Two Middle-Range Theories in Relation to a Phenomenon of Interest

Sample Solution

Phenomenon of Interest: Coping with Chronic Illness

Chronic illness is a pervasive and growing global health challenge, defined by long-lasting conditions that often require ongoing medical care and may limit daily activities. Examples include diabetes, heart disease, autoimmune disorders, and chronic pain. Coping with chronic illness involves the cognitive and behavioral efforts made by individuals to manage the demands and challenges posed by their condition, striving to maintain or improve their quality of life. This phenomenon is complex, encompassing physical, psychological, social, and spiritual dimensions.

Theory 1: Nola Pender's Health Promotion Model (HPM)

Core Concepts, Assumptions, and Purpose: Nola Pender's Health Promotion Model (1982, revised 1996) is a behavioral model that emphasizes health-promoting behaviors rather than disease prevention. Its core purpose is to explain and predict health-promoting behaviors and to guide nurses in assisting individuals to make informed decisions about their health. HPM is grounded in social cognitive theory and expectancy-value theory, positing that individuals are rational decision-makers who evaluate the likelihood of achieving desired outcomes.

Key Concepts:

• Individual Characteristics and Experiences: These include prior related behavior (the most powerful predictor) and personal factors (biological, psychological, sociocultural).
• Behavior-Specific Cognitions and Affect: These are crucial for health behavior change and include:

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  • Perceived Benefits of Action: Beliefs about the positive outcomes of engaging in a health-promoting behavior.
  • Perceived Barriers to Action: Beliefs about obstacles or costs associated with the behavior.
  • Perceived Self-Efficacy: Belief in one's own ability to successfully perform a behavior.
  • Activity-Related Affect: Feelings experienced before, during, or after the behavior.
  • Interpersonal Influences: Norms, social support, and role models from significant others.
  • Situational Influences: Perceptions of environmental factors that facilitate or hinder behavior.
• Commitment to a Plan of Action: The intention to perform a behavior.
• Immediate Competing Demands and Preferences: Alternative behaviors that may take precedence.
• Health-Promoting Behavior: The desired behavioral outcome.

Theoretical Framework and Application in Nursing Practice/Research: HPM's framework suggests that nurses can intervene by modifying individual factors and behavior-specific cognitions to encourage healthy behaviors. In nursing practice, HPM guides interventions aimed at empowering individuals to take control of their health. For example, a nurse using HPM would assess a patient's prior experience with coping, identify perceived benefits and barriers to managing their illness (e.g., "managing my diabetes will give me more energy" vs. "it's too hard to give up my favorite foods"), evaluate their self-efficacy in adhering to a medication regimen, and explore social support systems. The nurse would then tailor education and support to enhance benefits, reduce barriers, and boost self-efficacy.

In research, HPM is frequently used as a conceptual framework to investigate factors influencing health behaviors in various populations, including those with chronic illnesses. For instance, studies might examine the impact of perceived self-efficacy on adherence to exercise regimens in patients with heart failure or the role of social support in dietary changes for individuals with type 2 diabetes.

Theory 2: Katharine Kolcaba's Theory of Comfort

Core Concepts, Assumptions, and Purpose: Katharine Kolcaba's Theory of Comfort (1994, updated 2003) is a middle-range theory that focuses on the concept of comfort as a desirable and measurable outcome of nursing care. It is rooted in early nursing theorists (e.g., Henderson, Orlando) who implicitly discussed comfort, but Kolcaba made it explicit. The purpose of the theory is to provide a framework for assessing comfort needs, implementing comfort measures, and evaluating comfort outcomes, ultimately leading to enhanced health-seeking behaviors.

Key Concepts: Kolcaba defines comfort as the immediate state of being strengthened by having needs for relief, ease, and transcendence met in four contexts of experience:

• Relief: The state of having a specific comfort need met (e.g., pain relief).
• Ease: The state of calm or contentment (e.g., relaxation, peace).
• Transcendence: The state of rising above problems or pain (e.g., finding meaning, hope despite illness).

