Introduction
Nursing practice is a multi-layered and complex field, with the professionals exhibiting a great degree of power and influence over the patient’s well-being. Yet despite the great degree of subjectivity and the close relationship with the medical theoretical basis, the nursing field operates under the umbrella of its own theoretical foundation. An example of the well-known components of said foundation would be Dorothea Orem’s Theory of Self-Care and Kolcaba’s Theory of Comfort. Dorothea Orem’s Theory of Self-Care is centered around the positive relationship between a patient’s involvement in their treatment and their successful and rapid recovery. Kolcaba’s Theory of Comfort is a mid-range theory that emphasizes the importance of comfort and safety as human needs which need to be reinforced in healthcare, since healthcare provides a basis for numerous stressful situations.
Background Information
Dorothea Orem’s Theory of Self-Care, known also as Self-Care Deficiency Nursing Theory, originated in response to the author’s intention to improve the quality of nursing care in her district. The theory recognizes the importance of self-care and personal autonomy in a medical care process the patients are subjected to. The model connects concepts in such a manner that it offers a new perspective on a particular phenomenon (Younas, 2017). The principle is straightforward, yet it may be applied to a wide range of patients. Nurses can use it to guide and enhance practice, but it must be compatible with other well-established theories, laws, and principles.
Kolcaba’s Theory of Comfort was established for health practice, education, and research in the 1990s. It is based on the idea of prioritizing a patient’s comfort in the medical care process, despite the evident stress factors such process entails. Comfort is an immediate desirable consequence of nursing care, according to the model, and should be viewed as a requirement. Katharine Kolcaba created the Theory of Comfort after doing a concept analysis of relevant literature in the fields of nursing, medicine, psychology, psychiatry, ergonomics, and English (Puchi & Paravic-Klijn, 2018). Following the introduction of the three types of comfort and the four contexts of holistic human experience, discussed in greater detail later in the paper, a taxonomic framework was developed. Its main objective was to help with the assessment, measurement, and evaluation of patient comfort.
Philosophical Underpinnings
Dorothea Orem’s theory is built on the philosophical foundations of agency, autonomy and free will. Philosophically speaking, an agent is an individual having the ability to act, and the term “agency” refers to the exercise or expression of such ability. The scholars have developed a standard notion and theory of action basing on the philosophy of action. The former defines intentionality in terms of mental states and events, whereas the latter explains intentionality in terms of causation by the agent’s mental states and events. Furthermore, true agency appears to be demonstrated even by beings incapable of deliberate action (Younas, 2017). It has been claimed that agency may and should be described without reference to causally efficacious mental states and events. Consecutively, regardless of the gravity of their condition, mental or physical, a patient remains an agent by the nature of being human. They are therefore entitled to be informed on the necessary information about their medical care to become capable of exercising said agency in practice.
Regarding the freedom of will, the current literary body on the medical philosophy and ethics often lacks the sufficient consideration for the fundamental debate around it. This question is not properly addressed in the scientific discussion of decision-making ability and its clinical assessment. It is said that while assessing decision-making ability, the concept of free will must be included. It should, for example, be considered as part of the evaluation criteria for decision-making competence, and thus ideologically ties in with the previous point in this section. To summarize, there is currently no philosophical consensus on whether every human being is capable to exercise free will, as well as on the full definition of the concept. Nevertheless, the idea of personal autonomy and ability to make one’s own decision are prized in the Western school of philosophical and ethical thought. And since ethics is inseparable from the nursing practice, one might assume that so, by definition, is free will.
Kolcaba’s theory is based on the concepts of comfort and safety, as well as the place these ideals hold within a person’s value system. The theory of subjectivity in philosophy assumes that the pursuit of comfort is an inescapable part of demand. In general, the theory emphasizes the degree of patient autonomy as the basis for a healthy functionate relationship between a nurse and a patient. If a patient has a level of control over their recovery from the beginning, their transition to the post-care life would occur much human condition (Aksoy & Pasinlioğlu, 2017). It manifests in people’s subjectivity; the inability to separate their immediate perception of reality from their perceptions and opinions on it. It is therefore within the nature of a person to follow the path of the least resistance if they may, to ensure their views are respected and acknowledged.
