¶ … 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...

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.…