Middle Range Nursing Theory - Essay Example

? Kolcaba’s Comfort Theory in Nursing Practice of Introduction Frances Kolcaba, a nursing theorist of the contemporary period, has developed the Comfort Theory, which can be a helpful perspective to guide nurses in leading their patients toward a meaningful existence. This contemporary and practical middle range theory encourages nurses to revisit their beginnings and concentrate on their patients’ comfort needs in numerous aspects of their lives, including the physical, environmental, spiritual, psychological, financial, social, and psychological (Smith & Liehr, 2008). Patients that have terminal illness may feel distress or pain in any or all of these domains and that the desire for comfort should be evaluated and attended to on all areas, instead of simply focusing on the long-standing practice of managing physical pain. The purpose of this paper is to discuss Kolcaba’s comfort theory, particularly its history, principles, and concepts, and application to specific nursing practice. A Brief Description of Kolcaba’s Comfort Theory At the advent of the twentieth century, the concept of ‘comfort’ was applied in a broad way, and it was greatly appreciated in nursing. Furthermore, the capability to give comfort demonstrated the personality and skill of nurses. During this period, nurses thought that giving comfort was their sole responsibility. Comfort was mainly essential because therapeutic medical procedures were still absent (Kolcaba, 2003). Improving the comfort of patients was viewed as a proactive nursing objective that also was encouraging, and, in almost all instances, should involve progress from an earlier condition. Comfort arose from environmental, emotional, physical, and psychological interventions, but directives for special comfort procedures were under the doctor’s discretion. From its broad definition and great importance in nursing at the advent of the twentieth century, comfort changed to a less valuable nursing objective with a meaning more associated with the physical aspect. The latter part of the 20th century witnessed numerous developments in medicine and treatments generally stemmed from chemotherapy, radiation therapy, antibiotics, and surgical operations (McEwen & Wills, 2007). The value of family comfort started to surface during this period and families were regarded valid beneficiaries of comfort therapies. Nurses encouraged self-care in patients if at all possible. Comfort became the top priority of nurses only when their patients have terminal illness. Moreover, where nursing contexts were less affected by technology, like long-term care and nursing homes, comfort was more essential as a purpose of nursing (Fawcett & DeSanto-Madeya, 2012). Smith and Liehr (2008) argued that such pattern had wide-ranging repercussions for nursing in the twenty-first century, because of an increasingly aging population. More and more elders desire comfort in the remaining days of their lives. Frances Kolcaba describes comfort in nursing as “the satisfaction (actively, passively, or co-operatively) of the basic human needs for ‘relief’-- a condition wherein a patient’s special needs were met--, ‘ease’-- a condition of total peace and serenity-- or ‘transcendence’-- a condition wherein an individual overcomes pain and difficulties-- arising from health care situations that are stressful” (McEwen & Wills, 2007, 256). Kolcaba’s comfort theory takes place within a context made up of ‘three states of being’ and ‘four contexts’ wherein comfort for the ill can exist in (McEwen & Wills, 2007, 256). The three interconnected states of being wherein a patient is supported are relief, ease, and transcendence. The environmental, social, psychospiritual, and physical are the four contexts wherein comfort for patients takes place. The psychospiritual domain is where life’s purpose and meaning reside (McEwen & Wills, 2007, 256). Comfort theory is rooted in the idea that all human beings respond in a holistic way to difficult situations and that all human beings want and pursue comfort. Comfort is naturally a complex concept because experiences that influence one domain of an individual’s comfort indirectly affect other domains too. Kolcaba (2003) argues that such indirect and direct outcomes generate a stronger impact on comfort for the ill than would any experience gained alone; hence comfort processes are naturally holistic. Furthermore, the theory suggests that the interplay among all these comfort domains are important to gaining comfort and are directly evaluated and dealt with in the profession of nursing. Even though reaching a state of full and absolute comfort could be an impractical objective in palliative care, supporting and guiding patient with terminal illness discover meaning is a minor but vital task for nurses, besides the adoption of established comfort therapies and procedures (Smith & Liehr, 2008). Comfort theory does not guarantee that evaluating for dissonance within the stages of comfort will get rid of the whole discomfort of a patient. Yet, Kolcaba (2003) claims that the interplay between comfort procedures and the experiences themselves could assist a patient in reaching ‘ease’ and ‘transcendence’. Kolcaba (2003) emphasized that fulfilling the needs for comfort of professional nurses enhances nursing practice and, consequently, more positive patient outcomes. Some scholars have used comfort theory in enhancing surgical processes. Kolcaba (2003) applied the theory to the improvement of perianesthesia nursing practice. As stated by McEwen and Wills (2007), the theory became the foundation of acute care of elderly (ACE) for aged individuals undergoing orthopedic operation. Applying Kolcaba’s Comfort Theory The application of comfort theory to nursing practice involves several forms of comfort interventions that can be carried out to attain the objective of improving the overall comfort of patients. Standard comfort procedures are developed to sustain homeostasis like observing physiological functioning, and attending to negative changes in the patient’s condition (Smith & Liehr, 2008). Such procedures may also involve provision of needed medications and dealing with pain. These comfort measures are created to assist the patient in sustaining or restoring physical health and comfort. Holistic comfort measures, on the other hand, can be carried out to meet numerous comfort needs simultaneously. For instance, administering treatments and performing integrative and non-pharmacologic procedures can meet the needs of a patient within the four contexts of comfort. For instance, a patient’s desires for relief, ease, and transcendence can be met all at the same time through music therapy. Ease is achieved by the serenity the patient experiences while listening to a memorable song (McEwen & Wills, 2007). The music provides relief by evoking a feeling of peace in the patient and thus easing pain, fear, and discomfort. Transcendence is achieved as soon as the music encourages the patient to reflect spiritually or proactively. However, there could be instances wherein slight or minor enhancement in comfort is attained. Under such situations, nurse practitioners can explore prevailing factors to find out why comfort measures are ineffective. Factors like cognitive disability, depression, poverty, and abusive experiences may dampen the effectiveness of the key comfort interventions and procedures (Kolcaba, 2003). Nevertheless, the nurse should not be discouraged and by means of repeated provision of comfort care can guide patients in overcoming overwhelming situations. It is crucial to bear in mind that transcendence is an ultimate form of comfort. Conclusions Kolcaba’s comfort theory discussed in this paper comprises meanings, comforting measures or therapies, and the objective of heightened comfort. It is positive, strengthened, invigorated, deliberate, and desired by patients and all individuals in all contexts. Positive care aims not merely to reduce detrimental aspects of poor health like depression, anxiety, and pain, but to improve encouraging aspects of everyday life, like healing, freedom of movement, and comfort. Comfort is an encouraging experience that has been associated with positive involvement in healthy behavioral patterns. Comfort theory, just like any other midrange theories, is a valuable tool for nursing research and practice. This theory helps nurses understand the behavior of their patients, facilitating treatments that generate more positive outcomes. Due its value in nursing practice, comfort theory has been applied to different nursing areas. But comfort theory is largely applicable and essential to elderly care. Works Cited Fawcett, J. & DeSanto-Madeya, S. (2012). Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories. Philadelphia, PA: F.A. Davis Company. Kolcaba, K. (2003). Comfort Theory and Practice: A Vision for Holistic Health Care and Research. New York: Springer Publishing Company. McEwen, Melanie & Wills, E. (2007). Theoretical Basis for Nursing. New York: Lippincott Williams & Wilkins. Smith, M.J. & Liehr, P.R. (2008). 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