Middle Range Theories, Research Paper Example

The Story

My story is of a twenty-year-old female college student who has had issues about her weight, “since I can remember.” This young woman, Amanda, is an attractive girl who describes herself as obese. She is 5’6” tall and weighs two hundred pounds. I first met her when she began rooming in the dormitory with my daughter, three years ago. She has come to our house on many occasions and has grown close to my family and my family to her. I noticed that she would act embarrassed as she sat with us at the dinner table to eat. She would act sheepish as she put food on her plate, as though we were watching her and judging what she was eating. She came to me several months ago and asked me about a weight loss and exercise program, as her doctor had told her that she is a “borderline diabetic.” I recently asked her if I could tell her story and she said yes. We sat down last weekend for a long talk.

Amanda is a junior in college, her grades are excellent, and she is pleasant to be around. Amanda worries that she will have to start using insulin, and this thought “scares her to death.” Amanda says she has had weight issues her whole life, but the thought of diabetes now has her scared to death. She is so desperate to lose weight she has thought about taking drugs to do it. “Legal drugs I mean, like that phentramine,” she says.

Amanda has an older brother and a younger brother, neither of which have any weight issues. She said that often when she was a young child people thought she was the oldest as she was the biggest. She particularly remembers that her grandmother would look at her baby pictures and say, “look at those chubby cheeks and all those rolls you had!” She states, “I felt bad even as a little girl when she would say that.” Often in grade school she remembered people saying, “Oh she’ll grow out of it.”
In middle school at the age of thirteen Amanda started her menstrual cycle and that same year she began playing girls basketball and in fact she did start to slim down. She states, “I still was not a size one, but I did have a flat stomach and was in great physical shape.” Her mother would often tell her she would never be tiny because she was “built like her daddy.” “Dad isn’t fat, but he is stocky, big boned, in the legs especially, just like me,” she says. She felt her mother was trying to be encouraging, but it too made her feel bad. “I know Mom meant well, but I really did wish I could be petite like the other girls, but I knew she was right, I never would be.” In the eighth grade Amanda started running cross-country track and continued with basketball. “ I was in tremendous physical shape.” I asked if she were happy with her body image then. She tells me this story: “I felt good about myself, but my brothers would still tell me I was fat. It used to hurt my feelings really bad. If my parents heard them they would get in trouble. Honestly they didn’t do it all the time, usually just when they were mad at me or we were fighting like brothers and sisters do. I still knew that I wasn’t a skinny girl, but I would always tell them to look how flat my belly is. I was so proud of that.” Of note Amanda never had a boyfriend in middle school. “I remember a lot of my friends were starting to date, but I never did.” Middle school came and went and Amanda moved on to high school.

In high school Amanda didn’t run cross-country, but continued in basketball until her senior year. “I was tired of working out all the time and just wanted to hang out with my boyfriend.” Yes, Amanda had her first boyfriend. She had started dating this young man during her junior year of high school. He was five years older than her and in college. “He really liked me…and still does,” she says. Amanda brought some pictures of herself and him for me to see, “this is my junior prom.” Amanda looked beautiful in a red gown, with tiny spaghetti straps and so slim and in shape. I had never seen her so slender. She then showed me her senior prom pictures, “I had started gaining weight.” Amanda was not obese, but there was a noticeable weight gain from the picture just a year before. “I was still exercising, but not as faithfully as when I played basketball. I just wanted a break from worrying about it (weight) all the time.” As we looked at the pictures together Amanda told me this, “You know the whole time I was in middle and high school my brothers would still tell me I needed to lose weight. I thought I did too, but when I look at these pictures, I was not fat. Look at me now, now I am fat.”

Amanda says that at the end of her first year of college her older brother told her “you didn’t gain the freshman fifteen you gained the freshman forty.” Sadly she says “he was right.” Amanda climbed to about 220 pounds the end of her sophomore year, a gain of about 75 pounds since high school. “My mom would try to be subtle, asking if I ever used the gym or had I been swimming at the school’s pool, I knew what she meant.”

Amanda had a routine check-up during her sophomore year, “I think I wanted them to find some reason I was gaining weight, like my thyroid or something they could correct.” Instead Amanda was told her glucose was a little high, that she needed to follow-up. The doctor also told her she was obese. “Obese was a word I never used to describe myself. That really hit me hard.” Amanda left that appointment with the diagnosis on her chart of obesity with follow-up labs to be done to rule out diabetes. “I went home and googled everything I could about diabetes. A lot of it seemed to be about weight, so I decided I was going to lose the weight. I did not want to end up with those shots in my belly.” It didn’t work. Even with the scare of diabetes and needles, Amanda didn’t lose weight.

