Toward a Middle-Range Theory of Weight Management

Effectiveness of a Nurse-Led Telehealth Intervention to Improve Adherence to Healthy Eating and Physical Activity Habits in Overweight or Obese Young Adults

Excess weight and obesity have high prevalence rates globally and are associated with significant morbidity and mortality rates. In the wake of the COVID-19 pandemic, telehealth emerged as an effective tool for promoting healthy behaviours in the management of chronic conditions. This study employed a three-month quasi-experimental design with pre- and post-intervention measurements, assessing the progress of 82 adults assigned either to an intervention group (IG) or a control group (CG). A total of 66 participants completed the study, with 33 in each group. The IG had access to a telehealth-based platform providing educational content on healthy lifestyle habits and were followed up both in-person and remotely. The CG were monitored as usual, i.e., at their primary care nurses' discretion. The IG exhibited a statistically significant reduction in weight, BMI, and abdominal circumference, along with improved adherence to a heart-healthy diet, specifically the Mediterranean diet, and higher levels of physical activity. The nurse-led intervention (Care4US+), utilising telehealth from primary care, has proven effective in enhancing healthy behaviours and reducing cardiovascular risk factors.

A middle range theory of self- and family management of chronic illness

BACKGROUND

The Self- and Family Management Framework was created in 2006 to help structure self- and family management science. Based on a series of reviews and syntheses of emerging research and critical evaluation, we developed the Framework into a robust nursing theory.

PURPOSE

In this article, we reintroduce the Self- and Family Management Framework as the Middle Range Theory of Self- and Family Management of Chronic Illness.

METHODS

We review steps in the development and updating of the Framework, share rationale for advancement to a middle range theory, explicate components of the newly designed model, and propose future directions.

DISCUSSION AND CONCLUSION

It is our hope that this middle range theory will guide researchers and clinicians more comprehensively in supporting patients and families managing chronic illness, which will in turn inform continued theory development.

Orem's Self-Care Deficit Nursing Theory to Improve Children's Self-Care: An Integrative Review

Often school-age children are thought of as dependent on their parents and not necessarily involved in behaviors related to their own self-care. It is important to implement and advance self-care performance early in life to promote healthy lifestyles. This review examined the use of Orem's Self Care Deficit Nursing Theory in relation to children's self-care behaviors. This integrative review followed the Whittemore and Knafl guidelines. A systematic search was conducted using the nursing databases. The sixteen study articles were identified for the review, and five themes were identified. Children can develop skills and actively participate in maintaining health and wellbeing. Self-care programs based on Orem's theory are well suited to assist individuals including children to improve self-care skills that lead better self-care practices. Nurses guided by Orem's SCDNT will be well equipped to promote children's knowledge and self-care skills for maintaining health and preventing negative health outcomes.

Positive and negative ways that informal caregivers are affected by weight and weight management efforts for care recipients with spinal cord injury

PURPOSE

To understand how informal caregivers are affected by weight and weight management of care recipients with SCI.

MATERIALS AND METHODS

In-depth qualitative interviews were conducted with 24 informal caregivers of community-dwelling Veterans and civilians with SCI. Thematic analysis was conducted.

RESULTS

Three themes described how the care recipient's weight management efforts impacted the caregiver, including: (1) motivation and involvement in weight management efforts for themselves, (2) emotional well-being (positive and negative aspects), and (3) physical tasks (both ease and burden). Caregivers may experience emotional and/or physical burden by taking on extra caregiving tasks to help with care recipient's weight management. Caregivers also may experience positive impacts from the care recipient's weight management efforts, regardless of who drove the efforts, including improvement in their own motivation and involvement in weight management, enhanced emotional well-being (happiness for and with the care-recipient), and making physical caregiving tasks easier.

