Middle-range Theory Research Articles

Integrated Community Care Delivered by Public Health-Care and Social-Care Systems: Results from a Realist Synthesis.

Integrated community care (ICC) is defined as an interweaving of health-care and social-care interventions deployed in spatial and relational proximity using an interdisciplinary and cross-sectoral approach. Consideration of territory scale and time scale are at the center of ICC practices. Its deployment in public health and social care networks (HSCN) can be complex due to their broad mandate, the complexity of their management, and accountability. Therefore, we aimed to describe ICC delivered by public HSCN to determine how, why, for whom, and in what circumstances ICC works and produces outcomes. A realist synthesis was conducted consisting of five steps consistent with realist synthesis standards (RAMESES projects) to produce configurations of Context - Mechanism - Outcomes (CMOc) and development of a middle-range explanatory theory of why and how the identified outcomes may have occurred. In total, 26 studies were selected and used, as evidence, to support-either partially or fully-the production of CMOc based on the initial program theory. Nine unique CMO configurations were identified based on the data analyses and team discussion. ICC middle-range theory is informed by the CMO configurations identified. This realist synthesis allowed us to identify the central mechanisms of ICC delivered by public HSCN and to produce a middle range theory. ICC is based on a specific philosophy and deployed by a professional agency oriented toward a community agency within a local system of interdisciplinary and cross-sectoral action. Our middle-range theory will provide a solid analytical framework as a foundation for ICC implementation and future research.

Barriers and Facilitators Impacting Disease and Symptom Management Among College Students With Type 1 Diabetes: A Qualitative Study.

This study aimed to explore barriers and facilitators impacting disease and symptom management among college students living with Type 1 Diabetes (T1D). A qualitative, phenomenological approach using semi-structured, one-on-one interviews. Interviews conducted on Zoom (n = 28) and in-person (n = 3). Purposive sample of 31 college students living with T1D for at least 2years who attended large, 4-year public universities in the Southeastern United States. This study was theoretically informed using the Middle-Range Theory of Self-Care of Chronic Illness Integration of Symptoms to develop interview questions. Interviews were transcribed verbatim and uploaded in NVivo. Data were analyzed thematically using a codebook developed by the research team using the theory as a framework. Trustworthiness was established using an audit trail, memos, and negative case analysis. Four themes described barriers: diabetes burnout, challenges adjusting to a college lifestyle, difficulty receiving medical supplies, and insurance limitations. Five themes explained facilitators: years of experience managing T1D, tangible support with medical supplies, informational support for disease management, and emotional/technological support for disease and symptom management. Barriers and facilitators in this study should be addressed in future T1D interventions for college students. Findings can also guide healthcare professionals, health promotion practitioners, family, friends, and significant others on how to better support college students as they manage T1D.

Understanding adaptive tasks in cardiac rehabilitation among patients with acute myocardial infarction: a qualitative study

Background While Cardiac Rehabilitation (CR) programs have shown effectiveness in improving cardiac outcomes, there is limited understanding of how patients perceive and adapt to these interventions. Furthermore, alternative modes of delivering CR that have received positive evaluations from participants remain underexplored, yet they have the potential to enhance CR uptake. Objectives To explore the patient experience in CR programmes following Acute Myocardial Infarction (AMI) and describe their adaptive processing. Patients and Methods This qualitative study was conducted at a nationally certified centre in China between July 2021 and September 2022, encompassing three stages: in-hospital, centre-based, and home-based CR programs. Purposive sampling was used to select eligible AMI patients for in-depth semi-structured interviews. The interview outline and analytical framework were aligned with the key concepts derived from the middle-range theory of adaptation to chronic illness and the normalization process theory. The findings were reported following the Consolidated Criteria for Reporting Qualitative Research checklist. Results Forty AMI patients were recruited. Four main themes describing the process of AMI patients normalizing CR intervention were identified, including (1) experiencing CR service driving by role’s responsibilities, (2) engaging in collaborative relationship based on interpersonal trust, (3) exploring a personalized rehabilitation plan by complex integration, and (4) expecting a promised outcome to shape decision-making. Conclusion Integrated care interventions for AMI patients could benefit from a collaborative co-designed approach to ensure that CR interventions are normalized and fit into patients’ daily lives. Organizational-level CR services should align with the rehabilitation needs and expectations of patients.

