The Comparison Between Dorothea Orems Self-Care Deficit Nursing Theory and Kolcabas Theory of Comfort Essay

The Comparison Between Dorothea Orems Self-Care Deficit Nursing Theory and Kolcabas Theory of Comfort Essay

Theory Comparison Paper

The paper aims to compare a grand and middle-range theory. The chosen grand theory is Dorothea Orem’s Self-Care Deficit Nursing Theory and Kolcaba’s Theory of Comfort. Therefore, the main aim is to discuss, review and compare these theories.

Dorothea Orem’s self-care deficit nursing theory explains how nurses should intervene when helping their patients to maintain autonomy. The theory is a grand nursing theory that has a broad scope that comprises general concepts applicable in any nursing instance. Hence, from the theory’s perspective, nursing should be defined as the assistance provided to the patient population to provide and manage their self-care to enhance their human functioning away from the hospital (Tanaka, 2021). The theory adopts an individualized form that helps these patients to engage in self-care, which means that individual patients can initiate and perform various activities by themselves to maintain their well-being, health, and life. Hence, for adults, nursing requirements arise when they cannot maintain self-care continuously, thus needing assistance in sustaining health and life to recover from an injury or a disease and cope with these prevailing conditions’ effects. However, nursing intervention comes along for the children when their guardians or parents cannot maintain their therapeutic care continuously. Hence, the Orem theory’s scope is broad as it focuses on patients’ general self-care deficit during nursing practice The Comparison Between Dorothea Orems Self-Care Deficit Nursing Theory and Kolcabas Theory of Comfort Essay.

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The theory of Comfort, a middle-range theory, was developed in the 1990s by Kolcaba. The theory applies to healthcare research, practice, and education and can provide Comfort within the healthcare setting. From the theory’s perspective, Comfort is a factor that nursing care aims as a desirable outcome. The theory came about after Katharine Kolcaba analyzed the comfort concept, which involved various disciplines like medicine, nursing, psychiatry, psychology, English, and ergonomics. From the results obtained, Kolcaba concluded that Comfort is only achieved after engaging in a holistic nursing approach that involves transcendence, ease, and relief. The theory mainly addresses Comfort that patients, their families, healthcare organizations, and the community experience during healthcare practices.

The Selected Theories Background

Dorothea Orem was a daughter to a constructor and a stay-at-home mother and was born in 1914 as the last born. Orem’s entire career has been involved in theory development. Dorothea graduated in 1934 from Washington DC’s Providence Hospital School of Nursing and later graduated in 1945 with a nursing education degree (McEwan & Wills, 2021). Due to her hard work, Dorothea has been awarded numerous honorary degrees. Orem would go for highly valued nursing positions such as dictatorship in nursing departments and nursing schools when filling job positions. Her job also engaged in teaching nursing and biological sciences from 1939 to 1941 (McEwan & Wills, 2021). She was also employed in the United States health department, where she was assigned the role of a Practical Nurse Section curriculum consultant from 1958 to 1960. However, in 1960, she was part of the Local Program for Practical Nurse Exam modification, among other areas that engage with nursing practice. In the nursing field, Orem was one of the most influential thinkers who worked to ensure that she provided her expertise in nursing to enhance nursing practice until her demise in 2007. The theory that boosted Orem’s perspective in nursing is the theory of self-care deficit that she developed in 1971, which is still embraced in nursing schools today (McEwan & Wills, 2021). Despite Orem’s theory being a grand theory, the theory’s perspective is essential since it helps shape the nurses’ holistic approach toward their patients. Hence, Orem’s theory helps the nurses to determine the kind of patient care they need to involve within a given condition that the patient has since it emphasizes the need for the patients to maintain an autonomous state in the self-care processes. That is because Orem feels that the best way for a patient to recover is when they participate in maintaining independence over the patient’s self-care. The theory has been incorporated in Doctor of Nursing Practice programs. Also, it is important to note that the Orem International Society continues to keep its advocacy and research legacy despite being founded in 1991.

