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importance of observational learning and self-efficacy in behavior change

Respond to 4 colleagues by suggesting other middle-range theories for them to consider. Support your recommendations with at least one scholarly article to share with each colleague.

1. Nursing theory is a framework that provides nurses with a way to understand the nursing process and to guide their practice. (Roy, 2021). It helps nurses to make decisions about patient care, to communicate with other healthcare professionals, and to evaluate the effectiveness of their interventions.

Nursing practice, on the other hand, is the application of nursing theory to the care of patients. (Younas & Quennell, 2019).  It is how nurses use their expertise to help patients achieve their desired health outcomes.

Based on these definitions, nursing practice bridges scientific theory and quality nursing care. It is through nurse practice that scientific theories are put into action and that new knowledge is generated to improve the care of patients. (Ziegler, 2005).

The two are inseparable because nursing theory is developed from nursing practice, and nursing practice is informed by nursing theory. As nurses gain experience in practice, they can contribute to developing nursing theory by identifying new problems and challenges and testing and refining existing theories.

One area of practice concern is the significant nursing shortage in today’s environment and the inability to recruit highly skilled nurses into intensive care units (ICUs). This forces some healthcare organizations to hire new graduates directly into ICUs. Those novice nurses may not be equipped with the right skill set to deal with the work environment’s intensity and manage patients’ and families’ inability to deal with uncertainty and stress.

In this week’s discussion, I will look into an area of nursing practice related to equipping novice nurses in ICUs with the right skill set using Benner’s Model of Skill Acquisition to help families of critically ill patients deal with and adapt to stress using Hill’s theory of Family Stress and Adaptation.

This can be achieved by implementing middle range theories rather than grand theories, where, in this case, middle range theories in nursing serve as more specific and less abstract frameworks than grand theories. They are tailored to elucidate specific phenomena within nursing practice. These theories frequently serve as guiding principles for research and practical application, effectively bridging the gap between grand theories and real-world practice. (Smith & Liehr, 2008).

Using Benner’s nursing skill acquisition model, novice nurses with minimal experience can develop their skills in educating families of critically ill patients about stress management and adaptation to the new reality. Benner’s model underscores the notion that nursing expertise is cultivated through experiential learning. As nurses accumulate experience, they enhance their clinical judgment, sharpen their on-the-spot decision-making skills, and develop a profound comprehension of their patients and their unique requirements. This can help nurses cascade their learning in stages and build their confidence over time, which could also positively impact retaining novice nurses in hospitals by avoiding early turnover (Murray & Cope, 2019).

Hill’s original ABCX model, later expanded to the double ABCX Model, builds on the original theory of family adaptation to stress when dealing with long-term and chronic conditions (McEwen & Wills, 2019). When nurses are familiar with this model, they would understand that families faced with difficult situations will have to develop, over the course of the situation, abilities to overcome the hardships, mitigate the stress levels, and ultimately return back to a reasonably normal state. (McEwen & Wills, 2019)

Middle range nursing theories can significantly impact the nursing practice by guiding the development of nursing interventions, improving the quality of nursing care, promoting evidence-based practice, and advancing nursing science and theory. Overall, middle range theories can be a valuable tool for nurses to improve the quality of care they provide to their patients.

2. Nursing practice encompasses the daily clinical work of nurses in caring for patients across diverse settings and populations. The focus of nursing practice is providing excellent evidence-based care to improve patient outcomes. However, translating knowledge into the complex realities of practice remains an ongoing challenge. Thoughtfully selected nursing theories can guide nurses in improving care delivery for specific populations and issues (McEwen & Wills, 2019). In my own mental health nursing practice, I have identified medication non-adherence among patients with severe mental illness as a priority issue requiring attention. Medication non-adherence leads to higher rates of relapse, re-hospitalization, and poor long-term outcomes in conditions like schizophrenia and bipolar disorder. Applying relevant middle range nursing theories could enhance my ability to understand and address this issue in practice (McEwen & Wills, 2019).

