Middle-range Theory Research Articles

Empirical Testing of a Middle-Range Theory for Ineffective Breathing Pattern in Children With Congenital Heart Disease.

To test a middle-range theory (MRT) for the nursing diagnosis of ineffective breathing pattern in children with congenital heart disease (CHD) based on analysis of two general propositions. This cross-sectional study is guided by STROBE. The propositions represent hypotheses about the relationships between the concepts of this MRT to be tested empirically, and thus, log-linear models were used to verify the structure of the proposition related to the stimuli. Diagnostic accuracy measures, univariate logistic regressions and the Mann-Whitney test were used to analyse the structure of the propositions related to behaviours. The analysis of the propositions related to the stimuli (eight concepts, four of which were classified as focal stimuli and four as contextual stimuli) suggested a reclassification of the stimulus "deformities in the thoracic wall" which became too focal. In the analysis of the propositions related to behaviours (17 concepts, five of which were classified as acute confirmatory, nine as acute clinical deterioration and three classified as chronic), guided changes in the operationalisation of concepts were suggested after comparing clinical findings; thus, acute confirmatory behaviours now have 10 concepts, while acute clinical deterioration behaviours and chronic behaviours continued with nine and three concepts, respectively, but with reclassifications between them. Changes in the operationalisation of the classification of the elements of the two propositions occurred after comparing the clinical findings with the theoretical model. By establishing precise causal relationships and describing how IBP manifests itself over time in children with CHD, empirical testing of this MRT helps nurses understand clinical reasoning based on temporal logic and spectral interaction between diagnostic components, which in turn will improve the use and accuracy of nursing diagnoses. Children and adolescents with CHD were recruited for this study sharing their clinical history and physical lung examination.

Legal Certainty of the Meaning of the Parties' Agreement on the Authorized Capital of a Limited Liability Company

The impact of changing the amount of PT capital to an agreement between the parties has led to a lack of legal certainty for the involved parties. A significant legal conflict exists between Article 32 paragraph (1) of Law Number 40 of 2007 concerning Limited Liability Companies and Article 109 paragraph (1) of Law Number 6 of 2023 concerning the Stipulation of Government Regulations in Lieu of Law Number 2 of 2022 concerning Job Creation. The changes allow the amount of PT capital to be determined based on the agreement of the company's founders, leading to ambiguity in legal certainty. This research aims to examine and analyze the legal consequences of these regulations on the basic capital requirements for Limited Liability Companies in Indonesia, and to assess the legal certainty surrounding the agreement between parties regarding PT capital. The research employs a normative juridical method, utilizing statutory, comparative, and conceptual approaches. The analysis is grounded in the Theory of Legal Certainty (Grand Theory), Development Law Theory (Middle Range Theory), and the Theory of Good Corporate Governance (Applied Theory). The research found that changes in the regulation of basic capital, following the enactment of Law No. 6 of 2023, have contributed to legal uncertainty. This study aims to provide legal clarity on the consequences of these regulatory changes and their impact on corporate governance and legal compliance in Indonesia.

Content validation of the nursing diagnosis “ineffective protection” in the context of adolescents with cancer

ObjectiveTo analyze the relevance of a set of clinical elements to represent the content domain of the nursing diagnosis Ineffective Protection. Design and methodsThis study employed content validation, using expert judgment to assess the appropriateness of clinical indicators, etiological factors, and conceptual and operational definitions, integrating the collective wisdom framework, the theory of predictive diversity, and the determination of rater skill level. ResultsFrom the middle range theory, 28 clinical indicators and 17 etiological factors were identified, which were rated by 34 raters. The analysis showed that the clinical indicators restlessness and insomnia and the etiological factors ambient temperature and humidity were not considered relevant for the nursing diagnosis of Ineffective Protection, because the median content validity index was lower than 0.9. ConclusionsContent validation verified that most of the components of the nursing diagnosis of Ineffective Protection were considered relevant by judges. Practical implicationsIt is believed that the data obtained can help nurses to more easily evaluate the related factors and clinical indicators of Ineffective Protection presented by adolescents with cancer, which favors the process of diagnostic inference.

Karen J. Foli: A Nurse Scholar With an Unconventional Trajectory.

