This paper will focus on the mid-range theory called the Interaction Model of Client Health Behavior (IMCHB) which is used to introduce a comprehensive and systematic description of society-based elders. Abstract constructs, concepts, factors, and variables depicted by one dimension of the model could assess 54% of probability among elders’ health status, whereas 47% refer to the probability of well-being. The works of Lucy Graham, who discusses the model as a comprehensive tool for coping with HIV care across the lifespan, and Mathews, Secrest, and Muirhead, who analyze the theory as a model used for advanced practice nurses, will be discussed further. Additionally, the theory will be analyzed with regard to deductive reasoning, and the major concepts of the theory in terms of adults in the context of community interactions will be discussed. Finally, the paper will provide assumptions and propositions about the use of the Interaction Model of Client Health Behavior, examine the extent to which the theory can guide nurses, and analyze how it can be employed in the area of research.
Nursing Theory Analysis
Theory/Author Name and Background
The Interaction Model of Client Health Behavior introduced by Dr. Cheryl Cox is used to comprehensively and systematically describe society-based elders. It is composed of three major elements: client-professional interaction, client singularity, and health outcome. To begin with, client-professional interaction is based on four domains that affect patients’ health outcomes. First, the concept of client-professional interaction involves effective support, which is associated with meeting the clients’ needs (Cox, 1986). The second domain introduces health information which assists patients with further understanding their health outcomes, thus affecting their alternatives and lifestyle in managing their health outcomes (Cox, 1986). The third domain introduces decision control, whereas the final one introduces professional-technical competencies which rely on the skills employed by nurses.
The second variable of the proposed theory is client singularity. It relates to the background aspects of various patients which are composed of social influence, demographic characteristics, environmental resources and previous healthcare experience. At this point, educational level, age and gender are the examples of demographic features. Social influence is defined through marital status, and the length of hospitalization could refer to previous healthcare experience (Cox, 1986). The use of the model is usually made at highlighting various dimensions of client-professional interaction which could be enhanced and developed among nurses. The model can also assist hospitals in developing specialized training activities for nurses.
Dr. Cheryl Cox is a registered who also received the degree of Doctor of Philosophy. The theorist is also a member of St. Jude Children’s Research Hospital Epidemiology, Cancer Prevention and Control. She worked as a family nurse clinician in 1972; in 1982, she worked at the University of Rochester (American Public Health Association, 2013). Dr. Cheryl Cox also worked on the evaluation of health outcomes of cardiovascular diseases among survivors. Additionally, Dr. Cox spent over a decade translating her previous works related to the general population to modify the risk behavioral patterns of childhood cancer survivors (American Public Health Association, 2013). Hence, it can be inferred that the theorists’ background explains the major dimensions of the formed theoretical framework which is focused on the community development and is related to their backgrounds (American Public Health Association, 2013). Specifically, working in a community introduces a new framework within which an individual is analyzed from a social, demographic, and cultural perspective, including social influence, healthcare experience, and health outcomes.
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The theoretical framework has become the basis for many other research studies and procedures, which have resorted to the theory to explain their own practical and scientific findings. To begin with, Graham (2015) has resorted to the Interaction Model of Client Health Behavior as an underpinning for understanding retention mechanisms among HIV patients in the course of lifespan. Specifically, the author assumed that retaining people with HIV in care is essential for sustaining their longevity and quality of life. Individual health behavior aspects that influence care retention in the identified sphere are a daunting and multifaceted task. Current theories in health behavior are not effective enough to explore retention in the sphere of healthcare when used in isolation. Hence, the researcher resorted to a two-fold approach and employed two theories – Folkman’s Transactional Model of Stress and Coping and Cox’s Interaction Model of Client Health Behavior. The synergy of the models provides a comprehensive algorithm that would form the care retention practice and research throughout lifespan. It embraces interpersonal features along with the experience of coping with stress, which is inevitable when living with such illness as HIV.
In addition to the above presented interpretation and application of the theories, there are also other studies which focus on the theoretical framework. For instance, Mathews, Secrest, and Muirhead (2008) focused on the theory as a good model for guiding and controlling nurse practitioners in their practical activities. The selected theory was combined with the NP movements and writings on the nursing practical model to confirm that many practices in the healthcare environment have blurred the boundaries between nursing and medicine (Mathews et al., 2008). Additionally, the scholars introduced a nursing model which explores the aspects of clients’ individuality and uniqueness as well as evaluates interaction between clients and nursing practitioners to achieve positive health consequences. These variables should provide a new dimension through which this theory could be analyzed and evaluated.