Katharine Kolcaba was born in 1944 in Cleveland, Ohio. In 1965, Kolcaba attained a nursing diploma from a college known as St. Luke’s Hospital School of Nursing and later graduated in 1987 from the Case Western Reserve’s Frances Payne Bolton School of Nursing. As she continued to advance in her education, Kolcaba attained her Ph.D. in Nursing in 1997 and received Clinical Nursing Specialist certification (McEwan & Wills, 2021). Kolcaba mainly specialized in comfort studies, nursing theory, gerontology, instrument development, long-term care, end-of-life interventions, and nursing research. Due to her commendable work in nursing practice, Kolcaba has received numerous awards, the recent one being the Researcher of the Year in 2006 at the Sigma Theta Tau Chapter. After retiring, Kolcaba has focused on engaging the Sigma Theta Tau, Honor Society of Nursing, and American Nurses Association as a volunteer. Among her publications is the comfort theory as a nursing theory is a middle-range theory that was developed in the 1990s. From the theory, Kolcaba explains that patient Comfort exists in three forms: transcendence, ease, and relief. The theory is therefore relevant in nursing practice since it enables nurses to critically assess their patient’s comfort preferences and needs which is also essential when creating the care patients’ care plan to ensure that they meet these needs. That means when the nurses notice a slight change in patients needs they should also ensure that their preferences change.

Philosophical Underpinnings

Dorothea Orem’s theory bases its premise on the ability of human beings to adapt to their environment, making them more independent when managing and rehabilitating healthcare conditions, especially chronic ones. Hence, Orem’s philosophy is that patients wish to care for themselves, meaning there is a high possibility of them recovering when they become dedicated to participating in their health interventions (Tanaka, 2021). Hence, from a reader’s point of view, Orem’s theory proves that nursing is a special ability to provide care to patients, guiding them to achieve effectiveness and autonomy when caring for themselves. Such actions are essential since they help the nurses ensure that they correspond with the nursing care philosophy that aims at achieving optimal health care services that are patient-centered.

Kolcaba’s theory is grounded by the fact that human beings easily respond to stimuli despite the stimuli’ complexity as wholes. The whole response is perceived to be greater than an assessment of different responses separately and later evaluating the effects of such stimuli. That means Kolcaba’s perspective is based on the fact that a patient’s needs result from a situation that may create various stimuli, especially negative tension (Puchi et al., 2018). Hence, once the healthcare providers recognize the prevailing negative tension, they should always focus on the best ways to intervene to present positive outcomes by reducing the tensions. That is because once a patient experiences Comfort, it becomes easy to improve their health-seeking behaviors.

Major Assumptions, Concepts, and Relationships

Orem’s theory was subjected to changes meant to fit within the nursing system and individualistic concept. However, the initial theory is still intact. The main assumptions are that individuals should strive toward being self-reliant and responsible for their health care and the well-being of others in their families. Also, the theory presents patients as being unique, thus needing individualistic care approach, thus projecting nursing as an activity that requires effective interaction between different people. In that case, it is essential to ensure that self-care developmental and universal requisites are attained as crucial ill health and primary care prevention component (McEwan &Willis, 2021). That is because a patient can acquire a better way to address their prevailing health conditions by understanding their current health issues and the potential implications that these issues can have in their lives. That is because such understanding will help these patients develop appropriate self-care behaviors. It is also important to note that the theory assumes that dependent care and self-care are part of the practices that individuals learn within the socio-cultural context. Hence, Orem presents nursing as a combination of different disciplines, including art, technology, and service, while health is more of a state that represents whole or sound functionality and structurally with the environment representing the conditions, elements, and factors. The human concepts represent children, men, and women to represent a single societal unit and act as the material objects for healthcare providers. The nursing definition can refer to the deficit of developmental, universal, and other health-related issues. Such a position makes self-care more of the activities and practices to help individuals maintain their life and overall well-being The Comparison Between Dorothea Orems Self-Care Deficit Nursing Theory and Kolcabas Theory of Comfort Essay.

