NURS 8110 Week 10 Assignment Paper

Middle Range or Interdisciplinary Theory Evaluation- Major Assessment

As addressed this week, middle range theories are frequently used as a framework for exploring nursing practice problems. In addition, theories from other sciences, such as sociology and environmental science, have relevance for nursing practice. For the next few weeks you will explore the use of interdisciplinary theories in nursing.

This Assignment asks you to evaluate two middle range or interdisciplinary theories and apply those theories to a clinical practice problem (Spiritual beliefs of mental health linked to medication non-adherence). You will also create a hypothesis based upon each theory for an evidence-based practice project to resolve a clinical problem. NURS 8110 Week 10 Assignment Paper

To prepare:

• Review strategies for evaluating theory presented by Fawcett and Garity in this week’s Learning Resources.
• Select a clinical practice problem that can be addressed through an evidence-based practice project
• Consider the middle range theories presented this week, and determine if one of those theories could provide a framework for exploring your clinical practice problem. If one or two middle range theories seem appropriate, begin evaluating the theory from the context of your practice problem.
• Formulate a preliminary clinical/practice research question that addresses your practice problem.
• Briefly describe your selected clinical practice problem.
• Summarize the two selected theories. Both may be middle range theories or interdisciplinary theories, or you may select one from each category.
• Evaluate both theories using the evaluation criteria provided in the Learning Resources.

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• Determine which theory is most appropriate for addressing your clinical practice problem. Summarize why you selected the theory. Using the propositions of that theory, refine your clinical / practice research question.

Mental illness is associated with several factors that include genetic predisposition, substance abuse, infections, and perinatal complications. Other possible causes are beliefs with a cultural, spiritual, and or social predisposition. These beliefs vary from one society to another. Over time, the spiritual belief has been more common among believers of supernatural beings or forces.  Theory frameworks explored in the literature include the Health Belief Model and Neuman’s System Model. Both theories support the literature related to individual belief system and individual perception about life and health.

Key words:  spiritual beliefs, mental illness and medication non-adherence

Spiritual Beliefs, Mental Health, Medication Non-Adherence

Clinical Practice Problem

Spirituality is an essential dimension of mental health. It can impact coping, insight, and perceptions of the need for medication adherence positively. As such, people who hold a spiritual belief and still do not interfere with other forces of nature can easily transit the illness-wellness continuum (Choudhry et al, 2016). This is because medicine dictates the ill-health require medical interventions that have been well researched, and guidelines already exist. Therefore, integrating both spiritual beliefs into medical intervention can improve the wellbeing of an individual. However, this particular problem shows a deficiency of information or misinformation. This is because the patient does not adhere to medicinal prescriptions, believing that only a spiritual intervention is needed, or does not entirely believe that medications will not heal.

Spirituality can adversely affect mental health and damage medication adherence as patients and families take a passive role in health care. According to Ho et al. (2016), participants believed that a higher power being/god controlled their family members’ illnesses. Those who expressed this control belief were 4.75 times more like to have low or non-adherence to medication than those who did not (Choudhry et al, 2016). The control belief makes some patients believe that their mental diagnosis is God’s will or a punishment from God. Health care providers should assess and address patients’ spiritual needs, primarily through engaging spiritual care providers to optimize mental health.

Health Belief Model

The Health Belief Model is selected as a theory, which can provide a theoretical framework for addressing spiritual beliefs in mental health. Social scientists in the United States Public Service founded this model in the early 1950s. They developed it to understand why people did not adopt disease prevention approaches or early detection of illnesses. The health belief model (HBM) was later used to evaluate patients’ responses to disease and compliance with medical care interventions. The model proposes that the client’s belief in the threat of illness and the effectiveness of recommended medical care will predict treatment success (Maheri et al., 2017). The client’s beliefs will predict the likelihood that they will adopt the proposed interventions. NURS 8110 Week 10 Assignment Paper

Theorists believed that psychological and behavioral components affect health behavior. These components desire to get well or avoid illness, and they believe that certain health actions will cure or prevent illness. Subsequently, the patent and family’s health care decision will depend on perceptions of benefits and barriers related to health actions. The four constructs of HBM are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cue of action, and self-efficacy. Perceived susceptibility is assessment of vulnerability to a particular health problem. Perceived severity is individual insight of an adverse outcome from a particular event. Perceived benefits on the other hand is the perception of positive outcome from an action and finally, perceived barriers refers to identified obstacles for change. The theory has several limitations, such as it does not consider environmental factors that may promote or inhibit the recommended health behavior (Maheri et al., 2017).. The model assumes that everyone has an equal amount of information on the disease.

