NURS 8110 Week 10 Discussion – Psychosocial Theories in Nursing

Use of Psychosocial Theories in Nursing

Concepts in the Care Plan

Age Specific Patient Care

Social Psychology Theory in Breast Cancer Awareness

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Psychosocial Theories in Clinical Practice

Sample Solution Essay

Middle Range or Interdisciplinary Theory Evaluation

Nurse researchers have widely used middle range theories from the 1970s.  The simplicity and the fewer concepts of the middle range theories encourage the researchers to apply them in the research.  A middle range theory can emerge from the nursing practice or research, from combining the literature, and can also be developed from grand theories (McEwen & Wills, 2014).  Interdisciplinary theories from sociologic sciences, behavioral sciences, and biomedical theories can also be used in nursing research (McEwen & Wills, 2014).  The relevant theories   that are selected for any research study or application in the nursing practice must be evaluated for the effectiveness (Fawcett & Garity, 2009).

This assignment will help me as a doctoral student to learn how to evaluate the middle range theory or interdisciplinary theory for utilizing them in the nursing research.

Practice Problem

Uncontrolled type 2 Diabetes Mellitus leads to various complications that could be short term or long term.   In my workplace, there are many patients admitted with chronic disease conditions.  Their socio-economic status is low and has poor literacy.  Most of the patients are Hispanic. There is an increased number of readmissions among these patients.  The readmissions escalate the health care cost and reduce the reimbursements to the hospital.  I would like to conduct research about the impact of health literacy in improving the self-care in patients with type 2 diabetes which will help in minimizing the readmissions.

There is rich evidence that the patients will be engaged in the self-care activities if they have adequate health literacy and it will lead to effective glycemic control (Protheroe, Rowlands, Bartlam, & Levin-Zamir, 2017).  Poor health literacy about diabetes will lead to poor glycemic control as the patients will not participate to self-manage the condition (Friis, Vind, Simmons, Maindal, 2016).

My research will be focused on the effectiveness of health literacy on the self-care activities among patients with type 2 diabetes mellitus. NURS 8110 Week 10 Discussion – Psychosocial Theories in Nursing

Summary of Selected Theories

I would like to use Pender’s health promotion model from middle range theories and health belief model from behavioral science theories in my research.  The selected theories have the concepts to modify the participant’s behaviors by health literacy and improve the self-care activities in type 2 diabetes management.

Nola Pender published the health promotion model (HPM) in 1982 which is a middle range theory.  HPM originated from the nursing perspective of the social cognition theory and expectancy-value theory (McEwen & Wills, 2014).  Improving healthy behaviors will prevent or delay the complications.  HPM impacts the patient behaviors and promotes them to participate in activities to enhance their health (McCutcheon, Schaar, & Parker, 2016).  The major concepts of HPM are “individual characteristics and skills, behavior-specific cognition and affect, and behavioral outcome” (McEwen & Wills, 2014. pg. 235).  Individual characteristics and experiences are based on a person’s experiences related to the disease condition and the influence of the personal factors.  The cognition and affect are linked to the personal understanding about the benefits in modifying the behavior, barriers related to the change, social and situational influences, and the outcomes of the modified behavior.  The behavioral outcome will be the obligation to the improved behavior and health promotion (McEwen & Wills, 2014).  HPM model was used in nursing to improve the public health.  Nurses can implement HPM to motivate patients to be engaged in the self-care activities to improve the patient outcomes.  The motivation is possible by applying the concepts health education and individual development concepts (McEwen & Wills, 2014).

The second theory that I chose to use for my research is the health belief model (HBM).   HBM is a social psychology theory model which could be used in modifying the behavior. HBM focuses on the patient’s beliefs and attitudes and developed by a group of psychologists in 1950s (McEwen & Wills, 2014).  The concepts of HBM are “perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy” (Rosenstock, 1990; McEwen & Wills, 2014. pg. 324). There are three parameters set with HBM model.   They are individual perceptions, modifying factors, and a likelihood of action.  Different attitudes are the opinions of the people about contracting the disease, the effects of the disease if untreated, and the perception of the threat and the actions taken to eliminate the risk.  The second parameter is considering the modifying factors, in which the population is classified according to the demographic variables, socio-psychological variables, and structural variables and how it affects their lives with the disease (McEwen & Wills, 2014).

The demographic variables are gender, age, and race they belong. The socio-psychological variables are personality, social class, peer and reference group pressure.  The structural variables are the prior knowledge about the disease and previous contact with the disease, etc.  The individuals’ perception of the threat of the illness and cues of action are categorized under modifying factors.  The third parameter is the likelihood of action.  It includes the perceived benefits of the action minus perceived barriers to the action.  The goal of a likelihood of action is preventive health action.  HBM model can be applied in promoting patient’s self-care activities in risk prevention related to the disease condition (Bishop, Baker, Boyle, & Mackinnon, 2015). NURS 8110 Week 10 Discussion – Psychosocial Theories in Nursing.

Evaluation of the Selected Theories

Evaluation of the selected theories is a critical step before it is utilized in the research.  The selected theories for my research are HPM and HBM models, and they have social and theoretical significance.  Type 2 diabetes mellitus affects many people in the society, and the selected theories have impacts on the community health.  Utilization of HPM and HBM will generate or alter the new perception of the disease condition among the affected population (Fawcett & Garity, 2009).