Nurse scholar Karen J. Foli has had an unconventional trajectory. She has written everything from mysteries to thrillers to peer-reviewed journal manuscripts and Food and Drug Administration documents. She conceptualized and disseminated two middle-range theories, one surrounding parental postadoption depression and one surrounding nurses' psychological trauma. Foli's research has revealed a new type of nurse-specific trauma, insufficient resource trauma, which calls for efforts at the organizational level. Winner of several book of the year awards, she is now working on a third middle-range theory. Dr. Foli shares her journey and encourages nurses to give theory a shot.

Analysis and Evaluation of Situation-Specific Theories: Proposed Modifications in Existing Criteria for Analysis and Evaluation of Theories.

Although many situation-specific theories have been developed during the past several years, few of them have been analyzed and evaluated using criteria that are relevant for this type of theory. The purpose of this paper is to propose modifications in Fawcett's analysis and evaluation criteria of theories for application to situation-specific theories. The position taken is that important but minor adjustments are required to make these criteria suitable for the analysis and evaluation of situation-specific theories, taking the similarities and differences between middle-range theories and situation-specific theories into account.

A Middle-Range Theory of Nurses in Recovery From Substance Use

A Middle-Range Theory of Nurses in Recovery From Substance Use

Measuring Self-Care: A Description of the Family of Disease-Specific and Generic Instruments Based on the Theory of Self-Care of Chronic Illness.

In recent years, there has been an exponential increase in attention paid to the patient-reported outcome of self-care. Many investigators have used one of the families of self-care instruments freely available on the website www.self-care-measures.com. These self-care measures have been translated into many languages, which are also available on the website. The measures include both disease-specific and generic instruments, which are based on a common theoretical framework, the Middle Range Theory of Self-Care of Chronic Illness. The purpose of this article is to illustrate similarities among the instruments and to standardize their scoring, analysis, and use. We describe the Self-Care of Heart Failure Index, the Self-Care of Coronary Heart Disease Inventory, the Self-Care of Hypertension Inventory, the Self-Care of Diabetes Inventory, the Self-Care of Chronic Obstructive Pulmonary Disease Inventory, the Self-Care of Chronic Illness Inventory, and the Self-Care Inventory. Detailed guidance on scoring, translation, and analysis is provided. Complementary measures of self-care self-efficacy and those used to measure caregiver contributions to patient self-care are briefly described. Many of the common questions of instrument users are answered in this article. Following this guidance will facilitate consistent use of the instruments, which will enable users to compare their results to those of others worldwide and facilitate future reviews and meta-analyses.Clinical ImplicationsThis review, emphasizing standard scoring and interpretation, is useful for clinicians and researchers across various populations and settings.

Development of Theory of Uncertainty on COVID-19: Theory Derivation Based on Uncertainty in Illness Theory

Purpose: The purpose of this study is to develop the Theory of Uncertainty on COVID-19 using the strategy of theory derivation. Methods: Theory derivation was carried out in the following steps: review the literature to explore the phenomena related to uncertainty on COVID-19; select a parent theory that provides valuable concepts and a useful structure for derivation, and identify the concepts and structure of the parent theory to use in derivation; modify and redefine the concepts and structure of the parent theory to create a derived theory. In the literature review process, relevant findings were synthesized to support the propositions of the derived theory. Results: The Theory of Uncertainty on COVID-19 was derived from the Uncertainty in Illness Theory to make it relevant and applicable to a specific aspect of uncertainty on COVID-19, health-related uncertainty perceived by a person who has not contracted COVID-19. It is a middle-range theory targeting the general population and consists of a linear and unidirectional model centered on three themes: antecedents of uncertainty, appraisal of uncertainty, and coping with uncertainty. Conclusion: The Theory of Uncertainty on COVID-19 will be able to contribute to efforts to manage perceived uncertainty on pandemic diseases and improve individual biopsychosocial health in the future.

The Effects of Social Approval Signals on the Production of Online Hate: A Theoretical Explication

This essay explicates a middle range theory to predict and explain the propagation and magnification of hate messages on social media. It builds upon an assumption that people post hate messages in order to garner signals of social approval from other social media users. It articulates specific propositions involving several constructs, including signals of social approval, disapproval, and sufficiency of social approval. Six derived hypotheses predict how these dynamics apply in certain contexts of social media interaction involving hate posting. It reviews empirical research that applies to these hypotheses, raises issues for future research, and reviews concurrence and distinctions between this approach and other theories.

