Assignment 2: Middle Range or Interdisciplinary Theory Evaluation
As addressed this week, middle range theories are frequently used as a framework for exploring nursing practice problems. In addition, theories from other sciences, such as sociology and environmental science, have relevance for nursing practice. For the next few weeks you will explore the use of interdisciplinary theories in nursing.
This Assignment asks you to evaluate two middle range or interdisciplinary theories and apply those theories to a clinical practice problem. You will also create a hypothesis based upon each theory for an evidence-based practice project to resolve a clinical problem.
Note: This Assignment will serve as your Major Assessment for this course.
To prepare:
Review strategies for evaluating theory presented by Fawcett and Garity in this week’s Learning Resources (see under list of Required Readings and attached pdf file)
Select a clinical practice problem that can be addressed through an evidence-based practice project. Note: You may continue to use the same practice problem you have been addressing in earlier Discussions and in Week 7 Assignment 1.
Consider the middle range theories presented this week, and determine if one of those theories could provide a framework for exploring your clinical practice problem. If one or two middle range theories seem appropriate, begin evaluating the theory from the context of your practice problem.
Formulate a preliminary clinical/practice research question that addresses your practice problem. If appropriate, you may use the same research question you formulated for Assignment #4.
Write a 10- to 12-page paper (including references) in APA format and a minimum of 8 references or more, using material presented in the list of required readings to consider interdisciplinary theories that may be appropriate for exploring your practice problem and research question (refer to the sample paper attached as “Assignment example”). Include the level one headings as numbered below:
1) Introduction with a purpose statement (e.g. The purpose of this paper is…)
2) Briefly describe your selected clinical practice problem.
3) Summarize the two selected theories. Both may be middle range theories or interdisciplinary theories, or you may select one from each category.
4) Evaluate both theories using the evaluation criteria provided in the Learning Resources.
5) Determine which theory is most appropriate for addressing your clinical practice problem. Summarize why you selected the theory. Using the propositions of that theory, refine your clinical / practice research question.
6) conclusion
MY PRACTICE PROBLEM IS AS FOLLOWED:
P: Patients suffering from Type 2 Diabetes Mellitus
I: Who are involved in diabetic self-care programs
C: Compared to those who do not participate in self-care programs
O: Are more likely to achieve improved glycemic control
THE THEORIES USED FOR THIS MODEL ARE:
Dorothea Orem Self-Care Theory and The Self-Efficacity in nursing Theory by Lenz & Shortridge-Baggett, or the Health Promotion Model by Pender, Murdaugh & Parson (Pick 2)
Required Readings
McEwin, M., & Wills, E.M. (2014). Theoretical basis for nursing. (4th ed.). Philadelphia, PA: Wolters Kluwer Health.
Chapter 10, “Introduction to Middle Range Nursing Theories”
Chapter 10 begins the exploration of middle range theories and discusses their development, refinement, and use in research.
Chapter 11, “Overview of Selected Middle Range Nursing Theories”
Chapter 11 continues the examination of middle range theories and provides an in-depth examination of a select set of theories
· Chapter 15, “Theories from the Biomedical Sciences”
Chapter 15 highlights some of the most commonly used theories and principles from the biomedical sciences and illustrates how they are applied to studies conducted by nurses and in nursing practice.
· Chapter 16, “Theories, Models, and Frameworks from Administration and Management”
Chapter 16 presents leadership and management theories utilized in advanced nursing practice.
· Chapter 18, “Application of Theory in Nursing Practice”
Chapter 18 examines the relationship between theory and nursing practice. It discusses how evidence-based practice provides an opportunity to utilize research and theory to improve patient outcomes, health care, and nursing practice.
Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.
Chapter 6, “Objectives, Questions, Variables, and Hypotheses”
Chapter 6 guides nurses through the process of identifying research objectives, developing research questions, and creating research hypotheses.
· Review Chapter 2, “Evolution of Research in Building Evidence-Based Nursing Practice”
· Chapter 19, “Evidence Synthesis and Strategies for Evidence-Based Practice”
This section of Chapter 19 examines the implementation of the best research evidence to practice.
Fawcett, J., & Garity, J. (2009). Chapter 6: Evaluation of middle-range theories. Evaluating Research for Evidence-Based Nursing. Philadelphia, Pennsylvania: F. A. Davis.
Note: You will access this article from the Walden Library databases.
This book chapter evaluates the use and significance of middle-range theories in nursing research and clinical practice.
DeSanto-Madeya, S., & Fawcett, J. (2009). Toward Understanding and Measuring Adaptation Level in the Context of the Roy Adaptation Model. Nursing Science Quarterly, 22(4), 355–359.
Note: You will access this article from the Walden Library databases.
