Self Transcendence Middle Range Theory in Nursing Care

The Self Transcendence Middle Range Theory in Nursing Care. Mishel’s Theory of Uncertainty in Illness (1988-1990) explains how patients and caregivers interpret the uncertainty about the course of an illness.

What Is Self Transcendence Middle Range Theory in Nursing Care

As the name suggests, middle-range theories lie somewhere between the sweeping scope of grand nursing and a minute focus on practice-level theories. These theories are often phenomena-driven, attempting to explain or predict certain trends in clinical practice. They’re also testable or verifiable through research.. Additionally, it provides a framework for selecting of interventions that will improve the psychological and behavioral outcomes of uncertainty.

Self Transcendence Middle Range Theory Introduction to Self-Transcendence Middle Range Theory

The middle-range theory of Self-Transcendence was developed by Pamela G. Reed (1991, 1996, 2003) to enhance the understanding of well-being for individuals who experience heightened awareness of vulnerability and mortality. The theory posits that self-transcendence, the ability to expand one’s self-boundaries, is integral to achieving a sense of well-being, particularly in life situations where individuals are confronted with their vulnerability (Reed, 2003).

Two foundational assumptions underlie this theory:

1. Human beings are inseparable from their environment and capable of developing an awareness that transcends temporal and spatial dimensions.
2. Self-transcendence is an innate characteristic of humans that requires expression for the realization of their full potential (Reed, 2003).

Role in Nursing Care

Reed (2003) suggests that self-transcendence theory is grounded in research on post-formal thinking, which involves a more pragmatic, spiritual, and tolerant approach to ambiguity in life situations. Postformal thinking allows individuals to integrate their experiences, leading to a broadened awareness of moral, social, and historical contexts. This expanded perspective enhances one’s appreciation of life and self, making self-transcendence a crucial component in nursing care.

Nursing care, guided by self-transcendence theory, focuses on helping patients expand their self-boundaries and gain a deeper understanding of their life situations. Nurses can facilitate self-transcendence through therapeutic communication, providing opportunities for self-reflection, and fostering a supportive environment where patients feel safe to explore their spirituality, relationships, and purpose.

Concepts in Self-Transcendence Theory

The theory of self-transcendence is built upon three key concepts:

1. Self-Transcendence: Defined as the ability to expand self-boundaries across four dimensions:
   • Intrapersonally: Expanding awareness of one’s philosophy, values, and dreams.
   • Interpersonally: Enhancing relationships with others and one’s environment.
   • Temporally: Integrating past and future experiences to give meaning to the present.
   • Transpersonally: Connecting with dimensions beyond the commonly perceived world (Reed, 2003, p. 147).
2. Well-Being: A sense of feeling whole and healthy according to one’s criteria for wholeness and health. It is achieved when self-transcendence helps an individual integrate their life experiences meaningfully (Reed, p. 148).
3. Vulnerability: Awareness of personal mortality. This concept acknowledges the reality of human existence and the limitations imposed by health challenges or life-threatening conditions (Reed, p. 149).

The relationship between these concepts is complex. The link between self-transcendence and vulnerability is nonlinear, meaning that very low or very high levels of vulnerability may not necessarily result in increased self-transcendence. However, the relationship between self-transcendence and well-being is positive when the outcome indicator of well-being is favorable. Individuals who can transcend their immediate circumstances, despite their vulnerabilities, often experience a greater sense of wholeness and health.

Use in Nursing Research

The Self-Transcendence Scale, developed by Reed (1991), has been widely used in research studies focusing on various populations, including:

• Well Elders: Studies have explored how self-transcendence affects the well-being of elderly individuals who are not experiencing significant health issues.
• Elders Hospitalized for Depression: Research has examined the relationship between self-transcendence and recovery outcomes in elderly patients receiving treatment for depression.
• Oldest Old (Aged 80 to 100): Investigations have studied the role of self-transcendence in promoting well-being among the oldest segment of the population.
• Healthy Adults and Adults Facing End-of-Life Experiences: Studies have included adults with advanced breast cancer, AIDS, and other life-limiting conditions (Reed, 2003, pp. 152-156).

These studies consistently demonstrate that self-transcendence is positively associated with indicators of well-being across diverse human health experiences. Research findings suggest that as individuals engage in self-transcendence, they achieve greater levels of psychological and emotional health, even when facing significant health challenges.

Reed (2003) also references several dissertation studies that further support the relationship between self-transcendence and well-being, providing a substantial body of evidence that confirms the theory’s applicability in various contexts.

Use of Theory and Impact on Outcomes

Self-transcendence theory has been effectively applied in several areas of nursing practice, including:

• Bereavement Support: Helping individuals cope with the loss of loved ones by facilitating self-reflection and finding meaning in their experiences.
• Caregivers of Adults with Dementia: Assisting caregivers in managing the challenges associated with caring for loved ones with dementia, promoting personal growth and psychological well-being.
• Sobriety and Recovery Programs: Supporting individuals in substance abuse recovery programs to find purpose beyond their addiction and achieve a sense of wholeness.
• Primary Care Settings: Integrating strategies that promote self-awareness and spiritual growth to enhance overall health outcomes (Reed, 2003, pp. 158-161).

Strategies to enhance self-transcendence in nursing practice can be categorized into three types:

1. Intrapersonal Strategies: These involve practices that encourage self-reflection and inner growth, such as:
   • Meditation, Prayer, Visualization, Life Review, and Journaling: These activities allow individuals to clarify and expand their understanding of themselves and their situations, promoting healing and personal growth (Reed, 2003).
   • Positive Self-Talk and Challenging Activities: Engaging in activities that boost self-esteem and promote a sense of achievement and purpose.
2. Interpersonal Strategies: These focus on enhancing relationships and social connections, such as:
   • Support Groups and Group Psychotherapy: Providing opportunities for individuals to connect with others facing similar challenges, share experiences, and provide mutual support.
   • Altruistic Activities: Encouraging individuals to engage in helping others, which can promote a sense of purpose and fulfillment.
3. Transpersonal Strategies: These involve facilitating a connection with a higher power or a greater sense of purpose, such as:
   • Spiritual Practices: Encouraging practices that help individuals connect with a power greater than themselves, fostering a sense of peace and acceptance (Reed, 2003).

By implementing these strategies, nurses can help patients achieve a sense of self-transcendence, leading to improved health outcomes and overall well-being.

Conclusion

Self-transcendence is a middle-range theory that provides a valuable conceptual framework for nursing practice and research. It offers a structured approach for understanding how individuals can expand their self-boundaries and find meaning in their experiences, especially in situations where they face vulnerability and mortality. This theory is particularly relevant in nursing care, where fostering well-being and helping patients cope with illness and end-of-life situations are paramount.

Integrating self-transcendence theory into nursing education at both the undergraduate and graduate levels can enhance students’ awareness of the importance of self-transcendence in patient care. Teaching students to apply this theory in practice will guide their care and improve their understanding of theory-based practice, ultimately leading to better patient outcomes and a more holistic approach to health care.

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