Developing middle-range theories within a realist evaluation of how health committees support community capacity for health

Health committees link formalised health services and the community. However, ‘how, why, and for whom’ health committees work warrants further exploration. This article presents the development of a middle-range theory for how health committees work for building community capacity for health. Resulting programme theories from a realist evaluation in Uganda were synthesised for demi-regularities and supplemented by four key informant interviews – substantive theories were used to help explain the findings from the case studies to develop the final middle-range theories. Eighteen existing programme theories and 47 supporting context-mechanism-outcome configurations were synthesised into four middle-range theories for how health committees work for community capacity building for health at the individual, organisational, community and societal levels. The middle-range theories developed in this study provide important insight for those implementing health committees. Given the little guidance available for developing and refining middle-range theories, this study provides transparent methodological processes, which may assist future research.

Small To Medium Enterpirses In The Digital Era On Line Shop Professional Community (Kaji) In East Java

Small To Medium Enterpirses In The Digital Era On Line Shop Professional Community (Kaji) In East Java. The contribution of SMEs has had an impact on the regional and national economy (Bunga, 2022), the growth and development of SMEs in Indonesia cannot be separated from the various challenges faced, the economic crisis that occurred at the end of 1997 brought multi-economic impacts, including SMEs (Tejasari, 2008), the impact of Covid 19 which occurred in early 2020, the impact of the global economy occurred as a whole. SMEs also felt the same impact with the independence that SMEs have, being able to overcome global economic challenges (Aksan, 2022), entering the digital era. East Java UKM (KAJI) is faced with online shop UKM must be able to take a role and control the market so that the existence of SMEs is not eroded by digitalization, especially online shops. Legitimacy theory focuses on interactions between companies and society based on legitimacy theory, namely that a "social contract" occurs between companies and the community where the company operates and uses economic resources. It explains the concept of social contract, all social institutions, including companies, operate in society through social contracts, both explicit and implicit, their survival and growth is based on what consists of, the final result (social output) provided to the wider community, the distribution of economic, social and political benefits. to groups according to their power (Gray, 2001). The research method used in the research is qualitative analysis of case studies. Single case case study is used to obtain data from various primary and secondary research sources (observations, artifacts, archives, documents, interviews, multiple sources), is a research strategy involving one or more cases (multi cases) creating theoretical constructions, middle range propositions or theories based on empirical fact cases (Eisenhardt, 1989). The results of the research and discussion can be concluded that the existence of East Java UKM (KAJI) is described as follows: a. Able to support the family economy as an alternative source of family income, b. The existence of KAJI East Java, facilitates UKMs to establish friendly relations between UKMs, c. Market opportunities are still limited. SMEs still have difficulty marketing SME products. e. The attention received by SMEs in business development and capital assistance has not been maximized, f. Lack of innovation and creativity among SMEs. Suggestions for the existence of SMEs should receive more attention, especially in policies that support the existence of SMEs, especially the policy of implementing online shops to ensure the continuity of the existence of SMEs.

Konsep Model Teori Ramona T. Mercer Pada Asuhan Keperawatan Ibu Melahirkan

Ramona Thieme Mercer was born on October 4, 1929 is the author of the middle class theory of nursing known as the achievement of the maternal role. Mercer began her Nursing career in 1950, when she received a Diploma from St. Mary's. Margaret's School of Nursing in Montgomery Alabama. Mercer's theory is an example of a middle range theory, it has a lower abstraction that is derived from other theories so that it can be applied to more specific areas of nursing. A very interesting thing, of course, is when a nurse is able to translate how to develop this theory, it becomes easier to apply to patients. Maternal Role Attainment proposed by Mercer follows Bronfenbrenner's work in 1979 which is known as the bird's nest circle which includes a set of microsystem, mesosystem and macrosystem cycles. The application of the becoming a mother model in providing nursing care to postpartum clients is carried out to help clients achieve their role as a mother. So that the mother can provide good care for the baby and the baby can be fulfilled in psychosocial terms.

People living with Alzheimer's disease: Understanding the emerging phenomenon of retrograde plunge with the story theory-An inquiry method.

