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Hi, I am attaching the exact guidelines to this email. PLEASE look over them VERY CAREFULLY so the assignment is done correctly. The first attachment is the grading criteria. Please use the following theory as I was assigned it… I was assigned: Shana Spratt Leininger’s Cultural Care Theory
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MID-RANGE or NURSING PRACTICE THEORY PRESENTATION
GRADING CRITERIA
PowerPoint Presentation: You should complete this assignment by preparing and presenting a
5-10 minute PowerPoint presentation with voiceover OR a recorded Zoom presentation. In
addition to your textbook, you must use two (2) additional references.
Avoid using only word-for-word information from the text – Use your own words, as well
as textbook information, to explain the following:
Background of the Theorist/Theory (brief synopsis) (15%)
Purpose and Major Concepts (20%)
Context for Use and Nursing Implications (20%)
Evidence of Empirical Testing and Application to Practice (20%)
Annotated Bibliography reference (5%)
• Identify a nursing research article that uses the mid-range or nursing practice
theory that your presentation discusses. Create an annotated bibliography on a
slide at the end of the presentation (before your reference slide).
•
Examples of annotated bibliographies:
http://guides.library.cornell.edu/annotatedbibliography
https://owl.english.purdue.edu/owl/resource/614/01/
APA & Grammar/Spelling (10%) You must include APA formatted citations within your
slides when warranted. Additionally, you should include an APA formatted reference
slide. No grammar or spelling errors.
Quality of PowerPoint slides (5%)
Slides are professional in appearance
Presentation Skills (5%)
Speaker uses a clear, audible voice. Delivery is poised, controlled, and smooth. Good
language skills and pronunciation are used. Length of presentation is within the assigned time
limits (5-10 minutes).
Elms College School of Nursing
MSN Program
NUR 5005 Nursing Knowledge and Practice – Fall 1 2023
Mid-Range and Nursing Practice Theory Presentation Assignment
Professor: Dr. Laurie Downes
Week 6 Presentation: Please create a PowerPoint with voice over or recorded Zoom presentation of
your assigned theory. Upload in Moodle.
Name
Shana Spratt
Theory
Leininger’s Cultural Care Theory
Kayla Cardona
Meleis Transitions Theory
Winnie Olivo
Kolcaba’s Theory of Comfort
Advances in Nursing Science
Vol. 42, No. 3, pp. 206–215
c 2019 The Authors. Published by Wolters Kluwer Health, Inc.
Copyright
Integrating Symptoms Into the
Middle-Range Theory of
Self-Care of Chronic Illness
Downloaded from https://journals.lww.com/advancesinnursingscience by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3wX04VDhDA67eAI3DnCyu4CWEnAA9qjJGuH/5uHUzwvQ= on 09/08/2019
Barbara Riegel, PhD, RN, FAAN; Tiny Jaarsma, PhD, RN, FAAN;
Christopher S. Lee, PhD, RN, FAAN; Anna Strömberg, PhD, RN, FAAN
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.
Key words: nursing theory, self-care, symptoms
N
URSING theory and nursing research are
engaged in a dance that moves each forward with the goal of advancing nursing sci-
Author Affiliations: School of Nursing, University
of Pennsylvania, Philadelphia (Dr Riegel);
Department of Social and Welfare Studies
(Dr Jaarsma), and Department of Medical and
Health Sciences, Division of Nursing (Dr Strömberg),
Linköping University, Linköping, Sweden; and
Connell School of Nursing, Boston College, Boston,
Massachusetts (Dr Lee).
The authors gratefully acknowledge Karen Huss, PhD,
RN, FAAN, for her review of a prior version of this
article.
This is an open-access article distributed under the
terms of the Creative Commons Attribution-Non
Commercial-No Derivatives License 4.0 (CCBY-NC-ND),
where it is permissible to download and share the
work provided it is properly cited. The work cannot
be changed in any way or used commercially without
permission from the journal.
