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    • Applying Middle Range Theories to Practice

    Last week you began exploring literature in support of specific practice problem. One step in the analysis of literature is examining the theoretical framework that guided the study. Middle range theories are frequently used to guide nursing research and it is likely that some of the articles you reviewed used a middle range theory. This week, you will examine how middle range theories bring to light concepts in health care and the DNP-prepared nurse’s role in developing and refining middle range theories for advancing nursing science and improving practice.

    To prepare:

    • Reflect on the information presented in this week’s Learning Resources, focusing on the development and use of middle range theories in nursing practice and research.
    • Search the Walden Library and other scholarly databases looking for examples of the development, analysis, or use of middle range theories in clinical practice.
    • Determine current trends in the development and use of middle range theories in nursing practice and research.
    • Consider how the development of new middle range theories advances nursing as a science.

    By Day 3 post a cohesive response that addresses the following:

      • How does middle range theory illuminate concepts in health and health care delivery?

    2) What do you see as your particular role in developing (or evaluating) middle range theories?


    3) Why might that be important to advancing nursing science and improving clinical practice?


    • Required Resources



    • Course Text: McEwin, M., & Wills, E.M. (2014). Theoretical basis for nursing. (4th. ed.). Philadelphia, PA: Wolters Kluwer Health.

      • Chapter 10, “Introduction to Middle Range Nursing Theories”
      • Chapter 11, “Overview of Selected Middle Range Nursing Theories”

        Chapter 10 begins the exploration of middle range theories and discusses their development, refinement, and use in research. Chapter 11 continues the examination of middle range theories and provides an in depth examination of a select set of theories.


    • Course Text: The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence

      • Chapter 8, “Objectives, Questions, Hypotheses, and Study Variables”

        Chapter 8 guides nurses through the process of identifying research objectives, developing research questions, and creating research hypotheses.


    • Book Chapter: Fawcett, J., & Garity, J. (2009). Chapter 6: Evaluation of middle-range theories. Evaluating Research for Evidence-Based Nursing. Philadelphia, Pennsylvania: F. A. Davis.
      Retrieved from the CINAHL Plus with Full Text database.

      This book chapter evaluates the use and significance of middle-range theories in nursing research and clinical practice.

    • Article: DeSanto-Madeya, S., & Fawcett, J. (2009). Toward Understanding and Measuring Adaptation Level in the Context of the Roy Adaptation Model. Nursing Science Quarterly, 22(4), 355–359.
      Retrieved from the Sage Premier 2010 database.

      This article describes how the Roy Adaptation Model (RAM) is used to guide nursing practice, research, and education in many different countries.

    • Article: Jacelon, C., Furman, E., Rea, A., Macdonald, B., & Donoghue, L. (2011). Creating a professional practice model for postacute care: Adapting the Chronic Care Model for long-term care. Journal of Gerontological Nursing, 37(3), 53–60.
      Retrieved from the CINAHL Plus with Full Text database.

      This article addresses the need to redesign health care delivery to better meet the needs of individuals with chronic illness and health problems.

    • Article: Murrock, C. J., & Higgins, P. A. (2009). The theory of music, mood and movement to improve health outcomes. Journal of Advanced Nursing, 65 (10), 2249–2257. doi:10.1111/j.1365-2648.2009.05108.x
      Retrieved from the CINAHL Plus with Full Text database.

      This article discusses the development of a middle-range nursing theory on the effects of music on physical activity and improved health outcomes.


    Optional Resources:

    • Article: McCurry, M., Revell, S., & Roy, S. (2010). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.
      Retrieved from the CINAHL Plus with Full Text database.



    2) Application Assignment #5: Middle Range or Interdisciplinary Theory Evaluation [Major Assessment 3]

    As addressed this week, middle range theories are frequently used as a framework for exploring nursing practice problems. In addition, theories from other sciences, such as sociology and environmental science, have relevance for nursing practice. For the next few weeks you will explore the use of interdisciplinary theories in nursing.

    This Application Assignment, due in Week 10, asks you to evaluate two middle range or interdisciplinary theories and apply those theories to a clinical practice problem. You will also create a hypothesis based upon each theory for an evidence-based practice project to resolve a clinical problem.

    NOTE: This Application will serve as your Major Assessment for this course.

