Nursing Theory Analysis - Essay Example

NURSING THEORY ANALYSIS PAPER Vicky Brown School: UCLA Nursing theory analysis paper Introduction The role of the brain and for that matter the mind in controlling most of the processes of human life cannot be underestimated. Indeed for a better to be in very good position to go about normal daily activities, it is important that such a person will be in a right state of mind that is well guided and active to perform (Orlando, 1961). However, there are moments that such state of mental alertness is not achieved in people. Writing on various mental health conditions, Henderson (2006) noted that at a point in a person’s life, there is the possibility of coming across situations and circumstances that affect the right state of the mind. No matter how temporary such moments may be, it is always important that the right form of assistance will be received from experts so as to avoid complications (Kolcaba, 2003). For other people, their mental health conditions have already been diagnosed to be severe. For such people also, the need to seeking the right expert intervention may be seen as the way forward to attaining a fulfilling life. Certainly, the understanding that is developed here is that the expert delivering mental health care is always important when it comes to the need for people to be in the right state of mind. This paper therefore discusses ways in which mental health nurses use theory to go about their roles. Theory, author name and background In nursing in general and mental health nursing in particular, theories come in different forms, depending on what someone wants to achieve. One of these forms is what is known as mid-range theory. Mid-range theories have been explained to be those theories which comprise related concepts fixed around limited scope of the reality of nursing practice (March and McCormack, 2009). This means that mid-range theories are seen as connections to models that helps to define circles of practice and research that sets the pace for casual practice to take place. One of such mid-range theories that can be considered very appropriate and accommodating for the mental health nurse setting is the theory of comfort by Katharine Kolcaba. As the name implies, the theory of comfort focuses on the concept of comfort and how comfort must be approached by both the patient and the practitioner to ensure that clients are always in the right state of mind to operate or function effectively The comfort theory was developed by Katharine Kolcaba who is an American nursing professor. The theorist’s background in nursing education can be said to have affected her way of seeing mental health and thus the theory she developed. This is because the comfort theory has been noted to have been implemented very largely at the institutional level (March and McCormack, 2009). Meanwhile, it is at such level that the theorist has served as a professional for several years. It would therefore be true to argue that the theorist gained most of the inspiration and thoughts that led to the proposition of the comfort theory from her practical professional work. Apart from the influence of her workplace experience on the theory, it can also be said that several years of competitive academic learning have also helped Kolcaba to understand the basic rudiments of mental health nursing and mid-range theory better. This is because after earning diploma from the St. Luke’s Hospital School of Nursing, she furthered her education by taking up advanced learning, which earned her a Master of Science in Nursing in 1987. Her urge for learning did not stop there as she pursued academic intellectual expansion with a PhD from Western Reserve University in 1997. It was actually in this same school that she had her Master’s degree (North Georgia, 2011). The work of the theorist can be traced to several references of works that were started by her and others in the field of nursing. For example, reference can be made to an article Kolcaba published in 1991 titled “An analysis of the concept of comfort”. In this article, the theorist gave the fundamental ideologies that she believed came together to constitute comfort. This work was however not extensive enough to lead to a theory and so in 1994, she followed it up with another article titled “A theory of holistic comfort in nursing”. This was where the theorist started giving some critical theoretical underpinnings to the concept of comfort she had developed earlier. Particularly, she stressed in the article of holistic comfort is, and how important it is to approach comfort from that perspective rather than viewing it in isolated parts. There are other people whose works can also be mentioned as having influenced the work of the theorist. Some of these are the works of Ida Jean Orlando, who wrote about relief in 1961 and 1990, Virginia Avernal Henderson who wrote about ease in 1978, Josephine Paterson and Loretta Zdarad who worked on transcendence in 1976 and 1988 (North Georgia, 2011). The comfort theory can therefore be said to have its own foundations on which it was built. Kolcaba (1997) stressed that comfort operates in four major contexts of a person’s life. These contexts are physical, psychospiritual, social, and environmental. This means that when speaking of the concern or problems addressed by the comfort theory, it is possible to relate these four contexts to the problems. In effect, the theory addresses the physical, psychospiritual, social, and environmental problems of a person. Comfort addresses these problems by ensuring that a person experiences an immediate reaction of being strengthened (Kolcaba, 1997). Writing on impaired comfort, Kolcaba reiterated the point that for the four contexts of problems to be addressed effectively, it is important to have some other forms of personal needs met. These are relief, ease and transcendence. In effect, relief, ease and transcendence act as the phenomenon of concern that leads to the solving of the physical, psychospiritual, social, and environmental problems that a person encounters. Such inclusiveness for other phenomena to make comfort complete is the basis for arguing that comfort is a holistic state of a person’s wellbeing (March and McCormack, 2009). This means that once the state of comfort is realized, it is not just a single or a few areas of a person’s life that is improved but as many areas of life as possible. Theory Description There are always philosophical reasoning perspectives assigned to various theories. In the comfort theory, the form of theory that was used can be noted to be the inductive reasoning. Inductive reasoning may be explained to be a form of logical reasoning which