Nursing science includes not only clinical practice but also ongoing research aimed at creating theories to improve patient outcomes and provide higher quality care. A central theme in nursing practice is also the development of principles of holistic care, which addresses not only the health problems of patients but also takes into account other factors that affect their well-being. Betty Neuman is one of the most important nursing theorists who have contributed to the development of the profession. Her system model focuses on identifying stressors and developing an intervention plan to address them. While Neuman’s grand theory represents a comprehensive nursing practice model, the Comfort theory developed by Katherine Kolcaba represents a paradigm for creating a comfortable environment for patients by meeting their needs. Both theories focus on extraneous factors that nurses need to consider in order to improve the quality of care and implement a more holistic approach.
Neuman’s theory is a system of nursing theory and practice in which the patient is viewed as an integrated system. The stability of this system depends on the interaction of environmental factors while maintaining stability consists in addressing stressors of different origins. Interventions to eliminate stressful environments are a priority for nurses to create comfortable conditions for care. Kolcaba’s theory focuses directly on enhancing patient comfort in four different areas, which consists of identifying and meeting different types of needs. In particular, the theory also considers the patient as an integral system, the health-seeking behavior of which is formed depending on the level of his satisfaction with external conditions.
Background of the Theories
For a detailed study of theories, it is also necessary to consider the background and the prerequisites for their development. Betty Neuman was born in 1924 and received a nursing diploma from the People’s Hospital School of Nursing (McEwen & Wills, 2019). She later received her bachelor’s degree in psychology and public health. In 1966 Neuman also earned a master’s degree in “mental health and public health consultation” (McEwen & Wills, 2019, p. 157). Finally, in 1985 she also earned a doctorate degree in clinical psychology (McEwen & Wills, 2019). During her long career, Neuman acted as “a nurse, educator, health counselor, therapist, author, speaker, and researcher” (Gonzalo, 2021, para. 12). She is also an honorary member of the American Academy of Nursing. An extensive clinical experience has enabled Neuman to excel in educational and theoretical nursing practice.
Katherine Kolcaba is a more modern nursing theorist whose theory continues to be updated. Kolcaba was born in 1944 and is a specialist in gerontology, which influenced the formation of her theory (Katharine Kolcaba’s comfort theory, n.d). In 1965 she earned her diploma in nursing from St. Luke’s Hospital School of Nursing (Katharine Kolcaba’s comfort theory, n.d). By 1997, Kolcaba had already received a doctorate degree, as well as a “certificate of authority clinical nursing specialist” (Katharine Kolcaba’s comfort theory, n.d, para. 1). She currently continues to specialize in long-term care, gerontology, nursing theory, and research.
When creating a theoretical system, Neuman used knowledge from various areas of practice. In particular, she used stress, adaptation, and Gelstat theories as a theoretical basis for the development (Badenli & Duman, 2017). In more detail, Neuman drew on Selye’s work on stress and Lazarus on coping strategies (McEwen & Wills, 2019). In addition, the system developed by Neuman is comprehensive and holistic; therefore, to create it, it was also necessary to study the principles of systems construction. Thus, the theorist used the work of Chardin and Cornu, as well as von Bertalanffy and Lazlo, to study the integrity of systems and general systems theory (McEwen & Wills, 2019). Therefore, the philosophical basis of the theory was the concept of the “nature of living organisms as open systems in interaction with each other and with the environment” (Ahmadi & Sadeghi, 2017, p. 2). Within the framework of Neuman’s theory, systems consist of separate parts, the interaction of which ensures its integrity.
As the concept of stress, comfort has long been a subject of study in nursing science. In the process of developing her theory, Kolcaba, as Neuman, using knowledge from several fields, including nursing, medicine, psychology, psychiatry, ergonomics, and English. Additionally, the study of comfort was part of the research goals of the founder of nursing science, Florence Nightingale. Achieving comfort is seen as a fundamental challenge in nursing practice (Kolcaba, 2018). It may also be noted that Kolcaba’s theory also addresses consistency and is based on systems theory. In particular, this refers to the fact that achieving comfort can affect other aspects of human functioning.
