Breast Cancer and Theory

¶ … Interdisciplinary Theory Evaluation Middle range and interdisciplinary theories can significantly inform clinical practice. This is particularly true for Alberta Bendura's self-efficacy theory and Sister Callista Roy's adaptation model. This paper evaluates the applicability of the two models in breast cancer care. First, a description of breast cancer is provided. Next, the two theories are summarized. Attention is then paid to critical evaluation of the two theories. Finally, the most appropriate theory for breast cancer care is highlighted.

Description of Practice Problem Breast cancer is the most common type of cancer and top cause of cancer death in women across the globe (Jemal, 2011). Statistics indicate that breast cancer accounts for approximately a quarter of all cancers in women, with majority of the victims falling in the 40-49 years age group (Mousavi et al., 2007). Lifestyle factors such as smoking, physical inactivity, and unhealthy eating have been found to be the major causes of breast cancer (Jemal, 2011).

Compared to most other types of cancer, breast cancer has one of the highest rates of survival (Valdivieso et al., 2012). Even so, the condition has increasingly become chronic, with numerous persistent medical and non-medical complications occurring alongside it (Loh & Quek, 2011). Breast cancer can increase the risk of other morbidities, reduce the quality of life, and impose a significant economic and psychological burden on victims and their families. This necessitates more effective interventions.

Summary of Two Theories Self-Efficacy Theory With its roots in social cognitive theory, the theory of self-efficacy asserts that individual behaviour is influenced by what they think, believe, and feel (Bandura, 1977). In other words, psychological processes can lead to behaviour change by altering a person's level of self-efficacy. Self-efficacy, also referred to as personal efficacy, essentially denotes an individual's beliefs about their ability to reach a certain level of performance that influences events in their life (Loh & Quek, 2011).

Those beliefs influence one's thoughts, feelings, motivation, and behaviour, consequently affecting one's perception of challenges as well as their ability to deal with situations and accomplish a given task or goal (Porter et al., 2008). An individual's beliefs influence their behaviour through cognitive, affective, motivational, and selection processes (Bandura, 1977). From a cognitive perspective, for instance, low self-efficacy can cause an individual to view challenges or tasks as harder than they really are.

Motivation-wise, individuals with higher confidence in their abilities tend to perceive difficulties as challenges to be endured and overcome as opposed to threats to be avoided. They, therefore, tend to be motivated to accomplish tasks or face challenges. On the contrary, individuals with lower confidence in their abilities tend to view difficulties as threats, and thereby shy away from them -- they tend to have little motivation to face challenges (Bandura, 1977).

Roy's Adaptation Model With the assertion that health and illness are inevitable aspects of life, the adaptation model explains how individuals adapt to a changing environment. The model sees an individual as a system with interrelated components (psychological, psychological, and social) (Roy, 2015). The individual struggles to achieve a balance between these components and the external environment. The environment may include aspects such as family, social support, clinical experiences, and so forth.

As the individual constantly interacts with the changing environment, they innately adapt to the environment using biological, psychological, and social mechanisms. The individual's level of adaptation has a limit that indicates the extent of stimulation enough to trigger a positive response (Peterson & Bredow, 2009). According to the model, adaptation occurs in four modes: the physiologic, the self-concept, the role function, and the interdependence modes (Naga, Al-atiyyat & Kassab, 2013). Adaptation in the physiologic mode entails maintaining physical wellbeing. Nutrition and other basic needs fall in this mode.

The nurse, therefore, would seek to determine the extent to which the individual's survival needs are fulfilled. The self-concept mode relates to psychic wellbeing. This includes aspects such as self-perceptions and personal values. The role function mode emphasises social wellbeing. Getting used to various role adjustments in the course of one's life results in social adaptation. For instance, retirement from work may lead to changes in lifestyle. The interdependence mode further stresses the need for social adaptation. Ordinarily, individuals depend on others for help, affection, attention, and other purposes.

Overall, on the basis of these four modes, the goal of nursing practice is to promote adaptation, health, and quality of life (Peterson & Bredow, 2009). Prior to the commencement of care delivery, therefore, the nurse must assess the patient's wellbeing based on the four modes. The assessment informs the care decisions the nurse makes. Theory Evaluation A theory can be evaluated on the basis of two categories of criteria: internal criticism and external criticism (Peterson & Bredow, 2009).

Internal criticism entails the following elements: clarity (how easily the theory can be understood); consistency (extent of definitions and repeated use of key concepts); adequacy (the degree to which the theory applies to its underlying speciality); logical development (clear presentation of the reasoning and conclusions of the theory); and level of theory development (extent of research based on the theory).