seeks to build generalizations by inducing this from different specific observed instances (Kolcaba, 2001). What this implies is that a theory is said to be based on inductive reasoning when its application is based on the gathering of specific observations within an environment to proof the validity of the theory’s argument. Most certainly, there are a number of evidences that can be given with reference to comfort theory to justify that it is based on inductive reasoning. In the first place, Kolcaba (2001) admits that the comfort theory was built based on observations to rudimentary conceptual framework of specialized practice. By implication, the core concepts that make up the theory are those that are already prominent in different fields of nursing care such as dementia care. The comfort theory can be said to be founded on four major concepts, which also act as the contexts within which the various types of comfort can be experienced. These four concepts are physical, psychospiritual, environmental, and social contexts in which comfort occurs. Each of these is defined in both theoretical and operational manner whereby it is thought that they should be able to occur not just in theory but also in principle or practice. Physical is defined to be a context of comfort where the individual can experience tangible wellbeing of any form. Psychospiritual context also refers to the combination of psychology and spiritual wellbeing. Environmental comfort refers to where comfort is expanded to include other people and things in the surrounding of the individual, and social context is when comfort comes to affect other people around the individual positively (Kolcaba, 2001). Reading through all the major publications of the author, one thing that is very clear is that the theorist is always consistent with the use of the concepts as they are used to define the core basis on which comfort is established for any individual. Apart from the four concepts, there are other terms used on the theory which are also very consistent. Three of these are relief, ease and transcendence. The theorist explains that comfort is holistic only when it falls within these three parameters or types. Because of this, their usage is consistent in the study. From the generalized definitions given to the concepts, it is possible to interpret them both explicitly to conform to the inductive philosophical reasoning based on which they were established. This is because the inductive reasoning gives credence to the use of external frameworks in defining the theory, a reason it is possible to interpret them explicitly. The interpretation given to the physical context is that comfort to individuals, especially those with various forms of mental health conditions must be in such forms that can be testified and measured. This is because once comfort is not manifested in a physical manner, it is not possible to measure it and subsequently attest to its existence. The interpretation given to the psychospiritual context refers to the need for comfort to come to people in a more permanent and continual manner. This is because both the psychological and spiritual components of a person are thought to encompass a more permanent part of the person which remains with people as long as they have life (Henderson, 2006). Then also, the social aspect interprets the need for others, other than the direct beneficiary to also have a course to testify of the presence of comfort. This is because mental health has been noted to be a concept which is socially integrating. Lastly, the environment within which a person finds him or herself must be noted to exemplify the fundamental premise under which comfort must exist. Even though each of the concepts can be applied from an independent perspective, there are ways in which they relate to form a collective concept under the comfort theory. Orlando (1961) explained that the four major concepts that come under the comfort theory form the overall basis or underlying for a complete person. Based on this, it is easier to understand that it is virtually impossible to assume that the four cannot be related in a well fixed manner. For example, between physical context of comfort and social context, one would notice that until a patient or a person manifests comfort from a physical perspective, it cannot be possible for those within the social premise to witness and appreciate the existence of the comfort. The same can be said between environmental context and psychospiritual context. This is because as the psychospiritual context is an abstract context, it is important for there to be a form of visible presence within and around the environment of the individual for such comfort to be attested. In the conceptual interpretation of the major concepts, Kolcaba (2001) explained that when the four major concepts relate, they form the taxonomic structure of comfort. To a large extent, it would be understood that without relating the major concepts, it will be impossible to have the said structure in place. Evaluation There are important assumptions based on which the theory is founded both explicitly and implicitly. Four of these are clearly identified by North Georgia (2011). The first assumption is that human beings have holistic responses to complex stimuli. What this means is that once a person is presented with a complex stimuli, the person would be triggered to respond in a holistic rather than a partial manner. The second assumption is that comfort is a desirable holistic outcome that is crucial to the discipline of nursing. What this assumption means to the theory is that of the complex stimuli that can be applied to a person to produce holistic response, comfort is actually that holistic response or outcome to which a person responds to. There is a third assumption which is that human beings strive to meet their basic comfort needs. This assumption is one that is very important to mental health nursing. This is because based on this assumption, mental health nurses get to appreciate the need to allow patients to strive to achieve comfort through the assistance of nurses. The last assumption is that when comfort needs are met, patients are strengthened. It is based on this last assumption that the achievement of comfort is said to be important for mental health patients to gave wellness. Kolcaba (1994) rightly identifies a description for each of the four metaparadigm concepts of nursing. Under nursing, the theory explains that nurses have a responsibility to intentionally assess the comfort needs of patients and take a step ahead to design comfort measures that seek to directly address the needs. The nurse also has a role when it comes to the