    To prepare:

    • Review strategies for evaluating theory presented by Fawcett and Garity in this week’s Learning Resources.
    • Select a clinical practice problem that can be addressed through an evidence-based practice project. NOTE: You may continue to use the same practice problem you have been addressing in earlier Discussions and in Assignment #4.
    • Consider the middle range theories presented this week, and determine if one of those theories could provide a framework for exploring your clinical practice problem. If one or two middle range theories seem appropriate, begin evaluating the theory from the context of your practice problem.
    • Formulate a preliminary clinical / practice research question that addresses your practice problem. If appropriate, you may use the same research question you formulated for Assignment #4.

    You will continue working on this Application in Weeks 8, 9, and 10 using material presented in those weeks to consider interdisciplinary theories that may be appropriate for exploring your practice problem and research question.

    To complete:

    In a 6-page paper (including references):

    • Briefly describe your selected clinical practice problem.
    • Summarize the two selected theories. Both may be middle range theories or interdisciplinary theories, or you may select one from each category.
    • Evaluate both theories using the evaluation criteria provided in the Learning Resources.
    • Determine which theory is most appropriate for addressing your clinical practice problem. Summarize why you selected the theory. Using the propositions of that theory, refine your clinical / practice research question




Subject Nursing Pages 22 Style APA



Applying Middle Range Theories to Practice

The relevance and value of theories in nursing science, and specifically middle range theories, to the elucidation of concepts in health and healthcare delivery, and the entire nursing practice cannot be overemphasized. Nursing, like any other discipline, relies on theories for concept development and refinement, improvement of nursing practices, and most importantly, provide nursing knowledge, predictive value, and distinguishes the discipline from others by setting it as a unique profession (McEwin & Wills, 2014). Theories also provide nursing knowledge with an organized structure and means of data collections aimed at generally improving the nursing practice and healthcare delivery (McEwin & Wills, 2014).  There are three major types of nursing theories and these include grand or micro theories, middle range theories, and practice or situation specific theories (McEwin & Wills, 2014).  Middle range theories, unlike grand theories which are complex, non specific, and broadest in abstraction, are praised for their specificity, concreteness of concepts, practicability, and empiricism or testability of hypothesis (McEwin & Wills, 2014). Commonly used middle range theories include health promotion, chronic sorrow, uncertainty in illness, social support, quality of life, among many others (McEwin & Wills, 2014). Due to their ability to close the gap between theory and practice in nursing, middle range theories gained widely used internationally in the nursing profession and research (McEwin & Wills, 2014). Middle range theories also provide insights important not only to the understanding of and improvement of health and healthcare delivery concepts, but also in provoking nurse practitioners, scholars and other researcher in the field to engage in research seen useful in the advancement of the nursing science and improvement of clinical practice (McEwin  & Wills, 2014). This paper shall address how the middle range theories are valuable in illuminating concepts in health and healthcare delivery, and my role as a DNP nurse in evaluating middle range theories as well the importance of theory development and evaluation to the advancement of nursing science and improvement of clinical practice.

Middle Range Theories and Health and Healthcare Delivery Concepts

To begin with, new middle range theories brings along new concepts in  health and healthcare delivery that is useful in to organization and structuring of knowledge in the profession regarding health and health care delivery concerns. The theory can help explain health related concepts such as pain and hence and how best to manage it and suggest the necessary intervention (McEwin  & Wills, 2014).Through testing of various pain interventions for example, pain relief has greatly been improved among patients. Again, middle range theories illuminate on health concepts such as health promotion through description and explanation n ways of disease prevention for the improvement of the client’s health (McEwin & Wills, 2014). Through generation of testable hypothesis, middle range theories are in a better position to address health related issues that affects patients by coming up with effective interventions. Through their predictability, middle range theories are useful for investigations of health concepts such as symptoms of diseases, cultural issues, caring, social support, health quality and comfort, and their implications and predict outcomes of certain interventions (McEwin & Wills, 2014). Health care delivery can also be enhancing because these theories are easily applicable to nursing practice and therefore can be used to not only guide nursing interventions, but also improve the quality of cares nurses provide to patients. Through refinement and applicability of nursing practice, middle range theories may alter nursing conditions and hence improvements in health and healthcare delivery concepts. Since the theories focus on effects of nursing interventions to patients, they services delivered to patients can be tested and their effectiveness determined

Nurse’s Role in Developing and Advancing Middle Range Theories

As a DNP nurse, my role in the development and evaluation of middle range theories would be through engaging in extensive research, literature review of already established theories and generate my own concepts relevant to my area of interest in the discipline. I can also contribute to theory development through construction of hypothesis and clinical research questions that can be tested using middle range theories. I also as a DNP may also include writing and publishing papers concerning the theories. This would be important in advancing and improving clinical practice by increasing the body of knowledge to the discipline that is useful in advancing the discipline. Engaging in more research and application of middle range theories will also improve the discipline by refining the theories and its concepts, hence develop the theories further to become more specific, empirical, coherent and more relevant to the understanding and illumination of concepts in the discipline. As a nurse I would also engage in more application of middle range theories in nursing since in this way, their relevance and value in nursing interventions and outcomes can be realized.