These three types of comfort can be experienced in four contexts:

• Physical: Pertains to bodily sensations and homeostatic mechanisms (e.g., pain, nausea, temperature).
• Psychospiritual: Pertains to internal awareness, self-esteem, sexuality, meaning in life (e.g., anxiety, fear, hope).
• Sociocultural: Pertains to interpersonal, family, and societal relationships (e.g., support, acceptance, cultural practices).
• Environmental: Pertains to the external surroundings, conditions, and influences (e.g., lighting, noise, temperature, equipment).

Theoretical Framework and Application in Nursing Practice/Research: Kolcaba's framework proposes that nurses identify comfort deficits, implement comfort interventions, and then evaluate the patient's comfort level. If comfort is enhanced, it leads to increased engagement in health-seeking behaviors (e.g., adherence to treatment, seeking information) and institutional integrity (e.g., patient satisfaction, reduced readmissions). In nursing practice, a nurse applying the Theory of Comfort to a patient coping with chronic illness would conduct a holistic comfort assessment across all four contexts. For a patient with chronic pain from arthritis, the nurse might assess physical comfort (pain level), psychospiritual comfort (anxiety about future mobility), sociocultural comfort (impact on family activities), and environmental comfort (ergonomics at home). Interventions would then be tailored to address specific comfort deficits, such as pain management, relaxation techniques, family counseling, or home environment modifications.

In research, the Theory of Comfort is often used to design and evaluate interventions aimed at improving patient comfort and its subsequent impact on outcomes like patient satisfaction, quality of life, and adherence to care. For example, studies might investigate the effectiveness of aromatherapy on reducing anxiety (psychospiritual comfort) in patients undergoing chemotherapy or the impact of patient education on reducing the burden of self-care (ease) in individuals with newly diagnosed diabetes.

Comparison and Contrast of Perspectives

Comparison:

Both HPM and the Theory of Comfort are patient-centered middle-range theories that aim to improve health outcomes. They both implicitly recognize the importance of individual agency and internal states in influencing health behaviors. Both theories emphasize the nurse's role in assessment and tailored intervention. Critically, both theories view patient well-being (whether "health promotion" or "comfort") as a precursor to engagement in positive "health-seeking behaviors" or "health-promoting behaviors." They both guide nurses to move beyond a purely biomedical model to consider broader factors influencing the patient's ability to manage their condition.

Contrast:

The primary distinction lies in their core focus and the mechanism of change.

Theoretical Constructs:

• HPM: Primarily focuses on cognitive and affective factors that influence behavioral choices. Its key constructs (perceived benefits/barriers, self-efficacy, interpersonal/situational influences) directly relate to an individual's decision-making process regarding health actions. When applied to coping with chronic illness, HPM would analyze why a patient chooses to engage in self-management behaviors (e.g., exercise, medication adherence) or why they struggle with them.
• Theory of Comfort: Focuses on the immediate subjective experience of comfort across multiple dimensions. Its key constructs (relief, ease, transcendence, and their four contexts) directly describe the state of the patient's well-being. When applied to coping with chronic illness, the Theory of Comfort would analyze how the patient feels (e.g., are they physically comfortable, mentally at ease, socially supported?) and how improving this state can facilitate better coping.

Implications for Nursing Practice/Research:

• HPM: Leads to interventions that are more educational, motivational, and behavior-change oriented. Nurses using HPM might employ strategies like goal setting, self-monitoring, motivational interviewing, and identifying environmental cues to support desired behaviors. Research would often involve measuring changes in attitudes, beliefs, and overt behaviors.
• Theory of Comfort: Leads to interventions that are more directly focused on alleviating discomfort and promoting a sense of well-being. Nurses using this theory would prioritize symptom management, emotional support, creating a therapeutic environment, and fostering coping skills that promote a sense of inner peace. Research would often involve measuring changes in comfort levels and their correlation with other outcomes like healing or adherence.