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Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness

Riegel, Barbara, PhD, RN, FAAN; Jaarsma, Tiny, PhD, RN, FAAN; Lee, Christopher S., PhD, RN, FAAN; Strömberg, Anna, PhD, RN, FAAN

doi: 10.1097/ANS.0000000000000237
Original article: PDF Only

The Middle-Range Theory of Self-Care of Chronic Illness has been used widely since it was first published in 2012. With the goal of theoretical refinement in mind, we evaluated the theory to identify areas where the theory lacked clarity and could be improved. The concept of self-care monitoring was determined to be underdeveloped. We do not yet know how the process of symptom monitoring influences the symptom appraisal process. Also, the manner in which self-care monitoring and self-care management are associated was thought to need refinement. As both of these issues relate to symptoms, we decided to enrich the Middle-Range Theory with knowledge from theories about symptoms. Here, we propose a revision to the Middle-Range Theory of Self-Care of Chronic Illness where symptoms are clearly integrated with the self-care behaviors of self-care maintenance, monitoring, and management.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

School of Nursing, University of Pennsylvania, Philadelphia (Dr Riegel); Department of Social and Welfare Studies (Dr Jaarsma), and Department of Medical and Health Sciences, Division of Nursing (Dr Strömberg), Linköping University, Linköping, Sweden; and Connell School of Nursing, Boston College, Boston, Massachusetts (Dr Lee).

Correspondence: Barbara Riegel, PhD, RN, FAAN, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 (

The authors gratefully acknowledge Karen Huss, PhD, RN, FAAN, for her review of a prior version of this article.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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