The end of her sophomore year she started going back to the gym and running again. “I lost about thirty pounds and the doctor was happy. I didn’t have diabetes, but he told me to keep up the exercising and losing weight and that we would continue to do yearly checkups. I thought this was great…and I quit exercising. Now I have gained back up to around 200 pounds.” It was this point that Amanda asked my daughter if she thought I would help her with a program for her weight.

I asked Amanda what her biggest issues with her weight were and what she thought I could do to help. Amanda told me that she constantly thinks of “getting sugar” and how the thoughts of what that could lead into, “I even read you can go blind with diabetes.” This is accurate, a lot of health problems result from diabetes. We first discussed small goals and then it seemed to click for Amanda, “I know this isn’t going to happen fast, so I have a big goal to work for, my wedding.” Amanda explained that she and her boyfriend want to get married the summer after she graduates. This would give her almost two years to get into the “perfect shape.” She also tells me that even though it may be years down the road, she wants to have children, “I want to have kids someday and I read that sugar can be worse when you’re pregnant, I don’t want that.”

We discussed how it has to take time to lose the weight correctly and to keep it off. “Yeah I know, I didn’t put it on overnight and it sure won’t come off overnight,” she told me. This was true. Amanda decided that she had to have some kind of plan to start so she chose to go to Weight Watchers. She says herself, “I know I have to eat right, but getting the first few pounds off quick really does make me more motivated.” Amanda also added a daily exercise regimen. To date Amanda is sticking with it. “I’m weaning myself from Weight Watcher’s meals and cooking healthier.”

Amanda’s future includes short term and long term goals. Amanda has an overall goal to get the weight off and keep it off and to do everything in her own power not to develop diabetes. Amanda knows that this is going to be a long road. Amanda knows that the long term goal is going to require a life style change that she must commit to for a lifetime. “Besides eating right another goal I have is to make my exercise program a routine of daily life. It may take a while, but that’s another one of my long term goals.”
Short term goals such as inches and pounds to be lost and miles and minutes to add to exercising have been set. “My first big goal is a 5K race, I might have to walk it, but I am going to do it,” Amanda tells me excitedly. Amanda and her boyfriend are working at this together. “It’s great to have someone to keep you encouraged.” After talking to Amanda, I feel she is going to succeed at these goals; she has the knowledge and the enthusiasm to move into the future with a full hearted commitment to living healthy.

Introduction

The purpose of this paper is to show how middle range theories can be applied in the field of nursing to solve health problems. The knowledge of nursing includes theories, philosophies, the practice wisdom and research and evidence and theory–guided practice is the hallmark of the nursing practice. Middle range theories form part of the structure of nursing discipline and are important in addressing knowledge of the discipline through expansion of phenomena which have a relationship with the process of healing (Liehr R.  & Mary S. 2008). They are especially vital in advanced nursing because in addition to guiding everyday practice, they  also provide guidance in research  which is  a core component of advanced nursing in the.

Social Efficacy Theory

Self-efficacy is defined as ones belief that they have the abilities to act in a manner required to overcome situations that re prospective. It is the belief whether accurate or not that n individual has the ability to produce n effect.

Bandura developed Social Cognitive Theory in 1986 which views People as proactive, self-organizing, self-regulating and self-reflecting not as reactive organisms driven and shaped by hidden inner impulses and environmental factors.  This theoretical perspective views functioning of human beings as the product of interplay of behavioral, personal as well as influences from the environment. The factors that determine functioning of human beings in the Social cognitive theory have a reciprocal nature which enables efforts of   counseling and therapy to be directed at environmental, personal or behavioral factors. Therefore Strategies aimed at increasing well-being can be targeted at improving cognitive, motivational or emotional processes, changing the social conditions of the living or work environment of people or even increasing competencies of people’s behavior (Bandura, A. 1993).

Social efficacy  theory is based on the  view of a human agency whereby the agents are individuals  who are  engaged  proactive  developing themselves  and  whose actions can cause  things to happen. Individual beliefs form the key to this sense of agency among other personal factors .these beliefs enable them to  control  their feelings, thoughts and actions, that “peoples behavior is affected by what they feel, think and  believe ” (Bandura, 1986). Individuals are thus viewed as producers and as products of their own social systems and environment. Since human beings are social beings Bandura extended the human agency conception to include collective agency.  This means People work together on beliefs they share about their common aspirations and capabilities to make their lives better. The extension of the concept makes the theory to be applied in human change and adaptation in societies who are individually-oriented and the collectively-oriented societies as well (Bandura, A. 2001).