External criticism, on the other hand, focuses on the following aspects: utility (usefulness of the theory in practice); significance (extent to which the theory furthers knowledge); reality convergence (the underlying assumptions, principles, and interpretations of the theory); complexity (how the theory explains relationship between variables); discrimination (does the theory distinguish nursing from other disciplines); and scope (breadth of behaviours explained by the theory) (Peterson & Bredow, 2009). Self-Efficacy Theory Clarity: Key concepts (self-efficacy and human behaviour) have been stated and explained with sufficient clarity.

Although the theory belongs to the psychology field, it can be easily understood without substantial knowledge of psychology. Logical development: The theory is based on social cognitive theory and its development demonstrates logic. Key concepts, self-efficacy measuring tools, and conclusions have been advanced and explained in a systematic manner, clearly elucidating sources of self-efficacy and their extent of influence. Adequacy: The theory precisely asserts that self-efficacy serves a crucial role in facilitating behaviour change. Further, the theory can be applied in virtually all populations.

It can be applied in patients with diverse ages, genders, educational backgrounds, social statuses, racial backgrounds, ethnicities, and so forth. Consistency: There is consistency in the definition of key concepts throughout the entire description of the theory. These concepts include social cognitive theory, self-efficacy, and social learning. Uniformity in defining concepts provides greater understanding of the theory. Level of theory development: The self-efficacy theory was developed close to four decades ago. So far, numerous studies have been conducted in different settings to test the theory.

Ideal examples include Jeng & Braun (1994), Robinson-Smith, Johnston & Allen (2000) and Porter (2008). This means that it is a well-developed theory, and that the theory fits the definition of a middle range theory. Complexity: The two major variables underlying the theory are self-efficacy and human behaviour. The theory clearly explains the relationship between these two variables. The theory further demonstrates the link between external factors and self-efficacy, and between self-efficacy and cognitive, choice, affective, and motivational processes.

Discrimination: The theory is based on the social cognitive theory, which has applications in diverse disciplines. Nonetheless, the theory has widespread usage in the context of nursing, particularly in the management of chronic conditions (Robinson-Smith, Johnston & Allen, 2000; Porter et al., 2008; Marks, Allegrante & Lorig, 2005; Loh & Quek, 2011). Reality convergence: As mentioned previously, the self-efficacy theory inherently proposes that human behaviour and thoughts are influenced by personal efficacy.

There is a great deal of truth in this observation as confirmed by Robinson-Smith, Johnston & Allen (2000), Marks, Allegrante & Lorig (2005), Porter et al. (2008), and Loh & Quek (2011). This indeed explains why most successful people attribute their success to difficult moments. Kardong-Edgren (2013), however, asserts that there is often disconnect between the theory and practice in the sense that it may lead to the creation of a false sense of self-efficacy. Utility: The theory of self-efficacy has significantly informed research and clinical practice in diverse settings. Porter et al.

(2008) utilises the theory to examine pain management in patients with cancer, while Robinson-Smith, Johnston & Allen (2000) uses the theory to study the quality of life and depression in stroke patients. In these studies, and others, the theory has proved effective in facilitating behaviour change and improving patient outcomes. Significance: The theory of self-efficacy has without a doubt addressed key practice issues and contributed to the advancement of nursing knowledge.

Giving patients hope and assurance is an essential part of nursing work since optimism and self-confidence can be termed as crucial desired and expected patient outcomes. More importantly, the theory has provided the foundation for the development of other models, which have positively and significantly impacted nursing practise. Scope: The theory of self-efficacy has a fairly broad scope. It is applicable across diverse disciplines and practice settings. Roy's Adaptation Model Clarity: The major concepts underlying the model include adaptation, the person, the environment, health, and nursing.

These concepts have been clearly stated and explained. Nonetheless, as the theory specifically focuses on the nursing field, it may not be easily understood without considerable knowledge of the field. Logical development: Roy's adaptation is based on bio-psycho-social concepts. The development of these concepts and the ensuing conclusions demonstrates logic and a systematic approach. The theory sensibly shows how an individual's interaction with the external environment facilitates adaptation. Adequacy: According to the theory, it is precise that individuals constantly interact with a changing environment, consequently resulting in adaptation.

The adequacy of the theory further stems from the fact that it can be applied across diverse populations. Consistency: Key concepts (adaptation, the person, the environment, health, and nursing) are uniformly defined throughout the literature, enabling a better understanding of the model. Arguably, this is a major strength of the model compared to the self-efficacy theory. Level of theory development: Roy's adaptation model was developed around the same time the self-efficacy theory was developed, though the former came earlier.

