Resnick's Self-Efficacy Theory in Nursing Practice

Introduction to Resnick's Middle Range Theory

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 a university School of Nursing and a geriatric nurse practitioner. Her research is focused on motivation, particularly with older adults. She has written on motivation for older adults recovering from disabling events — noting, for example, that where motivation is high, recovery is more likely to be successful and life prolonged. She found support for her theory in this area (Resnick, 1998), 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 produce positive outcomes is important for nurses, because they are well positioned to facilitate such things. In her 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 improve patient outcomes as well (Resnick & Jenkins, 2000). This is especially important for older patients, whose level of motivation may vary considerably given a range of health and family factors.

Practical Applications of Self-Efficacy Theory

Resnick appears to have been influenced significantly by practice. While there are elements of her theory that are shared with Callista Roy's grand-level theory, Resnick's work is more firmly at the mid-level, dealing with how specific patients can achieve improved results. Her background combines both practical experience and academic training, something that has no doubt helped her in formulating her theory. Her experiences working with older adults inform her understanding of how to improve their motivation and what the determining factors are for higher motivation in this patient population. Her academic background, however, enables her to take her clinical observations, transform them into a testable theory, and refine it through rigorous study. She has developed a field instrument that measures self-efficacy and some of its underlying influences — a result of the productive interaction between her fieldwork and her academic skills.

There are a number of practical applications for Resnick's theory. It is worth noting that while Resnick works with the elderly and originally designed her theory around elderly patients and exercise, the theory applies well across all age groups. It is perhaps most important for the elderly because older adults do not always believe strongly in the merits of recovery — at an advanced age, they may feel that rehabilitation and exercise will not work, or that there is little point in pursuing it. Nurses can therefore intervene to help shift these beliefs.

Part of this intervention is direct: the nurse works with the patient to provide encouragement and a source of motivation, and offers ongoing support to help the patient overcome setbacks. However, the nurse also has the ability to enlist family members and friends to assist the patient. Social support networks are an important component in sustaining motivation at any age. People need to feel that they can succeed in their recovery and that there is a meaningful purpose in doing so. Resnick argues that by comprehensively addressing the problem of motivation, the patient can ultimately experience superior outcomes related to whatever treatment they must undertake.

Expanding the Theory Across Patient Populations

Resnick is also a strong advocate for applying her theory to encourage older adults to exercise as a preventative measure. Adults who have been physically active throughout their lives are more likely to respond readily, but Resnick argues that with appropriate motivation, any adult can be encouraged to improve his or her fitness. Her theory is therefore applied in clinical settings to work with patients, their friends, and their families to improve health outcomes through increased exercise. One of her most prominent studies focused on rehabilitation in elderly women who had experienced hip replacements — a significant clinical challenge — and when her theory was applied it appeared to enhance patient outcomes (Nurses.info, 2014).

One of the challenges identified in relation to Roy's Adaptation Model is that of cancer patients. As noted above, Resnick's theory has also been applied to this population, and the two theories complement each other well. Resnick's theory can be applied in practice to help cancer patients cope with their illness, the demands of chemotherapy, and other physical challenges. Part of surviving cancer involves the patient maintaining the will to live and the motivation to fight the disease. While this is certainly not the only factor in survival, a patient's determination always matters. In clinical practice, nurses can use this framework to encourage patients to endure physical challenges and to undertake exercises that help them remain as healthy as possible during debilitating cancer treatments. Bringing the person's social circle into the recovery process is a critical element of Resnick's approach, as is identifying a role model — whether a friend, family member, or a past patient who can serve as an example of success.

Two other clinical scenarios are perhaps less applicable to Resnick's theory. Terminal patients are unlikely to benefit meaningfully from Resnick's emphasis on exercise and rehabilitation. Similarly, childbirth and postpartum issues present a challenge, since Resnick's work deals specifically with motivation for exercise and physical rehabilitation rather than psychological dimensions of perinatal care. Resnick's theory therefore seems best suited to patients with physical ailments from which recovery is possible, and to older patients where there is an opportunity to take proactive measures to improve physical fitness before a catastrophic illness or injury occurs.