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Running head: Nursing Theory Comparison

Nursing Theory Comparison Rough Draft

Vivian Ocampo

West Coast University

Dr. Kendrick

March 1, 2020
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NURSING THEORY COMPARISON ROUGH DRAFT
Introduction

According to McEwen and Wills, “the use of theory offers structure and organization

to nursing knowledge and provides a systematic means of collecting data to describe,

explain, and predict nursing practice” (McEwen & Wills, 2018, p. 25). The use of theory in

nursing has allowed for advancement in practice as well as a framework for research.

Theories can be separated into grand theories, middle range theories, and practice theories.

Grand nursing theories provide a conceptual framework and consist of abstract concepts that

are not operationally defined. In comparison to this, middle range theories involve less and

more concrete concepts that are operationally derived from grand theories.

Examples of these theories include the grand theory of Faye G. Abdellah: patient-

centered approaches to nursing, and the middle range theory by Katherine Kolcaba: Theory

of comfort. Most nursing theories like this correlate to the metaparadigm of nursing.

Kolcaba’s theory of comfort revolves around a holistic approach while ensuring that the

patient’s comfort needs are involved in their plan of care to achieve optimal health. In

contrast to this, Abdellah’s patient-centered approach to nursing is considered a human needs

theory that was created to assist with nursing education and practice. (McEwen & Wills,

2018). The following paper will analyze and explain the significance of both theories while

correlating them to the writers current nursing practice.

Background of Theories

Katherine Kolcaba’s Theory of Comfort was first published in 1994. Kolcaba earned

a nursing diploma from St. Luke’s Hospital School of Nursing. By continuing to practice as a

senior nurse in a dementia unit, she blended her clinical and academic experiences, and was

later appointed to a position as a lecturer at the University of Akron College of Nursing”

conducted a concept analysis which eventually led to the development of the theory of

comfort

Faye G. Abdellah was one of the first nursing theorist. As McEwen and Wills stated,

“Abdellah earned her bachelor’s degree in nursing, master’s degree, and doctorate from

Columbia University, and she completed additional graduate studies in science at Rutgers

University” (McEwen & Wills, 2014, p. 139). Abdellah served as a chief nurse officer and

deputy U.S Surgeon General.

Philosophical Underpinnings

Abdellah’s patient-centered approach is considered a human needs theory and was

developed based on her nursing practice. This theory changed the focus of nursing theories

from a disease-centered approach to a patient-centered approach and moved nursing practice

to include not only the patient but also their families (National Women's Hall of Fame ,

2020). Faye Abdellah’s perspective as nursing as a profession guided her practice and

ultimately influenced her theory to encompass the context of evidence and scientific premise.

Overall, Abdellah’s patient-centered approach was created to assist in nursing education and

practice. Due to this, “Abdellah’s early interests centered on the scientific basis of nursing

theory and practice, she clearly felt the lack of nursing research limited the potential of

nursing to meet the needs of patients” (Snowden, Donnell, & Duffy, 2014, pg.57).

According to Snowden et al., (2014) “Kolcaba’s vision, leadership and ingenuity has

resulted in a nursing theory that recognizes, focuses and provides a means of systematically

evaluating the importance of comfort to the meaningful and therapeutic nursing care of

patients” (Snowden, Donnell, & Duffy, 2014, pg.130). Kolcaba’s nursing experience with
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individuals with dementia significantly contributed to the development of her theory.

Kolcaba’s theory closely relates to Florence Nightingale’s with an emphasis on the comfort

of patients. Katherine Kolcaba’s concept analysis demonstrated that comfort was not new to

nursing but that it could be correlated to a holistic approach to nursing.

Major assumptions, concepts, and relationships

The Theory of Comfort involves the construction of three concepts involved with

comfort: relief, ease, and transcendence. Kolcaba believed that a patient’s stimulus situation

could cause negative tensions, but that by increasing comfort measures, negative tensions

could be decreased and positive increased. McEwen and Wills state, “Comfort is viewed as

an outcome of care that can promote or facilitate health-seeking behaviors. It is posited that

increasing comfort can enhance health-seeking behaviors” (McEwen & Wills, 2014, p. 230).

Some of the major concepts described in Kolcaba’s Theory of Comfort include comfort

measures, comfort, comfort measures, comfort needs, health-seeking behaviors, institutional

integrity, and intervening variables. The theory also includes eight propositions linked to

define the concepts such as “when interventions are delivered in a caring manner and are

effective, the outcome of enhanced comfort is attained” (McEwen & Wills, 2014, p. 238).

The delivery of these propositions is essential because it enables the nurturing and proactive

environment seeked by patients.

Faye Abdellah was one of the few writers who first used a “nursing diagnosis” during

a time when nurses were taught to not “diagnose” patients. Although in earlier work

Abdellah had no openly stated assumptions, her later work state that she had added six

assumptions to the theory (McEwen & Wills, 2014, p. 140). These assumptions included:

changes that affect nursing; development of nursing leaders from underserved groups;
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continuing education for professional nurses; the need to appreciate the interconnectedness

of social problems; and the impact of problems such as poverty on health care delivery.

