Critique For Hypertension Study Health Essay

Critique a theory utilizing a standardised method, such as Walker and Avant, that could steer a survey of African American adult females with high blood pressure. A Denote the strengths and failings of the theory/model related to research and pattern stressing its relevancy to African American adult females with high blood pressure.
Theoretical Foundation
The theoretical model, Cox ‘s interaction theoretical account of client wellness behaviour ( IMCHB ) ( 1982 ) , was analyzed harmonizing to the theory analysis described by Walker and Avant ( 2005 ) . In the survey of medicine attachment issues in African American adult females with high blood pressure ( HTN ) , the IMCHB could function as a utile usher for research and clinical pattern.Critique For Hypertension Study Health Essay. This theoretical account is recognized as a middle-range theory because of its relevancy to pattern state of affairss ( Lasiuk & A ; Ferguson, 2009 ) . Walker and Avant ‘s ( 2005 ) theory analysis evaluates the IMCHB beginning, significance, adequateness, usefulness, generalizability, parsimoniousness, and testability.
Beginnings
Cox ( 2010, August 4 ) , while employed as a nurse practician at the University of Tennessee, was asked to put up a pattern for medical pupils in the Nashville and Memphis countries. She served clients, largely sharecrop farmers, who lived in little, yet proud communities. Cox said it was hard to understand their kineticss because the clients did non hold many resources, so the wellness attention suppliers has to calculate out how to do up for their deficiency of resources. As her work evolved, she found that set uping resonance was critical in order to calculate out what the clients knew about their wellness job and what they did non cognize. The clients in these communities were non motivated by their deficiency of cognition. Therefore she had to calculate out what the wellness job was and how to do it right. She determined that the client besides had to hold a function in what the wellness job was and how to do it right, along with cognition of the hazards involved, cognition of how they contributed to the hazard, and the function they needed to play with hazard decrease. In an attempt to calculate out the intercessions that yielded the best results, Cox got permission to tape record her client interactions. She discovered that her interaction was different from one client to the following. Critique For Hypertension Study Health Essay. In kernel, she responded to each client ‘s cues ; if the client was reasonably, dying, or shy, she had to integrate their cues into her interaction. Oftentimes, the client ‘s affect ( fright, anxiousness ) had to be dealt with earlier acquiring to their cognition base. During the interaction, she found that she influenced the client and the client besides influenced her: Common influence occurred during the interaction. As a consequence of the interaction, she expected to see alterations when she saw her clients once more in two hebdomads. She subsequently called these alterations dynamic variables ( intrinsic motive, cognitive assessment and affectional response ) , and these alterations were her cue to continue to the following measure. If there was no alteration, she had to reevaluate the background variables and start over ( Cox, 2010, August 4 ) .

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Cox ( 2010, August 4 ) worked about 10 old ages with this population who were preponderantly African Americans. She stated that these clients informed the IMCHB. She mentioned that if she had worked in suburban area with people who had sufficient resources, so the IMCHB would hold been different. Cox farther mentioned that if wellness attention suppliers today took more clip on the front terminal to thoroughly assess background variables, set up resonance, and measure the client ‘s cognition base, so they could unclutter up misperceptions, misinterpretations, and misknowlege, taking to better wellness results ( Cox, 2010, August 4 ) . Critique For Hypertension Study Health Essay.
As a consequence of her clinical pattern, Cox did non believe the nursing profession was making a good occupation of specifying the nurses ‘ function in impacting client wellness results. She felt there was deficiency in a figure of countries such as certification of client attention, proviso of nursing attention, run intoing client demands with nursing intercessions, and effectual wellness attention results after the nursing attention experience ( Cox, 1982 ) . Cox identified three countries that summarized the failures of nursing theory and research: ( 1 ) conceptualisation of the client as an person, ( 2 ) the procedure of client-professional interaction, and ( 3 ) wellness attention outcomes following nursing intercessions ( Cox, 1982 ) .
