Discuss why the authors of the Theory of Self-Care of Chronic Illness (Riegel, Jaarsma, & Stromberg, 2012) categorized their theory as middle range. Also, discuss whether you agree with this categorization and provide your rationale.

QUESTION

Discuss why the authors of the Theory of Self-Care of Chronic Illness (Riegel, Jaarsma, & Stromberg, 2012) categorized their theory as middle range. Also, discuss whether you agree with this categorization and provide your rationale.

Riegel et al. (2012) inducted the Theory of Self-Care of Chronic Illness (TSCCI) while working with heart failure patients along with their self-care (practice-specific theory). They subsequently categorized TSCCI as middle-range theory (MRT) based on the scope and level of theory rather than the purpose or source/disciplines (McEwen & Wills, 2019). I agree that TSCCI fits the MRT rather than practice (specific) or grand theory (generalized). TSCCI focused on individuals specific to some degree but not narrowed the scope as their previous studies of a specific group of illness-specific while Orem’s focused on general self-care. TSCCI has a limited number of concepts while propositions are clear. It paves for testable hypotheses in different clinical practices. The MRT, grand theory, and practice specific theory are interrelated (McEwen & Wills, 2019, p. 75; Walker & Avant, 201, p.21).

Discuss the strategy for theory development used for the development of the Theory of Self-Care of Chronic Theory, and the process (steps) used for development of this theory.

Riegel et al., (2012) utilized practice to theory approach to inductively develop TSCCI as MRT from their clinical practice challenges of self-care for heart failure patients (practice/situation-specific). The challenges the patients faced were self-care levels, and the patient’s decisions coincide with the chronic illness (Riegel et al., 2012). They did not believe Orem’s self-care was useful to describe illness-specific, but their previous study is relevant.

Researchers clearly stated the processes for their theory: 1. Concept development by clarifying and define self-care management, monitoring, and maintenance as a process then specify self-care monitoring as a bridge between self-care management and self-care maintenance with linkages and their revised model 2. Three assumptions of self-care. 3. 7 suggested Propositions to test in practice. 4. 8 affecting factors (facilitating and barriers) of self-care. 5. Presented both intended and unintended consequences/outcomes for future research.

Discuss the purpose of the Theory of Self-Care of Chronic Illness, and the context for use. Were the purpose and context explicitly stated in the article?

Authors explicitly stated the purpose and context of TSCCI are to “describe MRT of self-care that addressed the process of maintaining health with health promotion practices within the context of management required of chronic illness” (Riegel et al., (2012). Both presented in abstract, introduction, and conclusion sections. Reigel et al. (2012) did not believe Orem’s self-care was useful to describe self-care for chronic illness. Therefore, using their practice experience as a situation/practice specific theory to induct into MRT. They left possibilities for practice testing in other clinic settings.

Discuss whether the concepts in the Theory of Self-Care of Chronic Illness were theoretically and operationally defined. If so, identify the theoretical and operational definitions of the key concepts used in this theory.

TSCCI is an operational definition concept. Researchers defined and explained in-depth between the critical concepts of self-care management, monitoring and maintenance, and testable in other groups of patients with any chronic illness. They used literature and previous work models in heart failure to measure the concepts and formed a new self-care model with self-monitoring as a bridge between self-care management and self-care maintenance.

How are the concepts in this theory linked? Was there a model showing linkages of concepts?

Researcher did not think their concepts; self-care management, self-care monitoring and self-care maintenance; need to organize in any orders. They defined, evaluated, refined, and clarified how each concept has similarities, differences, and their linkage and referents for testability. They refined the concept and propositions of their previous studied model to create a new model to apply to TSCCI.

Discuss how the assumptions made by the authors contribute to the theory development.

The authors explicitly stated each of their three assumptions as true to accept the knowledge, support, and structure their testable propositions (Jacox, 1974; Powers & Knapp, 2010.  These assumptions are part of the self-care for illness-specific.

Assumption 1: Authors defined general self-care and how it is different from illness-specific.  Assumption 2: Authors brought back the decision making as a value position that someone can make a decision.

Assumption 3: Authors make a value position of how self-care with comorbidities instead of a specific illness and its complication from other providers’ advice.

ANSWER

1.

