Major Nursing Theories
Major Assessment using Theories in a Practice Problem
Brenda Gould-Johnson
Walden University
Scientific Foundations for Nursing
NURS 8110
Dr. Eric Anderson
August 10, 2013
Major Assessment Nursing is a science that may encompass other theories to support the research goal while evaluating the state of health of the client in response to the information, treatment and procedures to prevent or cure. These efforts are to get these individuals, families and groups to obtain and maintain an optimal health status. The practice theories, also known as middle range theories are easier for the DNP practitioner to apply health care interventions (Grove, Burns, & Gray, 2013). The clinical practice problem in this paper is Women …show more content…
Health Promotion related to breast cancer screening. The medical community and advance nurses are certain that many of the cancer deaths in women related to diagnosis of breast cancer could have been prevented through routine mammography (Humphrey, Helfand, Chan, & Woolf, 2002). The lack of breast cancer screening is particularly prevalent in populations of various ethnicities, who are underserved, uninsured, and many are not aware of the recommendation to perform the self-breast examination or schedule a routine mammogram. This paper will examine how two middle range theories, namely, behavioral and cognitive, are appropriate in addressing and supporting the clinical practice problem. A middle range conceptual framework allows the practitioner to explore the interrelated concepts, interactions with clients and researcher with creative interventions to solve the health problem (Zaccagnini & White, 2012). A middle range theory creates social significance to discover "what is known, what is not known (Cowen, 2005, p.298) in this health study with the understanding there is a relationship between behavioral theory and the clinical practice problem and cognitive theory and the clinical practice problem, regarding breast health screening. In the client care, the problem can be something that the practitioner wants the client to obtain or attain or maintain based on the intervention that will require cognitive exercise and behavioral adjustment or change. Cognitive theory is a borrowed theory used by nurses that have found it to be effective on the behavioral health units, for example, in reducing anxiety. This is particularly helpful to the advanced nurse in educating client/patient’s to acquire personal insights, introduced by H.E. Peplau (1963) (McEwen & Wills, 2011). Peplau believed, “that nurses play an essential role in helping clients reduce their anxiety and converting it into constructive action” (McEwen, 2011, p. 281). The interpersonal relationship between client and the nurse is vital in the healing process. The social aspect in the relationship between the health care staff and client is an active therapeutic environment or milieu of the client, if in a psychiatric setting. The internal conflicts that brought the client to a state of mind that he/she is no longer able to function in society safely must be explored through therapeutic communication within the milieu (Echternacht, 2001). The communication will require the nurse-client be in the therapeutic environment within talking distance. Social cognitive theory of learning is known as a cognitive learning activity which is observational learning that result in defined behaviors (Bandura, 1993).
In other words, we can also learn by observing other people. This ability began as youngsters instinctively. As advanced nursing professional, we must remember we are role models and should be on guard regarding our conduct. The social-cognitive learning theory is principled in observational activities and can drive a point to give attention or motivation. The observer watches an activity and is able to repeat the action or procedure. This vicarious learning can be learned by someone describing behavior and later demonstrating it (McEwen & Wills, 2011). The social cognitive action requires the researcher to understand and manage self-esteem and self-efficacy of those in the study. The researcher can control the environment but not the mental thoughts of a person. For example, the researcher could control the environment by putting everyone in a room and bring a power point presentation while addressing the clients. And be able to describe and give recall of what occurred in the closed-controlled environment (McEwen & Wills, 2011). Self-esteem actually is related to the inner stability of a person, how they view themselves, accepting personal “self-worth” (McEwen & Wills, 2011). It is necessary in the search design in understanding of how health care staff and community volunteers can model the …show more content…
social cognitive change, there needs to be educational training and word selection training. This procedure will assist in controlling the environment. In addition, use of a power point presentation would encourage women to be more involved and engages when encouraged to ask questions, ,as well as, participating in self-breast examination and scheduling mammography. Those nurses and community leaders and volunteers modeling positive behavior and educating the women in the community could produce positive outcomes. Then there are theories focused on the internal processes of learning, retaining knowledge to use in problem-solving (Ormrod, 2004). These are informational processing theories within the social-cognitive development. They point out long-term memory versus short-term memory systems that look at the sensory holds the information while it stores. Theory can develop from an actual identified nurse practice problem (McKenna, 1997). And focusing on the social-cognitive theory actually is a good identified area to acquire better outcomes. Being aware of the types of memory systems allows the presenter in providing the education piece that techniques to utilize, such as, audio-visual aids to facilitate learning segments in regards to the practice problem. Not only must the educational portion should be tailored to the audience, the amount of time for the information and the time of day. More importantly, measuring how much is retained can be tested or by completing an existing pre- and post-test for statistics. And social-cognitive theory concludes the behavior of the listener is guided by cognitive procedures rather than reinforced review. Another middle range theory used