Cox ‘s IMCHB is a deductive synthesis influenced by the work of four nonnursing wellness behaviour theoretical accounts that were derived chiefly from psychological and sociological influences ( Cox, 1982 ) . The Rosenstock ‘s wellness belief theoretical account, from a cognitive psychological background, addresses accounts of preventative wellness and unwellness behaviours whereby endangering wellness jobs cause people to seek attention and do wellness determinations ( Cox, 1982 ; Matthews, Secrest, & A ; Muirhead, 2008 ) . The Suchman theoretical account, derived from a sociological focal point, explains client wellness behaviours based on the influence of sociocultural variables and selected single features ( Cox, 1982 ; Matthews, et al. , 2008 ) . The Andersen and Newman theoretical account, built on the Suchman and Rosenstock theoretical accounts, adds economic and community resources ( Cox, 1982 ; Matthews, et al. , 2008 ) . The Self-regulation theoretical account, besides based on cognitive psychological science, explains the client ‘s ability to treat information from assorted beginnings and how this information influences the wellness attention job and actions to decide the job ( Cox, 1982 ) .Critique For Hypertension Study Health Essay.
Cox ( 1982 ) noted several defects in these wellness belief theoretical accounts. First, these theoretical accounts were non antiphonal to the multidimensionality and variableness in client behaviours and hence, they were considered to be of small benefit to the clinical practician. Second, these theoretical accounts lacked practical usage because they are discipline specific, therefore none of the theoretical accounts represented a holistic position of the client ‘s wellness beliefs or behaviour. Third, all of the theoretical accounts, except the self-regulation theoretical account, evolved from the medical theoretical account that focuses chiefly on the physiological and biological facets of diseases when naming and handling unwellnesss. Fourth, these theoretical account offered theoretical guess on the features of defiant clients, instead than more guidelines for intercessions. For some theoretical accounts, the word conformity implied that a client would release their freewill and take lone behaviours consistent with the ends established by the wellness attention supplier, pretermiting the individualistic nature of today ‘s clients ( Cox, 1982 ) .
The IMCHB has several premises: ( 1 ) the duty of attention remains the client ‘s duty ( Carter & A ; Kulbok, 1995 ; Cox, 1982 ) ; ( 2 ) most client wellness behaviours are voluntary whereby clients choose to prosecute in positive or negative behaviours based on their personal ends ( Cox & A ; Wachs, 1985 ) ; ( 3 ) the client has the ability to do their ain wellness attention picks and subsequent wellness behaviours ; ( 4 ) clients should exercise control over finding optimum wellness for themselves and the actions necessary to achieve their wellness position harmonizing to their environmental restrictions ; and ( 5 ) the client and wellness attention supplier ‘s perceptual experiences of world may differ, but the client ‘s perceptual experience dominates in their lives ( Carter & A ; Kulbok, 1995 ; Cox, 1982 ) .
Cox ( 1982 ) purports that wellness attention jobs today are non merely the wellness attention supplier ‘s concerns, they are the client ‘s concern every bit good.Critique For Hypertension Study Health Essay.  She farther asserts that with the coming of information engineering, much is known about causes and interventions of unwellnesss and wellness jobs. Therefore, intercessions should be centered on easing client wellness determinations and behaviours that promote positive wellness results ( Cox, 1982 ) .
Meaning
The three major elements in the IMCHB ( see Figure 1 ) are: client uniqueness, client-professional interaction, and wellness result. The IMCHB was formulated at an abstract degree and can non be tested straight. Therefore, a specific theoretical account for a peculiar wellness attention issue must be derived from the general theoretical account ( Cox & A ; Roghmann, 1984 ) . Concepts are operationally defined.
The client uniqueness constructs address assessment factors in the nursing procedure and these factors can be operationalized as the client ‘s human responses to existent or possible wellness jobs. The client professional interaction constructs address operational interaction factors relevant to nursing pattern and are apparent in nursing literature. The wellness results constructs are wide and can incorporate multiple result steps that are both operational and sensitive to nursing intercessions ( Cox & A ; Roghmann, 1984 ) . Harmonizing to Cox ( 1986 ) , the application of one, two or all three elements of the IMCHB can be operationalized dependant on the range of the research survey. The IMCHB has a wide model and wide conceptual variables reflective of an abstract theory that covers big content country and has been used in a figure of surveies with both qualitative ( Brown, 1992 ; Matthews, et al. , 2008 ) and quantitative research designs ( Dougherty, et al. , 1998 ; Marion & A ; Cox, 1996 ; Troumbley & A ; Lenz, 1992 ) .