Application of Middle Range and Interdisciplinary Theories in Exploring Nursing Practice Problem


The introduction and application of theories in the nursing profession revolutionized the profession not just in terms of generating and structuring of nursing knowledge or making the discipline distinct, but most importantly, theories did away with the use of irrational rituals and intuitions that had overshadowed nursing practice and ushered in an era of rationality, expertise, systematic thinking and practice, and even provided a moral and ethical foundation that guided nursing practice (McEwen & Wills, 2014). Theories of whatever kind used in nursing, therefore, are essential in providing more coordinated care to clients, establishing the purpose of nursing , enabling nurse discharge the professional duties with more conviction and organizing nursing knowledge for easier data collection, for descriptive, explanatory and predictive purposes in the discipline (McEwen & Wills, 2014). Nursing science has three major categories of theories and these include grand theories, middle range theories and practice or situation specific theories (McEwen & Wills, 2014).  For over decades, theories from these categories have been applied and used in the nursing profession to produce ne knowledge, enhance health care delivery, and importantly, yield more positive and better patient outcomes (Stevens, 2013). Middle range theories have, however, received more attention and popularity in the usage in advancing research efforts and practices in the field. Due to their role in generation and development of nursing knowledge, there has been a proliferation of this category of theories as they become widely accepted and used for research, widely practiced, and widely supportive of nursing practices (Stevens, 2013). Their preference in research stems from the fact that unlike grand theories for example, they are more appropriate in addressing clinical problems, and in generation and testing of clinical hypothesis suitable for a particular category of patients or clients (Stevens, 2013). It is less surprising therefore that middle range theories are frequently subjected to testing, frequently used to explore and investigate nursing problems and hence a subject of persistent refinement. Most of the middle range theories are unique to nursing, in that they are a direct result of nursing experience and research, but there are also a good number of them that come from other disciplines outside nursing such as psychology, sociology, environmental science and anthropology. The nursing profession is a dynamic one, and frequently, nursing has a professional obligation to ensure that healthcare and healthcare delivery practices conform to best practice and are f high quality (Peterson & Bredow, 2009). In this regard, more research in the profession is not only necessary, but also encouraged so as constantly improve care practices, clinical problem solving and quality service delivery for efficiency in the entire discipline (Peterson & Bredow, 2009). The complex nature of current global health problems and the need for nursing science to produce more evidence based interventions and care practices to clients implies necessitates the need for a broader approach in the disciplines research approach. Evidence based technique is one, and so is the use of approaches and ides form other disciplines outside nursing, such as social sciences, and this will complements the research efforts in nursing science and provide a wider perspective of studying and addressing clinical problems and challenges facing nursing as a distinct profession (Peterson & Bredow, 2009). This essay shall explore the use of middle range and interdisciplinary theories in solving real clinical practice problem. A brief overview of the clinical problem shall be provided, followed by a summary of two chose middle range theories. Next, an evaluation of the two theories based on Roy’s Adaptation Model ( RAM) shall be provided and the best theory to address the identified clinical problem shall be provided.