by nurses is categorized in behavioral sciences. The selected category is social psychology theories related to health promotion. Social psychology is subjugates to behavioral sciences, and it relates strongly to how humans think and act or react. Historically, the “model was understanding behavior changes” (McEwen & Wills, 2011, p. 290). In practice, nurses are involved in innovative activities to influence clients in making better choices attain health or maintain health through health promotion principles. McEwen & Wills (2011) say the behavioral change is the results of the client’s psychological, public and environmental conditioning. The metaparadigm evidence in the social psychology model/theory involves two areas Health Belief Model (HBM) and Theory of Reasoned Action (TRA)/Theory of Planned Behavior (TPB). Health Promotion programs, for example, breast cancer screening, are good application for behavioral science theory, namely, social psychology theory aspect. When a client’s belief is fixed on a threat to his/her health and does not see any a way out, behavior is formed or expressed and is categorized under HBM. Once the behavior is formed the health care professional imposes their influence to assist the client to formulate a positive decision, a behavioral change, for health improvement and a healthier life (McEwen & Wills, 2011). The seriousness of the health issue is decided initially by the client as they pull in all they know about the condition, along with anxiety and fear. At this point, the person’s perception or opinion is not necessarily based on facts. More information may be needed to satisfy the increasing anxiety. The increasing anxiety is considered a barrier which is affecting the psychological thinking regarding the persons’ health (Rosenstock, 1974). The goal in destroying any barrier that would impede the road to health and to influence the client to achieving self-efficacy. This confidence will boost the client to seeing themselves asking the health care staff, community leaders, and volunteers, this would be an accomplishment. Evidence of personal growth will be present when the health care professional’s educational material and suggestions helped catapult the client to consider and/or acceptance of the health promotion programs’ literature, power point presentation, discussion groups, all to stimulate dialogue and behavior change. The health promotion facilitator goal in every Breast Health Program is to make positive change. Client’s ability to reach a place within the social psychological model/theory to accept the health issue and feel and express confidence to a determinant state is called “salient belief” (McEwen & Wills, 2011). There is another factor that must be considered while all the psychological battle takes place, time. The emotional state of a person is complex and hard to determine when they can or will be able to digest or come to grips with the reality of the news of the diagnosis. There is no compass to show a person which way to go in this type matters because the emotional component of our being is complex. However, when a person advances to a place of acceptance then emerges another behavior, attitude, a new belief is formed about the issue and leads to what researchers’ Ajzen and Fishbein introduced in the 80’s. This social psychologist identified the relationship between intentions, attitudes, beliefs and behavior emphasizing people are rational, generally, and these same people can make important decisions based on the information they are given (Ajzen & Fishbein, 1980). The next step, after accepting the diagnosis, is releasing themselves from pre-conceived concepts and perceptions surrounding the diagnosis. In addition, their study resulted in a person will ponder over their beliefs and consider others opinions and often come to the conclusion of what others have said and change their behavior toward the issue. After carefully studying the text on theories on “Social Sciences” and “Behavioral
Sciences” with additional literature, the most appropriate theory for addressing the practice problem is found in behavior science, namely, Social Psychology Theory (SPT). The practice research question is why are there a large percentage of women with advance breast cancer due to the lack of awareness and education in performing SBE and/or receiving a mammography, as a part of early detection. The literature supports that there are still women not performing breast screening, particularly, in the underserved and uninsured populations. I have chosen this theory because of its’ many facets of examining the complex social psychological aspect of these women. Facets of interest are self-esteem, self-efficacy and perception of health within the low socio-economical communities in which they live. Bandura (1993) believes that people learn from observing others. It stands to reason if health is not observed as an important aspect of healthy living then as women become adults this could be considered the norm. A typical application of SPT is in the area of Health Promotion interventions ((McEwen & Wills, 2011, p. 283). Health care professional may use a social environment to present health related facts to a group (Ormrod, 2004). During the educational session, numerous interventions may be used, however, keeping in mind the women are adult learners and the presentations should reflect this important area. When the health professional utilizes TRA (Theory of Planned Behavior) principles, the nurse is trying to predict behaviors of those individuals listening, in hopes to influence or persuade (Poss, 2001). Another nursing application of SPT, the theory allows the creativity of the nurses on the Health Promotion team who are focusing on breast screening to develop effective strategies, such as, literature dissemination, mass media clips, games, and infiltrate the communities by identifying leaders and volunteers to influence this population to behavior change toward breast screening, thus develop a change in their health belief ((McEwen & Wills, 2011, p. 294). Motivating women to make an individual behavior change and actively participate in performing the self-breast examination (a screening) can positively help the individual, family, group as well as the future women in their community is the desired outcome in their health belief. In conclusion, I agree that middle range theory are to focus on the holistic approach to nursing and medical care.