This study aims to (1) introduce the emergent concept of the retrograde plunge experienced by people living with Alzheimer's disease and (2) illustrate how nurses can accompany those experiencing this phenomenon, as well as their family and formal carers, using the seven-phase inquiry process proposed by Smith and Liehr. Discursive paper. After describing the phenomenon and the Story Theory, the 7-phase Inquiry Process presents the fictional story of Mrs. Lurie, a nursing home resident. Story theory allows nurses to accompany Mrs. Lurie. The emergent concept of retrograde plunge is explained. Different tools such as genograms, story paths and eco-maps are presented. This discussion demonstrates how some perspectives can contribute to a better description of the retrograde plunge phenomenon. The narrative care approach can help give voices to people experiencing retrograde phenomena. The adoption of a perspective that considers embodied language could help to better understand the needs of a person. There is a lack of consistency and uniformity regarding the understanding of the retrograde phenomenon. This impacts the quality of care for people and the scientific knowledge, research and education of healthcare professionals. This issue should be addressed in future studies. This article shows how story theory helps nurses accompany those facing a retrograde plunge phenomenon, helps them tell their own stories and finds a way to resolve the situation. This article paves the way for further developments that must now be realized by the international community of experts involved in the care of people with Alzheimer's disease, from practical, academic and research perspectives. No patient or public was involved in the design or drafting of the discursive paper. WHAT PROBLEM DID THE STUDY ADDRESS?: The retrograde plunge is a phenomenon in which people living with Alzheimer's disease return to their past lives and re-experience with certain events. The retrograde plunge is a well-known concept that is poorly described in scientific literature and is sometimes misunderstood by families and professional caregivers. This discursive article explains the retrograde plunge phenomenon experienced by people living with Alzheimer's disease. WHAT WERE THE MAIN FINDINGS?: This article demonstrates how story theory helps nurses and families support people with retrograde plunges. This highlights the lack of consistency and uniformity in this phenomenon, which has implications for the quality of care, education and research. Story theory and the seven-phase inquiry process proposed by Smith and Liehr (in Middle-range theory for nursing, Springer Publishing Company, 2023) help to better understand and explain the retrograde plunge phenomenon. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This article advances nurses' knowledge in the different fields of practice, teaching and research. This article proposes links among the retrograde plunge phenomenon, embodied language and narrative care approach; this could offer further ways to develop nursing knowledge. This study has the potential to advance the knowledge of practice and education and offers new opportunities for research. There was no trial or protocol registration as this article is a discussion.

An Evolving Structure of Nature Immersion: Roots in Nightingale's Vital Power.

Background: In Florence Nightingale's view, vital power resides in both earthy materials and human nature and is an essential element of health. Vital power is defined as a health force that manifests in states of being while doing in nature to generate well-being, but little is known about the generative process of vital force. Purpose: This secondary study explored the vital power of children who experienced well-being while doing in nature. Methods: Using a framework of the Nature Immersion Model, directed content analysis of parental reflections on their children's vital power experiences sought to explore patterns of being while doing in nature observed in association with parental reports of: (a) change in their children's well-being and (b) qualities of vital power evident in parental descriptions of those changes in well-being. Conclusions: The essence of vital power encompassed feelings of a life-spark, natural energy that prompted a healing shift. Implications for Practice: Linkage between a middle-range Theory of Nature Immersion and Nightingale's perspective adds a new avenue for integrating the spiritual-physical-mental dimension of self during creative nursing praxis.

A protocol for a critical realist synthesis of school mindfulness interventions designed to promote pupils' mental wellbeing.

The review described in this protocol will be the first critical realist review of the literature reporting on the impact of school-based mindfulness interventions on the mental wellbeing of pupils. Mindfulness interventions are increasingly being introduced into schools to promote children's (and teachers') wellbeing. Findings from impact evaluations, including systematic reviews and metanalysis, suggest that school-based mindfulness interventions promote pupils' wellbeing. However, there is a need for further evidence on the underlying causal mechanisms and contexts that explain program outcomes, to provide insight into how mindfulness programs can be successfully implemented in other contexts. A critical realist review methodology will be used to provide a causal interdisciplinary understanding of how school-based mindfulness interventions promote the mental wellbeing of pupils. This will be done through a systematic literature review and extrapolating context, agency, intervention, mechanisms, and outcome configurations. This will enable an understanding of how, in certain contexts, pupils can use the resources offered by a mindfulness intervention knowingly or unknowingly to trigger mechanisms that promote their mental wellbeing and what mechanisms in the context support, restrict or prevent change. We will then use retrodiction and retroduction to develop the most plausible interdisciplinary middle-range theory to explain the findings. The review findings will inform a critical realist evaluation of a mindfulness intervention in schools. The findings from the review will also enable us to inform policymakers and other stakeholders about what conditions need to be in place for mindfulness interventions to promote pupils' mental wellbeing. We will publish the findings from the review in academic and professional publications, policy briefs, workshops, conferences, and social media.PROSPERO registration number: CRD42023410484.