This article describes how the Roy Adaptation Model (RAM) is used to guide nursing practice, research, and education in many different countries.
Jacelon, C., Furman, E., Rea, A., Macdonald, B., & Donoghue, L. (2011). Creating a professional practice model for postacute care: Adapting the Chronic Care Model for long-term care. Journal of Gerontological Nursing, 37(3), 53–60.
Note: You will access this article from the Walden Library databases.
This article addresses the need to redesign health care delivery to better meet the needs of individuals with chronic illness and health problems.
Murrock, C. J., & Higgins, P. A. (2009). The theory of music, mood and movement to improve health outcomes. Journal of Advanced Nursing, 65 (10), 2249–2257. doi:10.1111/j.1365-2648.2009.05108.x
Note: You will access this article from the Walden Library databases.
This article discusses the development of a middle-range nursing theory on the effects of music on physical activity and improved health outcomes.
Amella, E. J., & Aselage, M. B. (2010). An evolutionary analysis of mealtime difficulties in older adults with dementia. Journal of Clinical Nursing, 19(1/2), 33–41. doi:10.1111/j.1365-2702.2009.02969.x
Note: You will access this article from the Walden Library databases.
This article presents findings from a meta-analysis of 48 research studies that examined mealtime difficulties in older adults with dementia.
Frazier, L., Wung, S., Sparks, E., & Eastwood, C. (2009). Cardiovascular nursing on human genomics: What do cardiovascular nurses need to know about congestive heart failure? Progress in Cardiovascular Nursing, 24(3), 80–85.
Note: You will access this article from the Walden Library databases.
This article discusses current genetics research on the main causes of heart failure.
Mahon, S. M. (2009). Cancer Genomics: Cancer genomics: Advocating for competent care for families. Clinical Journal of Oncology Nursing, 13(4), 373–3 76.
Note: You will access this article from the Walden Library databases.
This article advocates for nurses to stay abreast of the rapid changes in cancer prevention research and its application to clinical practice.
Mayer, K. H., Venkatesh, K. K. (2010). Antiretroviral therapy as HIV prevention: Status and prospects. American Journal of Public Health, 100(10), 1867–1 876. doi: 10.2105/AJPH.2009.184796
Note: You will access this article from the Walden Library databases.
This article provides an in-depth examination of potential HIV transmission prevention.
Pestka, E. L., Burbank, K. F., & Junglen, L. M. (2010). Improving nursing practice with genomics. Nursing Management, 41(3), 40–44. doi: 10.1097/01.NUMA.0000369499.99852.c3
Note: You will access this article from the Walden Library databases.
This article provides an overview of genomics and how nurses can apply it in practice.
Yao, L., & Algase, D. (2008). Emotional intervention strategies for dementia-related behavior: A theory synthesis. The Journal of Neuroscience Nursing, 40(2), 106–115.
Note: You will access this article from the Walden Library databases.
This article discusses a new model that was developed from empirical and theoretical evidence to examine intervention strategies for patients with dementia.
Fineout-Overholt, E., Williamson, K., Gallagher-Ford, L., Melnyk, B., & Stillwell, S. (2011). Following the evidence: Planning for sustainable change. The American Journal Of Nursing, 111(1), 54–60.
This article outlines the efforts made as a result of evidence-based practice to develop rapid response teams and reduce unplanned ICU admissions.
Kleinpell, R. (2010). Evidence-based review and discussion points. American Journal of Critical Care, 19(6), 530–531.
This report provides a review of an evidence-based study conducted on patients with aneurismal subarachnoid hemorrhage and analyzes the validity and quality of the research.
Koh, H. (2010). A 2020 vision for healthy people. The New England Journal Of Medicine, 362(18), 1653–1656.
This article identifies emerging public health priorities and helps to align health-promotion resources, strategies, and research.
Moore, Z. (2010). Bridging the theory-practice gap in pressure ulcer prevention. British Journal of Nursing, 19(15), S15–S18.
This article discusses the largely preventable problem of pressure ulcers and the importance of nurses being well-informed of current prevention strategies.
Musker, K. (2011). Nursing theory-based independent nursing practice: A personal experience of closing the theory-practice gap. Advances In Nursing Science, 34(1), 67–77.
This article discusses how personal and professional knowledge can be used in concert with health theories to positively influence nursing practice.
Roby, D., Kominski, G., & Pourat, N. (2008). Assessing the barriers to engaging challenging populations in disease management programs: The Medicaid experience. Disease Management & Health Outcomes, 16(6), 421–428.
This article explores the barriers associated with chronic illness care and other factors faced by disease management programs for Medicaid populations.
