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Commentary: Analysis of the Explanatory Model of Health Promotion and QOL in Chronic Disabling Conditions
Rehabilitation Nursing Editorial Board Member
This article is an important contribution to rehabilitation nursing. As the specialty of rehabilitation has matured and those with disabilities are integrated into society, concerns beyond the immediacy of the disabling condition require greater attention. Phillips’ analysis of Stuifbergen’s model reveals a logical, testable theory that is useful not only in research, but also in guiding nursing practice.
Evidence-based practice has become synonymous with research. Fawcett et al. (2001), however, call for a more “comprehensive focus” (p. 115) than simply on empirics, emphasizing that theory is “the reason for and the value of the evidence” (p. 117). Nursing practice guided by sound nursing theory strengthens nursing’s role and contribution to the rehabilitation team. The research-tested theory presented here will do just that.
Figure 1 of the article provides a guideline for practice. In assessing a patient, specific questions to be explored will depend upon the person’s condition. The outcome variable of the model—quality of life (QOL)—could be determined by asking the person, what his or her concept of a good QOL would be. This concept could then form the basis of individualized goals. The desired health-promoting behaviors would depend upon the person’s condition, the expert opinion of the nurses and of the rehabilitation team, and the patient. While QOL and health-promoting behaviors may be relatively easy to identify, assisting the patient to reach them is not. The model, based upon the research, however, provides clear guidance.
Assessment of severity of illness, the person’s barriers, resources, self-efficacy, acceptance, current health-promoting behaviors, and current QOL will suggest the nursing plan of care. Research has shown the relationships among these variables, thus developing a plan to reduce the barriers and strengthen the resources will promote self-efficacy and acceptance. Higher self-efficacy and acceptance is related to engagement in health-promoting behaviors, and thus a higher QOL. The meaning of each of the concepts or variables is broadly defined; nurses in agencies could develop specific assessment tools appropriate to their populations. The tools used to develop the model also could be used; because these tools have been validated, they would be useful as well to further research the efficacy of the model.
Phillips’ critique of Stuifbergen’s model reveals a theory that extends beyond previous health-promotion models and has been supported by years of research and refinement to reach the highest level of evidence—the randomized clinical trial. Thus, this model offers rehabilitation nurses an evidence-based framework upon which to base practice.
Fawcett, J., Watson, J., Neuman, B., Walker, P. H., & Fitzpatrick, J. J. (2001). On nursing theories and evidence. Journal of Nursing Scholarship, 33, 115–119.