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Clinical Nursing Essay

Introduction

Nurses utilize multiple theories daily to care for patients and their families, though these theories range from grand, to situation-specific, to mid-range the nurse tends to focuses on which theory will provide the best care to his/her patient. Perhaps in my opinion mid-range theories with their growing frequency of use are best suited for nursing in the 21st century. Mid-range theories are said to be middle rather than ordinary but they are specific enough to evaluate observed situations (McCurry, Revell, &Roy, 2009). There are multiple reasons why mid-range theories offer some of the most up to date information when it comes to the care of our patients and families, but let’s just break it down to three; interpersonal relations, family, and health promotion. The middle range theories of these three examples will provide a set of assumptions and/or predictions from specific situations confirmed by research (Nolan & Grant, 1991).

Interpersonal relations

First, Hildegard Peplau’s Theory of Interpersonal Relations has influenced patient care in the 21st century worldwide. What is so crucial and probably most significant with this mid-range theory is its focus on human issues and its value of future generations (Barker, 1998). Nurses utilize this theory to treat each patient as an individual realizing that each person and their situation are unique. By applying this knowledge to each patient the nurse is able to develop a therapeutic relationship, which will promote the planning and implementation of nursing care. For nursing care to be successful they must view the nurse/patient relationship as a partnership being aware both are working together for a common goal (Barker, 1998). Also, interpersonal relations are used in all areas of nursing, which is why it is so important for the future of nursing, because without these relationships we would not be effective in our profession. These relationships are needed to expand our knowledge of each patient and their situation. By establishing trust the patients are encouraged to express themselves openly and honestly. Therefore the relationship built bridges
barriers that may have hindered the patient outcome.

Family

Second, Hildegard Peplau’s mid-range theory of family systems has revolutionized the nursing approach in which families are incorporated into decision makers. Currently, families are viewed as the most influenecial person when it comes to the care of their loved one, meaning not only are nurses to build a therapeutic relationship and trust with the patient but with their family as well (Forchuck & Dorsay, 1995). This theory molds nurses into advocates for the family unit, which in turn influences the patient’s quality of life. These relationships with families are crucial when it comes to care, for example, if a patient was unable to provide the nurse with health history or tell them when they are in pain the family is able to be the eyes, ears and speech of their loved one. This action improves the care for the patient and nurses need the families as much as the patient needs the nurse. This is one of the reason’s why this theory works in the 21st century even with all the technology in the world, we as nurses still need the human interaction to open our eyes to the patient/family dynamic.

Family system nursing is both the individual and the family simultaneously instead of just merely family nursing where the nurse takes care of the patient within the context of the family (Forchuck & Dorsay, 1995). This practice focuses on the interactions and relationships made between the nurse, individual and family. In order for this theory to be successful the nurse must be aware of the range of choices and downfalls associated with family system nursing. Also it is necessary to build on these relationships to provide creative personal choice and consistent flow of care for the patient to enhanced achievable goals. This engagement of nursing with family systems opens the door for problem solving of patient situations, which implements structure in the nurse/individual/family relationship (Forchuck & Dorsay, 1995).

Health promotion

Third, is the promotion and maintenance of health by utilizing Nola Pender’s Health Promotion Model. Health promoting behavior is enhanced through nursing practice, which enhances the patient’s overall well being. This mid-range theory is important today because it guides a supportive and educative system in health promotion in a patient who needs teaching and demonstration in performing self-care. By applying this method the nurse is able to identify patient’s health promoting behavior’s such as, health importance, self-efficacy, perceived control of health and perceived health status to find any gaps and/or barriers to their health promoting behavior (Simmons, 1990). By promoting health the nurse seeks to care for the individual by developing these behaviors of healthy living, which sets the stage for the individuals to gain knowledge to care for themselves. This applies to all nurses who actively promote healthy living by becoming an active influence in developing healthy living behaviors through education and guidance.

Conclusion

These middle range theories set the groundwork for research. Each are utilized daily in clinical practice to provide the best patient care. The rationale for considering the middle range theories is an important factor when considering a care plan, which requires the use of the nursing process. These theories follow the nursing process and help guide our responses to promote, educate, integrate and build relationships with these individuals and their families with the same common goal of promoting health. These authors point out how the nursing profession is influential in the care of other and how their actions influence health beliefs. These middle range theories build on other theories, which is why they are so important in nursing practice today. These theories can be used in different areas of nursing as well as using multiple theories in one area of nursing such as mental health. Also, middle range theories have identified multiple interventions for health related issues through simple research (McCurry et al., 2009). Nurses like myself have adopted these theories and incorporate them into daily practice to increase my own understanding of my patient and their situations and this is why I chose middle range theories.

References
Barker, P. (1998). The future of the Theory of Interpersonal Relations? A personal reflection on Peplau’s legacy. Journal of Psychiatric and Mental Health Nursing, 5, 213-220. doi:10.1046/j.1365-2850.1998.00128.x Forchuk, C. & Dorsay, J. (1995). Hildegard Peplau meets family systems nursing: innovation in theory-based practice. Journal of Advanced Nursing, 21,
110-115. doi:10.1046/j.1365-2648.1995.21010110.x McCurry, M. & Roy, C. (2009). Knowledge for the good of the individual and society: linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11, 42-52. doi:10.1111/j.1466769X.2009.00423.x Nolan, M. & Grant, G. (1992). Mid-range theory building and the nursing theory-practice gap: a respite care case study. Journal of Advanced Nursing, 17, 217-223. doi:10.1111/j.1365-2648.1992.tb01876.x Simmons, S. (1990). The Health-Promoting Self-Care System Model: directions for nursing research and practice. Journal of Advanced Nursing, 15, 1162-1166. doi:10.1111/j.1365-2646.1990.tb01708.x


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