IT Service Well-being, in the Higher Education Ecosystem

The holistic and systematic comprehension of service well-being is garnering increasing attention among scholars. The holistic understanding of Service well-being is significant since it helps to clarify the multi-actor and multi-level nature of complex services, such as IT services. The majority of research conducted in the IT service field primarily examines individual and micro-level interactions, neglecting the significance of a comprehensive and systemic perspective on service well-being. The study discussed in this article aims to overcome these constraints by examining the well-being of IT services from a “service ecosystem” standpoint. The research used an interpretative approach to construct a middle-range theory using a case study and grounded theory methodology within a higher education institution. The results uncover the factors that contribute to well-being and the effects on several levels of the IT service ecosystem (Micro, Meso and Macro) including Service encounter, Service facilitation, and Service integration levels. This study enhances the existing research on well-being in the IT service context by presenting a holistic framework for service ecosystem well-being which has significant theoretical and practical contributions.

A realist evaluation of the implementation of a national tobacco control program and policy in India.

There is a growing interest in studying and unpacking implementation of policies and programmes as it provides an opportunity to reduce the policy translation time lag taken for research findings to translate to policies and get implemented and understand why policies may fail. Realist evaluation is a theory-driven approach that embraces complexity and helps to identify the mechanisms generating the observed policy outcomes in given context. We aimed to study facilitators and barriers while implementing the Cigarettes and Other Tobacco Products Act, 2003 (COTPA) a comprehensive national tobacco control policy, and the National Tobacco Control Programme (NTCP), 2008 using realist evaluation. We developed an initial program theory (IPT) based on a realist literature review of tobacco control policies in Low- and Middle-Income Countries (LMICs). Three diverse states -Kerala, West Bengal, and Arunachal Pradesh- with varying degree of implementation of tobacco control law and program were chosen as case studies. Within the three selected states, we conducted in-depth interviews with 48 state and district-level stakeholders and undertook non-participant observations to refine the IPT. Following this, we organized two regional consultations covering stakeholders from 20 Indian states for a second iteration to further refine the program theory. A total of 300 Intervention-Context-Actor-Mechanism-Outcome (ICAMO) configurations were developed from the interview data, which were later synthesized into state-specific narrative program theories for Kerala, West Bengal and Arunachal Pradesh. We identified five mechanisms: collective action, felt accountability, individual motivation, fear, and prioritization that were (or were not) triggered leading to diverse implementation outcomes. We identified facilitators and barriers to implementing the COTPA and the NTCP, which have important research and practical implications for furthering the implementation of these policies as well as implementation research in India. In the future, researchers could build on the refined program theory proposed in this study to develop a middle-range theory to explain tobacco control policy implementation in India and other LMICs.

Exploring Symptom Management Experiences Among College Students With Type 1 Diabetes Mellitus Using a Theoretical Framework: A Qualitative Study.

The purpose of this study was to explore symptom management experiences among college students with type 1 diabetes mellitus (T1DM). Limited qualitative data using a theoretical framework exist that explore the self-care behavior processes for symptom management. A qualitative approach was used for this study. The middle-range theory of self care of chronic illness served as a framework for data collection and analysis procedures. Data collection included distributing a survey to collect participants' demographic and sociodemographic data and utilizing a semi-structured interview guide to conduct one-on-one interviews with 31 participants. Interviews occurred via Zoom (n = 28) and in person (n = 3). Interview transcripts were uploaded in NVivo for data management. The research team created a codebook using theoretical constructs to assist with thematic analysis. Data are representative of a sample whose characteristics include undergraduate students ages 18 to 23 living with T1DM for 2 years or more who attended large, public, 4-year universities located in the southeastern United States. Three main themes were created using theoretical constructs: symptom detection experiences, symptom interpretation experiences, and symptom response experiences. Two subthemes were identified for each theme. Participants engaged in symptom management for blood glucose regulation through detecting changes in their blood glucose physiologically and via technology. Additionally, symptom interpretation involved analyzing blood glucose trends and determining common causes of blood glucose changes. Symptom response included immediately addressing hypoglycemia but delayed responses addressing hyperglycemia. Challenges were present responding to hypoglycemia; therefore, additional research is warranted to improve symptom response skills.

