DNP 815 Topic 3 DQ 1 PEER RESPONSES
DNP 815 Topic 3 DQ 1 PEER RESPONSES
Conduct a literature search in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) using the terms middle range theory, mid-range theory, and nursing. Select one of the articles in which the development of a middle range theory is the major focus of the paper. Share the article citation and describe how the theory was developed.
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POST 1
Nursing presence has been a central focus for theorists, researchers, educators, and practicing professional nurses for over a half a century. Knowledge development and measurement of this experience is crucial at a time when human communication is becoming more impersonal, and nursing presence capability is potentially declining. Caring is viewed as the essence of nursing. However, caring is not a phenomenon exclusive to nurses. Hospitalized patients encounter numerous people in addition to nurses and each role and individual make an impact upon the care of the patient. These encounters can dramatically influence the level of satisfaction a patient feels about their hospital experience (Chinn, P., & Jacobs, M. 2017).
DNP 815 Topic 3 DQ 1 PEER RESPONSES
Jean Watson’s theory of human caring could have a positive effect on patient satisfaction. It was determined that satisfaction levels did improve significantly following a caring-based intervention. The original carative factors served as a guide to what was referred to as the core of nursing, in contrast to nursing’s trim. Core pointed to those aspects of nursing that potentiate therapeutic healing processes and relationships, they affect the one caring and the one being cared for. Further, the basic core was grounded in what I referred to as the philosophy, science, and even art of caring. Carative is that deeper and larger dimension of nursing that goes beyond the trim of changing times, setting, procedures, functional tasks, specialized focus around disease, and treatment and technology. Although the trim is important and not expendable, the point is that nursing cannot be defined around its trim and what it does in a given setting and at a given point in time. Nor can nursing’s trim define and clarify its larger professional ethic and mission to society. That is where nursing theory comes into play, and transpersonal caring theory offers another way that both differs from and complements that which has come to be known as modern nursing and conventional medical-nursing frameworks. This emerging model of transpersonal caring moves from carative to caritas. This integrative expanded perspective is postmodern, in that it transcends conventional industrial, static models of nursing while simultaneously evoking both the past and the future. For example, the future of nursing is tied to Nightingale’s sense of calling, guided by a deep sense of commitment and a covenantal ethic of human service, cherishing our phenomena, our subject matter, and those we serve (Johns, C., & Freshwater, D. 2018).
It is when we include caring and love in our work and in our life that we discover and affirm that nursing, like teaching, is more than just a job; it is also a life-giving and life-receiving career for a lifetime of growth and learning. Such maturity and integration of past with present and future now require transforming self and those we serve, including our institutions and the profession itself (Barnum, B. S. 2018).
References
Barnum, B. S. (2018). Nursing theory: Analysis, application, evaluation (5th ed.). Philadelphia: Lippincott.
Chinn, P., & Jacobs, M. (2017). Theory and nursing: A systematic approach. St. Louis: C. V. Mosby.
Johns, C., & Freshwater, D. (2018). Transforming nursing through reflective practice. London: Oxford Science Ltd.
POST 2
Many forms of theories exist in health care. Nurse leaders understand that having a foundation to guide practice provides an organized, systematic, set of guidelines to follow. In health care, theories exist for leadership, management, change, motivation, and organization. (Smith & Johnson, 2018). Nurse leaders use some theories to predict, understand, and lead innovation in corporations and successfully navigate the complicated healthcare environment.
Middle-range theories are intended for different focused areas of research and practice. The article provides an analysis of theory development strategies and future theoretical development. (Im, 2018). Theory-generating approaches that are specific to middle-range theories include “induction from practice”; (2) “induction from research”; (3) “concept building followed by testing in research and practice”; (4) “deduction from theories at a higher level of abstraction, including grand theories”; and (5) “derivation from theories of other disciplines that have foundations consistent with nursing’s disciplinary perspective.” (Liehr & Smith) (Im, 2018).
Middle-range theory development when analyzed showed four themes reflecting theory: direct links to specific areas of research and practice; confusion of middle-range theories and situation-specific theories; prevalent use of both induction and deduction; and use of various sources for theorizing. Middle-range theories should reflect specific areas of research so that they could be easily be used in research. (Im, 2018). According to Meleis, middle-range theories are the more limited scope and less abstracted, address specific experiences, and reflect practice, and “the concepts cross different nursing disciplines and reflect diverse nursing care situations. (Meleis, 2017) (Im, 2018).
Middle-range theories are useful when planning self-management skills for those with chronic health conditions. Health care expenditures in 2021 cost the United States over 300 billion dollars on medical treatment and healthcare utilization. (MacLeod, et al., 2017). Managing chronic conditions and self-care. A primary goal of self-care is to maintain health and prevent symptom exacerbations, self-care monitoring is an acknowledgment that a change has occurred, and the goal of self-care management is an effective treatment of symptoms.
The ability to use theoretical frameworks to practice as a leader is important in combating challenges and barriers such as staff resistance to change, decreased motivation, complacency, safety concerns, quality issues, and internal/external forces. (Smith & Johnson, 2018). Through the use of middle-range theories, implementing evidence-based practice programs to educate patients and staff. patients first master self-care maintenance and later build expertise in self-care monitoring and management. (Riegel, et al., 2019). People who perform all 3 behaviors are most proficient in self-care. Self-Care of Chronic Illness, symptoms are described as important to monitor and as giving direction to self-care management behavior in middle-range theories. When symptoms increase, patients can use different management strategies, such as changing medication, and diet or seeking advice from a clinician. (Riegel, et al., 2019). Roy’s Adaptation Model will be instrumental in guiding research, addressing specific experiences, and reflecting practice through adapting to internal and external environmental factors.
