Middle Range Nursing Theory Introduction A clinical nurse is generally involved with specialized research; for example, a clinical nurse specializing in oncology would likely be heavily involved in the treatment of patients with cancer, according to Andrea Santiago. That clinical nurse specialist (CNS) working with cancer patients may also create helpful protocols or other strategies to improve the delivery of services in a hospital (Santiago, 2013). This paper delves into the reasons why the CNS can (and will) benefit from the use of the middle range theory.
¶ … Range Nursing Theory
A clinical nurse is generally involved with specialized research; for example, a clinical nurse specializing in oncology would likely be heavily involved in the treatment of patients with cancer, according to Andrea Santiago. That clinical nurse specialist (CNS) working with cancer patients may also create helpful protocols or other strategies to improve the delivery of services in a hospital (Santiago, 2013). This paper delves into the reasons why the CNS can (and will) benefit from the use of the middle range theory.
What are middle range theories?
Judy Davidson (RN, DNP, CNS) explains that middle range theories are designed to "guide practice" for nurses (including clinical nurse specialists) and are "more focused than grand theories" because they zero in on a "single aspect of practice" and are not as general as grand theories (Davidson, 2010, p. 28). Moreover, because grand theories only offer a framework in terms of descriptions and prescribing within the nursing practice -- and middle range theories are "directly applicable to patient care and more prescriptive" -- middle range theories are easier to test (Davidson, 29).
Why would a CNS embrace the middle range theory?
The middle range theory has proven to be useful "…in both research and practice," according to the book Middle Range Theories: Application to Nursing Research (Peterson, et al., 2009, p. 36). The middle range theory can serve a "heuristic function" [a way of ranking various alternatives] in order to "…stimulate and provide rationale for studies" (Peterson, 35). Also the selection of the most important research questions can be guided through the use of the middle range theory, Peterson explains.
Through use of the theory a clinical nurse specialist can gain a deeper understanding of the patient's behavior, and from that deeper understanding the clinical nurse specialist can make suggestions as regards possible interventions along with an understanding as to how effective the intervention turned out to be (Peterson, 35). Peterson aims to show how valuable the use of the middle range theory is; hence, she has done the meta-research and reports that of 173 studies published in the journal Nursing Research from January 1994 through June 1997, just 79 of those studies embraced a theory (35). And of those 173 studies, 79 included the use of a theory; of those 79 studies that "identified a theory," 25 were nursing theories and 54 were "middle range theories borrowed from other disciplines, most frequently from psychology" (Peterson, 25).
Peterson asserts that notwithstanding the "great potential for guiding nursing practice" that middle range theories present, that potential goes underutilized. And moreover, Peterson points out that nurse researchers have been "…denounced for making use of middle range theories from disciplines other than nursing," in particular, from psychology (37).
Testing the middle range theory for the self-care of home-bound elderly
A peer-reviewed article in the Scandinavian Journal of Caring Sciences describes the process of "…developing an instrument to test the middle range nursing theory" as to how effective it would be vis-a-vis the self-care of home-dwelling elderly people (Rasanen, et al., 2007, p. 397). Also, this research sought to determine how effective the middle range theory would be in a clinical setting with reference to evaluating the self-care of home-bound older people.
The authors used four phases to test the middle range theory: a) the first phase was set in motion based on the theory; b) next, two home-bound elderly people were interviewed as a pilot program, and 20 elderly people completed a questionnaire and "…commented upon its ease of use"; the results from the questionnaire responses were used for the 2nd phase; c) using the results from the 2nd phase, data was collected from 200 home-bound seniors aged 75 and up from various locations in Finland; and d) the "content validity of the third version was assessed by three home-dwelling elders" (Rasanen, 397).
The authors learned through this test that the instrument used in a middle range theory context must be "…explicit and short enough" to be completed without taking a long time; and moreover, collecting data may require "structured interviews" due to the difficulty some elderly people will have in completing a questionnaire (Rasanen, 402). The results of this research showed clearly that the middle range theory, applied as an instrument of inquiry (with 9 background questions and 82 items that "measure the self-care" of home-bound elderly), is valid and reliable (Rasanen, 397).
Research related to Swanson's middle range theory of caring
How has Kristen Swanson's middle range theory of caring been used in actual nursing practice as presented in international journals? That question was researched by Birgitta Andershed and Kristina Olsson in the Scandinavian Journal of Caring Sciences. How was Swanson's middle range theory developed? The authors explain that Swanson used three "phenomenological studies" in her empirical development of the theory. The first involved 20 women who had miscarried; they were asked what caring behaviors were helpful to them; in the second Swanson study, 33 interviews were conducted with 19 care givers as to what it is like to be "…a provider of care on the Newborn Intensive Care Unit?" (Andershed, 2009, p. 599). The third study performed by Swanson delved into the responses of 8 mothers who had received "long-term nursing interventions"; how did they perceive the "nurse-patient relationship 4 years after the interventions?" (Andershed, 599).
These three empirical studies resulted in Swanson developing a middle range theory of caring based on the definition that "…Caring is a nurturing way of relating to a valued other person, towards whom on feels a personal sense of commitment and responsibility" (Andershed, 599). And the five caring processes in her version of a middle range theory were: "knowing" (understanding an event's meaning in the life of another person); "being with" (sharing joy, sorrow, and other feelings in an empathetic way); "doing for" (anticipating needs and performing nursing care); "enabling" (facilitating the other person's ability to heal); and "maintaining belief" (having faith and confidence that the client/patient will find meaning in the intervention) (Andershed, 599).
The authors located 120 published studies that involved middle range theories, and 97 of them mentioned Swanson's theory; of those, 9 articles applied Swanson's theory to practice or engaged in "theoretical discussions" about Swanson's theory; 8 articles of the 120 actually related findings that validated Swanson's theory; and 6 papers tested Swanson's theory (Andershed, 600). The salient point vis-a-vis Swanson's middle range theory of caring is that if people feel "…understood, informed, provided for, validated and believed in," they will then be "better prepared to integrate difficulties into their lives" (Andershed, 609).
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