The purpose of this assignment is to describe, evaluate, and discuss the application of a nursing mid-range theory of nursing. This analytical essay also provides an opportunity to connect theory and research to nursing phenomena. The nursing theory chosen for this analysis is the Self-Transcendence Theory by Pamela G. Reed.
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Theory/Author Name and Background
Born in 1952 in Detroit, Michigan, Pamela G. Reed earned her baccalaureate from Wayne University in 1974 and later MSN in psychiatric-mental health of children and adolescents, and nursing education in 1976. Pamela pursued her doctoral education at the same university in 1979 and got her Ph.D. in 1982, focusing on nursing theory and research and in adult development and aging. She completed her dissertation, which concentrated on the association between health and spiritual views on life and death in terminally sick and well people, under the supervision of Joyce Fitzpatrick.
Since January 1983, Pamela has been a member of the faculty at the University of Arizona College of Nursing, Tucson. She teaches, conducts research, and fulfills administrative duties in the academic affairs department, and Pamela has been awarded several times due to her contributions toward nursing theory and metatheory developments. The theorist concentrates on well-being and aging, and she was among the first researchers to study spirituality in nursing, which led to the development of the Self-Transcendence Scale and Spiritual Perspectives Scale. Most of her works are published in scholarly journals. Additionally, Pamela now focuses on research that addresses care providers in palliative knowledge in a family setting and nursing theories in knowledge development. She also co-edited both the 4th and 5th editions of the Perspectives on Nursing Theory. Additionally, Pamela is affiliated to the American Academy of Nursing and serves in other organizations, such as Sigma Theta Tau International, the International Society of Rogerian Scholars, and the American Nurses Association. She also serves boards of many nursing journals and actively contributes as an editor to a nursing discourse on Nursing Science Quarterly.
The influences of Pamela go beyond her research and scholarly publications. She directs her students in projects. Besides, Pamela’s theory and the two scales are widely applied in the field of nursing, and today, many more researchers continue to provide empirical evidence to advance her works.
The mid-range theory of self-transcendence by Pamela G. Reeds was developed in 1990 (Reed, 1991). It was largely based on the approach of deductive reformulation. The deductive reformulation strategy emanated from Pamela’s professors during her time at Wayne State University. It involves the use of knowledge acquired from the non-nursing theory that is redrawn deductively from a nursing conceptual model, and the theorist used life span developmental psychology for adult social-cognitive and transpersonal development to reformulate this mid-range theory by applying the principles of Martha E. Roger’s conceptual system that describes the unitary human being (Reed, 1991).
According to Pamela, her theory has three distinct sources. First, the theorist used the concept of a lifelong process to conceptualize human development that goes beyond the period of adulthood to processes of aging and dying (Reed, 1991). Previously, it was claimed that both mental and physical development stopped at adolescence. However, this concept, seen as a paradigm shift, explained that there was a continued possibility of development in advanced years.
Second, Pamela also based Self-Transcendence Theory on the earlier work of another nursing theorist, Martha E. Rogers. In Rogers’ work, three concepts of hemodynamics were consistent with the main principles of the progressing life span developmental theory (Reed, 1991). According to her integrality approach, development was seen as a factor of both human and circumstantial features, and the imbalance between an individual and the environment was considered a major causative factor of development. It was also observed that physical, environmental, emotional, and social aspects of development occurred at different periods for developmental progress.
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Based on the principle of policy developed by Rogers, human development was described as an innovative, unpredictable process. This argument is the same as the life span concept, which characterized the development as a nonlinear, progressive process during the course of the life span and manifest inconsistency within and across people and different populations. From Rogers’ resonancy principle, human development is a process of progress that is unpredictable but displays patterns and a sense of purpose. Moreover, life span proponents also claimed that the developmental process had complex patterns and organization (Reed, 1991). To this end, Pamela was able to reformulate knowledge acquired from other fields (life span developmental concept) using a suitable nursing conceptual system to develop this mid-range theory.
