Exploring Middle-Range Theories and Framing Practice Issues
Exploring Middle-Range Theories and Framing Practice Issues
Nurses face various difficulties in their work, with nursing burnout emerging as a particularly pervasive problem in recent years. For healthcare executives, managing nursing burnout has been a constant challenge. Its effects also affect the hospital’s standing, dependability, and capacity to deliver quality patient care (Kelly et al., 2020). Researchers and nurses must understand its root causes and risk factors to avoid burnout. Nursing burnout makes it hard for nurses to provide high-quality care because it prevents them from always being ready and attentive. The current problem has been addressed, and new care and service models have been developed using a variety of nursing philosophies. For instance, nurses use these ideas to structure and direct their activities in hospitals, clinics, and centers for healthcare (Dall’Ora et al., 2020). Following nursing theories ensures that practitioners have access to standard operating procedures (SOPs), enabling them to respond correctly in common and complicated circumstances.
Two Middle-Range Theories in Addressing Nurse Burnout
The conservation of resources theory and the theory of symptom management are two of the most pertinent mid-range ideas that explain nursing burnout.
Theory of Symptom Management
The term “SMT,” which stands for “Symptom Management Theory,” has uses outside of nursing and applies to many different areas. Since emotional problems frequently underlie nursing burnout, an effective treatment strategy is treating the symptoms before examining the underlying conditions and reasons (McEwen & Wills, 2014). It’s crucial to keep in mind that the concept was originally developed for symptom research and clinical treatment aims rather than to solve issues with human resource management in hospitals and clinics. This theory is a middle-range theory since it was developed with a focus on nurses and other practitioners participating in clinical practice and symptom research. Adopting this approach may improve present nursing techniques and teamwork, which will advance nursing as a profession as a whole.
This theory, whose central idea is around a person’s symptoms experience, aims to motivate nurses and researchers to address symptoms methodically and create more efficient management techniques. This middle-range nursing theory can effectively counteract nurse burnout. Nursing burnout can be successfully controlled by spotting and treating its early warning signs and symptoms (Silva et al., 2021). Almost all illnesses have a set of recognizable signs and symptoms that may be observed. Finding those more vulnerable to nursing burnout can help them express themselves clearly and respond correctly, which can help prevent burnout.
Conservation of Resources Theory
Conservation of Resources Theory is formulated to elucidate the dynamics of stress, bridging the gap between the demands imposed by the physical and social environment and individuals’ perception of their value and capacity to meet those demands. Resource conservation is important because people strive to gather, protect, and produce resources (McEwen & Wills, 2014). Resource conservation is a concept that outlines how to manage resources wisely to build or maintain existence and well-being. Particularly in human service, healthcare, and educational industries, the Conservation of Resources theory might shed light on burnout as it relates to those who experience job-related mental stress. The Conservation of Resources hypothesis, which contends that ongoing threats to valuable resources can cause burnout, can be used to understand burnout, which is characterized by tiredness as a result of excessive workloads (Prapanjaroensin et al., 2019). Additionally, this hypothesis contends that job performance could affect patient safety.
Practical Example
Sarah, a dedicated ICU nurse with seven years of experience, is facing nurse burnout in a busy urban hospital with high patient turnover. She’s emotionally exhausted, struggling to connect with patients, and doubts her abilities. Factors contributing to her burnout include a heavy workload, emotionally demanding cases, and a lack of support from hospital management. This burnout is reflected in her behavioral changes, such as arriving late, withdrawing from colleagues, and reducing charting quality. Patient care is compromised as Sarah becomes less attentive and less empathetic. Immediate intervention, including addressing staffing issues and providing support, is crucial to prevent further burnout and protect nurses’ well-being. Sarah should seek professional help to regain her passion for nursing.
