Middle-Range Theory

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Middle Range Theory

The middle-range theory is principally used in sociology to guide empirical inquiry. It is intermediate to general theories of social systems which are too remote from particular classes of social behavior, organization, and change to account for what is observed and to those detailed orderly descriptions of particulars that are not generalized at all. Middle-range explanatory theories specify relations between two or more concepts. Each explanatory theory explains why and the extent to which one concept is related to another concept. Middle-range theories deal with delimited features of social aspects, as is indicated by their designs. The middle-range theory involves concepts yet they are sufficiently close to recognized data to be combined in propositions that allow practical testing.  The middle-range theory can be applied to research in health promotion, modelling and role modelling, health-related quality of Life, comfort, deliberative nursing process and resilience according to the aspects of life (Alligood, 2014).

Nurses are the first contact patients see and interact with on a daily basis thus forming a close relationship. Patient care derives from knowledge, experience, and skills; emotional, psychological, coping skills, counselling and support among others in order to give full support to patients. The nurse’s role is to help patients with the activities required to achieve and maintain health, provide holistic nursing care through teamwork, compassion, cultural sensitivity, ethical awareness, and evidence-based practice.  Our nurses guide the patient through every step of the healing process.

As an Adult-Gerontology Nurse Practitioner (AGNP) in an advanced practice nurse role, I would apply Kristen Swanson’s Theory of Caring. The theory is consists of five principles that incorporate the overall representation of caring in nursing practice. This theory states that caring revolves around five categories: knowing, being with, doing for, enabling, and maintaining belief. Nursing theories are interrelated ideas to create an unconventional way of looking at a particular event, these theories are logical in nature, generalizable and are the foundations for reasoning that can be tested (Rahim, 2016).

Kristen M. Swanson Theory of Caring

Kristen M. Swanson, R.N., Ph.D., F.A.A.N. was born on January 13, 1953, in Providence, Rhode Island. Swanson currently holds the position as the Dean and Professor at the Seattle University College of Nursing.  Swanson is the first Virginia Mason Medical Center Distinguished Nurse Scholar. She is an alumnus of the Robert Wood Johnson Executive Nurse Fellows Program, an advanced leadership initiative for nurses in senior executive roles who strive to influence and develop the future U.S. health care system. Swanson conducts research funded by the National Institutes of Health and National Institutes of Nursing Research. Swanson publishes, mentors students and faculty, and serves as a specialist at national and international levels. In recognition of the many outstanding contributions to the development of the nursing discipline, among other honors. Her research concentrates on caring, responses to miscarriage and interventions to improve healing after early pregnancy loss. She has been a visiting professor in many countries such as the United States, Taiwan, Thailand, and Sweden, and is frequently requested to consult on policies to build and maintain a practice of patient-centered caring in healthcare facilities. Her caring theory has been applied to guide practice, learning, and research in schools and health-care settings around the world (Themes, 2017)

As a beginner nurse, more than anything Swanson needed to end up noticeably a learned nurse and in fact apt expert with an extreme objective of educating these aptitudes to others. Accordingly, she sought after graduate examinations in Adult Health and Illness Nursing Program at the University of Pennsylvania in Philadelphia. Swanson worked as a clinical instructor of medical-surgical nursing at the University Of Pennsylvania School Of Nursing.  Swanson decided to register as a Ph.D. student in the nursing program at the University of Colorado in Denver, Colorado. Swanson studied psychosocial nursing, emphasizing on examining the concepts of loss, coping, stress, person and personhood, interpersonal relationships, environments, and caring. As a doctoral student at the University of Colorado, as part of a hands-on approach experimenting with a self-selected health promotion activity, she took part in a caesarean birth support group which focused on miscarriage. At the support group, she noted that while the guest speaker who was a physician, concentrated on health problems and pathophysiology that was prevailing after a miscarriage, women who visited the meeting were more interested in talking about their personal experiences with pregnancy loss. That was a wake-up moment for Swanson and from that day on, she was determined to learn more about the human occurrence and replies to miscarrying. Miscarriage and caring became the focus of her doctoral dissertation and, subsequently, her program of research (Themes, 2017).