Client uniqueness, the first component, defines the individualism of the client and reflects holistic theory. Singularity addresses the client ‘s interaction with their background variables that include demographic features, client societal group influence, old wellness attention experiences, and environmental resources ( Cox, 1982, 1986 ) . These variables are extremely prognostic of wellness behaviours because of their synergistic nature: They do non happen in isolation and remain virtually unchanged during the client-provider relationship ( Cox, 1982 ) . The component of client uniqueness includes dynamic variables. The dynamic variables are correctable to act upon during the client-provider relationship and include intrinsic motive, cognitive assessment, and affectional response ( Cox, 1982 ) . Intrinsic motive represents free pick and the demand to be self-determined and competent in wellness behaviours. Motivation varies among persons and wellness state of affairss ( Cox, 1982 ; Cox & A ; Wachs, 1985 ) . Critique For Hypertension Study Health Essay. Cognitive assessment AIDSs in the client ‘s perceptual experience or reading of their current wellness province. Affectional response relates to the emotions of the client that have the capacity to impact knowledge and behaviour ( Cox, 1982 ) .
The 2nd component, a major influence on the client ‘s wellness attention behaviour, is the client-professional interaction. The four constituents of the interaction include proviso of wellness information, affectional support, decisional control, and professional proficient competences. How the client will utilize wellness information is dependent on other factors such as uniqueness, relationship with the wellness attention supplier, and client perceived control. Affectional support addresses the affectional response to maintain emotions integral so cognitive assessment will treat wellness information. Decisional control is dependent on equal cognitive, motivational, informational and affectional responses to obtain desirable consequences from decision-making. The proficient accomplishments of the wellness attention supplier, the last constituent, lessening as the client is able to increase their ability to treat information and do determinations for themselves ( Cox, 1982 ) .
The concluding component, wellness result, reflects the client ‘s wellness consequences based on behaviour. The five outcome elements include use of wellness attention services, client wellness position indexs, badness of wellness attention job, attachment to the recommended attention regimen, and satisfaction with attention ( Cox, 1982 ) .
The undermentioned relational statements ( Cox, 1982 ) imply directional relationships from background variables to dynamic variables, from dynamic variables to elements of wellness result, and from elements of client professional interaction to elements of wellness result.Critique For Hypertension Study Health Essay.  A causal relationship is noted at the nonrecursive block of the theoretical account.
Background variables ( demographic features, societal influence, old wellness attention experience, and environmental resources interact cumulatively, at the same time, and frequently interdependently ) have directional influence on dynamic variables
Background and dynamic variables ( intrinsic motive, cognitive assessment, and affectional response interact cumulatively, at the same time, and frequently interdependently ) have nonrecursive causal influence with elements of client professional interaction and a directional influence on elements of wellness result.
Elementss of client professional interaction ( affectional support, wellness information, decisional control, and professional/technical competences interact cumulatively, at the same time, and frequently interdependently ) has directional influence on elements of wellness result ( use of wellness attention services, clinical wellness position indexs, badness of wellness attention jobs, attachment to the recommended attention regimen, and satisfaction with attention ) .
The IMCHB is a in-between scope theory with wide boundaries. The content is abstract and covers a big content country, for illustration, the elements of client uniqueness are comprehensive and acknowledge personal, societal, psychological, and environmental influences on wellness behaviour. The theoretical account has been tested on multiple client populations such as kids ( Cox, 2003 ) , older adult females ( Cox, 1986 ) , and military forces ( Troumbley & A ; Lenz, 1992 ) . In a survey of with parents of kids with biochemical familial upsets, the overall theoretical account of three indepenct variables ( parental satisfaction with societal support, kid adaptative operation, and trouble run intoing the kid ‘s demands ) accounted for 50 % of the discrepancy in rearing emphasis utilizing the IMCHB.Critique For Hypertension Study Health Essay.  The relational nature of the major constructs were evident in this survey.