CONCLUSIONS

Rehabilitation providers can use these findings to educate dyads about potential impacts of weight management efforts for the care recipient, specifying areas that may cause burden but emphasizing the potential benefits for both recipient and caregiver. Integrating this education into rehabilitation practice may reduce overweight-related problems with function and declines in disability among dyads.Implications for RehabilitationInformal caregivers experience both positive and negative consequences with regard to weight management for individuals with SCI.Helping their loved one with weight management can facilitate informal caregivers' involvement in their own weight management activities.Findings may offer guidance to healthcare and rehabilitation providers as they incorporate weight management into education programs for informal caregivers of persons with SCI.Integrating this education into rehabilitation practice may reduce or delay overweight-related problems with function and declines in disability among dyads.

Orem's Self-Care Deficit Nursing Theory: Relevance and Need for Refinement

The purpose of this article is to highlight the relevance of Orem's Self-Care Deficit Nursing Theory (SCDNT) in contemporary and future practice, explicitly within the global self-care movement and interprofessional healthcare. The authors discuss the relevance and important strengths within Orem's nursing theory and recommend theoretical refinement within the context of significant societal and healthcare transformation. The constructs of global people-centered care and population health, with related social determinants of health, are identified as critical areas for development if SCDNT is to have continued relevance for nursing practice. Implications for theoretical thinking and nursing education are recommended.

The experience of menopausal women participating in weight management program: A pilot study

OBJECTIVE

Menopause is the transitional period of women transforming from middle age to old age, and often associated with obesity. Adequate weight control (ideal body weight maintenance) is an important issue for women's health. However, little is known about the experience of Taiwanese women participating in weight management programs.

MATERIALS AND METHODS

The current weight management program referred to the participation and completion of a 10 h weight management program (the course of 5 weeks, 2 h per week) at a community hospital in 2016 entrusted by the government in Taiwan. Using the descriptive phenomenological research method, purposive sampling, and a semi-structured interview guide, to conduct one-on-one in-depth interviews with menopausal women, did analyses.

RESULTS

Between August and September 2016, there were 71 subjects entering into the current study, with a median age of 56 (51-60) years. The median weight reduction was 0.6 kg at the end of the course but all were satisfied with it. There were four experiences detectable in the current study, including initial benefits from weight management programs, the difficulty in facing changes, adjustments, and a better body image.

CONCLUSIONS

Belief (for better health and body figure) and assistance (for change) were important issues in weight management programs, which can be used as reference for future designs of weight management program in overweight/obese menopausal women.

Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem's Self-Care Deficit Nursing Theory

Introduction

Many researchers have commended the self-care deficit nursing theory (SCDNT) developed by Orem as a means of improving patients' health outcomes through nurses' contributions. However, experimental research has investigated specific aspects of SCDNT, such as self-care agency and self-care requisites, rather than how the construct is practiced and understood as a whole. The current research presents a case study in which an advanced practice nurse (APN) used SCDNT-led practice within a primary healthcare setting that illustrates how the theory is applied to case management.

Methods

A case study was conducted by observing an APN during her work in the asthma clinic of a public hospital in Hong Kong. A comparison was made between the case management of the APN under observation with the nursing processes stipulated by the SCDNT across four key operations: diagnostic, prescriptive, treatment or regulatory, and case management.

Conclusion

During the observed consultation, the APN applied the four key operations. In SCDNT, the role of the APN is to apply practical nursing knowledge by determining how a patient can best undertake self-care within the circumstances of their living arrangements and support facilities. The case study also demonstrated that SCDNT-based nursing practice has strengths and limitations in a primary healthcare setting. The study concluded that Orem's SCDNT serves as an appropriate theoretical framework for nursing practice within primary healthcare settings. One practical consequence of using SCDNT is that it enables APNs to use nurse-sensitive indicators when evaluating their clinical practice. This study offers a practice update to increase the accountability of nursing practice for nurse-led healthcare services.