Overview of the Clinical Practice Problem: Prevalence of Chronic Diseases

At the global scale, there has been an upsurge in the number of suffering,  dying  or becoming disabled from chronic diseases and other health related conditions such as arthritis, obesity, cancer and diabetes (CDC, 2015).  These invisible epidemics cause widespread impact worldwide and a major health challenge for nurses, and the entire healthcare profession. Almost half of all adults worldwide suffer from one form of chronic disease or the other (WHO, 2015). Most of these chronic diseases account for 48% of deaths, led by cancer and cardiac diseases. Obesity and arthritis are also some of the major chronic diseases causing problems to world population with more and more people becoming obese and more and more people being rendered disabled (CDC, 2015). Diabetes on the other hand is responsible for the increased statistics on the number of people with kidney failure, not to mention rising number of lower limb amputations and blindness (WHO, 2015) Nurses have a role to play in clinical nursing practices and particularly in the promotion of health, control and prevention of such chronic diseases as well as their management. The increase in the number of people suffering from chronic diseases has a bearing for nurses since they are the ones who the first point of contact when patients are seeking care and support for their conditions (Kemppainen et al, 2013). The clinical problem and challenges for practicing nurses, therefore, is the constant pressure required and expected of them to deal with the chronic diseases among patients by coming up with effective ways of controlling, managing, and preventing the upsurge of chronic illnesses (Kemppainen,  Tossavainen,  & Turunen,  2013). Chronic diseases, because of their long lasting nature among patients, implies that such patients will often time require or be place in the care of nurses. The upward statistics regarding chronic diseases is a problem that weighs heavily not only on the healthcare system, but especially on nurses who have an important role in disease management and caring for patients (Kemppainen et al, 2013).  Since nurses are the fits point of contact, they are better placed to suggest appropriate interventions that will e useful for the patients and their family setting. Nurses also posses the relevant skill to provide ongoing care, patient assessment, and play an advocacy and educative role for the patients living with chronic diseases (Kemppainen et al, 2013). The consequences of chronic diseases that nurses encounter daily in their profession are therefore far reaching, leading high financial implications for the healthcare sector, premature deaths, poor quality life and productivity, and a strain to healthcare system (Kemppainen et al, 2013). This trend has a direct impact on nurses in clinical care setting. Nurses, regardless of the institution or community to which they are stationed are thus certainly affected with the high prevalence of chronic diseases and this implies that they need to be more active in managing, controlling and preventing the prevalence of chronic diseases by developing more effective intervention strategies to provide support to the patients and their families and increase their coping strategies and health behaviors (Srof & Velsor-Friedrich, 2006). Nurses can therefore not escape addressing the chronic disease problem and this means development of strategies and theories that will see a reversal of the costly trend.






Formulated Research Questions

  1. What is the effect of self efficacy on the rates of obesity among teenage girls?
  2. How is the health behavior of teenage girls related to prevalence of obesity?
  3. What is the effect of perceived barriers to action on obesity?

Summary of Middle Range Theories for Addressing Chronic Disease Prevalence

Middle range theories are the most preferred in nursing science for researching and addressing clinical problems because they are less abstract and contain few concepts hence nurses find it easier to work with this category of theories (Fawcett, 2005). Middle range theories will therefore be more suitable in researching for effective interventions for nurses to address the prevalence of chronic disease problem (Pender, Murdaugh & Parsons, 2002). These theories are also very readily applicable to nursing practice and this implies that a couple of them can actually be applied in the quest for effective interventions for the clinical problem presented above. The theories thus have the potential for improving research in nursing science as well as practice, because they are rich in rationale that guide nurses in coming up with effective interventions for chronic disease control (Stevens, 2013). The theories that will be used for this clinical problem is Nola Pender’s health promotion model and chronic sorrow and Kolcaba’s theory of comfort (Alligood, 2013). A summary of each of the theory is provided in the next paragraphs.