The authors of the Theory of Self-Care of Chronic Illness (TSCCI), Riegel, Jaarsma, and Stromberg (2012), categorized their theory as middle range. This categorization was based on the scope and level of the theory rather than its purpose or source/disciplines. The TSCCI was developed through the practice-to-theory approach, where the researchers utilized their clinical practice experiences with heart failure patients to inductively develop the theory.

I agree with the categorization of TSCCI as a middle-range theory. The focus of the theory is specific to individuals with chronic illness, but it is not limited to a narrow scope like practice-specific theories. Unlike grand theories that provide a broad understanding of phenomena, TSCCI has a limited number of concepts and clear propositions. This allows for the formulation of testable hypotheses in various clinical practices. The middle-range, grand, and practice-specific theories are interrelated and serve different purposes in advancing knowledge in nursing and healthcare.

The strategy for theory development used for the TSCCI was the practice-to-theory approach. The researchers identified the challenges faced by heart failure patients in self-care and sought to develop a theory that specifically addressed the process of maintaining health in the context of chronic illness. The development process involved concept clarification and development, the formulation of assumptions and propositions, and the identification of factors influencing self-care. The researchers also discussed both intended and unintended consequences or outcomes of self-care for future research.

The purpose of the TSCCI was explicitly stated in the article, which was to describe a middle-range theory of self-care that focused on the process of maintaining health through health promotion practices within the context of chronic illness management. The context for use of the theory was also explicitly stated, emphasizing its applicability to chronic illness management and the need for testing in other clinical settings. The authors highlighted the limitations of using existing self-care theories, such as Orem’s self-care theory, to adequately address the unique challenges of chronic illness self-care.

The concepts in the TSCCI were both theoretically and operationally defined. The researchers provided in-depth explanations and definitions of key concepts such as self-care management, monitoring, and maintenance. They drew upon existing literature and previous work models in heart failure to measure and operationalize these concepts. The concepts were linked through their interrelationships, but there was no specific model showing the linkages of concepts in the theory. The researchers believed that the concepts did not need to be organized in a specific order but rather existed as interconnected elements within the theory.

The assumptions made by the authors contribute to the theory development by providing a foundation for the formulation of testable propositions. The authors explicitly stated three assumptions that supported and structured their propositions. These assumptions were accepted as true and provided a basis for understanding the self-care practices specific to chronic illness. By acknowledging these assumptions, the researchers established a framework for further exploration and empirical testing of the theory.

In conclusion, the Theory of Self-Care of Chronic Illness (TSCCI) was categorized as a middle-range theory due to its scope and level of theory. The development of the theory involved the practice-to-theory approach, drawing upon the researchers’ clinical practice experiences with heart failure patients. The theory’s purpose and context were explicitly stated, emphasizing its relevance to chronic illness management. The concepts in the theory were both theoretically and operationally defined, and their interrelationships were discussed. The assumptions made by the authors contributed to the theory development by providing a basis for the formulation of testable propositions. Overall, the TSCCI offers a focused and applicable framework for understanding and promoting self-care in the context of chronic illness.

2.

The strategy for theory development used in the development of the Theory of Self-Care of Chronic Illness (TSCCI) was the practice-to-theory approach. This approach involves deriving theoretical insights and constructs from the practical experiences and challenges encountered in clinical practice. Riegel, Jaarsma, and Stromberg (2012) utilized their experiences working with heart failure patients and their self-care practices to develop the theory.

The process of developing the TSCCI involved several steps:

1. Concept Development: The researchers began by clarifying and defining the concepts related to self-care management, monitoring, and maintenance. They sought to understand the specific processes involved in maintaining health and managing chronic illness.

2. Assumptions: The researchers formulated three assumptions related to self-care. These assumptions served as foundational beliefs and guided the development of the theory.

3. Propositions: The researchers proposed seven testable propositions that described the relationships between the concepts in the theory. These propositions formed the basis for empirical testing and further validation of the theory.

4. Factors Affecting Self-Care: The researchers identified eight factors that influenced self-care in chronic illness. These factors encompassed both facilitators and barriers to self-care and provided a comprehensive understanding of the context in which self-care occurs.

5. Consequences/Outcomes: The researchers presented both intended and unintended consequences or outcomes of self-care for further research. These outcomes were identified to assess the effectiveness and impact of self-care practices on the health and well-being of individuals with chronic illness.