The key concepts that outline Kolcaba’s theory include the aspect of Comfort and holism. However, to understand the concepts outlined by Kolcaba’s theory, it is important to understand Comfort, comfort measures, comfort care, health-seeking behaviors, comfort needs, intervening variables, and institutional integrity (Puchi et al., 2018). Hence, the main assumption Kolcaba’s theory proposes is the need for the healthcare team and nurses to evaluate the patients’ and their families’ comfort needs. After identifying these needs, the healthcare providers must develop a design that will more effectively coordinate the necessary interventions to address these comfort needs. However, one most important factor that these healthcare providers must consider is assessing the intervening variables. If the intervening variables help the nurses deliver effectively and project care, the possible outcomes will be enhanced, thus improving healthcare outcomes. Some of these intervening variables include patient acuity and adequate staffing. Also, there is a need for the healthcare providers and nurses to ensure that they engage in realistic and desirable health-seeking behaviors such as carrying out evidence-based research to prove nurse productivity, thus attaining the overall comfort and treatment goals. Hence, the major assumption portrayed by Kolcaba’s theory is that when nurses, patients, and their families interact using health-seeking behaviors and are provided with Comfort, the ultimate result is that they will be more satisfied with the current healthcare services, thus promoting improved health-related outcomes. Also, once these nurses, patients, and their families become satisfied with an institution’s healthcare services and delivery, the instance boosts its sustainability and competitiveness. Hence, Kolcaba’s theory proposition may be more effective in policy improvements or evidence-based research to achieve the desired results.

Clinical Applications

Orem’s theory is substantial in nursing since nurses interact with daily self-care deficits. Therefore through the theory, it becomes easy for these nurses to formulate solutions for their patients as they address the need for their independence to enable them to control their treatment and rehabilitation. Hence, as a nurse, some of the important factors that one can learn from Orem’s theory include how to address issues like hygiene where the nurse needs to help them maintain their hygiene by providing them with motivation and reminders to such healthcare. The best way to engage them in a continuous and routine hygiene observation is by promoting them to daily washing up and bathing. Another factor to consider is patient grooming, where nurses can recommend more comfortable clothes, increasing the patients’ privacy and regular motivation (McEwan & Willis, 2021). Speech deficit is crucial since nurses should ensure that they engage speech pathologists to identify and find solutions to speech deficit cases that can interrupt patient communication. After patients have been hospitalized for a long, they may develop issues with feeding. However, as the patients recover, nurses must find meaningful ways to help them start feeding them, thus reducing care duties for their families since the patients will be more dependent on their meals. Hence, the main goal that Orem’s theory has is to help the nurses set concerns fostering their patients’ independency.

Kolcaba’s theory is also crucial in nursing practice through its three forms: transcendence, which is a comfort state that enables patients to win over their challenges; ease, which reflects comfort in contentment and relief when the nursing fraternity addresses all the patient’s needs. An example of how nurses use the three contexts is by providing patients that have undergone surgery with pain medication as part of relief comfort. The comfort theory can also be viewed in socio-cultural, environmental, and psycho-spiritual contexts. All these factors revolve around the patient’s environment (Bice & Bramlett, 2019). Therefore, nurses must evaluate patients’ environmental needs to ensure that they favor the patient’s comfort. For instance, nurses may come around patients and families that require the medical procedure to happen in the presence of a religious leader. In that case, the nurse should consult the nursing management to ensure they intervene on time to meet the patient’s comfort and improve their overall well-being. In such a case, Kolcaba’s theory is essential for nurses to ensure that they offer patient-centered healthcare services by engaging individualistic concepts since each patient has a different care approach.

