Nursing One mid-range nursing philosophy is that of Barbara Resnick, with her "Middle Range Theory of Self-Efficacy." This theory states that 'self-efficacy expectations and outcome expectations are not only influenced by behavior, but also by verbal encouragement, physiological sensations and exposure to role models or self-modeling" (Nurses.info, 2014).

Resnick is an Associate Professor at the University of Maryland School of Nursing. She is also a geriatric nurse practitioner at Roland Park Place. Her research is focused on motivation, particularly with older adults. She has written papers on motivation for older adults to recover from disabling events, for example, noting that where motivation is high recovery is more likely to be successful, and life prolonged. She found support for her theory in this study (Resnick, 1998), for example, lending credence to her prior work on finding ways to enhance the likelihood of recovery in all populations, but particularly in older and at-risk populations.

In another example, Resnick has tested the theory on older men recovering from prostate cancer. She notes that social support and beliefs about self-efficacy do correlate with recovery. Where beliefs about self-efficacy are low, or where there is little social support, motivation for success is lower and depression often follows (Weber, et al., 2004). This illustrates how this mid-level theory can be put into practice. Knowing that building a support network and providing positive reinforcement can have positive outcomes is important for nurses, because they have the ability to facilitate such things. In her role in clinical care of the elderly, Resnick has been able to put her theory into action, noting that a combination of managing expectations and providing incentives will improve self-efficacy and therefore will improve outcomes as well for the patients (Resnick & Jenkins, 2000). This is important for older patients, who may or may not have a high level of motivation given a variety of health and family factors.

Resnick appears to have been influenced by practice. While there are elements of her theory that are shared with Callista Roy's grand level theory, Resnick's is more at the mid-level, dealing with how specific patients can see improved results. Her background mixes both practical experience and academic, something that has no doubt helped her in formulating her theory. Her experiences working with older adults surely informs her theory about how to improve their motivation, and what the determining factors are for a higher level of motivation in this type of patient. However, it is her academic background that enables her to deliver a higher level of ability to take her observations, turn them into a theory and then be able to test that theory. She has therefore been able to refine her theory simply through her skill as an academic, testing her ideas and also developing a test for the field. This test measures self-efficacy and some of the underlying influencers, and again is the result of her field work in combination with her ability as an academic to test her theories.

Practical Application

There are a number of practical applications for Resnick's theory. It is worth taking into consideration that while Resnick works with the elderly and designed her theory around elderly and exercise, that this theory applies well across all ages. It is perhaps more important for elderly because they do not always have much belief in the merits of recovery -- if they are at an advanced age they may not feel like rehabilitation and exercise will work, or that there is no point. Nurses can therefore intervene to help them.

Part of this intervention is direct, where the nurse is able to work with the patient directly to provide them with encouragement and a source of motivation. By doing so, the nurse can enhance the motivation of the patient. Further the nurse is in a position to provide ongoing encouragement, which can help the patient to overcome setbacks. Thus, the direct intervention is one of the key ways to help the patient. However, the nurse also has the ability to call upon family members and friends to help the patient as well. Social support groups are an important component in providing motivation at any age. People need to feel that they can succeed in their recovery, and that there is a point to succeeding. Thus, Resnick argues that by comprehensively tackling the problem of motivation the patient can ultimately experience superior outcomes related to whatever treatment they must undertake.

Resnick is also a strong advocate for the use of her theory in getting older adults to exercise as a preventative measure. Adults...

Thus, her theory is often applied in the clinical setting to working with patients, their friends and their families to improve their health outcomes through increasing their exercise. One of her most prominent studies was on rehabilitation, for example in elderly women who had experienced hip replacements. This presents a significant challenge, but again when her theory is applied it seems to work to enhance patient outcomes (Nurses.info, 2014).
One of the problems that was identified in the previous paper on Roy's Adaptation Model was that of cancer patients. As noted above, Resnick's theory has also been applied to cancer patients. The two theories work well together, actually. Resnick's theory can be applied in practice to help cancer patients deal with their illness, the chemotherapy and other physical challenges. Part of surviving cancer is that the patient needs to have the will to live, and the motivation to fight the disease. This is certainly not the only factor in survival, but it always helps when somebody fights it. In clinical practice, this can be applied in that the nurses can encourage the patient to battle through the physical challenges, and to undertake exercises that will help with this process of staying as healthy as possible during debilitating cancer treatments. Bringing the person's social circle into the recovery process is a critical element for Resnick, as is having a role model. Both of these can be applied, either by using friends and family, or at least past patients who can be held up as a model of success.

Two of the other scenarios noted in the previous paper are perhaps less applicable to Resnick's theory. Certainly the one with the dying patients does not really apply, since terminal patients are not likely to benefit from Resnick's quest for more exercise. Childbirth and postpartum issues are also more of a challenge, since Resnick's work specifically deals with motivation for exercise and rehabilitation, rather than psychological issues. Resnick's theory, therefore, seems best applied to patients with physical ailments from which they can recover and for older patients where there is the opportunity to take proactive measures to improve their physical fitness before a catastrophic illness or ailment.

Practice

If practice incorporated Resnick's theory more often, it would make some changes. There are two key elements. The first is with proactive exercise, something that Resnick seeks to instill in older adults in order to enhance their lives. This is often something that we leave to individual choice. Practice can begin to take steps to improve motivation. Too often, health care is seen as something that you do once you are sick already, as opposed to something that is done proactively to avoid ailments and illness. Resnick's theory is more that if people are encouraged to exercise, and perhaps have a peer group to assist with motivation, that people will have higher motivation level, higher beliefs in self-efficacy and this will have positive outcomes.

Conclusions

Barbara Resnick has put forth a mid-level theory of self-efficacy that argues that self-efficacy expectations are affected by things like verbal encouragement, physiological sensations and exposure to role-models. Nurses can affect patients by providing some or all of these things -- verbal encouragement certainly, but also working with others who can be role models, or building support networks for the patient so that the patient has a high level of encouragement. When these factors are in place, the patient is expected to have higher levels of success.

In practice, Resnick's work has been applied especially in gerontology but also can be applied to a number of other practice areas as well, because of its basic principles of human motivation. Thus, Resnick makes for a good mid-level theory. There are instances where it is not going to be as useful, but in many situations it can help to bring about superior patient outcomes.

2.

Roy's Adaptation Theory can be implemented in practice in a few different ways. One is through an assessment guide, wherein a patient could be evaluated for fitness and environment in terms of their physical, social and psychological dimensions. When the nurse understands where a patient is with respect to these different dimensions, then the intervention can focus on those areas where the greatest amount of improvement is needed. A patient might otherwise be in good physical and psychological condition, but…