Kristen Swanson’s original work and phenomenon of concern 

Caring has been perceived as vital to nursing and is progressively set as one of the central ideas of an advanced nursing science. Swanson published her middle range theory of caring in 1991 and 1993. Swanson theory of caring was empirically developed from three phenomenological studies in separate perinatal contexts. On the foundation of these studies, Swanson established a definition of caring which she expressed as “caring is a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility” (Kalfoss, & Owe 2015).

According to the review article: Empirical Verification of Swanson’s Caring Processes Found in Nursing Actions: Systematic Review. In testing existing theoretical structures is an ongoing challenge in the discipline of nursing. Results from this study provide empirical validation of Swanson’s five caring processes of knowing, doing for, being with, enabling and maintaining belief in her theory of caring and lend experimental support for her meaning of caring. Swanson’s middle range theory provided a reasonable structure for the categorization of experimental indicators of caring actions from a systematic literature and contributed to the process of conceptualizing, understanding, and going beyond the empirical data (Kalfoss, & Owe 2015). In trying to analyse the findings under the separate processes, problems were encountered by the authors in that certain empirical indicators could be categorized under more than one process. For example, aspects of professional knowledge and skills could be regarded an empirical indicator in both Knowing and Doing For. Some of the subcategories in Knowing could also apply for all the other caring processes, just as the subcategories found in Being With could also be descriptive of other caring processes as well (Kalfoss, & Owe 2015).

Theory of Caring Inductive Reasoning

Swanson’s Theory of Caring was inductively realized by detailed phenomenological analysis with women who had miscarriages, caregivers of vulnerable infants in the NICU and socially at-risk mothers who had undergone long-term care from master’s prepared public health nurses (Peterson, & Bredow, 2013). The example is given through two investigations done on the theory of caring. The investigation that was done to apply this theory was used to ascertain that caring was useful in limiting the participants’ overall disturbed mood, depression, and anger. The study participants; those that were treated or not assigned less personal importance to miscarry and had greater levels of self-esteem and less anxiety, anger, and confusion. The discoveries of the investigation showed that while the progression of time positive affected ladies’ mending after a miscarriage, caring interventions positively affected diminishing the general bothered inclination, outrage, and level of dejection

The second aim of this investigation was to monitor the caring variable and identify whether caring was delivered as intended. In this investigation, caring was monitored in three different ways: (1) approximately 10% of counselling sessions were transcribed and data were analysed using inductive and deductive content analysis; (2) before each caring session, the counsellor completed McNair, Lorr, and Droppelman’s (1981) Profile of Mood States to monitor whether her own mood was associated with women’s ratings of caring after each session, using the investigator-developed Caring Professional Scale; and (3) after each session, the counsellor completed an investigator-developed Counsellor Rating Scale and took narrative notes about the counselling session. The most important finding of observing care was that the majority of the participants were exceptionally happy with caring they receive amid counselling sessions, recommending that caring was conveyed as proposed (Peterson, & Bredow, 2013).

Major concepts of the theory

Swanson used various theoretical sources while developing her Theory of Caring. Swanson’s theory caring revolves around five categories: knowing, being with, doing for, enabling, and maintaining belief.  Swanson explains each concept as: Knowing which seeks to endeavor to comprehend an occasion as it needs to mean in the life of the other. Knowing includes maintaining a strategic distance from presumptions about the significance of an occasion to the one looked after, fixating on alternate’s needs, leading the top to bottom evaluation, looking for verbal and nonverbal prompts, and drawing in the self of both. Being with involves being sincerely present to the other by communicating continuing availability, sharing emotions, and observing that the one administering care does not burden the one cared for. Doing for involves improving the situation for the other that he or she would improve the situation for themselves if they had the chance. Improving the situation alternate means giving consideration that is encouraging, defensive, and expectant, and additionally performing obligations skilfully and ably while safeguarding the individual’s pride. Enabling involves encouraging the other’s entry through life advances and new occasions by educating, clarifying, supporting, concentrating on applicable concerns, thoroughly considering issues, and producing options. Empowering advances the client’s personal healing, development, and self-care. Maintaining belief involves Managing confidence in the other’s ability to overcome an occasion or progress and face a future with meaning. The objective is to empower the other so that inside the requirements of his or her life, they can discover meaning and keep up an expectation-filled state of mind (Peterson, & Bredow, 2013).