Abdellah and her colleagues developed 21 nursing problems that elaborated on a

distinguished difference between nursing diagnoses and nursing functions. These patient-

centered approaches allow for nurses to thoroughly assess all aspects of the patient and

actively involve them in their plan of care.

Clinical Applications

Overall, Faye Abdellah was a strong advocate for improving the nursing profession

through research and education. Abdellah’s theory was “generated inductively though her

clinical experience and her research studies over a five-year period. At the point of

development, Abdellah’s framework was intended as a means of providing a clinical record

for learner nurses and to give a more robust framework to the curriculum of nurse education”

(Snowden, Donnell, & Duffy, 2014, pg. 61). This theory is mainly used for nursing

education but ultimately is used throughout all clinical practice. The initial aim was to have a

structure that the learner nurse could use to be record their knowledge and skills

development (Snowden, Donnell , & Duffy, 2014). In conjunction to this, Abdellah has also

published work on nursing, nursing research, and public policy related to nursing.

Kolcaba’s Theory of Comfort is adaptable to any health care setting or age group

(McEwen & Wills, 2014). The use of comfort in nursing can promote care that is holistic and

involves aspects such as physical, social, and environmental interventions. As McEwen and

Wills state, “Comfort Theory observes that patients experience needs for comfort in stressful

health care situations. Nurses can use a taxonomy system to identify the patient’s comfort

needs and then correlate this to design comfort measures for the patient.
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Application to Nursing Practice

The point of the patient-centered approach by Abdellah is to focus care on both the

patient and their family not just the individual’s diagnosis. The patient-centered approach

primarily focuses on the individual, addressing family and society as resources that could be

used to help patients achieve their health goals (Snowden, Donnell, & Duffy, 2014, pg. 84).

Nurses should thoroughly assess their patients, interconnect all the data involved with the

patient, and actively implement a plan of care that involves the patient and their family.

The comfort theory involves four contexts within which individuals experience the

three types of comfort (relief, ease, transcendence), which include physical, psychospiritual,

sociocultural and environmental. The use of these comfort experiences amongst patients

allows for the achievement of optimal health and recovery. In conjunction to this, as one of

the propositions of this theory states, “When patients and family members are given comfort

care and engage in health-seeking behaviors, they are more satisfied with health care and

have better health-related outcomes” (McEwen & Wills, 2014, p. 238).

Application to my practice

In my current nursing practice, I have been able to implement the theory of comfort in

the end-of-life patient care. According to an article in the Journal of Nursing Scholarship,

“Patients in institutionalized environments cope with a number of needs influencing their

comfort at their lives” (Kisvetrova, Vevodova, & Skoloudik, 2018). Nurses must react and

provide appropriate interventions for the needs of end-of-life patients in each dimension of

comfort care. This theory has been used to study the effects of end-of-life nursing education

on a nurse’s death anxiety, knowledge of the dying process, and related concerns (McEwen
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& Wills, 2014, p. 246). By consistently evaluating the comfort needs of the patient near end-

of-life, the family and the patient can cope more effectively.

In conjunction to this, the use of a patient-centered approach is used widely in all of

healthcare. This theory revolves around treating a person as a whole rather than just a

disease. In the hospital setting, physicians tend to care for patient’s based on their diagnosis

rather than overall needs. Abdellah’s 21 Nursing Problems are seen on a daily basis in the

health care setting and significantly impact nursing practice by conceptualizing the

profession.

Parsimony

Abdellah’s theory is of great complexity and focus, therefore it is not parsimonious.

According to McEwen and Wills, the model “touches on many factors in nursing but focuses

primarily on the perspective of nursing education. It defines nursing problems, 10 steps to

identifying client’s problems, and 10 nursing skills” (McEwen & Wills, 2014, p. 141).

The use of Kolcaba’s Theory of Comfort is universal and fairly simple. The

propositions of the theory are clear although it would be more apprehensible if it different

implication were to be applied.

Conclusion

The use of theories in nursing have allowed for a conceptual framework for research

and practice. Overall, both of these theories can be used in the nursing profession and go

hand in hand. The use of the theory of comfort is fairly simple and is an integral part of

nursing care. The purpose of this paper was to evaluate both theories and analyze their

significance to the nursing profession.

References

Kisvetrova, H., Vevodova, S., & Skoloudik, D. (2018, March). Comfort-Supporting Nursing

Activities for End-of-Life Patients in an Institutionalized Environment. Journal of

Nursing Scholarship, 50(2), 126-133.

Wolters Kluwer Health/Lippincott Williams & Wilkins.

National Women's Hall of Fame . (2020, February). Faye Glenn Abdellah. Retrieved from

National Women's Hall of Fame: https://www.womenofthehall.org/inductee/faye-glenn-

abdellah/

Snowden, A., Donnell , A., & Duffy, T. (2014). Pioneering Theories in Nursing . London.