Neuman’s Systems Model

Neuman’s Systems Model can provide a theoretical framework on how mental-health related spiritual beliefs affect medication adherence. Betty Neuman’s describes the Systems Model as an open- system-based viewpoint that provides a unifying effort for approaching numerous concerns. A system is a social issue that acts as a boundary for a single person, a group, or groups. The open client system interacts with the environment and outlines the field of nursing concerns. The theory focuses on the patient system’s response to actual or potential stressors from the environment. The stressors arise from internal, external, or created environments. One of the theory’s concepts is content, which encompasses a person’s variables concerning their interaction with the environment (Bademli & Duman, 2017).

The client’s system has protection from lines of resistance, which protects its core structure. The usual level of health is the standard line of defense, which is flexible. Several known and unknown stressors of varying potential can disturb the standard line of defense. When stressors overpower the defense line, the lines of resistance are triggered to move the system into wellness. The system requires adequate energy to achieve reconstitution with its line of defense. The model also focuses on nursing interventions in primary, secondary, and tertiary prevention. The nursing prevention interventions aim at retaining, attaining, and maintaining patient system wellness.

The theory assumes that each person has a unique client system with characteristics with a specific range of responses. Each client is a dynamic composite, which can move in any direction across the wellness-illness continuum. The internal resistance factors stabilize and realign the client into a normal wellness state. In theory, significant concepts include a human being who is an open-system interacting with the internal and external environment. The environment is a factor that affects the system. According to the theory, health is the degree of system stability. When the system needs are satisfied, optimal wellness exists. When emery to support life is unavailable, death occurs. Nursing interventions help the system adapt, adjust, retain, restore, or maintain stability among the client system variables. The nursing interventions act on stress-related situations or possible client system reactions to the stressors (Bademli & Duman, 2017). The concept of an open system describes a continuous flow of input, process, output, and feedback resulting from the interaction of elements.

Theory Framework Evaluation

Systems theory illustrates the effects environment on the health of the system. In this context, the patient is the system with a defense line, which can be altered by stressors from the environment. The theory has clinical significance as it outlines the importance of spiritual beliefs on the system’s mental health. A person can achieve complete mental health when internal and external stressors do not disturb their psychological or physical wellbeing. Additionally, the system (individual or group) can have a mental illness resulting from idiopathic to known causes. The line of resistance or action is taken to cure the condition depending on the patient or family’s knowledge and awareness about mental health. For some people, mental illness warrants intervention from faith or miracle healers. In this context, opting for spiritual intervention is the system’s resistance line (Bademli & Duman, 2017). Seeking spiritual healing can result from a lack of awareness about medical interventions, ignorance, or faith in healing’s supernatural power. NURS 8110 Week 10 Assignment Paper

Neuman’s theory is significant in clinical practice because it provides care providers with a comprehensive assessment, including patient stressors. The theory explains to the nurse how different levels of prevention can be used to address spiritual beliefs on mental health, which affect medication adherence. Conventionally, the line of resistance against alteration of the normal state of health seeks medical or professional intervention (Bademli & Duman, 2017). Medication or other medical therapies prescribed for a patient who believes in spiritual healing would be futile if the care provider does not offer adequate patient and family teaching.

HBM is a middle-range theory with six constructs which describe how patient consider different aspects of a health behavior before adopting it. The theory is significant in addressing spiritual beliefs on mental health and how they link with medication non-adherence. This theory is applicable in studying spiritual beliefs of mental health as it outlines several patient factors that affect health behavior. One of the constructs, perceived benefits, delineates a person’s perception of health behavior effectiveness. A person’s spiritual beliefs about mental health may make them consider non-medical interventions to treat the illness. When the patient or family of the ill person perceives that the available medical intervention is ineffective, they may easily avoid medication adherence (Maheri et al., 2017). Under the construct, the course of action that a person takes in curing an illness is dependent on the evaluation of perceived benefits and perceived susceptibility.

HBM has been tested in several studies, and it has proved that spiritual beliefs affect health behavior. The laypersons’ attitudes and beliefs about mental health are shaped by knowledge, cultural stereotypes, and spiritual beliefs. Spiritual teachings influenced beliefs about the nature and origin of mental illness. According to a meta-synthesis conducted by Choudhry et al. (2016), people attributed mental health to be a blessing from a spiritual connection with God.

