Application of a Middle-Range Theory to the Practice Problem

Subject: Other Medical Specialties
Pages: 5
Words: 1387
Reading time:
6 min
Study level: PhD


Many issues in nursing are patient-centered. To help patients cope with various adverse conditions nursing theorists developed a plethora of theories for nursing specialists to use and deliver the best quality of care. Nonetheless, nurses can also experience a variety of problems themselves. These issues also need an application of the theoretical framework in order to develop a deeper understanding of a complication and address it. As such, Clinical Nurse Specialists (CNSs) may face difficulty with defining their role in a hospital setting having a variety of skills and competencies. In order to alleviate the problem, one could apply Pamela Reed’s theory of Self-Transcendence. This article will, therefore, focus on describing the theory, its origins, applications, and ways of application to the abovementioned practical problem.

Description of the Theory

Reed’s theory of Self-Transcendence is based on several key principles. One of them is that humans and the environment are interrelated concepts. The other is that the awareness of humans of their environment can be gained by altering their consciousness through communication with God, other humans, and being close to nature (Reed, 2014). Such a multi-dimensionality of human beings separates them from the environment and, at the same time, creates a bond between the two. From the practical side, these principles enable a person to know oneself through meaningful activities, friends, colleagues, faith, etc. All these interactions broaden one’s mind and develop his or her understanding of health, life, and well-being. Through meaningful engagements with the outer world, a human can achieve mental, spiritual, and physical wholeness (Reed, 2014). One of the major assumptions of the theory was that the process of learning, health education, and general knowledge-building in nurses helps to promote positive health and wellbeing attitudes in patients.

Origins of the Theory

In the course of her life, Pamela Reed has been paying great attention to the spiritual aspect of life. As she evolved as a professional nursing theorist achieving bachelor’s and master’s degrees, and Ph.D., she applied the concept of spirituality to nursing health, well-being, end-of-life care, and other spheres of her research interest. According to Reed (2014), her theory is based on previous research of human development concepts, understanding of life through aging, an extension of life, and dying. Through such concepts, Reed imagined self-transcendence as a continuous path to building knowledge and developing an understanding of health and life.

In addition to that, the origins of Reed’s Self-Transcendence theory seem to be found in early theoretical concepts of Martha E. Rogers (Lerner, Theokas, & Bobek, 2005). The principles of Rogers’ understanding of development revolved around viewing it as a part of a human’s basic cognitive function that is influenced by external factors. Development, according to Rogers (Lerner et al., 2005) is fostered by the lack of alignment between the environment and humans. Reed’s own clinical practice also become one of the underlying motives in her theory. Her care practice and frequent communication with terminally ill and older adults made her reassess the process, and purpose of building knowledge.

Previous Application of the Theory

One of the early applications of the theory was grounded mainly in gerontology. Reed’s theory presupposes the developmental nature of senior people, which needs to be maintained through continuous stimulation of their cognitive process in order to maintain good health and wellbeing in such patients. Given these considerations, Reed applied her theory to measuring depression in older adults. For the purposes of such research, Reed devised a Developmental Resources of Later Adulthood (DRLA) scale consisting of 36 items. Higher DRLA scores usually indicated a low level of depression (McCarthy, Ling, & Carini, 2013). The scale helped address the developmental needs of senior patients and alleviate the symptoms of their depression through caring for their spiritual and other needs.

In further studies, the DRLA scale underwent more changes and emerged as a 15-item Self-Transcendence Scale (STS) (McCarthy et al., 2013). It was based on the transcendence factor or the summary of developmental needs, desires, and capacity that emerged from the previous research. It was also used to measure generativity, temporal and environmental integration, life enjoyment, adjustment, and learning patterns. As a result of all of those older adult studies, Reed found a strong correlation between self-transcendence, mental health, and wellbeing. She then applied these findings to advocate for the clinical and home use of various activities such as meditation, art, and reading as interventions to relieve patients with a lack of self-transcendence of their environment-related vulnerabilities and strengthen their mental health.

The theory was also applied to help introduce activities aimed at self-reflection, the inspiration of hope, and faith. These pursuits were implemented in hospitals and care homes in the form of group psychotherapies and support groups. The theory is also used to treat alcoholism through an environment designed by nurses in conjunction with recovery steps also facilitated by caregivers (Pagano, White, Kelly, Stout, & Tonigan, 2013).

