NURS 8114 Exploring Middle Range Theories and Framing Practice Issues
NURS 8114 Exploring Middle Range Theories and Framing Practice Issues
NURS 8114 Exploring Middle Range Theories and Framing Practice Issues
Diabetes-related complications are a clinical issue of concern in nursing practice. Management of diabetes in most patients has been a challenge resulting in increased complications. The most common complications include blindness secondary to cataracts, cardiovascular disease, neuropathy, kidney disease, and lower-extremity amputation (Papatheodorou et al., 2018). These complications have been a major cause of increased morbidity and mortality among individuals with diabetes. They have also placed a heavy economic burden on the US health care system.
Middle-range theories most valuable in addressing diabetes-related complications include the Health Promotion Model and Comfort Theory. The Health Promotion Model explains the variables that determine the chances that a person will engage in health-promoting behavior, including cognitive-perceptual factors, modifying factors, and cues to action (Peterson & Bredow, 2019). The Health promotion model can help address the practice issue by understanding patients’ attitudes and beliefs regarding diabetes and perceived vulnerability. The model can be used to modify patients’ cognitive-perceptual factors in order to increase their health-promoting behaviors (Peterson & Bredow, 2019). This can improve their diabetes self-management and health-seeking attitude and ultimately improve health outcomes.
In the Comfort theory, the nurse identifies patients’ needs that have not been met. The needs are modified by dominant variables, which are factors that the nurse cannot change. With this in mind, the nurse develops a comfort care plan, which aims to enhance comfort over a measurement of baseline comfort (Peterson & Bredow, 2019). When patients’ comfort is improved, they can engage more in health-seeking behaviors. The Comfort theory can address the diabetes issue by having nurses identify patients’ needs that have not been met, such as education, nutrition, and exercise needs (Peterson & Bredow, 2019). Nurses can then develop a comfort care plan for patients with diabetes. When the comfort is improved, patients can engage more in healthy behaviors such as physical exercises and attending diabetes clinics.
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NURS 8114 Exploring Middle Range Theories and Framing Practice Issues 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.
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.
Photo Credit: steheap / Adobe Stock
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.
- 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.
Helping-seeking behavior among mentally ill patients due to their cultural beliefs is a common problem among many patients. I have observed this when dealing with help-seeking behavior among sick, mental persons from different cultural backgrounds and beliefs. I have noticed that many ill people find it hard to seek help for their problems. Many prefer social isolation and fear interaction with others, including family members. Culture plays a big role in it. I have observed three different cases of such nature. The first case was a mild-aged man who was brought to the hospital forcefully by their family. He appeared mentally distracted and kept looking around the room as if afraid of some form of threat. He was unwilling to speak or answer questions that targeted his privacy and well-being. When asked about his perception of his condition, he stated that their culture teaches people that mental health is a curse and that it cannot be shared. He was not willing to accept certain types of medication due to his cultural beliefs about the use of medicine. Further diagnosis later revealed that he was developing depression.
The second and third cases involved two young men who were suffering from schizophrenia. Similar to the first case, they also presented with social withdrawal and did not want to seek help. Their family members had to bring them to the hospital by force, and they tried as much as they could to ensure that they could free themselves. The second man, who was roughly in his mid-twenties, later revealed that he was experiencing some bullying at school and that he was afraid of going back. The experience of the cases points out the issue of mentally ill individuals’ lack of willingness to seek help. As a result, many develop complicated conditions that are hard to manage. One reason is that they seek help when it is too late.
Additionally, others experience other problems, such as domestic violence and bullying, but are not willing to share their plight to obtain the help that they need to deal with the situation. The standard issue among all the cases was that each had a value of their cultural perception of their condition, thus making it hard to share it with the medical professional. It was hard for me to understand why their cultural beliefs about mental health conditions are such a big deal in the 21st century.
The subject of seeking help behavior among mentally ill patients is in line with nursing middle-range theories. One such theory is Leininger’s cultural care diversity and university theory. The theory considers patients’ cultural perceptions and understanding when offering adequate medical care regardless of their condition (McEwen & Wills, 2019). The theory finds cultural respect, diversity and similarities in cultural beliefs. Nurses need adequate training to ensure that they have a culturally congruent practice and care to provide the required help to patients from different cultural backgrounds. It also focuses on the similarities between cultures, and as a result, it ensures that patients with similar cultures can have the same nursing care. Obtaining nurses to meet a specific need significantly impacted by culture is essential. The case of the three patients helped me understand the need to address cultural beliefs towards mental conditions as a first step towards having proper mental help for patients. Changing the cultural narrative about mental problems through public education programs and training nurses on handling such patients help provide the needed support.
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!
Post a brief explanation of your critical question.