Hence, it is natural for patients to seek out the situations in which they are comfortable, including those that occur within their treatment process. A patient is naturally resistant to the situations of the absence of comfort and the presence of discomfort, which in practice shapes their perception on the healthcare quality. For a nursing practice to be assessed as effective and high quality it must, when at all possible, accommodate the patients’ needs in a way that satisfy their fundamental need for comfort. Other way of approaching the patient comfort might result in their reluctancy or refusal to collaborate with medical professionals, reducing the overall efficiency of the nursing care.
Major Assumptions, Concepts and Relationships
Dorothea Orem’s theory is rooted in the ideas of individual human value and the importance of will in medical practice. It is based on the assumption that every patient, regardless of the details and gravity of their condition, maintains the agency throughout the nursing care process applied to them. Within the theory, self-care is perceived as the practice of actions that an individual starts and undertakes on their own behalf to sustain life, health, and well-being. Age, developmental stage, experience, socio-cultural orientation, health, and accessible resources are all thought to influence self-care agency. Additionally, the theory admits that knowledge about the condition in question and relevant healthcare procedures is required for a patient to exhibit their personal agency in practice (Younas, 2017). A sum of self-care activities completed over a certain time period to fulfill self-care requisites is described as therapeutic self-care smoother.
Relief, ease, and transcendence are the three main types of comfort, according to Kolcaba, with each characterized by a unique set of traits. When a patient’s personal comfort needs are satisfied, the patient feels relieved and comforted by the services they received. A patient getting pain medicine in post-operative treatment, for example, is enjoying relieving comfort. Ease is concerned with comfort in a contented mood, such as reduction of anxiety in a patient. Transcendence is a condition of well-being in which patients are able to rise above their difficulties and might be the most difficult to achieve out of the three (Aksoy & Pasinlioğlu, 2017). The three types of comfort may and should co-exist, with each concerned with a particular plane of a patient’s well-being. Relief originates from the state of a specific need being met, ease characterizes the relieved emotional state and transcendence concerns the act of self-development and rising above the limitations.
Physical, psychospiritual, environmental, and sociocultural settings are the four contexts in which patient comfort might occur. Physical context concerns the direct biological processes of a patient’s body, its sensations, homoeostatic mechanisms, immune functions, endocrinology, etc. Psychospiritual concerns the internal awareness and the level of acceptance towards the post-care self, including esteem, identity, sexuality, and general sense of meaning or lack of thereof. Environmental concerns the external background of a patient’s experience, such as their relationships with sound, taste, visual imagery, and odor. Finally, sociocultural comfort context refers to the social and personal relationships with subjects and objects around the patient, their family members, healthcare personnel and colleagues.
Clinical Applications
Successful practice can be aided by providing patient care based on theoretical ideas. In the ambulatory surgical environment, Orem’s Self-Care Nursing Theory provides guidance for the practitioner. The nurse helps clients in this paradigm by serving as their advocate, teaching, leading, supporting, and creating a developing environment. From providing comprehensive care to educating the patient and family, there are several levels of care. Several clinical sub-sets of the medical care field, such as ambulatory medical care, are dedicated to the promotion of self-care as early as possible. As a result, self-care deficiencies caused by surgery and anesthesia are recongized as essential to address, to facilitate a patient’s dischargement from the ambulatory environment. It can therefore be assumed that the Self-Care theory has found its way in the evolution of the nursing science testability. It has done so by promoting and facilitating healthier relationships between the patients, their conditions and medical personnel involved.
The theory of comfort has been questioned at some medical and clinical circles as redundant and insufficiently based in science. However, the research has demonstrated its direct relevance to certain forms of clinical patient care, which are described in greater detail in the next section of the paper. Nevertheless, it is difficult to deny the Comfort Theory’s contribution to the measurability of nursing effectiveness. Unlike most other studies in the field, it is not compromised by the nature of self-reported results from the patients, but rather operates on them entirely. A patient’s ability to objectively evaluate their capacity to function independently and take care of themselves might be questioned, but they are fully capable of relating their level of comfort during healthcare.