Supply chain resilience as a system quality: survey-based evidence from multiple industries

PurposeExperiencing more frequent, system-wide disruptions, such as pandemics and geopolitical conflicts, supply chains can be largely destabilized by a lack of materials, services or components. Supply chain resilience (SCRES) constitutes the network ability to recover after and survive during such unexpected events. To enhance the understanding of SCRES as a system-wide quality, this study tests a comprehensive SCRES model with data from multiple industries.Design/methodology/approachThe study proposes a theoretical framework conceptualizing SCRES as system quality, extending the classical proactive/reactive taxonomy by multiple system states consisting of the supply system properties, behaviors and responses to disruptions. Underlying hypotheses were tested using an online survey. The sample consists of 219 responses from German industries. Maximum likelihood structural equation modeling (ML-SEM) and moderation analysis were used for analyzing the survey data. The study was particularly designed to elaborate on supply chain theory.FindingsTwo pathways of parallel SCRES building were identified: proactive preparedness via anticipation and reactive responsiveness via agility. Both system responses are primarily built simultaneously rather than successively. The present study further provides empirical evidence on the central role of visibility and velocity in achieving comprehensive SCRES, while flexibility only exerts short-term support after a disruption. The study additionally points to potential “spillover effects” such as the vital role of proactive SCRES in achieving reactive responsiveness.Originality/valueThe present study confirms and expands existing theories on SCRES. While stressing the multidimensionality of SCRES, it theorizes the (inter-)temporal evolution of a system and offers practical guidelines for SCRES building in various industrial contexts. It thus supports the transformation toward more resilient and viable supply chains, contributing to the increasing efforts of middle-range theory building to achieve an overarching theory. The study also points to potential future research avenues.

Middle-Range Theory of Occupational Stress in Health Professionals.

Occupational stress affects health professionals; however, no literature was found on the middle-range theory for this outcome in health professionals. Methodological study for the theoretical validation of a nursing diagnosis using the theoretical framework of Walker and Avant and the Betty Neuman systems models. The research was conducted in five stages: comprehension of the system model; selection and review of studies; development of the conceptual-theoretical-empirical structure; elaboration of a diagram and proposition of a nursing diagnosis; and evaluation of the empirical adequacy of the theory and validity of the system model. These steps were conducted using a scoping review and a sample of 138 articles selected in the Scopus, Web of Science, MEDLINE/PubMed, CINAHL, PsycINFO, LILACS, Science Direct, Cochrane Library, and Google Scholar databases. A data extraction instrument was developed, and study variables (attributes, antecedents, and clinical consequences) were analyzed using descriptive statistics (absolute and relative frequencies) and presented in tables. The middle-range theory comprised 16 concepts, 20 propositions, and one diagram. A total of 15 related factors, 29 defining characteristics, six at-risk populations, and one associated condition were indicated to propose the nursing diagnosis for occupational stress. The middle-range theory supported elaborating elements to propose a nursing diagnosis for occupational stress.

Middle-Range theory of the nursing diagnosis of sedentary lifestyle in young adults.

To construct a middle-range theory for the nursing diagnosis of Sedentary Lifestyle in young adults. A methodological study for the validation of a nursing diagnosis based on a Middle-Range Theory, carried out in six stages: definition of the approach; definition of theoretical-conceptual models; definition of main concepts; development of a pictorial scheme; construction of propositions; establishment of causal relationships and evidence for practice. The theory construction was operationalized through an integrative review and supported by Roy's adaptation model. Three essential attributes were identified; 10 antecedents; 7 clinical consequences; a pictogram, 9 propositions, and 11 causal relationships and evidence for practice. The middle-range theory for the nursing diagnosis of Sedentary Lifestyle in young adults was constructed, expanding the understanding of this phenomenon, to be applied in clinical practice by nurses.

Risk for imbalanced blood pressure pattern among incarcerated women: Middle-Range Theory.

to develop a Middle-Range Theory for the Risk for imbalanced blood pressure pattern among incarcerated women. theoretical development study to obtain the theoretical-causal validity of the Nursing Diagnosis Risk for unstable blood pressure. The Middle-Range Theory was developed according to six stages: establishment of the approach to developing the theory; definition of the conceptual models to be later analyzed; definition of the main conceptions; a pictorial diagram; propositions; causal relationships and evidence for practice. two attributes and 20 antecedents related to imbalanced blood pressure were identified, a pictorial diagram was developed, and nine theoretical propositions were presented. the theory developed here favors the diagnostic reasoning of nurses and contributes to planning actions to promote the cardiovascular health of incarcerated women. A new proposition for the diagnosis of Risk for unstable blood pressure was also structured with a new title, definition, and etiological factors.