Practical Problem

The practical problem to which the chosen middle-range theory will be applied is the vagueness of the role of Clinical Nurse Specialists. The problem stems from the fact that such nursing specialists being highly educated, skilled and competent usually practice in a single area (McClelland, McCoy, & Burson, 2013). This situation does not let CNSs develop and implement their multifaceted potential. In addition to that, colleagues, friends, and other people are often incapable of appreciating and comprehending the diversity of skills and abilities available to these nursing professionals. Confusion among colleagues, lack of understanding from family, friends, and clinical management, lack of education on the role, and other factors influence the understanding of the latter in CNSs (Foster & Flanders, 2014). Furthermore, it undermines their potential to deliver the best services to patients and apply the whole range of their skills to practice.

Application of the Theory to the Current Practice Problem

Reed’s Self-Transcendence theory can be applied to the problem of CNSs role vagueness and help conquer it. Due to the inability of certain specialists to discover their true potential as professional and skilled nurses, there may arise an issue of work engagement. According to Palmer, Quinn Griffin, Reed, & Fitzpatrick (2010), self-transcendence has a strong positive correlation with work engagement. Self-transcendence dictates that one can find meaning and explanation of any concept in collaboration with multiple facets of reality. Therefore, it could be possible to assume that CNSs can increase their understanding of their role through meaningful activities shared with colleagues, patients, nursing management, friends, God, etc. Consequently, by applying this theory, CNSs could resolve their issues with productivity and role acknowledgment using their talents to their fullest potential.

Through using STS as a tool for identifying issues with self-transcendence and underlying role vagueness. However, certain modifications to the items may be required. To alleviate the issue nursing managers or CNSs themselves can organize roundtables where the roles of the latter can be discussed. Through collaboration with colleagues, individuals could better understand the peculiarities and principles of role-management and identification. Such an integrative education will help cope with possible work satisfaction issues, related minor mental health problems, and other adverse effects of role vagueness. Faith can add another facet to the understanding of one’s role. It may be considered unnecessary or irrelevant in a clinical setting and among the nursing community, but the relief and alternative view it provides may help certain people find tranquility in their occupation.

Self-transcendence may also work as a paradigm for further knowledge building. The disarray of humans and the environment here can be perceived as a mismatch in personal role understanding in a CNS and such understanding in everyone else. Gaps in education that may be the underlying reason for role vagueness can be addressed through Reed’s theory and the above-mentioned pathways of communication with the environment.


All things considered, Reed’s Self-Transcendence theory is a powerful tool that can provide an insight into one’s relationship with the outside world. In application to the nursing issue at hand, it can become the paradigm of knowledge development that will help CNSs to bridge their educational gap. In addition to that, it could address their productivity problem through collaboration with colleagues and management in an aspiration to acquire role clarity. The practical implementation of the theory in the form of STS scale could also help identify role issues, provided enhancements are made to the tool.


Foster, J., & Flanders, S. (2014). Challenges in CNS practice and education. OJIN: The Online Journal of Issues in Nursing, 19(2). Web.

McCarthy, V.L., Ling, J., & Carini, R.M. (2013). The role of self-transcendence: A missing variable in the pursuit of successful aging? Research in Gerontological Nursing, 6(3), 178-186.

McClelland, M., McCoy, M. A., & Burson, R. (2013). Clinical nurse specialists: Then, now, and the future of the profession. Clinical Nurse Specialist, 27(2), 96-102.

Pagano, M. E., White, W. L., Kelly, J. F., Stout, R. L., & Tonigan, J. S. (2013). The 10-year course of Alcoholics Anonymous participation and long-term outcomes: A follow-up study of outpatient subjects in Project MATCH. Substance Abuse, 34(1), 51-59.

Reed, P.G. (2014). Theory of self-transcendence. (3rd ed.). New York, NY: Springer Publishing Company.

Palmer, B., Quinn Griffin, M. T., Reed, P., & Fitzpatrick, J. J. (2010). Self-transcendence and work engagement in acute care staff registered nurses. Critical Care Nursing Quarterly, 33(2), 138–147.