Nursing Practice Inspires Theory for Diabetes Self-management Theory
The current ANS featured article is titled, “A middle range theory for diabetes self-management mastery.” It is authored by Jennifer A. Fearon-Lynch, MSN, RN, doctoral student at the University of Massachusetts Dartmouth and Caitlin M. Stover, PhD, RN, Assistant Professor, Chairperson of Community Nursing Department, University of Massachusetts Dartmouth.
Ms. Fearon-Lynch shared this background of her work, which originated from her clinical practice with people who are living with diabetes:
The middle range theory being featured in our article evolved from a theory class assignment during year one of doctoral studies. As a clinical nurse, I have concentrated much of her practice in the area of medical surgical nursing and currently works at an acute care facility in southeastern Massachusetts. The high prevalence of diabetes within this geographic location and varied patients’ responses to self-management captured my attention and interest.
Observation during nurse-patient encounters revealed that the complexity of diabetes self-management often produced stressful experiences such as chaos, distress, and disturbances in routine. Despite diabetes-related stresses, some patients gained mastery over stress, accepted their chronic illness, and engaged in health protective behaviors while others demonstrated little or no motivation to self-manage and were frequently admitted to the hospital with abnormally high blood glucose levels and diabetes associated health problems. An attempt to understand why people choose not to engage in positive lifestyle practices associated with desirable diabetes management outcomes generated several questions that became the genesis of the theoretical inquiry. These are, “Why do some people with diabetes gain mastery over the illness-related stress and emerge with positive attitudes and fortitude and some do not?” Furthermore, “Why do some people exhibit motivation to engage in health care behaviors associated with desirable outcomes and others express little or no desire to participate?” How can people be assisted to handle the experience of stress accompanying diabetes related events that have important effects on their life?
As interest in the phenomenon grew stronger, literature from nursing and psychology were reviewed on mastery and motivation. Despite application of theories to bolster human’s response to effectively self-manage, no single theory adequately addressed the issue. Two theories appeared to best describe the phenomenon of interest: The theory of Mastery (TM) from nursing and Organismic Integration Theory (OIT) (extrinsic motivation) from psychology. However, examination of the theoretical properties of TM showed it did not completely fit the problem at hand since it did not explain the role of motives as a stimulus to moderate the direction and strength of the theory’s variables: certainty, change, acceptance, and growth. In addition, it lacked clarity in relation to how the theoretical variables are strengthened and supported. Lastly, distal factors triggering TM proximal variables were not explicit. As a result, TM was modified by integrating concepts from OIT to act as distal factors impacting the TM fundamental variables to produce mastery over stress and consequently more energy to effectively self-manage diabetes. The integrated theory better explains the phenomenon and is not only applicable to people with diabetes, but any chronic illness condition that is impacted by stressful experiences.
The middle range theory has the potential to masterfully influence individuals’ response to diabetes-related stress, thus resulting in better diabetes self-management behaviors. Nursing science could benefit from the feasible translation of the theory in diverse clinical settings to generate health-promoting behavioral interventions for individuals with diabetes and other chronic health conditions. The theory has not yet been tested. However, since components of the theory were synthesized using constructs from extant, reputable theories it is likely to have a robust impact on the chronic illness population. The authors welcome anyone who wishes to apply the theory in research and practice to do so and disseminate the result through scholarly dialogue.
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