According to McEwen and Wills (2011), concepts such as pain, symptom management, cultural issues, and health promotion issues are commonly addressed. The target population in the research study is the issues surrounding women who are underserved, uninsured who live in the similar environment a metropolitan community who do not routinely perform breast cancer screening and the reasons why not. The disparity surround this health issue and the possibilities to combat this is situation is exciting and unending in the literature. The behavioral theorist seemed appropriate for this study since one of my goals in this population is change behavior, which will take dedication, research, education, testing, and creative ways to present the material, requiring some reinforcement and reminders to perform monthly SBE and scheduled mammography. If any testing is needed prior to mammograms due to other health issues, the theory developed can be revisited to examine due to any testing (McKenna, 1997). The research does encompass borrowing several theories to support the goals for healthy behavior change for the population and allows the nurse to deliver the best care for the community (McEwen & Wills, 2011, figure
13.2). Health Promotion will positively affect health behaviors of individuals and communities, with nursing education, pamphlets, demonstrations, and a host of other strategies. This concept is seen as a process through assisting people to increase their ability to release some health belief controls, increase their knowledge base and improve their health using behavior change action (Milton-Underwood, 2003). Breast health, breast awareness and breast screening are crucial, if the women in this population want to have improved outcomes. The nurses’ role is advocate, educator, motivator, counselor, support and researcher in this battle against breast cancer through health promotion principles utilizing borrowed behavior sciences theory, namely, social psychological theory. The advanced nurse is able to develop theory or concept selection to formulize a framework to meet the health issues of each patient (McKenna, 1997).
References
Ajzen, I., & Fisbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall.
Bandura, A. (1993). Perceived self-efficacy in cognitive development and functioning. Educational Psychologist, 28(2), 117-148.
Echternacht, M. M. (2001). Fluid group: Concept and clinical application in the therapeutic milieu. Journal of the American Psychiatric Nurses Association, 7(1), 39-44.
Grove, S. K., Burns, N., & Gray, J. R. (2013). The practice of nursing research:
Appraisal, synthesis, and generation of evidence (7th ed.). St. Louis, MO: Evolve Elsevier.
Humphrey, L. L., Helfand, M., Chan, B. K., & Woolf, S. H. (2002). A summary of the evidence for the U.S. Preventive Services Task Force. Annual Internal Medicine, 137(347-360), 347-360.
McEwen, M., & Wills, E. M. (2011). Theoretical basis for nursing (3rd ed.). Philadelphia, PA: Wolters Kluwer Lippincott, Williams & Wilkins.
McKenna, H. P. (1997). Nursing theories and models. Retrieved August 09, 2013 from http://web.ebscohost.com.ezp.waldenulibrary.org/
Milton-Underwood, S. (2003). Improving chances: Nursing celebrating, embracing, and promoting breast health among African American women. Advance for Nurses, 1(10), 25-30.
Ormrod, J. E. (2004). Human learning: Principles, theories, and educational applications (4th ed.). Englewood Cliffs, NJ: Prentice-Hall.
Poss, J. E. (2001). Developing a new model for cross-cultural research: Synthesizing the Health Belief Model and Theory of Reasoned Action. Advances in Nursing Science, 23(4), 1-15.
Rosenstock, I. M. (1974). The health belief model and predictive health behavior. Health Education Monographs, 2, 354-436.
Zaccagnini, M. E., & White, K. W. (2012). The doctor of nursing practice essentials: A new model for advanced practice nursing. Sudbury, MA: Jones & Bartlett Publishers.
