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Empirical Knowledge Development


In this research paper, the author examines the concept of moral distress and the middle-range theory of interpersonal relations within the nursing practice setting. The paper also discusses the moral distress concept, how it relates to the notion of hardiness, and its impact on nursing. It further explains the influence of the middle-range theory, its metaparadigm, and phenomena towards nursing. The assumptions of the concept of moral distress and hardiness in nursing are conversed on how they co-relate to improve the well-being of nurses and patients in the health industry.

Various ways of structuring concepts and their effects have been highlighted. The significance of the middle range concepts, namely moral distress and hardiness, are deliberated on in detail, and their interest in the nursing goals is emphasized. The interpersonal relations theory is structured and conceptualized in identifying the empirical knowledge development of the moral and hardiness concepts and its impact on nursing.

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The nursing theory and knowledge development came into existence in the early 1960s when the profession was evidently in need of developing its theories of knowledge in helping the nursing fraternity. During this period, the prominence of the theories was integrated into other aspects of disciplines, including sociology, medicine, and psychology that were compared with the theoretical framework. They analyzed the nursing practices that led to the development of conceptual frameworks that acted as a core foundation for developing the nursing concept, theory, and knowledge.

It took time for the nursing community to develop its theoretical concepts in the early 1980s when the nursing domain theories emerged. Scholars from the nursing frat came up with ideas for developing and implementing their theories that would see it achieve the desired principles for the improvement of nursing practices. In this era, the nursing realm concepts emerged, making the emphasis related to nursing practices shift from the borrowing ideas on analyzing the existing theories, implementing them, and developing unique models that were directly related to nursing.

These nursing theories and knowledge development that came into existence had a broad and clear perspective of the nursing discipline that was acceptable to the nursing society. The core concepts of nursing metaparadigm inclusive of nursing, persons, health, and environment were the main interest subjects in terms of the nursing practices. Those interrelationships and integration of the nursing metaparadigm had unique disciplinary perspectives towards nursing and its concepts of development (Chinn, 2011). The interpersonal relations theory in nursing and the concept of moral distress, courage, and hardiness deliver a dignifying, clear, and applied study in explaining its significance to the nursing industry.

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Concept of Moral Distress in Nursing

Nursing developed its concepts through the knowledge of conceptual models that were established after defining nursing practices, determining their crucial principles and goals as well as clarifying the scope of nursing practices. Those ideas came from concepts that were generalized, logical, and relatively unpretentious in terms of nursing. They had a testable hypothesis with a particular phenomenon relating to nursing and were correlated in other validated theories. Developing those ideas needed the same phenomenon interrelating to the same concepts of nursing and explaining their relationships to each other while they were predictive.

Moral distress towards nurses is a concept that defined the physiological, psychological, and emotional suffering experienced in the workforce. They occur inconsistently due to the nurse’s ethical values, moral commitments, and principles held by the practitioners (Smith, 2014). Moral distress focuses on institutional practices and policies that lead nurses into doing things that are morally wrong. This study emphasizes on a variety of empirical tools that identify some of the sources of moral distress and measure their impact on nurses as well as assess their effects on professionals in the health sector. Nursing ethics play a vital role in research on moral distress and the courage of nurses.

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The empirical research carried out by the nursing integrity contemplates moral distress in the health sector to include contested and evolving concepts that describe the nursing profession. As described by Jameton in the early 1980s, moral distress is a feeling of pain and psychological imbalance that affects nurses when they find themselves in contradicting situations of being unable to do the right thing to a patient. It arises when a nurse has the conscious of doing the right thing but has institutional constraints that make it difficult for them to take a course of action towards the patient. Moral distress is caused by unsuccessful institutional advocacy, growing unrealistic hope, deprived and futile health care that demoralizes the output of nurses (Masters, 2011).

Factors influencing the moral distress are levels of the peer support and staff's educational class. Nurses with a higher degree of education and experience tend to have a high level of moral distress. It affects the nurse’s health and diminishes the provision of health care to patients who often cause anger and frustration in the workplace.

How the Concept of Moral Distress Is Related to Hardness in Nursing

The concept of hardiness entails stress and coping with the strategy of nurses in their workforce. A coping mechanism, personality style, exercise habits, and support systems are some of the characteristics that influence individuals in exhibiting hardness. Moral distress is correlated with hardiness in demonstrating the nurse’s problems in the workplace. Stress is crucial in diminishing one’s performance that endangers their well-being as it is a reaction of an organism towards problems.

In achieving a nursing goal of providing better healthcare services to the society, the concept of hardiness and moral distress combines the help in coming up with long-lasting solutions that will improve the development of nurses' knowledge in the health sector. Understanding the association of moral distress and hardiness is crucial and beneficial to the nursing faculty as it imparts them with strategies of handling and caring for patients at a professional level.

The Structuring of Moral Distress

Moral distress can be managed by asking, affirming, assessing, and acting on its setbacks. In this regard, the strategies that are predominantly used include speaking up in identifying the core problems, voicing opinions, and though gathering facts that affect nurses directly and indirectly. Nurses need to be accountable and deliberate in knowing how to speak the needs of patients and their own and accepting the consequences when things turn out in an unexpected way. The nursing industry has built support networks to help in addressing the moral distress that affects its practitioners.

