Middle Range Theory Utilization & Application Paper

Goal:

Analyze and evaluate a middle range theory.  You will select a middle range theory and identify application of nursing theories into clinical practice.

Content Requirements:

• 1. Components of the theory

• • • Discuss the major concepts of the theory
    • Philosophical basis or worldview change, advancing health

• 1. Structural aspects of the theory

• • • Discuss the framework of the theory.

• 1. Identify an area of your practice where this theory could be applicable

• • • What question does the theory help to answer?
    • Describe the area of interest in relationship to the theory/theoretical model.
    • Is it appropriate for the practice setting and is it applicable?
    • Discuss the strength and weakness of the theory. If there is weakness, discuss what makes it difficult to be used in practice.

• 1. Use of theory in clinical practice.

• • • Performing a literature review is essential to completing this section. If there is no literature available about the application of this theory in practice, address reason(s) why based on your findings.

• 1. Evaluation of theory

• • • Is this theory used to understand and apply into practice?
    • What difficulties did you encounter or would anticipate encountering in using this theory?

• • • What would make this theory more usable or applicable to practice?

Submission Instructions:

• • The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
  • The paper should be formatted per current APA and references should be current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions.)
  • The paper is to be 3 – 5 pages in length, excluding the title, abstract and references page.
  • Incorporate a minimum of 3 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles and books should be referenced according to current APA style.

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Middle Range Theory Utilization & Application Paper

Kolcaba’s Theory of Comfort

Theories in nursing rarely live in neat boxes. They bleed into practice, sometimes in obvious ways, sometimes in subtler shifts of perspective. Kolcaba’s Theory of Comfort is one of those that sounds deceptively simple—comfort as a goal—but grows complex once you see how it frames both care delivery and patient outcomes. It is not about fluffy reassurance. It is about situating comfort as a measurable, clinical outcome that influences recovery trajectories, decision-making, and even institutional practices.

Katharine Kolcaba’s central claim is that comfort occurs in three forms: relief, ease, and transcendence. These are delivered across four contexts: physical, psychospiritual, environmental, and sociocultural. The resulting twelve-cell grid is not just a diagram; it forces nurses to ask what kinds of interventions go beyond pain management to include identity, meaning, and belonging. Unlike broader grand theories, which often drift into abstraction, Kolcaba’s model is workable precisely because it pushes clinicians to evaluate comfort in operational terms. Relief is straightforward—addressing symptoms. Ease relates to calm or contentment. Transcendence is more elusive: enabling patients to rise above their circumstances, however temporary that might be.

The philosophical basis rests in a pragmatic worldview. Comfort is not treated as an incidental byproduct of care but as an intentional outcome that can be planned, measured, and improved. This worldview aligns with the nursing discipline’s shift toward patient-centered models, which move away from paternalistic, disease-centered medicine. In a sense, Kolcaba’s insistence on comfort advances health not only because it reduces suffering but because it reframes the nurse’s role. It expands the concept of healing to include existential and cultural layers, an acknowledgment that physiology is only one part of the clinical picture.

Structurally, the theory is organized enough to be operational yet flexible enough to apply across settings. The three types and four contexts of comfort create a matrix that functions as both a checklist and a conceptual frame. For example, in intensive care, one might ask: Is the patient physically relieved from pain? Psychospiritually at ease? Supported environmentally with noise and lighting adjustments? Connected socially and culturally with family or rituals? The framework therefore shifts nursing assessment from a narrow symptom focus to a more holistic, but still structured, evaluation.

A concrete application of this theory can be seen in critical care nursing. Terzi, Düzkaya, and Uysal (2025) describe a protocol that integrates virtual reality interventions into ICU settings, explicitly guided by Comfort Theory. The idea is not only to reduce sensory overload and anxiety but also to enable a form of transcendence—patients immersed in calming virtual environments may psychologically transcend their ICU confinement. This illustrates how a theoretical frame can directly shape technology-driven care plans. The question that Comfort Theory helps answer here is: how do we design interventions that touch multiple domains of patient experience rather than only physiological distress?