Nursing theories are organized conceptual frameworks designed to describe, explain, predict, or prescribe nursing care. Grand theories, like Martha Rogers’ Science of Unitary Human Beings, provide broad understandings of the core concepts of nursing (McEwen & Wills, 2019). However, middle range theories have a more limited scope focused on particular populations, settings, or nursing problems. According to McEwen and Wills (2019),  middle range theories are more pragmatic and applicable to focused practice issues like medication non-adherence. For this issue, I have identified two excellent middle range theories to apply – the Health Belief Model and Orem’s Self-Care Deficit Theory.

The Health Belief Model posits that a person’s health behavior is determined by their perceived susceptibility to a health problem, perceived severity of the consequences, perceived benefits of taking action, perceived barriers to taking action, cues/reminders to take action, and self-efficacy or confidence in their ability to succeed (Khalifeh et al., 2023). To apply this model to medication adherence, nurses would assess patients’ perceptions in each of these areas through questioning and active listening. According to Khalifeh et al. (2023), the nurse could target education and interventions to address any misconceptions, highlight benefits, problem-solve around barriers, provide reminders, and build the patient’s confidence in being able to take their medications consistently.

Orem’s Self-Care Deficit Theory identifies when nursing care is needed – when an individual is unable to fulfill biological, psychological, developmental, or social self-care needs (Sheng & Meng, 2020). For medication adherence, this may involve deficits in knowledge of the medication regimen, motivation to take medications, or ability to organize and remember doses. Nurses conduct assessments to identify any self-care deficits. According to Sheng and Meng (2020), the goal is to support the patient in developing the necessary knowledge, will, and concrete skills to perform self-care and gain autonomy. Nursing interventions guided by this theory for medication adherence may include patient education on medications, motivational interviewing to improve willingness, teaching habit formation and reminder strategies, family/social support, simplified regimens, pill organizers, and other techniques to build self-care capabilities (Sheng & Meng, 2020). Regular reassessment identifies any continuing deficits requiring nursing support.

In conclusion, thoughtfully applying middle range nursing theories like the Health Belief Model and Orem’s Theory can provide invaluable frameworks for addressing medication non-adherence in mental health practice. These theories illuminate the cognitive, emotional, and functional factors influencing this health behavior while suggesting targeted nursing interventions. More broadly, nursing theories provide guiding conceptual understandings that support excellence in the applied clinical work of nursing practice across settings and populations (McEwen & Wills, 2019).

3. According to Afaf Meleis (2010), Transition Theory focuses on individuals adapting to new roles or situations. In addressing the high turnover rate among newly graduated nurses, Meleis’s transition theory can provide insights into understanding new nurses’ challenges and stressors during their transition from student to professional nurse. Meleis’s theory emphasizes providing support, guidance, and resources to facilitate successful role transitions. By utilizing this theory, healthcare organizations can develop structured orientation programs, mentorship initiatives, and ongoing professional development opportunities for new nurses. These interventions can help new nurses navigate the transition more smoothly, enhance their confidence, and improve their job satisfaction, thus reducing turnover rates.

For example, a hospital could implement a mentorship program where experienced nurses are paired with new graduates. This mentorship can provide emotional support, share practical insights, and offer guidance during transition. Additionally, providing educational workshops and resources designed for new nurses can empower them to develop the necessary skills and competencies for their roles, increasing their job satisfaction and commitment to the organization.

Albert Bandura (1986) states that Social Cognitive Theory emphasizes the importance of observational learning and self-efficacy in behavior change. In addressing high turnover rates among new nurses, Bandura’s theory can be valuable in enhancing their confidence and motivation to remain in their positions. New nurses often learn from their peers and role models, and by observing successful nurses who manage the challenges of the clinical setting, they can build their self-efficacy and sense of competence. Bandura’s theory suggests that providing opportunities for new nurses to observe and interact with skilled and confident nurses can positively impact their belief in their ability to handle the demands of their roles.

