Middle Range Theory for the Nursing Diagnosis of Excessive Caregiving Burden

Abstract

Purpose

To describe a Middle Range Theory (MRT) capable of conceptualizing and clarifying Excessive Caregiving Burden (ECB), based on Betty Neuman's Systems Model theory, supporting the validation of the phenomenon as a nursing diagnosis present in the NANDA-I classification.

Data Sources

The MRT was developed based on the theoretical-causal validity method by Lopes & Silva, following steps: (1) definition of the approach for constructing the MRT, (2) definition of the main concepts, (3) development of the pictorial diagram, (4) construction of propositions and (5) establishment of causal rela tionships and evidence for practice. The construction of a predictive theory was anchored in Betty Neuman's Systems Model and facilitated by integrative and systematic literature reviews on clinical indicators, etiological factors, and risk conditions.

Data Synthesis

The theory identifies 26 clinical indicators, 23 related factors, seven populations at risk, and five associated conditions for Excessive Caregiving Burden. The pictogram represents the dynamic interaction of concepts around intrapersonal, interpersonal, and extrapersonal stressors and the caregiver's lines of defense, illustrating the underlying causal mechanisms of ECB. Sixteen theoretical propositions were established, relating related factors and observable clinical manifestations.

Conclusions

The predictive MRT for Excessive Caregiving Burden advances nursing knowledge by defining the causal mechanisms around caregivers, which are affected by stressors influencing the manifestation of this undesired human response, supporting the diagnostic structure of Excessive Caregiving Burden and proposing its refinement as a nursing diagnosis in NANDA-I.

Implications for Nursing Practice

The results will provide nurses with a conceptual and practical tool to identify the manifestation of Excessive Caregiving Burden in caregivers, recognize clinical indicators or etiological factors, and implement preventive and therapeutic interventions. It strengthens the scientific basis of nursing practice, improves caregivers’ health outcomes, and contributes to advancing standardized nursing language through the refinement of this diagnosis present in NANDA-I.