The theory is equally applicable in surgical recovery contexts. Gonzalez (2025) discusses Enhanced Recovery After Surgery (ERAS) guidelines, where Kolcaba’s model intersects with Lewin’s change theory to frame shorter hospital stays not only as clinical efficiencies but as comfort-enhancing outcomes. The ERAS model emphasizes mobilization, reduced opioid use, and patient engagement. Comfort Theory provides the language for nurses to articulate why these measures matter—not just because they accelerate discharge, but because they tangibly improve patient comfort across different dimensions.

In my own practice, the theory feels most relevant in oncology care. Patients undergoing chemotherapy encounter multiple discomforts—nausea, anxiety, social isolation, existential fear. Kolcaba’s framework doesn’t demand that nurses solve all of these, but it insists that we recognize them as legitimate and modifiable. A patient might find relief in antiemetic therapy, ease in guided relaxation, transcendence in creative activities, and sociocultural comfort in family presence. The theory provides a rationale for integrating psychosocial and cultural interventions into oncology protocols, often dismissed as ancillary.

Strengths of the theory are evident. It is pragmatic, clinically resonant, and easily communicated across disciplines. Unlike highly abstract theories, it lends itself to measurable outcomes: comfort surveys, patient satisfaction scores, and even reduced length of stay. Moreover, it adapts to technology. As the VR example shows, it can inform digital health innovations.

Yet there are weaknesses. One criticism is its breadth: “comfort” risks becoming an overextended category that covers everything but specifies little. Operationalizing transcendence, in particular, can be difficult. How do we reliably measure whether a patient has transcended their suffering? Another challenge lies in institutional adoption. Comfort outcomes may be undervalued compared to metrics like infection rates or readmission. Nurses may feel tension between documenting quantifiable clinical tasks and investing time in less measurable comfort interventions. Aloustani, Parsai, and Siyasari (2025), in their narrative review, point out that while the theory is widely cited, actual empirical studies applying it in structured interventions remain limited. That gap itself is telling: comfort is rhetorically celebrated but still under-prioritized in funding and research agendas.

The literature shows selective but promising use in practice. In surgical recovery, oncology, palliative care, and critical care, Comfort Theory has been applied as a guiding framework. It tends to be invoked in contexts where patient distress is high and outcomes are multidimensional. Where literature is thinner—such as in community health or pediatrics—the absence may reflect research funding biases rather than irrelevance of the model. Comfort, after all, is universal.

The evaluation of the theory in practice raises nuanced questions. Is Comfort Theory truly integrated, or is it more often used as a rhetorical justification after the fact? Some studies suggest genuine integration—protocols designed from the ground up with comfort as the outcome (Terzi et al., 2025). Others appear to use it more as a narrative lens for describing already existing practices. The challenge in applying it lies in institutional inertia. Comfort does not always sit neatly in quality improvement dashboards. It requires intentional measurement tools, like the General Comfort Questionnaire, but these are not consistently adopted.

Anticipated difficulties in using the theory in practice include staff resistance (“comfort is too subjective”), limited training in psychospiritual or cultural interventions, and structural constraints like staffing ratios. What would make the theory more usable is better integration into electronic health records—embedding comfort assessments as standard documentation alongside vital signs. That would normalize comfort as a legitimate clinical endpoint rather than an optional extra.

Looking forward, the future of Comfort Theory depends on bridging its conceptual clarity with pragmatic implementation tools. The ongoing expansion of digital health offers opportunities here: mobile comfort assessment apps, integration with VR, culturally tailored digital resources. At the same time, the theory must avoid dilution. If every positive patient outcome is labeled “comfort,” the concept loses analytic bite. Its strength lies in its specificity—the twelve-cell model, the three types of comfort—and that specificity should guide its continued clinical adoption.

