Category: Nursing Theory

Introduction to the Theorist

Majority of individuals chase nursing profession with the aim of being involved in assisting patients to get well. However, this was not the case with Imogene King. Her dream had been to be a teacher. When she grew up, her uncle offered her the opportunity to train as a nurse. She could not resist the offer, as it would allow her to escape from her small hometown known as West Point, Lowa. As she left for Missouri, she never figured that she would eventually become a pioneer and adored nurse theorist (Pamela, 2009).

History and Overview of the Theorist

The nursing theorist was born Imogene King in 1923. She was the lastborn in a family of three children. She studied in the small village of West Point called Lowa. Her childhood dream to become a teacher was sustained until she completed her pre-college school. King was not comfortable in her town setting despite the motivation to become a teacher. The offer by her uncle to train as a nurse presented the timely chance to move out of West Point. King received her Nursing Diploma at the age of twenty-two years. When she received the diploma from St. Johns Nursing Hospital in Missouri, she had no idea that three decades down the line she would be the most esteemed Nursing Theorist. At the age of twenty-five years, she received a Bachelor of Science in Nursing and Education. This includes minors in Philosophy and Chemistry from the same nursing hospital.

King practiced as a nurse for the next nine years while pursuing a Master of Science in Nursing at the hospital university. The challenges that she faced did not deter her from pursuing Doctorate in Education at Teachers College in Columbia University. She received the doctorate in 1961 after which she fully engaged in her career as a professional nurse. Her tenacity to be a teacher was reflected when she was appointed as the Superintendent Director of the Ohio State University specifically the School of Nursing. Between 1961 and 1980, she was appointed an Educator at St. Johns University, South Florida University and Loyola University thus further demonstrating her urge to be a teacher (Pamela, 2009). She demonstrated her prowess in nursing education when she published Toward a Theory for Nursing: General Concepts of Human Behavior. This was followed by A Theory for Nursing: Systems, Concepts, Process. King’s Theory of Goal Attainment developed when she sought to respond to her own concerns including “The goal of nursing, roles of a nurse and the expansion of nurses understanding to offer quality care.” After receiving multiplicity of honors during practice, King passed on 24 December 1997.

Major Components of the Theory

The major components of the theory are discussed below.

Man

The theory begins with the individuals having health needs that are categorized into three. First, it is necessary to have health information, which is functional. Second, there is need for healthcare to aim at the prevention of sickness. Third, there is need for healthcare when individuals lack the capacity to assist themselves. The individual’s discernment of the needs is influenced by a variety of factors including the consciousness that one exists, growth and maturity, body image as well as knowledge. In this concept, the objective of the individual is to gratify the needs. For the individual to achieve this one ought to ask for assistance from other sources. When the individual opts to consult a nurse, the perception of the nurse is influenced through the constituents present in the individual. This develops interaction between the individual and the practitioner whether verbal or non-verbal.

Health

According to King, health is the state of being complete and functional. These include being communal, conscious, coherent, reactive, purposeful, perceptive, action and tome oriented. The interference of the said holistic and practical state results in illness. King acknowledges the capacity of an individual to “constantly regulate to the interior and exterior stressors” through the optimization of accessible resources to attain “the optimum potentiality for daily existence”. King held the position that the objective of nursing is to assist persons in maintaining their wellness in order to function properly.

Nursing

King viewed nursing as the process of consistent and active human interaction between the individual and the nurse via verbal and non-verbal communication. The communication should be targeted at establishing the common objectives of attaining care for the individual (Clarke et al., 2009). This can be attained by agreeing upon the methods of attaining the objectives founded on the common discernment of the prevailing nursing situation. King conceptualized this as the interpersonal system under the Theory of Goal Attainment.

Environment

This aspect forms the foundation for the interactions between the patient, the nurse and the surroundings. The surroundings include social settings, school, and church that the individual is in contact with throughout lifetime. The interior surroundings change energy thus allowing the individual to adapt to the exterior surrounding changes. The exterior surroundings include formal and informal societies. The nurse is part of the exterior surroundings. Through communication between individuals, his nurse and his environment, the perceptions of the nurse and the surrounding are influenced via the same aspects that influenced him in creating his perceptions. By interacting with the patient, the nurse and the environment are able to realize accurately a representation of the patient’s perception. This allows the nurse and the environment to discover the means through which the objective is to be realized. The connection between the nurse and the individual allows the attainment of a mutually agreeable upon goal by those involved (Lavin & Killeen, 2008).

Conceptual Model

The interpretive method was selected for this study. It was selected as it enables one to examine the position and applicability of King’s theory to the nursing practice. Nurses pursue the career with the aim of becoming instrumental in assisting individuals to get healthy. In order to achieve this, it is imperative to set health objectives with the individual patient. Consequently, the nurse takes appropriate measures to realize the goals. In healthcare settings, it has been proved that communication between a nurse and an individual patient while collaborating towards the mutually agreed objectives makes the realization of the goals feasible. King’s model focuses on several techniques to assist nurses in the nurse-client relationship. She utilized a ‘systems’ perspective in developing the dynamic interactive system frameworks and the resulting Goal Attainment Theory (Davis, 2008). The theory entails the significance of interacting, perception, development, self, personal time, privacy, role and communication. King held that both the client and the nurse contribute essential awareness and information to the interaction as they collaborate to attain the set objectives.

The interactive methods utilized by King to develop the model include personal approach, interpersonal approach and social approach. The model is feasible and failure to integrate the concepts may lead to substandard nursing practice.

Relationship between the Key Elements of the Theory

The key elements of the Goal of Attainment Theory are inherently realized in the interpersonal system. This is where two individuals’ who are often unfamiliar persons collaborate in a health care setting to assist or to be assisted to attain the state of wellness that allows the affected individual to function properly. The elements focus on transactions, contact and interactivity between Dyads (two persons), the nurse and the client. For a nurse to help the patient effectively, the two must interact. This interaction is built on communication. Such communication can be either verbal or non-verbal. The two must come to terms with the goal of the interaction being agreed between the two. Failure to establish communication is detrimental to the health of the client. These elements fit together as the absence of one element is crippling to the theory and consequently the health of the patient.

Evaluation of the Model

King’s Theory has been integrated in many nursing curricula worldwide. It holds an essential position in the nurse training and practice fraternity. It is critical in achieving desirable health statuses for individuals and consequently the society. The theory is fundamentally founded on the nurse-client interactions and the arrangement (environment) in which they occur as vital to the achievement of the client’s health goals. A client and the nurse create a team and concur on objectives. Eventually, they execute the mutually agreed objectives to realize the goals. In order to evaluate the effectiveness of the model, it is important to review how each of the systems that form the theory fits in the attainment of client health.

Personal system

The system is founded on the individual. The concepts involved include space, time, development, growth, perception and the self. These are essential in understanding individuals as they focus on how the nurse views the individual client. The perception is the most essential as it determines behavior through learning and self-image (King, 2009). In evaluating this system, it will be observed that the patient requires personal space, time, development, growth and the opportunity to come to terms with the self. This allows the person to be able to relate to the situation and appreciate that he requires help if he cannot help himself to attain and maintain health.

Interpersonal system

This system is related to a number of concepts including relations, role and transactions. It is indicative of the relationship between the client and the nurse in the care provision setting. The relationship between the nurse and the client in King’s context referred to as Dyads is fundamental in order to attain the agreed upon objectives. In this regard, the system fits well as it is imperative for the patient to create a mutual connection with the nurse. This will allow the nurse to assess the needs of the patient effectively. By so doing the patient will understand his role in attaining wellness (King, 2009). The role of the nurse will also be established. It is important that the connection be maintained to allow transactions to take place. The model fits well with real life application as the nurse’s role may be limited in helping the patient if a connection is not established. Without an agreement, the goals may not be realized.