Developing critical enquiry, capacity, capability and confidence in the health and care workforce.

Health and care staff have limited opportunities to design, deliver and lead critical enquiry activities. To explore barriers and enablers of building capacity, capability and confidence of these practitioners who wish to undertake critical enquiry activity. A realist conceptual framework including the development of middle range theory allowed analysis of the scholarship process and outcomes. Data were collected through snap surveys, interviews (face to face and online) and project output (posters). Nine scholars completed the programme and all participated in the study. They all experienced an increase in capacity, capability and confidence in critical enquiry activity. Six overarching themes arose from analysis of the interviews and snap survey data: value; expertise; attitudes; meaningful, responsive support; brain space; and skill and knowledge acquisition. A combined focus on people and project while staff remained embedded in their work area was key for the growth of skills and knowledge and creating impact from projects. Guilt at having dedicated time to take part in the programme was a self-imposed barrier to building capacity and capability. Social capital (gained from bringing together individuals from different groups with shared values) facilitated bonding, which increased psychological safety and helped enable capability and confidence. The combination of theory and practice embedded in a real-world context led to positive outcomes for staff, patients, carers and the facilitation team as real-life changes were made in clinical environments.

Exploring patients with COPD self-care behaviours and self-efficacy and their interconnections: A network analysis.

The aim of this study was to investigate self-care behaviours of patients with chronic obstructive pulmonary disease (COPD), understand their complex interconnections and identify key behaviours influencing self-care and self-efficacy. An observational, cross-sectional study design. The outpatient department of two tertiary hospital. A convenience sample of patients with a diagnosis of COPD were included (n = 222). Self-care behaviours were assessed using the Chinese version of self-care of chronic obstructive pulmonary disease inventory based on the Middle-Range Theory of Self-Care of Chronic Illness. Patient self-care efficacy was evaluated using Chinese version of Self-Care Self-Efficacy Scale in Chronic Obstructive Pulmonary Disease. Employing network analysis, associations between behaviours (nodes) and their interrelationships (edges) were deciphered. The study was reported following the STROBE checklist. Among the spectrum of self-care behaviours, patients exhibited the most pronounced deficiencies in behaviours directed to enhancing breathing, monitoring extra-respiratory symptoms and problem-solving. Within the network, the most central emerging behaviour was the modification of prescribed therapy at the worsening of symptoms, as suggested by healthcare providers, which drives all self-care behaviours. The confidence in being able to do something to relieve symptoms, despite difficulties, was a bridging activator of self-care. The network structure underscored the prominence of self-care self-efficacy in driving self-care maintenance, monitoring, and management behaviours. Education programs for COPD should prioritise enhancing breathing, symptom monitoring and problem-solving skills. The crucial self-care behaviour in COPD involves adjusting treatments in response to symptom changes. Patient confidence in symptom alleviation acts as a catalyst for self-care engagement. Targeted assessments addressing these aspects could enhance educational interventions, ultimately improving COPD patient outcomes. This study has been registered in the Chinese Clinical Trials Registry (registration number: ChiCTR2200059764; registration date: 11 May 2022).

The lived experience of loneliness and social isolation in patients with pulmonary arterial hypertension: A phenomenological study