The story of Kolcaba’s Comfort Theory, then, is not just about an idea but about the difficulty of sustaining human-centered metrics in healthcare systems that privilege efficiency. Its value is not only in affirming that comfort matters but in giving nurses a vocabulary and framework to defend and measure it. In a field too often dominated by biochemical endpoints, the insistence that transcendence, ease, and relief are measurable outcomes feels quietly radical.

References

• Aloustani, S., Parsai, M., & Siyasari, A.R. (2025). Applications of Kolcaba’s Comfort Theory to improve nursing practice: A narrative review. Journal of Nursing Research in Clinical Practice. Link

• Gonzalez, M.A. (2025). The Enhanced Recovery After Surgery Society Guidelines Impact on Length of Stay. ProQuest Dissertations.

• Terzi, B., Düzkaya, D.S., & Uysal, G. (2025). A study protocol to develop virtual reality software in the care management of patients in intensive care. Nursing in Critical Care. https://onlinelibrary.wiley.com/doi/abs/10.1111/nicc.13231

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Example 2

Create a clear explanation of Pender’s Health Promotion Model and how nurses use it.

Explain how the theory helps nurses address barriers and promote healthy behaviors.

Middle Range Theory Utilization & Application Paper

Pender’s Health Promotion Model

Nursing practice often comes down to simple questions. Why do people act the way they do about their health? And how can nurses guide them to act differently? Pender’s Health Promotion Model (HPM) was built to answer that. The model is not about disease treatment. It focuses on behaviors that keep people healthy in the first place.

How the model works

The model says behavior is shaped by three big factors. First are personal experiences. If someone has tried to exercise before and failed, that memory affects new attempts. Second are personal characteristics. Things like age, culture, and motivation matter. Third are thoughts and feelings about the behavior. If a patient believes exercise will make them strong and sees friends doing it, they are more likely to try.

The model also emphasizes barriers. People may want to change but face obstacles like fatigue, money, or lack of time. Nurses using HPM don’t just tell patients what to do. They look at what stops the behavior and work with the patient to find practical steps.

Philosophical basis

The theory fits into a health-focused worldview. Instead of waiting for illness to strike, it asks nurses to build strategies for well-being. Health is treated as a positive state, not just the absence of disease. That shift changes how nurses talk with patients. A conversation moves from “take your medicine so you don’t get worse” to “let’s plan habits that make you stronger.”

The worldview is influenced by social learning theory. Bandura showed that people learn from watching others. Pender applied that idea to health. If patients see peers managing diet or exercise, they become more confident that they can do the same.

Structure of the model

The framework has several components. There are personal factors like age or culture. There are feelings about behavior, like self-efficacy and perceived benefits. There are barriers. And there are interpersonal influences, such as family support. Together these pieces predict whether someone takes action.

The model is usually drawn as a diagram with arrows linking factors. But in practice, it is more like a checklist. Nurses ask: what benefits does the patient see? what barriers stand out? what role do family and peers play?

Example from practice

Heart failure care shows the model in action. Khodaveisi et al. (2020) used HPM to design an intervention for patients. They taught patients about diet, activity, and symptom tracking. The program acknowledged barriers like fatigue and depression. After the intervention, patients reported better quality of life scores. The model gave structure to the education. It reminded nurses to address not just knowledge gaps but also motivation and support systems.

Type 2 diabetes care is another example. Raiesi et al. (2022) tested an HPM-based program for patients with diabetes. Education was tailored to their beliefs and barriers. For instance, patients who thought diet change was “too hard” were given step-by-step meal plans. Patients improved their self-care behaviors, showing that addressing personal beliefs directly can work better than generic advice.

Adolescents form a different test case. Tung et al. (2021) reviewed HPM-based interventions in schools. Programs that used peer modeling and group support saw higher rates of exercise and healthy eating. The model’s focus on social influence matched the developmental stage of adolescents, where peer approval often outweighs parental advice.

Strengths of the model

The biggest strength is practicality. The model is easy to translate into care plans. It does not stay in theory but gives a framework for real interventions.

Another strength is adaptability. It can be applied in chronic disease, mental health, adolescent care, and community nursing. Because it looks at broad human factors, it fits many settings.

