Application of Middle-Range Nursing Theory to Resolve Health Disparity

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Table of Contents

Introduction
Rationale for Selecting Illness-Constellation Model
Concepts of Illness Constellation Theory
Graphic Representation
Healthcare Disparity
Application of Theory in Clinical Setting
Evaluation of the Theory
Conclusion
References

Introduction

The middle range theories (MRT) substantially contribute to the advancement of nursing-specific knowledge. Its first proponent, Robert Merton, stated that the MRT entails somewhat circumscribed phenomena that are empirically testable (Im & Meleis, 2021). The models are situation specific and serve as a guide in identifying phenomena of interest to healthcare professionals, such as the social determinants of health (SDoH). The purpose of this paper is to apply one of the MRT known as the Illness-Constellation Model in guiding the understanding of the mortality of African American women in prenatal. Although pregnancy is not a disease, the theory can help understand the complications that black women go through when pregnant and guide how to minimize their mortality.

Rationale for Selecting Illness-Constellation Model

The illness constellation model differs from the traditional views as it considers ill-health from both the perspective of the physical manifestation and the coping behavior of the person. The main proponents of the theory are Morse and Johnson, who did their research in 1991. They discovered that the prognosis of an illness was affected by personal character as well as their social context, including the family members and their friends (Butts & Rich, 2021). The model has four stages which were common themes expressed by patients and their family members during the research.

The first stage, in theory, is uncertainty, when the person suspects something is not alright with their body and feels overwhelmed. The family starts monitoring and becomes concerned as they suspect something is wrong too. Next, the individual goes into a disruption stage where they relinquish control and distract themselves as their significant others become vigilant and accept responsibility (Butts & Rich, 2021). The third stage is regaining self, where the patient makes sense of their condition as they set goals, renegotiate roles, and seek reassurance for recovery. The family and friends give their support, monitors, and buffer. In the final stage of regaining wellness, the patient takes charge and seeks closure as the family and friends relinquish control.

The reason for selecting the model is that it fits well with the desire for pregnancy, maximizing the wellness of the mother and the baby during pre and post-natal care delivery. Moreover, the illness constellation model emphasizes the notion of control to ensure the autonomy of the patient. The stages of illness constellation model fit in well with the needed prenatal care; hence, the theory is situation specific. The theory is straightforward to apply to the selected population and their health disparity.

Concepts of Illness Constellation Theory

There are considerable variations through the four stages, but the main concepts are useful in guiding healthcare providers (figure 1). The theory considers patients as individuals whose behavior and actions are relevant and vital in recovery. The other significant concept of the model is that the ramifications of a person’s experience of illness results in profound changes in the roles, interactions, and relationships with their family and friends (Butts & Rich, 2021). For the patient to regain high levels of wellness, they must go through a legitimate task of resolving the changes in roles and interactions with significant others.

Graphic Representation

Figure 1: Showing Diagrammatic Representation of the Illness Constellation Model

Healthcare Disparity

There is a significant racial and ethnic disparity in maternal mortality and morbidity in the United States. African American women have a three to four times higher chance of developing pregnancy complications (Howell, 2018). Unfortunately, most of the difficulties that result in the death of pregnant black women are preventable (Jamila et al., 2019). For instance, Erica Garner, the “Black Lives Matter” activist, died in 2017 following a heart attack while pregnant (Novoa & Taylor, 2018). Her death is an illumination of the devastating issues that African American mothers face regardless of their level of education or educational status. Therefore, the illness constellation model can guide the understanding of the experiences of African American Black women and, in doing so, help to improve their prenatal wellness. The clinical setting for this application is the obstetric clinic care for pregnant women.

Application of Theory in Clinical Setting

The conception and the early signs and symptoms of pregnancy represent the first stage of the model. The woman may miss their period, feel nausea, or have changes in appetite, making them suspect that they are pregnant. The family members begin noticing some changes at this stage and come to the same conclusion. The concern may come if the woman has other issues such as chronic disease or substance use disorder (Hansen & Moloney, 2019). Once it is apparent that the woman is pregnant, they may have to shift some duties to friends and family as they take rest and make some changes in their schedule to accommodate their state.

At one point in the disruption stage, the patient may have to accept that they can no longer be in control. For example, during labor, they may depend entirely on their caregivers while seeking reassurance that everything will be fine. The direction for healthcare workers is to coordinate with the family and friends of the pregnant black women to understand their complications and treat them promptly. If the first three stages are done correctly, there will be little, if any, mortality. Thus, in the fourth stage of regaining wellness, the woman gives birth safely and starts post-natal care while still under the observation of the healthcare providers in coordination with the significant others.

Evaluation of the Theory

Statistical assessment of records on mortality of African American due to lack of prenatal care is the most effective way of evaluating the success of applying the theory. For example, after applying the model for one year, the number of black women dying from pregnancy-related complications must significantly. The evaluation can be done using interviews with the African American communities who have been pregnant or have had their relative or friend pregnant. The expectations are patient satisfaction and improved quality of life. Moreover, the competencies of nurses should improve due to working with non-trained caregivers through the stages mentioned in the model. Resultantly, the clinical practice becomes better.

Conclusion

In conclusion, the illness constellation model is one of the MRT that is situation-specific, providing a wide range of applications for health disparities such as the high mortality rate among black women during pregnancy. The theory presumes that people undergo four primary stages, from wellness to illness and back to restoration of health. The same steps apply to pregnant women from the time of conception, through the changes, up to childbirth. Using the model can guide how nurses can involve their family and friends to improve the outcome for such women. To ensure continuous improvement, quantitative and qualitative measures are applied in evaluating the process.

References

Butts, J. B., & Rich, K. L. (2021). Philosophies and theories for advanced nursing practice. Jones & Bartlett Learning.

Hansen, A., & Moloney, M. (2019). Pregnancy‐related mortality and severe maternal morbidity in rural Appalachia: Established risks and the need to know more. The Journal of Rural Health, 36(1), 3-8. Web.

Howell, E. A. (2018). Reducing disparities in severe maternal morbidity and mortality. Clinical Obstetrics & Gynecology, 61(2), 387-399. Web.

Im, E., & Meleis, A. I. (2021). Situation specific theories: Development, utilization, and evaluation in nursing. Springer Nature.

Jamila, T., Hamm, K., Novoa, C., & Phadke, S. (2019). Eliminating Racial Disparities in Maternal and Infant Mortality. A Comprehensive Policy Blueprint. Center for American Progress. Web.

Novoa, C., & Taylor, J. (2018). Exploring African Americans’ high maternal and infant death rates. Center for American Progress. Web.

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