The Client Experience Model: Synthesis and Application to African Americans with Multiple Sclerosis
Holland, Brian E., Gray, Jennifer, Pierce, Teri G., Journal of Theory Construction and Testing
African Americans with multiple sclerosis experience significant vulnerability and healthcare disparities. The Client Experience Model (CEM) is a broad-based middle range theory for delivery of nursing care that facilitates positive healthcare experiences and improved health outcomes. The four concepts of security, communication, interaction, and expectation are theorized to influence the client experience. Developed from clinical observations, CEM is refined through theory synthesis and application to practice. This article compares CEM with Kolcaba's Comfort Theory and assesses its applicability to the care of African Americans with multiple sclerosis.
Keywords: African Americans, Client Experience Model, health-seeking behaviors, multiple sclerosis, positive health outcomes, theory synthesis
Middle range theories generate new ideas related to the art and science of nursing practice. The Client Experience Model (CEM) is a broad-based middle range theory designed to guide nursing practice, facilitate positive healthcare experiences, and improve health outcomes. New middle range theories require ongoing evaluation through theory synthesis and application to practice (Meléis, 2007). In this article, conceptual bases of CEM are validated through theory synthesis, and CEM's application to African Americans (AA) with multiple sclerosis (MS) is examined.
Background of the Problem
Multiple sclerosis is a debilitating disease often affecting the physical and emotional aspects of one's life. Estimation of MS prevalence worldwide is 2.5 million; of this group, approximately 225,000-350,000 persons are age 65 years or older (Awad & Stuve, 2010). Current estimates suggest 400,000 people are living with MS in the U.S. (Multiple Sclerosis Association of America [MSAA], 2009). In 1978, the prevalence of MS in the U.S. was 108 per 100,000; in 2006, the prevalence had risen to 177 per 100,000 (Confavareux et al., 2006). In 2010, the prevalence for physician-diagnosed MS remained 99-178 per 100,000. MS is considered a disease of young adults. The age range of first diagnosis is 1 8-45 years. Once diagnosed, the average duration of illness is 18.7 years. Forty seven percent of persons have the progressive form of MS. Life expectancy of persons with adultonset MS is similar to the general population because of improved medical and nursing care (Awad & Stuve, 2010).
Because MS is a disease that is not reported to the Centers for Disease Control and Prevention, MS prevalence data for AA are limited. Of the 16,500 persons registered in a national MS research database, only 5.1% were AA (Weinstock-Guttmann et al., 2003). Although the prevalence of MS among AA appears to be low, AA are over-represented in more severe categories of MS. AA experience an earlier disease onset and more disabling effects of MS than Whites. On average, AA admitted to U.S. nursing homes are approximately six years younger than Whites with MS. AA experience a greater volume of cerebral lesions compared to Whites with MS (Kister et al., 2010).
Disease progression is categorized as adult onset MS or late onset MS, which affects the elderly. Elderly persons are more likely to live alone, have lower incomes, and experience more significant disability related to MS. Two disease stages of MS are identified in the literature: relapsing remitting MS and progressive relapsing MS. Eighty percent of patients with MS experience relapsing remitting MS, which is characterized by worsening neurological symptoms followed by partial or complete remission. An estimated 50% of patients with relapsing remitting MS convert to progressive relapsing MS within 10 years of disease onset. Progressive relapsing MS is characterized by steady neurological decline with intermittent exacerbation of neurological symptoms (Awad & Stuve, 2010).
The most common early symptoms of MS include fatigue, balance problems, and weakness (Awad & Stuve, 2010). …