Major Assumptions, Concepts, and Relationships
The basis of Neuman’s theory is the consideration of the patient as a system of interacting aspects. In particular, human being represents a “composite of five interacting variable areas……. physiological, psychological, sociocultural, developmental, and spiritual” (as cited in McEwen & Wills, 2019, p. 157). Each variable is responsible for different areas of human functioning. Physiological refers to the body, psychological refers to mental processes, sociocultural refers to the influence of social and cultural factors, developmental refers to age-related changes, and spiritual refers to spiritual beliefs (Ahmadi & Sadeghi, 2017). All presented variables, in turn, interact with the environment, which consists of three areas: internal, external, and created (McEwen & Wills, 2019). Each aspect of the external environment influences how the patient adapts to stress. The concept of health within the framework of the theory is also of key importance, as it refers to the patient’s stable system and his maximum well-being at a certain point (as cited in McEwen & Wills, 2019). Thus, the goal of nursing practice is to achieve stability of a person’s system for optimal response to stressors of the environment.
Within the framework of the system, there are also other concepts that are important for understanding the principles of its functioning. First of all, illness is defined as the opposite of health and “represents a state of instability and energy depletion” (Ahmadi & Sadeghi, 2017, p. 2). Each human organism, in turn, has a nucleus, which consists of basic mechanisms. Such a core is protected by lines of defense, which can be external or internal. The outer lines of defense are flexible and respond to environmental stressors, while the inner ones are stable (Ahmadi & Sadeghi, 2017). Stressors can be of an intrapersonal, interpersonal, and extrapersonal nature, which determines how patients adapt to them. The stability of a system depends on the ratios of five variables, which can both maintain and disrupt the stability of the system.
In line with the concepts presented, Neuman defines a three-step process that enables nurses to cope with the stressors faced by patients. Nursing diagnosis involves the collection of relevant and comprehensive data for variable analysis. Nursing goals are determined through negotiations with the patient to identify perceptions and attitudes. Nursing outcomes include the evolution of perspective changes or adjustments to nursing goals (Ahmadi & Sadeghi, 2017). Neuman also defines three levels of intervention, primary, secondary, and tertiary, which occur at different stages of stressor management (Ahmadi & Sadeghi, 2017). Thus, the system is considered as the interaction of components and their combination in response to environmental factors.
The core concept of Kolcaba’s theory is comfort within nursing practice. She defines it as “the satisfaction (actively, passively, or cooperatively) of the basic human needs for relief, ease, or transcendence arising from health care situations that are stressful” (as cited in McEwen & Wills, 2019, p. 232). At the same time, achieving comfort is an immediate and desirable outcome of nursing practice (Lima et al., 2016). In turn, the state of comfort also depends on several variables in the context in which it exists. Physical variables include the patient’s body and the processes taking place in it. Psychospiritual aspects relate to external self-perception, self-esteem, and spiritual values. Environmental variables will include external factors that a person can perceive through sensory channels. Sociocultural refers to the relationship between a person, his family, and society, as well as traditions and religious practices (Kolcaba, 2018). Each of the described variables affects the presence of certain needs in a person, the satisfaction of which leads to the achievement of comfort.
The nursing practice consists of identifying these needs and identifying the tools to meet them. The challenge for nurses is to combine the appropriate interventions to address the needs of the patient. Collaboration of nurses, patients, and their families is also required in the process of developing the necessary action plan to evaluate all variables (Lima et al., 2016). Achieving comfort provides all participants with the opportunity to be involved in health-seeking behaviors that address healthcare-related needs (McEwen & Wills, 2019). In turn, satisfaction with the quality of the services provided will allow a medical institution to raise its level in the public consciousness and ensure its prosperity (McEwen & Wills, 2019). Thus, by addressing the primary needs of patients in the four groups of variables, it is possible to provide better quality care and improve overall healthcare.
Neuman’s theory is widely used in both nursing education and practice. In particular, this theory is often used as a standard of practice in many areas of healthcare (McEwen & Wills, 2019). In particular, the theory in the clinical setting can be applied to directly provide greater patient satisfaction with care. For example, a study by Sultan (2018) demonstrated that the use of Neuman’s System enabled interventions to be identified and significantly reduced patient stress levels. The study by Ahmadi and Sadeghi (2017) also illustrates that applying the model allows nurses to classify the types of stressors that can be minimized by different interventions. The contribution of the model to the development of nursing science is also important, within the framework of which the patient began to be considered as an integral system, which is influenced by many factors (McEwen & Wills, 2019). This theory is useful not only in therapy but also in public health work, as it views prevention as an intervention. Thus, the theory allows not only to improve the quality of care by working with stressors but also to expand the nurses’ understanding of holistic healthcare practices.
