Application of Middle Range Theories in Nursing Practice

  1. Based on the Case Study of Ms G. (presented below) and your readings in Smith (2020) and/or Peterson and Bredow (2020), or theories from other health related disciplines, such as:
    • Lazarus & Folkman Stress & Coping McCubbin’s Family Resiliency Model Fishbein’s Theory of Reasoned Action
    • Ajzen’s Theory of Planned Behavior
    • Health Belief Model
    • Olson’s Circumplex Model (Family) Belsky’s Parenting Model
    • Locus of Control
    • Selye’s Stress Model
    • Theory of Learned Resourcefulness Bandura’s Self-Efficacy Theory
    • Family Life Cycle
    • Aguilera & Messick’s Crisis Intervention Theory

SELECT ONE Middle Range Theory that you believe would be appropriate to guide the nursing care of Ms G.

  1. Based on the Selected Middle Range Theory Discuss the Following:
    • Theory Development
    • Purpose
    • Assumptions
    • Key Concepts
    • Propositions of the Theory
  2. Based on the Middle Range Theory:
    • Identify Three Nursing Assessment Questions
    • Identify Three Nursing Actions (Interventions)
  3. Write one research question based on the middle range theory and the care of Ms G.
  4. Discuss how knowledge of a middle range theory has informed or guided your nursing practice in the care of Ms G.

Case Study of Ms. G

Demographic Information: 42-year old Hispanic female
Primary Care Clinic Visit: Appointment made in primary care clinic for recurrent vaginal infections and follow-up for atypical cells on pap smear.
Initial complaint: “I am having bleeding between my periods. I have pain in my abdomen and back. I have been feeling lousy for weeks.”

Diagnosis: Stage III Cervical Cancer

History of Present Illness
• Current admission to the medical-surgical unit for a total abdominal hysterectomy
• Post-operative day 3: Patient reporting abdominal pain (7/10 in intensity), intermittent nausea with vomiting, chills and sweats, anxious mood, generalized weakness and insomnia. No frequency on urination or urinary burning. Reports slight red vaginal discharge.
• Emotional Outlook: Crying: States “I knew something bad was going to happen to me. Am I going to die? God is angry with me.”

Past Medical and Surgical History
• History of constipation since childhood. Takes Metamucil daily to promote regularity
• History of asthma
• Termination of pregnancy six months before her divorce since her husband did not want any more children and unstable relationship
Psychiatric History
• Post-partum depression after each pregnancy. Treated with anti-depressants and counseling.

Social History
• No history of substance use
• Reports two to three glasses of wine with dinner every night
• Limited social network since divorce
• Unable to work at present- income $31,000 per year

Cultural/Spiritual History
• Family originally from Puerto Rico.
• Faith-Catholic though has not attended church recently.

Sexual and Reproductive History
• Menarche age 12; sexual abuse age 14 by family friend
• Two Cesarean sections (Patient’s age 24 and age 29)
• Used birth control pills
• Has new sexual partner who she met at work
Family History
• Sons have been delinquent at school; participation in gang activity
• Unavailability of support of parents due to their own chronic illness (Father-prostate cancer; Mother- depression)
Activities of Daily Living
• Limited energy to perform IADLs or ADLs.

Develop ONE Research question to test the Middle Range Theory 2 points
Discuss how knowledge of this middle range theory informs your nursing practice 3 points

Full Answer Section

       
    • Secondary Appraisal: The evaluation of one's coping resources and options to deal with the stressor.
    • Coping Strategies: Problem-focused coping (addressing the source of stress) and emotion-focused coping (managing emotional responses to stress).
  • Propositions:
    • Individuals' perceptions of stress are influenced by their cognitive appraisals.
    • Coping strategies are influenced by personal resources, social support, and cultural factors.
    • Effective coping can reduce the negative impact of stress.

Nursing Assessment Questions Based on the Theory

  1. Primary Appraisal: "How do you perceive your current situation? What does this mean to you?"
  2. Secondary Appraisal: "What resources do you have to cope with this situation? Who can you rely on for support?"
  3. Coping Strategies: "What strategies are you using to manage your stress and anxiety?"

Nursing Interventions Based on the Theory

  1. Cognitive Restructuring: Help Ms. G. reframe her thoughts and perceptions of the situation to reduce negative thinking.
  2. Stress Management Techniques: Teach relaxation techniques, such as deep breathing and meditation, to manage physical and emotional symptoms.
  3. Social Support Facilitation: Encourage Ms. G. to connect with support networks, such as family, friends, or support groups.

Research Question

  • How does the use of cognitive-behavioral interventions impact the psychological well-being and coping strategies of cancer patients undergoing treatment?

Informing Nursing Practice

Understanding Lazarus and Folkman's Stress and Coping Theory has significantly informed my nursing practice in caring for patients like Ms. G. By recognizing the importance of cognitive appraisal and coping strategies, I can:

  • Empathize with patients: I can better understand how patients perceive their situation and the emotional toll it takes on them.
  • Tailor interventions: I can develop individualized care plans that address patients' specific needs and coping styles.
  • Promote resilience: I can help patients build resilience by teaching effective coping strategies and encouraging social support.
  • Advocate for patient-centered care: I can advocate for policies and practices that support patient well-being and reduce stress.

By applying this theory, I can provide compassionate and effective care that addresses the psychological and emotional needs of patients facing significant health challenges.

 

Sample Answer

       

Theory Development, Purpose, Assumptions, Key Concepts, and Propositions

  • Development: This theory emerged from the work of Richard Lazarus and Susan Folkman in the 1980s.
  • Purpose: To understand how individuals perceive and respond to stressful events.
  • Assumptions: Individuals actively appraise stressors and choose coping strategies to manage them.
  • Key Concepts:
    • Primary Appraisal: The initial evaluation of a stressor to determine its significance.