Swanson’s theory is consistent in applying the theory. The theory was formed from Swanson concentration on investigating caring from the point of view of 19 professional caregivers and 7 parents of new-born children hospitalized in the neonatal emergency unit). She found that the caring process she had recognized through her dissertation look into were additionally relevant to parents and experts who were in charge of dealing with babies in the NICU. Swanson used the caring theory not only for definitions or depicting the demonstrations of caring but also could recommend that clinical care in a perplexing situation requires adjusting of tending to self as well as other people, joining to others and in addition one’s part, overseeing duties, and keeping away from awful results for self, others, and society (Peterson, & Bredow, 2013).

Swanson’s theory was noted in an explicit form, indicated the different ways in which the theory could be applied in all aspects of nursing. Swanson apply the theory of care because as nurses it is imperative to use “care” when applying our theory and practical skills. The concepts establish that caring is used as a tool to study the meaning and practicing the art of caring for patients. Swanson believes that caring is a universal phenomenon which is central to the nursing profession. In addition, she states that for the students to offer therapeutic nursing care, they should acquire the knowledge of caring values, theories, practices, and beliefs (Peterson, & Bredow, 2013).

Assumptions

1.     The theory uses caring an essential component of nurse–client relationship in any setting (Peterson, & Bredow, 2013).

2.    How the use of evidence-based practice as a guide to gained momentum in nursing by using more practice-relevant research and have a closer working relationship between clinicians and researchers (Peterson, & Bredow, 2013).

3.    Caring transpires in every nurse-client relationship that includes skilful utilization of caring processes (knowing, being with, doing for, enabling, and maintaining belief) (Peterson, & Bredow, 2013).

4.    Caring is determined by the nurse’s perspective (maintaining belief), knowledge of client’s occurrence (knowing), verbal and nonverbal communication with the client (being with), enabling (believing in the client’s ability to live through difficult transitions), and outcomes of caring (intended outcomes of nursing process) (Peterson, & Bredow, 2013).

Four Concepts of the Nursing Metaparadigm

The four metaparadigms of nursing include health, person, environment, and nursing. The metaparadigm of the person focuses on the patient who is the recipient of care which includes a person’s religiosity, culture, relatives, and colleagues or socioeconomic status (Branch, et. al., 2016). According to Swanson’s Theory of Caring outlines that the personhood is established within the nursing method which states that persons “are unique beings which are in the midst of becoming and whose wholeness is made manifest in thoughts, feelings and behaviors”. She continues to establish that the thoughts following personhood impact how the concepts of “clients” and “nursing” are understood and establish a relationship with the person and the environment. She also leaves open the idea of “other” being individual or collective, as well as the concept of relevance to future, past, or present (Peterson, & Bredow, 2013).

The metaparadigm environment includes both internal and external circumstances related to the patient which includes the communications patients have with visitors as well as their surroundings (Branch, et. al., 2016).  Swanson’s Theory of Caring outlines her perspective of the environment by explaining that the environment includes any setting that can alter or be adjusted by the client in a socio-political, biological, psychological, spiritual and socio-economic setting (Peterson, & Bredow, 2013).

The metaparadigm of health refers to the quality and wellness of the patient which includes the access the patient has to health care (Branch, et. al., 2016). Swanson’s Theory of Caring outlines her perspective of health which includes: Health can be an absence of illness, health can be an ability to fulfil a role, health can be an ability to adapt and health can be a pursuance of well-being. She also established that health is socially determined, and consequently develops adjacent to trends and differences in societal values, norms, and beliefs (Peterson, & Bredow, 2013).