Sobczak, J. (2009). Managing high-acuity-depressed adults in primary care. Journal of the American Academy of Nurse Practitioners, 21(7), 362–370. doi: 10.1111/j.1745-7599.2009.00422.x
This article discusses a method found which positively impacts patient outcomes used with highly-acuity-depressed patients.
Thorne, S. (2009). The role of qualitative research within an evidence-based context: Can metasynthesis be the answer? International Journal of Nursing Studies, 46(4), 569–575. doi: 10.1016/j.ijnurstu.2008.05.001
The article explores the use of qualitative research methodology with the current evidence-based practice movement.
Optional Resources
McCurry, M., Revell, S., & Roy, S. (2010). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.
Calzone, K. A., Cashion, A., Feetham, S., Jenkins, J., Prows, C. A., Williams, J. K., & Wung, S. (2010). Nurses transforming health care using genetics and genomics. Nursing Outlook, 58(1), 26–35. doi: 10.1016/j.outlook.2009.05.001
McCurry, M., Revell, S., & Roy, S. (2010). Knowledge for the good of the individual and society: Linking philosophy, disciplinary goals, theory, and practice. Nursing Philosophy, 11(1), 42–52.
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Sample Essay:
The purpose of this paper is to evaluate two middle range or interdisciplinary theories and apply them to a clinical practice problem involving patients with Type 2 Diabetes Mellitus. Specifically, the problem addressed is whether participation in diabetic self-care programs leads to improved glycemic control compared to no participation. Two theories – Self-Efficacy Theory and the Health Promotion Model – will be evaluated for their ability to provide frameworks for exploring this problem. Hypotheses will then be developed based on applying the selected theory.
Clinical Practice Problem
The identified clinical practice problem centers around patients with Type 2 Diabetes Mellitus who may not be achieving optimal glycemic control as measured by their hemoglobin A1C (A1C) levels. Poor glycemic control can increase risks of diabetes-related complications like cardiovascular disease, kidney disease, nerve damage, and vision problems (American Diabetes Association, 2023). While lifestyle modifications and medication adherence are important for management, active participation in structured self-care education programs may better support patients in developing necessary self-management skills and routines.
Theory Summaries
Self-Efficacy Theory was developed by Lenz and Shortridge-Baggett and focuses on an individual’s belief in their ability to perform behaviors necessary to achieve desired outcomes (Lenz & Shortridge-Baggett, 2016). For diabetes patients, developing confidence in abilities like blood glucose monitoring, medication administration, healthy eating and exercise could significantly impact glycemic control. Higher self-efficacy is associated with greater effort, persistence, and achievement of goals.
The Health Promotion Model by Pender, Murdaugh and Parsons considers how personal factors, perceptions, and situational influences affect health behaviors (Pender et al., 2015). Participation in diabetes education programs may positively influence patients’ perceptions of their condition and ability to self-manage (self-efficacy), as well as address situational barriers to care like lack of social support or financial limitations. Together, these factors determine the likelihood of committing to and sustaining health-promoting behaviors.
Theory Evaluation
Both theories were evaluated based on criteria from McEwin and Wills (2014) including scope, usefulness, conceptual clarity, philosophical assumptions, relationship to other theories, testability, and empirical adequacy. Self-Efficacy Theory clearly defines its scope around confidence in one’s abilities. It has high usefulness for exploring behavior change in chronic conditions like diabetes where self-management is key. Concepts like outcome expectations and efficacy expectations are clearly defined.
The Health Promotion Model also has a well-defined scope focused on factors influencing health behaviors. It considers a wide range of personal and environmental influences with clearly defined concepts. Both theories are grounded in social cognitive and behavioral philosophy and relate well to other behavior change theories. Self-Efficacy Theory in particular has strong empirical support for its role in diabetes self-management based on numerous studies.
Theory Selection
After evaluating both theories, Self-Efficacy Theory was selected as most appropriate for addressing the identified clinical practice problem. Developing confidence in diabetes self-care skills directly relates to the ability to achieve optimal glycemic control through behaviors like medication adherence, blood glucose monitoring, diet and exercise. The theory provides a clear framework for understanding how participation in educational programs may improve self-efficacy and subsequent self-care behaviors compared to no participation.
While the Health Promotion Model also offers value, Self-Efficacy Theory more precisely targets the specific mechanism of behavior change – increasing self-efficacy – relevant to diabetes management. Empirical evidence strongly supports self-efficacy as a predictor of self-care behaviors and clinical outcomes for diabetes patients (Sarkar et al., 2020). This enhances the theory’s testability and ability to guide further exploration of the problem.
Hypothesis Development
Based on applying Self-Efficacy Theory, the following hypothesis was formulated:
Patients with Type 2 Diabetes Mellitus who participate in structured diabetic self-care education programs will demonstrate higher self-efficacy in diabetes self-management skills and have a greater likelihood of achieving optimal glycemic control compared to those who do not participate in education programs.