Throughout the process, the researchers drew upon existing literature and models in the field of self-care, particularly in the context of heart failure. They critically evaluated and refined the concepts, propositions, and assumptions based on their findings and insights from their previous studies.

The practice-to-theory approach allowed Riegel et al. to bridge the gap between practical experiences in clinical settings and the development of a theoretical framework that specifically addressed the self-care needs of individuals with chronic illness. By integrating their knowledge and observations from practice, they were able to develop a theory that was relevant, applicable, and could be tested and refined in various clinical contexts.

In summary, the strategy for theory development used in the development of the TSCCI was the practice-to-theory approach. The researchers utilized their clinical practice experiences to identify challenges and develop theoretical constructs related to self-care in chronic illness. The process involved concept development, formulation of assumptions and propositions, identification of factors affecting self-care, and consideration of consequences or outcomes. This systematic approach enabled the researchers to create a theory that provided a framework for understanding and promoting self-care in the context of chronic illness.

3.

The purpose of the Theory of Self-Care of Chronic Illness (TSCCI), as stated in the article by Riegel et al. (2012), is to describe a middle-range theory (MRT) of self-care that addresses the process of maintaining health through health promotion practices within the context of managing chronic illness. The theory aims to provide a framework for understanding and guiding self-care behaviors specific to individuals living with chronic illnesses.

The context for the use of the TSCCI is within the realm of chronic illness management. The theory focuses on individuals who are faced with the ongoing challenges of managing their health and well-being in the context of a chronic illness. It aims to provide insights and guidelines for healthcare professionals, researchers, and individuals themselves to promote effective self-care practices that can improve health outcomes and enhance quality of life.

The purpose and context of the TSCCI were explicitly stated in the article. The authors clearly articulated their intention to develop a theory that specifically addresses self-care in the context of chronic illness. They acknowledged the limitations of existing theories, such as Orem’s general self-care theory, in adequately describing the unique self-care needs of individuals with chronic illnesses. By explicitly stating the purpose and context of the theory, the authors provided a clear framework for understanding the focus and scope of the TSCCI.

Overall, the purpose of the TSCCI is to contribute to the knowledge and understanding of self-care in the context of chronic illness and to provide practical guidance for individuals, healthcare providers, and researchers. The context for its use lies in the field of chronic illness management, where the theory can inform interventions, strategies, and research efforts aimed at promoting effective self-care behaviors and improving health outcomes for individuals living with chronic conditions.

4.

In the Theory of Self-Care of Chronic Illness (TSCCI) developed by Riegel et al. (2012), the concepts were both theoretically and operationally defined. Theoretical definitions provide a conceptual understanding of the key concepts within the theory, while operational definitions offer specific criteria or measures for observing and assessing those concepts.

One of the key concepts in the TSCCI is “self-care management.” The theoretical definition of self-care management refers to the individual’s ability to engage in activities and behaviors that promote health, prevent complications, and manage the symptoms and challenges associated with their chronic illness. Operationally, self-care management can be measured through the assessment of specific behaviors, such as medication adherence, dietary choices, exercise routines, and symptom monitoring.

Another concept in the TSCCI is “self-care monitoring.” The theoretical definition of self-care monitoring involves the individual’s ability to systematically observe and evaluate their own health status, symptoms, and responses to treatment. It includes the awareness of changes in one’s condition and the ability to make adjustments in self-care practices accordingly. Operationally, self-care monitoring can be measured through self-report measures, symptom diaries, or the use of monitoring devices or technologies.

The concept of “self-care maintenance” is also included in the TSCCI. The theoretical definition of self-care maintenance refers to the individual’s ability to sustain and continue with self-care practices over time. It involves the development of routines, habits, and strategies to ensure ongoing self-care adherence and the prevention of relapses or setbacks. Operationally, self-care maintenance can be assessed by evaluating the consistency and persistence of self-care behaviors over an extended period.

By providing both theoretical and operational definitions, the TSCCI offers a comprehensive understanding of the key concepts and their practical application. The theoretical definitions establish the conceptual framework and underlying principles of self-care in chronic illness management, while the operational definitions provide concrete ways to assess and measure the concepts in research and clinical practice. This combination allows for a more precise and nuanced understanding of self-care behaviors and their impact on health outcomes for individuals living with chronic illness.

