When you critically evaluate a study, you must decide whether you agree or disagree with the researcher’s theoretical framework (the underlying assumption or theory that supported the formation of the hypothesis and the development of the research design). The following scenarios have two possible hypotheses, each driven by a different theory.
Choose one scenario and one hypothesis from that scenario. Identify your personal assumptions about this hypothesis and choose a nursing theory to support your assumptions. You may use information from (Links to an external site.) to help you. Defend your answer.
Scenario 1: A patient with chronic back pain requests a narcotic prescription.
1. Hypothesis: In patients with chronic back pain not caused by injury, what is the effect of eight weeks of physical therapy compared to oral narcotic medication on the patients’ perception of pain?
2. Hypothesis: Are patients with chronic back pain who are denied narcotic pain medications at increased risk of depression as compared to patients on a prescribed pain regimen using oral narcotics?
Scenario 2: A diabetic patient misses several follow-up appointments.
1. Hypothesis: In patients with type 2 diabetes, does the use of an educational diabetic phone app improve compliance with appointments, diet, and medication regimens?
2. Hypothesis: Do patients with type 2 diabetes with a low economic status miss more follow-up appointments than patients with type 2 diabetes with a high economic status?


Response 1: (chislon)

Scenario 1: A patient with chronic back pain requests a narcotic prescription.
1. Hypothesis: In patients with chronic back pain not caused by injury, what is the effect of eight weeks of physical therapy compared to oral narcotic medication on the patients’ perception of pain?

Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated (U.S. Department of Health and Human Services, n.d.). Since a patient’s report of pain is objective, it is sometimes hard to determine if that patient is in pain. These symptoms may help you to identify if a patient is in pain: Diaphoresis, hypertension, pupil dilation, tachycardia, and tachypnea.
When a patient is in pain, they will want that pain to be relieved very quickly. Therefore, most will rather take oral narcotic medications than do 8 weeks of physical therapy. Physical therapy results may improve the cause of the symptoms but will aggravate the pain before making it better while oral narcotics will immediately control the pain but will not address the root cause of the problem. The main purpose of pain management should be to relieve the pain, resolve the root cause, and improve the patient’s functionality. Kolcaba’s Theory of comfort puts comfort as an immediate desirable outcome of nursing care. According to Kolcaba, comfort is the product of holistic nursing art (Petiprin, 2019).
In regard to the hypothesis and concurring with Kolcaba’s theory of comfort, I will lean towards a combination of both oral narcotic medication and physical therapy. In all cases, the patient desires will need to be discussed. Since the pain is a chronic issue and narcotic medication can do more harm in the long run, the patient may choose to conform to an eight weeks physical therapy plan. I also suffer from chronic lower back pain and have been through several physical therapy plans but sometimes I need some sort of analgesics for breakthrough pain. It is important to discuss all the options available to the patient and to give them autonomy in their healthcare decisions. They will also need to be educated on the risks and benefits of each choice. More adverse effects are seen using oral narcotics while physical therapy yields lower risks. For a patient to receive immediate pain relief, oral narcotics are optimum, but they must consider the long-term effects. Metabolization and excretion of these medications may cause injury to the liver, kidney, and other organs.

Response 2 (ann)

Scenario 2- Hypothesis 2: Do patients with type 2 diabetes with a low economic status miss more follow-up appointments than patients with type 2 diabetes with high economic status?
My personal assumptions about this hypothesis is that those with lower economic status may miss more follow up appointments due to the fact that they are not able to afford there appointments or even their medications. This may lead to embarrassment and not wanting to follow up with the doctor as they have not been following the plan of care that was given to them. According to Orem’s self care theory nurses must allow patients to care for themselves as much as possible. Patients beliefs about medical care are often driven by what they learn in their environment. If you grow up in a higher economic family that always goes to their checkups and doctor appointments you are likely to continue on that path. If you grow up in a poor family that doesn’t go to the doctor unless you have to, they you are also likely to continue this pattern.
According to Orem’s theory, “which is the practice of activities that an individual initiates and performs on his or her own behalf to maintain life, health, and well-being; self-care agency, which is a human ability that is “the ability for engaging in self-care,” conditioned by age, developmental state, life experience, socio-cultural orientation, health, and available resources; therapeutic self-care demand”. (2020, July 19) As you can see social-cultural orientation and available resources affects ones ability to care for oneself. If one lacks resources such as money they may not take care of such things as follow up appointments.