It also focuses on changing its work environment in ways that will increase productivity in patients. Educating nurses on the impact of moral distress is also another strategy while making interdisciplinary views open to all nurses and finding the root causes of the problem is essential. Over the years, policies and workshops have been developed to encourage the nursing fraternity through moral consultations.

The distress and hardiness concepts need to be constricted depending on their effects on health. They also need to be narrowed, since they characterize a client-family-nurse interaction to the nursing’s purpose of the health creation and wellbeing.

Interpersonal Relations Theory in Nursing

The middle range theory in nursing targets particular concepts and phenomena, like stress, health, and pain, though it is limited to the research as compared to the grand theory. It has a broader scope than the grand theory does, in particular with less abstract. In addition, it is more concrete in terms of research. This middle-range theory was developed from the research that has been acquired from the grand theory. Its concepts are directed specifically to nursing situations that have an impact on the nursing industry. Researching through the middle range theory has more positive test results in the nursing theory and knowledge development as it is more appropriate for empirical testing and development in theory.

They are a center of knowledge development in the nursing industry tested in the research through practice-oriented nursing and are narrow in scope. The middle range concept discussed in this study is the interpersonal relations between the nurse and patient and its impact on health in the nursing industry as related by Peplau (McGonigle, 2012).

Communication in interpersonal affairs is a skill to understand the patient and nurse relationship that is essential in the health sector. This middle-range theory is significant in the nursing industry as it helps us to understand the significance of the interpersonal relationship in theory and knowledge development in nursing. Communication in nursing comprises of non-rational and rational expressions of body gestures, needs, wishes, and desires of a nurse and patient. A spoken language is critical in the nursing sector where patients and nurses communicate with each other in order to enhance the delivery of health services with positive results.

An interpersonal relationship is a core process in nursing that occurs between the patient and nurse in situations of actions between the two recognizing feelings and individual thoughts (Chinn, 2011). In understanding the patient-nurse relationship, the observation is a necessary skill as it aims at verifying the interactive drama, clarifying their needs and identifying the vital responsibilities of both parties. The nurse's and patient's personalities act as a pattern to stabilize the characteristics of an individual’s life as it determines the actions taken.

In promoting the personality development, this theory assists nurses by providing them with the experience of understanding a character. Exploitation, orientation, resolution, and identification are aspects of a patient-nurse relationship with aspects, including personality, destructive and constructive behaviors, that help in psychobiological experiences for the energy anxiety. Nurses and patients learn to live together as a phase of the development and formation of a decent personality relation between them through participating with each other, delaying a personal satisfaction and counting on others in the health sector. The interaction relation role for a nurse helps them to identify strangers being a resource person and acts as a counselor in providing health services (Masters, 2011).

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Interpersonal relations were developed by Peplau and were the first modern nursing theories to be used in guiding the nursing practice and tested in the actual world. This model has been viewed as profitable to the nursing industry as it brought patients and nurses together at an interpersonal level. It is of paramount significance as it entails human contact which is an essential element in providing the nursing care to patients. Through an interpersonal relationship, nurses understand their behaviors on how to relate with patients, while helping others in identifying personal difficulties experienced in the nursing industry.

In the context of a relationship in the nursing industry, interpersonal relations assist in problem-solving that may arise between a patient and nurse. In the long run, it nurtures the growth and boosts the learning process of nurses and patients. Goal attainment requires growth and producing a relationship between both parties. Patients and nurses understanding each other contribute to positive results in situations like surgery.

Interpersonal relations are substantially remarkable because they have changed the nursing industry over the years with positive results of involving patients and nurses in the process of communication with each other. Peplau used both the inductive and deductive methods in developing the theory of interpersonal relationships in nursing. She integrated different ideas from other scholars, like Sigmund Freud, in coming up with the interpersonal concept through the deductive method. Such philosophies include the self-system development, modes of self-experience, and anxiety that drove people to relate to each other (Smith, 2014).

Some of the inductive approaches in developing the interpersonal relation theory include the naming of different phenomena that were used in developing the theory, observing people’s behavior with the available explanatory concepts, while repeating the observations in similar conditions and noting regularities in the data previously witnessed. Observations made in determining the interpersonal affairs resulted in the phenomena being clearly defined and improved during the testing on patients. Interventions during the testing determined the effects of the phenomenon on interpersonal relations between patients and nurses (Masters, 2011).

In developing the middle-range theory of interpersonal relations, the research revealed that using the nurse-patient data interaction gave out more flawless results that had a positive impact on the theory and knowledge development in nursing. Some of the metaparadigm research in developing and understanding the interpersonal relationships are nursing, persons, nurse-patient, health, and environment


An interpersonal relation is directly involved in the nursing industry as it is a therapeutic process. It brings in the human relationship, whereby a sick patient is in need of health facilities and services that require professionalism from a nurse who is competent, understanding, and with the best skills in terms of the delivery and provision of healthcare. In this theory, nursing is viewed as an interpersonal process that is therapeutic in providing the well-being of an individual. Its functionality is a process of making health possible for patients in need of health care in society. It is also a mature force and an instrument for promoting personal health care in a productive, creative, and constructive way of improving the health standards of individuals (McGonigle, 2012).