The authors have disclosed that they have no significant relationships with, or financial interest in, any
commercial companies pertaining to this article.
Correspondence: Barbara Riegel, PhD, RN, FAAN,
School of Nursing, University of Pennsylvania,
418 Curie Blvd, Philadelphia, PA 19104 (briegel@
nursing.upenn.edu).
DOI: 10.1097/ANS.0000000000000237
206
ence. Nursing theory is defined as “a creative
and rigorous structuring of ideas that project a
tentative, purposeful, and systematic view of
phenomena.”1(p155) Nursing research refers to
research that provides evidence used to support nursing practice. Nursing theory needs
to be based on and driven by research, and,
in turn, nursing research needs to be derived
from and contribute to theory if we are to
successfully explain and predict patient experiences surrounding health and illness.
The theory-data cycle of development specifies that the empirical data derived from research serve to develop, revise, and refine
theory whereas theory helps shape research
questions, establish hypotheses, develop interventions, and select outcome variables
(Figure 1). Theoretical propositions posed to
describe or explain a complex reality can be
tested in research, and the results of these
studies can be used to further alter, expand,
modify, or refine theory. Even in established
and well-tested nursing theories, propositions
remain tentative. When new research accumulates, theories may be revised or refined
with the goal of creating solid evidence-based
Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness
Statement of Significance
• We know that self-care involves a
process of health maintenance,
monitoring for changes in signs
and symptoms, and management
of those changes when they
occur.
• We know that symptoms
influence self-care behaviors.
• This article describes how
symptoms influence self-care
behaviors. Specifically, this
article describes the importance
of symptom detection,
interpretation, and response as
core elements of the self-care
process.
knowledge useful for guiding clinical practice. In this approach to theory development,
there is a need for exploration, refinement,
and critical reflection on the place and value
of existing concepts and the need for expanding or developing others.
With the goal of theoretical refinement
in mind, the purpose of this article was to
evaluate the Middle-Range Theory of Self-Care
Figure 1. Graphic illustration of the manner in which
the theory-data cycle of development builds science.
Research questions are derived primarily from existing research literature. When these questions are
tested empirically, the research findings are used to
develop, revise, and refine theory. Theory helps shape
subsequent research questions, establish hypotheses,
develop interventions, and select outcome variables.
207
of Chronic Illness2 to identify areas where
empirical tests of the theory are likely to be
problematic. We used Weber’s3 framework
for theory development and evaluation to
determine where the Middle-Range Theory
of Self-Care of Chronic Illness2 lacked clarity
so that we could rectify issues by integrating
concepts from other models and theories.
CURRENT STATE OF THE
MIDDLE-RANGE THEORY OF SELF-CARE
OF CHRONIC ILLNESS
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.4-6
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 Illness2 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,7-9 lower hospitalization rates,10-13
and less mortality than those who report poor
self-care.14
In the Middle-Range Theory of Self-Care
of Chronic Illness,2 self-care is defined as a
process of maintaining health—the central
208
ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2019
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), selfcare 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.2 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 selfcare 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.
After a thorough analysis of existing parts
of the theory (eg, concepts, associations), we
identified 2 important issues needing further
development. First, the concept of self-care
monitoring was determined to be underdeveloped. Relatively, little research has been conducted on the process of self-care monitoring,
so more research may reveal what patients
think about monitoring (eg, their response
to engagement in body listening and routine
appraisal for bodily changes) if monitoring of
signs (eg, blood pressure) differs from that of
symptoms (eg, fatigue). We do not yet know
how the process of monitoring interacts with
the appraisal process. Are patients who monitor routinely more adept at judging changes?
We anticipate that more research will lead to
further revisions of the theory in the area
of self-care monitoring. Second, the manner
in which self-care monitoring and self-care
management are associated is underdeveloped in the existing theory. Logically, those
who do not monitor well probably do not
management well, but this hypothesis has not
been tested. As the Middle-Range Theory of
Self-Care of Chronic Illness aims to describe
and explain the process of maintaining health
within the context of the symptom management required of those with a chronic illness
and their families,2 we decided to enrich the
theory with knowledge from other theories
about symptoms.
