Applying a Model of Practice to Advanced Nursing Roles

The application of nursing theories provides a solid foundation for directing practice, research, and teaching in the ever-changing field of healthcare. Grand and middle-range nursing theories stand out among the many theoretical frameworks because of their various applications and significance to advanced practice nursing. These theories help advanced nurses to navigate complex patient scenarios, make informed decisions based on scientific knowledge, and drive innovation in patient care (Butts & Rich, 2021). This discussion deals with the application of grand and middle-range nursing theories to guide advanced nursing practice. The paper will focus on how one grand and one middle-range nursing theory was used in research and the significance of these theories to advanced practice nursing.

Categorizing Nursing Theories

Nursing theories can be broadly categorized into grand, middle-range, and practice-level theories. Grand theories are described as broad conceptual frameworks that provide a wide view of nursing practice. These theories are used to address key concepts of nursing like human beings interaction, health, and nursing as a whole (Butts & Rich, 2021). An example is Jean Watson’s theory of human caring which deals with the promotion of health, preventing illness, and caring for the sick. Middle-range nursing theories, on the other hand, are more specific and focused, addressing particular phenomena within nursing practice. The theories in this category focus on addressing a specific nursing issue making them more tangible (Butts & Rich, 2021). An example is the health promotion model by Pamela Pender. Practice-level nursing theories are highly specific and bound to certain contexts that feature specific patient populations or clinical settings. The theories in this category usually help nurses in day to day management of patients (Butts & Rich, 2021). An example is Dorethea Orem’s self-care deficit theory which deals with providing care to individuals who are unable to care for themselves.

Research using a Grand Nursing Theory

One of the grand nursing theories utilized in the identified study is Watson’s theory of human caring. This article describes research conducted to determine the impact of Watson’s human caring-based health promotion program on caregivers of patients with schizophrenia. The aim was to determine the sense of coherence and well-being among caregivers of persons with schizophrenia when Watson’s theory was used (Bagheri et al., 2023). Using a randomized controlled trial approach, 72 caregivers were allocated into two intervention programs and two control groups. Based on the findings from the research, the health promotion program facilitated ongoing intrapersonal, and holistic caring (Bagheri et al., 2023). In addition, the utilization of Watson’s theory improved the sense of coherence and well-being in caregivers of persons with schizophrenia.

Schon Reflective Model in Nursing

Watson’s grand nursing theory concepts and propositions supported the research in various ways. Firstly, the concept of caring relationship mentioned by Watson was utilized to foster supportive and empathetic relationships between caregivers and individuals with schizophrenia in the research. Activities such as empathetic listening sessions, communication skills training, and psychoeducation were performed to ensure caring relationships existed between caregivers and patients (Devi et al., 2022). Secondly, the concept of holistic care was utilized to provide comprehensive support systems to caregivers. For example, a nursing instructor with experience in mental health provided individualized education to caregivers regarding personal conditions, needs, and preferences (Bagheri et al., 2023). Mindfulness and self-awareness were also promoted through weekly exercises. Lastly, a healing environment as described by Watson was provided whereby caregivers had access to community resources, respite care services, and opportunities for social connection and engagement. Watson’s theory helped during the research by emphasizing the importance of establishing caring relationships, addressing holistic care needs, and promoting self-care and empowerment for caregivers of individuals with schizophrenia.

Research using a Middle Range Nursing Theory

A middle-range nursing theory selected for this discussion is Pender’s health promotion model. The identified article involved research aimed at identifying factors associated with older adults’ participation in community-based health promotion activities using Pender’s health promotion model (Chen & Hsieh, 2021). The cross-sectional study involved 139 older adults recruited from a community center. Using the health promotion activities outlined by Pender, a health promotion activity questionnaire was developed. The findings from the study indicated that perceived benefits as outlined by Pender were the strongest predictors of health among older adults (Chen & Hsieh, 2021). In addition, self-efficacy also proved to be a determinant of older adult’s participation in community activities.

Pender’s health promotion model was used in the research to provide a framework for understanding health-promoting behaviors among older adults. The researchers used Pender’s model to develop questionnaires. For example, questionnaire statements regarding perceived benefits had 19 items, self-efficacy 10 items, and social support 14 items (Chen & Hsieh, 2021). Apart from the questionnaires, the researchers analyzed the relationship between health promotion and behavioral outcomes. According to the health promotion model, health-promoting behaviors lead to positive health outcomes (Chen & Hsieh, 2021). The analysis later revealed that participation in community-based health promotion activities was dependent on outcomes like improved physical function, social connectedness, and quality of life.

Based on the key sections of the selected article, it is clear that Pender’s health Promotion Model was used in an explanatory manner. This research used the model as a framework to understand understand the factors influencing older adults’ participation in community-based health promotion activities. The researchers used components such as perceived benefits, social support, perceived barriers, and self-efficacy as described in the theory to develop the questionnaire used in collecting data. Overall, the theory was used to analyze the relationships between various constructs and provide insights into how these factors contribute to older adults’ engagement in health promotion activities.

 Theory and Research in Advanced Nursing

The importance of theory to advanced nursing practice cannot be overstated, especially for the role of Family Nurse Practitioners. Grand, middle-range, and practice-level theories provide a conceptual framework that guides advanced practice nurses in their decision-making, clinical reasoning, and delivery of patient care (Younas & Quennell, 2019). For example, nursing theories offer foundational principles to inform clinical practice. They provide structured approaches to assessing, diagnosing, and providing treatment to patients. Secondly, theories help the FNP to provide patient-centered care by defining culturally sensitive approaches to care delivery. Regarding the advancement of nursing practice, theories provide room for further research and investigation into actions that can improve nursing care delivery (Younas & Quennell, 2019). In addition, theories provide room for innovation whereby frameworks can be used to generate new ideas and develop novel approaches to patient care.

References

Bagheri, S., Zarshenas, L., Rakhshan, M., Sharif, F., Sarani, E. M., Shirazi, Z. H., & Sitzman, K. (2023). Impact of Watson’s human caring-based health promotion program on caregivers of individuals with schizophrenia. BMC Health Services Research, 23(1), 711. https://doi.org/10.1186/s12913-023-09725-9

Butts, J. B., & Rich, K. L. (2021). Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning.

Chen, H. H., & Hsieh, P. L. (2021). Applying the Pender’s Health Promotion Model to identify the factors related to older adults’ participation in community-based health promotion activities. International Journal of Environmental Research and Public Health, 18(19), 9985. https://doi.org/10.3390/ijerph18199985

Devi, B., Pradhan, M. S., Giri, M. D., & Lepcha, M. N. (2022). Watson’s theory of caring in nursing education: challenges to integrate into nursing practice. Journal of Positive School Psychology, 1464-1471.

https://www.journalppw.com/index.php/jpsp/article/view/3297

Younas, A., & Quennell, S. (2019). Usefulness of nursing theory-guided practice: An integrative review. Scandinavian Journal of Caring Sciences, 33(3), 540–555. https://doi.org/10.1111/scs.12670