Social System

The system indicates how the practitioner relates to the coworkers and the client surroundings in general (Barrett, 2009). The client surroundings in this context refer to the people in the client’s society that have common goals, interests and values regarding health. The system forms the basis of social interactivity and relations (King, 2009). It forms the foundation for the establishment of guidelines for behavior and actions. The model is important in making the patient realize that he needs that support his environment including relatives, family, the society and the nurse. Irrespective of whether or not the patient can help himself, the environment is important given that social connections are important in maintaining individual health.

Application of the Model

Nursing Education

According to King, the fundamental basis of a nursing curriculum should be the vibrant nurse-patient interaction. The programs should train participants to become valuable and productive professional nurses as they accumulate knowledge and skills in the nursing profession. It should involve conditions to the nursing training such as biophysical sciences and arts. Training experiences should help the perception of the trainee regarding the position of health and possible disruptions in the state of health.

Nursing Research

The final intention of study is to resolve the impacts of common objectives setting and implementing the appropriate nurture interventions associated with the objectives on goal accomplishment. The event of interest in exploration should be interactions and wellness. King proposed that the exact challenges to be researched should be real or possible disturbances in the patient’s capacity to be productive in social roles. The essential role of research in nursing is intrinsic in all her discussions regarding nursing theory and skill enhancement.

Nursing Practice

Founded on King’s principles, the objective of nursing practice is to facilitate persons to achieve and maintain their health. Whenever there are some disturbances to the health status including sicknesses or disability, the practice should have the ability to resolve all these (Gianfermi & Buchholz, 2011). King asserted that nursing practice should take place in severe or chronic healthcare settings. It should also take place in suitable surroundings when giving healthcare in order to ensure wellness.

References

Barrett, M. (2009). Nursing environment for clients’ health. Journal of Nursing Measurement, 16 (2), 13–24.

Clarke, S. et al. (2009). The role of symptom distress and goal attainment in promoting aspects of psychological recovery for consumers with enduring mental illness. Journal of Mental Health, 18(5), 389-397.

Davis, L. (2008). Middle range theory development using king’s conceptual system. Nursing Philosophy, 9(4), 283-284.

Gianfermi, R. & Buchholz, S. (2011). Exploring the relationship between job satisfaction and nursing group outcome attainment capability in nurse administrators. Journal of Nursing Management, 19 (3), 1012-1019.

King, M. (2009). King’s conceptual system, theory of goal attainment, and transaction process in the 21st century. Nursing Science Quarterly, 20(2), 89–108.

Lavin, M. & Killeen, M. (2008). Tribute to Imogene King. International Journal of Nursing Terminologies and Classifications, 19(2), 44-47.

Pamela, C. (2009). Imogene M. King’s scholars reflect on her wisdom and influence on nursing science. Nursing Science Quarterly, 22(2), 128-133.

Introduction

Nursing innovation and change management are critical for enhancing health, avoiding illnesses, identifying and mitigating risk factors, cultivating healthy lifestyle attitudes, and validating care and treatment approaches. The goal of healthcare innovation is to create better and more efficient health policies, systems, items, and technology, as well as services and distribution channels that benefit people. The specific nursing theory that will be encompassed in the paper is Kurt Lewin’s change management theory, whereas the theoretical framework is related to nursing and medication administrations and errors.

Nursing Framework

In the healthcare sector, change is a common phenomenon due to the rapidly changing medical and social environments. One of the developments caused by the information era is the digitalization and computerization of nursing networks and systems (Bozak, 2003). As a consequence, nurses’ opinions regarding technology and transformation in the workplace vary greatly (Bozak, 2003). The nurse practitioner or specialist must be aware of the elements that support and hinder change in order to efficiently transfer the healthcare personnel from one platform to another (Bozak, 2003). Nurses will need to devise strategies to help them go forward with the transformation. Kurt Lewin’s three-stage paradigm, often known as the structured concept of organizational development, is a fundamental notion that is still believed to be relevant. Lewin, a sociology professor and philosopher, proposed the three-stage hypothesis. In this approach, he highlighted unfreezing stage, transformation, or transition, and freeze, or refreeze phase, as a basic model for analyzing the process of organizational or institutional transformation. Change is a difficult transition for people or organization, and it is rarely straightforward. It requires numerous phases of shifts or misunderstandings before reaching a point of stability.

Framework Concepts

Concerning the analysis of the concepts within the framework, it is possible to emphasize several relevant notions. Firstly, the change framework should be ubiquitous since it is utilized by various healthcare specialists for multiple medical purposes. The first step in the theory is transition unfreezing, which is one of the most crucial phases in the overall change management plan. It entails cultivating a realization for relocating from one’s current normal routine and comfort zone to a converted condition, as well as enhancing people’s preparedness and willingness to change. The second step is also known as the transitional phase or the stage of real change execution. It entails a willingness to accept better ways of doing things and operating. The individuals are unfrozen at this point, and the real modification can be applied. People proceed from the phase of transition to a substantially more normal position, which is possible to be described as the stable equilibrium point during the last step, which is refreezing. The final step of refreezing occurs when individuals embrace or adapt new methods of working or transformation, integrate it as a part of their lives, and form new connections.

Relationship of Variables

Considering the relationship of variables within the framework, which is Kurt Lewin’s change management theory, it is compulsory to emphasize the factors that can change due to specific conditions and contexts. Variables in the input information can be generally included in one of the categories listed: individual characteristics and data of patients and personnel, equipment and methodology, or facility features. In addition, another set of variables related to the theoretical framework is medication errors. To prevent the harm induced by prescription and medication mistakes, a medication safety system of education can be devised and executed (Dennison, 2007). It may be inferred that robust administrative assistance and follow-up were required to create behavioral changes that could lead to a reduction in damage caused by prescription errors (Dennison, 2007). These variables are critical to analyzing the potential implications of Kurt Lewin’s change management theory in terms of nursing practice.

Nursing Framework Significance

Considering the significance of the chosen nursing framework, it is feasible to emphasize the necessity of implementing change in rapidly evolving medical conditions. In medical situations, executing a change among practice might cause depression or fear of rejection in nurses, resulting in unwillingness to change. Medication mistakes in healthcare facilities have terrible implications for both the patient and the nurse, but they may be dramatically minimized by implementing technology that enhances patient care. Kurt Lewin’s change theoretical framework can be used to help a large mental hospital implement bar-coded medication systems. Lewin’s theory can help organizations to identify how transformation impacts them, identify hurdles to effective implementation, and uncover conflicting forces that influence human behavior throughout change.

Conclusion

To summarize, due to the quickly changing medical and social contexts, change is a typical occurrence in the healthcare sector. The digitization and computerization of nursing networks and systems is one of the advancements brought about by the digital age. Kurt Lewin’s three-stage paradigm, sometimes known as the structured model of organizational growth, is a foundational concept that is still widely accepted. The change framework should be widely used since it is used by a variety of healthcare professionals for a variety of medical goals. Individual traits and statistics of patients and workers, equipment and methods, and facility features are only a few of the variables that may be found in the input data. Medication mistakes are also a collection of factors connected to the theoretical framework.

Reference

Bozak, M. G. (2003). Using Lewin’s force field analysis in implementing a nursing information system. Computers, Informatics, Nursing: CIN, 21(2), 80–87. Web.

Dennison, R. D. (2007). A medication safety education program to reduce the risk of harm caused by medication errors. Journal of Continuing Education in Nursing, 38(4), 176–184. Web.

