Middle Range Nursing Theory

Middle Range Nursing Theory

Introduction

The main goal of the nursing profession is to improve the health outcomes and quality of life of individuals, families, communities, and society at large. Both nurses and patients have a role to play in achieving this goal. However, nurses encounter various problems in their day to day practice, which hinders them from reaching the purposes of the nursing profession. Various nursing problems are addressed by multiple nursing theories (Smith & Gullett, 2015). Just like other professional disciplines, nursing has a body of knowledge. Nursing theories are a fundamental part of the body of knowledge encompassed by nursing practice and guide the thought process of nurses as they provide care to their patients. They provide a framework for both nursing practice and research in nursing. Through nursing theories, nurses become aware of their role in healthcare, thus fostering collaboration with other healthcare professionals (Smith & Gullett, 2015). The primary goal of nursing theories is to promote development and comprehension of nursing practice. Nursing theories are categorized into three levels depending on their scope and scale of abstraction (Smith & Gullett, 2015). These include grand nursing theories, middle-range nursing theories, and nursing practice theories. Middle range nursing theories bridge the gap between the other two nursing theories. They explain, predict, or describe phenomena. This paper will analyze, evaluate, and give the application of the middle range nursing theory of self-efficacy.

Background of the Theory

Self-efficacy theory is enshrined in the Social Cognitive Theory as proposed by Bandura (Mareno, 2016). Albert Bandura is a psychologist known for his groundbreaking work in social cognitive psychology. Self-efficacy theory states that an individual’s belief that they can complete a particular task is altered by their psychological well-being. Bandura proposed that an individual’s personality is made up of their traits, behavior, and environment. This model is known as triadic reciprocality and forms the central concept upon which the self-efficacy theory is built (Maddux & Kleiman, 2018). The principal aim of this theory to explain and link an individual’s behavior to not only outcome expectations but also their self-efficacy expectations. Self-efficacy expectations are an individual’s judgment of their ability to complete a particular task. In contrast, outcome expectations are the individual’s judgment of the final consequence that results from successful completion of the job in question (Mareno, 2016). Self-efficacy expectations determine the amount of effort and individual puts towards the realization of behavioral change. They also influence the persistence of an individual in achieving behavioral change in the face of obstacles.

Just like theories of other professional disciplines, self-efficacy theory has assumptions, concepts, and propositions when it comes to nursing practice. A concept is a word used to describe a phenomenon. A proposition is a statement giving the relationship between two or more ideas. An assumption is a belief of a theory. The concept, in theory, is that cognitive processing sets the stage for reflective thought, which in turn pushes individuals to set behavioral standards and the skills required to achieve them. Individuals can, therefore, reward or punish themselves based on how their behavior equates to a self-generated external evaluation criterion (Mareno, 2016). In this regard, the self-efficacy theory assumes that people have authority over what they do and, therefore, decide their behavior. A high self-efficacy may boost one’s confidence resulting in success. However, sometimes it gives one false belief, which is a recipe for failure. Self-efficacy judgment is a crucial tool when it comes to enhancing competence because it influences an individual’s thoughts and actions.

Individuals derive the impetus to change their behavior from different sources of self-efficacy judgment. These sources work reciprocally and include enactive attainment, vicarious experience, verbal persuasion, and physiological feedback (Mareno, 2016). Enactive achievement refers to the mastery of performing a particular behavior. According to Bandura, enactive attainment comes from previous success or failures in achieving something similar to a specific behavior, the context of behavioral change, and self-perception of the difficulty level involved. Mastery of one pattern of behavioral change may enhance an individual’s ability to perform another behavioral change (Mareno, 2016). Vicarious experience is the feeling individuals get when they see other people performing the same behavioral change without experiencing any adverse effects. This serves as extrinsic motivation to the observer, who conditions himself to believe that he is also capable of performing the same behavioral change. Verbal persuasion involves the use of verbal suggestions to coax an individual into believing that he can successfully perform behavioral changes (Maddux & Kleiman, 2018). Bandura also suggested that an individual’s response to physiological markers such as stress or anxiety partially determines his ability to make a behavioral change successfully. If the physiological indicators are negative, then the individual is less likely to believe that he can perform behavioral changes.