My critical question is why there are so many people who suffer from co-occurring mental health and substance use disorders. Comorbidities are defined as two conditions or illnesses that manifest in the same individual, either concurrently or consecutively. Additionally, comorbidity suggests that the disorders interact, influencing each other’s course and prognosis. It may be challenging to diagnose the underlying mental illness in those who use drugs, and some patients require abstinence for a while for diagnostic reasons. (Igbal, 2019). People who suffer from co-occurring mental health and drug use disorders appear to be becoming more and more prevalent every day. I understand there is a critical part that health practitioners and the legislature need to play in reducing the incidence of comorbid mental health illness and substance use. In the United States, 9.2 million adults have a co-occurring disorder, according to SAMHSA’s 2023 National Survey on Drug Use and Health. (SAMHSA, 2023). The rate of substance abuse is very alarming and makes one wonder if there is a possibility of a decrease in the number of substance users. In certain instances, people self-treat underlying mental disorders with illicit drugs. Chronic drug use can eventually result in a substance use disorder (SUD), which can exacerbate the underlying mental disorder. Extensive education needs to be provided on the risk of illicit drug abuse in all populations, especially in women of childbearing age, to reduce incidents like fetal alcohol syndrome/exposure of the fetus to illegal drugs. Compared to individuals without mental illness, patients with comorbid disorders exhibit worse treatment adherence and increased rates of treatment dropout, which has a detrimental impact on outcomes. For better patient outcomes and quality improvement, the problem of an increase in patients with co-occurring mental health illnesses and substance use disorders needs to be addressed.
Addressing the critical question
A strategy that can help to address comorbid substance use and mental health illness is education. Clinical could provide teaching opportunities to both clinicians and patients to ensure the clinician is knowledgeable on the topic and provide evidence-based education to the patient. (Frank et al., 2022). Clinicians can provide patients with education on the dangers of illicit drug use and the health implications. When two or more conditions are the focus of treatment, it is referred to as integrated treatment. One example of integrated treatment is using several therapies, such as pharmacotherapy and psychotherapy. Research has consistently demonstrated that integrated treatment for comorbidity is superior to treating individual illnesses with separate treatment programs. (Kelly & Daley, 2013). Encouraging syringe exchange programs can help reduce the risk of infection from sharing needles with intravenous drug users. Research demonstrates that funding preventative initiatives can help communities save money and lives. For example, Patient education on syringe exchange locations can help reduce the risk of sharing or reusing needles for IV drug users. Monthly community fairs or adding a drug prevention class to all schools would help create the needed awareness and save the lives of innocent students who might be introduced to drugs.
Consequently, President Biden unveiled his Unity Agenda at the State of the Union address. President Biden’s agenda includes addressing our country’s mental health problem and combating the overdose epidemic. (NIDA, 2022). The President’s mental health initiative is built around three pillars:
Boost System Capability, Link Americans to Care, and Assist Americans through the Development of Healthy Environments. (NIDA, 2022). These interventions can help enlighten, provide care to those with comorbid disorders and ensure a safer environment for everyone.
The value of addressing the quality improvement initiative.
The value of addressing this quality improvement initiative would help reduce the initiation of illegal drug use, addiction/dependence on illicit drug use, the incidence of drug-induced psychosis/coma, or even Death from drug overdose. Clinicians can help improve patient health by encouraging patients with mental health and substance use to seek care and utilize pharmacotherapy and psychotherapy as treatment modalities to help ensure patient well-being.
Syringe exchange Programs can help halt the spread of HIV and other infectious diseases, such as hepatitis C. They also assist in connecting drug injectors with addiction treatment and HIV screening. (NIDA, 2022). By treating patients for SUDs and other mental diseases regardless of their color, socioeconomic background, sex, or location, healthcare professionals can contribute to the reduction of health disparities and reduce possible stigmatization. The aforementioned evidence-based quality improvement measures are all warranted in their attempt to lower the proportion of individuals who have a co-occurring mental health illness and substance use disorder and who do not seek treatment.
In conclusion, proper interdisciplinary collaboration can help reduce gaps in treatment and ensure prompt care to patients dealing with comorbid mental health disorders and substance use.
Submission and Grading Information
NURS 8114 Exploring Middle Range Theories and Framing Practice Issues 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
Week 2: Applying Middle Range Theories to Nursing Practice
As a registered nurse or APRN, no doubt the issue of managing patient pain is one you have dealt with repeatedly. In identifying successful approaches to addressing and alleviating pain, you may have looked to theories of pain management to inform your practice.
The work you begin this week will guide and prompt you in the further application of theory to nursing practice. You will start with an overview of middle range theories, which in the world of nursing theory refers to theories that relate to particular phenomena, such as pain. Your study of nursing theory will be made more meaningful as you identify a practice issue of special interest to you and investigate nursing theories that apply to it.
As you continue to develop your philosophy of nursing practice, consider middle range nursing theories that may be defining for you. Expanding your familiarity with theories that inform the many dimensions of nursing will support your leadership as a DNP.
Learning Objectives
Students will:
- Analyze issues in nursing practice
- Evaluate middle range nursing theories in relation to nursing practice
- Analyze middle range nursing theories in relation to philosophies of nursing practice
Learning Resources
Required Readings (click to expand/reduce)
McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.
McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.
McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.
Document: Writing a Philosophy of Nursing Practice (Word document)
(Review from Week 1)
Required Media (click to expand/reduce)
Optional Resources (click to expand/reduce)
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NURS 8114 Exploring Middle Range Theories and Framing Practice Issues Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NURS_8114_Week2_Discussion_Rubric
Grid View
List View
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
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