The fourth metaparadigm is the nursing component which makes an indication to the nurse and how he or she will apply their education and abilities when caring for patients. It also refers to the attributes of the nurse who is providing the care (Branch, et. al., 2016). Swanson’s Theory of Caring outlines her perspective of nursing to establish the fact that nursing includes nursing values, history, expertise, knowledge, universality, and passion and encompass all her five processes of knowing, being with, doing for, enabling, and maintaining belief. Swanson establishes that the act of nursing emerges as a knowledge base that is inherent and acquired thus it manifests itself.  There are subtle acts of caring which are imperative to the client’s health and the “care” received is dependent upon that (Peterson, & Bredow, 2013).

The theory of caring provide a role in helping nurses to see how other theorist have developed their own way of caring for the patients (Branch, et. al., 2016). The theory is easy to understand and is consistent in using applicable assertions the note how the theory applies each concepts. To be able to apply theories as a nurse practitioner, this is a role that calls for nurse practitioners to show sympathy at their core and willingness to work closely with patients which will allow them to determine the best care plan for those persons in the healthcare facilities.

To be able to advance in this role by engaging my patients from an expert level, I will have to enrol in the Masters of Science in Nursing (MSN) program. As such I will be able to apply my skills as an Adult-Gerontology Nurse Practitioner (AGNP) in my practice. This will enhance my role in the nursing field because the program includes nursing theory, clinical experience, management, pharmacology, and research. The overall idea is to allow all nurses, at all levels, to perform to the fullest extent of their training. This would enable nurses to maximize their value to the healthcare team and it can even help lower the cost of healthcare overall. Advance practice nurses need to handle greater empowerment of patients, improved system leadership, modernized workforce, accelerated innovation, improvements in quality of care and greater efficiency. For example, I will be able to create a plan of care by the implementation of treatment, providing health preservation, health advancement, disease prevention, and treatment. This assists with assessing and diagnosing health status, ensuring a professional, and collaborative approach to care and act as service by being a teacher and coach to patients. It will also enhance my evidence-based practice skills which will also help me to redesign care for my patients that are effective, safe, and efficient.

In conclusion, caring is also used as an intentional mutual human process in which the nurse responds with authentic presence to enhance the well-being of patients. Additionally, nurses should utilize the nursing process as a scientific and clinical reasoning approach to patient care that includes planning, analysis, evaluation, assessment, and implementation. Additionally, the theory of the caring executes change and leadership by ensuring that each nurse utilizes the concept of caring which includes putting the patient first at all times. This vision allows for the nurses to adapt to change, resolves conflicts in an efficient manner and assess leadership. Thus, Successful outcomes of nursing care are based on the speed with which or degree to which the patient independently performs the activities of daily living.  The outcome for this care theory is to emphasize the importance of increasing the patient’s independence so that progress after hospitalization would not be delayed.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reference

 

Alligood, M. R. (2014). Nursing theorists and their work (8th ed.). St. Louis, MO: Elsevier/Mosby.

Branch, C., Deak, H., Hiner, C., & Holzwart, T. (2016). Four Nursing Metaparadigms. Retrieved from https://scholarworks.iu.edu/journals/index.php/iusburj/article/viewFile/22199/28143

Kalfoss, M., & Owe, J. (2015). Empirical Verification of Swanson’s Caring Processes Found in Nursing Actions: Systematic Review. Open Journal of Nursing, 05(11), 976-986. doi:10.4236/ojn.2015.511104

Peterson, S. J., & Bredow, T. S. (2013). Middle range theories: application to nursing research. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health.

Rahim, L. (2016). Comparison between two nursing theories: Rogers and Leddy Journal Of Nursing, 6(1), 1-5

Themes, U. (2017, February 09). Theory of Caring. Retrieved from https://nursekey.com/theory-of-caring/

 

 

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