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DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theories

DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theories

Compare and contrast a minimum of two middle range theories and describe how one of these middle range theories could serve as a foundation for direct practice improvement. Provide examples and literature support. Explain how these theories guide nursing practice and how nursing practice and theories guide research

Middle range theory is a dimension of nursing knowledge with promise for guiding practice and research. Imogene King in the early 1960s developed the Goal Attainment theory which describes a dynamic, interpersonal relationship in which a patient grows and develops to attain certain life goals. (king,1992). It is a process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication, they set goals, explore means, and agree on means to achieve goals.

Katharine Kolcaba’s middle range nursing theory on the other hand is centered on comfort. It was first developed in 1991 based on holism and human needs, this theory is described by two ideas such as type of comfort (relief, ease, transcendence) and context for comfort (physical, psychospiritual, environmental, social). Kolcaba described Patient comfort as strengthening the immediate state of being through physical, psychospiritual, social, and environmental nursing interventions in the context of institutional outcomes (Liehr & Smith 2017). Patients experience a sense of relief when their individual comfort needs are met. Patients are at ease in situations that enable them to be calm or content.

 

To compare and contrast both theories, Katharine Kolcaba’s middle range theory of comfort can be used to enhance the environment of patients in cardiac care where the patients are subjected to noise, interruptions, as well as a myriad of monitoring alarms. A loud and chaotic environment can negatively affect healing process of patients. Through the use of a “quiet time” intervention derived from comfort theory when applied in care of cardiac patients it will greatly improve cardiac patients’ experiences of comfort.  (Krinsky, et al 2014).  The theory of goal attainment describes the goal of nurse patient interactions that lead to transactions and goal attainment. Goal setting is based on the nurse’s assessment of the patients concerns, problems and disturbances in health, their perception of problems and their sharing of information with patients and their families to move toward quality improvement in their health.

These ideal middle range theories coupled with clinical research can help equip hospitals and nurses with effective methods to improve patient comfort, attain established goals through communication in order to facilitate healing. Imogen goal attainment theory provides knowledge, process and outcome, it is the heart of quality assurance programs in healthcare and leads to quality improvement in nursing. As Katharine Kolcaba stated, if patients experience comfort, then they are more satisfied with the care given, and the nurses as well as the institution will benefit. Both theories can be utilized to achieve quality improvement.

 

References

 

King I. M. (1992). King’s theory of goal attainment. Nursing science quarterly5(1), 19–26. https://doi.org/10.1177/089431849200500107

Krinsky, R., Murillo, I., & Johnson, J. (2014). A practical application of Katharine Kolcaba’s comfort theory to cardiac patients. Applied nursing research : ANR27(2), 147–150. https://doi.org/10.1016/j.apnr.2014.02.004

Liehr, P., & Smith, M. J. (2017). Middle Range Theory: A Perspective on Development and Use. ANS. Advances in nursing science40(1), 51–63. https://doi.org/10.1097/ANS.0000000000000162

Types of Nursing Theories DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theories

Dickoff and James (1968) described four types of theory: (1) descriptive, (2) explanatory, (3) predictive, and (4) prescriptive.

Descriptive theories are the first and most important level of theory development as they determine what will be perceived as the essence of the phenomenon under study. Descriptive theories describe, observe, and name concepts, properties, and dimensions but they don’t explain the interrelationships among concepts or propositions, and they don’t indicate how changes in one concept affect other concepts.

There are two major types of descriptive theories. The first one is Naming Theories which describe the dimensions or characteristics of a phenomenon. The second type of descriptive theories is Classification Theories which describe dimensions or characteristics of a phenomenon that are structurally interrelated and are sometimes referred to as a typologies or taxonomies. Descriptive theories are generated and tested by descriptive or exploratory research.

Explanatory theories are the second level in theory development. They relate concepts to one DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theories another and describe and specify some of the associations or interrelations between and among the concept. This type of theories attempt to tell how or why the concepts are related and may deal with causality, correlations, and rules that regulate interactions.

Predictive theories intend to describe precise relationships between concepts and are the third level of theory development. Predictive theories are generated and tested by experimental research and are able to describe future outcomes DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theories

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Prescriptive theories which are the highest level of theory development prescribe activities necessary to reach defined goals. In nursing, prescriptive theories address nursing therapeutics and predict the consequences of interventions. Prescriptive theories have three basic components: (1) specified goals or outcomes, (2) explicit activities to be taken to meet the goal, and (3) a survey list that articulates the conceptual basis of the theory.

Over the past 50 years, middle-range theories have been developed which are guiding nursing practice (Liehr & Smith, 2017). The push towards evidence-based practice in Magnet Hospitals and DNP programs has brought to light the importance of these theories. In looking at middle-range theories for a chronic illness or congestive heart failure (CHF|), Riegel’s Theory of Self-Care of Chronic illness describes how self-care is performed when someone is healthy and with chronic illness (Riegel et al., 2019).