Abstract

Modern nurses have to deal with different patients and make sure their services and knowledge are accurate and helpful. There are many models to be applied to real-world nursing, and the need theory developed by Virginia Henderson is one of the methods for analysis. In this paper, the conceptual model analysis of Henderson’s work is developed to clarify its origins, focus, and content. Her theory represents the idea of a nursing role as an assistant to patients in their intention to learn medical terms and conditions. As well as any nursing theory, the need theory is based on four major concepts, health, individual, environment, and nursing.

Henderson gave a definition to each issue and developed propositions to link patients and nurses. Individual care, education of patients, and cooperation in healthcare settings are the elements of the analysis. Evaluation of the model includes the discussion of its logical congruence, legitimacy, and generation to prove the correctness of its application in today’s nursing practice with respect to patients’ and their families’ needs and expectations.

Introduction

Among a variety of clinical situations and people, any nurse should understand and follow specific concepts and standards. In nursing practice, Virginia Henderson is known as one of the most influential contributors, whose theory of need is based on a perfect combination of education, practice, and extensive research. She was an author of a unique function of nursing and the identification of patients’ needs. Henderson (1964) explained that a nurse has to complement the patient by “supplying what he needs in knowledge, will, or strength to perform his daily activities” and follow the treatment prescribed (p. 66).

Fourteen components are introduced as a nursing concept to underline the patient’s independence and nurses’ support, which perfectly meets my beliefs about nursing in the modern world. Her education at the Army School of Nursing, teaching career, research activities, and traveling experience serve as a solid background for the model development. The science of nursing was emerged out of Henderson’s discussions and observations of the relationships between patients and nurses. This paper aims at analyzing and evaluating the basics of Henderson’s theory of need, along with its concepts and applicability in today’s practice.

Analysis

Origins of the Model

The events of World War I had a significant impact on Henderson and her intention to strengthen the role of nursing in patient care. She wanted to identify the main needs of sick and wounded people and help them recover. To define nursing, Henderson introduced 14 needs according to which nursing care must be developed through bodily and emotional functions (Masters, 2018). A peculiar feature of Henderson’s work is a combination of practical and research activities. A future theorist believed that the quality of human life depends on how well a nurse understands his/her functions. While revising Textbook of the Principles and Practice of Nursing written by Harmer at the beginning of the 20th century, Henderson came to the conclusion that nurse functions were poorly recognized (Masters, 2018).

In addition, no licensed backgrounds for competent care were developed at the moment. Therefore, she found it obligatory to add her definitions of nursing to Harmer’s revised version. Her motifs and philosophical claims were directed to the possibilities of patients to improve their care by recognizing their needs and cooperating with nurses.

In her work, Henderson addressed several theorists and authors to show what was known about nursing. She was fascinated by the work of Florence Nightingale, who underlined the development of best conditions for patients, or Effie Taylor, who said about the importance of adapting to therapy and treatment, (Henderson, 1964). In the theory of need, the philosophy of patient independence in health care was reflected. This world view encouraged people to learn about their responsibilities and use nurses as one of the credible sources of information and motivation. Supported by a properly chosen medical terms and definitions, the offered model was positively accepted by the nursing community.

Unique Focus

The goal of the nursing need theory is to introduce a unique focus of nursing and prove its appropriateness. A patient is defined as an individual with a need to achieve autonomy in personal care, and a nurse as a person for professional assistance (Fernandes, Clares, Borges, da Nóbrega, & de Freitas, 2019). In terms of the chosen model, all the fourteen needs of patients may be divided into four groups, including biological or physiological, moral or spiritual, psychological, and social (Fernandes et al., 2019).

As a rule, patients do not have enough knowledge about all these needs, and a nurse must help in recognizing and understanding these issues and make sure high-quality care is offered. According to Carper (as cited in Durepos, Orr, Ploeg, & Kaasalainen, 2018), there are four main categories of nursing knowledge that has to be identified, including empiric, ethic, aesthetic, and person. The theory of needs properly reflects each of the categories, proving that systematically organized data is as important as each patient’s personal information, interests, obligations, and judgments.

Content

As well as any theory or nursing model, Henderson’s need theory is characterized by well-defined concepts and propositions. It is not enough for nurses to care for patients and educate them. Nurses must understand how to devote themselves to patients and improve the quality of care to promote wellbeing every day and night. Ndiok and Ncama (2018) specify that Henderson focused on individual care through the prism of 14 components that explain the nursing role and preferred actions to preserve health. In the following table, the metaparadigm of Henderson’s need theory is introduced.

Theorist Name: Virginia Henderson.

Evaluation

Explication of Origins

The model introduced by Henderson is one of the most successful attempts to determine the role of nurses and explain the major aspects of nursing care that has to be offered to a patient. Its philosophical claims are explicit and serve as a good foundation for other theories and approaches. Every patient is unique and possesses a number of personal interests, demands, and expectations.

Therefore, it is correct to admit that Henderson chose to focus on individual care, where the role of a nurse is to assist with activities (Ahtisham & Jacoline, 2015). The achievements that had been made by the American Nurses’ Association, Nightingale, and Taylor before Henderson’s work were accurately defined and explained (Henderson, 1964). Therefore, the origins of the theory remain clear and thoughtful to prove its urgency and appropriateness for the century.

Comprehensiveness of Content

The evaluation of the nursing model is based on the content and an understanding of the concepts and propositions. In Henderson’s work, there are certain shortages like the necessity to define responsibilities on both a patient and a nurse without their consent. The proposition that a patient has to address a nurse to learn better his or her condition and available therapies is not an option but an obligation. Another important aspect is the link between concepts. In this need’s theory, the author underlined the impact of nurses’ and patients’ abilities to share information and analyze needs and the neglect of the worth of experience and the duration of care.

Despite these misunderstandings and shortcomings, the chosen theory may be sufficiently broad to support nursing research, education, and administration. A person may not have every need (out of 14) to be identified. Still, a nurse has to be responsible to do for the patient to act normally, to obtain physical strength, and to learn something new about health (Ndiok & Ncama, 2018). The connection between the concepts of health, individual, environment, and nursing makes the model recognizable and effective.

Logical Congruence

In Henderson’s model, several world views are mentioned, which makes it critical to evaluate its logical congruence that is evident. Different categories of nursing knowledge are reflected by the model because a nurse should not only support or educate a patient but also assess his or her emotional and physical status and develop appropriate recommendations (Ahtisham & Jacoline, 2015). All viewpoints are divided into within the framework and incorporated in regards to the person’s needs and nurse’s assessment possibilities.

Generation of Theory

The definition given by Henderson in the need theory was one of the most influential moments in nursing practice. It changed the way nurses developed their services around the globe and improved patients’ health and wellbeing. Maslow’s hierarchy of needs is one of the theories that have been generated from the model under analysis. Millions of people compare and contrast the concepts of both theories to clarify their strengths and weaknesses.

Legitimacy

Regarding the main idea of Henderson’s approach, the application of the model is feasible and remains competitive in the field of nursing. Sometimes, it is normal to observe that the list of needs is not full for every patient due to specific clinical situations, patients, and other external details (Ndiok & Ncama, 2018). It is useful in guiding nursing assessment and the development of care that can be offered to patients and their families.

Contributions

Paying attention to the overall contribution of the model to nursing, one should admit that Henderson succeeded in the personalization of care and the recognition of the role of both a patient and a nurse. There are many ways of how care and treatment are introduced and implemented in different clinical situations, but the standards of individual care cannot be broken (Ahtisham & Jacoline, 2015). The need theory is not only a guide for patients and nurses but a rule to improve the quality of care and communication in medical settings.

