Lecture 6: Middle Range Theories

Describe middle range theories.

• narrower in scope than grand theories

• have a substantive focus

• are clearly stated and easy to understand

• have fewer concepts and propositions

• may specify an area of practice, client age range, nursing actions, or interventions, and outcomes

• can easily be adopted to guide nursing practice

• can be tested empirically

What 5 things do middle range theories usually include?

• the situation or health condition involved

• client population or age group

• location or area of practice

  • degree of generalizability across settings or situations → neither too broad, nor too concrete

• nursing actions or interventions

• anticipated client/patient outcomes

How many concepts are in middle range theories? What is the relationship like?

2+ concepts with a specific relationship between the concepts

Describe concepts in middle-range theories.

• relatively concrete and specific

• yet sufficient abstract to be applied across multiple settings

• often operationally defines

Describe relationships in middle-range theories.

• relatively concrete and specific

• can be empirically tested

What kinds of relationships are usually implicated in middle-range theories?

causal → cause and effect

Inductive development of middle range theories?

• from research and practice

  • moving from data or practice to more general propositions

Deductive development of middle range theories?

• from grand nursing theories

  • moving from broader propositions to more concrete theory

From what are middle-range theories derived from?

• combination of existing nursing and non-nursing theories

• derivation from non-nursing theories

• derivation from clinical practice guidelines and standards for practice rooted in research

Describe the complexity of grand theories.

broad view of phenomena

Describe the complexity of middle range theories.

focuses on specific phenomena

Describe the generalizability/specificity of grand theories.

non-specific to setting or specialty

Describe the generalizability/specificity of middle-range theories.

may be generalized to multiple settings

Describe the concepts/relationships of grand theories.

• abstract

• theoretically defined

Describe the concepts/relationships of middle range theories.

limited number (2+) that are specifically linked; operationally defined

Describe the testability of middle range theories.

usually generate testable hypotheses

Describe the testability of grand theories.

not testable

Describe the source of development of middle range theories.

evolve from grand theories, research, literature, and practice

Describe the source of development of grand theories.

thoughtful appraisal, many years

Theoretical foundations for Pender’s health promotion theory?

• social cognitive theory

• expectancy value theory

• health belief model

Describe the social cognitive theory in one sentence.

I can do it

Describe the expectancy value theory.

It will be worth it

Describe the source of development of middle range theories.

evolve from grand theories, research, literature, and practice

Describe the health belief model in one sentence.

focus on fear or threat of illness as a source of motivation for health behaviour

What 4 things did Pender believe about health?

• encompases all behaviour for enhancing health

• applies in the absence of threats and fear of illness

• not just freedom from disease

• applies across the lifespan

According to Pender, what is health / health promotion be about?

• bio / psycho / social processes that motivate a person to engage in behaviour that promote health

• includes a person’s own view of themselves and their lifestyles

• measures taken to promote good health

What explicit assumptions does Pender about about a person?

• creates conditions through which they can exercise their unique human potential

• plays an active role in their health behaviour, making changes

• has the skills and ability to engage in self-assessment

• actively seeks to regulate behaviour

• initiates behaviours that modify their environment

• can be influenced by health professionals throughout the lifespan

What are the 3 parts to Pender’s health promotion model?

1. Individual characteristics and experiences

2. Behaviour specific cognitions and affect

3. Behavioural outcome

What are the 2 parts of Part 1 of Pender’s Health Promotion Model: Individual Characteristics and Experiences?

1. Prior related behaviour

2. Personal factors

What are the 3 parts of “Prior Related Behaviour” in Individual Characteristics and Experiences in Pender’s Health Promo Model?

• often the best predictor of future behaviour is past behaviour

• direct effects of prior behaviour is that of habit formation

• indirect effects are associated with self-efficacy, perceived benefits and barriers, positive or negative activity-related effects

What direct effect does Pender believe prior behaviour causes?

habit formation

What indirect effects does Pender believe prior behaviour has?

• self-efficacy

• perceived benefits and barriers

• positive or negative activity-related effects

What are the 3 “Personal factors” in Individual Characteristics and Experiences in Pender’s Health Promo Model?

• biological

• psychological

• sociocultural

What are examples of biological factors in “Personal factors” in Individual Characteristics and Experiences in Pender’s Health Promo Model?

• BMI

• puberty status

• menopausal status

• aerobic capacity

• frailty

• strength agility

• balance

What are examples of psychological factors in “Personal factors” in Individual Characteristics and Experiences in Pender’s Health Promo Model?

• self-esteem

• self-motivation

• perceived health status

What are examples of sociocultural factors in “Personal factors” in Individual Characteristics and Experiences in Pender’s Health Promo Model?