Conclusion
In conclusion, SMT makes it possible to spot changes in a nurse’s performance on the job, a skill also available to coworkers familiar with SMT. This may entail giving coworkers feedback. Nursing burnout may be conceptualized using the Conservation of Resources hypothesis, which can help prevent or worsen it. Various middle-range nursing and borrowed ideas have successfully addressed the concerns of professional nurses regarding burnout. These ideas have been discovered to be the most organized and pertinent in the present situation
References
Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human Resources for Health, 18(1), 1–17. https://doi.org/10.1186/s12960-020-00469-9Links to an external site.
Kelly, L. A., Gee, P. M., & Butler, R. J. (2020). Impact of nurse burnout on organizational and position turnover. Nursing Outlook, 69(1), 96–102. https://doi.org/10.1016/j.outlook.2020.06.008Links to an external site.
McEwen, M., & Wills, E. M. (2014). Introduction to middle range nursing theories. Theoretical basis for nursing, 213-227.
Prapanjaroensin, A., Patrician, P. A., & Vance, D. E. (2019). Conservation of resources theory in nurse burnout and patient safety. Journal of Advanced Nursing, 73(11), 2558–2565. https://doi.org/10.1111/jan.13348Links to an external site.
Silva, L. A. G. P. da, Lopes, V. J., & Mercês, N. N. A. das. (2021). Symptom management theory applied to nursing care: scoping review. Revista Brasileira de Enfermagem, 74(3). https://doi.org/10.1590/0034-7167-2020-1004
PEER 2
Brytnee Barbara Frances Lolli
Understanding nursing as a unique practice comes from accepting and acknowledging nursing theories, which help distinguish nursing from other medical fields. These theories guide nurses in making decisions for patient treatment, providing clarity on treatment pathways and outlining the true meaning of nursing (Wayne, 2023). Utilizing nursing concepts comes from staff identifying issues or gaps in practice within their daily routines, researching relevant literature, and using this knowledge to help close these gaps by providing solutions while creating more comprehensive care for patients. After reviewing various nursing theories, I have selected two to discuss and their relation to a healthcare disparity in my practice.
Practice Issue Identified
As a nurse, you will likely encounter patients with a history of substance abuse. Substance abuse is a significant health risk and public health issue, and correctional institutions have no scarcity of individuals suffering from intoxicating substances. Cates and Brown (2023) report a 35% rise in opiate-related overdoses in 2020-2021 compared to the previous year, in addition to a staggering incarceration rate of 2.1 million people held within our correctional institutions. When arrested, individuals can no longer access these substances and withdraw. Withdrawal symptoms are wide-ranging, including sweats, restlessness, insomnia, tremors, nausea/vomiting, irritability, seizures, and occasionally death (Sharp et al., 2023). Therefore, understanding addiction and withdrawal is crucial for helping patients overcome addiction and the acute withdrawal phase.
The practice issue identified is the knowledge and management of addiction and withdrawal symptoms in correctional institutions. At this time, patients who report opiate, benzodiazepine, narcotic, or alcohol (ETOH) use are placed onto a clinical opiate withdrawal scale (COW) or a clinical institute withdrawal assessment for alcohol (CIWA) at intake and are monitored for multiple days. The COW and CIWA assessments have attached protocols that allow patients who score at a certain level to receive medication. However, not all patients obtain medication based on their vitals and symptoms. Any patient going through withdrawal suffers to some extent, which drives a need to understand addiction better, its drives, and the symptoms accompanying the withdrawal to have more suitable treatment options available for patients who do not score high enough to receive protocol medication.
Valuable Middle-Range Theories for Practice Issue
As mentioned, nursing theories help shape practice and guide nurses throughout their careers and daily patient care. There are multiple nursing theories, ranging from grand, middle, and practice-level areas, when referencing these concepts. Grand theories are broad in scope, middle-range theories are narrower than grand theories and address more specific circumstances, and practice-level theories are concentrated on distinct situations, residents, and times (Wayne, 2023). This discussion will use two middle-range theories to address the identified health issue.