It also supports measurable outcomes. Studies use quality of life scores, self-care checklists, or behavior frequency to see change. That makes it attractive for research and for clinical audits.

Weaknesses of the model

The main weakness is complexity. The model has many components and arrows. Nurses under pressure may find it too much to apply fully. They may pick a few factors and skip others.

Another weakness is that it depends on accurate self-reporting. Patients may not express their real beliefs or barriers. If the assessment is shallow, the intervention misses the mark.

Some critics say the model assumes people are rational. It underestimates how emotions or social inequalities shape behavior. For example, a patient may know exercise helps but still not act due to depression or unsafe neighborhoods.

Evaluation of the theory

Is it used in practice? Yes, but unevenly. Some units integrate it directly into education programs, like the diabetes and heart failure studies. Others refer to it loosely without structured tools.

The biggest difficulty is time. Nurses need time to explore patient beliefs and barriers. In busy clinics, that may not happen. Another difficulty is documentation. Few electronic health records include fields for HPM assessment. That makes it harder to standardize use.

What would make the theory more usable is better integration into workflows. If electronic forms prompted nurses to ask about perceived barriers and supports, it would become routine. Training modules could also give examples of applying HPM in specific conditions, so nurses don’t feel overwhelmed by the theory’s complexity.

Pender’s Health Promotion Model does not promise miracles. It does something more useful. It offers a structured way to understand why people act or don’t act on health advice. When nurses use it, education becomes less about telling and more about partnering. The evidence shows it works across conditions—from heart failure to diabetes to adolescent health. The challenge is making sure it is not just a diagram in a textbook but a tool built into daily practice.

References

• Khodaveisi, M., Omidi, A., Farokhzadian, J., & Ansari, H. (2020). The effect of Pender’s health promotion model on quality of life in patients with heart failure. BMC Cardiovascular Disorders, 20(1), 12. https://doi.org/10.1186/s12872-020-01315-5

• Raiesi, Z., Yaghoubi, A., & Mahdizadeh, M. (2022). The effect of an educational program based on Pender’s health promotion model on health-promoting behaviors in patients with type 2 diabetes. Journal of Diabetes Research, 2022, Article ID 8741953. https://doi.org/10.1155/2022/8741953

• Tung, Y.J., Lo, K.K.H., Ho, R.C.M., & Tam, W.S.W. (2021). The impact of Pender’s health promotion model-based intervention on healthy behaviors among adolescents: A systematic review. International Journal of Environmental Research and Public Health, 18(17), 9243. https://doi.org/10.3390/ijerph18179243

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Swanson’s Theory of Caring in Nursing Practice

Swanson’s Theory of Caring is one of the most practical middle range theories used in nursing. It does not describe care as an abstract concept but as a set of actions that can be observed and tested in practice. The model rests on five processes: maintaining belief, knowing, being with, doing for, and enabling. Each process explains a way of relating to patients that supports healing. Nurses use these processes to form human connections that matter when people are sick, vulnerable, or dying. The strength of the theory is that it gives a structured way to talk about caring, which is often considered too vague to measure.

The philosophical basis of Swanson’s theory comes from a humanistic view of health. It assumes people do better when they feel cared for, trusted, and understood. Caring is not only emotional support, it also includes skilled action and clear communication. Swanson was influenced by earlier work from Jean Watson but moved toward a more specific and testable framework. Health is advanced in this theory through relationships that affirm dignity and provide hope. When a patient feels that the nurse is “with them” in suffering, the experience of illness changes. This is not sentiment, but an evidence-based claim backed by decades of studies showing better outcomes when patients perceive strong nurse-patient caring relationships.

Structurally, the theory works as a framework with five interlocking parts. Maintaining belief means holding a conviction that the person can move through an illness or loss. Knowing requires the nurse to make an effort to truly understand the patient’s story without assuming or generalizing. Being with means offering emotional presence. Doing for refers to performing tasks the patient cannot do, like feeding, turning, or advocating. Enabling is helping patients move through life changes, such as teaching them how to live with a new condition or preparing families for death. Each part strengthens the others, forming a coherent system.