• race

• ethnicity

• acculturation

• education

• socioeconomic status

What are the 6 parts of Part 2 of Pender’s Health Promotion Model: Behaviour-Specific Cognitions and Affect?

1. Perceived benefits of action

2. Perceived barriers to action

3. Perceived self-efficacy

4. Activity-related affect

5. Interpersonal influences

6. Situational influences

What are the 3 parts of “Perceived Benefits of Action” in Behaviour-specific Cognitions and Affect in Pender’s Health Promo Model?

• increases with prior personal experience with positive outcomes

• increases with observation fo others with good outcomes

• can be intrinsic or extrinsic

What are the 3 parts of “Perceived Barrier to Action” in Behaviour-specific Cognitions and Affect in Pender’s Health Promo Model?

• directly by blocking the action

• indirectly by decreasing a commitment to act

What is the KEY PART of Perceived Barrier to Action?

the barriers are perceived

What are the 2 parts of “Perceived Self-efficacy” in Behaviour-specific Cognitions and Affect in Pender’s Health Promo Model?

• one’s judgement of one’s ability to do something

• not about skills; judgement about what can be accomplished with them

What are the 2 parts of “Activity-related Affect” in Behaviour-specific Cognitions and Affect in Pender’s Health Promo Model?

• feelings related to the behaviour

• consider affect before, during, and after the action

What are the 3 “Interpersonal Influences” in Behaviour-specific Cognitions and Affect in Pender’s Health Promo Model?

• thoughts and beliefs about the behaviours, attitudes, and beliefs of others

• modeling and learning from watching others

Sources of “Interpersonal Influences” in Behaviour-specific Cognitions and Affect in Pender’s Health Promo Model?

• family

• peers

• health care providers

• social support

What are the 3 “Situational Influences” in Behaviour-specific Cognitions and Affect in Pender’s Health Promo Model?

• perception of available options

• degree of demand

• environmnetal factors can encourage or discourage an activity

What are the 3 parts of Part 3 of Pender’s Health Promotion Model: Behavioural outcome?

1. Immediate Competing Demands (low control) and Preferences (high control)

2. Health Promoting behaviour

3. Commitment to a Plan of Action

What are the 2 parts of “Immediate Competing Demands and Preferences” in Behaviour-specific Cognitions and Affect in Pender’s Health Promo Model?

• interrupt immediately prior to the intended behaviour

• differs from barriers - alternate behaviours

What 2 things does initiated behaviour depend on in “Commitment to a Plan of Action” in Behaviour-specific Cognitions and Affect in Pender’s Health Promo Model?

• Initiated behaviour depends on

  • commitment

  • strategies identified

What is “Health Promoting Behaviour” in Behaviour-specific Cognitions and Affect in Pender’s Health Promo Model?

desired behavioural outcome

What are the 3 main implications of the Health Promotion Model in nursing practice?

• offers a method for the assessment of client’s health-promoting behaviours

• offers client characteristics as targets for assessment

• suggests that nursing interventions can be designed to alter client’s perceptions to promote health behaviours

What are the 3 targets for interventions in the HPM for nursing practice?

• perceived self-efficacy

• perceived barriers and benefits

• interpersonal and situational influences

What are the 4 main implications of the Health Promotion Model in nursing research?

• HPM provides a structure for the development of instruments

• original model validated by way of Health Promoting Lifestyle Profile

• Over 50 studies have tested the predictive capability of the model

Describe a situation-specific theories.

• clinically specific

• reflect a particular context

• lower level of abstraction - more concrete

  • provides direction

  • blueprints

• easily applied in nursing research and practice

What is situation-specific theory similar to? What parts?

The development phase of situation-specific theory is similar to the implementation process of evidence-based practice

What specific steps of situation-specific theories and evidence-based practice are similar?

• identifying a clinical problem

• conducting a comprehensive literature review

• evaluating and critiquing the evidence

• determining appropriate interventions

• assisting clinicians to make decision in specific conditions or situations

What desired outcome do situation-specific theory and evidence-cased practice share?

developing nursing interventions that can be applied in clinical practice to improve the health of patients

What 5 health care challenges faces nurses in the 21st century?

• chronic conditions

• aging population

• diverse population

• health disparities

• limited English proficiency

What is the future of nursing theory development and utilization influenced by?

trends and patterns in populations in the physical environment and the changes in lifestyles and modes of communication

What does increasing life expectancy of populations require in the future?

• advances in science

• better control of infections

• interventions more responsive

What will geographical movement of populations lead to in the future?

• urban to rural

• migration

What will electronic health systems require in the future?

• more access to information by the public

• more opportunity/deferral for self-care and decision-makign