DESCRIPTION OF SYMPTOM THEORIES
There are numerous classic symptom theories used to guide research in nursing
and related disciplines. We considered the
Dynamic Symptom Model,15,16 the Theory
of Unpleasant Symptoms,17 the Model of
Pathways to Treatment,18 the Illness Action
Model,19 the Symptoms Experience in Time
Model,20 the Situational Adaption Model,21
Self-Regulation Theory,22 the Symptom Interpretation Model,23 the Cognitive Perceptual
Model of Symptom Perception,24 Cue Competition Theory,25 Kolk’s Symptom Perception Model,26 and the Psychophysiological
Comparison Theory,27,28 because they complement the central arguments of the MiddleRange Theory of Self-Care of Chronic Illness in
their description of symptoms or position selfcare as an antecedent or consequence related
to symptoms. Below we describe elements of
the major symptom theories in nursing.17,29,30
In general, these theories aim to explain and
predict symptoms as well as to describe how
patients and caregivers appraise and act to
control symptoms when they occur.
Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness
209
Self-care and symptom theories often address the same concepts. In the Dynamic
Symptom Model,15,16 self-care is described
as an antecedent of the symptom experience, symptom trajectory, and symptom consequences. However, self-care is not specially
mentioned as an element of the intervention
strategy to relieve symptoms. In the MiddleRange Theory of Self-Care of Chronic Illness,
symptoms are described as important to monitor and as giving direction to self-care management behavior. That is, when symptoms
increase, patients can use different management strategies, such as changing medication
or diet or consulting a clinician. Detection, interpretation, and response are important elements of many symptom appraisal theories,31
and these concepts are vital parts of self-care
monitoring and management in the MiddleRange Theory of Self-Care of Chronic Illness.
the detection of bodily changes.31 Bodily
changes may be localized (eg, mid-sternal
chest pain) or generalized (eg, fatigue) and
can be detected by any of the body’s senses.
Theoretical discussions of symptoms specify
that detection of bodily changes may reflect a
difference in intensity and/or frequency of the
patient’s normal sensations that is sufficient
in magnitude, novelty, or significance to be
perceived.18,31 Detection of bodily changes
causes a disturbance in equilibrium19 that
drives patients to engage in self-care.32 As
symptoms are detected, they must be interpreted with meaning applied to bodily
changes, labeling them as symptoms. By definition, if a bodily change is not perceived, it
is not a symptom.
The symptom experience
The interpretation of bodily changes frequently involves characterizing the change
and applying meaning. As an example of characterization, Lenz et al17 defined symptoms as
entailing intensity (ie, severity, strength, and
amount), quality (ie, what a symptom feels
like, and location), duration (ie, frequency
and duration of intermittent and persistent
symptoms, and the temporal relationship between symptoms and activity), and distress
(ie, the degree to which the person is bothered by the symptom(s)—reflective of how
the patient interprets and experiences the
meaning he or she assigns to it). Armstrong30
defined the symptom experience as the perception of the frequency, intensity, distress,
and meaning of symptoms as they are produced and expressed. Furthermore, Henly
et al20 defined the symptom experience as
a flow process of evaluating and reevaluating
symptom perception, timing, distress, intensity, and quality.
A salient theme across multiple symptom
theories is that multiple symptoms frequently
occur simultaneously and are multiplicative17
or catalytic in effect.30 Moreover, certain
symptoms (particularly those that are serious, unpleasant, or inexplicable)20 draw
Across existing symptom theories, symptoms are defined as subjective physical or
mental experiences, appraised and defined by
the patient, and reflective of an altered health
state or change therein. For example, Lenz
et al17 defined symptoms as subjective experiences and indicators of change in function
as experience by the person. Dodd et al29 defined symptoms as based on the perception of
the individual experiencing the symptom and
his or her self-report. Armstrong30 stated that
each symptom was individually defined by the
patient. Insights from numerous lines of inquiry related to symptoms can be synthesized
into the categories of detecting, interpreting,
and responding to bodily changes (ie, symptoms). In the following section, we focus our
attention on the detection and interpretation
of bodily changes as symptoms. We address
the response to symptoms as they occur during self-care, as described in the Middle-Range
Theory of Self-Care of Chronic Illness.