There are three concepts to Riegel’s theory which include self-care maintenance, self-care monitoring, and self-care management. Those who perform different self-care activities regardless of their health status will have a higher quality of life. For someone which a chronic illness such as CHF, self-care may be able to decrease any exacerbations and treat symptoms appropriately. DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theories

This model aids nursing in assisting the patient in understanding that the decisions they make in their care will positively or negatively impact their quality of life. Riegel’s Theory of Self-Care of Chronic Illness can be a foundation for direct practice improvement for congestive heart failure, diabetes, and other chronic illnesses. DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theories

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In contrast, Jean Watson’s Philosophy and Science of Caring is focused on the care that nursing gives to the patient and how caring interventions can be delivered to the patient through therapeutic communication and human touch (Wei et al., 2019).

Using Watson’s theory in the daily practice of nursing benefits the patient and the nurse through nursing satisfaction, nursing practice, and patient safety. A foundation for a facility that provides quality patient care is an organization that provides a caring environment to colleagues and patients. DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theories

The impact on patient safety comes from caring attitudes towards each other, confidence building, and maximizing teamwork and professionalism. As nursing turnover continues to increase, Watson’s Philosophy and Science of Caring needs to be incorporated into nursing programs, preceptor, and mentor programs to ensure that we care for our patients and each other.

References

Liehr, P., & Smith, M. J. (2017). Middle range theories. In J. Fitzpatrick (Ed.), Encyclopedia of nursing research (4th ed.). Springer Publishing Company. Credo Reference: https://lopes.idm.oclc.org/login?url=https://search.credoreference.com/content/entry/spennurres/middle_range_theories/0?institutionId=5865

Riegel, B., Jaarsma, T., Lee, C. & Strömberg, A. (2019). Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science, 42 (3), 206-215. DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theorieshttps://oce-ovid-com.lopes.idm.oclc.org/article/00012272-201907000-00006/HTML 

Wei, H., Fazzone, P. A., Sitzman, K., & Hardin, S. R. (2019). The Current Intervention Studies Based on Watson’s Theory of Human Caring: A Systematic Review. International Journal for Human Caring, 23(1), 4–22. https://doi-org.lopes.idm.oclc.org/10.20467/1091-5710.23.1.4

Nursing was first introduced to theories in the 1970s. During this era, they were primarily based on the definition of nursing practice. Scholars later noticed that the gran theories lacked proposition, specificity, and empirical testing when applied directly to patient care (Im, 2018). In the 1800s, middle-range theories began (Im, 2018). They were developed based on theoretic induction and deduction on literature and research (Im, 2018). Middle theories provide and explanation of relationships and predictions (Im, 2018).

Its purpose is to narrow the nursing focus with outcomes (Im, 2018). Thus, providing a high problem specification. On the contrary, this can also cause it to fail tests easily. It may also require more significant amounts of observation to increase knowledge. There are most often a limited number of variables. They are also valuable as they allow the opportunity to connect with gran theories and current practice. In nursing practice, theory guides research questions, and research assists in generating theories.

One middle-range theory chosen for the project is Kolcabas Comfort theory. It focuses on relief, ease, and transcendence (Barreto et al., 2022). The elements involved are physical, psychospiritual, environmental, and sociocultural (Barreto et al., 2022). As previously mentioned in week one’s discussion, this theory is often used in acute and or palliative settings. However, this theory could serve as the foundation for the project as it will allow patients to identify comfort measures in a medical emergency with Five Wishes. The application is outcome-oriented, specific to provide comfort, can be applied to the intervention, and is readily available.

 

Another example is the Theory of Unpleasant Symptoms. It was first developed in 1995 (Lima et al., 2019). It is based on identifying nonpharmacological ways to manage symptoms. The three major related parts are physiologic, psychologic, and situational factors (Lima Gomes et al., 2019). As symptoms are subjective, they are described by timing, intensity, distress, and quality with a multidimensional approach (Lima Gomes et al., 2019). This directly influences the patient’s performance (Lima Gomes et al., 2019).

Its end goal provides a clear and measurable outcome when applied to assess before and after the intervention. This holistic approach can be used in multiple areas of practice and populations. It can be used to describe, explain, and predict in the clinical setting. This theory is ready for application, just like the Kolcabas theory, and shares the common goal of middle-range theories.DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theories

 

References: DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theories

Barreto Cardoso, R., Pereira Caldas, C., Gomes Brandão, M. A., Alfradique de Souza, P., & Ferreira Santana, R. (2022). Healthy aging promotion model referenced in Nola Pender’s theory. Revista Brasileira de Enfermagem, 75(1), 1–9. https://doi.org/10.1590/0034-7167-2020-0373

 

Im, E.-O. (2018). Theory development strategies for middle-range theories. Advances in Nursing Science, 41(3), 275–292. https://doi.org/10.1097/ANS.0000000000000215

 

Lima Gomes, G. L., Rodrigues Lopes de Oliveira, F. M., Fernandes Barbosa, K. T., Torres de Medeiros, A. C., Melo Fernandes, M. das G., & Lima da Nóbrega, M. M. (2019). Theory of Unpleasant Symptoms: critical analysis. Texto & Contexto Enfermagem, 28, 1–10. https://doi.org/10.1590/1980-265X-TCE-2017-0222

Over the past 50 years, middle-range theories have been developed which are guiding nursing practice (Liehr & Smith, 2017). The push towards evidence-based practice in Magnet Hospitals and DNP programs has brought to light the importance of these theories. In looking at middle-range theories for a chronic illness or congestive heart failure (CHF|), Riegel’s Theory of Self-Care of Chronic illness describes how self-care is performed when someone is healthy and with chronic illness (Riegel et al., 2019).