Brenda Gould-Johnson
Walden University
Scientific Foundations for Nursing
NURS 8110
Dr. Eric Anderson
August 10, 2013
Major Assessment Nursing is a science that may encompass other theories to support the research goal while evaluating the state of health of the client in response to the information, treatment and procedures to prevent or cure. These efforts are to get these individuals, families and groups to obtain and maintain an optimal health status. The practice theories, also known as middle range theories are easier for the DNP practitioner to apply health care interventions (Grove, Burns, & Gray, 2013). The clinical practice problem in this paper is Women …show more content…
Health Promotion related to breast cancer screening. The medical community and advance nurses are certain that many of the cancer deaths in women related to diagnosis of breast cancer could have been prevented through routine mammography (Humphrey, Helfand, Chan, & Woolf, 2002). The lack of breast cancer screening is particularly prevalent in populations of various ethnicities, who are underserved, uninsured, and many are not aware of the recommendation to perform the self-breast examination or schedule a routine mammogram. This paper will examine how two middle range theories, namely, behavioral and cognitive, are appropriate in addressing and supporting the clinical practice problem. A middle range conceptual framework allows the practitioner to explore the interrelated concepts, interactions with clients and researcher with creative interventions to solve the health problem (Zaccagnini & White, 2012). A middle range theory creates social significance to discover "what is known, what is not known (Cowen, 2005, p.298) in this health study with the understanding there is a relationship between behavioral theory and the clinical practice problem and cognitive theory and the clinical practice problem, regarding breast health screening. In the client care, the problem can be something that the practitioner wants the client to obtain or attain or maintain based on the intervention that will require cognitive exercise and behavioral adjustment or change. Cognitive theory is a borrowed theory used by nurses that have found it to be effective on the behavioral health units, for example, in reducing anxiety. This is particularly helpful to the advanced nurse in educating client/patient’s to acquire personal insights, introduced by H.E. Peplau (1963) (McEwen & Wills, 2011). Peplau believed, “that nurses play an essential role in helping clients reduce their anxiety and converting it into constructive action” (McEwen, 2011, p. 281). The interpersonal relationship between client and the nurse is vital in the healing process. The social aspect in the relationship between the health care staff and client is an active therapeutic environment or milieu of the client, if in a psychiatric setting. The internal conflicts that brought the client to a state of mind that he/she is no longer able to function in society safely must be explored through therapeutic communication within the milieu (Echternacht, 2001). The communication will require the nurse-client be in the therapeutic environment within talking distance. Social cognitive theory of learning is known as a cognitive learning activity which is observational learning that result in defined behaviors (Bandura, 1993).
In other words, we can also learn by observing other people. This ability began as youngsters instinctively. As advanced nursing professional, we must remember we are role models and should be on guard regarding our conduct. The social-cognitive learning theory is principled in observational activities and can drive a point to give attention or motivation. The observer watches an activity and is able to repeat the action or procedure. This vicarious learning can be learned by someone describing behavior and later demonstrating it (McEwen & Wills, 2011). The social cognitive action requires the researcher to understand and manage self-esteem and self-efficacy of those in the study. The researcher can control the environment but not the mental thoughts of a person. For example, the researcher could control the environment by putting everyone in a room and bring a power point presentation while addressing the clients. And be able to describe and give recall of what occurred in the closed-controlled environment (McEwen & Wills, 2011). Self-esteem actually is related to the inner stability of a person, how they view themselves, accepting personal “self-worth” (McEwen & Wills, 2011). It is necessary in the search design in understanding of how health care staff and community volunteers can model the …show more content…
social cognitive change, there needs to be educational training and word selection training. This procedure will assist in controlling the environment. In addition, use of a power point presentation would encourage women to be more involved and engages when encouraged to ask questions, ,as well as, participating in self-breast examination and scheduling mammography. Those nurses and community leaders and volunteers modeling positive behavior and educating the women in the community could produce positive outcomes. Then there are theories focused on the internal processes of learning, retaining knowledge to use in problem-solving (Ormrod, 2004). These are informational processing theories within the social-cognitive development. They point out long-term memory versus short-term memory systems that look at the sensory holds the information while it stores. Theory can develop from an actual identified nurse practice problem (McKenna, 1997). And focusing on the social-cognitive theory actually is a good identified area to acquire better outcomes. Being aware of the types of memory systems allows the presenter in providing the education piece that techniques to utilize, such as, audio-visual aids to facilitate learning segments in regards to the practice problem. Not only must the educational portion should be tailored to the audience, the amount of time for the information and the time of day. More importantly, measuring how much is retained can be tested or by completing an existing pre- and post-test for statistics. And social-cognitive theory concludes the behavior of the listener is guided by cognitive procedures rather than reinforced review. Another middle range theory used by nurses is categorized in behavioral