Environments and social systems influence human behavior through psychological mechanisms of the self system. Hence, social cognitive theory posits that factors such as economic conditions, socioeconomic status, and educational and familial structures do not affect human behavior directly. Instead, they affect it to the degree that they influence people’s aspirations, self-efficacy beliefs, personal standards, emotional states, and other self-regulatory influences (Pajares 2002). Self-efficacy beliefs influence the choices made by people as well as their course of action. People always go for activities and tasks in which they have confident and avoid difficult ones. Unless people trust their actions in bringing the desired results, then they have little incentive to pursue those actions. Factors that   influence behaviour are founded in the core belief that one is able to accomplish such behaviour. These beliefs also help in determining the mount of effort put on an activity, their perseverance when confronted by difficulties and their resilience amidst adverse situations. People with higher sense of efficacy will have more efforts, resilience and persistence. The individuals with a big sense of personal competence will take difficult activities as challenges which need to be mastered not as threats to be evaded. Such people  have greater inner  interest and  engross deeply  in activities, set challenging gaols for  themselves  and have  strong commitment to these activities  which they  sustain even in the face of setbacks for  they are able to  recover very quickly  their sense of efficacy after  setbacks and perceive  failure as  consequence of  insufficient efforts or  inefficient knowledge and skills which they believe they can  acquire. As a result self-efficacy beliefs have powerful influence on the level of accomplishment that individuals achieve ultimately (Bandura, A. 1991).

The level of perception of self efficacy affect health behaviors like dieting, physical exercise,  use of condom, dental hygiene,  self-examination of breast non-smoking, use of seat belts among others .  The beliefs of Self-efficacy are cognitions which determine whether changes of health behavior will be started,  the effort  put forth to change the risk behavior and the length of period it will be sustained amidst failures and obstacles which may undermine ones motivation. Self-efficacy affects   health behavior directly and indirectly through its effects on set goals. Self-efficacy influences the challenges that people take on as well as how high they set their goals for example “I intend to reduce my smoking,” or “I intend to quit smoking altogether”. Models of social-cognitive which touch on health behavior change have the construct which perceive self-efficacy as moderators, mediators or predictors. Self-efficacy should enhance formation of intentions of behavior, developing plans of action as well as   initiation of the actions. Self-efficacy can also help in preventing relapse or act as a moderator therefore support the process of translating intentions into action (Bandura, A. 1991).

The obesity story shows  functioning of human beings as the product of interplay of behavioral, personal as well as influences from the environment a perception which   forms the root of the self efficacy theory.  This lady has self efficacy beliefs and the story shows how they re influenced by her surrounding like the brothers who discourage her, the doctor who is very supportive and also school mates whom her indirectly as she wants to be like them something that encourages her to adopt health behaviors as advised by the doctor .its very clear that the lady has very strong self efficacy believes which enables her to try all means possible to lose her weight. its these beliefs which encourages her to go on even when there seemed to be no results after the first time she exercised the fact that she goes on to read bout diabetes shows that she attributed her first failure to loose weight to insufficient information and its also very clear that Amanda believes that she is capable of protecting herself from diabetes and the secondary effects like loss of sight .the lady also sets long term goals to maintain the status after weight lose showing how the self efficacy beliefs she has raised her persistence and resilience .

Conclusion

The advanced nurses rely on observation, interviews with the patient, and physiological indicators in conjunction with the theory to achieve the goal of providing care in the human health care experience. It is vital that the nurse choose empirics which are suitable for the theories and the philosophic perspectives (Liehr R. & Mary S. 2008). A convergence of the theoretical perspectives with the practical applications and the knowledge of nursing helps develop a good ground upon which the nursing practice can be based and in most cases with highly satisfactory results. The necessary analysis of causative agents in sickness is a major step towards effective nursing. The interplay between social factors as well as environmental factors in human health is also put into sharp focus in analyzing and applying middle range theories. Despite the manner in which all other factors may pan out, the self efficacy theory is most important in controlling such problems that stem from ones lifestyle such as obesity and weight problems. The understanding that one needs to resolve to control habits that precipitate these problems is very important towards solving them. The importance of this story is that it demonstrates the applicability of the middle range theories not only in nursing research but also in the actual clinical application of nursing.

References

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.

Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes, 50, 248-287.

Bandura, A. (1993). Perceived self-efficacy in cognitive development and functioning. Educational Psychologist, 28, 117-148.

Bandura, A. (2001). Social cognitive theory: An agentive perspective. Annual Review of Psychology, 52, 1-26.

Liehr R.  & Mary S. (2008). Middle Range Theory for Nursing. New York :Springer publishers

Pajares.  (2002). Overview of social cognitive theory and of self-efficacy. Retreived month day, year, from http://www.emory.edu/EDUCATION/mfp/eff.html