Conceptual Components of Theory
Conceptual Components of Middle Range Theory
Middle range theories were introduced in 1974 to nursing and set to describe, explain, or predict phenomena (McEwin & Willis, 2019). The process is done by testing the said theory for its validity. One aspect of nursing care that the author finds necessary is critical thinking skills. Understanding what is happening with a patient and how to make prudent decisions is of great importance. As the author is now a nurse educator, it posed the question of whether graduate nurses can make the right decisions based on Intuition. The theory of intuitive decision-making in nursing was established by using theory synthesis and empirical evidence resulting from research (Payne, 2015). This theory has different components that deal with the nurses’ thinking skills and response to an issue. Payne’s (2015) pilot study included Intuition, somatic state, skin conductive response, nursing experience, pattern recognition, memory, and decision-making between novice and experienced nurses. All of the components were considered for testing the theory of intuitive choices making.
How Components are Observed and Measured
One of the defining marks of a middle-range theory is it is measurable. In the study of intuitive decision making, observations and cumulative research are used to measure the components. Gray et al. (2017) stated that structured observation cautiously defines specific behaviors or events to be inspected or observed in a study. Researchers determine how the observations are to be made, recorded, and coded. Observations could be caused by following critical patients with new graduate and experienced nurses to see the decision-making skills in action. Several components can be tested by administering a test to a significant number of nurses within the range of novice and experience. There are critical thinking modules available to have nurses identify symptoms in patients and anticipate care. This module is assigned to all new graduates at the facility; I began my nursing career many years ago. It is difficult to describe why or how a nurse performs tasks, interventions, and patients with good outcomes due to other prevailing variables. With the components that the author is set to test and observe, it will make the theory more appropriate for a middle-range theory.
There are various studies regarding this subject. The pilot study of the selected article was not followed up that I could find. I did, however, find similar articles more focused on the experience of nurses and decisions. Nibbelink and Brewer (2018) found that nursing experience, organization, and unit cultures influence education, patient status, situational awareness, and autonomy, all affecting intuitive decision-making. This furthers the theory furthers the concept that experienced nurses have more developed decision-making skills. Theories based on nurses decision making may have profound effects, not only on understanding the way nurses make decisions, but on how hospitals can support the development of intuitive decision-making in their nurses (Payne, 2015).
Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.
McEwin, M., & Wills, E. M. (2019). Theoretical basis for nursing. (5th ed.) Philadelphia, PA: Wolters Kluwer Health.
Nibbelink, C. W., & Brewer, B. B. (2018). Decision‐making in nursing practice: An integrative literature review. Journal of clinical nursing, 27(5-6), 917-928.
Payne, L. K. (2015). Toward a theory of intuitive decision-making in nursing. Nursing Science Quarterly, 28(3), 223-228.
Conceptual Components of Theory
Middle-range theory has a distinct approach and concepts only utilized to create a definitive proposal. This theory is preferred because they create a foundation for “testable hypotheses” in relation to a particular trend or specified patient populations (McEwin & Wills, 2019, p. 38). A distinct example can be serenity being reviewed in those recovering from alcohol or drug addiction using the 12 step AA program. Serenity was reviewed as a main focal point because it allowed a healing component while experiencing a “spiritual awakening” (Rushing, 2008, p. 206). Overall, there is a transformation of oneself by attaining serenity during the healing process over addiction (Rushing, 2008).
Selected Middle-Range Theory
A selected example of a middle range theory that can be applied to practice is Kolcaba’s Comfort Theory. The term comfort is directly related to any learned experiences in a person’s life. Any interventions that are completed are done for the purpose of relieving distress and to allow “sensitivity and empathy” (Peterson & Bredow, 2013, p. 160). It is noted by Kolcaba that “comfort is a positive concept and is associated with activities that nurture and strengthen patients” (March & McCormack, 2009, p. 76). Therefore, any health care discipline or practice can institute Kolcaba’s theory as it does appear is three forms: relief, ease, and transcendence. These three forms can be evident throughout any of the four frameworks of physical, psychospiritual, environmental, and sociocultural. Overall, if comfort is heightened the patient will increase health-seeking behaviors (March & McCormack, 2009, p. 77).
Theory Components in Practice
Comfort Theory can be presented in practice by first viewing a situation, reviewing the interventions needed, and enhance comfort. Distinct examples could be end-of-life comfort care for a patient and their family, regardless of the causation such as cancer or dementia. Three examples in occurrence with the three forms of Kolcaba, ease, relief, and transcendence would be the feeling after one’s anxiety is recognized and addressed, relief of pain after pain medication is administered, and physical therapy in a cardiac rehabilitation setting (March & McCormack, 2009).
Theory’s Development and Change
Originally in the early 1990’s the thought of comfort was the goal in medicine and nursing, since then it became a moot point in healthcare. The Comfort Theory then evolved from Katharine Kolcaba in the 1990’s (March & McCormack, 2009). As the theory evolved so did nursing alongside it. As nurses it is important to remember with experiences comes learning and to be reminded that “we are the stories we tell and our stories provide a sense of connection to other people” (Rushing, 2008, p. 206). With knowing one’s attitude and behavioral control this can provide the needed support and be the foundation of creating interventions suitable to impact a patient’s behavior (Perkins et al., 2007). This type of insightful information creates professional development by showing a continual commitment to specified skills and pathways within nursing (Cooper, 2009).
March, A. & McCormack, d. (2009). Nursing theory-directed healthcare: Modifying Kolcaba’s comfort
theory as an institution-wide approach. Holistic Nursing Practice, 23(2), 75-80.
McEwin, M., & Willis, E.M. (2019). Theoretical basis for nursing. (5th ed.). Philadelphia, PA: Wolters
Cooper, E. (2009). Creating a culture of professional development: A milestone pathway tool for registered nurses. Journal of Continuing Education in Nursing, 40(11), 501-508.
Perkins, M., Jensen, P., Jaccard, J., Gollwitzer, P., Oettingen, G., Pappadopulos, E., & Hoagwood, K.
(2007). Applying theory-driven approaches to understanding and modifying clinicians’ behavior: What do we know? Psychiatric Services, 58(3), 342-348.
Peterson, S. & Bredow, T. (2013). Middle range theories: Application to nursing research (3rd ed.).
Philadelphia, PA: Wolters Kluwer Health & Lippincott Williams & Wilkins
Rushing, A.M. (2008). The unitary life pattern of persons experiencing serenity in recovery from alcohol
and drug addiction. Advances in Nursing Science, 31(3), 198-210.
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