The final source of materials for the theory was evidence acquired from clinical research and experiences, which showed that clinically dejected older patients displayed limited developmental abilities to support their sense of well-being when they encountered diminishing cognitive and physical attributes relative to other mentally healthier older groups (Reed, 2009).
The theory of self-transcendence is based on three major concepts, namely vulnerability, well-being, and self-transcendence (Reed, 1996). Vulnerability reflects an individual’s consciousness of personal mortality, which refers to maturation in the later period of adulthood or near the end-of-life. Therefore, self-transcendence is a pattern linked to later development in the context of maturation or near the end-of-life (Reed, 1991). The concept of vulnerability widens the mindfulness of an individual’s mortality situation to account for other life experiences, such as chronic conditions, disability, childbearing, and parenting. Self-transcendence shows changes in perceived boundaries that extend an individual past the immediate and narrow perspectives of self and the world. They extend the scope of one’s viewpoint. These changes are outward for other persons and the environment, inward for greater self-awareness of values and beliefs, and temporal to integrate experiences and future to improve the present (Reed, 1991). Finally, well-being is a good sense of general health and feeling whole. It accounts for both body and mind. Within the context of the theory of self-transcendence, well-being is associated with changes in advanced age, including frailness and stress.
The above three concepts are explicitly defined. Various personal and contextual factors and their relationships could affect the course of self-transcendence as it contributes to well-being (the concept mediating-moderating factors concept). For instance, age, cognitive functions, gender, spiritual viewpoints, environments, and other life events are moderating-mediating factors that ultimately influence the course of self-transcendence and well-being. They can enhance or fade the relationship and interactions between the three concepts of the theory of self-transcendence.
In this theory of self-transcendence, the intervention takes place at two points (points of intervention concept) where concepts interact with the self-transcendence process. Nursing interventions could be directed at an individual’s inner resources to realize self-transcendence, or they may indirectly target personal and contextual elements, which influence relationships among the three concepts of the theory of self-transcendence.
This theory is based on some major assumptions. The theorist developed a process model methodology for creating conceptual frameworks to assist nurse educators and practitioners in clinical settings. Based on the model, health remains a major concept, which influences other nursing activities, the environment, and the person. The main assumption is that the nursing discipline is to create and engage knowledge to enhance health processes and positive outcomes (Reed, 1996).
The constituents of the model are health, nursing, the person, and the environment. Health in the model is seen as a process of life with both positive and negative outcomes from where an individual develops exceptional values and environments for enhancing well-being (Fresson, Dardenne, Geurten, Anzaldi, & Meulemans, 2017). The purpose of nursing is to help individuals using interpersonal processes and interventions, which allow them to acquire the skills necessary to improve their health and well-being. Persons are depicted as developing throughout the life span as they interact with others and the environment characterized by complexity and fluctuations with both positive and negative impacts on health and well-being. Finally, environmental factors, such as family, physical features, social networks, and community resources affect health outcomes, and nurses could influence them through interventions to restore well-being.
As previously discussed, the three main concepts of this theory are vulnerability, well-being, and self-transcendence. Vulnerability refers to self-awareness of mortality, which results from processes of aging and other phases across an individual’s life span. Vulnerability shows that individuals realize self-transcendence in the context of confronting end-of-life issues and other life challenges, such as disability and chronic diseases (Reed, 2009). Self-transcendence shows changes in the observed boundaries, which extends an individual beyond their immediate and defined points of view of self and the environment. These changes could be outward, inward, temporal, and transpersonal. Well-being is associated with general health and a feeling of wholeness.
These three major assumptions are explicitly explained. Self-transcendence is considered higher in individuals who face end-of-life challenges than in other healthier persons (Drageset, Haugan, & Tranvåg, 2017). End-of-life challenges are widely considered because they occur with various life events, such as aging, diseases, and other experiences that enhance the awareness of an individual’s mortality. The theory also shows that conceptual boundaries influence a person’s well-being. Based on their nature, changes in conceptual boundaries affect well-being in a positive or negative way throughout a life span. For example, the theory shows that enhanced self-transcendence is associated with positive developments in cognitive health, which is a reflection of well-being for an individual with end-of-life challenges. On the other hand, depression and lack of strong social networks would be seen as negative health outcomes, particularly poor mental health (Reed, 2009). The theory further shows that personal and environmental factors influence all the three key concepts of the theory.