Application to My Practice

As I continue my nursing practice, Orem’s theory will be crucial as I work to enhance care for the elderly. That is because I will need to assess the patient’s conditions to acknowledge their needs effectively. There will also be a need to engage the patients, their families, and other healthcare providers in an effective communication strategy to help coordinate care. That is because the elderly requires clear communication to understand their prevailing conditions and how well they are independent, including what they should avoid. The elderly must understand that they must stay within the home compound to avoid falls that may injure or fracture their bones, thus causing adverse effects. It will also be necessary to ensure that these patients’ care plan is well assessed by involving the patient and their families’ input to make them feel part of the process, thus increasing their chances of adhering to treatment and disease management recommendations

Kolcaba’s theory will be effective in my nursing practice since I will understand the elderly patient’s comfort from their view. For instance, when attending to elderly patients within the end-of-life stage, I will acknowledge that the patients might be anxious about death since they already know that their death may be nearing. Hence, I will need to indulge in evidence-based research reflecting on prior similar cases to get a whole picture of how such patients need to be addressed appropriately, thus providing a holistic approach to them.

Parsimony

Despite Orem’s theory encouraging nurses to ensure that patients are more independent when approaching self-care, Kolcaba’s theory provides an effective approach that aims at shaping care toward providing Comfort to the patients. Hence, both theories acknowledge the importance of healthcare providers and their impact on the care process. For instance, when attending to an elderly patient with a chronic condition like an autoimmune issue, the healthcare providers will engage Orem’s theory in educating the patients on how to be independent when managing the condition. The case will also need to engage Kolcaba’s Comfort theory to ensure that the patient achieves the required health outcomes. When evaluating the theories for parsimony purposes, they do not need more money or other resources since they aim to ensure that the patients, healthcare providers, and families adhere to disease interventions.

Conclusion

The paper has addressed two theories, Dorothea Orem’s self-care deficit theory as a grand range theory and Katharine Kolcaba’s theory of Comfort as a middle-range theory. From the perspective of these theories, it is evident that most nursing theories aim at enhancing care quality and patient outcomes. The exploration provided by the two theories shows that despite most theories using different approaches to address healthcare-related issues, they always have similar goals to enhance patients’ health outcomes and well-being. As for Orem and Kolcaba’s theories, it is easy for nurses to combine the theories’ perspectives to ensure that the patients receive holistic and ultimate care. That is because Orem’s theory promotes self-care and autonomy in patients, while Kolcaba’s theory aims to eliminate stress-related issues that may interfere with the patients’ Comfort, derailing their journey to achieve positive outcomes.

References

Bice, A. A., & Bramlett, T. (2019). Teaching nurses from a holistic comfort perspective. Holistic Nursing Practice, 33(3), 141-145. doi: 10.1097/HNP.0000000000000325 The Comparison Between Dorothea Orems Self-Care Deficit Nursing Theory and Kolcabas Theory of Comfort Essay

McEwan, M., & Wills, E. M. (2021). Theoretical basis for nursing. Lippincott Williams & Wilkins.

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. doi: 10.1097/HNP.0000000000000275

Tanaka, M. (2022, May). Orem’s nursing self‐care deficit theory: A theoretical analysis focusing on its philosophical and sociological foundation. In Nursing Forum (Vol. 57, No. 3, pp. 480-485). https://doi.org/10.1111/nuf.12696

Grand and Middle Range Theory Review

The purpose of this paper is to review two selected nursing theorist one grand and one middle range theory. Throughout this paper the grand theory of Florence Nightingale’s environmental theory and the middle range theory of Kristen Swanson’s theory of caring will be discussed, reviewed, and compared.

Florence Nightingale’s environmental theory has five important elements, pure water, pure air, efficient drainage, light and cleanliness. Thus, producing a healthy atmosphere crucial for healing (Zborowsky, 2014). Her theory in considered a grand theory because it has a broad scope. It presents general concepts that are good for directing, explaining, and predicting nursing situations (McEwen & Wills, 2017). The grand theories are relevant to all areas of nursing yet may not be beneficial to detailed research questions because of its broad scope.

Kristen Swanson’s theory of caring is a middle range theory with five caring processes, knowing, being, doing, enabling, and maintaining belief (Jarvis, 2019). This theory supports nursing care as a process that develops from the nurses’ beliefs, knowledge, and relationship with the patient. This is a middle range theory that is narrower in scope than grand range theories and assist in guiding nursing practice and research (McEwen & Wills, 2017). Middle range theories are therefore more straight forward and limited to an area of practice. Swanson’s theory originated around pregnancy issues.