There is another important research study which analyzed the level of patients’ satisfaction with the nursing care with reliance to the Interaction Model of Client Health Behavior. Specifically, Tang, Soong, and Lim (2013) state that patient satisfaction was represented as a viable outcome measure of the quality of the healthcare delivery system. Satisfaction assessments reflect the patients’ expectations about the quality of care they receive. In this respect, the scholars sought to explore patients’ satisfaction by using Patient Satisfaction with Nursing Care Scale which was designed on the basis of Cox’s Interaction Model of Client Health Behavior. The findings revealed that patients have a moderate level of satisfaction with nursing care. The majority of patients were highly satisfied with the support provided by nurses by means of caring, respect, and responsiveness. At the same time, a lower level of satisfaction was noticed in regard to family involvement in decisional control. There were no tangible differences in patients’ satisfaction in terms of gender, age, and social status. In general, the study highlighted a significant difference in examining patients’ ethnicity and satisfaction, thus determining the degree of patients’ satisfaction along with the contributing factors which improve the quality of nursing care. Finally, the study also proved that patient’s satisfaction could provide an insight as to how nursing could be improved with expanding knowledge about patient’s social and ethnic background. Such a framework is essential for establishing trustful and close relationships between a patient and a nurse. What is more important, further research can also resort to qualitative assessment of patients’ perception along with the essence of quality care.
In order to explore the theory in more depth and detail, it is necessary to refer to the concept of deductive reasoning, an approach that defines general postulates which have specific outcomes in a certain environment. In this respect, the general idea of the theory refers to the assumption that patients’ background has a potent influence on interaction between a client and a healthcare professional. Hence, the theory could be used as a basis for greater systems which introduce new approaches, principles, and methods designed for advancing caring models. In this respect, the theory could become a part of larger systems, such as self-care promotion. The model could be applied to a range of cases and content analysis, particularly to conceptualizing practical observations and empirical studies in which the use of a specific framework creates a strong platform for systematizing knowledge. Hence, the concepts represented in the model – client singularity, client-professional interaction, and health outcomes create a comprehensive picture of how the treatment process should take place. Furthermore, the Interactive Model of Client Health Behavior is also used to analyze the patient’s social influence and previous experience on his or her cognitive appraisal and attitude to the treatment process and professionals’ competence. To support the idea, Ackerson (2011) introduced a qualitative study for exploring social influence of women’s previous experience on their cognitive appraisal. The research revealed that the theory is useful for structuring and designing cervical cancer screening health behavior research since it managed to fill all possible gaps in the treatment routine.
The above-presented studies resorted to Cox’s theoretical frameworks to explore the extent to which the major concepts of the theory are introduced, namely client singularity, health outcome, and client-professional interactions. As it has been mentioned, client singularity is essential for defining patients’ social, cultural, and ethnical backgrounds since it affects their outlook on healthcare professionals’ level of competence and quality of care in general. In this respect, the research studies presented above explicitly refer to this aspect. For example, Tang et al. (2013) chose this dimension as the forefront concept for estimating the quality of care. They provided an in-depth analysis of all dimensions of patients’ life, including family engagement, personal beliefs and outlooks on nursing care to define the extent to which they relate to the quality of care. Similarly, Graham (2015) resorted to all three elements to prove that the theory gives sufficient grounds for estimating the role of client singularity and its adherence to the community. Theses aspects must be analyzed and introduced for understanding the patient not as a human being with certain illnesses and physical deviations but also as a personality with specific views, beliefs, and outlooks.
With regard to the above-presented explanations, it could be stated that the concepts shaping the entire theory are represented explicitly in the studies proposed above. They have been used as the key issues which are discussed in the light of the Interactive Model of Client Health Behavior to define direct relationships and compare them with the current practices. Furthermore, the theory also serves as a starting point for analysis, evaluation, and synthesis of related theories to expand on the research area. Finally, the research studies chosen for expanding on the practical side of the theory provide a sufficient explanation of each concept relation to the theory. For instance, client singularity concept defines how patients’ background and demographic features define the vector in which nurses and physicians should approach a specific client, leading to specific health outcomes.