Application

Nowadays, Henderson’s model is frequently applied to real nursing practice. Ahtisham and Jacoline (2015) introduced the example of how a female patient X is admitted to the surgical unit with suicidal attempts and assessed by means of the concepts of the theory. Palliative care is based on the same concepts to educate patients through cooperation with nurses (Ndiok & Ncama, 2018). This theory helps achieve independence among older adults and maintain physical and mental integrity (Fernandes et al., 2019). The improvement of human wellbeing and increased patient knowledge are evident outcomes of this model’s application.

In a nursing setting, I find this model helpful due to the possibility to help patients and underline the role of nurses in practice. I believe that nurses should be properly aware of how to assist ordinary people and use their communicative skills in dealing with a disease. For example, after surgery, a patient and his or her family must learn the basics of a healthy lifestyle to predict complications or recurrence. Attention to patient’s needs is a good and clear plan to be followed for the control and prevention of diseases.

In general, I find the model developed by Henderson more than a century ago a credible source of information for modern practice. Nurses understand the impact of their actions on human health and improve their skills to make sure their help and recommendations are accurate and effective. The chosen theorist changed the quality of nursing care, and I want to believe that her viewpoints, like my own position, are correct for people to be strong, healthy, and ready for treatment.

References

Ahtisham, Y., & Jacoline, S. (2015). Integrating nursing theory and process into practice; Virginia’s Henderson need theory. International Journal of Caring Sciences, 8(2), 443-450.

Durepos, P., Orr, E., Ploeg, J., & Kaasalainen, S. (2018). The value of measurement for development of nursing knowledge: Underlying philosophy, contributions and critiques. Journal of Advanced Nursing, 74(10), 2290-2300. Web.

Fernandes, B. K. C., Clares, J. W. B., Borges, C. L., da Nóbrega, M. M. L., & de Freitas, M. C. (2019). Nursing diagnoses for institutionalized elderly people based on Henderson’s theory. Revista Da Escola de Enfermagem Da USP, 53. Web.

Henderson, V. (1964). The nature of nursing. American Journal of Nursing, 64, 62–68. Web.

Masters, K. (2018). Models and theories focused on nursing goals and functions. In J. B. Butts & K. L. Rich (Eds.), Philosophies and theories for advanced nursing practice (3rd ed.) (pp. 954-1015). Burlington, MA: Jones & Bartlett Learning.

Ndiok, A., & Ncama, B. (2018). Assessment of palliative care needs of patients/families living with cancer in a developing country. Scandinavian Journal of Caring Sciences. Web.

Introduction

• Martha Elizabeth Rogers’ theory helps nurses deliver quality healthcare to their patients.
• Rogers’ theory that gave nursing a new meaning.
• The theory views human beings as unitary systems in the environment.
• This presentation explains why Roger’s nursing theory can be used to assess patients’ health patterns and behavior.

Overview of the Theory

• Martha Rogers’ theory is the “Unitary Human Beings Theory” (Fawcett, 2003).
• The theory views human life as a continuous process.
• The process changes depending on the person’s experiences and interaction with the environment.
• Nurses should use evidence-based approaches to examine and analyze their patients’ health.
• The nursing philosophy indicates why a person’s health is the manifestation of the human-environment relationship (McEwen & Willis, 2010).

Applying the Theory to Understand the Assessment of Patients’ Patterns of Health Behavior

• The theory identifies human beings as unified object that cannot be understood by summarizing their parts.
• Human beings and environment have four dimensional integrated energy fields (Tomey & Alligood, 2006).
• The theory helps nurses understand the assessment of patients’ health patterns and behavior.
• The caregiver should examines both the human and environment fields in order to understand the causes of a specific condition or disease (Fawcett, 2003).
• The theorist also explains why patients can achieve their health goals even when suffering from a terminal disease.
• Nurses should use the theory to establish and re-pattern the existing energy fields. This will help nurses examine and adjust the human-environment relationship.
• Nurses should use evidence-based practices to deal with the issues affecting their patients.
• The idea of science and art fosters awareness and creativity thus assessing the patient’s health patterns and behaviors (McEwen & Willis, 2010).

Applying the Theory to Help the Patient

The “Rogerian Ethics” presented below encourages nurses and caregivers to promote testability. This helps nurses develop the best relationship with their patients.

• The idea helps nurses to focus on scientific inquiry in order to understand the environment dynamics that affect disease human development and healing.
• This will be a creative and artist approach to understand the health patterns of different patients and provide them with best support and care.
• The theory will promote consciousness among the nurses and patients. This will help improve the patient’s health situation (Nortvedt, 2000).

Conclusion

• Nursing can be successful even if it does not treat a disease (Fawcett, 2003).
• Martha’s theory encourages nurses to improve the wellness and living conditions of their patients.
• Life can be meaningful even when suffering from a specific disease (Watson & Smith, 2002).
• The caregiver will use different scientific models to readjust the human-environment relationship. This explains why the theory is a powerful nursing tool.

Reference List

Fawcett, J. (2003). The Nurse Theorists: 21st Century Updates: Martha E. Rogers. Nursing Science Quarterly, 16(1), 44-51.

McEwen, M., & Willis, E. (2010). Theoretical Basis for Nursing. Philadelphia: Lippincott Williams & Wilkins.

Nortvedt, P. (2000) Clinical sensitivity: the inseparability of ethical perceptiveness and clinical knowledge. Scholarly Inquiry for Nursing Practice, 14(1), 1-19.

Tomey, A., & Alligood, M. (2006). Nursing Theorists and Their Work. St. Louis, MO: Mosby.

Watson, J., & Smith, M. (2002). Caring science and the science of unitary human beings: a trans-theoretical discourse for nursing knowledge development. Journal of Advanced Nursing, 37(5), 452-461.

The adoption of Peplau’s theory of interpersonal relationships in nursing practice is well-justified by numerous evidence-based studies incorporating this approach. The application of the pre-defined stages, which are orientation, identification, exploitation, and resolution, allows scholars to conclude on their feasibility for improving corresponding competencies (Hariyati & Ungsianik, 2018). Thus, for example, the results of a pre-experimental study on their inclusion in the training programs of head nurses in one of the private healthcare facilities in Jakarta confirm their usefulness for the specified objective (Hariyati & Ungsianik, 2018). The rationale for this framework’s selection was determined by the need to increase the employees’ knowledge of interpersonal and counseling roles in the workplace alongside their leadership skills (Hariyati & Ungsianik, 2018). The outcomes proved the correlation between the efficiency of the developed initiative and the principles of the theory, which means that the latter provides sufficient support for such experiments.

Another example of the practical implementation of Peplau’s theory in a hospital setting is its use for examining the experience of involuntary migrants. This category of citizens is vulnerable due to their life circumstances, and adopting this approach is beneficial for their empowerment (Ikafa & Holmes, 2020). The rationale for its selection is connected to the fact that these people’s needs include a greater degree of support than that of local populations. Meanwhile, it is frequently neglected, whereas the inclusion of Peplau’s stages of developing relationships between nurses and these patients is advantageous for a positive outcome (Ikafa & Holmes, 2020). The researchers proved that they correlate with the tasks of improving migrant support services as it can make them culturally appropriate and sufficient for the identified needs while ensuring everyone’s access to them (Ikafa & Holmes, 2020). In this way, the theory supports critical initiatives, which are to be developed in healthcare in the future.

References

Hariyati, R. T. S., & Ungsianik, T. (2018). Improving the interpersonal competencies of head nurses through Peplau’s theoretical active learning approach.Enfermeria Clinica, 28, 149-153.

