Middle Range Nursing Theory

Middle range theories are made up of models and propositions that can be measured empirically. Nonetheless, in terms of scope, middle-range nursing theories are narrower than grand nursing theories and present an effectual link connecting grand nursing theories and nursing practice. Nursing models are based on a number of things with the first one being needs. Such models aim at assisting individuals to accomplish their physical along with mental needs. Nonetheless, these models have one shortcoming in the sense that they predominantly rely on the medical model of health and at the same time places the patient in an explicitly reliant position. Another type of middle range deals with the relationships and interactions nurses form with patients.

The other middle range theory in nursing is based on the outcome. Principally, the theory treats nurses as the changing power which enables individuals to adjust to or deal with ill health.
Education
Critical Reflection
The main aim of nursing is to maintain a patient’s health in the best state possible. Such an objective can only be realized through understanding the phenomenon in question based on nursing research, application, as well as theory. One of the most used concepts in health-related research is self-efficacy. Self - efficacy theory (1977) originated from Dr. Bandura’s Social Cognitive Theory.
Semantic clarity: The Theory of Self-efficacy states that self-efficacy expectations and ending expectations are subjective to behavior and verbal support, physiological atmosphere and contact with models or self-modeling (Resnick and Spellbring). Self-efficacy, broadly speaking, is a belief or collection of people’s beliefs that determine a person's ability to autonomously exert goal-oriented behavior and, consequently, influence the most important aspects of his or her life. It can determine how an individual feels, thinks and emote oneself in concern to its’ health. Self – efficacy also influences enthusiasm and behavioral conducts regarding health. It assists people to put in effort and achieving their goals with flexibility irrespective of the failures encountered.
Semantic consistency: Self-efficacy is mostly used in cases that require self-management and self-care.

Consequently, self-efficacy has been identified as an important forecaster of successful and efficient self-management. As a matter of fact, increasing self-efficacy is usually taken to be an imperative intermediary of the effects of physical activity interventions. Bearing in mind that the foregoing are demonstrated realities in the lives of typical representatives of the population at large, it follows logically that nursing patients -- who by definition are facing looming obstacles in the form of their health woes -- are particularly in need of cognitive tools that give them something to hope for and therefore to aim for. This is where self-efficacy theory steps in, and based on the preceding discussion it may be taken as incontrovertible fact that patients who are unable to harbor self-efficacious beliefs in some, and perhaps most, cases are poor candidates for a return to full health, unless they happen to be ailing from a condition that may resolve spontaneously or more slowly without intervention from patents themselves. (Bandura, 1994)

Structural clarity: The self-efficacy model is of tremendous applicability in a nursing setting. Dr. Bandura notes that even ordinary social situations are typically fraught with things most people simply balk at confronting. Research and analysis identified specific ways in which behavior change techniques (BCTs) were connected with increases in self-efficacy as well as physical activity for healthy people. Self-efficacy is the relationship between the cognitive processes of individuals and the impact of environmental factors on accomplishing their goal irrespective of the