Some people attributed mental illnesses to supernatural and spiritual origins. People attributed mental disorders to wrath from God, evil spirits, and curses. The review of studies revealed about health-seeking behavior of people with mental illness. Some people may be discouraged from seeking medical, psychological, or any professional treatment because of the perceived susceptibility to evil spirits, curses, and or the wrath of God for evil doing. Therefore, they link their susceptibility to benefits. Likely, the patient perceives that seeking spiritual intervention will help cure the illness and not the doctor’s medication. However, from the understanding, such a condition will need professional management and not spiritual intervention as the primary intervention. Over time, the patient will notice that the situation does not change; instead, it worsens. This is when the illness’s perceived severity will strike the patient (Maheri et al., 2017). As such, the patient may be triggered to seek medical intervention because their perceived benefits are no longer sufficient.

The Health Belief Model directs care providers to consider the patient and family’s level of information about mental health. Lack of awareness about mental health treatment can make some believers despise medications prescribed by medical practitioners. Choudhry et al. (2016) highlight how spiritual beliefs affect medication adherence. If a patient who believes in spiritual healing opts to seek medical intervention for their mental illness, they can easily avoid the prescribed medications. Mostly, such beliefs are present n marginalized populations who lack correct information about mental health. Consulting faith and spiritual healers from different cultures are common among these populations (Grove et al., 2012).

Application to Clinical Practice Problem

Nursing practice is a professional body that is both a science and an art. Art and science are interdependent and are continuously evolving. The evolution of these two vital segments has been promoted by evidence-based nursing practice (McEwen et al., 2017). Use of nursing theories is an essential process of evaluating the effectiveness of science in solving the clinical problem. There is an advanced form of nursing science that uses an evidence based practice to to review existing knowledge and practice. This advance form promotes progress in the career and solving clinical concerns in the field (McCurry et al., 2010). Clinically, theories are significant in understanding the nature of the clinical problems and provide a structure for addressing each concern. This is why nursing research utilizes theories of nursing extensively. Existing nursing theories are dynamic and provide an overview of almost all nursing program challenges, right from academic to clinical sector. Therefore, identifying a specific theory that addresses the challenge within the practice area is essential (Saunders & Garity, 2009). NURS 8110 Week 10 Assignment Paper

In this clinical problem, both Neuman’s theory and HBM provide a framework that analyses the problem critically showing how personal beliefs can interfere with s treatment plan.  HBM is the theory of choice because it posits that the six constructs predict an individual’s health behavior and fit diverse cultural contexts. Therefore, nurses and other care providers should utilize this theory to define their patients’ health behaviors and develop effective interventions to manage their needs (Maheri et al., 2017). In this clinical problem, care providers identify a knowledge deficit as a perceived barrier to the patients’ health and the delivery of care. As such, the most appropriate intervention is to address the barrier. The care provider may consider educating the family or the patient. This will promote understanding and improve the patients’ health behavior, which efficiently promotes care delivery. Additionally, it alleviates their fears regarding perceived benefits or barriers to health behavior, promoting optimal health achievement. The propositions of this model can be used to answer the research question on whether spiritual beliefs about mental health affect medication non-adherence.

References

Bademli, K., & Duman, Z. C. (2017). Conceptual framework for nurses in the use of the Neuman Systems Model on caregivers of people suffering by schizophrenia. International Archives of Nursing and Health Care, 3(3), 1-5.

Choudhry FR, Mani V, Ming LC, Khan TM. Beliefs and perception about mental health issues: a meta-synthesis. Neuropsychiatry Dis Treat. 2016; 12:2807-2818 https://doi.org/10.2147/NDT.S111543

Grove, S. K., Burns, N., & Gray, J. (2012). The practice of nursing research: Appraisal, synthesis, and generation of evidence. Elsevier Health Sciences.

Ho, R. T. H., Chan, C. K. P., Lo, P. H. Y., Wong, P. H., Chan, C. L. W., Leung, P. P. Y., & Chen, E. Y. H. (2016). Understandings of spirituality and its role in illness recovery in persons with schizophrenia and mental-health professionals: a qualitative study. BMC psychiatry, 16(1), 86.

Maheri, A., Tol, A., & Sadeghi, R. (2017). Assessing the effect of an educational intervention program based on Health Belief Model on preventive behaviors of internet addiction. Journal of education and health promotion, 6, 63. https://doi.org/10.4103/jehp.jehp_129_15

McCurry, M. K., Revell, S. M. H., & Roy, S. C. (2010). Knowledge for the good of the individual and society: linking philosophy, disciplinary goals, theory, and practice. Nursing philosophy, 11(1), 42-52.

McEwen, M., & Wills, E. M. (2017). Theoretical basis for nursing. Lippincott Williams & Wilkins.

Saunders Elsevier. Fawcett, J., & Garity, J. (2009). Chapter 6: Evaluation of middle-range theories. Evaluating research for evidence-based nursing (pp. 73-88). Philadelphia, PA: NURS 8110 Week 10 Assignment Paper