Pick one middle range theory (other than chronic sorrow) from the readings that made an impression on you. Describe a nursing practice scenario where this theory would have helped you when working with a client/patient. What intervention would you have changed/modified or tried instead?

1. WRITE ONE PAGE This weeks discussion will focus on Middle-Range theories.

For your initial post, pick one middle range theory (other than chronic sorrow) from the readings that made an impression on you. Describe a nursing practice scenario where this theory would have helped you when working with a client/patient. What intervention would you have changed/modified or tried instead?

2RESPOND TO THIS POST:
.One of the middle-range theories that I found interesting was Nola Pender’s Health Promotion Model (HPM). Pender first published this model in 1982, (McEwen & Wills, 2018). Her model integrates behavioral science into nursing to determine which factors will influence health behaviors.

Pender’s model includes three main categories. The first category is an individual’s characteristics and experiences. This category includes a person’s prior related behavior and personal factors. The next category is a person’s behavior-specific cognitions and affect. This includes a person’s perceived benefits of action, perceived barriers to actions, perceived self-efficacy, activity, related affect, interpersonal influences, and situational influences.

This last category is the behavioral outcome, which includes one’s commitment to a plan of action, immediate competing demands and preferences, and health-promoting behavior. All of these factors are analyzed and integrated into the nursing teaching to promote health enhancement behaviors.

I find this model particularly relevant because it considers the complexity of each individual and integrates their individuality into the teaching to promote better health outcomes (McEwen & Mills, 2018). This model can easily be applied to various topics. It would be beneficial to use this model when discussing healthy diets. There is a plethora of information about what a nutritious diet consists of, yet many people do not meet their nutrition requirements. The information is out there but it is not being applied in many people’s lives. The healthy eating discharge instructions that I have come across seem to reiterate the information that is commonly known. Unfortunately, in my experience, this information rarely gets applied to individuals’ lives.

I believe it would be valuable to change the practice of delivering generic information and incorporate the Pender Health Promotion Model to create plans that will be more applicable to each individual. For example, if I had a patient who belonged to a certain culture, I would include healthy recipes that were more consistent with dishes that they are familiar with. Instead of requiring the patient to adopt a new diet, I would supply information that would allow them to incorporate healthier choices into the diet they are familiar with. I would also take the time to evaluate other factors such as their perceived self-efficacy. This would allow me to address any barriers that may have. By tailoring health information to each patient I believe there will be an improvement in health compliance.

Reference

McEwen, M. & Wills, E.M. (2018). Theoretical basis for nursing (5th ed.). Lippincott Williams & Wilkins.

3.RESPOND TO THIS POST:
The Tidal Model, developed in the 1990’s by psychotherapist Phil Barker, describes psychiatric nurse practice to focus on three care processes and emphasizes the fluidity of human experience characterized by change and unpredictability. (McEwen & Wills, 2018) The Tidal Model was originally introduced in acute psychiatric care settings and evolved into a care continuum that emphasizes the individual’s care needs. It focuses on the critical or immediate, developmental and transitional. It is classified as a middle range model due to the development and adaptation of assessment and care delivery tools. This model stems from the chaos theory stating that, “small changes in initial conditions can produce chaotic and unpredictable changes in later conditions” (Barker, 2001). It demands that people reclaim their personal story of mental distress, and recover their voices. It means they are able to use their own language, metaphors, and personal stories to express the meaning in their own lives. In turn, nurses can individualize their care according to the patient’s life experiences, sense of self, perceptions, thoughts, and actions.

Water is used as a core metaphor that acknowledges the fluidity of the human experience along with its changes and unpredictability. “People who experience life crises are in deep water and risk drowning, or feel as if they have been thrown onto the rocks.” (Barker, 2001) Psychiatric nursing plays a vital role in their recovery in the forms of crisis intervention, so that the patient may return to their safe haven, get back on course, and live a meaningful life. Lastly, the Tidal Model focuses on the person’s needs to feel understood and validated. The person is represented in the world, self, and others domains. In the world domain, the focus is the person’s needs to feel heard and understood, the self-domain focuses on the person’s need for emotional and physical security, and the other domain focuses on support or services a person might need for their everyday life. (Barker, 2001)

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