Empirical support for the theoretical account is sound. Qualitative ( Brown, 1992 ; Matthews, et al. , 2008 ) and quantitative ( Dougherty, et al. , 1998 ; Marion & A ; Cox, 1996 ; Troumbley & A ; Lenz, 1992 ) research surveies support the relational statements.
Adequacy
The IMCHB is reasonable and the constructs and relationships are clear. The research supports valid decisions. Predictions can be made from the theoretical account and research workers agree with the anticipations. The logical sequence is similar to the stairss of the nursing procedure and the scientific method. Published by Cox and Roghmann ( 1984 ) , the consequences of the empirical testing of this theoretical account demonstrates the ability of the theoretical account to steer scientific probes. A diagram is shown in Figure 2. The relationships specified in the theoretical account are drawn with solid lines and arrows bespeaking the way of relationships. The relational statements depicting the figure are listed:
Background variables have directional influence on dynamic variables
Dynamic variables have nonrecursive causal influence with elements of client professional interaction and a directional influence on elements of wellness result.
Elementss of client professional interaction have directional influence on elements of wellness result.
As indicated inside the single boxes and depicted by dual pointers, background variables, dynamic variables, and elements of client professional interaction interact cumulatively, at the same time, and frequently interdependently.
Figure 2. Logical adequateness of Cox IMCHB.
Utility
The IMCHB is used as a theoretical account for nursing pattern and provides the model for legion research surveies ( Dougherty, et al. , 1998 ; Waisbren, Rones, Read, Marsden, & A ; Levy, 2004 ) . Research supports the theoretical account as a utile tool to explicate and foretell specific wellness behaviours. Because the IMCHB was derived from other wellness belief theoretical accounts, there are obvious similarities, nevertheless it differs in several ways: the ( 1 ) ability to see the individualism of clients ; ( 2 ) influence of the client-provider relationship ; and ( 3 ) wellness attention suppliers ability to impact client wellness results based on intercessions ( Matthews, et al. , 2008 ) . Critique For Hypertension Study Health Essay.Since the theoretical account is non limited to nursing pattern, it can be used as an interdisciplinary theoretical account in any type wellness attention puting ( Cox & A ; Roghmann, 1984 ; Matthews, et al. , 2008 ) .
Generalizability
The IMCBM has a wide model that has been tested in assorted research surveies ( Dougherty, et al. , 1998 ; Troumbley & A ; Lenz, 1992 ; Waisbren, et al. , 2004 ) utilizing selected conceptual variables from the theoretical account. Use of the theoretical account in this mode does non give consideration to the interaction of all variables in the theoretical account. Therefore, the consequences of these surveies must be interpreted with cautiousness and the strength of the overall model of the theoretical account is decreased. Due to the complexness of the theoretical account, it has non been tested in its wholly, therefore generalisations are limited. Large graduated table funded surveies to prove the theoretical account in its entireness are warranted ( Carter & A ; Kulbok, 1995 ) .
Parsimony
The IMCHB lacks simpleness and parsimoniousness and Cox describes the theoretical account as missing a. Alternatively, the theoretical account is general, comprehensive, and complex with multiple variables that could show statistical challenges, particularly the presence of feedback loops/ mutual relationships ( Cox, 1986 ) . In add-on, the theoretical account has a wide model that could let the coincident scrutiny of multiple variables, nevertheless, it must be narrowed to the specific variables of involvement ( Troumbley & A ; Lenz, 1992 ) . Although this theoretical account could be reduced to a simplistic format to obey the statistical regulations of factor analysis, structural equation mold, and development of instrumental variables, Cox ( 1986 ) contends that this attack would overlook the interaction and mutual opposition of variables evident in this theoretical account. Therefore, Cox ( 1986 ) stated that she would instead give statistics than hinder the cognition necessary to better the hereafter of nursing pattern and research. Critique For Hypertension Study Health Essay.