Abstract Background Pulmonary arterial hypertension (PAH) is a rare, complex and chronic disease, characterised by a mean pulmonary arterial pressure at rest above 20 mmHg, determined through right heart catheterisation. As the disease progresses, symptoms (e.g., chest pain, syncope, respiratory distress) occur, which negatively impact quality of life. Moreover, symptoms of PAH can impair activities of daily living and social functions, leading to social isolation and loneliness. So far the experience of social isolation and loneliness in PAH patients. Purpose To explore the lived experience of social isolation and loneliness in patients with PAH. Methods A multicentre descriptive phenomenological study was conducted with semi-structured interviews driven by the Middle Range Theory of Social Isolation. This study followed the COREQ guidelines, and data analysis was conducted using the Elo and Kyngäs method. Results Seventeen patients (mean age 55,3 years; range 21-83 years; n=3 male) recruited from specialized clinics or patient associations across different Italian regions, participated in the interviews. The results show that patients with a marked symptomatology experience daily moments of loneliness and social isolation that inevitably impact the quality of life. While, patients with a mild symptomatology or with drug support can lead a life similar to that before diagnosis. Three main categories emerged. First, within the main category of loneliness emerged generic categories including emotions associated with loneliness (anger, depression, frustration, guilt, fear)as well as the influence of loneliness on the disease and the various strategies to limit it. Second, for the main category of social isolation were also identified other generic categories including networks of support of the person with PAH (family, social and work), emotions related to social isolation (dismissal and pretend to be well) and the influence of social isolation on the path of illness. Finally, generic categories related to well-being, autonomy, health, self-care activity or health promotion performed by the patient emerged for the main quality of life category. Conclusion The findings of this study contribute to a more in depth understanding of the factors influencing the quality of life of patients with PAH and enlighten the design of interventions aimed at improving their condition. Integration of these results with quantitative data regarding the extent of the influence of loneliness and social isolation is warranted.

Virtual reality and cardiac rehabilitation: a new middle-range theory to outline its mechanism of effectiveness

Abstract Background To reduce symptoms and improve outcomes in patients with cardiovascular diseases, international guidelines recommend cardiac rehabilitation. However, patients’ adherence to rehabilitation programs remains suboptimal, compromising its beneficial effects. Virtual reality has proven to be effective in enhancing adherence to rehabilitation in different fields (e.g., neurological and post-trauma). In the cardiological field, it has been proven effective in improving functional capacity and several psychological parameters (e.g., anxiety, depression, and emotional stress). Despite the increasing use of this digital technology, there is still a lack of information regarding its underlying mechanism of effectiveness. Purpose This middle-range theory aims to explain the mechanism of effectiveness of virtual reality in cardiac rehabilitation. Methods An inductive-deductive approach was used to develop this middle-range theory. Three steps were conducted including synthesis of key concepts, definition of the relationship between these concepts, and setting up of a hypothetical model. Results This middle-range theory proposes both proximal and distal outcomes of virtual reality. Proximal outcomes are classified as responses at the psychological (i.e., emotional stress, depression, and anxiety) and physical (i.e., exercise capacity) level, which, in turn, influence adherence to rehabilitation (i.e., distal outcome). Mediators of the relationship between virtual reality and outcomes are both at a proximal and distal level. The proximal mediators are activated at the neurological level to generate a multisensory experience of sight, hearing, and touch. This alters perception, by inducing an immersive altered state of consciousness and activating the distal mediators of attention, enjoyment, and sense of presence. The activation of the distal mediators promotes distraction from negative external stimuli related to the disease and healthcare setting and perception of positive emotions by interacting with the virtual world. Consequently, these mediators influence physical and psychological responses that enhance overall adherence to cardiac rehabilitation. Moderators of the relationship between virtual reality and rehabilitation adherence include age, gender, trust in technology, and cognitive status (Figure 1). Conclusions This middle-range theory aims to clarify the mechanism by which virtual reality enhances adherence to cardiac rehabilitation. Further qualitative and quantitative studies are warranted to test its hypothetical model.

What is the gender motive? A comparison of the main approaches used in feminicide statistics and communication

Despite the widespread use of the term “femicide”, there are no agreed guidelines to define the phenomenon. This has led to frequent statistical contradictions. In recent years, two main approaches have emerged: the broad-range one, in which victims are often defined by the mere fact that the murderer was male, while motives are only auxiliary; in the second, instead, gender motives play the main role, following middle-range theory perspective. The aim will be to provide a new set of indicators to identify victims of femicide more precisely, distinguishing them from other female murders. The use of precise indicators is not limited to the classification of victims, as it can also enable more appropriate prevention programmes and more respectful communication.

Development and Effectiveness of a Pattern Management Educational Program Using Continuous Glucose Monitoring for Type 2 Diabetic Patients in Korea: A Quasi-Experimental Study.

