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NURS 8114 Discussion Exploring Middle Range Theories and Framing Practice Issues Walden

NURS 8114 Discussion Exploring Middle Range Theories and Framing Practice Issues Walden

Nursing theories form an integral part of nursing research and nursing practice. In particular, they are useful in addressing various clinical problems, such as patient issues surrounding chronic illnesses (McEwan & Wills, 2021). One of such problems is increased cases of hospitalizations of medication non-compliant patients having various chronic conditions. Increased rates of hospitalizations have various negative impacts, such as increased healthcare spending. Therefore, innovative and sustainable strategies should be used in controlling them.

Some of the middle-range theories that can be used in addressing the problem include Nola Pender’s Health promotion model and the Self-care of chronic illness theory. These theories can effectively be used to address the problem due to their theoretical underpinnings. For example, Pender views health as something that is more than the absence of diseases (Wilson, 2021). Therefore, such will be used as part of a health promotion initiative among the non-adhering patients to reduce the incidences of rehospitalization.


Hello, thanks a lot for your insightful discussion about applying middle-range theories in solving the indicated clinical problem. I would like to add that; indeed, the theories can help in guiding the implementation of an initiative that focuses on addressing the condition. However, it is imperative to note that nursing theories offer far more than that, as they sometimes become instrumental in understanding a particular phenomenon of clinical setting (Smith, 2019). Allow me to ask a few questions. Can you please explain further in the use of the theories how you will apply various concepts in your project?

It is also important to know that theories, when well used, usually have frameworks that can be applied widely and in a specific clinical setting. It would be appropriate to thoroughly check the underpinnings of a particular theory to find out if it is relevant or suitable for a particular situation or clinical issue.


McEwan, M., & Wills, E. M. (2021). Theoretical basis for nursing. Lippincott Williams & Wilkins.

Smith, M. C. (2019). Nursing theories and nursing practice. FA Davis.

Wilson, J. C. (2021). Nola J. Pender: Health Promotion Model. Nursing Theorists and Their Work E-Book, 320.

Inconsistent  clinical care of vulnerable  populations in the Emergency Department is the practice issue. One identified vulnerable population is the homeless. “Homeless patients are a unique patient population with high occurrence of inappropriate emergency department utilizations” (Holmes et al., 2020). Lack of knowledge base can be identified as one reason for the gaps in the patient care received. Brown and Steinman (2013) concluded the ED care of the older homeless adult differ from the ED care of the younger homeless adult.

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The American Association of Critical Care Nurses Synergy Model of Patient Care and Benner’s Professional Advancement Model are the two middle range theories that are most valuable in addressing this issue. The Synergy model basic concept is that the patient’s needs and their level of need will determine the competencies the nurse needs to develop a synergistic  patient-nurse relationship. The more competent the nurse the more valuable the relationship and patient outcomes. The synergy model  characteristic of patient  vulnerability requires the nurse to be competent as a moral agent and advocate for the patient. Benner’s competency based theory of professional advancement describes the stages of the nurse knowledge based on the skills that the nurse has achieved. The more advices the knowledge and practice of the nurse helps to prepare the nurse to collaborate and advocate for the homeless patient in the community and within the health care system.


American Association of Critical-Care Nurses. Appendix C: the synergy model. In: Standards for Acute and Critical Care Nursing Practice. Aliso Viejo, CA: American Association of CriticalCare Nurses; 2000: 47-55.

Brown, R. T., & Steinman, M. A. (2013). Characteristics of Emergency Department Visits by Older Versus Younger Homeless Adults in the United States. American Journal of Public Health103(6), 1046–1051. https://doi-org.ezp.waldenulibrary.org/10.2105/AJPH.2012.301006

Holmes, C. T., Holmes, K. A., MacDonald, A., Lonergan, F. R., Hunt, J. J., Shaikh, S., Cheeti, R., D’Etienne, J. P., Zenarosa, N. R., & Wang, H. (2020). Dedicated homeless clinics reduce inappropriate emergency department utilization. Journal of the American College of Emergency

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Infections, a threat to quality healthcare outcome at home

The home health care system is rapidly gaining popularity across the US, and has been deemed to be cost effective and more convenient for patients and their family members, however, patients at home are considered to be at a very high risk for infections; respiratory, urinary, and wound site infections (Shang et al., 2020) being the most common. This may be attributed to the fact that most patients getting admitted into the HHC system often have suffered a severe health condition and in a state of limited physical activity (Shang et al., 2020).

Some of the factors that have been identified to favor infections among home health care patients include: patients with recent (within the past 6 months) multiple hospitalizations history; severe medical condition, impaired movement/physical activity, inadequate knowledge of correct medical procedure by the caregivers, as well their lack of training – the very problem I see in my practice that I intend to address.

Although the patient’s conditions may hinder physical activities, risking their contracting infections, increased wound site infections and UTIs are mostly directly related to the inadequacy of proper medical care from the caregivers. In my experience, caregivers tend to kick off so well, strictly following instructions and procedures, but wane as care lasts. At times when I trained them again, they (the caregivers) have improved in caring, and their patients recording minimal infections.

With the ever-evolving technology, the caregivers are to be constantly educated to use modern equipment to facilitate physical movement, which in turn reduces infections; prevent falls leading to reduced accidents and wounds.

To what extent will quality education of caregivers prevent infections among patients in home healthcare system, thereby prevent rehospitalization as well as reducing cost?

according to Smith and Lehr (2008) the middle range theory of dynamics of caregiving is identified as the force motivating caregivers and care recipients to assume and continue the caregiving relationship, whether they are paid or unpaid (p. 261). These same caregivers enable patients who are being discharged from the hospitals as well as serve as a bridge linkingambulatory care facilities and patients.

Another middle range theory of my interest is that of symptom management. Identifying any new symptoms in home healthcare is very crucial, determining to some extent the outcome of the condition. For example, a deep wound site infection can cause fever, sweating, restlessness; systemic symptoms, which when identified on time, may prevent a septic event. Other aspects of symptom management include symptom experience, symptom management strategies, and symptom status outcomes (Smith & Liehr, 2008, p. 146)


Agency for Healthcare Research and Quality. (September, 2018). Fall prevention in hospitals training program. https://www.ahrq.gov/patient-safety/settings/hospital/fapp-prevention/index.html

Shang, J., Wang, J., Adams, V., & Ma, C. (2020). Risk factors for infection in home health care: Analysis of national Outcome and Assessment Information Set data. Research in nursing & health, 43(4), 373–386. https://doi.org/10.1002/nur.22053

smith, M. J. & Liehr, P.R. (2008). Middle Range Theory for Nursing, Second Edition: Vol. 2nd ed. Springer Publishing Company.

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