Examining progression and degeneration of nursing science using Imre Lakatos's methodology of scientific research programs

Over the years, nursing research and practice have been through remarkable transformations in response to evolving and emerging healthcare systems and practices. Regarding research, nurses moved beyond merely using the quantitative methodology to combining qualitative, quantitative and mixed methods. In practice, nurses have transitioned from the delivery of medical-based care to nursing theory-guided practice, evidence-based practice, knowledge translation and transformative practice. Some domains of nursing research and practice became progressive, while others degenerated. This paper aims to examine how different domains of nursing research and practice progress and degenerate using Imre Lakatos's methodology of scientific research programs. Lakatos differentiated scientific and pseudoscientific knowledge and coined the idea of scientific research programs. He believed that science in any discipline develops so that some programs are more progressive and others' degenerative. The degeneration and progression of programs occur steadily and rationally and are determined based on the extent of development and programs' potential to predict new solutions to old problems. Adopting this idea could enable nurses to critically analyse research programs in everyday knowledge development to use valid and legitimate programs for informing nursing practice.

A Middle-Range Theory for Nurses to Diagnose Ineffective Infant Feeding Patterns

PURPOSE

To construct a middle-range theory, based on the Roy adaptation model, for nurses can diagnose an ineffective infant feeding pattern.

DATA SOURCE

Scientific findings were used through a literature review and the concepts of the Roy model.

DATA SYNTHESIS

The theory indicated new elements for the diagnosis: 12 etiological factors and 13 clinical indicators. Most of those are not contained in the NANDA taxonomy.

CONCLUSION

The middle-range theory for these diagnoses highlights the need for a review of the components present in the taxonomy.

IMPLICATIONS FOR NURSING PRACTICE

This approach guides research on nursing diagnoses to revise the content of the theory and to expand its concepts and elements for the diagnosis of an ineffective infant feeding pattern.

Development of middle-range theories in nursing

ABSTRACT Objective: To identify in the literature how Middle-Range Theories (MRT) are being developed in Nursing. Method: Integrative review on the databases Lilacs (Latin American and Caribbean Literature in Health Sciences), Scopus, Cinahl (Cumulative Index to Nursing and Allied Health Literature), Web of Science and PubMed portal, using the keywords middle range theory and nursing, as well its Portuguese correspondents (Lilacs), and the Boolean operator AND. The sample included 25 articles. Results: All articles presented concepts related to MRT. Most developed a synthesis picture. Some theories have formulated specific propositions, hypotheses, and names. Only 16 articles cited the methodological framework, while 22 used theories or models for theoretical foundation and 11 carried out literature reviews. Final considerations: The development of MRT included the presentation of fundamental concepts, synthesis, propositions, hypotheses and specific name. The MRT is recognized as a way of developing knowledge to guide the nursing practice.

Theory Development Strategies for Middle-Range Theories

The purpose of this article is to present an analysis on the theory development strategies that have been used to develop middle-range theories through an integrated literature review and to provide directions for future theoretical development in nursing. First, theory development strategies that have been suggested and used in nursing are briefly discussed. Second, the methods used for the analysis are described. Then, 4 themes reflecting the theory development strategies that have been used to develop middle-range theories are discussed. Finally, suggestions for future theoretical development in nursing are made on the basis of the findings.

A Substruction Approach to Assessing the Theoretical Validity of Measures

BACKGROUND

Validity is about the logic, meaningfulness, and evidence used to defend inferences made when interpreting results. Substruction is a heuristic or process that visually represent the hierarchical structure between theory and measures.

PURPOSE

To describe substruction as a method for assessing the toretical validity of research measures.

METHODS

Using Fawcett's Conceptual-Theoretical-Empirical Structure. an exemplar is presented of substruction from the Individual and Family Self-Management Theory to the Striving to be strong study concepts and empirical measures.

RESULTS

Substruction tables display evidence supporting theoretical validity of the instruments used in the study.

CONCLUSION

A high degree of congruence between theory and measure is critical to support the validity of the theory and to support attributions made about moderating, mediating, causal relationships, and intervention effects.