sciences. The selected category is social psychology theories related to health promotion. Social psychology is subjugates to behavioral sciences, and it relates strongly to how humans think and act or react. Historically, the “model was understanding behavior changes” (McEwen & Wills, 2011, p. 290). In practice, nurses are involved in innovative activities to influence clients in making better choices attain health or maintain health through health promotion principles. McEwen & Wills (2011) say the behavioral change is the results of the client’s psychological, public and environmental conditioning. The metaparadigm evidence in the social psychology model/theory involves two areas Health Belief Model (HBM) and Theory of Reasoned Action (TRA)/Theory of Planned Behavior (TPB). Health Promotion programs, for example, breast cancer screening, are good application for behavioral science theory, namely, social psychology theory aspect. When a client’s belief is fixed on a threat to his/her health and does not see any a way out, behavior is formed or expressed and is categorized under HBM. Once the behavior is formed the health care professional imposes their influence to assist the client to formulate a positive decision, a behavioral change, for health improvement and a healthier life (McEwen & Wills, 2011). The seriousness of the health issue is decided initially by the client as they pull in all they know about the condition, along with anxiety and fear. At this point, the person’s perception or opinion is not necessarily based on facts. More information may be needed to satisfy the increasing anxiety. The increasing anxiety is considered a barrier which is affecting the psychological thinking regarding the persons’ health (Rosenstock, 1974). The goal in destroying any barrier that would impede the road to health and to influence the client to achieving self-efficacy. This confidence will boost the client to seeing themselves asking the health care staff, community leaders, and volunteers, this would be an accomplishment. Evidence of personal growth will be present when the health care professional’s educational material and suggestions helped catapult the client to consider and/or acceptance of the health promotion programs’ literature, power point presentation, discussion groups, all to stimulate dialogue and behavior change. The health promotion facilitator goal in every Breast Health Program is to make positive change. Client’s ability to reach a place within the social psychological model/theory to accept the health issue and feel and express confidence to a determinant state is called “salient belief” (McEwen & Wills, 2011). There is another factor that must be considered while all the psychological battle takes place, time. The emotional state of a person is complex and hard to determine when they can or will be able to digest or come to grips with the reality of the news of the diagnosis. There is no compass to show a person which way to go in this type matters because the emotional component of our being is complex. However, when a person advances to a place of acceptance then emerges another behavior, attitude, a new belief is formed about the issue and leads to what researchers’ Ajzen and Fishbein introduced in the 80’s. This social psychologist identified the relationship between intentions, attitudes, beliefs and behavior emphasizing people are rational, generally, and these same people can make important decisions based on the information they are given (Ajzen & Fishbein, 1980). The next step, after accepting the diagnosis, is releasing themselves from pre-conceived concepts and perceptions surrounding the diagnosis. In addition, their study resulted in a person will ponder over their beliefs and consider others opinions and often come to the conclusion of what others have said and change their behavior toward the issue. After carefully studying the text on theories on “Social Sciences” and “Behavioral
Sciences” with additional literature, the most appropriate theory for addressing the practice problem is found in behavior science, namely, Social Psychology Theory (SPT). The practice research question is why are there a large percentage of women with advance breast cancer due to the lack of awareness and education in performing SBE and/or receiving a mammography, as a part of early detection. The literature supports that there are still women not performing breast screening, particularly, in the underserved and uninsured populations. I have chosen this theory because of its’ many facets of examining the complex social psychological aspect of these women. Facets of interest are self-esteem, self-efficacy and perception of health within the low socio-economical communities in which they live. Bandura (1993) believes that people learn from observing others. It stands to reason if health is not observed as an important aspect of healthy living then as women become adults this could be considered the norm. A typical application of SPT is in the area of Health Promotion interventions ((McEwen & Wills, 2011, p. 283). Health care professional may use a social environment to present health related facts to a group (Ormrod, 2004). During the educational session, numerous interventions may be used, however, keeping in mind the women are adult learners and the presentations should reflect this important area. When the health professional utilizes TRA (Theory of Planned Behavior) principles, the nurse is trying to predict behaviors of those individuals listening, in hopes to influence or persuade (Poss, 2001). Another nursing application of SPT, the theory allows the creativity of the nurses on the Health Promotion team who are focusing on breast screening to develop effective strategies, such as, literature dissemination, mass media clips, games, and infiltrate the communities by identifying leaders and volunteers to influence this population to behavior change toward breast screening, thus develop a change in their health belief ((McEwen & Wills, 2011, p. 294). Motivating women to make an individual behavior change and actively participate in performing the self-breast examination (a screening) can positively help the individual, family, group as well as the future women in their community is the desired outcome in their health belief. In conclusion, I agree that middle range theory are to focus on the holistic approach to nursing and medical care.
