Application of Middle-Range Nursing Theory - Essay Example

Application of Middle-Range Nursing Theory Application of Middle-Range Nursing Theory Middle range theories refer to a set of related ideas which focus on a limited dimension in the nursing field. The theories incorporate concepts as well as suggested relationships among the concepts which can be depicted in a model (George, 2010). They are less abstract and have fewer variables hence can be applied directly. Besides applying middle range theory to a case study, this paper gives a brief description of the major contributor to the theory and describes the theory at length. A notable contributor to the middle-range theories is Hildegard E Peplau (1909-1999). She was born in Reading, Pennsylvania. Her parents were immigrants of German decent. She was the second born in a family of six children. As recorded by Peterson and Bredow, Dr. Peplau began her nursing career in 1918 as a graduate of Pottstown School of Nursing and later worked in Pennsylvania and New York (Peterson & Bredow, 2008). She earned a bachelor’s degree in interpersonal psychology at Bennington College in 1943. Later on, she earned both her master’s and doctoral degrees from Teachers College, Columbia University and was a member of the faculty of the College of Nursing; Rutgers University between 1943-1945 (Peterson & Bredow, 2008).She was also an advisor of the World Health Organization and a visiting professor in various universities. Hildegard Peplau created middle-range theories. This lofty and noble theory has evidently revolutionaries the scholarly work of nursing. As a core contributor to mental health reform, she advocated for humane treatment of patients who have both behavioral and personality disorders (Peterson & Bredow, 2008). In 1948, she wrote a book entitled Interpersonal Relations in Nursing. In her book, she emphases the significance of nurse-patient relationship as the foundation of nursing practice. Middle-range theories have proved to be the most significant for both practice and research. Their growth is continuum rather than discrete. New models are stated and added regularly. The theories base their focus mainly on the emotional aspects such as grief, pain, guilt and hope as experienced during nurse-patient interactions (Smith & Liehr, 2008). It is important therefore, to understand the framework within which the middle range theories exist. As it is prevalent in many disciplines to have their own constructs for considering their theories and applications, there also exist a construct within the health discipline known as the Ladder of Abstraction. According to Peterson & Bredow (2008), the Ladder of Abstraction delineates three different levels of ideas pertaining health concepts such as pain. It is therefore comprised of three distinct rungs, each representing a different perspective and approach to a health matter. The three rings are: philosophical, theoretical and empirical arranged in descending order (Peterson & Bredow, 2008). Thus, the philosophical rung represents more abstract thoughts as compared to theoretical as well as empirical rungs. Middle-range theories fall within the theoretical level. This level is characterized with symbols, ideas and concepts. The theories fall between the microrange theories and the grand theory. Microrange theories are applicable in specific circumstances. They are also limited to a particular field of study or a specified population (Peterson & Bredow, 2008). On the other hand, grand theories cover a wide scope. Apparently, Middle-range theories are broader in scope as compared to microrange theories and have a larger focus as compared to grand theories. With this background information, it is necessary to examine the three middle range theories within the framework of Ladder of Abstraction in regards to pain as a common health issue. Arranged in the order of abstraction, the 3 middle-range theories are: the symptom management theory, the unpleasant symptom theory and finally, the story theory. Symptoms management theory determines the intervention strategies using a systematic approach. This could be achieved through the use of questions. According to George (2010), the theory affects the symptoms experience as well as patient’s outcomes (George, 2010). Within the system management model, there is an interrelationship between the person, health state and the environment. There is also a further interrelationship between evaluation, perception and response within the symptom experience (George, 2010). The interrelationship can be depicted in an instance involving a patient undergoing pain. In such a situation, the patient’s perception as well as response to the symptom affects evaluation. For example, if a patient feels that the pain he/she veneering is not bad, he/she may claim that he/she needs no medication just yet. Even so, George (2010) concludes that the ideas vindicated by the symptoms management theory regarding