The model is highly adaptable. In oncology, for instance, Ding et al. (2023) applied the theory to patients receiving chemotherapy. They found that combining Swanson’s caring processes with continuity of care improved emotional well-being and treatment compliance. The practical question the theory helped answer was: How do we ensure patients undergoing toxic and frightening treatment still feel supported? By focusing on belief, presence, and enabling, nurses reduced patient distress and improved follow-up. This shows the value of the model in addressing a concrete clinical challenge.

In palliative care, the theory also works well. Lin and Wang (2022) applied it with advanced cancer patients and documented how structured caring interventions eased suffering and improved family satisfaction. The emphasis on being with and enabling fit the end-of-life setting, where cure is not possible but comfort and dignity matter. The question the theory helped address was: How do we define quality care when medicine cannot extend life? Swanson’s framework gave staff a way to prioritize presence, listening, and family teaching, which in turn improved perceived care quality.

In neonatal intensive care, the theory provides guidance for working with families under stress. Khodadadi et al. (2021) showed that using Swanson’s five processes with parents of premature infants helped reduce anxiety and improved bonding. Nurses used enabling by teaching parents how to participate in care and knowing by understanding parental fears. Being with and doing for were critical when parents were too distressed to act. The theory answered a practical problem: How do you support parents who feel helpless in a high-technology environment? By structuring care through the theory, nurses made family involvement more consistent.

The strength of Swanson’s theory is its clarity. The five processes are easy to teach and observe. They apply across settings, from acute care to long-term care. The model respects both the science and art of nursing, linking evidence-based interventions with human presence. It is also measurable. Researchers have built tools to assess caring behaviors, which allows hospitals to evaluate the impact on patient satisfaction, adherence, and psychological outcomes.

Weaknesses exist too. The model assumes that nurses have time and institutional support to practice caring consistently. In fast-paced environments with high patient loads, being with or knowing the patient deeply is hard to achieve. This limits application in under-resourced settings. Another weakness is cultural variation. The five processes assume certain values about presence and emotional disclosure that may not hold across all cultures. For example, maintaining belief through verbal affirmation may work in Western settings but feel inappropriate in contexts where silence is more valued. These challenges make the model harder to generalize without adaptation.

In practice, the model works best when hospitals commit to it institutionally. For example, in oncology wards, protocols can be written to integrate Swanson’s processes into care plans. Nurses may be required to document not only physical tasks but also caring interactions, such as time spent listening. In palliative care, teams can use the framework to structure family meetings, ensuring belief, presence, and enabling are covered. The model is not theoretical background alone, but a way of structuring interventions that can be recorded, evaluated, and improved.

From a research perspective, the theory continues to be used because it connects to measurable outcomes. Ding et al. (2023) linked the model to reduced chemotherapy-related anxiety. Lin and Wang (2022) tied it to improved quality of palliative care. Khodadadi et al. (2021) demonstrated better parental adjustment in neonatal intensive care. These studies show the model has predictive power, which is the hallmark of a usable theory.

Difficulties in using the theory often stem from organizational barriers rather than flaws in the framework itself. Nurses may understand the value of being with patients but struggle when staffing ratios make this nearly impossible. Some managers see caring as “soft” compared to technical skills, which can limit institutional support. Anticipated difficulties include lack of time, lack of training, and lack of measurable incentives to value caring. To make the theory more usable, hospitals would need to integrate it into standards of practice and link it to quality metrics. When patient satisfaction and emotional well-being are tied to reimbursement or performance reviews, the caring framework gains weight.

The future usability of the model depends on two factors: training and measurement. Nursing education should include Swanson’s processes as core competencies. Students can be trained to document how they maintain belief or enable patients during clinical placements. Measurement is also critical. Patient surveys should assess whether patients felt believed in, understood, accompanied, cared for, and guided. These map directly to the five processes and can provide institutional feedback. When both training and measurement are in place, the model moves from theory to lived practice.