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Explicit and Implicit Dimensions of the Theory
As it has been mentioned previously, the major purpose of Cox’s theory is to define and explain the connection between client singularity, client-professional interaction, and health consequences. When it refers to client singularity, emphasis should be placed on such aspects as cognitive appraisal, affective response, and intrinsic motivation, which could become an explicit framework for shaping new training courts and activities. Second, client-professional interaction should stem from the fact of existence of cooperation and agreement between a healthcare provider and a client, client’s opportunity to decide on the need to adhere to the recommendations of healthcare professionals, and no blame on the part of professionals in case of clients’ failure to comply with the healthcare provider’s treatment plan and recommendations.
When it refers to implicit outcomes of the theoretical framework, one should admit that the patient’s dimensions rely on a variety of individual features which define the extent to which the patient is able to cope with healthcare challenges. These features involve physical, psychological, social, environmental, and personal aspects. At this point, the IMCHB suggests that nurses should take into consideration those features when a planning a care program for patients.
Four Concepts of a Nursing Metaparadigm
Person. While deliberating the theory application in terms of personal dimensions, it should be stressed that the theory defines client’s behavior as the key factor affecting the nature of treatment programs composed. In this respect, Cox (1986) believes that a person is defined through his or her attitude toward the quality of care or a combination of social, cultural, ethnical, and psychological paradigms.
Health. When it refers to health criteria, emphasis should be placed on Cox’s interpretation of health welfare through the client’s social, psychological and individual well-being. In other words, previous health experience should also be taken into consideration while developing an individual treatment plan for a specific patient. Thus, Mathews et al. (2008) assume that advanced healthcare relies on holistic assessment of all demographic features of a patient.
Environment. The environment is apparently the central focus of the theoretical framework because it defines the patients’ direct actions regarding the quality of care they receive as well as healthcare outcomes for a specific group of patients. In this respect, Tang et al. (2013) explored certain aspects of patient’s satisfaction, which can differ depending on their previous health experience and social status as well as the extent to which nurses take care of their family status.
Nursing. Finally, nursing perspective closely relates to the underpinnings of the Interactive Model because it defines specific paradigms and principles of interaction between a patient and a nurse at a professional level. It is also a prompt algorithm for exploring the patients’ medical record, including social background, individual and ethnical peculiarities.
Clarity of the Theory
In general, the four concepts represented through the Interactive Model of Client Health Behavior recognize the importance of the person and his/her environment in developing a treatment plan. Additionally, it allows understanding a person both as a patient and as an individual with reliance to the patient’s outlook on health. Therefore, Cox (1986) assumes that client health behavior directly depends on a range of factors, including such perspectives as patient’s social background, health experience, medical record, and nurses’ level of engagement with those issues. With this in mind, it could be stated that the theory is consistent, clear, and explicit in terms of identification of major dimensions, concepts, and their interaction with each other. It can also shed light on the current applications and interpretations in the nursing environment with reliance on patients’ responsiveness and understanding of care.
In conclusion, it should be stressed that the application of the Interactive Model of Client Health Behavior can significantly contribute to the nursing and medical practice. It is critical to pay attention to such issues as nurses’ professionalism and responsiveness, patient’s background, and demographic characteristics, which are essential for developing an individualized approach. First of all, it should be admitted that the theory has a universal nature because it could be applied to any demographic group. For instance, Cox’s framework could be used to fight with the childhood obesity. The point here is that it is possible to explore nursing interaction with the patient and influence their motivation, values, and perceptions as well as their positive outlook on healthcare in general. Secondly, the theory could be skillfully combined with other theoretical frameworks for the purpose of introducing new programs, activities, and systems that would advance the quality of care. The influence of interactive relationships could be represented through self-care systems which rely on the examination and observation of self-care agencies, including such features as demographic and social status, the level of patients’ awareness of treatment procedures, and specific behavioral outcomes. A holistic approach, therefore, should serve as the major platform for enhancing new methods, models and principles in developing new solutions. What is more important, the proposed system can also provide new advances in the nursing care, producing new skills, experiences, and interactions which would seek to improve patient’s satisfaction with the quality of healthcare delivery. Finally, cognition and mediation are also at the core of health outcomes, which could be achieved through educational and supporting dimensions on the part of healthcare professionals. Cox’s model is still on the path of further development and advancement because it can be applied to other target audience irrespective of the methods used.