ coping and anxiety levels. Variables such as stress among nursing students were addressed by improving coping mechanisms, preparing students for new environments, and thus reducing stress and anxiety.

Katherine Kolcabas’ holistic comfort theory enhances nursing practice and establishes best practices; for nursing guides in nursing practices. According to Kolcaba (1994), comfort is “the satisfaction (actively, passively, or cooperatively) of the basic human needs for relief, ease, or transcendence arising from stressful health care situations.” She created a comfort taxonomic structure (comfort grid) that identifies the patient’s needs. The physical, psychospiritual, sociocultural, and environmental needs are all addressed (1994). They discussed the comfort grid and their findings in the study, “Application of Kolcaba’s comfort theory to the management of a patient with hepatocellular carcinoma” (Shu Hua, 20170), to establish the needs of the patient in pain under palliative care, improving patient outcomes. Caring for someone in need and responding to their needs during a stressful event improves the patient’s outcomes and how they feel cared for by healthcare professionals (McEwen & Willis, 2019; Kolcaba, 1994).

The Roy adaption model (RAM) encourages patient adaptation, which is a goal of nursing care; this theory reflects how individuals or groups respond to events in their environment. Callis (2020) talked about various nursing variables like CF and BO, their effects on patients, and poor outcomes. Roy’s theory defines nursing as a scientific and humanistic profession that believes specialized knowledge is critical to the community’s health and well-being (Hamzehpour et al., 2018). Callis (2020) discussed the application of Roy’s theory to the design and evaluation of hospital-based programs. Tea for the soul (TFS) is a theoretical framework developed by a hospital’s clergyman and social workers to address the needs of nurses in difficult situations such as bereavement. Emphasizing the importance of self-care, the well-being of patients and staff, compassion, and understanding others and their needs will help to reduce CF and BO.

Nursing theories and nursing practice complement one another. The application of nursing theories aids in the development, comprehension, and implementation of processes and procedures that benefit nursing practice. The application of theoretical frameworks provides tools for meeting the needs of healthcare professionals and others, thereby improving outcomes and patient and healthcare professional satisfaction.

References

Callis, A. M. (2020). Application of the Roy Adaptation Theory to a care program for nurses. Applied Nursing Research, 56. 

Durgun Ozan, Y., Duman, M., Çiçek, Ö., & Baksi, A. (2020). The effects of clinical education program based on Watson’s theory of human caring on coping and anxiety levels of nursing students: A randomized control trial. Perspectives in Psychiatric Care, 56(3), 621-628. 

Hamzehpour, H., Valiee, S., Majedi, M. A., Roshani, D., & Seidi, J. (2018). The Effect of Care Plan Based on Roy Adaptation Model on the Incidence and Severity of Delirium in Intensive Care Unit Patients: A Randomised Controlled Trial. Journal of Clinical & Diagnostic Research, 12(11), 21-25. 

Labrague, L. J., & de los Santos, J. A. A. (2021). Resilience as a mediator between compassion fatigue, nurses’ work outcomes, and quality of care during the COVID-19 pandemic. Applied Nursing Research, 61. 

McEwen, M., & Willis, E.M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer

Shu Hua, N. G. (2017). Application of Kolcaba’s Comfort Theory to the Management of a Patient with Hepatocellular Carcinoma. Singapore Nursing Journal, 44(1), 16-23.

Watson, J. (2009). Caring science and human caring theory: Transforming personal and professional practices of nursing and health care. Journal of Health & Human Services Administration, 31(4), 466-482.

Watts, S. A., & Thorne-Odem, S. (2020). Nursing yourself away from burnout and compassion fatigue to resilience and joy at work. Nursing Made Incredibly Easy!, 18(6), 6-8. 

Discussion: Exploring Middle Range Theories and Framing Practice Issues

You will begin this Discussion by identifying a practice issue that will be your frame of reference as you analyze the theoretical basis of nursing practice. Be aware that your choice can potentially carry through the course, as you will continue to address this issue in the context of other types of theories in Week 3. This practice issue can also be one focus of your Module 3 exploration of evidence-based practice and quality improvement, and your Module 4 investigation of a critical practice question. Consequently, as you prepare for this Discussion, think carefully about your example for connecting middle range nursing theories to patient care.

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To prepare:

  • Analyze your nursing practice for issues of particular interest or concern to you. Identify one issue as the focus of your application of theory to practice. NURS 8114 Discussion Exploring Middle Range Theories and Framing Practice Issues
  • Review the Week 2 Learning Resources to identify specific middle range theories that may apply to your practice issue.
  • Choose at least two middle range theories that might be most relevant and valuable in addressing your practice issue.
  • Search the Walden Library for scholarly articles that address application of middle range theories to practice issues.
  • Consider how to frame your focus practice issue in terms of the middle range theories that you have selected.

With these thoughts in mind …

By Day 3 of Week 2

Post an explanation of your practice issue. Then, describe two middle range theories that are most valuable in addressing this issue and explain why. Be specific and provide examples.

Read a selection of your colleagues’ posts.

By Day 6 of Week 2

Respond to at least two colleagues on 2 different days by suggesting other middle-range theories for them to consider. Support your recommendations with at least one scholarly article to share with each colleague.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 of Week 2 and Respond by Day 6 of Week 2

To Participate in this Discussion:

Week 2 Discussion

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_8114_Week2_Discussion_Rubric

Excellent

90%–100%

 Good

80%–89%

 Fair

70%–79%

 Poor

0%–69%
Main Posting:

Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
40 (40%) – 44 (44%)

Thoroughly responds to the Discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least three current credible sources.
35 (35%) – 39 (39%)

Responds to most of the Discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least three credible references.
31 (31%) – 34 (34%)

Responds to some of the Discussion question(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Cited with fewer than two credible references.
0 (0%) – 30 (30%)

Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible references.
Main Posting:

Writing
6 (6%) – 6 (6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.
5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.
4 (4%) – 4 (4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.
0 (0%) – 3 (3%)

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Posting:

Timely and full participation
9 (9%) – 10 (10%)

Meets requirements for timely, full, and active participation.