To apply this theory, hospitals can organize regular meetings or workshops where experienced nurses share their success stories, their challenges during their initial years, and how they overcame them. This can help new nurses see the progression and growth possible over time, increasing their self-efficacy. Incorporating positive reinforcement and recognition for new nurses who demonstrate practical clinical skills and problem-solving can further enhance their self-efficacy and job satisfaction.

Framing Practice Issue with Middle Range Theories:

Using Meleis’s transition theory, the hospital can develop a comprehensive orientation program that includes mentorship, preceptorship, and ongoing education tailored to new nurses’ needs. This would ensure that new nurses receive the necessary support and resources during their transition, enhancing job satisfaction and reducing turnover rates.

Applying Bandura’s social cognitive theory, the hospital can create opportunities for new nurses to observe experienced nurses in action, providing them with role models to learn from and boosting their confidence in their abilities. This can increase job satisfaction and a higher likelihood of remaining in their positions.

4. Healthcare is a tough job that has many complexities involved and being a leader in healthcare can be very challenging. I find this to be most true post Covid. I feel like there has always been a nursing shortage but post Covid it seems worse. At this time I think the shortage in staff as a whole is causing one of the most concerning practice issues. This shortage is not just nursing it appears to be in all work areas; transport, dietary, supply chain, etc. However, my greatest concern at this point involves nurses as my organization continues to talk about how this shortage is going to get worse. With nurses being essential and making up such a large group of professionals this will obviously impact the quality and type of care delivered in the future (Tamata & Mohammadnezhad, 2023). This shortage however is not isolated to my state or my organization but is a global issue. Covid added to this burden causing a high burnout rate among nursing staff. I think another big issue that is important to highlight is an increase in work violence that impacts work satisfaction negatively. Verbal abuse is reported as the highest form of abuse in healthcare with staff in an inpatient setting is impacted at much higher rates then those in an outpatient setting (Hadden, Annamaraju, & Toney-Butler, 2023). There are so many factors overall though that impact the shortage these are just a few.

Middle range theories can be beneficial in outlining a solution to a problem and how to go about fixing it. Through the use of Pender’s Health Promotion model leaders can use information to determine what impacts are effecting positive health promotion and predict behaviors associated with it. The Pender model has been used successfully by many nursing scholars to determine and predict health behaviors (McEwen & Wills 2019). I think it is important to look at these health behaviors and predict how individuals will act and respond to promote better health outcomes. With there being a nursing shortage and prediction that the shortage is just going to get worse we must begin planning. This planning would be helpful for the best outcomes if we could understand the actual needs of our patients and predict the best delivery of the treatments. Overall health promotion can help individuals stay healthier and in turn out of hospitals easing a burden on staff. It was thought that Covid kept individuals from seeking treatment in fear of going into medical settings, thus putting off health and health promotion. Thus making individuals sicker and requiring more complex care when they did finally seek treatment. With the use of Pender’s Model health promotion and preventative care could be of great benefit to keeping individuals out of the hospital unless absolutely necessary. This in turn would ease up the load on nursing and medical staff. 

Transitions Theory is another middle range theory that could help with staffing shortage. We looked at how health promotion and prediction of health behaviors can keep individuals out of the hospitals thus lowering the medical load and burden, but this is a different approach. Transitions Theory looks at what a person is capable of actually doing. Looking at an individuals cultural needs and social diversity helps to identify a certain group of patients and their needs. We are striving for individualized care as a whole, but tend to forget that the patient has many factors that impact their overall readiness to learn, ability to learn, and capability of learning how to care for themselves and factors to keep them healthy. The focus is still on prevention of care and keeping individuals out of the hospitals, but this theory looks at it in a deeper level. This focus would also promote a deeper understanding of an individuals illnesses. For example, a thorough discharge plan with individualized education for that particular patients learning and social needs would be beneficial to keeping the patient compliant and not returning (McEwen & Wills 2019). Essentially, through the use of both Pender’s Model and Transitions Theory the focus is to keep the individual informed of their own overall health, provide patient centered education that they understand, provide support, and health promotion. The goal with these approaches are to keep individuals healthier and out of the hospitals and medical centers unless necessary, thus decreasing the workloads on staff.