Detecting bodily changes as symptoms
Several symptom theories are explicitly focused on symptom appraisal and start with
Interpreting bodily changes
as symptoms
210
ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2019
more energy in interpretation and eventual
management.
With respect to the meaning applied to
symptoms, bodily changes may be interpreted within social and cultural norms21 ;
this can lead to stoicism or concealment of
certain symptoms and overexpression of others as a function of what is perceived to
be acceptable. Bodily changes may be interpreted as a function of emotion and illness
representations22 including attribution (eg, fatigue from heart failure vs pulmonary disorder vs a normalized function of aging).22-24
Thus, the condition to which a symptom is attributed by the patient is inextricably linked
to the meaning that is applied to the experience. Bodily changes may be interpreted
differently depending on cognitive resources
and external sensory input24-26 ; this includes
external stress that may cause patients to be
unaware of major body changes. Finally, bodily changes may be interpreted on the basis of motivation to maintain physiological
stability.27,28
Recently, Whitaker et al31 harmonized findings across many symptom theories to
categorize antecedents preceding the detection and interpretation of bodily changes
as knowledge (ie, familiarity, awareness,
or understanding of bodily sensations acquired through experience or education),
attention (ie, focusing on relevant stimuli
while ignoring distractors), expectation
(preexisting beliefs, contextual biases,
and general heuristics or shortcuts), and
identity (ie, distinct characteristics of an
individual and his or her role in society).
Specific to nursing symptom management
theories, antecedents to interpreting bodily
changes have been categorized as being
physiological/disease-health related,17,20,29,30
personal,20,29,30 psychological,17,29 situational/ environmental,17,20 sociological,29
and developmental factors.29
Simply put, the process of detection, characterization, and meaning applied to bodily
changes as symptoms is complicated. Hence,
it is not surprising that the interpretation of
bodily changes may be inaccurate (ie, mis-
interpretation of a bodily change or the absence thereof as a symptom)25,31 and highly
variable among patients living with the same
condition. Importantly, there is room for improvement in how the detection and interpretation of bodily changes as symptoms are
incorporated into theories of self-care, which
we address further in our discussion of future
research.
Example integration of self-care and
symptom theories
In the following, we provide an example
to illustrate how to link the self-care perspective with the symptom management perspective. What would it look like if we studied
heart failure from a self-care perspective? The
patient with heart failure commonly experiences a variety of disabling symptoms that
are exacerbated by missing medication doses,
dietary indiscretions, and failure to maintain
an active lifestyle. Using a self-care perspective, the patient and the clinician would focus on self-care with the goal of preventing symptoms. That is, symptoms are something to be avoided and self-care is a primary
means of doing so. If symptoms occur, poor
self-care might be suspected. The clinician
might focus an assessment on reasons for poor
self-care and interventions to improve various aspects of self-care, including monitoring of symptoms and responding to symptoms
when they occur. Without more in-depth information on the symptoms experience, the
patient and the clinician might overlook the
complexity of symptom clusters33,34 and the
different dimensions of the symptom experience. Advice might be focused on “what
actions to take with this specific symptom”
without seeing the total picture of how symptoms and the management of symptoms with
self-care might interact. For example, increasing diuretics in response to dyspnea—a common self-care intervention—without considering the diurnal variation of the symptom
experience could affect sleep patterns.
What would it look like if we studied
heart failure from a symptom perspective?
Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness
Using symptom theory to guide care, attention would be given to the symptom itself
(eg, severity and interference thereof) rather
than addressing why it occurred. As noted in
the National Institutes of Health (NIH) Symptom Science Model, complex symptoms,
sequelae, and clusters of symptoms are
studied through a disease agnostic lens.35
The symptom phenotype is characterized
using physiologic and biologic measures
derived from genomics, proteomics, and
metabolomics (ie, omics). Thorough understanding of the symptom experience may result, but the patient and the clinician also
might overlook other important aspects of
the situation that are not directly related to
the symptom experience. For example, as described in a recent qualitative study, missing
medication doses or dietary indiscretions may
not be suspected if not temporally related to
the symptom experience.36
What would it look like if we studied heart
failure from an integrated approach? An
integrated approach might entail a more complete appreciation of the impact of symptoms
on self-care and the influence of self-care
on symptoms. For example, in the SituationSpecific Theory of Heart Failure Self-Care,37
the concept of self-care monitoring from the
Middle-Range Theory of Self-Care of Chronic
Illness was operationalized in a unique and
specific fashion for patients with heart failure
because of their symptom issues. In the
Middle-Range Theory, self-care monitoring is
defined as the process of “observing oneself
for changes in signs and symptoms.”2(p196)
But heart failure causes problems with the
ability of patients to detect and interpret
changes in signs and symptoms. Specifically,
the insular cortex is the area of the brain responsible for interoception or the perception
of sensations originating within the body.38
However, lesions of the insular cortex have
been found in patients with heart failure.39
Even those patients with heart failure who are
diligent in observing themselves for changes
may not be successful in self-care monitoring
because of these cognitive changes. Thus, we
proposed a process that we named symptom
211
perception in the Situation-Specific Theory
of Heart Failure Self-Care.37 In that theory,
symptom perception was said to involve body
listening, monitoring, recognition, interpretation, and labeling of signs and symptoms. This
is an example of how self-care and symptom
theories can be integrated to achieve a more
complete theory relevant to patients with
heart failure. Importantly, an integrated
approach would involve robust measurement
of both symptoms and self-care, as advocated
in the NIH Symptom Science Model.35
PROPOSING A REVISION OF THE
MIDDLE-RANGE THEORY INTEGRATING
SYMPTOMS
At this point, recognizing the role of
symptoms in patients’ decisions regarding
self-care behaviors, we propose that incorporating symptoms more explicitly into the
Middle-Range Theory of Self-Care of Chronic
Illness can help refine the theory and improve
our ability to explain self-care and predict
performance of self-care and the outcomes
achieved. In the following, we use existing
research to support proposed associations in
the revised theory.
Self-care is fundamentally a decisionmaking process influenced by reflection.40
Self-care theory is broader than symptom theory, but here we acknowledge the strong influence of symptoms on the self-care decisionmaking process. Symptoms themselves can
be indicators of a bodily change, but research has confirmed that changes in the illness may not always cause symptoms.41,42 We
also note that symptoms may or may not reflect an objective change in the chronic illness because detection and interpretation of
bodily changes are complicated and imprecise processes.43,44 That is, some people may
not be aware of changes in illness by objective measures because they do not detect or
interpret those changes as symptoms. Conversely, symptoms may escalate in frequency
and/or intensity in the absence of an objective change in illness. It is not unusual to see a
212
ADVANCES IN NURSING SCIENCE/JULY–SEPTEMBER 2019
patient presenting to the clinician with a complaint of symptoms that cannot subsequently
be attributed to a change in objective data. All
of these factors influence the decisions that
people make about self-care.
