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Applying Middle Range Nursing Theories


Obesity becomes one of the most critical problems among children worldwide, especially in some populations. The surveys regarding Mexican-American school-age children in the US reveal the fact that this population is more prone to obesity compared to the White population. Several reasons affect the rapidly growing rates of obesity in the identified population, among which one may enumerate inappropriate nutrition, a lack of physical exercise, unstable sleep patterns, family attitude to this health concern, etc. In order to make an attempt to resolve the given problem, it is essential to apply middle-range nursing theories based on competence, culture, and caring. This paper will discuss the application of Benner’s model of skill acquisition and development and the theory of human caring elaborated by Swanson to the problem of obesity in Mexican-American school-age children.

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Application of Theories

Benner’s model of skill acquisition and development implies the creation of a basis for describing, forecasting, explaining, and controlling phenomena related to the professional activities of nursing personnel. The premise of the theory is the statement that the competence of nursing staff depends on the continuous acquisition of experience, knowledge, and clinical skills, both on theoretical and practical levels (Attard, Baldacchino, & Camilleri, 2014). The paramount objective of the mentioned model is to provide nurses with clear guidelines for advancement by setting fixed goals for every level. There are five consistent levels, including novice (analytical recognition, decision, and awareness control), advanced, beginner, competent, proficient, and expert (holistic recognition, intuitive decision, and absorbed awareness).

The following plan of the theory application may be suggested considering the identified health concern:

  • training of nursing personnel based on the theory with the help of clinical mentors and expert nurses;
  • development of criteria for belonging to every clinical step in every department, depending on the clinical specialization;
  • personnel monitoring depending on the level of competence;
  • drawing up individual plans for professional development of nurses;
  • conducting periodic evaluations of the promotion of employees based on interviews and surveys (see Figure 1 in Appendix).

At the novice stage, a nurse follows the rules without paying attention to the context and a complete sense of responsibility. The above level will transform into an advanced one when a nurse will develop organizational principles to quickly access special rules that relate to a specific task; therefore, competence is characterized by active decision-making in the choice of an action plan. Proficiency will be shown by excellent intuition and empathy to guide decisions and develop specific rules to formulate plans (Pearson, 2013). The level of experts implies a firm commitment to rules to an intuitive way of reasoning based on tacit knowledge.

The second theory of human caring seems to be essential to apply as it will effectively complement the first one. Butts and Rich (2018) reckon that the middle-range theory of nursing based on caring was developed by Swanson, who considered and adjusted the principles developed by Watson’s theory of human caring. Swanson defines her approach to caring as nurturing the way of treating patients with a sense of responsibility and commitment (Desmond et al., 2014). The five caring processes suggested by the mentioned theorists may be applied to the problem of obesity in Mexican-American children in the US as follows:

  • Maintaining belief. Nurses are expected to understand their patients’ beliefs and views on the process of caring and treating, demonstrating faith in them.
  • Knowing. Making it clear what patients expect (reduce weight, achieve adequate treatment from others, etc.).
  • Being with. Showing emotional presence and ensuring that patients feel connected with their nurse by sharing the reality and demonstrating that their health issues matter.
  • Doing for. Specifically to the problem under discussion, nurses should employ compassioning, comforting, guiding, and supporting techniques and behaviors to both children and their patients.
  • Enabling. Provide relevant information on how the problem may be addressed, what are the steps needed, how long it would take, and any other required data.

Outcomes and Implications

In order to measure the effectiveness of the application of the proposed theories, it is essential to focus on the outcomes. Among the outcomes that would help to evaluate the application of Benner’s model of skill acquisition and development, it is possible to note successfully performed helping role, monitoring function, management of changing environment, quality of care, use of knowledge and skills in practice, and relationships between a nurse and a patient (Porr & Egan, 2013). The final evaluation will be based on the combination of the above elements. The process of giving formative evaluation is to be conducted every certain period for all nurses. As for the caring theory of Swanson, the outcome of its application implies the establishment of proper relationships in three directions: a nurse to a patient, a nurse to other nurses, and a nurse to self. In other words, the application should benefit not only a patient but also a nurse since such an approach to caring will ensure a proper understanding of how to care about others and find a balance with self. The enhanced health outcomes in patients compose another expected outcome.

As for implications, the application of the above theories would promote patient satisfaction and improvement of their health conditions. The formative assessment of the competence theory would allow a nurse and a manager to provide feedback through a personal interview, during which the goals and plans for continuous improvement of professional activities will be discussed. In addition to better cooperation between nurses, greater nurse-patient collaboration would be achieved based on compassion, respect, and emotional presence. In other words, the practice gap would be reduced. The discussed theories may also be supported by Papadopoulos, Tilki, and Taylor’s model of cultural competence and the theory of praxis suffering (Shen, 2015). While the former focuses on a cultural component of care, the latter refers to conceptualizing the emotional responses of a patient to disease as enduring or emotional suffering.

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This paper discusses the application of Benner’s model of skill acquisition and development and Swanson’s theory of human caring to the health problem of obesity in Mexican-American school-age children. Based on the components of the above theories specific steps were suggested to apply them in practice with an attempt of addressing the given health concern. In particular, novice, advanced, beginner, competent, proficient, and expert levels regarding Benner’s model as well as maintaining belief, knowing, being with, doing for, and enabling were presented. Among the outcomes to be evaluated are relationships between patients and nurses, care quality, management of changing environment, and the use of knowledge and skills in practice. The expected implications of the application are improved patient satisfaction, better health outcomes, and appropriate collaboration between nurses and patients, and increased understanding of patients’ needs.


Attard, J., Baldacchino, D. R., & Camilleri, L. (2014). Nurses’ and midwives’ acquisition of competency in spiritual care: A focus on education. Nurse Education Today, 34(12), 1460-1466.

Butts, J.B., & Rich, K.L. (2018). Philosophies and theories for advanced nursing practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.

Desmond, M. E., Horn, S., Keith, K., Kelby, S., Ryan, L., & Smith, J. (2014). Incorporating caring theory into personal and professional nursing practice to improve perception of care. International Journal for Human Caring, 18(1), 35-44.

Pearson, H. (2013). Science and intuition: Do both have a place in clinical decision making? British Journal of Nursing, 22(4), 212-215.

Porr, C., & Egan, R. (2013). How does the nurse educator measure caring? International Journal of Nursing Education Scholarship, 10(1), 35-43.

Shen, Z. (2015). Cultural competence models and cultural competence assessment instruments in nursing: A literature review. Journal of Transcultural Nursing, 26(3), 308-321.

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Conceptual map.
Figure 1. Conceptual map.

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