Disrupted mother-fetus dyad risk in high-risk pregnancies: a Middle-Range Theory.

to develop and evaluate a Middle-Range Theory for the nursing diagnosis "Disrupted Mother-Fetus Dyad Risk" in high-risk pregnancies. this methodological study was conducted in two stages: theory development and evaluation. Dorothea Orem's General Nursing Model was used as the theoretical-conceptual foundation. Evaluation was conducted using the Delphi method with seven judges, and consensus was achieved when the Content Validity Index of the evaluated items was ≥ 0.80. the theory identified 20 elements of the nursing diagnosis "Disrupted Mother-Fetus Dyad Risk" (10 risk factors, 4 at-risk populations, and 6 associated conditions), 14 propositions, and 1 pictogram. After two rounds of evaluation, the theory was considered consistent, with consensus reached for all items, each achieving a Content Validity Index ≥ 0.80. the Middle-Range Theory included biopsychosocial factors explaining the nursing phenomenon "Disrupted Mother-Fetus Dyad Risk," which aids in nurses' diagnostic reasoning.

Brazilian nursing specific situation, middle and micro-range theories: a bibliometric study.

to map the nursing theories developed in stricto sensu graduate programs in nursing in Brazil. a bibliometric study, carried out on the Coordination for the Improvement of Higher Education Personnel Theses and Dissertations Portal in October 2023. The controlled descriptors "Nursing Theory" and "Nursing Models" and the uncontrolled descriptors "Theories" and "Middle-Range Theory" were used. Selected studies were cataloged for analysis, which was conducted by the study authors, who have a doctoral degree and expertise in research on nursing theories. thirty-nine nursing theories were mapped, with a predominance of middle-range theories (79.5%), focusing on nursing diagnostic concepts and use of the theoretical-methodology strategy of theoretical-causal validity. the study identified nursing theories developed in Brazil, recognizing trends, development strategies, theorized objects of disciplinary interest and investments necessary for practical application in Brazilian contexts.

The Regulations for the Formation of the Association of Owners and Residents of Flat Units (PPPSRS) Create Justice

The formation of the Association of Owners and Residents of Flats Unit (PPPSRS) has an important role in encouraging a fair and equitable legal mechanism for Owners and Residents of Flats Units. However, in terms of the formation of the Association of Owners and Residents of Flats Unit (PPPSRS), the implementation of Law No. 20 of 2011 concerning Flats is still not optimal, as evidenced by the rampant conflict between owners and residents of flats with developers caused by developer interference in terms of formation and decisions made by the PPPSRS dispatcher. The weak supervision of apartment developers makes it freer to master the management of flats where it has been regulated that developers manage temporary flats, which is a maximum of 1 (one) year starting from the handover of apartment units. The research method used in writing this dissertation is the normative juridical research method, which is research that focuses and examines the application of rules and norms in positive law. Using the theory of Justice by John Rawls as the grand theory, the Organ Theory by Otto von Gierke as the middle range theory and the theory of Agreement by Subekti as the applied theory. The results showed that the implementation of the agreement between the owners and residents of the current apartment units in practice is not in accordance with what is regulated in Law No. 20 of 2011 concerning Flats because each interprets a rule based on its importance. as stipulated in Article 59. The transition period is calculated from where the handover is first, because many have received units for more than 5 (five) years, however, PPPSRS has not yet been formed due to the reluctance of developers to facilitate the formation of PPPSRS. For this reason, the author suggests that the government needs to be present to overcome the problems in the Agreement of the Association of Owners and Residents of Flats Unit (PPPSRS) both in its formation and implementation, so that a special institution is needed under the Minister of Public Works and Public Housing which oversees PPPSRS called the Flats Protection and Supervision Agency (BPPRS). For this reason, it is necessary to change the construction of Article 5 paragraph (2) of Law No. 20 of 2011 concerning Flats which stipulates the Flats Protection and Supervision Agency (BPPRS) as the Government representative responsible for the implementation of Flats.