Testability
Cox ‘s IMCHB is described as a middle-range theory and one of the related standard is the ability to bring forth testable hypothesis: Hypothesis can be generated from the IMCHB. All three elements of the theoretical account have undergone dependable statistical measurings whereby parts of the theoretical account have been tested ; nevertheless, the theoretical account has non been tested in its entireness due to its complex nature. Cox and Roghmann ( 1984 ) conducted an empirical trial of the IMCHB to show the testability of the theoretical account in a secondary information analysis of the determinations of 203 adult females at-risk for foetal abnormalcies to find factors that predicted if they would hold or non hold an amniocentesis. The secondary informations contained all major variables for this survey. Data were analyzed utilizing multiple arrested development, discriminant analysis, and structural equation patterning to depict the consistence of correlativities and associations. Consequences revealed first-class know aparting ability, right predicted 87.2 % of those who would or would non hold an amniocentesis, and explained 58 % of the discrepancy in the client ‘s amniocentesis determination that was explained by the elements and variables/concepts in the theoretical account.
Strengths and failings of theoretical account
Harmonizing to Cox ( 1982 ) , theories should supply replies to the inquiries of what nursing is ” and what nursing does. ” Theories are developed to steer pattern, but become useless when they attempt to alter what is ” without first turn toing what is ” ( Ohashi, 1985 ) . Cox centers the IMCHB on the holistic client life style and wellness behaviour and the function of the wellness attention supplier in set uping client behaviour to accomplish positive wellness results. The strength of Cox ‘s theoretical account lies in the client-focused theoretical model that can be used to steer both pattern and nursing research ( Cox, 1982 ) .
The IMCHB was originally designed as a normative theory for nursing ( Cox, 1982 ) .Critique For Hypertension Study Health Essay.  Three of the four factors of normative theory as described by Dickoff and James ( 1968 ) are apparent in the IMCHB and considered strengths of the theoretical account: ( 1 ) factor-isolating ( categorization or calling the presented state of affairs ) in the elements of client uniqueness, ( 2 ) factor associating ( state of affairs depiction or interrelatedness of factors ) in the uniqueness dynamic variables, and ( 3 ) state of affairs associating ( prognostic, if A happens, so B happens ) in the assessment stage of the elements of client-professional interaction ( Carter & A ; Kulbok, 1995 ; Dickoff & A ; James, 1968 ; Dickoff, James, & A ; Wiedenbach, 1968 ) . This theoretical account has shown positive consequences in foretelling and explicating wellness behaviours. Large per centums of the discrepancy of wellness behaviours have been explained by parts of the theoretical account used in assorted surveies ( Cox, 1986 ; Cox & A ; Roghmann, 1984 ; Marion & A ; Cox, 1996 ; Waisbren, et al. , 2004 ) .
The 4th factor, state of affairs bring forthing ( normative, activities to convey approximately desired results ) is viewed as a strength of the IMCBH ( Carter & A ; Kulbok, 1995 ; Dickoff & A ; James, 1968 ; Dickoff, et al. , 1968 ) , but a failing in clinical pattern. The nonrecursive portion of the theoretical account where mutual relationship should be is non good developed in nursing pattern whereby consistent effectual wellness results are apparent. The demands of nursing pattern and the client-staff ratio does non let nurses to pattern systematically in the mode described in this theoretical account. As nursing pattern continues to germinate, the normative ideation of this theoretical account could go a world.
The complexness the IMCHB is besides viewed as both a strength and failing. As a strength, the complexness of the theoretical account allows for the survey of multiple variables and is ideal for working with clients who have complex wellness behaviours. African American clients in peculiar, have an array of complex physical, psychosocial, and environmental factors that impact unwellness such as high blood pressure. Since African Americans informed the initial beginnings of this theoretical account, the constructs fit the many-sided nature of their wellness behaviours good ( Cox, 2010, August 4 ) . As a failing, the complexness of proving the full theoretical account may be clip devouring and expensive. Because the complexness of the theoretical account, it has non been tested in its wholly, therefore generalisations are limited.Critique For Hypertension Study Health Essay.  In add-on, when selected conceptual variables in the theoretical account are tested without sing the interaction of all variables in the theoretical account, the consequences of the survey must be interpreted with cautiousness and this decreases the strength of the overall model of the theoretical account ( Carter & A ; Kulbok, 1995 ) .