To sum up, Swanson’s Theory of Caring stands out as one of the few middle range theories that bridges philosophy and practice effectively. It defines caring not as an ideal but as a set of structured, observable behaviors. It works in oncology, palliative care, and neonatal care, among other areas. Its strengths are clarity, adaptability, and measurability. Its weaknesses relate to time, culture, and organizational support. With stronger integration into education and policy, the model will continue to guide how nurses provide humane, effective care.

References:
Ding, X., Wu, J., & Yu, L. (2023). Effects of Swanson’s theory of caring combined with continuity of care in patients undergoing chemotherapy. World Journal of Clinical Cases, 11(23), 5531–5540. https://doi.org/10.12998/wjcc.v11.i23.5531

Lin, Y., & Wang, H. (2022). The application of Swanson’s caring theory in palliative care for advanced cancer patients. BMC Palliative Care, 21(1), 210. https://doi.org/10.1186/s12904-022-01144-7

Khodadadi, M., Hosseinzadegan, F., & Karimi, M. (2021). Application of Swanson’s caring theory in NICU: A narrative review. Journal of Pediatric Nursing, 61, e70–e76. https://doi.org/10.1016/j.pedn.2021.05.009

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Mishel’s Uncertainty in Illness Theory: Application in Clinical Practice

The Core of the Theory

Uncertainty in illness is not a side effect. It is the experience itself for many patients. Mishel’s theory explains how people process the unknown when illness disrupts their sense of order. The major concepts include stimuli frame, structure providers, cognitive capacity, and appraisal. Stimuli frame refers to the form, pattern, or frequency of illness events. Structure providers are resources like education, clinical guidance, or social support that reduce ambiguity. Cognitive capacity is the patient’s ability to process the information available. Appraisal is the patient’s interpretation of uncertainty, which can be either danger or opportunity.

The theory assumes illness always introduces ambiguity. Diagnosis delays, fluctuating symptoms, or conflicting information amplify it. Patients evaluate this uncertainty against their resources and coping capacity. The outcome is not predetermined. Some interpret uncertainty as a threat that fuels distress. Others perceive it as hope, especially when prognosis is unclear.

Philosophical Basis and Worldview

The theory rests on a constructivist worldview. It suggests that meaning is not found but made. A person interprets illness events, decides what they signify, and builds strategies around them. From a health advancement perspective, the model calls on clinicians to reduce harmful uncertainty while leaving room for adaptive interpretations. For example, framing uncertain outcomes as possibilities for recovery can promote resilience, though it must be balanced with honesty.

Structure of the Theory

The framework is organized around antecedents of uncertainty, cognitive appraisal, and coping strategies. Antecedents include symptom pattern, familiarity with events, and available information. If these are inconsistent or insufficient, uncertainty rises. Appraisal determines whether uncertainty leads to anxiety or adaptive hope. Coping strategies follow appraisal. They may involve seeking information, leaning on social support, or reframing the meaning of illness.

The structure also includes adaptation outcomes. These outcomes span emotional well-being, quality of life, and functional health. In some cases, uncertainty that is not resolved but managed constructively can improve psychological resilience.

Clinical Relevance in Practice

The model has practical traction in critical care, oncology, and chronic illness management. For example, a patient in intensive care awaiting test results may face days of unknowns. Nurses trained in Mishel’s framework are better equipped to identify which parts of uncertainty are modifiable. Explaining procedures, clarifying timelines, and engaging families reduce ambiguity. Other uncertainties, such as long-term prognosis, may not be resolvable. Here the focus shifts to coping strategies.

Research shows that uncertainty in critical care discharge is particularly intense. A recent study on patients leaving intensive care found that using Mishel’s framework guided interventions like structured education sessions and follow-up calls. These interventions reduced distress and improved adaptation to ward settings (Romero-Pastor et al., 2025).

What the Theory Helps Answer

The central question is: How does a person interpret and adapt to the unknown during illness? The model gives clinicians a way to track not only what is medically uncertain but also how the patient makes sense of it. It highlights gaps between what professionals think is clear and what patients still find ambiguous.