It has been previously shown that the model of the theory of self-transcendence incorporates all the four meta paradigms of nursing – person, environment, health, and nursing (Jarrin, 2012). According to the theory, nurses generally assist their patients through skills and knowledge acquired to enhance health and well-being. Health is the main activity that influences nursing practices, the person, and the environment. Based on the four meta paradigms, this model shows that nursing specialty should create and apply knowledge to promote health. The theory demonstrates a sense of lucidness and consistency based on its assumptions. Individuals are seen as open systems who have some conceptual boundaries that limit or define their realism and offer a sense of fulfillment and connectedness with self and the environment. These assumptions clearly demonstrate that people are integral to their surroundings, which are characterized by changes that significantly influence human development and health. The theory, therefore, is an important tool for demonstrating one’s conceptual self-boundaries that may be evaluated to improve health outcomes.
One can also deduce that the theory presents the concept of self-transcendence as an important aspect of development. That is, a person must exhibit it like any other element of development in life for them to realize a continued sense of connectedness and wholeness. It is an innate human trait that a person can actualize to realize purpose and meaning in life. In short, the theory of self-transcendence is narrow in scope, simple and straightforward like other mid-range theories (McEwen & Wills, 2014).
Pamela developed this theory with the idea of nursing processes geared toward achieving human well-being. As such, the theory of self-transcendence is applied in three distinct areas – nursing practice, education, and research. In nursing practice, supporting meaning and purpose in life as the number of the aging population continues to rise is now extremely important in nursing (Drageset et al., 2017). Nurses apply their acquired knowledge of health, environments, and persons to deliver quality care. Nursing practices or interventions adopted are largely based on constructs of the person (self-transcendence), well-being (health), and vulnerability (environment). In this regard, nurses should apply diverse nursing activities, such as meditation, life assessment, and spirituality to facilitate the development of self-conceptual limits (Drageset et al., 2017). Additionally, the theory is applied in self-reflection, hope, altruism, and faith, as well as in other group psychotherapy and cancer support groups to allow patients to assess their values and share experiences in life to determine meaning in their health conditions (Milani, Amiri, Vejdani, Salehiniya, & Malek-khahi, 2017).
In education, the theory of self-transcendence and its related themes are widely found in many nursing education works. Self-transcendence is seen as an example of a suitable philosophical nursing foundation. It is linked to development and health in studies. Nursing is used to facilitate processes of human capacity development. It enhances well-being, and nurses are trained on the importance of self-transcendence to understand patients with end-of-life issues.
Additionally, many research studies now offer empirical evidence to support the application of self-transcendence theory to enhance patient health. Patients with intractable disease, chronic health issues, and end-of-life conditions have realized improved health outcomes when concepts of this theory were applied (Vitale, Shaffer, & Acosta-Fenton, 2014). Overall, the theory of self-transcendence is widely applied in different nursing settings in which patients’ well-being could be hindered by end-of-life challenges.
In this essay, the nursing theory of self-transcendence was explored. This mid-range theory was developed based on the concepts of the deductive reformulation in which theoretic knowledge of life span developmental psychological was reformulated to provide new guiding principles for nursing education, care, and research. It incorporates all four meta paradigms of nursing to enhance well-being. Empirical evidence and clinical experiences were also applied in the development of the theory, and they suggest that the theory of self-transcendence is important for application in diverse nursing settings particularly where patients’ life outcomes are hampered by end-of-life challenges.
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Drageset, J., Haugan, G., & Tranvåg, O. (2017). Crucial aspects promoting meaning and purpose in life: perceptions of nursing home residents. BMC Geriatrics, 17(1), 254-263. Web.
Fresson, M., Dardenne, B., Geurten, M., Anzaldi, L., & Meulemans, T. (2017). The Role of self-transcendence and cognitive processes in the response expectancy effect. Psychologica Belgica, 57(2), 77–92. Web.
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