Nursing Theory in Practice: Comfort Versus Self Care Perspectives

1. Nursing Theory in Practice: Comfort Versus Self Care Perspectives Trudi McIsaac, 3399005 Athabasca University

2. objectives • Describe Kolcaba’s Comfort Theory. • Describe Orem’s Theory of Self Care. • Discuss comparisons between Kolcaba and Orem in regards to a patient scenario. • Contrast Kolcaba and Orem’s theories in reference to a patient scenario. • Discuss the implications these theories have on nursing practice.

3. Kolcaba’s comfort theory • Katherine Kolcaba (2003) first developed her Comfort Care Theory in the 1990’s. • It was based as a middle range theory meant to help guide health practice, education and research (Kolcaba, 2011). • Her goal was to place comfort as the forefront of health care and focus on comfort to help patient’s meet their health needs while improving patient outcomes (Bergstrom, Hakansson, Stromberg & Bjersa, 2018; HARVEY & Kovalesky 2018; Kolcaba, 2011; Krinsky, Murillo & Johnson 2014; Samonte & Vallente, 2018).  • Comfort theory was to be used to prioritize patient comfort based on the assessment of nurses (Samonte & Vallente, 2018; Karabulut, Aktas, Gurcayir, Yilmaz & Gokmen, 2015). • It is based on three stages of comfort described as relief, ease and transcendence (Kolcaba, 2011). These stages of comfort are achieved through the use of four contexts, and main concepts of Kolcaba’s theory. 

4. Kolcaba stages of comfort • Relief addresses patient comfort (e.g.. Pain alleviated through the use of analgesia) and is achieved through alleviation of symptoms (Kolcaba, 2011; Samonte & Vallente, 2018). • Ease is achieved through contentment felt by the patient (e.g.. The alleviation of anxiety caused by uncertainty and illness) and is addressed by the nurses as they discuss issues being experienced by the patient (Kolcaba, 2011; Samonte & Vallente, 2018). • Transcendence is achieved by the patient being able to rise above the challenges they face and defined by how they cope with their illness (Bergstrom et al. 2018; Kolcaba, 2011; Samonte & Vallente, 2018).

5. Kolcaba continued…

6. Dorothea orem: Theory of Self CAre • Dorothea Orem (1995) first developed her Theory of Self Care in 1971, but further developed her theory in 1980, 1995 and finalized it in 2001. • Her theory focuses on patients having the ability to be self reliant and responsible for the care of themselves and their families. According to Orem (1995), people are distinct individuals, and nurses should seek to successfully meet universal and development self-care requisites as they are an important component of primary care prevention and ill health ((Denyes, Orem & SozWiss, 2001; Dorothea Orem’s Self-Care Theory, 2012; Mohammadpour, Sharghi, Khosravan, Alami & Akhond, 2015). • A person’s knowledge of potential health problems is necessary for promoting self-care behaviors. Self care and dependent care are behaviors learned within a socio-cultural context (Denyes et al. 2001; Dorothea Orem’s Self-Care Theory, 2012). • The goal for the nurse interaction is to select actions that help their patients and their families maintain or change conditions in themselves or their environments (Felipe, Araujo & Vitor,2014; Denyes et al. 2001). This is encompassed through the patient’s perspective of their health condition, the physician’s perspective, and the nursing perspective (Dorothea Orem’s Self-Care Theory, 2012).

7. Orem: theory of Self-Care continued…

8. Orem: Theory of self-care – Deficit and process

9. scenario

10. comparison

11. contrast

12. Contrast continued

13. summary • Both of these theories focus on the nurse-patient relationship and how they can improve this relationship in order to improve patient outcomes. • Both theorists use their perspectives to provide a better overall picture of the patient’s health and how the nurse can use this in practice to improve their patient’s hospital stays and overall outcomes. Both theorists would look to alleviate pain and suffering of cardiac patients, such as the patient in the scenario. • By using their theories in order to reduce pain, manage symptoms of their disease, and maintain their feelings of health and wellness both in hospital and at home.

14. Implications for nursing practice • Proficient nursing assessment should be used to gain a better perspective regarding patient’s needs. • By using Kolcaba’s (2003) theory, nurses will be better able to recognize patient’s pain and discomfort and the actions they can take to alleviate it. This also teaches patient’s signs and symptoms to look for in order to have a better experience while in hospital. These interventions also are able to transcribe well after discharge. • Orem’s (1995) theory allows nurses to empower their patients by giving them better access to information and resources while enabling them to become more independent. This improves patient’s outcomes by giving them autonomy and the skills to manage their health conditions at home.