The IMCHB is a nursing pattern theoretical account that closely parallels the nursing procedure in the countries of appraisal, intercession, and rating ( Dougherty, et al. , 1998 ) . As a consequence, nurses in the clinical pattern scene should be able to utilize most elements of this theoretical account with easiness. This theoretical account is applicable to nursing pattern is because it is a middle-range theory, a definite strength of the theoretical account.
The background variables are inclusive of factors such as lower socioeconomic position ( instruction, income, business ) , demographic features ( race, age, sex ) , and environmental resources ( substandard vicinities, hapless entree to wellness attention ) that contribute to cardiovascular disease. The clients decision-making procedure about wellness behaviours may be affected by their background variables. Therefore, it is the attendant picks, and non the background variables that influence wellness results and become ends for nursing intercessions ( Cox & A ; Wachs, 1985 ; Marion & A ; Cox, 1996 ) . Bing able to research legion background variables and the picks made as a consequence of the variables could supply insight into nonadherent behaviours in African Americans with unwellness such as HTN. New behavioural penetrations could assist nail specific intercessions that may change the client ‘s motive for attachment to wellness attention governments and better wellness results ( Cox & A ; Wachs, 1985 ) . This demonstrates the theoretical account ‘s strength in describing and foretelling wellness behaviours and has deductions for both pattern and research. Critique For Hypertension Study Health Essay.
In the theoretical account, the wellness results are determined by the mutual interactions between the client and wellness attention supplier related to client wellness concerns ( Cox & A ; Roghmann, 1984 ) . If interactions between the wellness attention supplier and the client are positive, so positive wellness results may emerge and the antonym may happen if the interactions are negative. Consequently, the consequence of the client-provider relationship on wellness results could be perceived as both a strength and failing.

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Intrinsic motive is a strength of the theoretical account that may explicate grounds for nonadherence in single clients. It may besides foretell why some clients adhere to wellness attention intercessions while others do non ( Troumbley & A ; Lenz, 1992 ) . This part of the theoretical account has both pattern and research deductions, particularly for African Americans with HTN who may or may non adhere to order antihypertension medicines.
This model merely focuses on elements of the client-professional interaction. This may be a restriction since nurses interact with other members of the interdisciplinary squad, work with inanimate objects, and have assorted functions in the wellness attention puting and profession organisations ( Dickoff & A ; James, 1968 ; Ohashi, 1985 ) . All of these interactions may impact the client-professional interaction in assorted ways such as utilizing another member of the wellness attention squad ( chaplain ) to supply affectional support or acquiring patient wellness information from a professional nursing organisation.
Since its origin, the IMCHB has remained stable without any alterations. This could certify to the strength of the theoretical accounts ability to accurately portray what nursing is ” and what nursing does. ”
Relevance to African American Women with Hypertension
Harmonizing to Cox ( Cox, 2010, August 4 ) , African Americans informed the IMCHB.
The complexness of the IMCHB creates the thought platform for African American adult females because they have an array of complex physical, psychosocial, and environmental factors that farther complicate high blood pressure. In fact, high blood pressure is a multifactorial status and this offers some support to the many-sided nature of the intervention procedure ( Gutierrez & A ; Peterson, 2007 ) .Critique For Hypertension Study Health Essay.  This gives some acceptance to the high prevalence of HTN in African American adult females and sheds visible radiation on the limited success of attachment intercessions ( Douglas, et al. , 2003 ) . Therefore, the complexness of this disease procedure requires a theoretical account such as the IMCHB that allows for the survey of multiple background variables along with dynamic variables to supply insight into complex, hazardous wellness behaviours. This theoretical account is relevant to the attention of African American adult female. Critique For Hypertension Study Health Essay.