According to McEwen and Wills (2011), concepts such as pain, symptom management, cultural issues, and health promotion issues are commonly addressed. The target population in the research study is the issues surrounding women who are underserved, uninsured who live in the similar environment a metropolitan community who do not routinely perform breast cancer screening and the reasons why not. The disparity surround this health issue and the possibilities to combat this is situation is exciting and unending in the literature. The behavioral theorist seemed appropriate for this study since one of my goals in this population is change behavior, which will take dedication, research, education, testing, and creative ways to present the material, requiring some reinforcement and reminders to perform monthly SBE and scheduled mammography. If any testing is needed prior to mammograms due to other health issues, the theory developed can be revisited to examine due to any testing (McKenna, 1997). The research does encompass borrowing several theories to support the goals for healthy behavior change for the population and allows the nurse to deliver the best care for the community (McEwen & Wills, 2011, figure
13.2). Health Promotion will positively affect health behaviors of individuals and communities, with nursing education, pamphlets, demonstrations, and a host of other strategies. This concept is seen as a process through assisting people to increase their ability to release some health belief controls, increase their knowledge base and improve their health using behavior change action (Milton-Underwood, 2003). Breast health, breast awareness and breast screening are crucial, if the women in this population want to have improved outcomes. The nurses’ role is advocate, educator, motivator, counselor, support and researcher in this battle against breast cancer through health promotion principles utilizing borrowed behavior sciences theory, namely, social psychological theory. The advanced nurse is able to develop theory or concept selection to formulize a framework to meet the health issues of each patient (McKenna, 1997).
References
Ajzen, I., & Fisbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall.
Bandura, A. (1993). Perceived self-efficacy in cognitive development and functioning. Educational Psychologist, 28(2), 117-148.
Echternacht, M. M. (2001). Fluid group: Concept and clinical application in the therapeutic milieu. Journal of the American Psychiatric Nurses Association, 7(1), 39-44.
Grove, S. K., Burns, N., & Gray, J. R. (2013). The practice of nursing research:
Appraisal, synthesis, and generation of evidence (7th ed.). St. Louis, MO: Evolve Elsevier.
Humphrey, L. L., Helfand, M., Chan, B. K., & Woolf, S. H. (2002). A summary of the evidence for the U.S. Preventive Services Task Force. Annual Internal Medicine, 137(347-360), 347-360.
McEwen, M., & Wills, E. M. (2011). Theoretical basis for nursing (3rd ed.). Philadelphia, PA: Wolters Kluwer Lippincott, Williams & Wilkins.
McKenna, H. P. (1997). Nursing theories and models. Retrieved August 09, 2013 from http://web.ebscohost.com.ezp.waldenulibrary.org/
Milton-Underwood, S. (2003). Improving chances: Nursing celebrating, embracing, and promoting breast health among African American women. Advance for Nurses, 1(10), 25-30.
Ormrod, J. E. (2004). Human learning: Principles, theories, and educational applications (4th ed.). Englewood Cliffs, NJ: Prentice-Hall.
Poss, J. E. (2001). Developing a new model for cross-cultural research: Synthesizing the Health Belief Model and Theory of Reasoned Action. Advances in Nursing Science, 23(4), 1-15.
Rosenstock, I. M. (1974). The health belief model and predictive health behavior. Health Education Monographs, 2, 354-436.
Zaccagnini, M. E., & White, K. W. (2012). The doctor of nursing practice essentials: A new model for advanced practice nursing. Sudbury, MA: Jones & Bartlett Publishers.