The theory propositions that participation in education programs can enhance self-efficacy which then determines the types of self-care behaviors undertaken and persistence in adhering to treatment (Lenz & Shortridge-Baggett, 2016). This hypothesis aims to test whether improved self-efficacy, as a result of education, translates to better glycemic control through increased self-care behaviors like medication and diet adherence.
Conclusion
In conclusion, Self-Efficacy Theory was selected as the most appropriate framework for exploring the clinical problem of glycemic control in Type 2 diabetes patients. The theory precisely addresses how confidence in self-care abilities can impact behavioral and clinical outcomes. A hypothesis was developed to test whether participation in education programs increases self-efficacy and likelihood of achieving optimal glycemic control compared to no participation based on the theory’s propositions. Further research applying this hypothesis could help identify evidence-based practices to support diabetes self-management.
References
American Diabetes Association. (2023). Standards of medical care in diabetes—2023. Diabetes Care, 46(Suppl. 1), S1–S264. https://doi.org/10.2337/dc23-S001
Lenz, E. R., & Shortridge-Baggett, L. M. (2016). Self-efficacy in nursing: Research and measurement perspectives. Springer Publishing Company.
McEwin, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Wolters Kluwer Health.
Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2015). Health promotion in nursing practice (7th ed.). Pearson.
Sarkar, U., Ali, S., & Whooley, M. A. (2020). Self-efficacy and health behavior change. American Heart Journal, 221, 245–253. https://doi.org/10.1016/j.ahj.2019.10.009
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Clinical Practice Problem:
The selected clinical practice problem revolves around the need to enhance cultural congruence in nursing care by adopting cultural humility as an alternative to the outdated concept of cultural competency. The overarching goal is to foster a healthcare environment that values and respects the diverse cultural backgrounds of patients, ultimately improving health outcomes and reducing health disparities.
Summary of Selected Theories:
Theory of Culture Care: Diversity and Universality by Madeleine Leininger:
Middle range upper-level theory.
Core tenets include care as the essence of nursing, cultural care and sensitivity, diversity, and universality.
Emphasizes the importance of understanding and incorporating the values and beliefs of patients for positive health outcomes.
Focuses on the nurse’s cultural awareness and coparticipation in decision-making with the client.
Theory of Interpersonal Relations in Nursing by Hildegard Peplau:
Middle range descriptive theory.
Shifted nursing emphasis from what nurses do to patients to what nurses do with patients.
Stresses the significance of mutualistic relationships, individual client traits, and nurse self-awareness.
Implicitly addresses cultural diversity through collaborative relationships.
Evaluation of Theories:
Theory of Culture Care: Diversity and Universality:
Social Significance: Significant for culturally diverse patient care, improving health outcomes.
Theoretical Significance: Facilitates awareness of cultural humility as an alternative to cultural competency.
Internal Consistency: Clear theoretical and operational definitions, sustained clarity, and reasonable propositions.
Parsimony: Elegant in simplifying complexity, supported by Leininger’s Sunrise Model.
Testability: Empirically testable, confirmed through various research methods.
Theory of Interpersonal Relations in Nursing:
Social Significance: Significant for multicultural patient care, reducing health disparities.
Theoretical Significance: Pioneering focus on patient experiences and stories, with implicit relevance to cultural sensitivity.
Internal Consistency: Fairly divergent semantic clarity but maintained operational definitions and reasonable propositions.
Parsimony: Parsimonious, capturing essential features without loss of content.
Testability: Capacity for empirical testing, but limited explicit hypothetical testing.
Most Appropriate Theory:
The Theory of Culture Care: Diversity and Universality is deemed most appropriate for exploring cultural humility’s impact on nursing practice. Leininger’s precise propositions allow for hypothesis testing and objectification, aligning well with the goal of fostering cultural humility. Peplau’s theory, though profound, has limitations in testability and precision regarding cultural aspects.
Refined Clinical Practice Question:
Patient Population: Patients of culturally diverse backgrounds incongruent with the nurse.
Intervention: Staff education program to improve cultural awareness and sensitivity.
Comparison: No education (all staff offered education).
Outcome: Evaluation of knowledge pre-and post-education.
Clinical Practice Question: In patients of culturally diverse backgrounds incongruent with the nurse, how does an education program aimed at improving staff education by the nurse improve staff knowledge regarding cultural sensitivity?
In conclusion, the Culture Care: Diversity and Universality Theory offers a robust framework for addressing the clinical practice problem, aligning with the principles of cultural humility and promoting a more inclusive and effective approach to patient care.