Applications to Nursing Practice
For a certain subset of patients, there comes a breaking point after which they do not perceive themselves as capable of exercising self-care. In such conditions, a person is uninterested in looking after themselves, often due to the very nature of their diagnosis. This renders the person completely or partially reliant on the caregiver. A similar scenario occurred in a clinical environment, when Orem’s theory was completely implemented, resulting in good improvements in an individual’s health and assisting the patient in accepting reality and taking responsibility for his own health and problems. The value of this theory is to take care of the patient at correct time with appropriate decision so patient can recovery rapidly with a decreased hospital stay (Ali, 2018). It is particularly applicable in the setting of psychiatric care due to the social stigma complicating the natural independent recovery process and the tense bonds forming between patients and medical profesisonals.
Kolcaba’s Comfort Theory is easily adaptable to cardiac patients, with particular comfort requirements that are common among them being simple to include into a nursing practice. The items in the table may also vary during the course of a patient’s hospital stay since comfort is a dynamic and ever-changing condition. Nurses may utilize their ideas and practice to help drive research towards patient-centered comfort treatments. Nightingale’s theories lay a solid foundation for taking into account all aspects of the patient and surroundings that affect comfort. In terms of evaluation and action, Kolcaba’s middle range theory offers a taxonomy of elements to examine. Additional insights into what constitutes comfort care come from nurses’ practical experiences and anecdotal evidence. These tools, in combination with clinical research, can assist hospitals and nurses in developing successful strategies for improving patient comfort and facilitating healing. If patients feel comfortable, they will be happier with the treatment they get, and both the nurses and the institution will gain.
Applications to My Practice
Furthermore, both of the theories can be successfully applied to the clinical vaccination setting to achieve an increase in the efficiency of the medical care provided. Obama’s Self-Care theory might influence the individual’s behaviors between receiving several doses of the COVID-19 vaccine. As the guidelines of the public health demand, a patient is not considered to be fully vaccinated before receiving two shots of the vaccine, and thus have to continue perceive themselves as risk group members. As with the theory assumptions, this level of awareness and agency is achieved by informing the patients in detail on the virus, the vaccination process and their in navigating the situation.
The Comfort theory, in turn, is perpetuated within the vaccination clinics on a lesser scale, as is fitting for the theory being a mid-range one. The vaccination process is by definition an uncomfortable, but an essential one, and the nursing professionals ensure they are being as accommodating as possible towards the patients. The vaccination-themed badges, water bottles and, occasionally, portions of sweet snacks are made available to the patients after the vaccination to put them at ease.
Parsimony & Conclusion
Despite the difference in scale and philosophical basis, both of the theories are relatively easy to understand, as they align with the generally well-known principles of the medical practice. The first theory is rooted in ethics and the navigation of autonomy, agency and freedom of will in a complicated and structurally uneven yet entirely functionate relationship between a nurse and a patient. The second is from the very start rooted in practice and emphasizes the importance of a subjective patient comfort aspect, that is often overlooked otherwise. In conclusion, both theories present a valuable contribution to the medical practice and the vaccination setting in particular.
References
Aksoy Derya, Y., & Pasinlioğlu, T. (2017). The effect of nursing care based on comfort theory on women’s postpartum comfort levels after caesarean sections. International journal of nursing knowledge, 28(3), 138-144. Web.
Ali, B. H. I. (2018). Application of Orem self care deficit theory on psychiatric patient. Annals of Nursing and Practice, 5(1), 1-3. Web.
Puchi, C., Paravic-Klijn, T., & Salazar, A. (2018). The comfort theory as a theoretical framework applied to a clinical case of hospital at home. Holistic nursing practice, 32(5), 228-239.
Younas, A. (2017). A foundational analysis of dorothea orem’s self-care theory and evaluation of its significance for nursing practice and research. Creative Nursing, 23(1), 13-23.