MIDDLE-RANGE THEORIES AND NURSING PRACTICE ISSUES
There are several different types of theories in nursing. Grand theories look at nursing from a broad perspective of human needs. In contrast,
middle-range theories are narrower in focus, and look at specific aspects of the nursing profession. Due to their narrower scope, middle-range theories are more applicable for use in actual nursing practice.
High level middle-range theories can be quite complex (for example, Benner’s “Novice to Expert Theory” and Leininger’s “Theory of Culture Care Diversity and Universality”). Less complex middle-range theories include Mishel’s “Uncertainty in Illness Theory,” Kolcaba’s “Comfort Theory,” and Lenz and Pugh’s “Theory of Unpleasant Symptoms.” Some middle-range theories are even more specifically focused. For example, Beck’s “Postpartum Depression Theory” or Eakes et al.’s “Theory of Chronic Sorrow.”
For this Discussion, you will identify a practice or organization issue of importance to you. Then, you select two middle-range theories and apply them to address the practice or organization issue.
Note: The practice issue you select will also inform your work in Week 3 (and can potentially be utilized throughout the remainder of this course).
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
To Prepare
· Reflect on your nursing practice to identify issues of particular interest or concern to you and/or your organization.
· Select
one practice or organization issue on which to focus for this Discussion.
· Review the Learning Resources for this week, focusing on specific middle-range theories that may apply to the practice or organization issue that you selected.
· Select
two middle-range theories that you believe are relevant and valuable in addressing the practice or organization issue you selected.
By Day 3 Of Week 2
Post the following:
· Identify the practice or organization issue you selected. Explain why you chose it.
· Describe the two middle-range theories that you selected. Explain why you chose them.
· Explain how you would apply each middle-range theory to the practice or organization issue. Be specific and provide examples.
Note: Your posts should be substantial (500 words minimum), supported with scholarly evidence from your research and/or the Learning Resources, and properly cited using APA Style. Personal anecdotes are acceptable as part of a meaningful post but cannot stand alone as the entire post.
RESPOND TO THIS DISCUSSION POST
L R
Organization Issues
My current organization needs help recruiting and retaining qualified healthcare professionals and burnout among nurses. I chose these issues because they affect patient care. Organizations post job positions with specific aims to attract qualified candidates. However, qualified candidates only apply for jobs due to clear job descriptions, which confuse potential candidates and prevent them from applying. Lack of competitive compensation makes it hard to attract top talent to an organization. My organization currently has more as-needed (PRN) nurses than full-time nurses (FTE). Many nurses have full-time jobs at other organizations, and the pay is usually better with those organizations. Burnout is high among full-time nurses. Due to a lack of staff, my organization relies on our FTE nurses, who work day and night shifts. The FTE nurses are preceptors and charge nurses on the units while admitting and discharging patients. Performing these tasks daily can promote potential burnout. Nurses seek work-life balance to maintain family time, off weekends and holidays, travel, and time for rest to prevent burnout (Ghani, 2024).
Middle Range Theories
The nursing intellectual capital theory focuses on the factors influencing nurse recruitment and retention within an organization (Covell & Sidani, 2013). Organizations want nurses with experience and knowledge to care for patients, which determines patient and organizational outcomes. Nursing intellectual theory research demonstrates how quality affects an organization’s work environment. Human resources and staff development are significant in ensuring nurses continue professional development and maintain up-to-date certifications. For example, nurses are required to take yearly handle-with-care (HWC) classes in mental health nursing. These classes educate and demonstrate ways of managing disruptive and aggressive behaviors in mental health patients.
The theory of caregiver stress focuses on how being a caregiver can affect one’s psychological and physical health. Caregivers in stressful environments may respond with poor performance, low morale, and less job enjoyment. Mental health nurses care for all mental health patients of all ages and races. For example, nurses are pulled to other units to care for patients different from their assigned units due to nurse shortage. One unit is geriatrics; many nurses are exhausted from the complete care of patients and those requiring two to three dressing changes a day. The low-middle-range theory is fairly applied to a narrow range of patients and situations (McEwen &
Willis, 2023).
Middle Range Theory and Organization
The nursing intellectual capital theory explains why hiring and retaining qualified nurses is essential. Education and professional development are ongoing due to the frequent changes in medicine and technology. Patients are living longer with complex diseases and treatments. Therefore, education and professional development are vital to deliver quality patient care. Mental health is a specialty that requires specific education focused on cognitive and substance abuse patients. With adequate staffing, code blue events could have been better for quarter 3 of 2024. The short-staff issue has resulted in failed codes. My staff development team has performed mock codes twice weekly on the units due to failed codes. Education on code blue is not the issue; it’s staffing. Recruiting and retaining qualified individuals and ongoing professional development will promote better patient and organizational outcomes.
The theory of caregiver stress explains how nurses may experience burnout due to working long hours. For example, nurses working on a unit for 12 hours four to five days a week
due to staffing issues may result in burnout. Short-staffed can lead to less patient care, medication errors, and high infection rates. Quality nursing is essential for effective patient care. Nurses working long hours multiple days a week to cover a unit’s vacancy affect their physical and mental health, leading to burnout.
Conclusion
Middle-range theories create statements that data can define. Utilizing both theories can address issues of retention while preventing nurse burnout. Patient safety and quality care are the focus. Nursing shortages and burnout are expected to intensify as baby boomers age and the need for health care grows (Nursing Shortage Fact Sheet, n.d.).
References
Covell, C., Sidani, S., (May 31, 2013). “Nursing Intellectual Capital Theory: Implications for
Research and Practice” OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2,
Manuscript 2.Ghani, S. (2024, August 15). PRN vs. Per Diem: A Definitive Guide. indeed.com.
Links to an external site.McEwen, M., & Wills, E. M. (2021). Theoretical basis for nursing (6th ed.). Wolters Kluwer.
Nursing Shortage Fact Sheet. American Association of Colleges of Nursing. (n.d.).
