Identify a practice or organization issue of importance to you. Then, you select two middle-range theories and apply them to address the practice or organization issue.
Reflect on your nursing practice to identify issues of particular interest or concern to you and/or your organization.
Select one practice or organization issue on which to focus for this Discussion.
Review the Learning Resources for this week, focusing on specific middle-range theories that may apply to the practice or organization issue that you selected.
Select two middle-range theories that you believe are relevant and valuable in addressing the practice or organization issue you selected.
Post the following:
Identify the practice or organization issue you selected. Explain why you chose it.
Describe the two middle-range theories that you selected. Explain why you chose them.
Explain how you would apply each middle-range theory to the practice or organization issue. Be specific and provide examples.
Sample Answer
That is a fantastic application exercise that bridges nursing theory with real-world practice challenges.
🏥 Practice Issue: Alarm Fatigue in the ICU
The practice issue I have selected is Alarm Fatigue in the Intensive Care Unit (ICU).
I chose this issue because it is a critical safety and quality problem directly impacting patient outcomes and staff burnout. The constant, non-critical noise from monitors in the ICU leads nurses to become desensitized (fatigued) to alarms. This can result in delayed responses, disabled alarms, or even missed true patient emergencies, posing a significant risk of patient harm. It represents a systemic failure that is both clinical and organizational.
Selected Middle-Range Theories
I have selected two middle-range theories that offer complementary frameworks for analyzing and solving the problem of alarm fatigue: Mishel's Uncertainty in Illness Theory and Orem's Self-Care Deficit Theory (SCDT).
1. Mishel's Uncertainty in Illness Theory (MUIT)
Description: MUIT focuses on the cognitive state experienced when a person cannot adequately structure or make meaning of an event, often due to a lack of clear, consistent information. Uncertainty is characterized by ambiguity, complexity, lack of information, and unpredictability. The theory posits that people strive to reduce uncertainty.
Why Chosen: While often applied to patients, the theory is highly relevant to the nursing staff's cognitive environment. Alarm fatigue creates a state of uncertainty and cognitive overload for the nurse. The nurse is constantly exposed to alarms, most of which are false or non-actionable (ambiguity and complexity). This constant sensory input creates uncertainty about which alarm is real and requires immediate action, leading to the maladaptive coping mechanism of fatigue and desensitization.
2. Orem's Self-Care Deficit Theory (SCDT)
Description: SCDT states that nursing care is required when an individual is unable to meet their own self-care requisites (universal, developmental, or health deviation). The core concept is the self-care deficit, where the self-care demands exceed the individual's self-care agency (ability).
Why Chosen: SCDT provides a framework for analyzing the nurse's ability (agency) to perform the universal self-care requisite of maintaining patient safety in the context of a flawed environment. Alarm fatigue creates a deficit in the nurse's agency to maintain a safe environment because the system (the overwhelming alarm volume) places an excessive, unnecessary burden (demand) on the nurse's cognitive ability.