Indeed, a closer look at the two models reveals that Roy's adaptation model was part of the theories that provided foundation for the development of the self-efficacy theory. To this end, several studies have been carried out in different contexts to test the theory (Purcell & Dorsey, 1990; Piazza et al., 1992; Weiss et al., 1994; Rogers & Keller, 2009; Ursavas, Karayurt & Iseri, 2014), an indication of a sufficiently developed theory. Complexity: The major variables underlying Roy's adaptation model include adaptation, the person, the environment, health, and nursing.

The relationship between the variables is clearly explained, clearly demonstrating how the person reacts to the environment. Discrimination: Unlike the self-efficacy theory, Roy's adaptation model clearly differentiates nursing from other disciplines. Indeed, the theory was primarily developed to be used within the context of nursing. Reality convergence: Roy's adaptation model essentially asserts that health and illness are inevitable in life, and that individuals constantly respond to a changing environment to find a balance between the individual (as a system) and external environment.

This assertion has been validated by research (e.g. Rogers & Keller, 2009; Ursavas, Karayurt & Iseri, 2014). Utility: The model has remarkably informed nursing research and practise across a range of chronic conditions. In their study, for instance, Rogers & Keller, (2009) demonstrate the usefulness of the model in promoting physical activity in physically inactive older adults. Ursavas, Karayurt & Iseri (2014) further show the effectiveness of the model in delivering nursing care to breast cancer patients.

Significance: The theory has also highlighted important issues in nursing practice and contributed immensely to nursing knowledge. The model particularly provides valuable guidelines for assessing overall patient wellbeing and making care delivery decisions. Scope: Though Roy's adaptation model can be applied to diverse populations, it is mainly restricted to nursing. This means that the theory has a relatively limited scope compared to the self-efficacy theory. Selection of Appropriate Theory Both Roy's adaptation model and the self-efficacy theory have significantly contributed to clinical research and practice.

Indeed, selecting the most appropriate model between the two may not be as straightforward as one may think. Their clarity, consistency, adequacy, logic, utility, significance, and pragmatism are commendable. Even so, the self-efficacy theory appears more appropriate. First, compared to Roy's adaptation model, the theory of self-efficacy is somewhat less complicated, making its application in practice much easier. Nonetheless, the simplicity of the model does not necessarily mean lack of rigour. More importantly, the importance of self-efficacy for individuals with breast cancer and other chronic conditions cannot be overemphasised.

Indeed, for individuals with chronic conditions, self-efficacy can result in better coping with the condition and its side effects, and create a sense of control over one's health status (Marks, Allegrante & Lorig, 2005). When individuals have greater confidence in their ability to overcome the condition, they are more likely to easily cope with the situation. Breast cancer is without a doubt life-threatening condition. News of the condition often raises intense emotions and discomfort in the affected individual.

It can raise anxiety, fear, confusion, and psychological distress; with most victims worrying that they will not recover. Higher self-efficacy, however, can minimise this psychological burden. Research has in fact demonstrated that higher confidence in one's ability to adapt to stressors can minimise symptoms, emotional distress, hopelessness, and the burden of pain, and contribute to physical and functional wellbeing (Robinson-Smith, Johnston & Allen, 2000; Marks, Allegrante & Lorig, 2005; Porter et al., 2008).

More specifically, in Loh & Quek's (2011) research, which was conducted within the context of breast cancer, it has been shown that a self-management program based on the concept of self-efficacy was effective in improving coping behaviour in the long run. Consequently, positive patient outcomes can positively affect both formal and informal caregivers (Porter et al., 2008). When patients cope with a chronic condition, nurses and other practitioners delivering care to the patient gain a sense of joy and fulfilment.

Similarly, their families and loved ones become happier due to reduced emotional discomfort. This further demonstrates the appropriateness of the self-efficacy theory in the practice setting in relation to breast cancer management. From a practice perspective, it is imperative for health care practitioners to pay greater attention to encouraging patients' self-confidence, self-efficacy behaviours, as well as self-care expectations (Robinson-Smith, Johnston & Allen, 2000). They should emphasise to breast cancer patients why self-belief is important. This entails giving them hope and assuring them that they can conquer the condition.

In his theory, Bandura (1977) asserts that cognitive processes and behaviour are influenced by not only self-perception, but also external experiences. In other words, an individual's self-efficacy can be shaped by external factors such as what they observe in other individuals around them. Therefore, when clinical practitioners portray breast cancer.