Pender’s Health Promotion Model
Pender’s health promotion model (HPM) focuses on behaviors that promote a healthier lifestyle, how perceived barriers influence choices, and how these choices affect health outcomes (Mehri et al., 2023; Narenji et al., 2023). Due to the focus of the HPM, this theory is influential in aiding a better understanding of addiction. By concentrating on the behaviors and thoughts of individuals who are using addictive substances, there is a significant potential to identify characteristics, thought processes, or conditions that lead individuals to these actions. While these life choices may not be health-promoting, scholars can “head poor choices off at the pass” and stop (or make more difficult) patients from obtaining these substances in the first place with a foresight of their intentions. Suppose patients discuss barriers to treatment, socioeconomic or environmental inequalities, and even demographics with their providers or healthcare staff. In that case, the gaps are easily outlined and can be addressed to help decrease substance abuse, the potential for withdrawal, and the need for medications.
Lenz and Colleague’s Theory of Unpleasant Symptoms
Lenz and her colleague’s theory of unpleasant symptoms (TOUS) addresses how nursing actions can help individuals through the experience of unpleasant symptoms while helping the nurse understand the patient’s perspective of those symptoms (Moore, 2021). With TOUS, there are three related parts, which include the symptoms, the influencing factors causing the symptoms, and the outcome of those symptoms (Blakeman, 2019). Understanding the withdrawal symptoms described by the patients, the factors causing them, and their perceived outcomes allows healthcare workers to treat these symptoms and offer better insight into assessing multiple symptoms simultaneously. When nurses look at these manifestations of withdrawal as a whole, a bigger picture starts to form, leading to better treatment options or policies versus the current practices. Furthermore, enacting a policy through the understanding of suffering for individuals who may not score high enough on the COW/CIWA assessments to help reduce their symptoms and misery. With quicker identification of at-risk patients and behaviors, treatment can be implemented sooner, leading to a swifter recovery, less torment, and better health promotion.
Conclusion
Nursing theories drive the practice to provide the most up-to-date and efficient care. Any individual in healthcare can utilize these theories, including those in a correctional setting. Individuals with substance abuse disorders deserve access to the most current and efficient treatment options. By utilizing the HPM and TOUS models, nurses within the correctional field can glean better knowledge of the process of addiction and the impactful behaviors that surround the decision-making of the individuals afflicted. Additionally, by better understanding their symptoms and suffering, new treatments can be created that are more readily available and provide faster, more efficient outcomes for patients to feel better. However, the most impactful takeaway from utilizing these theories is learning what causes people to turn to substance abuse and their behaviors to create policies or treatments that turn them away from using illicit or addictive substances in the first place.
References
Blakeman, J. R. (2019). An integrative review of the theory of unpleasant symptoms. Journal of Advanced Nursing, 75(5), 946–961. https://doi.org/10.1111/jan.13906
Cates, L., & Brown, A. R. (2023). Medications for opioid use disorder during incarceration and post-release outcomes. Health & Justice, 11(1), 4. https://doi.org/10.1186/s40352-023-00209-w
Mehri, S. M., Hashemian, M., Joveini, H., Sharifi, N., Rakhshani, M. H., & Assarroudi, A. (2023). The effect of web-based family-centered empowerment program in preventing the risk factors of substance abuse in students’ parents; application of the health promotion model. Journal of education and health promotion, 12, 175. https://doi.org/10.4103/jehp.jehp_831_22
Moore, A. K. (2021). The holistic theory of unpleasant symptoms. Journal of Holistic Nursing, 40(2), 193–202. https://doi.org/10.1177/08980101211031706
Narenji, M. A., Khazaee-Pool, M., & Iranpour, A. (2023). Development and psychometric properties of a health-promoting self-care behavior scale (HPSCB-S) in recovered patients from drug addiction. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-15311-9
Sharp, A., Generes, W. M., & Thomas, S. (2023, May 4). Drug withdrawal symptoms, timelines, and treatment. American Addiction Centers. https://americanaddictioncenters.org/withdrawal-timelines-treatments
Wayne , G. (2023, July 12). Nursing theories and theorists: The Definitive Guide for Nurses. Nurseslabs. https://nurseslabs.com/nursing-theories
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