Posts main Discussion by due date.
8 (8%) – 8 (8%)

Meets requirements for full participation.

Posts main Discussion by due date.
7 (7%) – 7 (7%)
Posts main Discussion by due date.
0 (0%) – 6 (6%)

Does not meet requirements for full participation.

Does not post main Discussion by due date.
First Response:

Post to colleague’s main post that is reflective and justified with credible sources.
9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
7 (7%) – 7 (7%)
Response is on topic and may have some depth.
0 (0%) – 6 (6%)
Response may not be on topic and lacks depth.
First Response:
Writing
6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.
4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.
0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.
First Response:
Timely and full participation
5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.
4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.
3 (3%) – 3 (3%)
Posts by due date.
0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.
Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.
9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
8 (8%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting.
7 (7%) – 7 (7%)
Response is on topic and may have some depth.
0 (0%) – 6 (6%)
Response may not be on topic and lacks depth.
Second Response:
Writing
6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.
4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.
0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.
Second Response:
Timely and full participation
5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.
4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.
3 (3%) – 3 (3%)
Posts by due date.
0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.
Total Points: 100

Name: NURS_8114_Week2_Discussion_Rubric

Initial Post

Nursing philosophy is defined as assumptions or beliefs about the nursing practice (McEwen & Willis, 2019).  A key term related to philosophy is epistemology, which helps answer questions about the nursing practice and how to interpret the outcomes. Philosophy of science in nursing explains the meaning of science in nursing with the use of theories and laws (McEwen & Willis).  The foundation of science in nursing is explained through rationalism and empiricism.  According to Alligood and Toomey philosophies of nursing science using rationalism are guided by cause and effect when attempting to explain a disease process (2010). On the other hand, empiricism collects facts to explain a disease process (Alligood & Toomey, 2010).

Nursing theories have always been a part of the nursing profession since Florence Nightingale.  Middle-range nursing theories helped to explain different concepts in the nursing practice as well as nursing philosophy.  The middle-range theory provides more accurate answers related to questions about certain nursing practice questions (Alligood & Toomey, 2010).

When considering a particular nursing practice in my area of study concerning it, it is related to how diversity can impact patient outcomes in neonates or pediatric patients. As nurses, it is important to educate ourselves on differences that exist among the patients we care for.  These differences can impact discharge time, complications during the course of the hospital stay, and the morbidity or mortality rate for the patient.

Two middle-range nursing theories that have proven to help support this nursing practice concern are the “Theory of Caring” by Kristen Swanson and the “Culture Care Theory of Diversity and Universality” by Madeline M. Leininger.  The Theory of Caring focuses on knowing, being with, doing for, and maintaining belief (Alligood & Toomey).  Leininger is specifically a middle-range theory however it focuses on culture and care of diverse cultures.  According to Alligood and Toomey, Leninger stresses the terms of transcultural nursing, culturally competent nursing care, and culture care diversity.  In my area of nursing practice, there are inconsistencies in doing what is best for the patient and overlooking the cultural diversity that exists to improve the patient’s health outcome.

References

Alligood, M.R., & Tomey, A.M. (2010). Nursing theorists and their work (7th ed). Mosby Elsevier.

McEwen, M., & Willis, E.M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.

Week 2

Initial Post

Practice Issue

Acute heart failure exacerbation management is challenging. Heart failure patients can be difficult to manage. These patient can be non-compliant with medication and dietary restrictions. They have a rate of two or more hospitalizations a year. Re-admission of heart failure patients within 30 days is a practice issue. While hospitalize these patient is diuresis and discharged at their base weight. In less than 30 days the fluid is re-accumulated and the patients are re-hospitalized. Health care systems take a significant cut in re-imbursement if re-admission occurs.

Middle Range Theories

The central concept of Benner’s Model is competence, skill, clinical knowledge, and clinical practice (McEwen and Hall, 2015). It is important to reward and retain nurses for their clinical expertise in a clinical practice. The nurse practitioner starts off as a novice and transitions in to an expert. Nurse can make this transition with a combinations of skill development, understanding the patient population, creating as strong educational foundation, and personal experience. This theory assists nurses to become experts in heart failure and develop the skills needed to provide the best care for this patient population.

 

Pender’s Health Promotion Model is designed to increase the patient’s level of wellbeing (McEwen and Hall, 2015). Patients are multidimensional as they interact within their environment in the pursuit of health. Focusing on the patient’s experiences, behaviors, and cognitive affect can lead to health promotion. Identifying the patient’s specific behaviors that lead to re-hospitalization and help to interrupt negative patterns will decrease the risk of readmission within 30 days of hospital discharge. This will lead to improved health, increase functional ability and help the patient lead a better quality of life.

Reference

Alder, John & Muacevic, Alexander. (2020). Reducing All-cause 30-day Hospital Readmissions for Patients Presenting with Acute Heart Failure Exacerbations: A Quality Improvement Initiative. Cureus. 2020 Mar; 12(3): e7420. Published online 2020 Mar 25. doi: 10.7759/cureus.7420

Donaho, Erin, Andrea, Hall, Andrea, & Gass, Jennifer. (2015). Protocol‐Driven Allied Health Post‐Discharge Transition Clinic to Reduce Hospital Readmissions in Heart Failure.  Journal of the American Heart Association. Vol. 4, No. 12.

McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer

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