As shown in Figure 2 illustrating a proposed integration of symptoms into the
Middle-Range Theory of Self-Care of Chronic
Illness, symptoms influence various element
of the self-care process. Specifically, people
may be more willing to perform self-care
maintenance and follow the treatment plan
if they have symptoms. Research has shown
that the experience of having symptoms can
motivate chronically ill individuals to perform
self-care.32 However, depressive symptoms
and cognitive decline can blunt self-care by
decreasing motivation to engage in healthy
behaviors.45-47
We propose that symptoms interact
most directly with self-care monitoring and
self-care management. Active monitoring
for symptoms is needed for awareness and
interpretation of bodily changes as symptoms. At this point, we have integrated these
processes into self-care monitoring. That is,
even in someone who engages in tracking
of his or her activity, signs, and symptoms,
the self-care management response is not
generated without awareness and interpretation of bodily changes as symptoms and the
recognition of symptoms as being linked to
or attributed to a chronic condition. These
processes have been shown to differ by clinical phenotype.48,49 For example, personality
traits, gender, and age are known to influence symptom awareness, interpretation,
and recognition.50 Aging may blunt symptom
perception.51 Somatic awareness has been
found to be blunted in older persons with
heart failure.52,53 Cultural and societal factors
may influence the expression of symptoms.54
There are also gender differences. For
example, women may be more willing to
acknowledge symptoms than men.55
Logically, without symptom detection and
interpretation, self-care management or the
response to symptoms will not occur. Ideally, any self-care management behavior is followed by evaluation—a process of judging
whether the behavior was helpful and should
be repeated. The evaluation process is better
in patients with better somatic awareness.50
To summarize, symptoms are both an antecedent and a consequence of self-care. The
experience of having symptoms can build
skill in self-care maintenance, monitoring,
and management.56 As an antecedent, symptoms often motivate individuals to engage
in self-care behaviors. Other antecedents include experience,57 skill,58 and self-care confidence or self-efficacy,59 all of which can be
influenced by the symptom experience, as
described later. Cultural beliefs,60 values,61
Figure 2. Model integrating symptoms with self-care as defined by the Middle-Range Theory of Self-Care of
Chronic Illness. Although depicted here as linear, we see the self-care process as including feedback loops. Note
that the overlap between the bottom arrows and core self-care model is both theoretical and imperfect and
indeed a target of further refinement.
Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness
reflection,40 habits,62 cognitive and functional
abilities,63 support from others,63-65 and access to health care60 all influence the self-care
process.
Consequences of self-care are shown in
Figure 2 as outcomes. These outcomes
include illness stability,63 health,66 well-being,
quality of life,7 perceived control,67 and
clinical outcomes such as the need for
hospitalization,63 health care costs,68 and
symptom burden.69 Mortality risk is lower
in patients receiving longer duration selfcare interventions.70 Perceived health, wellbeing, and quality of life are largely a function of symptoms. Although many people
with chronic illness tolerate symptoms, severe symptoms were associated with poor
quality of life.7 In another sample, symptoms
were the primary reason why patients sought
acute care.71 Thus, the control of costs associated with chronic illness may be addressed
with symptom management strategies.
CONCLUSION
Weber3 argues that the most important
contributions to knowledge development are
theories that are developed sufficiently to
allow for explanation and prediction. Thus,
213
our goal was to refine the Middle-Range Theory of Self-Care of Chronic illness to address
2 identified issues: (1) further development
of the concept of self-care monitoring, and
(2) further development of the manner in
which self-care monitoring and self-care
management are associated. We approached
these issues by integrating symptom theory
into the Middle-Range Theory of Self-Care
of Chronic Illness.2 The 2 perspectives—
self-care and symptoms—are clearly related.
By explicitly integrating them, our hope is
that the contribution of symptom theory to
self-care theory will be further developed and
the ability of self-care to mitigate symptoms
will be appreciated. Both perspectives are
central to a holistic approach to patient care.
We believe that this integrated theory will
be of use to both clinicians and scientists.
Clinicians working with people with chronic
illness are encouraged to embrace an assessment and intervention approach that integrates the impact of symptoms on self-care.
Scientists are encouraged to test hypotheses
derived from this refined theory to further
our understanding of how the detection, interpretation, and response to symptoms can
and should be incorporated into interventions
designed to improve self-care.
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