Appropriateness in Practice Settings

The model suits high-uncertainty environments: oncology, critical care, transplant units, or rare disease clinics. It is less directly applicable in short, well-structured treatments where prognosis and procedures are stable, like appendectomy recovery. Still, even in routine care, uncertainty about pain or recovery speed surfaces. The theory keeps clinicians alert to these concerns.

Strengths and Weaknesses

A major strength is its patient-centered orientation. It validates the lived experience of not knowing as central to care. It also provides clear intervention points: improve information clarity, strengthen support systems, and help patients appraise uncertainty adaptively.

Weakness arises from the complexity of measuring uncertainty. Tools exist, such as Mishel’s Uncertainty in Illness Scale, but they depend on patient self-report. Some patients struggle to articulate ambiguity. Another limitation is cultural variability. What counts as tolerable uncertainty in one context may feel unbearable in another. This complicates standardized interventions.

Literature and Application Evidence

Studies applying the theory confirm its value. In oncology, interventions rooted in the model reduced psychological distress by targeting informational gaps and reframing prognosis uncertainty (Bailey et al., 2022). In chronic illness, structured education improved coping outcomes when aligned with Mishel’s constructs (Kerrigan et al., 2021). In critical care discharge, the framework guided personalized communication strategies that reduced post-ICU anxiety (Romero-Pastor et al., 2025).

One theme across the literature is that uncertainty is not always negative. In some advanced cancer cases, patients treated uncertainty as space for hope when prognosis was poor. Interventions had to respect this function instead of removing it completely.

Anticipated Challenges in Practice

Nurses applying the model often confront institutional constraints. Limited time makes in-depth conversations about uncertainty difficult. Documentation systems focus on symptoms and interventions, not ambiguity. Another challenge is clinician discomfort. Many prefer giving clear answers, even if they simplify reality, rather than sitting with uncertainty alongside patients.

A further obstacle is translating theory into protocol. While the model maps uncertainty well, operational guidelines vary. Some hospitals create structured discharge education protocols based on the theory. Others rely on informal application, which is harder to evaluate.

Making the Theory More Usable

For broader adoption, two shifts are needed. First, integrate uncertainty assessments into standard nursing documentation. If a nurse can rate patient-reported uncertainty levels daily, interventions can be tracked. Second, expand training that normalizes clinician engagement with uncertainty. Teaching nurses how to communicate ambiguity without eroding trust is central.

Technological tools also have potential. Digital follow-up platforms could monitor patients after discharge, addressing unresolved questions and reducing avoidable readmissions.

Evaluation of the Theory

The model has proven effective in understanding patient experiences of ambiguity. It is used in oncology, critical care, and chronic illness, and publications continue to refine applications. The difficulty lies not in theoretical soundness but in institutional uptake. Clinicians need structured pathways to move from identifying uncertainty to delivering targeted interventions.

Despite challenges, the model remains highly relevant. Healthcare rarely eliminates uncertainty. Instead, it manages it. Mishel’s theory equips nurses with a structured way to do so without dismissing patient concerns or over-promising certainty.

References

Bailey, D. E., Landerman, L., Barroso, J., Mishel, M. H., & Belyea, M. J. (2022). Uncertainty, symptoms, and quality of life in patients with cancer. Journal of Advanced Nursing, 78(2), 453–463. https://doi.org/10.1111/jan.15026

Kerrigan, J. M., Parker, P. A., & Clayman, M. L. (2021). Patient uncertainty in chronic illness: A review of interventions based on Mishel’s theory. Patient Education and Counseling, 104(3), 491–500. https://doi.org/10.1016/j.pec.2020.09.020

Romero-Pastor, M., Ricart-Basagaña, M. T., & Icart-Isern, M. T. (2025). Uncertainty experienced by the critical patient upon discharge to the general ward: Care proposals from the perspective of Mishel’s theory. Nursing in Critical Care. https://doi.org/10.1111/nicc.13217