Ikafa, I. N., & Holmes, C. A. (2020). Empowering migrants during the resettlement process: Applying Peplau’s theory of interpersonal relations. Mental Health Practice, 23(5), 29-36.

Introduction

The nursing practice relies heavily on theories and models postulated by various scholars and on different aspects of the nursing profession (Avant & Walker, 2005, p.5). In recent times, as a result of advances in information technology, much information has been stored in electronic devices for easier retrieval. As a result, many websites have been created which consists of many advanced theories. However, some websites are lacking in some information and present the researcher with a difficult time trying to retrieve the much-needed information about certain theories. The following paper compares and contrasts some theorist sites on the availability of information on the Nursing Process Theory by Ida Jean Orlando, showing how easy it is to use this model in nursing practice and how current the information is on the websites.

Availability of this theory on the websites

According to Fitzpatrick & Whall (1996, p.2), a theory is, “a set of concepts, definitions, and propositions that project a systematic view of phenomena by designing specific interrelationship among concepts for purposes of describing, explaining and predicting.” It follows then, that these sites must outline every aspect of a theory to bring to the researcher all the concepts of the theory for easier application. The University of San Diego website is effective in outlining the Nursing Process Theory as it has several links which guide the researcher to view the theory beginning with its postulator, description of the theory itself to its current usage in nursing practice. Likewise, the Clayton State University website follows the same trend by linking the researcher to the nursing theories website that introduces the reader to the theory, giving its process and application, and finally concluding by giving its uses in both research and clinical practice. The information provided is current since there are continuous updates to these websites.

Related publications

After researching for some years, Orlando developed her theory and it was published together with her book in 1961. She continued researching to further develop her theory making various publications in journals and books. In 1967, her article entitled ‘The patient’s predicament and nursing function’ was published in the Psychiatric Opinion Journal. Later on, after another research at Mclean Hospital, she published another book in 1972 entitled The Discipline and Teaching of Nursing Processes giving her findings (Nursing Theories Page, 2010, para. 1-4).

Application of the Nursing Process Theory in nursing practice

This theory is applied to find the role of the nurse in offering care to the patient. It outlines the role of the nurse in finding out the patients immediate needs to be taken care of, explaining how the nurses need to use their perception, thoughts on these perceptions to judge the patients’ behavior, and finally explains how nurses determine the nature of the patient’s distress and the kind of help the patient needs.

Importance of this theory to nursing practice

This theory helps the nurses keep their main focus on their patients identifying their distress and the type of care needed. It guides the nurses in keeping their reactions in control and this prevents inaccurate diagnosis or embarking on caring plans which are ineffective. This theory also guides the nurse in evaluating her care by observing the patients’ outcomes in terms of care. According to Schmieding (University of Rhode Island College), this theory is clear, concise, and easy to use. It is therefore one of the theories of nursing that are used to provide efficient nursing care to patients.

Conclusion

In conclusion, the nursing profession relies much on theories that provide concepts and models that guide the practice of nursing. These theories have been supplied to the users online by various websites. The information provided is current since these websites are updated regularly. The Nursing Process theory is important to the nursing profession as it guides the nurses on ways of handling patients thus providing efficient nursing care. Nurses need to provide care to their patients to reduce and end human suffering and death. By so doing they follow in the footsteps of Florence Nightingale.

Reference list

Clayton State University School of Nursing (2010). Nursing Theory Link Page. Web.

Fitzpatrick, J.J. & Whall, A.L. (1996). Conceptual Models of Nursing: Analysis and Application. Appleton & Lange.

USD Hahn School of Nursing (2003). The Nursing Theory Page. Web.

Walker, L.O. & Avant, K.C. (2005). Strategies for Theory Construction in Nursing. New Jersey: Pearson/ Prentice Hall.

I decided to watch Dorothea Orem’s video because I heard a lot about her revolutionary approach to patient care. Nowadays, a comprehensive approach to patient care is evident to all teachers, nurses, and doctors. However, this was not always the case, and Dorothea Orem made a breakthrough in her time, allowing society to look at the nursing profession differently (Miller, 2021). An overly conservative approach to nursing makes it rigid, and help from nurses is presented as fragmented. For these people, assistance includes wound care, support for the most straightforward organic processes, monitoring the patient’s daily activities. However, Dorothea Orem first raised the issue of hospital care as the interaction of two independent subjects: the patient and the nurse.

I generally agree with the exit model proposed by Dorothea Orem because this model posits the idea that workers are critical of their tasks. Society should not perceive nurses as poorly educated nurses whose duties include cleaning the hospital ward after the patient and bandaging wounds. Nurses can and should do this, but it is not their only responsibility. Nurses are specialists with their philosophy and view of the phenomena of life and death and various diseases. However, Dorothea Orem’s ideas about self-care are not always detailed by her, which makes it unclear exactly how young students or aspiring nurses should behave to fit this theory.

What surprised me most about the video was Dorothea Orem’s ambitious approach and vision when she answered a question from an interviewer about the impact of her theory. Dorothea Orem understands the fundamental implications of her thesis on the countries of Europe, Canada, and the United States. She emphasizes that the idea radically changes the approach to the tasks of nurses in general. It surprises me because such theories most often find an application after the death of their authors. In most cases, the authors of ideas cannot see the fruits of their labors with their own eyes. However, Dorothea Orem was able to do it, and her pragmatic approach and calmness in the story surprised me. I was surprised by the short story about Dorothea Orem’s childhood at the beginning of the video. However, on the other hand, this story shows that most professional nurses have been inspired to work since childhood.

I would recommend this video to other students, but I would strongly advise conservative people to watch it. Sometimes people are sure that the work of a nurse does not require excellent skills, and people who could not enter medical universities can quickly become nurses. Dorothea Orem’s video demonstrates the importance of awareness and logic in the work of a nurse and the will and confidence. After watching this video, I think many people will have respect for nurses, even if before that they considered them to be lower staff who only help doctors.

The video was interesting for me and perhaps even emotionally impressive. After watching, I felt inspired and remembered all the friends who once spoke to me about the work of nurses. Dorothea Orem is an example of a calm and reasonable woman who can hardly be attributed to the role of Mother Teresa. People like Dorothea Orem want to do a good job and sincerely want to grow. What I find most valuable is that after watching this video, the work of a nurse begins to be presented as a system of patient education. In this system, the nurse helps the patient acquire skills that are useful in his current condition and helps get used to the disease or overcome it. In addition, the nurse is an independent knowing subject, and the patient is not a helpless object.

References

Miller, S. (2021). Dorothea Orem: Pioneer of the self-care nursing theory. The Sentinel Watch. Web.

A Generalized Overview

Ida Jean Orlando has developed a consultative care process that allows nurses to formulate an effective care plan adapted to any situation. Ida Jean Orlando’s deliberative nursing process theory emphasizes the reciprocal relationship between patient and nurse. A “deliberative” process was presented as a guide for nurses to practice effectively (Rich & Butts, 2021). Orlando separated the nurse from medicine, where nurses determine nursing actions rather than being guided by physician instructions, organizational needs, and past personal experiences. The theory assumes that the nurse’s role is to identify and meet the patient’s immediate need for help. According to the theory, any patient’s behavior can be a cry for help.

Explanation, Control and Prediction

The theory suggests that when patients cannot cope with their needs, they are distressed by feelings of helplessness. Patients are unique and individual in the way they respond. Nurses offer motherhood and care similar to an adult taking care of and raising a child (Nursing Theories and Nursing Practice, 2019). People can be secretive or open about their needs, perceptions, thoughts, and feelings. The patient cannot state the nature and significance of the anxiety without the help of a nurse or them first establishing a helpful relationship with the patient. Thus, Orlando’s concept suggests that nursing involves establishing contact with the patient to provide competent care. The nurse is a separate significant link and not just obeys the doctor’s orders. Nurses are needed to respond to the earliest symptoms and the most hidden requests for help.