Background

According to Zborowsky (2014). Florence Nightingale was born on May 12, 1820 in Florence Italy. She was born into an affluent family however never felt comfortable with socializing. She had a classical education and early on was interested in ministering to the poor and ill. She felt nursing was her purpose and calling. Her parents were not supportive of her desire to pursue nursing training. In 1851, she received her educational and clinical training in Germany. In 1854 she served as a nurse in the Crimean war, then went to London. There she was awarded money from the British government. She took that money and started a school for nurses in 1860. Her goal was to teach what was needed to be done and how to do it. She also taught about symptoms of diseases and what they meant. In 1859, her famous book, Notes on Nursing, was published she distinguished nursing separate from medical knowledge and taught on the purpose of nursing duties (McEwen & Wills, 2017). She improved statistics analysis with her observations and aided the military hospitals in efficient restructuring of services. She died August 13, 1910 spending her life preventing disease and providing safe and compassionate care to the impoverished and suffering. Florence Nightingale has been seen as the originator of nursing theory and certainly one of the most prominent nurses throughout history (Zborowsky, 2014).

Kristen Swanson was born January 13^th, 1953 and received her baccalaureate degree in 1975 from the University of Rohde Island. In 1978 she received her master’s degree in nursing from the University of Pennsylvania and then her Ph.D. from the University of Colorado (Swanson, 1991). According to Amendolair (2012), her doctoral dissertation was focused on caring for patients having a miscarriage (spontaneous abortion). She was influenced by Dr. Jean Watson’s grand theory of Human Caring Theory developed in 1970. Then in 1991 Swanson developed her theory encompassing the five processes of caring. She was also interested in socially at-risk mothers. Currently she is the Dean and Professor at the Seattle University College of Nursing and is on the board of the American Association of Colleges of Nursing (AACN). Her theories help patients deal with miscarriages and cover helpful counseling, her theories encompass physical and emotional healing. She is also an alumnus of the Robert Wood Johnson Executive Nurse Fellows Program, this is a progressive leadership resource for nurses in upper level administrative roles who purpose to lead changes in the United States healthcare system (Swanson, 1991).

Philosophical Underpinnings

According to McEwen & Wills (2017) Florence Nightingale theory is thought to be a wide-range viewpoint yet her work is a foundational philosophy. Her fundamental principle was healing and consequent to it are the principles of leadership and worldwide action. Together these principles are needed to provide healing. The environmental theory has inspired the nursing profession and education for over 150 years. Nightingale did not think that nurses were meant to be submissive to doctors. She saw nursing as an individual vocation all its own. Florence Nightingale’s educational model teaches nurses to be aware of patients’ needs, meet patients’ needs and know how to carry out the professional actions of a nurse. Nightingale’s philosophy came about over years of providing nursing care and study. It is an intellectual and factual philosophy and is categorized as a grand theory.

The philosophical underpinnings and contributions of Swanson’s theory of caring can also be reviewed by the four concepts of the nursing metaparadigm, person, health, environment, and nursing (Jarvis, 2019). The person being the most essential part of Swanson’s theory this emphasis on the caring process as the philosophical underpinnings. The viewpoint of Swanson’s theory is that nurses are educated through scientific information and learning through clinical practice, humanities and cultural values (Peterson & Bredow, 2019). Each person is unique and made up of their own feelings, ideas and behaviors. The nurse not only addresses the patient but family and society. The environment should be therapeutic for the patient. The concept of caring especially in the instance this theory was derived, is clearly powerful and beneficial to the wellbeing of the patient both physically and emotionally.