Kolcaba’s theory also focuses on managing stressful environments to improve patients’ outcomes. Within this theory, nurses also identify the needs of patients in order to undertake appropriate interventions (McEwen & Wills, 2019). As Neuman’s theory, this system provides an opportunity for nurses to expand their understanding of holistic care (McEwen & Wills, 2019). Research by Lima et al. (2016) shows that applying theory to a clinical setting allows the patient to experience “comfort as the immediate result” (p. 4). Nurses identify a person’s needs and apply the necessary interventions to meet them, which increases satisfaction. Additionally, after the elimination of discomfort factors, nurses and patients “agree on the health-seeking behaviors that are desirable and real” (Lima, 2016, p. 4). Thus, the application of the theory to the clinical setting allows for better patient outcomes and also contributes to nursing science by expanding the concept of holistic care.
Application to My Practice
In my practice, both theories can be applied to provide better quality care. In particular, Neuman’s System minimizes the impact of negative stressors to improve patient satisfaction. As a nurse, I can identify aspects that need intervention and invite the patient to address them. For example, I can help patients with a high level of religious need to organize regular spiritual practices that will make them feel more comfortable in the healthcare setting. Another example would be promoting community involvement in prevention programs, as often groups of people, including ethnic minorities, have less access to healthcare. Neuman’s theory can be applied to expand the access of such groups to health services and increase their comfort in interacting with the system through the assessment of sociocultural stressors.
Kolcaba’s theory has a similar application as it also improves patient comfort. As part of my practice, I can analyze the discomfort factors of patients and develop intervention plans. For example, I can make the patient’s environment more comfortable by providing additional warmers in cold weather. These interventions will help stimulate health-seeking behavior and improve cooperation between the patient and me. Another example would be greater interaction with the patient’s family to increase social comfort and minimize feelings of loneliness in the healthcare setting.
Neuman’s theory includes many concepts that interact with each other and lead to different outcomes. This factor makes this system quite complex both to understand and to apply (McEwen & Wills, 2019). However, various graphical representations, including diagrams and tables, can help in describing the theory. Meanwhile, the complexity of this theory is directly related to the positive outcomes that its application can provide, as well as the high level of results of its utilization.
Kolcaba’s theory includes relatively fewer concepts and assumes the identity of a limited number of relationships between them. Thus, this theory is simple enough to understand and apply. At the same time, it requires a high level of analytical skills to identify discomfort factors and develop strategies to minimize them but does not suggest specific steps. Thus, the theory is less elaborate and more general than Neuman’s, which reduces its level of complexity.
The Neuman System Model and the Comfort theory offer nurses the opportunity to theorize and integrate holistic care into practice. Both theories focus on making the patient more comfortable in healthcare. Neuman’s theory is a complete system of nursing science, while Kolcaba’s theory offers more of a standard of practice. However, they can be used together to create more patient-centered care and achieve better patient outcomes.
Ahmadi, Z., & Sadeghi, T. (2017). Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal Experimental, Translational and Clinical, 3(3), 1-8. Web.
Bademli, K., & Duman, Z. (2017). Conceptual framework for nurses in the use of the Neuman Systems Model on caregivers of people suffering by schizophrenia. International Archives of Nursing and Health Care, 3(3), 1-5. Web.
Gonzalo, A. (2021). Betty Neuman: Neuman Systems Model. Nerseslabs. Web.
Katharine Kolcaba’s comfort theory. (n.d). Psych-Mental Health NP. Web.
Kolcaba, K. (2018). Kolcaba’s comfort theory. Nursology. Web.
Lima, J., Guedes, M., De Silva, L., Freitas, M., & Fialho, A. (2016). Usefulness of the comfort theory in the clinical nursing care of new mothers: Critical analysis. Revista Gaúcha de Enfermagem, 37(4), 1-5. Web.
McEwan, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.
Sultan, B. (2018). Application of Betty Neuman theory in care of stroke patient. Annals of Nursing and Practice, 5(1), 1-4.