Improving the Outcome of Patient Care

Improving patient care in Orlando’s concept is achieved by improving communication between patients and nurses. Such a nurse can recognize all changes in the patient’s health status. Most importantly, with this approach, the moral anxiety of the patient is greatly reduced. The nurse helps to eliminate the feeling of helplessness through proper care and psychological rapprochement with the patient. The nurse becomes the most important link in the chain, which helps the patient not to become discouraged.

The Usage in Practice

I will draw from this approach the need to develop a strong psychological bond with the patient for my practice. It is also important for me to realize that I am a separate significant unit of the medical system, which does not just follow the doctor’s instructions. I will also apply this theory to recognize the patient’s help signals and help overcome feelings of helplessness.

References

Rich, K. L., & Butts, J. B. (2021). Philosophies and Theories for Advanced Nursing

Practice. Jones & Bartlett Learning.

Smith, M.S. (Ed.). (2019). Nursing Theories and Nursing Practice. F.A. Davis Company.

Abstract

Quality-Caring Model was developed by Duffy and Hoskins and introduced in 2003. According to this approach, the quality of nursing depends on the relationships and interactions that occur between nurses, their patients, and their families. Apart from the patient-nurse autonomous interactions, the latter serves as an integrator between an individual and other team members to ensure adequate cooperation.

The implications of the environment and the process of caring are combined within this model to create a quality care practice. The idea is that when an honest and good relationship is established, a nurse can understand the needs of their patients better. At the same time, the latter can feel more comfortable sharing important health-related details, affecting the efficiency of treatment. This paper discusses the mid-range model of Quality-Caring and outlines the main principles, concepts, and other aspects of this concept.

Introduction

Mid-range nursing theories aim to bridge the gap between the theory and practice of nurses. One of these models was developed in 2003 to promote the importance of the interactions between a nurse and their patient and the impact of this relationship on the health outcomes.

The Quality-Caring Model was selected as the focus of this paper since it highlights the aspects of care that are beyond the understanding of medicine or human biology, which help address many illnesses but are insufficient to make an impact on one’s attitude towards health. This aspect is especially crucial for Family Nurse Practitioners (FNP) since they often work with patients long-term and have to address chronic illnesses, which implies a change in a person’s lifestyle for achieving successful management. As such, this paper aims to explore the concept and theory of the Quality-Caring model and argue that this approach has to be an integral part of an FNP’s professional practice.

Biography

This theory was developed by Joanne Duffy and Lois Hoskins in 2003. The bibliography of the two includes several notable moments. Hoskins was engaged in studies connected to nursing care at the University of America in Washington. Duffy (2016; 2019) is a practitioner and author of several books, such as “Professional practice models in nursing: Successful health system integration” and ” Quality-Caring in nursing and health systems: Implications for clinicians, educators, and leaders” that focus on the implications of the explored nursing care model in practice.

Duffy is a professional nurse with a Ph.D. degree, who is also a professor at West Virginia University Hospitals (Duffy, 2019). Duffy worked as a cardiovascular specialist and Director of Nursing Services, and she was influenced by the Theory of Human Caring and Quality of Health Model. Thus, the achievements of Duffy include extensive clinical practice and academic work, while Hoskins helped Duffy develop the model and publish articles that describe it.

Summary

Scope

The scope and central thesis of this model focus on the main element of nursing practice that affects the quality of outcomes. The work of nurses and the relationship they establish with their patients has a direct impact on the quality of health outcomes. According to Duffy (2016), the main idea of this model is that relationship-centeredness, and therefore, nurses should focus on developing a relationship with patients and their families. Moreover, this includes the interactions a nurse has with other team members since the efficiency of those can also impact the type of information and quality of diagnosis produces by the medical personnel. Thus, nurses are a link between patients, other healthcare professionals, and health outcomes.

In general, the central thesis of this theory is the idea that nursing is a relationship-centered profession. Thus, it is vital to dedicate much attention to developing communication skills and focusing on building relationships with patients and their families. Duffy (2019) argues that caring relationships established by nurses enable better health outcomes for their patients, which positively affects the quality of health services. Professional encounters and the focus on relationships is the main factor that affects the patients and the caring process facilitated by nurses.

Context

The central meta paradigm concept of this model is the environment that affects a patient and their health and can be affected through communication. Duffy (2019) states that “relationships are the context of human birth, living, working…” (p. 67). The idea is that when a person feels cared for and is in a trustworthy relationship with the healthcare provider, they can feel more comfortable when sharing details about their condition, symptoms, and other health-related factors, which otherwise can be missed. Moreover, Duffy (2019) argues that such people are more inclined to follow the recommendations of medical professionals.

It is significant because the provision of health services is a complicated matter that involves not only efforts from medical professionals, such as nurses, availability of resources and variety of treatment options but also the willingness of a person to rely on the advice of their provider (Duffy, 2019). This enables the change of old patterns of behavior that possibly led to the development of a condition and successful management of the disease.

Patients should be regarded as complex beings whose health is affected by multidimensional factors. More specifically, people are interconnected with other individuals, including healthcare professionals, and their health is a result of these interactions (Duffy, 2016).

The other meta paradigms of nursing focus on a person, health, and nursing. From a nursing meta paradigm perspective, this model leverages the care provided by these medical professionals and addresses the idea that relationships facilitated by nurses and the safe environment created by them are crucial (Duffy, 2016). From the perspective of health, the model suggests that effective communication, such as cooperation with teams, can affect the outcomes of treatment. From a person’s perspective, this model leverages the main elements of this metaparadigm – patient and their families. According to the Quality-Caring approach, a nurse should communicate with an individual and their family members.

Content

The unique concepts that are a part of the Quality-Caring Model include the focus on the relationship between a patient and a nurse, as a basis of healthcare quality. This approach suggests that focusing on trust, mutual respect, and ensuring sensitivity to needs are essential for adequate caring (Duffy, 2019). The primary principle of this model is the uniqueness of each patient case. Based on this model, health is viewed as a dynamic structure, dependant on the context and setting. Therefore, nurses can have a direct impact on the quality of outcomes by addressing the environment, cooperation, and caring attitudes.

The model urges nurses to work on the environment in which their patients receive healthcare services, to create a caring atmosphere that will help improve outcomes of treatment. Duffy (2019) states that relationships are the core element of this environment because they enable nurses to understand the needs of their patients better. In the context of the environment, this includes everything that a patient sees and encounters over the course of treatment in a healthcare facility. Thus, the unique concepts of this model are the approach to nursing that emphasizes professional relationships.

Applicability

Setting

This research paper focuses mainly on the implications of the Quality-Caring Model for the work of FNP. However, there are examples from other fields that highlight the beneficial impact of this model on a patient’s well-being. One of them is empirical research by Compton et al. (2018) in which the authors assess and evaluate the perception of patients regarding nurses’ attitudes and the impact of the nurse-patient relationship on their health upon discharge. The findings suggest that care displayed by nurses is an essential indicator of quality.

The selected setting, in which the Quality-Caring Model will be applied, is the daily practice of an FNP who often encounters individuals with chronic illnesses, which require ongoing monitoring and education regarding the management of their illness to ensure a sufficient quality of life. According to Compton et al. (2019), “mutual problem solving might be an appropriate area for nurses to focus on” (p. 1680).

According to the examined model, this is an essential factor since it encourages nurses to interact with patients and their families, confront issues, and find suitable resolutions to problems that patients may encounter. Another implication is the need to assess how a specific patient perceives caring behavior, since the approach to caring may be different for people. This is also achieved through communication with patients and the establishment of a relationship.