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Major Assumptions, Concepts, and Relationships

Florence nightingale’s theory has the straightforward and understandable ideas of health and wellness. She also defines it as “the act of utilizing the environment of the patient to assist him in his recovery” (Nightingale, 1992, p.41). Therefore, the environment is an external factor that can affect the patient’s health. The five environmental factors are the foundation of the theory. The nurse is accountable to adapt and assess the environmental setting so that it will improve the patient’s health. The concepts of Nightingales’ theory are fresh air, pure water, effective drainage, cleanliness, and light (Zborowsky, 2014). According to Selanders & Crane (2012) the concepts can be branched out into heading that expand on the five environmental factors. First the health of the house, construction should ensure air is not stagnant. Next ventilation and warming, supplying fresh air without odors. Then the need for direct sunlight and a quiet environment, never waking a patient intentionally. Variety is expanded upon as Nightingale would rotate paintings, provide activities, and read and write with the patient so they were not bored. The bed and sheets were to be in the sun light and the bed not to be shaken or sat on. Personal cleanliness is encouraged as the nurse is to wash her hands often. Nutrition was encouraged in small frequent feedings and the nurse was not to distract them when they were eating. Socially is was encouraged to support the patient and talk with them. Nightingale wrote over 150 books and reports on healthcare topics and she is credited with producing one of the first forms of the pie chart. Hospitals are cleaner because of Nightingales early work and education of nurses, making them a safer place to be.

Swanson’s theory of caring is based on her research and practice. According to Amendolair (2012) Swanson classified five activities that nurses used to improve patient care and meet their needs. These practices include knowing, being with, doing for, enabling, and maintaining belief. To improve nursing care and foster the patients’ health both physically and emotionally, the nurse incorporates these five activities and makes a personal, patient centered plan of care. In doing this the nurse also expresses dignity and importance of the patient. Swanson focused on pregnancy issues in her theories and reports that nurses are natural caregivers. Her theories have been used in obstetric education. The caring theory’s first component of caring is knowing, here the nurse avoids assumptions, does a detailed assessment and looks for cues. Being with, denotes enduring with the patient, sharing, but not burdening the patient. Doing for, is comforting, protecting, anticipating needs, and preserving the patient’s dignity. Enabling or informing, would be validating the patient’s feelings, advocating, explaining and giving back. In maintaining belief, the nurse would offer realistic hopefulness, believing in the patient and helping the patient to find meaning. In practice the nurse should utilize all five caring process steps. Swanson is still practicing and publishing today using her theories to improve healthcare and nursing The Comparison Between Dorothea Orems Self-Care Deficit Nursing Theory and Kolcabas Theory of Comfort Essay.

Clinical Applications

The clinical applications of Florence Nightingales’ environmental theory put the responsibility of the patient on the nurse’s assessment skills and ingenuity. Even though the nurse can be busy and have many sick patients it is their responsibility to prevent bedsores, report and treat a fever, make sure the patient is nourished and warm and monitor their vital signs, lab results and environment for safety. The nurse should identify and reduce patient distress. She called nursing an art not a science and detailed many nursing tasks are still pertinent today (McEwen & Wills, 2017). Research today has reinforced her ideas on noise in the patient care area and environmental cleanliness and safety (McEwen & Wills, 2017). Therefore, today the clinical application of Nightingales theory stands true in healthcare and has stood the test of time.

Swanson theory of caring includes physical and emotional care for women who have miscarried, neonatal intensive care unit (NICU) caregivers, and mothers considered socially at risk (Jarvis, 2019). According to Kavanaugh, Moro, Savage, and Mehendale (2006) her clinical applications are relevant not only within those specific care settings but also in other delicate topics that involve vulnerable patients. This includes parents who had suffered the death of their infant or were engaged in making a life support decision because of possibly giving birth to a very premature infant less than 26 weeks gestation. In this study the caring characteristics and the trusting relationship that was formed by following Swanson’s caring theory produced a more productive and positive outcome perceived by the patient. Therefore, the clinical applications of Swanson’s caring theory are relevant and remain useful in clinical practice.

Application to Nursing Practice

An example of how Florence Nightingale’s theory is used today in nursing practice would include advocacy. Nursing is a complex profession and although Nightingale did not address specifically nurse advocacy, all her theories support this idea. In her publications she was a voice advocating for equal human rights, involving religion, sex, status, and the right to a peaceful death (Selanders & Crane, 2012). In this way Nightingale was ahead of her time and remains relevant today. In her environmental theories a good example of an application today could be seen in home health evaluations and care. Nurses are trained to look for unhealthy and unsafe living conditions, identify them and improve them. This would be the approach set forth in Nightingale’s theory.