15. Both of these theorists focus on the nurse-patient relationship and how they can improve this relationship in order to improve patient outcomes. • Kolcaba (2003) and Orem’s (1995) theories work to improve patient’s wellbeing on a long term scale, and for the focus of cardiac patient’s, this would lead to better quality of life, and improved hospital experiences and reduced readmissions.

16. Questions? • If you have any questions or any information you would like to add to this presentation please feel free to contact me at: • tmcisaac1@athabasca.edu

17. references • Bergstrom, A., Hakansson, A., Stromberg, M. W., Bjersa, K. (2018). Comfort theory in practice – Nurse anesthetists’ comfort measures and interventions in a preoperative context. Journal of PeriAnesthesia Nurses, 33, 162-171. doi: 10.1016/j.jopan.2016.07.004 • Delatorra, P. G. & Chaves, S. P. (2013). Educational technology for the hospital discharge of the elderly subjects undergoing percutaneous transluminal coronary angioplasty. Journal of Nursing UFPE, 7, 5040-5043. doi: 10.5205/reuol.4700-39563-1-ED.0707esp201330 • Denyes, M. J., Orem, D. E. & SozWiss, G. B. (2001). Self-care: A foundational science. Nursing Science Quarterly, 14, 48-54. Retrieved from: https://journals.sagepub.com/home/nsq • Dorothea Orem’s Self-Care Theory. (2012). In Nursing theories: A companion to nursing theories and models. Retrieved from: http://currentnursing.com/nursing_theory/self_care _deficit _theory. html • Felipe, L. C., Araujo, A. R. A. & Vitor, A. F. (2014). Nursing process according the model of self-care in a cardiac bedridden patient. Journal of Research Fundamental Care Online, 6, 897-908. doi: 10.9789/2175-5361.2014v6n3p897 • Harvey, K. A. & Kovalesky, A. (2018). Post-operative pain and comfort in children after heart surgery: A comparison of nurses and families pre-operative expectations. Journal of Pediatric Nursing, 43, 9-15. doi: 10.1016/j.pedn.2018.07.014 • Karabulut, N., Aktas, Y. Y., Gurcayir, D., Yilmaz, D. & Gokmen, V. (2015). Patient satisfaction with their pain management and comfort level after open heart surgery. Australian Journal of Advanced Nursing, 23, 16-24. Retrieved from: http://www.ajan.com.a

18. references • Krinsky, R., Murillo, I. & Johnson, J. (2014). A practical application of Katharine Kolcaba’s comfort theory to cardiac patients. Applied Nursing Research, 27, 147-159. doi: 10.1016/j.apnr.2014.02.004 • Kolcaba, K. (2003). Comfort theory and practice: a vision for holistic health care and research. Springer Publishing Company, New York • Kolcaba, K. (2011). Comfort theory. Nursing theories: A companion to nursing theories and models. Retrieved from: http://currentnursing.com/nursing_theory/comfort_theory_ Kathy_Kolcaba.html • Noguchi-Watanabe, M., Yamamoto-Mitani, N., Arimoto, A. & Murashima, S. (2017). Relationship between patient group participation and self-care agency among patients with a history of cardiac surgery: A cross-sectional study. Heart & Lung, 46, 280-286. doi:10.1016/j.hrtlng.2017.04.006 • Mohammadpour, A., Sharghi, N. R., Khosravan, S., Alami, A. & Akhond, M. (2015). The effect of a supportive educational intervention developed based on the Orem’s self-care theory on the self-care ability of patients with myocardial infarction: A randomised controlled trial. Journal of Clinical Nursing, 24, 1686-1692. doi: 10.1111/jocn.12775 • Orem, D. E. (1995). Nursing: Concepts of practice (5th ed.). St. Louis, MO: C. V. Mosby. • Samonte, P. R. V. & Vallente, R. U. (2018). Comfort theory (nursing). Salem Press Encyclopedia of Health. Retrieved from: https://www.salempress.com • Williams, S. & Ramos, M. C. (1993). Mitral valve prolapse and its effects: A programme of inquiry within Orem’s self-care deficit theory of nursing. Journal of Advance Nursing, 18, 742-751. Retrieved from: https://www.wiley.com/enus/Journal+of+Advanced +Nursing- p- 9780JRNL61470