Orem’s self-care deficit nursing theory. Nursing Theory. (2020, July 19). Retrieved November 9, 2021, from

Additional Question to respond to

Theoretical frameworks helps to connect the researcher to existing knowledge regarding a given topic. Reflecting on your role as a professional nurse and change processes that you have participated in, What effect does a theoretical framework have on research? How does it influence the outcome of research studies?






Reply 1 :(Chislon)

I agree with you that a thorough evaluation of a patient who reports chronic pain is essential to determine if the patient’s pain is caused by Physiological processes or mental processes. On the other hand, the consideration of patient autonomy is a vital factor for making a decision on whether to administer oral narcotic medication or physical therapy to a patient. According to Lajam et al. (2019), a patient can therefore only exercise effective autonomy if they are well informed and educated on a given subject. Effective patient education on various issues related to physical therapy or administration of oral narcotics would therefore be needed before administering any of the interventions to relieve pain in the patient who reports chronic back pain. For instance, the patient would need to be educated that physical therapy will not be an instant relief for their chronic back pain but might be the more sustainable approach to relieve pain due to the absence of any severe side effects. On the other hand, the patient would need to be educated that oral narcotic prescriptions can bring the fastest relief of pain but may increase the chances of severe side effects, including addiction. A consideration of the past history of the patient, including any reported abuse of pain medication such as opioids, can also be a significant factor in determining whether to administer oral narcotic medication to the patient or recommend physical therapy. It will therefore be unethical and unprofessional for a healthcare practitioner to recommend narcotic medication that might be addictive to a patient with a history of opioid pain medication addiction (Lajam et al., 2019


Lajam, C. M., Cenname, J., Hutzler, L. H., & Bosco, J. A. (2019). Ethics of Opioid Prescriber Regulations. Journal of Bone and Joint Surgery, 101(23), e128.



Reply 2 (Ann)

I agree with you that type 2 diabetes patients who belong to a lower socioeconomic status may miss more follow-up appointments compared to those of higher economic status.  I also agree with you that the social-economic status of patients plays a significant role in determining whether they keep their appointment or not. Patients of low economic status may not have sufficient health insurance coverage and may struggle to settle the payment related to appointments (Suwannaphant, 2017). Such patients may therefore not be motivated to honor all their appointments. In many instances, type 2 diabetes patients belonging to low economic status might also have lower educational levels compared to those of high economic status. As a result of having lower educational levels type 2 diabetes patients of low economic status might therefore possess low health literacy. Having low health literacy might therefore make type 2 diabetes patients of low socioeconomic status not understand the importance of follow-up appointments in the management of their condition (Suwannaphant, 2017).


Suwannaphant, K. (2017). Association between Socioeconomic Status and Diabetes Mellitus: The National Socioeconomics Survey, 2010 and 2012. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. Published.



Additional Question

Theoretical frameworks help organize research studies and also to organize data and results of research studies. For instance, a researcher will rely on a theoretical framework to develop a conceptual framework and to come up with a hypothesis. A researcher will also rely on a theoretical framework to organize past knowledge related to a particular topic and to determine the research gaps that would require further research to fill. Theoretical framework can also be utilized to analyze the results of a study and to make sense of abstract data. The theoretical framework, therefore, ensures that the outcomes of research studies are significant by filling specific research gaps (Collins & Stockton, 2018).


Collins, C. S., & Stockton, C. M. (2018). The Central Role of Theory in Qualitative Research. International Journal of Qualitative Methods, 17(1), 160940691879747.

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