In Swanson’s theory of caring the successful use of the five caring processes, knowing, being, doing, enabling, and maintaining belief would help a family cope after a miscarriage (Jarvis, 2019). The first thing a nurse would do is to give compassion, provide time and space for the family and be a good listener when they talk. Form a patient nurse relationship, touch her hand, and let her know how sorry you are for their loss. Assist the patient and encourage them to do what they normally do for themselves and provide privacy. Placing a rose or a sign on the door that fetal demise has happened to alert staff to be respectful and sympathetic. Provide a journal for the family to write down their feelings, information on the healing process, and support groups. Lastly provide closure by offering the family to hold the baby. Step by step going through the process will provide support for the family and will help the grieving patient move on.

Application to My Practice

In my nursing practice Nightingale’s theory is very relevant. Working with the elderly I encourage sunlight and walks outside on sunny days. I urge patients to eat healthy and offer healthy snacks. I am assessing the situation and environment to improve the comfort of the patient and safety of the environment to prevent injuries. The room must be kept clean and orderly, and patients have the option to request a quiet room at night, and not be disturbed. Patients are also engaged during the day with activities and religious services. This theory provides patients with a happy and healthy living environment.

Swanson’s theory of caring in my practice is useful although I could only find one reference to this theory in the elderly. I know I have used the process with grieving patients or patients that have received a poor prognosis. According to Yin-Tzu, Sin-Rong, and Chi-Yin (2019) utilizing the five steps in an elderly patient with vasculitis, unable to walk and delayed discharge from the hospital provided the patient with hope and positive beliefs about the future. When disease and lack of mobility in the elderly cause a feeling of hopelessness, working through the five steps of caring is a way to form a trusting and caring relationship with a patient and provide emotional support.

Parsimony

Nightingale concisely stated how important the environmental theory was to care for sick patients. She has condensed her thoughts into small volumes and included information about nursing treatment, patient needs, good structures where the patients can be treated, and the management of hospitals (McEwen & Wills, 2017).

Understand parsimony is to observe that the description with the least number of steps is often the strongest. Swanson’s theory can be simplified into two steps, see figure 1. The five steps of her theory can be condensed to maintain the parsimony of her idea: nursing philosophies and experience nursing will produce acts of caring and in the end, patient wellbeing (Swanson, 1993).

Conclusion

This review and assessment have been an opportunity for me to understand and be grateful to the nurse theorist who have made such a vast contribution to the nursing profession and healthcare industry. Nightingale theory is developed around simple and familiar concepts that are easy to utilize and practice. Today healthcare has so many amazing advancements and technology, yet if Nightingale’s basic principles are followed disease will be prevented. Likewise, Swanson’s theory has a simplicity of caring that is clearly healing when a patient is hurting physically and emotionally. The caring theory of being emotionally present for the patient, respecting the patient’s dignity, maintaining a knowledgeable practice, being objective and meeting the needs of the patient as a unique person, gives patients the ability to express themselves and improve their wellbeing. This piece has encouraged me to further understand nursing theory and improve my nursing care and make it more of an art.

References

Amendolair, D. (2012). Caring Model: Putting research into practice. International Journal of Human Caring, 16(4), 14-21. DOI:10.20467/1091-5710.16.4.14

Jarrin, O. F. (2007). An integral philosophy and definition of nursing. School of Nursing Scholarly Works. 47. https://opencommons.uconn.edu/son_articles/47

Jarvis, K. (2019). Swanson’s theory of caring: An application to the role of nursing Education. International Journal for Human Caring, 23(3), 266-271. DOI: 10.20467/1091-5710.23.3.266

Kavanaugh, K., Moro, T. T., Savage, T., & Mehendale, R. (2006). Enacting a theory of caring to recruit and retain vulnerable participants for sensitive research. Research in Nursing & Health, 29(3), 244-252. https://pubmed.ncbi.nlm.nih.gov/16676343/

McEwen, M., & Wills, E. M. (2017). Theoretical basis for nursing. Lippincott Williams & Wilkins.