the interrelationship of health status, environment and the patient are only meant to offer a guidance in the nursing decisions when handling patients veneering pain(George, 2010).. The second theory is the unpleasant symptoms theory. Unpleasant symptoms could be defined as subjectively experienced indicators the affect performance (Peterson & Bredow, 2008). According to Peterson and Bredow (2008), unpleasant symptoms are described by timing, intensity, quality and distress. They are influenced by situational, physiological and psychological factors (Peterson & Bredow, 2008). Consequently, the affected performance outcomes can eventually influence the symptom experience as well as the accompanying factors which affect that experience. This theory also talks about the concept of symptoms clusters. With particular reference to cluster symptoms, the theory assumes that people in totally unrelated situations can experience similar symptoms. Also, the theory assumes that symptoms are individual phenomena which occur in family and community contexts (Peterson & Bredow, 2008). The most abstract of the middle-range theories is the story theory. Smith and Liehr (2008), describes a story as an active process by which a person recognizes him/herself in relation to others through deliberate nurse-patient dialogue (Smith & Liehr, 2008).Such a story presents itself in the course of a purposive conversation between a patient and a nurse regarding a certain health challenge. A nurse, for instance, may prompt a patient to tell about what he/she (the patient) knows about a specified health challenge. This could be done by simply a nurse posing questions relating to that issue. This way, the nurse gets a chance to hear about all the prevailing issues about that condition from the patient’s purview. The process of story gathering is also known to cause some sort of a relief feeling (Peterson & Bredow, 2008). The story theory is based on some assumption. First, the theory assumes that human beings exist in the moment that is influenced by the part, the present and the future in the course of interactions with the world (Peterson & Bredow, 2008). The second assumption is that each and every person creates and develops meaning. The two authors conclude that theory is therefore grounded on the concepts of intentional dialogue, connecting with self-in-relation as well as creating ease by developing story plot (Peterson & Bredow, 2008). Story telling theory requires extensive analysis of the narrative data collected. This could be done through qualitative methods or linguistic analysis (Chinn & Kramer, 2010). Middle-range theories have been successfully applied in many instances. We can therefore incorporate the ideas of these theories in helping the patient in our case study. This case study involves a patient who is discharged from hospital after treatment for a congestive heart failure. There is a non-compliance tendency observed in the patient. The patient depicts this through his continued smoking habit. This habit perpetuates chest pains. Concepts of both symptom management theory, unpleasant symptoms theory and story theory could be applied. In regards to symptom management theory, the patient can be channeled through a series of questions. These questions will end up providing information upon which assessment could be made. The information gathered will also be a prerequisite in defining intervention .With specific reference to unpleasant symptoms theory, the patient can also be taken through, symptoms assessment, symptom relief intervention and symptom management process. Finally, with regards to story theory, the patient can be prompted by a nurse to tell what he thinks about the chest pains. Basing on what the patient will say, the nurse gets a chance to hear about all the prevailing issues about the chest pains from the patient’s purview. This process may end up causing some sort of relief to the patient. To conclude, as sustained by the above discussion, it is apparent that none of the three theories is eminently above the others. Thus, different theories guide different actions. Each of the theories offers a distinctive and lofty viewpoint and facts through which a health matter could be evaluated and addresses. These pieces of facts could be interwoven into a rudimentary base of knowledge that could bring palpable results in a myriad of health situations. References Chinn, P. L., & Kramer, M. K. (2010). Integrated theory & knowledge development in nursing: Chinn, integrated theory and knowledge development in nursing. (8 ed.). Philadelphia: Mosby. George, J. B. (2010). Nursing theories: The base for professional nursing practice. (6 ed.). New Jersey: Prentice Hall. Peterson, S., & Bredow, T. S. (2008). Middle-range theories: Application to nursing research. (2 ed.). Baltimore: Lippincott Williams & Wilkins. Smith, M. J., & Liehr, P. R. (2008). Middle range theory for nursing. New York: Springer Publishing. Read More