The prevalence of diabetes has increased worldwide. Therefore, interest in improving glycemic control for diabetes has grown, and continuous glucose monitoring (CGM) has recently received attention as an effective glycemic control method. This study developed and evaluated the effectiveness of an education program for pattern management using CGM based on Whittemore and Roy's middle-range theory of adapting to diabetes mellitus. A quasi-experimental study was conducted on 50 adult patients with type 2 diabetes who visited the outpatient clinic of a university hospital. The experimental group was treated with a pattern management program using CGM for 12 weeks and six personalized education sessions were provided to the patients through face-to-face education and phone monitoring. The frequency of diabetes-related symptoms in the experimental group decreased, and social support (t = 2.95, p = 0.005), perceived benefits (t = 3.72, p < 0.001) and self-care significantly increased (t = 6.09, p < 0.001). Additionally, the program was found to be effective in improving HbA1c (t = -3.83, p < 0.001), FBS (t = -2.14, p = 0.038), and HDL-C (t = 2.39, p = 0.021). The educational program developed through this study can be implemented as a self-management approach for individuals with type 2 diabetes using CGM, aimed at enhancing glycemic control and preventing complications.

Self-care behaviours of first-generation Chinese immigrants living with cardiovascular disease: A qualitative study.

To identify and describe self-care behaviours performed by Chinese immigrants living with cardiovascular disease in Australia, and factors perceived as barriers and facilitators to evidence-based cardiac self-care. A qualitative descriptive design. Individual semi-structured phone interviews were conducted among participants meeting the following criteria: (1) first-generation Chinese immigrants to Australia, born in Mainland China, Hong Kong, Macao or Taiwan; (2) Australian permanent residents or citizens; (3) self-reported or medically diagnosed with coronary heart disease, stroke or heart failure; (4) able to speak English or Mandarin; (5) able to provide informed consent, excluding those with history or evidence of impaired cognition such as dementia. Participants were recruited via social media, Chinese community associations and medical centres from September 2021 to June 2022. Data were analysed using inductive and deductive thematic analysis, guided by the Middle-Range Theory of Self-Care of Chronic Illness. The study was reported in line with the COREQ checklist. Twenty participants were interviewed, 60% female, mean age 69.9 years. Most migrated to Australia at older age following their retirement in China; most had limited English proficiency. Many practiced adequate self-care for their CVD in self-care maintenance and monitoring. Variously, they adopted heart-healthy diets, developed exercise routines, attended medical services and closely monitored their body signs and symptoms. However, self-adjusting medications, taking Traditional Chinese Medicine and self-administering health supplements were prevalent practices and first-response management of acute cardiac symptoms was suboptimal. Linguistic and cultural barriers to obtaining mainstream heart health information meant most participants resorted to informal, anecdotal and mainland Chinese sources. Diverse factors were held responsible for sub-optimal self-care behaviours but lack of access to linguistically and culturally appropriate heart health information was widely blamed. Linguistically and culturally appropriate community-based heart health education programmes are urgently needed, targeting healthy lifestyle modification, medication literacy and cardiac symptom management. Study findings can be used to improve cardiac nurses' cultural sensitivity and practices targeting Chinese immigrants. Partnering with Chinese community associations offers health service providers and policymakers an innovative route to co-design and deliver targeted heart health education interventions and support for this population. Chinese community centre managers contributed to data collection by supporting participant recruitment.

Opportunities and challenges in designing and evaluating complex multilevel, multi-stakeholder occupational health interventions in practice

ABSTRACT Extant research suggests the effectiveness of Occupational Health Psychology (OHP) interventions depends on their design in the broader organisational context. While the field recognises that pre- and posttest evaluation do not sufficiently capture the complex dynamics around OHP interventions, complex multi-level OHP interventions are still scarce in the literature. As established intervention implementation frameworks suggest, it remains difficult to address this complexity in practice. The present position paper re-evaluates lessons learned from two complex European OHP intervention projects, by applying the Integrated Process Evaluation Framework (IPEF) and related theories to bridge the gap between the theoretically recognised complexity and practical challenges. The re-evaluations emphasise that programme-multilevel theories rooted in OHP-perspectives contribute to adequately hypothesising around systemic factors and mechanisms relevant to OHP interventions. Concretely, middle range theories that outline how an intervention’s mechanisms work within a specific context to produce certain outcomes are crucial. Additionally, strategically and actively involving key stakeholders at all levels of the system and across the different intervention phases improves the embedding of OHP interventions in organisations. We elaborate on these insights with seven concrete recommendations for complex OHP intervention research.