There are three concepts to Riegel’s theory which include self-care maintenance, self-care monitoring, and self-care management. Those who perform different self-care activities regardless of their health status will have a higher quality of life. DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theories

For someone which a chronic illness such as CHF, self-care may be able to decrease any exacerbations and treat symptoms appropriately. This model aids nursing in assisting the patient in understanding that the decisions they make in their care will positively or negatively impact their quality of life. Riegel’s Theory of Self-Care of Chronic Illness can be a foundation for direct practice improvement for congestive heart failure, diabetes, and other chronic illnesses.

In contrast, Jean Watson’s Philosophy and Science of Caring is focused on the care that nursing gives to the patient and how caring interventions can be delivered to the patient through therapeutic communication and human touch (Wei et al., 2019). Using Watson’s theory in the daily practice of nursing benefits the patient and the nurse through nursing satisfaction, nursing practice, and patient safety.

A foundation for a facility that provides quality patient care is an organization that provides a caring environment to colleagues and patients. The impact on patient safety comes from caring attitudes towards each other, confidence building, and maximizing teamwork and professionalism. As nursing turnover continues to increase, Watson’s Philosophy and Science of Caring needs to be incorporated into nursing programs, preceptor, and mentor programs to ensure that we care for our patients and each other.

 

References DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theories

 

Liehr, P., & Smith, M. J. (2017). Middle range theories. In J. Fitzpatrick (Ed.), Encyclopedia of nursing research (4th ed.). Springer Publishing Company. Credo Reference: https://lopes.idm.oclc.org/login?url=https://search.credoreference.com/content/entry/spennurres/middle_range_theories/0?institutionId=5865

 

Riegel, B., Jaarsma, T., Lee, C. & Strömberg, A. (2019). Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness. Advances in Nursing Science, 42 (3), 206-215. https://oce-ovid-com.lopes.idm.oclc.org/article/00012272-201907000-00006/HTML

 

Wei, H., Fazzone, P. A., Sitzman, K., & Hardin, S. R. (2019). The Current Intervention Studies Based on Watson’s Theory of Human Caring: A Systematic Review. International Journal for Human Caring, 23(1), 4–22. DNP-815A Topic 3 DQ 1 Compare and contrast a minimum of two middle range theorieshttps://doi-org.lopes.idm.oclc.org/10.20467/1091-5710.23.1.4 

Middle range nursing theories are used to guide everyday nursing practice. These theories tend to have a specific focus and is used for implementing nursing interventions that promote optimal outcomes. One middle range theory is Jean Watson’s Theory of Human Caring. The theory focuses on creating a caring-healing environment through human-to-human interactions. In this theory caring is defined as being authentically present, open to compassion, and showing love and kindness towards self and others (Wei et al., 2019). In my healthcare organization our professional practice model is based off this theory. As a magnet organization, we recognize the importance of nurses caring for themselves as this is the only way they can care for others. We have Caritas rooms which is a quiet space for self-care for the nurses. Nurses use these rooms to center themselves and decrease stress which allows them to provide a higher level of care to those they serve. In applying this to a direct practice improvement initiative, nurses could use this theory to create a healing environment. Research shows that patients who received these caring based interventions report decrease in anxiety and depression, less pain, and an increase in emotional well-being (Wei et al., 2019). Another middle range theory is the Deliberative Nursing Process by Ida Orlando. This theory suggests nurses should create a care plan based on assessment, diagnosis, planning, implementation, and evaluation to adapt to the patient needs (Petiprin, 2020). This theory is intentional which allows the nurse to provide individualized care as they understand the needs to the patient.

 

Overall, nursing theories guide nursing practice by providing a foundation for nursing care and the decisions nurses make when delivering patient care. Nurses also use theories to evaluate the care interventions to determine if the patient achieved optimal outcomes. Theory helps to guide research and supports interpretation of what is being studied.

 

References

 

Petiprin, A. (2020). Ida Jean Orlando. Nursing Theory. Retrieved July 22, 2022, from https://nursing-theory.org/nursing-theorists/Ida-Jean-Orlando.php

 

Wei, H., Fazzone, P. A., Sitzman, K., & Hardin, S. R. (2019). The current intervention studies based on Watson’s theory of human caring: A systematic review. International Journal for Human Caring23(1), 4–22. https://doi.org/10.20467/1091-5710.23.1.4