obstacles.
Structural consistency: On its own, knowledge is not a satisfactory forecaster of an individual’s capability to integrate the required self-care behaviors into their daily activities of their normal living. Dr. Bandura’s design of the self-efficacy model aimed at analyzing the role of self-referent thought in intellectual and psychosomatic functioning. Although his self – efficacy model was implemented for different studies but it produced similar results for them. As a result, the main structure of the self – efficacy model remain consistent for all types of studies he performed. His arduous nature towards the exploration of self-efficacy model led to the advancement of nursing field.
Simplicity or Complexity: In simplicity, self-efficacy affects the efforts that people wish to offer and establishes the determination of the efforts in reference to failures and obstacles. In reality the stronger the perceived self-efficacy, the more enthusiastic and determined are the efforts. People are predisposed to evade tasks that they feel surpass their coping skills, but they take on activities they consider that they are confidently able to handle. In complexity, nurses are charged with the responsibility of making them believe that they can achieve. There are four major sources of information for perceived self-efficacy. First, there is the principle active attainment. The principle is based on past experiences and is the most dominant front of efficacy information (Liu, 2012). On the other hand, vicarious experience is the visual understanding observes other fruitfully performing similar behaviors. Verbal persuasion involves verbal support made to encourage people of their abilities to accomplish what they are searching for. Last is the physiological state which can affect the level of self-efficacy when individuals read their somatic symptoms based on aversive encouragement. However, these theories are too abstract and hard to put into practice.
Generality: The ways in which self-efficacy theory apply in nursing section are many and varied indeed. Again, however, it cannot be overemphasized that belief is the cornerstone of patient management in this context. People are more likely to undertake a desirable behavior if they believe the behavior will, in fact, affect the outcome they desire. They must also believe that they can successfully carry out that behavior. As Bandura (1994) points out, courses of action are initially organized in thoughts and beliefs, which determine the kinds of anticipatory scenarios that they construct and rehearse -- that they visualize. Those who apply self-efficacy visualize success scenarios, which continually feed a stream of positive guides and supports for performance. (Bandura, 1994)
Accessibility: Self – efficacy theory originated from the social cognitive theory of Bandura’s. With increasing attention in medical field, this theory is broadly applied in behavior change. In addition, the theoretical concepts of self – efficacy are used in the behavioral psychiatric therapy for depression, bipolar disorder etc. Furthermore, the analysis and evaluation of self – efficacy theory is imperative to stimulate behavior variations in dental clinical practice. Thus, the scope of self – efficacy theory can be extensively applied as a precursor of understanding of the patient’s health.
Importance: Research is consistently evident as Bandura implemented his theory of self-efficacy for different studies yet received similar results. Self-efficacy theory model aims at assisting individuals to accomplish their physical along with mental needs. It is increasingly becoming popular because of its frame work for many research studies. It helps to assess a wide ranging sense of individual capability to efficiently deal with stressful situations. According to Bandura (1989) the importance of self-efficacy as “an important set of proximal determinants of human motivation, affect, and action” (p. 1175). These beliefs create a form of action through motivational, intellectual, and emotional superseding processes.
Empirical Evidence: Empirical evidence in general diabetes management, diet therapy, and insulin administration a positive correlation between self-efficacy and management of diabetes. In a research conducted using Likert scale ranging from 1 (strongly agree) to 6 (strongly disagree), and with 18 positive-worded items are reverse-scored, with a higher score indicative of higher level of self-efficacy. From the research Ting ting Liu 2008 identified four characteristics of self-efficacy. First was the cognitive acknowledgment of essential particular techniques and skills necessary to assume diabetes self-management. Second was the apparent potential outcome of self-management. The third was self-confidence in the ability to carry out self-management and lastly sustained efforts in self-management of diabetes. Therefore, self – efficacy has been an essential contributing factor in self – management among senior people with diabetes. Thus decision – making and solving can see an amalgamation of an application of self – efficacy keeping older adults with diabetes in concern.
The purpose of the article “Self-efficacy and self-management after stroke: a systematic review” was to analyze the after effects that self –efficacy may have on post stroke. According to the writers of the article, 22 articles from 104 article searches met the criteria to be included in the review. As per the article, self-efficacy is an important variable linked with various post-stroke outcomes. In a study of 37 elderly individuals suffering from stroke demonstrated that patients with low self-efficacy during discharge exhibited less distinct development in motor function as well as balance 10 months following discharge than those exhibiting high self-efficacy during discharge (Jones & Riazi, 2011). Henceforth, the writers of the article required further empirical evidence in order to conclude whether self – efficacy has a supplementary prognostic value over development in motor functions.
The objective of the article, “What are the most effective techniques in changing obese individuals’ physical activity self-efficacy and behavior: a systematic review and meta-analysis” was to research which Behavioral Change Techniques (BCTs) brought changes in self – efficacy and the physical activity of obese grownups. According to the results of a systematic study of 61 adults that was conducted, self – efficacy was least affected than the physical activity of individuals by BCTs. 19 BCTs were found that induced changes in the physical activities of adults. Also, no relationship was found in between self-efficacy and physical activity. As a result, physical activity behavior was more influenced by a majority of techniques whereas self-efficacy had minimal effects. It was observed by the writers of the article that mechanisms other than self – efficacy might have an increasing effect of physical activity of obese individuals.

References
Liu, T. (2012). A Concept Analysis of Self-Efficacy Among Chinese Elderly with Diabetes Mellitus.Nurs Forum, 47(4), 226-235. doi:10.1111/j.1744-6198.2012.00282.x
Olander, E., Fletcher, H., Williams, S., Atkinson, L., Turner, A., & French, D. (2013). What are the most effective techniques in changing obese individuals’ physical activity self-efficacy and behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act, 10(1), 29. doi:10.1186/1479-5868-10-29
Smith, A. (2005). Middle Range Theory for Nursing. Clinical Nurse Specialist, 19(1), 49. doi:10.1097/00002800-200501000-00015
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