Nora Pender’s Health Promotion Model

Nurses, regardless of their work situation or community are have to learn new strategies on how that can help patients and families deal control, manage and prevent prevalence of chronic dieses which are rampart in every corner of the world (Peterson & Bredow). The major factor promoting this problem are usually lifestyle choices or factor such as the type o foods and individual takes, exercise and how effectively and individual manages stress (Pender et al, 2002). Nurses are thus better placed to ensure that individuals adopt better and healthier life styles to not only improve their quality of life, but also ensure that chronic diseases are kept at bay (Stevens, 2013). The health promotion model ( HPM) that was first published by Nola Pender is effectively at the nurses disposal for utilization in benefiting large number of their clients in different settings, such as work place, learning institutions, or healthcare agencies (Pender et al, 2002).  Since Nurses are well equipped with many relevant skill including advocacy skills, the health belief model can be to promote heath of clients by creating desirable behavioral changes such as eating health foods, exercising and other health related behaviors that fosters a healthy lifestyle (Pender et al, 2002). This model originated from expectancy value and cognitive theories constructed form a nursing point of view. The purpose of the HPM was to make use of ideas from the behavioral science to create a positive change on the health of individuals (Alligood, 2013). Together with the biopsychosocial model, HPM act acts as a guide for nurses to motivate clients to adopt behaviors that promote health. This model as over the year used in science nursing in the research that is concerned with determination of health promotion outcomes on the health behaviors and health lifestyles of individuals (Srof & Velsor-Friedrich, 2006). The major concepts for the theory include the nature or personal characteristics of an individual and their experiences, individual cognitive behaviors such as the perceived barriers in adopting health related habits, and behavioral outcomes such as preference and commitment to health related behaviors. Context wise, HPM can be used across a large number of populations of different ages and sex such as in learning institutions, churches or working environments (McEwen & Wills, 2014). The theory works on the understanding that health does not necessarily mean absence of disease and therefore it focuses more on illnesses as well as health of individuals to achieve longevity (McEwen & Wills, 2014). This makes this theory expansive in addressing chronic health since it has a broader definition of what constitutes health. It also provides nurses with an opportunity to extent their services and assistance to individuals suffering from chronic health and their families in the path to living a health life. The model highly advocates for early detection and treatment of chronic illness such as cancer and diabetes, and other preventive interventions (Peterson & Bredow). The health promotion model is based primarily on the human behavior theory which posits that human behavior has a significant contribution to health or lack of it (Peterson & Bredow). It also put emphasis on an individual’s effectiveness in undertaking health related activities such as exercise. Bearing some semblance to the health belief model, the HPM implies that nurses should be on the fore front of assessing the health of their clients and also target influencing their health related behaviors by enhancing on their client’s level of self efficacy (Peterson & Bredow). Appropriate intervention strategies according to this model should therefore target a patients’ perception such health concepts as diet, exercise, stress management mechanism among many other as ways of promoting healthy living (McEwen & Wills, 2014).

Kolcaba Theory of Comfort

The theory is consistent with the nursing practice, which entails providing comfort to their clients as well as their families through what the theory terms as comfort interventions (McEwen & Wills, 2014). The idea of comfort and care have philosophical bases in nursing practice, and as this theory explains, can be achieved by nurses being more patient focused (Kolcaba & Kolcaba, 1991). The purpose of this theory is to provide patients with a degree of comfort described here as active or passive satisfaction among patients from rather stressful healthcare situations (McEwen & Wills, 2014). It also aims to provide patients with a kind of comfort that is supposed to encourage them to seek health interventions.  Among the major concepts in the theory include comfort, health seeking behavior (HSB), comfort care, comfort needs of patients among many other related interventions (McEwen & Wills, 2014). Some of the major propositions of this theory require nurses to identify the comfort requirements of their clients and design appropriate interventions aimed at ensuring that patients comfort needs are met (Kolcaba, 2001). The more comfortable nursing interventions make the patients and their families comfortable, the more they are likely to display the health related behaviors (Kolcaba, 2001). The theory is applicable in situations where patients are experiencing great distress due to healthcare situations or illnesses, including chronic illness and hence are in dire need of comfort care or nursing interventions to promote comfort (Peterson & Bredow). Over the year, the concept of comfort has greatly been enhanced with advancements in the medical field, thus nurses have more ways of ensuring patients for instance even among patients with severe pains or cancer, or severe chronic diseases (Kolcaba, 2001). The general major assumptions of the theory is that all human beings not only holistically respond to some form of stimuli, but also have a holistic need to meet their comfort needs through various endeavors (Peterson & Bredow). The theory has been widely used in nursing practice and research since all the prepositions found in this theory can indeed be tested for the improvement of health and healthcare delivery.

Middle Range Theory evaluation

In nursing science, research is usually conducted to either test a middle range theory or come up with a new one altogether and the testing is essential in evidence for their suitability in nursing practice (Fawcett & Garity, 2009). Evaluation of a theory is also essential in the advancement or nursing research. Theory evaluation means examining a theory form a systematically and based on a particular criteria (Fawcett & Garity, 2009). When examining a theory, some attributes of a theory are given particular attention including origins, meaning, usefulness, testability and even the extent to which the theory can be generalized (McEwen & Wills, 2014). When evaluating middle range theories, how useful a theory is in as far as guiding nursing practice and the entire nursing fraternity including administration should be considered Evaluation also provides insights into a theory’s major concepts as well as the identification of a theory’s strengths and weaknesses (McEwen & Wills, 2014). Because middle range theories help nurses generate or test the theories, they are essential for nurses in as far as sound research work is concerned (Fawcett & Garity, 2009). Their systematic evaluation using one of the numerous versions of evaluating middle range theories provided in the text is thus necessary. Here, the two middle range theories shall be evaluated using Face’s criteria or recommendations of middle theory evaluation. According to Faucet, evaluation, which seeks to determine how good a theory is, has four major steps including significance (social and theoretical), internal consistency, parsimony application and testability of the theory (Fawcett & Garity, 2009).