“Application of Transitions Nursing Theory among Patients with Cardiac Arrests to Assess the Impact of Cardiopulmonary Resuscitation Duration on Functional Outcome—A Conceptual Framework”

Background: Change is the only constant in life, and humans continuously strive to cope and adapt based on the changes in their health (physical and mental) status. Cardiovascular diseases (CVD’s) are the leading cause of cardiac emergencies that cause enormous impact on patients, families, and health systems prompting processes and strategies for coping with their health status changes and their aftermath effect. Aim: A discussion of the conceptual framework of transition theory applicable to the study to assess the impact of the cardiopulmonary resuscitation (CPR) duration on the functional outcome among patients with in-hospital cardiac arrest (IHCA). Methodology: The transition theory, a middle-range and situation specific theory is applied to the prospective study conducted at a tertiary care hospital in South India. The outcomes were measured using the cerebral performance category (CPC). Results: The theory identifies that cardiac arrest is a situational transition affected by the chronicity of the disease as described with unfavorable outcome with CPC score of 3–5. The fear of death, dependency state of the patient in an unfavorable outcome based on CPC, and caregiver burden on family due to the prolonged duration of acuity of the disease or death of the patient are identified as properties in this theory. Based on the study, the personal meaning includes lifestyle modifications, the impact of spiritualism, financial stability, and the educational qualifications of the patient and family identified as personal meanings that play a major role as facilitators and inhibitors. The patterns and responses in this study identified with follow-up appointments, confidence in caring for themselves, and coping for themselves among the survived cardiac arrest patients. The nursing therapeutics identified from the study are risks identified from the comprehensive assessment, readiness to intervene and implement nursing actions, educating the patient and family based on the transition, and enhancing the creation of a healthy environment. Conclusions: The transition theory is holistically applicable for patients with cardiac arrest, identifying the process and changes adapted by the patient and family with the progression of the disease and the roles adapted by the family members in the event of the patient’s death.

Middle-range theory for nursing for care in the context of cardiovascular risk.

to develop a middle-range nursing theory for care in the context of cardiovascular risk. a theoretical development study, through induction through research and ICNP® practice standards, carried out in six stages: concept analysis; ICNP® terminological subset structuring; theory contextualization and purpose; proposition construction; modeling; and assumption construction. the Theory of Care in the Context of Cardiovascular Risk has a middle-range scope, describing care, prescribing actions to promote health and reduce cardiovascular risk. Thirteen propositions were constructed in three categories (nursing metaparadigm, central and factorial concepts), two models and 16 assumptions. the theory contributes to the construction of knowledge arising from the nursing process for care in the context of cardiovascular risk, generating propositions, assumptions and modeling, which will enable theoretical testing.

From Engineering Change to Enterprise Change Management: An empirical study on CM2 processes in the automotive industry

Companies need to respond to changing market requirements with product and process improvements. In order to better meet the needs of consumers, technical changes must be made within the product lifecycle of products. This can, for example, change the product's shape, ft or function. Engineering Change Management (ECM) processes are an elementary part of Product Lifecycle Management (PLM) and support handling these changes. ECM ensures that changes are assessed, communicated, coordinated, and implemented in time. The present research is based on a case study in an automotive company analysing the way of working within current ECM implementations against the CM2 framework proposed by Wu et al. [1]. Based on the comparison of qualitative interviews and company documents, the analysis shows deviations in the ECM process, especially regarding the implementation of changes in the plants. We suggest expanding the ECM process framework towards an Enterprise Change Management, including master data change in the IT systems and involving all relevant departments to implement the change successfully in the plant(s). Thus, we propose expanding the existing CM2 framework to inform ECM middle-range theory. In addition, recommendations for a successful ECM implementation are deduced from the comparison.

Middle-range theory of the existential dimension of being-in-the-world of chronic kidney disease: Grounded Theory.

to develop a middle-range theory of the existential dimension of being-in-the-world of chronic kidney disease in the light of humanistic nursing theory. exploratory-descriptive, qualitative, Grounded Theory study, whose guiding question was: what theoretical relationships can be established between clinical practice carried out in the context of renal replacement therapies and the concepts of humanistic nursing theory? Data were collected through semi-structured interviews with nursing staff and chronic kidney disease patients. a theory was developed that describes and explains the existential dimension of being-in-the-world of chronic kidney disease, identifying the qualitative evidence present in this context. the theory contributes to clinical nursing practice qualification in nephrology, consolidating nursing as an art and science, because it arises from care practice and research, in addition to rescuing what differentiates it within the health disciplines, which is care par excellence.