Nursing Practice

In the nursing situation, where an FNP provides healthcare services to individuals continuously, the Quality-Caring Model is essential. This is supported by the evidence from Compton et al. (2019) that suggests that patients value the care provided by a nurse, and it affects their perception of the quality of services. Apart from formally assessing the illness history or a given patient, a nurse should engage in a conversation about health and illness to fully understand the perception of this individual.

In relation to chronic conditions, by establishing a relationship with patients and their families, a nurse can gain a better comprehension of the management practices an individual uses. For example, they can ask and receive an honest answer about diet and exercising routings from patients who have diabetes, which can be an issue if an individual feels shame regarding their habits. However, in accordance with the Quality-Caring Model, a nurse can provide better care by having a complete understanding of an individual’s health state.

Feasibility

Similar to any other nursing theory, the Quality-Care Model has several limitations and weaknesses that can obstruct one from applying it in practice and must be discussed to use it in nursing successfully. Mainly, it requires an investment of time-based resources and money (Utley, 2017). This is connected to a need to educate all professionals working in a given hospital, for example, all nursing personnel, to ensure that adequate communication across different teams can be established in accordance with this model. Therefore, the main problem that can be anticipated as part of the implementation of Quality-Care Model is that other care providers must be involved in the process of implementing its principles.

However, the theory is not too complicated since it is connected to all aspects of the nursing meta paradigms. The Quality-Care Model can contribute to healthcare by promoting an establishment of cooperation between nurses and their patients. For example, the two parties will be able to work on the management of chronic conditions more effectively, by cooperating and communicating clearly to define any obstacles or issues.

References

Compton, E., Gildemeyer, K., Mason, T., Hartranft, S., & Sutton, S. (2018). Nurses’ caring behaviors: The perception of patients with cancer at the time of discharge after surgery. Clinical Journal of Oncology Nursing, 22(2), 169–174. Web.

Compton, E., Gildemeyer, K., Reich, R., & Mason, T. (2019). Perceptions of caring behaviours: A comparison of surgical oncology nurses and patients. Journal of Clinical Nursing, 28(9-10), 1680-1684. Web.

Duffy, J. R. (2016). Professional practice models in nursing: Successful health system integration. Springer Publishing Company.

Duffy, J. R. (2018). Quality caring in nursing and health systems: Implications for clinicians, educators, and leaders (2nd ed.). Springer Publishing Company.

Utley, R. A. (2017). Care and caring frameworks. In K. Henry, L. Smith, & R. A. Utley (Eds.), Frameworks for advanced nursing practice and research: Philosophies, theories, models, and taxonomies (pp. 57-90). Springer Publishing Company.

Out of the magnitude of the nursing theories which include practice nursing theories, mid-range nursing theories, and grand nursing theories, it appears that mid-range theories deserve more attention and focus. My choice of a mid-range nursing theory is backed by the explanation that mid-range nursing theories tend to be more specific and narrow in the area of their application. Furthermore, mid-range theories serve as a bridge between the nursing practice and the grand nursing theories (Peterson & Bredow, 2008). With this in mind, the mid-range theories offer more than concepts and vague ideas, which are theoretical in nature. Mid-range theories, in my opinion, serve as nursing strategies with a theory-based practical approach that may be effectively applied in various outpatient settings.

The interest in mid-range nursing theories is on the increase, and more and more publications are released dedicated to various theories which are successfully applied in various patient settings. The majority of the mid-range theories are used to foster research and practice, in this light, the paper will focus on the emergence of the mid-range theory and its application as well as approaches relating to its application. For my paper, I have selected, out of many, the theory of comfort, introduced by Katharine Kolcaba.

The theory of comfort was developed by Katharine Kolcaba in the early 90s. Katharine was born on December 8^th, 1944 in Ohio, Cleveland. She went to St. Luke’s Hospital School of Nursing where she obtained her first diploma in 1965. She then proceeded with her education and attended Frances Payne Bolton School of Nursing in Case Western Reserve University in 1987. In 1997, she obtained a PhD. in nursing and was awarded a certificate of authority as a clinical nursing specialist. During her studies, Katharine studied various medical areas including Long Term Care Interventions, Gerontology, Instrument Development, End of Life and Nursing Theory, Research pertaining to nursing and comfort. It was during Kolcaba’s master studies that she took a position of a head-nurse in an Alzheimer’s unit and became interested in the outcomes of comfort, and decided to impart a theoretical shape to the theory of comfort. It was as early as in 1991 that Katharine published her first article ‘An analysis of the concept of comfort’ laying the groundwork for the comfort theory. In 1994, Katharine published another article ‘theory of holistic comfort in nursing’. Working as a university teacher, Katharine published a series of articles, and eventually all her work boiled down to the book, ‘Comfort Theory and Practice: a Vision for Holistic Health Care and Research’ which was published in 2003. In 2007, Katharine retired from the university as a full-time teacher, although she continues to teach part time and does not abandon her research of the comfort theory.

Theoretical development of the theory of comfort has been backed up by a series of peer-reviewed articles published in prominent medical journals over the last 20 years. The theory of comfort has become a foundation for an array of thesis and dissertations, and the concept itself blossomed into a solid middle-range medical theory and research (Peterson & Bredow, 2008). Since the 1990s, multiple nursing books focusing on mid-range theories have been published, and rarely was Kolcaba’s theory of comfort omitted from the scope of multiple mid-range theories.

Having studied Kolcaba’s works on the theory of comfort, it is hard to escape a conclusion that Katharine uses an inductive approach in putting forward her mid-range medical theory. Based on the premise that deductive reasoning is founded on a rule or a law, or a principal for that matter, and then specific examples are presented to ascertain that the theory applies to them. Conversely, inductive reasoning is founded on examples or situations which demonstrate whether the principal will emerge. Kolcaba used an inductive approach, because the fundamental concept of comfort (whether environmental, physical, or cultural) is abstract in nature. Comfort itself is an ambiguous notion, and definitions or views of what it means may vary among patients. Using an inductive approach, Kolcaba discovers the comfort needs of the patient by placing him in a situation where the comfort conditions are created. The patient is relieved of chronic pain, and then the level of comfort, based on patient’s preferences is enhanced. The patient is then encouraged to adopt health-seeking behaviors as advised by the nurse. Certain conditions created for a patient and a series of observations of patient’s reaction allowed Kolcaba, based on inductive approach, to see that the theory of comfort was valid.

It is interesting to trace the roots of the Theory of Comfort in Kolcaba’s work. As Katharine wrote in her article ‘A Taxonomic Structure for the concept comfort’ the ideas behind the theory of comfort, specifically on Relief were adapted from Ida Jean Orlando’s work where the central job of nurses was to relieve the patient’s needs. Virginia Henderson’s work on Ease was used to define the state of calm and contentment, and finally Josephine Paterson and Loretta Zderad’s work on Transcendence and Kolcaba’s interpretation of it as the patient’s ability to rise above problems and pain (Kolcaba, 1991). Eventually, those three pillars were used by Kolcaba in her definition of comfort.

The comfort theory developed by Kolcaba studies the obstructions and problems in a healthcare situation, such as chronic illness or pain that may prevent a patient from achieving a state of comfort (Kolcaba, 1994). The theory describes comfort as an immediate, desirable atmosphere for the patient that needs to be created in a nursing care setting. In her later paper, published in 2001, Kolcaba expands the definition of comfort as a state where basic human needs for ease of being, state of relief, and transcendence are met (Kolcaba, 2001). The four concepts of comfort defined by Kolcaba are placed in four contexts: 1. Physical – which relates to a patient’s sensations which may depend on cold and heat levels, disruptions, bleeding, etc. 2. Psychospiritual which relate to how a patient identifies his place in a community, that includes his esteem, beliefs, his power and authority, and community’s respect. 3. Environmental, relating to the immediate surroundings of a patient, such as light, sound, noise level, furniture, view from the windows, etc. and finally 3. Sociocultural relating to patient’s relations with his family and society at large (Kolcaba, 2006).

