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A Middle-Range Theory

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Miranda Rodrigues

on 19 October 2013

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Transcript of A Middle-Range Theory

A Middle-Range Theory
of Self-Care of Chronic Illness

After conducting many studies in regards to self-care in the heart failure patient, it was determined that there was a need for additional information to build upon the "situation-specific theory of heart failure self-care" (Jaarsma, 2012)

The following are some articles published by the authors:

Holst M, Willenheimer R, Martensson J, Lindholm M, Stromberg A. Telephone follow-up of self-care behaviour after a single session education of patients with heart failure in primary health care. Eur J Cardiovasc Nurs. 2007;6(2):153-159.

Stromberg A, Martensson J, Fridlund B, Levin LA, Karlsson JE, Dahlstrom U. Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial. Eur Heart J. 2003;24(11):1014-1023.

Jaarsma T, van der Wal MH, Lesman-Leegte I, et al. Effect of moderate or intensive disease management program on outcome in patients with heart failure: Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH). Arch Intern Med. 2008;168(3):316-324.

Simply put, a meeting of the minds was how this theory was formed. The group of authors who have worked together to evaluate self care in the heart failure patient determined the need for a broader audience. A new model was developed through a detailed and refined review of the heart failure literature.
Theoretical Components
Self Care Maintenance
Self Care Monitoring
Self Care Management
Self Care Maintenance
Self-care maintenance is defined as those behaviors used by patients with a chronic illness to maintain physical and emotional stability.
Self Care Monitoring
The process of observing oneself for changes in signs and symptoms.
Self Care Management
The response to signs and symptoms when they occur.
Theory to practice
"In clinical practice, the theory can be used to structure an assessment of where in the self-care process a particular patient is struggling. Someone who is unable to recognize symptoms needs a very different intervention than someone who is poor in self-care maintenance. For example, symptom recognition may need skill whereas adoption of specific self-care maintenance behaviors may require motivation. Assessment of where in the process a particular patient is having difficulty will lead to a tailored intervention that may be more advantageous and cost-effective than a general intervention that addresses areas of self-care that the patient has already mastered." (Jaarsma, 2012)
This theory was constructed from several different methods:
From previous research in heart failure
Orem's Grand Theory of Self Care
Existing nursing theories
Type I Diabetes
A 20 year old male newly diagnosed with type I DM. Given his age the practitioner should be able to identify a strong need for this patient who has recently "lost control" of his life to find a way to regain control. One approach is the use of this theory. The nurse could use the visit to guide the patient in lifestyle activities and goals to benefit his well being. Such as exercise and proper nutrition for diabetics. These are examples of the self care maintenance concept. Self care monitoring should include glucose checks and being able to identify changes in daily routine such as more frequent urination or thirst which would indicate signs of poor control over glucose. If this occurs, it is important to follow the course to determine the need to seek consult. If the patient is able to identify a variation in symptoms and then act appropriate, then this will indicate proper self care management. Use of this theory in practice has many benefits to the patient. One proposed by this theory is that "individuals who perform evidence-based self-care have better outcomes than those who perform self-care that is not evidence-based." (Jaarsma, 2012)

Jaarsma, T., Riegel, B., & Stromberg, A. (2012). A middle-range theory of self-care

of chronic illness [Electronic Version]. Advances in Nursing Science. 35,


McEwen, M. & Wills, E. (2011). Theoretical Basis for Nursing (3rd ed.)

Philidelphia: Lippincott Williams & Wilkins.

Miranda A Rodrigues
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