A. Look for an example of middle-range theory. Evaluate it as to the following (Be sure to justify your answers):
1. Congruence with nursing standards.
2. Congruence with current nursing interventions or therapeutics.
3. Evidence of empirical setting, research support and validity.
4. Use by educators, nursing researches or nursing administrators.
5. Social relevance
6. Transcultural relevance
7. Contribution to nursing
8. Conclusions and recommendations.
The middle-range Theory of Comfort by Katharine Kolcaba described the concept of comfort as existing in three forms (relief, ease and transcendence) and its inter-relationship with four different contexts of experience (physical, psychospiritual, sociocultural and environmental). (Kolcaba, 2003)
In 2005, the Philippine Board of Nursing created the Committee on Core Competency Standards Development in collaboration with the Commission on Higher Education Technical Committee on Nursing Education with the primary goal to develop the competency standards for nursing practice in the country which will then serve as a unifying framework for nursing education, regulation and practice (http://bonphilippines.org, accessed March 30, 2012). Among the eleven key areas of responsibility for nursing practice, the domain of “quality and safe nursing care” includes promotion of safety and comfort where Kolcaba’s theory can be integrated. Comfort has always been included in nursing education, and Kathatine Kolcaba’s theory seems simple yet an effective one when caring for a patient. We all know the definition of comfort; what we do not know is the science and the concept behind it and it is good that one fellow nurse has developed a theory to guide us in giving comfort measures. Katharine Kolcaba has presented the different types and taxonomy of comfort and has correlated it with our unique function which involves the holistic approach.
The comfort theory was first used by Kolcaba in her study in the Guided Imagery (GI) audiotape for women with breast cancer going through conservative treatment (Radiation Therapy) and yielded positive results. Hogan-Miller (1995) also approached Kolcaba in using the comfort framework in her study on immobilization of post-angiography patients. Other settings in nursing practice where the comfort framework was used include the burn unit, gynecological examination, hospital ship, medical and surgical, midwifery, hospice, long-term care, infertility, acute care for elders, urinary incontinence, newborn nursery, emergency department, psychiatry and critical care. For each setting, the General Comfort Questionnaire, the primary tool for comfort measurement, was revised to address relevant concerns in other settings leading to the creation of more specific nursing comfort instruments. (Kolcalba, 2003 as cited in http://comfortcareinnursing.blogspot.com, accessed March 30, 2012)
The theory’s social and transcultural relevance is already imbedded/integrated within the taxonomic structure formulated by Kolcaba herself. It is considered expansively as two out of the four contexts of experience. Her views on holism have resulted in the need to cover these areas of concern, making the theory universally accepted and relevant.
The theory’s contribution to nursing couldn’t be ignored. The concept of comfort has always been present in this particular discipline since its inception more than a hundred years ago. However, due to Kolcaba’s efforts, the concept is now enjoying a much more defined and refined status – measurable, more operative and better understood. To put it in her husband’s own terms: “If your discipline is going to progress as a science, you must define your central terms precisely so you can understand each other and develop ways to conduct research about them. All disciplines must define their concepts. We have demonstrated that ‘comfort’ is used in many ways and has many meanings. Our work is an effort to build clarity about what you mean when you discuss and address patient’s comfort” (Quoted from Mr. Rey Kolcaba as cited in Comfort Theory and Practice by K. Kolcaba, 2003).
In summary, a review and analysis of the theory only cemented its importance in the field of discipline that is of nursing. It is at the same level to which ‘caring’ as a nursing value has long established its status. After tackling on this subject matter, I find it difficult not to stress its importance and the need for its integration in the practice.
B. Search the literature for example of published accounts of nursing theory evaluation or theory analysis. Give your comments.
BT Basavanthappa’s Nursing Theories (2007) identified and enumerated the most prominent nursing theories of our time, made analysis as well as evaluation on each of them. For the purpose of this activity, knowing that the most basic of all theories would obtain the most number of critiques by the sole nature of its primitiveness, I have chosen the nursing theory of Florence Nightingale. Nightingale’s theory contains three major relationships – environment to patient, nurse to environment, and nurse to patient. Nightingale viewed environment as the main factor acting on the patient to produce an illness state and regarded disease as “the reactions of kindly nature against the conditions we have placed ourselves”. The nurse as manipulator of environment and actor on the patient is described when Nightingale said nursing “ought to signify the proper use of fresh air, light, warmth, cleanliness, quiet and the proper selection and administration of diet – all at the least expense of vital power to the patient.”
Basavanthappa said that Nightingale attempted to provide general guidelines for all nurses of all times. (Basavanthappa, 2007) He further stated that while many of her specific directives are no longer applicable, the general concepts such as the relationships between the nurse, patient and environment are still persistent. He believes that her theory does not restrict its roles to a professional nurse but a nurse defined as a woman who at some time has charge of somebody’s health. He saw Nightingale’s view of humanity as somewhat consistent with her religious beliefs – doing the will of God which relegated the patient to a passive role.
He further criticized that there is a lack of patient involvement in the attainment of wellness. Some of Nightingale’s assertions have now fallen to misuse, others now reduced to becoming ludicrous. Her unshakable disdain for the germ theory of disease and adherence to dirt and dampness as pathogenic seems crude and less than progressive. Likewise, her emphasis on personal observation rather than formation of a unified body of nursing knowledge has now completely become irrelevant. In the end, it was the lack of specificity though that hindered the use of her ideas for the generation of nursing research. (Basavanthappa, 2007)
While Basavanthappa criticized Nightingale’s numerous attempts to describe and create structure on the discipline of nursing, he nevertheless praised and credited her for her contributions to the field even going beyond by stating that she was “brilliant and creative” and that she “gave nursing much food for thought” (Basavanthappa, 2007).
Basavanthappa was thoroughly knowledgeable of the subject at hand, an important criterion in order to be able to give an unbiased evaluation. He was objective and precise on the points of commendation as well as on the points of critique. He was clear with his use of the process of theory evaluation. He described it first, then analyzed before proceeding with the actual evaluation. He identified the gaps in the theory, identified its degree of usefulness with regards to current nursing practice and most importantly, he determined and acknowledged, in retrospect, the theory’s contribution to the scientific knowledge.
C. As you assess the current climate and structure of the health care system, what group of theories may provide frameworks for better quality care? Which group of theories may be complimentary to the needs of the patients in the 21st century? Dorothy Orem’s group of theories has been the most widely discussed and nationally and internationally used theories in nursing (Meleis, 2012). Furthermore, the original set of questions that prompted development of Orem’s self-care theory is very similar to most other theorists’ questions. To drive the point even more, Orem herself believed that “…self-care deficit theory in nursing will fit into any nursing situation because it is a general theory, that is, an explanation of what is common to all nursing situations, not just an example of an individual situation” (Orem, as cited by Meleis, 2012).
It is because of the sweeping, general, all-encompassing applications of Orem’s group of theories that has made it the theory of choice even with the current health care systems. It strives to update itself with every revision and with every new edition of her publication making sure that it stays relevant; keeping with the times, up-to-date with all the advancements and new discoveries both in the nursing field and in the development of nursing practice.