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Middle Range Nursing Theories


Nursing theories describe the nursing profession and provide a basis for distinguishing it from other disciplines. Nursing seeks to establish itself as a composition of a scientific knowledge base that enables it to increase its healthcare practice visibility. These theories guide the care provision in the professional practice, and its implementation depends on the level of competencies of the primary health practitioner. Middle-range nursing theories tend to be more specific and link the grand nursing theories to practice. They try to explain different phenomena in clients’ care, and their usefulness can be tested (Warren, 2016). Therefore, this paper will describe the value, worth, and significance of the middle range theory of nurses’ psychological trauma to the practice.

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Structural Components of the Theory

The nurse’s psychological trauma theory is a middle-range theory that aims to support patient care and the nurses’ psychological well-being. The purpose of this theory is to explain the nurse-centered and patient-centered sources of psychological traumas. It is classified as a middle-range theory in nursing as it tries to uncover one aspect of patient care which affects nurses. First, this theory suggests that psychological traumas in the healthcare setting may arise from the nurse’s or the patient’s day-to-day activities. Nurses encounter emotional challenges during the dissemination of individualized care plans to patients. These traumas may arise from disasters at the workplace, inadequate resources, medication errors, and workplace trauma (Foli & Thompson, 2019). Furthermore, this school of thought proposes that each nurse has unique personal competencies in managing stress. Other capabilities, including individual resiliency, post-traumatic stress management, and the organization’s resources to help persons manage pain effectively, are instrumental inadequately managing work traumas for nurses. Therefore, this theory calls for the empowerment of the nurse’s capabilities in managing hospital-acquired stress.

Second, this theory of a nurse’s psychological trauma suggests that each individual perceives stress differently. The ability to manage traumas is significantly shaped by personal biological, genetic, physical, cultural, and spiritual experiences. The daily nursing practice stressors can be a source of depression or anxiety for nurses and patients. The patient’s worries may arise from long durations of hospital stay or the treatment outcomes. Hence, some individuals tend to leave the nursing practice, of poor services, provision of inpatient care, and engaging in substance abuse (Foli & Thompson, 2019). This theory assumes that the generation of trauma-centered nursing and patient interventions is necessary to reduce hospital stressors’ psychological burden. Therefore, this theory calls for the nurses’ active management and the patients’ psychological stressors for effective clinical outcomes.

Functional Components of the Theory

An understanding of the operational definitions of the terms used in this theory is imperative. First, a stressor refers to an unpleasant sensation experienced by a nurse or a patient that significantly affects their well-being. These stressors impair the optimal daily functioning of a human being. Another term used in this text is the allostatic load which is the constant and prolonged exposure to stressors with profound physical and emotional consequences. The sustained sensation of uneasiness has detrimental effects on an individual if not adequately addressed. Moreover, the words mitigators and buffers are widely cited by the proposers of this theory. They refer to the personal or institutional factors that empower the patients and nurses to manage the stressors effectively (Foli & Thompson, 2019). They include specific capabilities such as post-stress growth, individual resiliency to stress, and system or organization resources available for managing psychological disturbances. The understanding of these operational terms used in this theory contributes significantly to its application in nursing practice.

The theory of nurses’ psychological trauma is presented logically by its proposers. First, the approach begins by describing the concepts of psychological stressors in the current healthcare field. This introduction gives the reader an in-depth understanding of the underlying problem. Then, the theory provides clear explanations of the probable sources of discomfort to nurses and patients in the hospitals. Additionally, the authors give the significance of the theory of nurses’ psychological trauma to the nursing practice, including the ways to manage stress. Finally, this theory provides a brief explanation of the implications of the identified ideas to the current healthcare practice. The authors suggest how healthcare managers can resolve the nurses’ and patients’ stressors (Foli & Thompson, 2019). This theory’s logical presentation improves a reader’s understanding of the text for practical implementation in practice.

The proposers of this theory identified several consequences that may arise from this theory. Implementing this theory’s recommendations will promote the resolution of the patients’ and nurses’ stressors. Hence, nurses’ job turnover rates due to experiencing psychological disruption during patient care will significantly be decreased with its effective management. Effective stress management of nurses is instrumental in improving patient care due to improved job satisfaction. The nurses’ undesirable emotional feelings of anxiety and depression are addressed by implementing the theories’ suggestions (Foli et al., 2020). Furthermore, the patient’s hospitalization length is consequently reduced with effective patient care and improved immune response secondary to peace of mind. The effective implementation of the recommendations of this theory has positive outcomes for the nursing practice.