re-assessment of patients after periods of interventions have been carried out. When it comes to patient, the theory identifies a patient to be a person, family or whole community that has need of all forms of health care be it primary, tertiary or preventive care (Kolcaba, 2010). The third metaparadigm which touches on environment explains that any phenomenon that is found in the surroundings of the patient that affects comfort or can be manipulated to lead to comfort is part of the environment. In the last instance, reference is made to health, where it is said that the comfort theory must lead to the optimum function of a patient. Most certainly, the theorist put together several attempts that clearly established the consistency of the comfort theory. For example, the four contexts and the three types of comfort that were stressed at the very beginning of the theory was used throughout the theorist’s work to explain how comfort is achieved and how individuals can use it to accomplish different goals in life. From the onset, the theorist explained that the only circumstance under which real comfort can be said to have been attained is when individuals aspire for it in wholeness leading on from here, the theorist consistently stood by this ground and established several scenarios under which should be the case. For example, it was strongly defended that even though psychospiritual context of comfort may be a commendable goal to pursue, this would not be of significant importance to the patient until there is a means by which this is exemplified in a physical context. Again, there was consistency with the inductive reasoning that was used to set the theory. Application There are several ways in which the comfort theory would guide nursing practice, particularly mental health nursing practice. First, the theory through the four metaparadigm has clearly identified the nurse as the major facilitator and stakeholder at the center of the wholeness process of comfort. This realization can help nurses to take maximum responsibility without shedding any when it comes to the need to fast tracking the mental health improvement process for patients, particularly through the acquisition of comfort. Again, the systematic nature of the theory makes its application in nursing very easy. For example through the taxonomical structure that is given in the theory, it is easier for nurses to use the theory as a guide in the delivery of mental health care through the provision of comfort to patients. What is more, the theory is well positioned to make the evaluation of mental health hospital care very easy and more qualitative. As a result, nursing actions are enhanced as they are able to evaluate their own practices to determine how appropriately they have applied the theory. In mental health nursing, the comfort theory can be applied to give holistic care. Very often, mental health practitioners have been criticized for not being thorough with the delivery of their work (Orlando, 1961). Some who are in the field have attributed the absence of thoroughness to the fact that mental health conditions manifest in many different forms. This is however a major limitation to practice because once some part of a patient’s health condition is treated and the rest are neglected the implication is that the aspect that is neglected can easily resurface. Through the major concepts and holistic stimuli approach to the comfort theory, nurses in mental health sector will be equipped with simple procedures that makes it possible to overcome the challenge of just looking at the outside of larger health problems but rather look at the conditions of patients more holistically. In the long run, it is expected that this theory will improve the overall nursing practice as a mental health nurse. Conclusion To conclude, it will be reiterated that theories are very important in nursing practice, particularly in the mental health nursing. More to this, the use of comfort theory helps in outlining the need for all individuals to be adequately made whole and relieved of any forms of distress they may be suffering. As mental health nurses seek to give patients this form of relief from their distress and other forms of mental discomfort, the comfort theory comes in as the best intervention to turn discomfort into comfort. The background to this theory was noted be have been centered on the basic assumption that human beings exhibit holistic response to complex stimuli and that comfort is an outcome that reflects the form of complex stimuli that a person had (Henderson, 2006). The theorist therefore holds a generalized assumption that once comfort is gained or attained, patients become strengthened emotionally, psychologically, intellectually, and even physically (Kolcaba, 2003). In line with this position by the theorist, comfort theory comes as one of the most comprehensive theories which makes considerations for not just one area of a person’s life but in several areas including physical, social, environmental, and pyshcospiritual. It is therefore very important that nursing practitioners adapt to the use of a theory such as the comfort theory. What is more, because comfort theory builds on holistic wellness that seeks to justify that a person must experience a state of relief, ease and transcendence before comfort can be reached, those parameters act as the basis on which the generalization of the theory is induced. This inductive reasoning is also hoped to be applied in practical nursing whereby the search for comfort will be founded by other well known and approved forms of theories and theoretical findings. References Henderson V. (2006). The nature of nursing. New York: Macmillan; 1966. Kolcaba, K. (1994). A Theory of Comfort for Nursing. Journal of Advanced Nursing, 19, 1178-1184. Kolcaba, K. (2001). Evolution of the mid range theory of comfort for outcomes research. Nursing Outlook, 49(2), 86-92. Kolcaba, K. (2003). Comfort Theory and Practice: A vision for Holistic Health and Research. New York: Springer Publishing Company. Kolcaba, K. (2010). Nursing Diagnosis Handbook: An evidence-based guide to planning care. (9th Edition). New York: Print Mark Publications. March, A and McCormack, D (2009). Nursing theory-directed healthcare: modifying Kolcabas comfort theory as an institution-wide approach, Holistic Nursing Practice, 23 (2): 75–80 North Georgia (2011). Background of Theory Development. Retrieved September 18, 2014 from https://sites.google.com/a/northgeorgia.edu/middle-range-nursing-theorist-presentation/background-of-theory-development Orlando I. (1961). The dynamic nurse-patient relationship: function, process, and principles. New York: Putnam; 1961. Read More