5.

The concepts in the Theory of Self-Care of Chronic Illness (TSCCI) are linked through their interdependence and the relationships they establish within the theory. While there is no specific model provided in the information provided, the authors of the TSCCI discuss the linkages between the concepts and how they contribute to the overall understanding of self-care in the context of chronic illness.

The three main concepts in the TSCCI are self-care management, self-care monitoring, and self-care maintenance. These concepts are interconnected and build upon each other to form a comprehensive approach to self-care in chronic illness.

Self-care management involves the individual’s ability to engage in activities and behaviors that promote their overall health and manage their chronic illness effectively. It includes actions such as medication adherence, lifestyle modifications, and following treatment plans. Self-care management forms the foundation of the individual’s ability to take responsibility for their health and well-being.

Self-care monitoring is the concept that bridges self-care management and self-care maintenance. It involves the individual’s ability to systematically observe and assess their health status, symptoms, and responses to treatment. Self-care monitoring helps individuals track changes in their condition, identify potential issues or triggers, and make informed decisions about adjusting their self-care practices.

Self-care maintenance focuses on the individual’s ability to sustain and continue with self-care behaviors over time. It involves the development of routines, habits, and strategies to ensure ongoing adherence to self-care practices. Self-care maintenance aims to prevent relapses or setbacks and promote long-term self-care engagement for optimal health outcomes.

While the specific linkages between the concepts are not illustrated through a model in the information provided, they are inherently connected within the framework of the theory. Self-care management sets the stage for self-care monitoring, which, in turn, informs self-care maintenance. The concepts work together to create a cyclical and iterative process of self-care in the context of chronic illness.

By understanding the linkages between these concepts, healthcare professionals and individuals with chronic illness can develop interventions and strategies that address the different aspects of self-care, promote self-management, and enhance overall health outcomes.

6.

The assumptions made by the authors in the Theory of Self-Care of Chronic Illness (TSCCI) play a crucial role in contributing to the development of the theory. These assumptions provide a foundation upon which the theory is built and guide the formulation of testable propositions and the overall understanding of self-care in the context of chronic illness.

The first assumption made by the authors is that individuals with chronic illness have the ability and responsibility to engage in self-care practices to manage their condition. This assumption acknowledges the agency and autonomy of individuals in taking an active role in their own health and well-being. By assuming that individuals can participate in self-care, the theory emphasizes the importance of empowering individuals with chronic illness to be active participants in managing their health.

The second assumption is that self-care practices are influenced by various factors, including individual characteristics, social support, and healthcare systems. This assumption recognizes that self-care is not solely determined by individual actions but is influenced by a range of contextual factors. It highlights the importance of considering the broader social, cultural, and environmental influences on self-care behavior and tailoring interventions accordingly.

The third assumption is that self-care practices should be guided by evidence-based knowledge and informed decision-making. This assumption underscores the importance of using reliable and up-to-date information to guide self-care behaviors. It emphasizes the role of healthcare professionals in providing accurate information and support to individuals with chronic illness, enabling them to make informed choices about their self-care practices.

These assumptions contribute to theory development by shaping the direction and scope of the theory. They provide a theoretical framework through which self-care in chronic illness can be understood and studied. By accepting these assumptions, researchers and healthcare practitioners can focus on investigating and developing interventions that align with the belief in individuals’ capacity for self-care, the influence of contextual factors, and the importance of evidence-based knowledge.

Additionally, these assumptions guide the formulation of testable propositions within the theory. They inform the development of hypotheses that can be empirically examined to further validate and refine the theory. By grounding the theory in these assumptions, researchers can explore the effectiveness of self-care interventions, identify factors that facilitate or hinder self-care practices, and contribute to the ongoing development and improvement of self-care strategies for individuals with chronic illness.

In summary, the assumptions made by the authors in the TSCCI provide a conceptual framework that guides theory development and research in the field of self-care for chronic illness. These assumptions shape the understanding of self-care, highlight the influence of contextual factors, and emphasize the importance of evidence-based knowledge in guiding self-care practices. By accepting these assumptions, researchers and healthcare professionals can advance the knowledge and practice of self-care in the context of chronic illness.