Both theories have internal consistency as the concepts are clearly defined and ready to be used in the research project.  I am planning to use the meaning of the theory’s concepts without alterations as it may lead to redirecting the definition of the selected concepts (Fawcett & Garity, 2009).  Inductive reasoning is seen in both theories as the research is focused on identifying the existing knowledge among the selected population and apply that knowledge to the general population (Fawcett & Garity, 2009).

The criteria of parsimony are that the selected theory must have a few simple concepts that explain the meaning of the theory.  This principle of a theory will account for the meaning of its concepts to others without compromising the content of the theory (Fawcett & Garity, 2009).  HPM and HBM have very fewer ideas and easy to explain.  The researcher will explain the selected theories concepts in a simple manner.  There is a less possibility to alternate the meaning of these concepts as they are straightforward and concise.

The final evaluation criterion is testability.  Testability means whether the concepts are individually measurable in the research and reported (Fawcett & Garity, 2009).  In the selected research project, the concepts of HPM and HBM will be measured.  One or few of the concepts in the chosen theory will be analyzed in the research about type 2 diabetes mellitus.

The evaluation of the selecting theory using the assessment criteria revealed that the HPM and HBM models could be utilized for the research about the effectiveness of increased health literacy on self-care compliance among adult type 2 diabetes mellitus patients.

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Most Appropriate Theory for the Practice Problem

I choose to use HPM than the HBM to address my practice problem.  HPM categorizes the factors that affect healthy behaviors and focuses on a higher level of well-being and self-actualization.  The expected outcomes will be health promotion.  HBM supports the disease avoidance and helps in preventive health action among the selected population.

HPM model focuses on how the individual reacts to the environment in achieving the health promotion (Koehne, 2015).  My aim is to concentrate on the health promotion activity and application of HPM in my research will help me to obtain the goal of the study.  There are modifiable behavioral factors related to my practice problem. The behavioral and cognition factors may affect the individual’s perception about the disease, it’s effects if not treated, and the action to be taken to avoid or minimize the complication to promote health (McEwen & Wills, 2014).  The analysis of the individual and behavioral concepts will help me to implement an action plan to improve the individual’s commitment to action towards health promotion activities.  Also, nursing measures that are taken to alter the person’s perception about the disease will change the adverse effects of barriers to improve the self-efficacy of the individuals (Ho, Berggren, & Dohlborg-Lyckhage, 2016).

My refined research question is, “what is the effect of increased health literacy on self-care compliance among adult patients, ages 25 to 65, with type 2 diabetes mellitus to improve the glycemic control?”.  The research question is refined based on the concepts of the HPM model.  The idea of perceived self-care efficacy and commitment to action will help me address the practice problem and achieve the effective glycemic control.  The other concepts of HPM will help me identify the factors that affect the individual’s perception about the disease, the effects, and the barriers to modifying the healthy behavior.

Conclusion

I gained insights about the importance of evaluating the theories in research and learned how to evaluate them using the criteria from the learning resource by Fawcett and Garity.  I learned in depth about the HBM and HPM model and choose the appropriate model to apply in my research to address the practice problem.

References

Bishop, A. C., Baker, G. R., Boyle, T. A., & Mackinnon, N. J. (2015). Using the health belief model to explain patient involvement in patient safety. Health Expectations, 18(6), 3019-3033.             https://doi.org/10.1111/hex.12286

Fawcett, J., & Garity, J. (2009). Evaluation of middle range theories. In Evaluating research for evidence-based practice (pp. 73-88). Philadelphia, Pennsylvania: F. A. Davis.

Friis, K., Wind, B. D., Simmons, R. K., & Maindal, H. T. (2016). The relationship between health literacy and health behavior in people with diabetes: A Danish population-based study. Journal of Diabetes Research, 2016 (7823130), 1-7. https://doi.org/10.1155/2016/7823130

Ho, A., Berggren, I., & Dohlborg-Lyckhage, E. (2010). Diabetes empowerment related to Pender’s health promotion model: a meta-synthesis. Nursing & Health Sciences, 12(2), 259-267.             https://doi.org/10.1111/j.1442-2018.2010.00517.x.

Koehne, K. (2015). A new threat to the nursing workforce: take a stand!  Creative Nursing, 21(4), 234-241. https://doi.org/10.1891/1078-4535.21.4.234

McCutcheon, T., Schaar, G., & Parker, K. L. (2016).  Pender’s health promotion model and HPV health-promoting behaviors among college-aged males: concept integration. Journal of Theory Construction & Testing, 10(1), 12-19. Retrieved from CINAHL Plus with Full Text

McEwen, M., & Wills, E. M. (2014). Theoretical basis for nursing (4th ed.). Philadelphia, PA: Wolters Kluwer.

Protheroe, J., Rowlands, G., Bartlam, B., & Levin-Zamir, D. (2017). Health literacy, diabetes prevention, and self-management. Journal of Diabetes Research, 2017 (1298315), 1-3. https://doi.org/10.1155/2017/1298315. NURS 8110 Week 10 Discussion – Psychosocial Theories in Nursing