Refinement of the Beliefs About Personal Weight Survey

This study tested the revised Beliefs About Personal Weight Survey-2 (BPWS-2) in 200 African American women, 18 to 40 years of age. Confirmatory factor analysis of a priori hypothesized factors resulted in 5 subscales-weight acceptance (8 items); excess weight acknowledgment (5 items); conventional weight regulation (3 items); circumstantial weight regulation (9 items); and weight concern (10 items). The Cronbach α ranged from 0.67 to 0.89. The factors demonstrated patterns of association with eating behavior, body mass index, body image, and psychosocial (depression and perceived stress) variables associated with weight. The BPWS-2 is the first instrument designed to measure beliefs about one's personal weight, thus results make important new contributions to the understanding of weight management.

Uso Del Condón en Adolescentes Nahuas, un Modelo Explicativo

En México, la población indígena supera los siete millones de habitantes, en Puebla el grupo más representativo es el Náhuatl. Sin embargo, las condiciones de vida, salud, educación y transporte son precarias para esta población. En los adolescentes, las responsabilidades como el matrimonio, la familia y los compromisos ante la comunidad, favorecen conductas de riesgo sexual que dificultan su desarrollo económico, social y reproductivo. El objetivo fue proponer un modelo explicativo del uso del condón en adolescentes nahuas. Método. Bajo el marco de la teoría social cognitiva, el concepto de valores culturales de Leininger y el proceso de la sustracción teórica, se desarrolló este artículo. Se muestran las relaciones del modelo con las proposiciones y los factores que influyen en el uso del condón para este grupo específico. Finalmente, el modelo explica las variables de interés, los niveles de abstracción y las relaciones entre sí en el contexto náhuatl. El siguiente paso será implementar los indicadores empíricos para conocer el grado de influencia de los factores personales y ambientales hacia el uso del condón en adolescentes nahuas. Resultados que aportarán información para el desarrollo del conocimiento en enfermería y la reducción de riesgo sexual de esta población.

Interactive Theory of Breastfeeding: creation and application of a middle-range theory

ABSTRACT Objective: To describe a breastfeeding theory based on King's Conceptual System. Method: Theoretical study that used analysis of concept, assertion synthesis, and derivation of theory for the creation of a new theory. Results: King's system components were associated with elements of the breastfeeding process and a middle-range theory was created, which describes, explains, predicts, and prescribes breastfeeding by analyzing factors that precede and affect it, as well as their consequences on the breastfeeding process. Conclusion: The Breastfeeding Interactive Model is abstract enough to be applied in different social, cultural, political, and economic contexts, because it conceptualizes breastfeeding in systemic, dynamic, and procedural aspects. Based on a conceptual model of nursing, it contributes to the scientific construction of the subject; however it can also potentially be applied by other professionals involved in breastfeeding assistance.

A Foundational Analysis of Dorothea Orem’s Self-Care Theory and Evaluation of Its Significance for Nursing Practice and Research

In-depth understanding of the ontological and epistemological assumptions of nursing theories can be achieved through theory analysis. Several theory analysis criteria have been proposed for examining ontological and epistemological assumptions, but there are limited examples of actual analysis of these assumptions. This article presents an analysis of the ontological and epistemological assumptions of Dorothea Orem’s self-care theory and evaluates its significance for nursing practice and research.

Development and Validation of the Beliefs About Personal Weight Survey Among African American Women

The purpose of this study was to develop the Beliefs about Personal Weight Survey among African American women. Sixty-five items were developed from literature and sample participants to characterize beliefs about personal weight in 3 domains: descriptors, causes, and consequences. The items were administered to 150 community-dwelling African American women, 18 to 40 years old, recruited from 5 sites. Factor analysis supported a 4-factor solution with the following dimensions: overweight acceptance, overweight concern, conventional weight regulation, and circumstantial weight regulation. These factors were significantly associated with weight management behaviors and body mass index. Profile analysis indicated distinct factor belief profiles by 3 weight categories.