Question

Obtain a copy of some recent nursing journals from the last three years (e.g., American Journal of Nursing, Nursing, RN). Examine practice-focused articles and identify theories that affect the suggested nursing interventions and nursing implications. You should identify at least two theories. Are these interventions are currently being used.

Answer 1

The Integrated Theory of Health Behavior Change (ITHBC)

Chronic Conditions and Behavior Change

Researchers suggest that personal behaviors cause more than 50% of illnesses. Approximately 12% of children have special healthcare needs, 7% of persons younger than 65 years have a serious life-altering chronic condition, and 37% of persons older than 65 years have 3 or more serious chronic conditions. Day-to-day management of these chronic conditions is the responsibility of the person and his/her family. However, persons and their families are often not prepared to assume this responsibility. Repeated readmission to acute care facilities, failure to reach targeted outcomes, and the continued need for unscheduled outpatient services are indicators that people need more help. Healthcare systems are being challenged to assume a greater role in assisting persons to better care for themselves. Successful management of chronic conditions benefits people as it improves their health status and well-being .Success enhances a family's cohesion and functioning.Improved outcomes also benefit the healthcare system and society.

Health behaviors required to manage chronic conditions are numerous and varied.There is a growing body of evidence that there is a core group of behaviors common across the management of chronic conditions.For example, people with chronic conditions change their behaviors to manage symptoms such as pain, fatigue, or shortness of breath. Persons self-administer prescribed and over-the-counter medications. Health behaviors needed to manage medications include having and using resources to obtain the medications; accurately self-administering medications over time; and recognizing and reporting adverse effects, unintended outcomes, or failure to attain desired outcomes. Persons must know how to monitor and make decisions about disease indicators such as blood glucose, peak flow reading, or weight gain. People who successfully manage chronic conditions manage negative emotions associated with chronic conditions and fulfill responsibilities to their concomitant life roles.

Health Promotion and Behavior Change

Health promotion also requires people to initiate and maintain health behavior changes. Commonly recognized behaviors such as activity and exercise, good nutrition, stress management, limited alcohol consumption, and smoking cessation positively affect health. Enactment of prevention behaviors is also needed. Prevention behaviors include things such as screening for breast cancer, applying preventative strategies for bone loss during menopausal transition and with age, or obtaining immunization for prevention of human papillomavirus infection. To improve or maintain their health status, people must have healthy lifestyles. Although the value of engaging in health-promoting activities is generally accepted, there is significant variability in how primary health promotion is incorporated into the healthcare system, schools, the work-place, and communities.

The discovery of knowledge about diseases, technological assessments, and pharmacology has far outpaced the knowledge of how to help people incorporate healthcare advances into their daily lives. Abundant information about health promotion is available, but the quality and accuracy of information differ across sources. Relatively little is available to help people sort through information, let alone apply it to their lifestyles. Healthcare professionals need to better understand how health behavior change is made and their role in facilitating and supporting change. How do people make health behavior change that persists over time?

Descriptive Midrange Theory and Advanced Practice Nurses

In contrast to the grand theories of nursing, midrange or middle-range, theories are more concrete and more easily used to guide practice. Often synthesized from knowledge and derived from the work of nurses or persons in other disciplines, midrange theories focus on a specific phenomenon like pain or uncertainty. Midrange theories are designed to be used in practice. There are numerous opportunities for advanced practice nurses (APNs) to use midrange theory while providing and directing clinical care. Using midrange theory can assist with the transfer, application, and evaluation of knowledge across individual and groups of patients. “Descriptive theory provides a description of what is happening in a situation and reveals the components that exist in a situation.

An essential characteristic of APNs is use of theory in practice. Clinical nurse specialists (CNSs) use theory to provide or direct patient care, in their work as consultants to staff nurses, and as leaders influencing and facilitating system change. Clinical nurse specialists use midrange theories that address phenomena relevant to their specialty. Theory-based practice enhances achievement of positive patient outcomes. It provides an explanation for a person's response to his/her condition or treatment. Theory-based practice helps clinicians be faster as it focuses their assessment. It fosters a match between the theory and evidence-based interventions and outcomes with existing, sensitive measures. Using theory decreases distractions and reduces time obtaining and sorting irrelevant information. It facilitates clear and timely communication with other professionals and interested parties (eg, health plan or insurance). Using theory is smart practice. Clinicians are able to observe patterns more quickly, manage complexity, and provide or direct holistic care. Using theory enhances the development of “practice wisdom” because it fosters pattern recognition.. Using theory helps ensure that a CNS practice is holistic and comprehensive.