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Explain How the Concepts of the Conceptual Model and Middle-Range Theory Are Consistent and Are Linked

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A conceptual model deals with abstractions (concepts) that are assembled because of their relevance to a common theme. Conceptual models provide a conceptual perspective on interrelated phenomena, but they are more loosely structured than theories and do not link concepts in a logical deductive system. A conceptual model broadly presents an understanding of a phenomenon and reflects the assumptions of the model’s designer. Conceptual models can serve as springboards for generating hypotheses

Some writers use the term model to designate a method of representing phenomena with a minimal use of words, which can convey different meanings to different people. Two types of models used in research contexts are schematic models and statistical models. Statistical models, not discussed here, are equations that mathematically express relationships among a set of variables and that are tested statistically.

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The concepts for the middle range for Comfort Theory include comfort needs, comfort interventions, intervening variables, enhanced comfort, health-seeking behaviors, and institutional integrity. All of these concepts are relative to patients, families, and nurses. There are eight propositions which link the above concepts together. All or parts of the Comfort Theory can be tested for research. In the comfort theory, Kolcaba asserts that when healthcare needs of a patient are appropriately assessed and proper nursing interventions carried out to address those needs, taking into account variables intervening in the situation, the outcome is enhanced patient comfort over time. Once comfort is enhanced, the patient is likely to increase health-seeking behaviors. These behaviors may be internal to the patient (eg, wound healing or improved oxygenation), external to the patient (eg, active participation in rehabilitation exercises), or a peaceful death. Furthermore, Kolcaba asserted that when a patient experiences health-seeking behaviors, the integrity of the institution is subsequently increased because the increase in health-seeking behaviors will result in improved outcomes. Increased institutional integrity lends itself to the development and implementation of best practices and best policies secondary to the positive outcomes experienced by patients. To translate the concepts to practice the effectiveness of a holistic intervention can be targeted to the taxonomic structure for enhancing comfort in a specific patient, family, or nurse population over time

Holistic comfort is defined as the immediate experience of being strengthened through having the needs for relief, ease, and transcendence met in four contexts of experience (physical, psychospiritual, social, and environmental).The comfort theory has been operationalized in many research settings with a variety of patient and target populations ranging from end of life care to the comfort of nurses. Despite nurses as frontline caregivers for dying patients and their families many nurses have identified that they struggle with the responding adequately to the emotional devastation to parents and siblings when caring for a neonate with an unresolved terminal condition. With the advances in neonatal care and life sustaining treatments, sick and very preterm infants do not often die in utero, at birth, or shortly after birth, but instead they often live much longer in a healthcare paradigm of comfort care and dignified death. This relatively new emersion of the end of life model integrates a more holistic approach which considers a more comprehensive view of the patient’s needs (emotional, spiritual, and medical).

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Three approaches to connecting conceptual models and middlerange theories have been identified. One approach is the direct derivation of a middle-range theory from a conceptual model. For example, two theories of family health have been directly derived from King's Conceptual System (Villarruel AM, Bishop TL, 2001). This approach assures a logical linkage between the conceptual model and the middle-range theory. The logic is assured because the world view (reaction, reciprocal interaction, simultaneous action) undergirding the conceptual model and the world view undergirding the theory are the same. The second approach is to link an existing middle-range nursing theory with a conceptual model of nursing. For example, a researcher might want to link the nursing theory of uncertainty in illness with Johnson's Behavioral System Model. This approach is problematic in that the world view undergirding Johnson's conceptual model and the world view undergirding the conceptual model from which the theory was derived may not be logically congruent. Logical congruence would be evident only if the world view undergirding Johnson's conceptual model and the world view undergirding the conceptual model from which the theory was derived are the same. The third approach is to link an existing middle-range theory borrowed from another discipline with a conceptual model of nursing

For example, the theory of planned behavior, from the discipline of social psychology, has been linked with Neuman's Systems Model and with Orem's Self-Care Framework (Doornbos MM., 2000). As with the second approach, this approach is problematic in that the world view undergirding the Orem's conceptual model and the world view undergirding the conceptual model from which the theory was derived may not be logically congruent. Logical congruence would be evident only if the world view undergirding Orem's conceptual model and the world view undergirding the conceptual model from which the theory was derived are the same. Latham (40) rejected the third approach on the grounds that it does not contribute to the advancement of the discipline of nursing. She declared: Grafting a particular borrowed theory onto a nursing conceptual model may be a questionable exercise. … Rather the emphasis could be placed on creating distinctive cognitive approaches with the parameters of nursing. … Nursing research will not advance knowledge if it continues to hang on the coattails of other disciplines.

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To summarize, verbal encouragement from a trusted, credible source in counseling or education form has been used alone to strengthen efficacy expectations. The final information source physiological feedback or state during a behavior can be important in relation to coping with stressors, health functioning, and physical accomplishments

Interventions can be used to alter the interpretation of physiological feedback and help individuals cope with physical sensations, enhancing self efficacy and resulting in improved performance.

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Villarruel AM, Bishop TL, Simpson EM, Jemmott LS, Fawcett J. Borrowed theories, shared theories, and the advancement of nursing knowledge. Nursing Science Quarterly 2001; 14: 158-63.

Popper KR. Normal science and its dangers. In: I. Lakatos & A. Musgrave (Eds.), Criticism and the growth of knowledge. London: Cambridge University Press; 1970; 51-8.

Popper KR. Conjectures and refutations: the growth of scientific knowledge. New York: Harper and Row; 1965.

Slife BD, Williams RN. What's behind the research? Discovering hidden assumptions in the behavioral sciences. Thousand Oaks, CA: Sage; 1995.

Doornbos MM. Using King's systems framework to explore family health in the families of the young chronically mentally ill. In: M. A. Frey & C. L. Sieloff (Eds.), Advancing King's systems framework and theory of nursing. Thousand Oaks, CA: Sage. 1995; 192-205.

Doornbos MM. King's systems framework and family health: The derivation and testing of a theory. Journal of Theory Construction and Testing 2000; 4: 20-6.

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