Every profession comprises of a special body of knowledge that defines the way things are handled. Previously, nursing as a profession depended on knowledge, theories, and concepts from other fields such as sociology, medicine, and psychology as a basis for practice. Currently, Nursing has its set of activities that are used in developing its research. These activities such as theories and models provide information regarding goals of practice, the scope of nursing, principles forming the basis of practice and finally defining nursing and nursing practice. Middle range theories are commonly used in nursing practice to develop concepts and phenomena used in nursing practice. An example of these theories is uncertainty in illness which is mostly used in chronic illnesses.
Middle range theories address the knowledge of nursing practice through targeting specific concepts and phenomena such as stress and pain. The concepts are related to the caring and healing process which is essential in providing quality care to patients. Though limited in scope, these theories encourage research in nursing as they provide profound operational concepts while enabling empirical testing. It is important to note that these theories are specific to nursing and are easy to use and apply. Middle range theories are characterized by the concepts being specific to nursing, possible to apply to several situations, assumptions, relevant to the users and should be outcome oriented but not instructions of what should be done. There is a relationship between middle range theories and sociology. The theories are used in sociology to guide empirical inquiry (Smith & Liehr, 2008). This is achieved through systematic efforts that explain any observations in social organization, social change, and social behavior. Each middle range theory has its base in paradigmatic perspective.
One of the daily middle range theory practiced in our day to day lives is the theory of uncertainty in an illness which is characterized by questions on test results that are inconsistent, diagnoses, type of treatment to be pursued and also the type of care given to the patient such as the type of food to be consumed. The key term in this theory which is uncertainty is defined as the inability to explain the meaning of events related to the illness. Medical practitioners are unable to determine specific events and objects related to diagnosis and accurate treatment of the disease. A common application of this theory is when a person is diagnosed with a chronic illness. Though uncertainty decreases over time as more symptoms arise, it may also return if the illness recurs (Merle, 2010). During the diagnoses phase of an illness, uncertainty is considered as the most depressing aspect. It is recommended that the health care providers lessen the uncertainty through providing the patient with adequate information about the illness. Additionally, nurses should show confidence in knowledge regarding the disease. Other aspects that are important in this theory include personality of the patient and their level of literacy. A positive person may use this opportunity to re evaluate their life and focus on leading a healthy one. Similarly, a literate person is easy to work with while targeting at minimizing the effects of the illness.
Mast (1995) is of the opinion that nursing practice of uncertainty is affiliated with illnesses that are life threatening and whose treatment technology is rapidly growing. Research done by nurses focuses on variables that precede and influence this uncertainty. Further, they study how patients can cope and adapt to the uncertainty. Findings from his research that focused on adult illness related to uncertainty indicated that the aspect in illness is depressing and is a major influence on patients adaptive and coping responses. The study further explored the implications for nursing practice as well as future research on the theory. The middle range theory of uncertainty in illness is common in chronic illnesses as ascertained by Mishel (1998) who critiqued the theory after conducting a research on it. The research concentrated on the causes and consequences of uncertainty in diagnosing and treatment of the chronic illness. Among the consequences noted in the study was stress and depression to the patients. Also, there was a risk of health care providers treating the wrong disease. A study on breast cancer which is one of chronic illness showed that there was a relationship of uncertainty, treatment, control and threats to coping strategies employed by women diagnosed with breast cancer (Hilton, 1989). The study also showed various strategies adopted by the patients who faced a threat of high control and recurrence which is a characteristic of uncertainty.
While focusing on developing evidence-based proposals for treating chronic illness such as cancer, uncertainty in illness is an important aspect in determining the factors to consider in devising my strategies. Such factors include the side effects of chemotherapy such as insomnia and hot flushes. An example of an evidence proposal I studied that employed this theory was the effect of fatigue, soft music and controlled sleeping hours on cancer patients in the acute facility. In this proposal, it is important to note that symptoms in the patients varied which was a critical aspect to consider in its development. Additionally, the stage of cancer also varied which meant that the patients were to be exposed to different activities.
In conclusion, nursing practice requires a set of concepts and theories that provide sufficient knowledge on the best ways to provide quality care to patients. Middle range theories which major on this practice develop concepts and phenomena based on research and empirical testing. An example of middle range theory is uncertainty in an illness which focuses on health care providers not being sure on diagnosing and treating diseases. This is common in treating chronic illnesses such as cancer. Various studies that study this theory have shown effects such as depression and stress in patients as a result of uncertainty.
Hilton, B. A. (1989). The relationship of uncertainty, control, commitment, and the threat of recurrence to coping strategies used by women diagnosed with breast cancer. Journal of behavioral medicine, 12(1), 39 54.Mast, M. E. (1995). Adult uncertainty in illness: A critical review of research. Scholarly inquiry for nursing practice 9(1), 3 24.Merle Mishel (2010) Uncertainty of illness - Merle Mishel middle range nursing theorist. Retrieved July 21, 2016, from https://sites.google.com/a/northgeorgia.edu/merle-mishel-middle-range-nursing-theorist/home/uncertainty-of-illness
Mishel, M. H. (1988). Uncertainty in illness. Image: The Journal of Nursing Scholarship, 20(4), 225 232.
Smith, M. J., & Liehr, P. (2008). Understanding middle range theory by moving up and down the ladder of abstraction. Middle range theory for nursing, 13 31.
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