A nurse and patient are organisms in the nursing industry who correlate to achieve the goal of improving the health standards in society. Interacting with one another results in conception and desirable achievement.

Nurse and patient

Being a professional, a nurse acts as a definable expert with the ability to solve human health problems of a patient with whom they are interacting. Skills acquired in nursing identify the health problems of a patient and are meant to improve health status through integrity and commitment.

Health and Environment

It is the gradual improvement of personality in humans through the productive and constructive involvement of a patient and nurse, working together with an aim of sustaining the well-being of the community’s unstructured components related to bringing out a significant outcome to the health sector.

Description of the Theory of Interpersonal Relations

An interpersonal relationship is achieved through philosophical practicalities and assumptions. The philosophical foundation is a phenomenology, an epistemology, and deterministic factor of a consistent paradigm that emphasizes receiving the logical positivism and knowledge which value the stability in the well-being of an individual. Phenomenology acts as a fundamental element in the value-laden of health. While a nurse participates with a patient, interpretations arise which help in improving the health of an individual. The participation of a nurse and patient is communicatively encouraging, and respect determines the outcome.

The philosophical basis creates a foundation that is meaningful to the nurse's observation of a patient which makes them decide on the actions to take in meeting the patient’s needs. The patient’s personality, involving the illness, is identified through the interactive sessions of verbal and nonverbal communication channels improving in care.

Assumptions emphasize the growth and development of interpersonal relations between patients and nurses. Psychobiological experiences influence the achievement of a relationship between a patient and a nurse who is taking care of him or her (Masters, 2011). A nurse is unique in responding to patients' needs and providing the opportunity of improving a patient’s wellness with the help of the interpersonal competence technique. The core functions of personality are developed and grown in interacting with a professional nurse. Psychological experiences, like anxiety, conflict, and frustrations, are influenced by the functional temperament of individuals through the experience.

Empirical Knowledge in Interpersonal Relation of Middle-Range Theory

Empirical knowledge entails counting on others in the communication channel, delaying satisfaction in encouraging expression of feelings. Identifying oneself enhances the relationship and participating with others in decisions and problem-solving. An observation, recording, and application of the theory research are other empirical methods of understanding an interpersonal relationship. This middle-range theory of an interpersonal relationship between patients and nurses has created a modern understanding of the nursing practice that is essential for improving the health sector. It is essential to integrate this model into the science of nursing in identifying ways of improving the well-being of patients (McGonigle, 2012).

Relating Interpersonal Relationship in Nursing to Caring

The interpersonal relationship between patients and nurses is directly involved in caring for patients through nurturing the value of the well-being of individuals. The service for humanity in the health sector is altruistic care guided by the research focused on creating a caring and healing environment, which assists the community in maintaining a state of the optimal well-being of life experienced since birth. Swanson’s discussion of the caring theory relates to interpersonal relations in improving the nursing sector and enabling it to achieve its goals.

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Relating Interpersonal Relationship in Nursing to Social Support

The support of patients by nurses is vital in caring for the well-being of individuals through appraisal, emotional, formal, informal, informational, instrumental, social, and perceived support. It correlates with the interpersonal relationship addressing a structural and interactive platform in nursing to improve the health of individuals. The goal of achieving better nursing practices and saving more lives through social support protects individuals from life stressors who adopt the interpersonal relations theory. The support received through the social network brings in a feeling of belonging to patients and nurses who interact in assisting each other (Chinn, 2011).

Relating Interpersonal Relationship in Nursing to Comfort

The comfort of a patient and nurse strengthens the need for transcendence, relief, and ease of pressure. The professionalism of a nurse improves, while a patient gets the feeling of hope. The interpersonal relationship between a nurse and patient through the comfort intervention resolves to improve the nursing practice and well-being of the society. The desire for the sociocultural and psychospiritual comfort catalyzes the healing process of patients and encourages nurses to perform better in their field (Chinn, 2008). Quality health care facilities with an ethical working environment improve the interpersonal relationship between patients and nurses.


The concept of moral distress and hardiness in the nursing industry are issues of concern that have seen the health sector improve over the years. These concepts occur on a day to day setting that involve nurses acting against their better assessment due to external and internal constraints in their working station. Carrying out actions, while putting aside moral values, impends the authenticity of better results as it is inevitable at times. However, the strategies and approaches summarized above can reduce the level of hardiness and moral distress concepts to maintain the integrity of nurses and preventing the progression of occurring issues that affect them.

Secondly, the interpersonal relation theory argued above gives a clear view of the significance of improving the nursing practices as it relates to other disciplines in the cultural context. The nursing fraternity needs to commend the raising concerns, invest in leaders to be role models, and implement the organizational strategies that are ethical to the nursing network.

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