Evaluation of Pender’s Health Promotion Model


Pender’s health promotion model (HPM) is one of the explicitly stated middle range theories. Significance refers to the degree of usefulness of a theory to the society and to the theory itself in terms of knowledge generation and advancement nursing (Fawcett & Garity, 2009). This HPM is highly significant because it addresses chronic diseases that affect large numbers of people globally such as diabetes and obesity (Pender et al, 2002). It is also applicable where there are large groups of people such as schools and work places (Pender et al, 2002). The theory also addresses individuals suffering from not so common diseases among a large population such arthritis, but whose effects have large impacts on the quality of lives of those affected. This theory is also theoretically significant based on the fact that is has proved useful in shedding light on the understanding and predicting of health outcomes of individuals based on their health behaviors. This has been useful for nurses in providing solutions for clients in large care settings, schools, churches, care agencies and such like. The theory has, however not yet filled the gap on knowledge concerning cute chronic care settings.

Internal Consistency

The theory meets the internal consistency criteria because it is easily comprehensible and all the major concepts, models applied, and propositions well documented rationally and consistently (Fawcett & Garity, 2009). Its major concepts such as perceived barriers and benefits, self efficacy, and health promoting behaviors are consistent and well explained. All the multiple concepts the theory uses are well identifies and defined. There is also semantic consistency since all the terms are consistently and explicitly elucidated. The theory’s proposition that individuals usually strive to achieve the behaviors that they perceive to reap great value to them is also rational, and so are the relationships established in the theory. Both inductive and deductive reasoning applied to the theory’s prepositions are flawless


Parsimony is determined by the number of concepts and propositions presented in the entire theory (Fawcett & Garity, 2009). Focus here is on the concise nature of the theory and simplicity. The health promotion model is concisely and simply stated and hence can easily be understood even just from the title. The number of concepts used in the theory are relatively few, and so are the propositions. This makes is not only concise, but friendly to work with in research. Parsimony in the theory is further enhanced in the theory with the fact that on several occasions, the theory has been empirically tested and supported by numerous other research findings (Fawcett & Garity, 2009)


Many scholars have engaged in the empirical testing of this theory and this means that the theory is testable empirically. While most of the concepts in the theory have been empirically tested, not each and every one has. Among the concepts have been tested include health promoting behavior, self efficacy, diabetes, and exercise. There is no evidence that the rest of the concepts such as behavior specific cognition to have been subjected to empirical testing. While the data and hypothesis of the theory have been tested using data analysis techniques, the criterion for testability of testing research is not evident.

Kolcaba Theory of Comfort

Significance of the Theory

The theory is socially significant since it focuses on providing care that increases comfort and reduces healthcare related stress among patients regardless of their age or health situations (Kolcaba & Kolcaba, 1991). The theory is holistic and all inclusive and thus targets a large number of clients. There have been criticisms, however, that Kolcaba’s focus on mental and physical stress of individuals is not socially comprehensive enough to render this theory of greater social significance. While the theory deals with a concept that is a relevant for all categories of patients (comfort), it does not explicitly address major health conditions impacting on a large community, and this compromises its degree of social significance (Kolcaba & Kolcaba, 1991). Theoretical significance is, however, well served by the theory since it provides insights into how comfort can be integrated into nursing practice to provide a holistic care for all categories of patients

Internal Consistency

There is sufficient and consistent information that has been provided about this theory and so its theoretical concepts and propositions are simple and comprehensible, hence internally consistent. The major concepts in the theory have been well identified such as comfort and health seeking behaviors. It is thus easy to discern the concerns of the theory with regard to patient comfort. Semantic clarity has been achieved in the theory because its concepts are not only explicitly stated, but also consistently used. The concept of theory has however been numerously defined in different ways and used in multiple ways hence compromising on semantic consistency of the theory. The propositions used in the theory such as nurse’s identification of the comfort requirements of a patient are logical and following the rule of deductive reasoning.


