Development of Mid Range Nursing Theory

There are numerous valuable outcomes that nurses can achieve by using conceptual models. theories, and empirical indicators for their advanced nursing practice. It is possible for the nurses to apply the models or theories to real-world nursing practices, research, and education. In order to develop a first-hand experience in this area, this paper will examine how the Conceptual - Theoretical - Empirical (CTE) structure translates into nursing practice, and it will be based on the Roy Adaptation Model using the middle range nursing Theory of Caregiver Stress.
Evaluation of The Conceptual-Theoretical-Empirical Linkages
It is quite evident that there is a direct linkage between the conceptual, theoretical, and empirical models that assist to guide their application in nursing practice, research, and education. Fawcett (2009) posits that it is not possible to conduct nursing research or practice without using guidance from a conceptual model. It is preposterous to assume that the development of any theory can take place without the theory being based on a conceptual model. This is the reason why the CTE structure for theory development or theory generating research moves inductively from the conceptual model to the relevant empirical indicators needed to first generate a theory. The deductive steps involved in the CTE structure used for theory-testing research on nursing practice flow from the conceptual model to the theory to the empirical indicators (Fawcett, 2009). Using this step-wise fashion, the CTE can be used for a broad range of applications, that include conceptualizing the manner different individuals adapt to and interact with their environment by drawing from the Roy Adaptation Model.
Evaluation of The Selected Theory
The Roy Adaptation Model conceptualizes an individual as being an adaptive holistic system that interacts with its environmental stressors (stimuli). The CTE structure, when applied to the Roy Adaptation Model (RAM), includes some abstract concepts as environmental stimuli, coping processes, and modes of adaptation (Fawcett & Garity, 2008). The RAM has been used in numerous studies, but there are only a few studies on caregiving that have used this conceptual model. RAM was developed from three human responses namely focal, conceptual, and residual based on the stimuli input from the environment. The Theory of Caregiver Stress is directly derived from the Roy Adaptation Model and it is used as a basis for understanding the relationships among caregivers and the stress faced when caring for a chronically ill relative. The objective of this middle theory is to predict the caregiver stress and the outcomes from demographics characteristics, stressful life events, the objective burden of caregiving, social support, and social roles.
The Theory of Caregiver Stress has four assumptions of the caregiver that include the caregiver can respond to environmental changes, the caregivers' perceptions will determine how he/she will respond to the environmental stimuli, the caregivers' adaptation is a function of their environmental stimuli and adaptation level, and the caregivers' effectors are results of chronic caregiving such as marital satisfaction and self-esteem. This theory explains the caregiver's social role, how they cope with stress, and how they reduce stress. There are several propositions that have been listed in this theory that can be applied to nursing practice.
Evaluation of The Empirical Indicators
The Theory of Caregiver Stress has three main structures namely input, control, and output. The input section comprises on the objective burden, which is the focal stimulus for the caregivers’ situation. This means that it is the tasks that are associated with caregiving of a person who has a chronic condition. This is because the responsibilities might include offering hours of care or management of care arrangement. which might initiate the coping mechanisms. The responsibilities placed on the caregiver will interfere with other aspects of the caregivers' life like interpersonal relationships or finances and these are referred to as the contextual stimuli. The control process of the theory is the link between the input and the output. The input can also be referred to as the environmental stimuli and the output the adaptation responses. The coping mechanism of the caregiver is all encompassed within the control process. Depression is a coping mechanism in this theory and it is also associated with the output modes or adaptive modes on different degrees.
The output section comprises of the responses that the caregivers will experience as a result of the stress. Responses fall into four main categories namely physical function, self-esteem, role enjoyment, and marital satisfaction (Tsai, 2003). An adaptive response is demonstrated if the caregiver is able to maintain their physical function, have a high self-esteem, high role enjoyment, and high levels of marital satisfaction. All these are demonstrative of a positive adaptation to their caregiver stress. However, if there is any lack of adaptation in either of the four categories, then the caregiver could be considered to be having maladaptive responses.
Evaluation of Research Findings
In a majority of the research that has been conducted it has been established that caregiver stress is contributing factor to the care provided to the patient. There are many harmful effects that caregiving can have on a caregiver's physical, emotional, and psychological well-being. Using this theory, nursing can be advanced in that nurses will be able to learn more about how they can reduce the risks associated with caregiver stress and allow the caregivers to have balanced lifestyles. Being able to predict the advancement of caregiver stress is vital in its prevention. Current research findings have indicated the causes and how many caregivers have managed to handle the stressors or environmental stimuli. There is a need for further research especially in the educational field to identify why young caregivers are more likely to suffer from caregiver stress that the older caregivers. It has been posited that the more experienced caregivers have learned how to cope with the environmental stimuli, and it would be beneficial if the young caregivers were also trained on how they could also cope with stress.
Evaluation of The Utility and Soundness of The Practice Theory
From the research findings, one can clearly see that the Theory of Caregiver Stress does support the usefulness of the conceptual model of RAM. Based on RAM's conceptualization of an individual as being adaptive, it is clear that this theory is a guide for C-T-E structure construction (Tsai, 1998). The content of the theory is beneficial for that advancement of nursing practice because it touches on the nursing roles of caregiving. It is also beneficial to other caregivers especially family members. The findings of the theory have shown that it mirrors the conceptual model that it is derived from and the subjects have been able to develop methods for coping and adapting to the different environmental stimuli that they experience.
References
Fawcett, J. (2009). Using the Roy Adaptation Model to guide research and/or practice: construction of conceptual-theoretical-empirical systems of knowledge. Aquichan, 9(3), 297-306.
Fawcett, J., & Garity, J. (2008). Evaluating research for evidence-based nursing practice. Philadelphia, PA: FA Davis.
Tsai, P.-F. (1998). Development of a middle-range theory of caregiver stress from the Roy adaptation model.
Tsai, P.-F. (2003). A middle-range theory of caregiver stress. Nursing Science Quarterly, 16(2), 137-145.