Middle-Range Theory Continues to Guide Nursing Practice

Middle Range hypothesis Continues to Guide breast feeding Practice Lisa M. Sanford Maryville University Middle Range Theory Continues to Guide Nursing Practice Nursing speculation has three distinct categories to describe the level of precis Grand, Middle-Range, and Situation-Specific (Meleis, 2012, p. 33). Hugh McKenna (1997) defined these three categories, stating Grand scheme is highly abstract and is broad in scope. Middle-range theory is to a greater extent focuse and is normally the end product of a research study.Narrow-range theory is even more unique(predicate) and while also being based on research findings, it strings specific actions in the achievement of suitable goals (p. 17). When thinking about breast feeding theory, one might ask What is the purpose of theory? Is it even applicable to current treat practice? The best response to answer these questions I have found is from Meleis (2012) The first uses of theory ar to provide insights about nurse practice situations and to guide research. Through interaction with practice, theory is shaped and guidelines for practice evolve.Research validates, refutes, and/or modifies theory as well as generates new theory. Theory consequently guides practice (p. 35). This explanation of theory by Meleis identifies nursing as a profession. Without theory to shape and guide nursing practice and research, nursing would not evolve and would remain stagnant. Additionally, without theory could take ins really claim that we are a profession? I think not. I believe that theory is necessary for the personal identity of nursing as a profession verses a vocation.The nursing profession as a whole has had issues with identity for various reasons. I believe this to be true in part due to the numerous educational ways of entering the profession. I cannot think of any other field where one could earn two a diploma, two-year associates degree or a four-year baccalaureate degree as a starting point into a profes sion. The educational debate still continues, however, in recent age more emphasis is being made to have the baccalaureate nurse the entry level of the nursing profession.Evidence from research has suggested that the baccalaureate-prepared nurse is associated with a five percent lower mortality rates in both the likelihood of patients dying inside 30 days of admission and the odds of failure to rescue in hospitalized guests (Aiken, Clarke, Cheung, Sloane, & Silber, 2003, p. 1617). This research study was conducted because nursing is a profession. Would research in nursing even exist if thither were no theory? All in all, taken to its end, the loss of theory could mean the demise of nursing as a profession.When reflecting on current trends of clinical practice, I feel that middle-range theories are more applicable. Middle-range theories are broad enough to incorporate in everyday clinical practice for the average floor nurse without being too narrow in scope as the situation-specif ic theories. Additionally, middle-range theories are less abstract than bossy theories and are easier to relate to and put into practice (Liehr & Smith, 1999, p. 85). One example of applying middle-range nursing theory into practice is patient education. Patient education is a major focus of the clients I serve post transplant.It is imperative that a newly transplanted client understand his/her medications that are such an integral part of their new life in order to maintain the transplanted organ. Caring through Relation and Dialogue A Middle-Range Theory for Patient reading is derived from the two disciplines of nursing and education (Sanford, 2000, p. 8). According to Sanford (2000), A middle-range theory addressing the phenomenon of patient education through sympathize with can add clarity and direction to this area of concern for nursing, and it can provide an opportunity to colligate theory, practice, and research (p. ). Caring and dialogue are described in this theory as follows Dialogue is a process of naming our world. It is a process that opens the possibility for participants to pose problems, to critically reflect, and to perceive solutions not previously realized. This process occurs within a caring relation where the attentionr and the cared-for exhibit receptivity and engage in reflection, invitation, assessment, revision, and further exploration (p. 9). Another example of the applicability of middle-range theory is the theory of care transitions.A hot composition in todays times involves hospital acquired conditions (HACs) and readmission rates. Medicare expenditures are estimated at $15 billion p.a. due to readmissions (Averill, et al. , 2009, p. 1). As a result, policymakers have implemented the The Deficit Reduction Act of 2005, which eliminates any add-on in hospital payments due to the occurrence of HACs. Furthermore, it is viewed that high readmission rates are a reflection of curt quality, and ospital payments for readmissions we re recommended in the FY2010 budget from the Obama Administration to reduce payments for readmissions as one way of controlling Medicare expenditures (Averill, et al. , 2009, p. 1). As a staff nurse, I am all aware of the importance of HACs and the importance of diligent documentation. For example, when a client is admitted a thorough assessment is completed. Wounds and skin breakdown are crucial to document upon an admission or a transferred client to our division.If the documentation of skin assessment is not completed correctly, then the blame is dictated on our unit for an ulceration if it was not charted within 24 hours of admission. What are the causes or issues that surround care transitions? Increasingly fragmented care is one reason associated with hospital readmission rates. Issues include communication breakdowns related to plans of care, undecipherable expectations, uncertainty about illness trajectories, lack of continuity in medical follow-up, and incomplete or inacc urate understanding of medication regimens (Geary & Schumacher, 2012, p. 237).In my practice of nursing, the utilization of inpatient care management for clients begins upon admission in conceptualization for discharge. A multidisciplinary approach of the transplant team includes the doctors, inpatient nurses, social workers, dieticians, case coordinators, post-transplant coordinators, and transplant pharmacists working unitedly to coordinate and ensure continuity of care upon discharge. According to Geary & Schumacher (2012), Through the transition process, agents act and interact within relationship with each other, causing emergence of new behaviors and outcomes.Just as important, through supportive dialogue and discussion, sensemaking is enabled for everyone snarled in the transition, effectively reenvisioning multiple understandings of the situation and changing outcomes for the better (p. 246). Middle-range nursing theories can be viewed as a cookbook for nursing. There are many recipies in the middle-range theories which can be utilized by the average hospital-based nurse in a variety of ways. In any given 12-hour shift of a nurse, there are several theories which can be applied to specific situations.I have unknowingly used nursing theory in my practice over the years. This course has brought to my attention the diverse ways in which I have used middle-range nursing theories and has given me a better understanding of how nursing theory is applied to current clinical nursing practice. It is my opinion that middle-range nursing theories will continue to guide nursing practice throughout the 21st Century. References Aiken, L. H. , Clarke, S. P. , Cheung, R. B. , Sloane, D. M. , & Silber, J. H. (2003).Educational Levels of Hospital Nurses and Surgical Patient Mortality. The Journal of the American Medical Association, 290(12), 1617-1623. Averill, R. F. , McCullough, E. C. , Hughes, J. S. , Goldfield, N. I. , Vertrees, J. , & Fuller, R. L. (2009, Summer) . Redisigning the Medicare con PPS to Reduce Payments to Hospitals with High Readmission Rates. Health Care Financing Review, 30(4), 1-15. Geary, C. R. , & Schumacher, K. L. (2012). Care Transitions Integrating Transition Theory and complexity Science Concepts.Advances in Nursing Science, 35(3), 236-248. Liehr, P. , & Smith, M. J. (1999). Middle Range Theory Spinning Research and Practice to constitute Knowledge forthe New Millennium. Advances in Nursing Science, 21(4) 81-91. McKenn, H. (1997). Nursing Theories and Models. New York Routledge. Meleis, A. I. (2012). Theoretical Nursing Development and mature (5th ed. ). Philadelphia Lippincott, Williams & Wilkins. Sanford, R. (2000, March). Caring through Relation and Dialogue A Nursing Perspective for Patient Education. Advances in Nursing Science, 22(3), 1-15.