Lecture 6 - Middle Range Theories (: Flashcards
What are the purposes of middle range theories, according to Pender?
Middle range theories that have been tested in research provide evidence for evidence-based practice, thus facilitating translation of research into practice
What kind of theories tend to specify into an area of nursing and demographic, can be easily adopted to guide practice by guiding interventions, and can be tested empirically?
Middle Range
What is the typical relationship between concepts of middle range theories?
What are characteristics and concepts of middle range theories?
Cause –> Effect relationships
Limited concepts that are operationally defined, concrete and specifically linked, and broad enough to be applied across settings
According to Lenz (1996), through which approaches are middle-range theories developed? What kind of theories are they based from?
Through induction (research + practice) and deduction from grand nursing theories
Derived from a combination of existing nursing and non-nursing theories
What is the purpose of a middle-range theory?
To generate testable hypotheses
What is the generalizability of middle-range theories?
The must be generalized, but to multiple settings
Which theories were Pender HPM based on?
Bandura’s social cognitive theory (1977)
Expectancy Value theory (Feather, 1982)
Health Belief Model (Becker, 1974)
What is the main idea of Bandura’s Social Cognitive Theory (1977)?
Observational learning (Behaviour, personal factors, the environment)
What is the main idea of Feather’s expectancy value theory (1982)?
A theory of motivation that describes the relationship between a person’s expectancy for success at the task or the achievement of a goal in relation to the vale of the task completion of goal attainment.
What is the Health Belief Model (Becker, 1974)?
A health promotion model that focuses on fear or threat of illness as a source of motivation for health behaviour.
According to Pender, health is…
More than the absence of fears of illness
–> Biopsychosocial processes that motivates a person to engage in behaviours that promote health.
What explicit assumptions does Pender make?
Every person…
Creates conditions through which they can exercise their unique human potential
Play an active role in their health behaviour
Has skills and abilities to engage in self-assessment
Actively seeks to regulate behaviour
Initiates behaviours that can modify their environment
Can be influenced by health professionals through the lifespan.
What are the three main concepts of Pender’s HPM?
Individual characteristics and experiences
–> Biological, psychological, sociocultural; prior related behaviour
Behaviour-specific cognition and affect
–> Includes perceived benefits, barriers, self-efficacy, and activity related affect
–> Also, interpersonal and situational influences
Behaviour outcomes
–> Immediate competing demands, preferences, and a commitment to a plan of action contribute to health promoting behaviour
What are some common critiques to Pender’s HPM?
Complex, stage based, and impractical in application
No concrete assessment, intervention, or reevaluation tools
Places all responsibility on client
Trivializes real barriers placed on people
Does not apply to broad population - children, groups (but claims to!)
What does Derek Yach argue about health promotion in his Ted talk?
We must redefine what is unacceptable to produce change - He states that inaction in health promotion is unacceptable and that healthcare should go beyond simply disease prevention.
The best way to prevent disease is to actively promote health outcomes - it must be at the center of healthcare.
“Make the healthy choice the easy choice”
What context do situation specific theories reflect? How abstract are they? How are they meant to be applied?
The are clinically specific and reflect a particular context
They have a lower level of abstraction, are more concrete, and provide direction and blueprints that can easily be applies in research and practice.
How are situation-specific theories tested?
Evaluated case-by-case or by use with specific populations
Where do situation-specific theories evolve from?
Application of middle range theories to specific situations
How are the development and implementation of situation specific theories and EBP similar?
Both involve:
Identifying a clinical problem
Conducting a comprehensive literature review
Evaluating and critiquing evidence
Determining appropriate interventions
Assisting clinicians to make decision in specific conditions or situations
How are the desired outcomes of situation-specific theories and EBP similar?
They share a common goal of developing nursing interventions that can be applied in clinical practice to improve the health of patients
What are the five health challenges that nurses are facing in the 21st century?
Chronic conditions
Aging population
Diverse population
Health disparities
Limited English proficiency
What factors should be considered in the development of new situation specific nursing theories, according to Meleis and Topaz (2021)?
Increasing life expectancy due to advances in science, better infection control, and more responsive interventions.
Migration and urban to rural movement
Electronic health records leading to more access to information by the public and more opportunity for self-care and decision-making.
What recommendations do Liehr & Smith (1999) recommend to future middle range theory creators?
- Clearly articulate theory name and approaches for generating it
- Clear conceptual linkages in a diagrammed model
- Articulate research-practice links of the theory
- Create association between new theory and disciplinary perspective in nursing
- Move middle range theory to the front lines of nursing practice and research for furthur analysis, critique, and development
