Identify explicit and/or implicit assumptions (values/beliefs) underlying the theory. On what major assumptions does the theory build? Examine if the theory has a description of the four concepts of the nursing metaparadigm. If so, how are they explained in the theory If the metapardigm is not explained, what elements do you see as relevant to the theory, and why Discuss the clarity of the theory. Did it have lucidness and consistency?
The Middle-Range Theory of Self-Care of Chronic Illness has been used widely since it was first published in 2012. With the goal of theoretical refinement in mind, we evaluated the theory to identify areas where the theory lacked clarity and could be improved. The concept of self-care monitoring was determined to be underdeveloped. We do not yet know how the process of symptom monitoring influences the symptom appraisal process. Also, the manner in which self-care monitoring and self-care management are associated was thought to need refinement. As both of these issues relate to symptoms, we decided to enrich the Middle-Range Theory with knowledge from theories about symptoms. Here, we propose a revision to the Middle-Range Theory of Self-Care of Chronic Illness where symptoms are clearly integrated with the self-care behaviors of self-care maintenance, monitoring, and management.
The Middle-Range Theory of Self-Care of Chronic illness has gained the attention of clinicians and researchers worldwide, already resulting in 244 citations in the 6 years since publication. Work to date on the theory has successfully described the process of self-care behaviors in various populations and identified numerous factors affecting the self-care process. Middle-Range Theory Report Assignment Paper
As described in the original theory, self-care is performed in both healthy and ill states. It is important to note that everyone engages in some level of health-promoting self-care daily. However, self-care might have another meaning to patients with a chronic illness, since living optimally with a chronic illness often requires a set of behaviors to control the illness process, decrease the burden of symptoms, and improve survival.
Self-care is essential in the long-term management of chronic illnesses, and the purpose of the Middle-Range Theory of Self-Care of Chronic Illness was to capture a holistic view of the manner in which patients with varied or multiple chronic conditions care for themselves. Self-care influences both clinical and person-centered outcomes in patients with chronic conditions. Those who engage more effectively in self-care have better quality of life, lower hospitalization rates, and less mortality than those who report poor self-care.
In the Middle-Range Theory of Self-Care of Chronic Illness, self-care is defined as a process of maintaining health—the central phenomenon—through health-promoting practices and managing illness. These behaviors are performed in both healthy and ill states. Self-care can be seen as an overarching construct built from the 3 key concepts of self-care maintenance (eg, adherence to self-care behaviors such as regular exercise and taking medication as prescribed), self-care monitoring (eg, regular measurement of changes, routine testing), and self-care management (eg, changing the diet or medication dose based on detection and interpretation of symptoms). The 3 concepts of self-care maintenance, monitoring, and management are closely related; therefore, the performance of sufficient self-care encompasses all 3 behaviors.
For patients with chronic disease, it may be necessary to regulate and adapt self-care during the course of the disease, for example, with illness exacerbation, if a comorbid illness occurs, or if an advanced treatment is needed. The goal of self-care maintenance is to maintain health and prevent symptom exacerbations, the goal of self-care monitoring is recognition that a change has occurred, and the goal of self-care management is effective treatment of symptoms.
Self-care behaviors reflect a sequence that builds on a foundation of self-care maintenance. That is, most patients first master self-care maintenance and later build expertise in self-care monitoring and management. People who perform all 3 behaviors are most proficient in self-care. However, for a variety of reasons, people with chronic illness often skip elements of the process, leading to problems in the successful performance of self-care. Middle-Range Theory Report Assignment Paper