Components for Evaluating This Theory

The theory of the nurses’ psychological trauma is in line with the principles of nursing practice. First, this theory advocates for the consideration of the emotional components of the patients’ health. This idea is similar to the principle of holistic patient care required of professional nurses. Nurses should institute interventions that meet the individual patient’s emotional, physical, mental, social, and spiritual well-being. Furthermore, this theory suggests adopting a caring and empathic attitude during the management of hospitalized patients. Adopting positive attitudes in inpatient care is a vital component of the nursing profession that promotes trauma-informed care (Foli & Thompson, 2019). This type of care provision prevents the traumatization and retraumatization of the patient or other staff during the care delivery. Therefore, this theory provides a basis for effective nursing management.

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This theory is relevant and valid to the current practice in healthcare management. Care delivery is characterized by numerous psychological trauma sources to both patients and nurses that call for comprehensive management. Patients suffer from stress during hospitalization, which begins from the uncertainty of the treatment outcomes to the healthcare personnel’s frequent therapeutic interventions. Furthermore, nurses encounter stressors during care dissemination to the patient. Factors that generate stress for nurses include high workload, workplace violence, historical traumas, and trauma from disasters. Therefore, this theory is helpful as it addresses the current healthcare problems that disrupt patient management. It also provides a basis for adopting trauma-centered self and patient care necessary to reduce the nurse’s impact and psychological stressors (Bruce et al., 2018). Theories that aim to improve care delivery and decrease the patient’s burden are fundamental and appropriate to the nursing practice.

Implications of This Theory to Nursing Practice

The implementation of this theory has several implications for the practice of nurses. First, this theory calls upon nurses to take an integral role in addressing the stressors that patients face. The patient’s emotional well-being is equally significant as their overall psychological health as it influences treatment outcomes. Second, nurses need to monitor their coping abilities with traumas. Ineffective adaptation to traumas by nurses has significant effects on nurses’ health, therefore, calling for a teamwork approach to improve the care providers’ response to stressors. This theory also calls for sustained changes to the healthcare policies in decreasing the impacts of the stressors on the nurse’s health (Foli et al., 2020). Organizational changes are required to promote adequate staffing in healthcare providers’ hospitals and the resolution of violence at the workplace as these are the potential sources of nurses’ trauma.

Additionally, this theory makes significant contributions to the nursing practice today. First, it shows the advantages of policy changes in promoting the psychological well-being of nurses. Policy changes which aim to increase nursing staffing are effective in reducing the workload of nurses. This theory also necessitates for the hospital organization to address workplace violence against nurses (Eriksson et al., 2018). Second, this theory promotes the significance of adopting a holistic approach to patient care to ensure optimal psychological health. It also contributes to nursing research by providing a database for creating an evidence-based body of nursing practice knowledge (Eriksson et al., 2018). This data is necessary for improving the management of trauma inpatient care. This theory provides a basis for future research in nursing practice. Other views are needed on the influence of the professional aspects, including the unit of admission on nurses and patients’ psychological health.


According to nurses’ psychological trauma theory, patients and nurses experience significant psychological traumas in hospitals. The increased workload and workplace violence raise the nurse’s psychological impairments. Several consequences of psychological traumas to nurses include anxiety and depression. Individual traits such as resilience and post-traumatic growth are beneficial for managing psychological stressors. Furthermore, this theory calls for patients’ holistic management for effective outcomes and has contributed immensely to nursing knowledge on psychological care and nursing research.


Bruce, M. M., Kassam-Adams, N., Rogers, M., Anderson, K. M., Sluys, K. P., & Richmond, T. S. (2018). Trauma providers’ knowledge, views, and practice of trauma-informed care. Journal of Trauma Nursing: The Official Journal of The Society Of Trauma Nurses, 25(2), 131–138.

Eriksson, I., Lindblad, M., Möller, U., & Gillsjö, C. (2018). Holistic health care: Patients’ experiences of health care provided by an advanced practice nurse. International Journal of Nursing Practice, 24(1), e12603.

Foli, K. J., & Thompson, J. R. (2019). The influence of psychological trauma in nursing. Sigma.

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Foli, K. J., Reddick, B., Zhang, L., & Krcelich, K. (2020). Nurses’ psychological trauma: “They leave me lying awake at night.” Archives of Psychiatric Nursing, 34(3), 86–95.

Warren, H. (2016). Middle-range theories: Frameworks for examining a nonsurgical cosmetic problem. Plastic Surgical Nursing: Official Journal of the American Society of Plastic and Reconstructive Surgical Nurses, 36(1), 9–11.

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