Nightingale, F. (1992). Notes on nursing: What it is, and what it is not. Lippincott Williams & Wilkins.

Peterson, S., & Bredow, T. S. (2019). Middle range theories: Application to nursing research and practice. Lippincott Williams & Wilkins.

Selanders, L., & Crane, P. (2012). The voice of Florence Nightingale on advocacy. The Online Journal of Issues in Nursing, 17(1). https://pubmed.ncbi.nlm.nih.gov/22320877/

Swanson, K. M. (1991). Empirical development of a middle range theory of caring. Nursing Research, 40(3), 161-166. https://pubmed.ncbi.nlm.nih.gov/2030995/

Wojnar, D. M., & Swanson, K. M. (2007). Phenomenology: An exploration. Journal of Holistic Nursing, 25(3), 172-180. DOI:10.1177/0898010106295172

Yin-Tzu Chen, Sin-Rong Lin & Chi-Yin Kao. (2019). Applying Swanson’s theory of caring to manage powerlessness in an older patient with vasculitis. Journal of Nursing, 66(3), 112–119. DOI: 10.6224/JN.201906

Zborowsky, T. (2014). The legacy of Florence Nightingale’s environmental theory: Nursing research focusing on the impact of healthcare environments. HERD: Health Environments Research & Design Journal, 7(4), 19-34. https://doi.org/10.1177/193758671400700404

Swanson’s Theory of Caring

Figure 1. The Structure of Caring displayed in its original format from Swanson (1993) “Nursing as Informed Caring for the Well-Being of Others”, (p.355).

PLEASE READ THESE IMPORTANT INSTRUCTIONS!!

I want every one of you to be rewarded for your hard work on these papers. In order to get the best grade possible, please follow these instructions.

Step One– choose your theories. If they are listed in the reading, consider them approved, no need to send the request to me via the Journal area!!!

Based on the reading assignment (McEwen & Wills, Theoretical Basis for Nursing,Unit II: Nursing Theories, chapters 6–9), select a grand nursing theory.
Based on the reading assignment (McEwen & Wills, Theoretical Basis for Nursing,Unit II: Nursing Theories, chapters 10 and 11), select a middle-range theory.

Please use these bold headings to organize your paper. You are simply comparing the two theories back and forth.

In your reading, you will find a thorough description of each component below and fully describes what you need to research about your chosen theories to fill in the section.

Introduction

Overview of your chosen grand theory

Overview of your chosen middle range theory

You will have a separate paragraph in each section, one for your grand range theory and one for your middle range theory.

Background of the theories

(Grand theory chosen)-

(Middle range theory chosen) –

Philosophical Underpinnings

(Grand theory chosen)-

(Middle range theory chosen) –

Major assumptions, concepts, and relationships

(Grand theory -)

(Middle range theory -)

Clinical applications

(Hint: usefulness/value to extending nursing science testability)

(Grand theory-)

(Middle range theory -)

Application to nursing practice

(Hint: Comparison of how to use of your theories in nursing practice)

(Grand theory-)

(Middle range theory -)

Application to my practice

(Hint: Specific examples of how both theories could be applied in your specific clinical setting)

Grand theory-

Middle range theory –

Parsimony

(Hint: how simple or complex are the theories?

Grand theory-

Middle range theory

Conclusion

Every formal paper must have a formulated conclusion!

Four References:Course text and a minimum of three additional sources.
The paper should be 8–10 pages long- notincluding your Cover and Reference pages.
Times New Roman,12-point font, and double-spaced with 1″ margins.
APA format (7th ed.) a properly formatted cover page and reference list. See the link below for 7th edition APA updates!

THEORIES CHOSEN:

GRAND NURSING THEORY:

Dorothea Orem: The Self-Care Deficit Nursing Theory

MIDDLE RANGE THEORY:

Kolcaba’s Theory of Comfort The Comparison Between Dorothea Orems Self-Care Deficit Nursing Theory and Kolcabas Theory of Comfort Essay