The theory is relatively parsimonious and this is because the theory has numerous concepts, and a total of eight propositions which robs it some of its parsimonious value b making its contents less concise. The theory of comfort is however concisely stated in an easier way to understand what it is about form the title. All the relevant data have been briefly presented in the theory.


This theory has also been tested empirically on several occasions and by different researchers. Most of its concepts were also measured though not each of the concepts of the theory has ever been tested. Its assertions were also tested using the data analysis techniques used in research.

Most Appropriate Model: Pender’s Health Promotion Model

From the above summary of the two theories and most importantly the evaluation of the two theories, I have arrived at Pender’s health promotion model as the most appropriate theory to address my clinical practice problem of prevalence of chronic diseases such as cancer and diabetes. The whole goal of theory analysis and evaluation as performed above is to come promote through understanding of a theory, and then after evaluation, pick out the most suitable theory for nursing science research in terms of robustness. Base on Faucet’s criteria for theory evaluation, the health promotion models seems to be more robust not only in terms of meeting most of the evaluation criteria prescribed by Faucet, but also because it is the one that provides the best fit for my clinical problem. This theory is also more preferred of the two because of its high social significance as it addresses major health concerns across world population and its richness in pragmatic adequacy as required by Faucet’s framework. The theory is not only frequently utilized in the nursing practices, but also easier to work with since is does not require specialized skills. Most of the outcomes of using the research have also yielded positive outcomes in nursing practice in so far as promotion of positive health outcomes is concerned.

Refined Clinical Research Questions

  1. What behavioral characteristics are increases rates of obesity among teenage girls?
  2. How is perceived barrier to action related to rates of obesity among teenage girls?
  3. What is the effect of self efficacy in the healthy eating habits among teenage girls?


In conclusion, chronic illness are prevalence globally and a major concern for healthcare worker especially nurses who are play an important role in establishing first contact of care to chronically ill patients. Middle range theories are widely utilized in the nursing practice not only to generate and test theories, but also to provide evidenced based practice in the profession to deal with major health challenges. The problem of chronic illness can best be addressed from the lens of Pender’s health promotion model, since it is appropriate and pragmatic in addressing such health concerns affecting the wider public. Application of middle range theories not only advance the nursing profession, but also enable utilization, generation, testing and refinement of nursing science theories.



Alligood, M. R. (2013). Nursing theorists and their work. Elsevier Health Sciences.

Centers for Disease Control and Prevention ( CDC) ( 2015). US Department of Health and Human Services. Chronic diseases: The leading causes of death. Retrieved from: www.cdc.gov/chronicdisease/overview/

Fawcett, J. (2005). Middle range nursing theories are necessary for the advancement of the discipline. Aquichan, 5(1), 32-43.

Fawcett, J., & Garity, J. (2009). Evaluating research for evidence-based nursing practice. FA Davis. Retrieved from the CINAHL Plus with Full Text database.

Kemppainen, V., Tossavainen, K., & Turunen, H. (2013). Nurses’ roles in health promotion practice: an integrative review. Health promotion international, 28(4), 490-501.

Kolcaba, K. (2001). Evolution of the mid range theory of comfort for outcomes research. Nursing Outlook, 49(2), 86-92.

Kolcaba, K. Y., & Kolcaba, R. J. (1991). An analysis of the concept of comfort. Journal of advanced nursing, 16(11), 1301-1310.

Majid, Shaheen et al. “Adopting Evidence-Based Practice in Clinical Decision Making: Nurses’ Perceptions, Knowledge, and Barriers.” Journal of the Medical Library Association : JMLA 99.3 (2011): 229–236. PMC. Web. 14 Oct. 2015.

McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing. (4th. ed.). Philadelphia, PA: Wolters Kluwer Health.
Peterson, S. J., & Bredow, T. S. (Eds.). (2009). Middle range theories: application to nursing research. Lippincott Williams & Wilkins.

Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2002). The health promotion model. Health promotion in nursing practice, 4, 59-79.

Srof, B. J., & Velsor-Friedrich, B. (2006). Health promotion in adolescents: A review of Pender’s health promotion model. Nursing Science Quarterly, 19(4), 366-373.

Stevens, K. (2013). The impact of evidence-based practice in nursing and the next big ideas. OJIN: The Online Journal of Issues in Nursing, 18(2), 4. Retrieved from: nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html

World Health Organization. (2005). preventing chronic diseases: a vital investment: WHO global report.


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