Evaluation of the Theory

Significance

The self-efficacy theory originates from both psychology and philosophy. In psychology, it is enshrined within the social cognitive theory, while in philosophy, it is enclosed within the interactive-integrative paradigm (Maddux & Kleiman, 2018). This theory takes a complementary worldview approach where human beings interact with one another and with their environment, thus establishing reciprocal relationships. According to the reciprocal worldview, change is an outcome of many probable factors. The Roy adaptive grand theory of nursing takes a similar worldview approach as the self-efficacy theory. Both theories define human beings as biological, social, and psychological, continually interacting with their environment as well as people in their social network (Smith & Gullett, 2015). An example of such an interaction is an individual going to a support group to change how he perceives himself and boost his self-efficacy. This example emphasizes the significance of the self-efficacy theory in nursing.

Internal Consistency

The significant concepts put forward by the self-efficacy theory are consistent. However, the association between outcome expectations and self-efficacy is not uniform. According to Bandura, both the ideas of self-efficacy and outcome expectations are part of the social cognitive theory (Mareno, 2016). However, the role played by self-efficacy in social cognitive theory is so overwhelming that it had to be developed into a separate theory.

Parsimony

            Self-efficacy theory explains all its significant concepts clearly and in the simplest way possible. Considerable ideas are self-efficacy expectations and outcome expectations, which are simple ideas that are easy to understand (Maddux & Kleiman, 2018). This ease in explanation makes the whole theory self-explanatory and predictable. The concepts of self-efficacy theory have also been explained by other scholars apart from Bandura. This broad scholarly view of the theory means that by comprehending its major concepts, one can soundly apply them in nursing practice and research.

Testability and Empirical Adequacy

Self-efficacy theory is categorized under middle range theories because of its tangibility and testability. Its significant concepts can be applied in professional bodies of knowledge such as nursing and also in research. The theory originates from the social cognitive theory of psychology but takes a worldview approach similar to the Roy adaptive grand theory of nursing (Maddux & Kleiman, 2018). Bandura first developed tools for measuring self-efficacy expectations and outcome expectations in 1977. Elshatarat applied the self-efficacy theory in testing for self-efficacy in tobacco users (Elshatarat et al., 2016). Resnick also used the theory to study the relationship of osteoporosis, fear of falling, and self-efficacy expectations to exercise. Other researchers in nursing have also studied the use of self-efficacy theory in the management of chronic illnesses such as diabetes (Miller, Lasiter, Ellis & Buelow, 2015). Simply put, the self-efficacy theory has been widely used as a framework for other studies emphasizing its testability and empirical adequacy.

Applications in Clinical Practice

Self-efficacy theory continues to be used in nursing practice in giving care to patients, nursing education, professionalism, and nursing competency. Elshatarat proposed a model to help tobacco smokers to quit smoking using self-efficacy theory (Elshatarat et al., 2016). In his study, Elshatarat offers five approaches which include assessment of the patient’s smoking behavior, informing the patient on the dangers of smoking and asking him to quit, assessing the patient’s willingness to quit, assisting the patient to quit smoking and following up to check on the patient’s progress (Elshatarat et al., 2016). Self-efficacy theory is also used by nurses to comprehend barriers and enablers of self-efficacy in vulnerable populations. In such people, nurses can provide an opportunity for enactive attainment, encourage family members to be role models in effecting behavioral change, reduce the risk and severity of negative physiological markers such as anxiety and use professional communication skills to help patients change their behaviors (Mareno, 2016).

Conclusion

The concepts of self-efficacy theory remain applicable and relevant in many fields. The theory connects the behavioral change process to the social network and surroundings of an individual. It proposes that an individual may acquire the motivation to change behavior from his personal experiences, persuasion from other people, and physiological responses. An individual is also motivated to change his behavior based on the consequences accrued from the behavioral change process. The major concepts of this theory are self-efficacy expectations and outcome expectations, which have also been studied and tested by other scholars and researchers. This emphasizes the significance, testability, and empirical adequacy of the self-efficacy theory.

References

Elshatarat, A.R. et al. (2016). Self-efficacy in treating tobacco use: A review article. Sage Journal, 25(4), 243-248, doi.10.1177/2010105816667137

Maddux, J. E., & Kleiman, E. M. (2018). Self-efficacy. Guilford Press.

Mareno, N. (2016). Applying middle-range concepts and theories to the care of vulnerable populations. Caring for the Vulnerable: Perspectives in nursing theory, practice, and research, 117-139.

Miller, W. R., Lasiter, S., Ellis, R. B., & Buelow, J. M. (2015). Chronic disease self-management: a hybrid concept analysis. Nursing Outlook, 63(2), 154-161.

Smith, M., & Gullett, D. (2015). Nursing theories and nursing practice (4th ed.). F. A. Davis Company.