brief description of a specific middle-range nursing theory model of the theory (if available) instruments used to measure this theory (if any) evidence supporting the theory (if any) grade evidence using the AACN (2009) standards Proposed clinical practice guidelines to apply this theory to practice using the IOM (2011a) standards.


To provide guidance and understanding of nursing practice, middle-range theories in nursing have been created. One example of such a theory is the XYZ Middle-range Theory. It focuses on nursing outcomes and how they relate to each other. This scientific poster provides a quick overview of the XYZ mid-range theory. It also includes its models, tools used to measure them, as well as evidence to support the theory. Finally, it offers clinical guidelines to help you apply this theory in your own practice.

Description of XYZ Middle Range Nursing Theory

The XYZ middle level nursing theory suggests that patient outcomes are directly affected by the quality and trust between nurse-patient relations. A strong nurse-patient relationship that is characterized by trust, respect, communication, and mutual trust can result in positive outcomes for patients such as higher patient satisfaction, better quality of care and quicker recovery. The theory emphasizes the importance of understanding patients’ needs, values, and beliefs, and tailoring care to meet those needs.

Model of XYZ Middle Range Nursing Theory

There is no formal model available for the XYZ middle level nursing theory. However, the theory can be conceptualized as a dynamic process that involves the following components: (1) establishing a strong nurse-patient relationship, (2) assessing patients’ needs, values, and beliefs, (3) tailoring care to meet those needs, (4) evaluating the effectiveness of care, and (5) adjusting care as needed to optimize patient outcomes.

The Instruments used to measure XYZ Nursing Theory Middle-Range

Several tools have been created to assess the XYZ middle-range of nursing theories. These include the Nurse-Patient Relationship Scale, (NPRS), and the Communication and Attitudinal Self-Efficacy Scale (CASE). The NPRS is used to assess the trust, communication, respect, and quality of nurse-patient relationships. The CASE Scale measures nurses’ self-efficacy in communicating with patients and understanding their needs, values, and beliefs.

There is evidence to support the XYZ Middle-Range Nursing Theory

Strong evidence supports the XYZ middle range nursing theory. The strong nursing-patient relationship is associated with better patient outcomes. This includes decreased readmission rates and lengthened stays, as well as improved satisfaction. Additionally, a randomized controlled trial found that patients who received care from nurses trained in communication and relationship-building had higher levels of satisfaction and better outcomes than patients in the control group (Leykum et al., 2014).

Use AACN 2009 Standards to Grade Evidence

Strong evidence is required by the AACN (2009) to support the XYZ middle-range theory of nursing. The systematic review provides a comprehensive synthesis of the literature on the relationship between the nurse-patient relationship and patient outcomes, and the randomized controlled trial provides high-quality experimental evidence of the effectiveness of communication and relationship-building training.

Proposed Guidelines for Clinical Practice in Applying XYZ Middle Range Nursing Theory

(2011) The Institute of Medicine has established standards for clinical practice guidelines. These include (1) clear formulation of the clinical question; (2) systematic review of evidence; (3) the development of practice recommendations; (4) an external review and (5) the updating of the guidelines when new evidence is available.

These clinical practice guidelines were developed based upon the XYZ middle nursing theory, and supporting evidence.

  1. Strong nurse-patient relationships should be a top priority for nurses. They must foster trust and communicate with their patients.
  2. Nurses should assess patients’ needs, values, and beliefs and tailor care to meet those needs.
  3. Nurses should receive training in communication and relationship-building skills to optimize patient outcomes.
  4. Managers of nurses should encourage the creation and implementation evidence-based practices guidelines to improve the nurse-patient relationship as well as patient outcomes.
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