Kolcaba wrote that patients have implicit and explicit comfort needs, and when they are attained, patients are motivated to adopt life-seeking behaviors and take up a new health routine (Kolcaba, 2001).

The fundamental values and beliefs underlying the theory of comfort stem from Kolcaba’s assumption that patient needs if met encourage them to achieve better results in rehabilitation and follow a new life routine. The second assumption underlying the theory states that patient needs are governed by his expectations, and patients expect nursing care to be within competence. Finally, when nurses provide better comfort conditions for the patient, better results are achieved leading to overall patient satisfaction and financial stability of the medical institution (Kolcaba, 2001).

Concepts and ideas that provide a foundation for the theory of comfort stem from comfort needs, comfort intervention, enhanced comfort levels, and health-seeking behaviors. These concepts are aligned with mid-range theories, as they are well-defined and specific. All of the above concepts are relevant to patients, families, and nurses (Peterson & Bredow, 2008).

Despite a wide range of nursing theories, there are four basic nursing metaparadigms that address the patient as a whole (Peterson & Bredow, 2008). The first one relates to the patient’s health and patients as human beings. The second deals with the environment in which the patient is placed, and the surroundings that affect the patient. The third one relates to a patient’s health component, exploring how a person’s physical, emotional, social well-being is incorporated in health care. The final metaparadigm deals with the nursing concept which involves application of knowledge, skills, technology, and expertise that is used in achieving the best outcome for a patient.

It is interesting to place the four nursing metaparadigms into the dialogue with Katharine Kolcaba’s comfort theory. The first one relates to ‘human beings’, the theory of comfort is directly aligned with this metaparadigm as comfort is essential to all people. Kolcaba notes that patients who are more comfortable are more likely to adopt healthy behaviors (Kolcaba, 2001).

The second metaparadigm dealing with the environment is directly linked to Kolcaba’s theory of comfort. Improving the patient’s surroundings may lead to enhancing the patient’s comfort level. When a nurse works to eliminate negativity in the surrounding environment, it results in patient’s positive thinking and better attitude to life and health as a whole.

The third ‘health’ metaparadigm is closely linked to the theory of comfort as well. Kolcaba (2003) says “health is comfort” (p.35). It explicitly implies that health does not exist without comfort and any illness, even a minor ailment, will disrupt a patient’s comfort level. Comfort provides a positive state for a patient and results in quicker rehabilitation process, quicker discharge, reduced number of re-admissions, and increased patient satisfaction with care provided (Peterson & Bredow, 2008).

The fourth, and the final ‘nursing’ metaparadigm, is in direct context of Kolcaba’s comfort theory. The comfort theory encourages nurses to address the patient’s needs to achieve a better comfort level. Kolcaba wrote that providing nursing care for the patient needs to transcend the medical application (Kolcaba, 2001). Aside from skilled medical services, a nurse needs to provide compassionate care to patient and seek to establish and maintain a strong-nurse-patient relationship based on trust and mutual understanding of the patient’s goals and objectives. Only by meeting the patient’s comfort needs and goals, may the nurse envisage that the rehabilitation process will be more successful. As seen from Kolcaba’s works, the four fundamental nursing paradigms are aligned with the theory of comfort.

Kolcaba’s theory of comfort is presented in a lucid and consistent way. The theory was proposed in the early 90s and since then, Kolcaba continued developing, honing and expanding it. The consistency of the theory is backed by multiple studies and interventions undertaken within the frames of the comfort theory. Given an array of articles by Kolcaba dedicated to the theory which have been written over the last two decades, the theory is presented in a clear and lucid manner, allowing medical staff to use it as guidance or a benchmark for their research.

Kolcaba notes that the understanding of comfort and its principals directly guides nursing care (Kolcaba, 1994). The comfort theory may be incorporated in physical, social, and environmental interventions. A patient’s comfort should not be limited to relieving pain and administering a medication only, a series of interventions such as merely helping the patient to reach the bathroom, providing a reassurance about a treatment and rehabilitation, tidying his room, providing him with the information on the course of treatment may all contribute to an atmosphere of nurse-patient trust. According to Kolcaba, the theory of comfort provides guidance for nursing actions and research, because comfort has an outcome that can be measured in terms of better patient rehabilitation (Kolcaba, 1994).

The theory of comfort is directly related to my nursing setting which is a family nurse practitioner or a nurse in an urgent care setting. It is essential that comfort level of the patients is attained to ensure better results and outcomes. Working as a family nurse practitioner, it is crucial that the medical procedures be directed not only to pain relief or prescribing the appropriate medicine, but also to creating a favorable comfort level within the family. When a patient is afflicted with an illness, it is not only he or she who is affected, his family members also need to be considered as a driving force towards patient’s discharge and rehabilitation. Any illness, be it major or a minor ailment, disrupts the comfort level and affects the social identity, patient’s role, financial stability, and plans for the future (Dalteg, Benzein, Fridlund, & Malm, 2011). By applying the theory of comfort to patients, and establishing an atmosphere of trust, I will encourage patients to engage in health seeking behaviors and adopt a healthy life-style.

By integrating a comfort theory into my nursing practice, I will ask patients and families what I can do specifically to make them feel more comfortable. Before providing comfort to patients, it is important to assess their comfort needs. When performing the duties of a family nurse practitioner, I will teach families about comfort so that they may create and maintain a comfort level in their homes. Communication becomes increasingly important in nurse-patient relations, and compassionate care needs to be an integral part in patient care. It is important that each patient receives individualized care where his culture and social surroundings are taken into account. By applying the theory of comfort in a nursing practice, the nurse needs to be engaged in nurse-patient relations at all levels of providing care and comfort.

According to the theory of comfort, patients who need urgent care are more stressed, and therefore, their comfort needs may be met by nurses (Kolcaba, 2001). When a patient is admitted to an urgent care unit, and a surgery is scheduled shortly, enhanced comfort level may help ease the initial distress, help support the patient and ready him for an upcoming surgery or a procedure.

The theory of comfort, developed by Kolcaba and now practiced by thousands of nurses, deserves interest and provides a fertile field for research for all nurse practitioners.

Reference List

Dalteg, T., Benzein, E., Fridlund, B., & Malm, D. (2011). Cardiac disease and its consequences on the partner relationship: A systematic review.European Journal of Cardiovascular Nursing, 10, 140-149. Web.

Kolcaba, K., (1991). A Taxonomic Structure for the concept comfort.Journal of Nursing Scholarship, 23(4), 237-240. Web.

Kolcaba, K., (1994). A theory of holistic comfort for nursing.Journal of Advanced Nursing, 19(6), 1178-1184. Web.

Kolcaba, K., (2001). Evolution of the mid range theory of comfort for outcomes research. Nursing Outlook, 49(2), 86-92. Web.

Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and research. New York, New York: Springer Publishing Company.

Kolcaba, K., Tilton, C., & Drouin. (2006). Comfort theory: a unifying framework to enhance the practice environment.The Journal of Nursing Administration, 36(11), 538-544. Web.

Peterson, S. J., & Bredow, T. S. (2008). Middle-Range Theories: Application to Nursing Research. Philadelphia, Pennsylvania: LWW.