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Theoretical And Philosophical Foundations In Nursing

Everyone has experienced some type of uncomfortableness or pain. Possibly it could be the most typical reason why people seek health care. The role of the nurse is to provide care for clients in many adjustments and situations in which interventions are provided to promote comfort. Comfort is an idea central to the fine art of medical. Nursing Theorists refer to comfort as a basic client need for which nursing care is delivered. The concept of comfort is subjective thus each individual has diverse physiological, social, spiritual, internal and cultural, characteristics that affects how comfort is interpreted and experienced. Because of this assignment, a theory of comfort produced by Katherine Kolcaba will be talked about.

Theory Overview

The idea of comfort is not really a new strategy and has been a goal or results of nursing since Florence Nightingale. Comfort is a holistic outcome since it designates a energetic and multifaceted express of persons. Thinking about the outcome of comfort requires an intra-actional point of view because interventions that are intended to enhance one or more areas of comfort indirectly enhance other aspects (Kolcaba, 1994). During the development of the comfort theory, Kolcaba conducted a thought examination of comfort that analyzed books from several disciplines including medical, medicine, psychology, psychiatry, ergonomics and English (Dowd, 2002). This review verified that comfort is a positive concept and is associated with activities that nurture and strengthen patients.

Kolcaba arrayed different aspect of comfort in a two dimensional grid. First, Kolcaba defined comfort as existing in 3 forms: ease, relief and transcendence. In the first sense, the status of efficiency, comfort will not mean absence of discomfort but rather this express is in accordance with individual characteristics. That is, persons are different in the way they explain and experience pain and easiness. In the next state, the pain relief sense, you can find rest from conditions that cause or donate to discomfort. The ultimate condition, the renewal sense, refers to a state to be strengthened and having enhanced capabilities and positive behaviour. The second dimensions of comfort is the contexts in which comfort occurs. The contexts were produced from the nursing books about holism (Kolcaba, 1992). The first framework is physical, pertaining to bodily sensations, the second reason is psychospiritual, regarding the internal knowing of home, including esteem, sexuality, signifying in one's life and marriage to a higher order or being. The third context is sociable, pertaining to social, family and ethnic associations and the fourth and previous framework is environmental regarding light, noise, atmosphere, colour and heat. When the two sizes are contrasted the result is a two-dimensional grid with 12 areas of comfort. Items for comfort questionnaires can be produced from each facet that is pertinent to a specific research question. Making the idea of comfort measurable Kolcaba put together the basis for the development of the theory of comfort.

Kolcaba publicized a midsection range-theory of comfort in 1994 recommending that when comfort is enhanced, patients are strengthened and therefore able to take part in health seeking behaviours. In 2001, a subsequent article provided an development of the theory to add institutional final results. In 2003, Kolcaba released a comprehensive reserve about the development, trials and request of the idea. Kolcaba will not believe a focus on comfort is exclusive to nursing while she believes that her theory can be interdisciplinary and this multiple occupations can converge around her theory of comfort providing all natural care to patients. One of the main theory assertions is that when health care needs of a patient are appropriately evaluated and proper medical interventions are carried out to address those needs, considering variables intervening in the problem, the outcome is improved patient comfort over time. Once comfort is increased, the patient is likely to increase health-seeking behaviours. These behaviours may be inside to the patient (rest from pain or improved oxygenation), external to the individual (eg. active involvement in treatment exercises) or a peaceful fatality. Furthermore, Kolcaba asserted that when a patient encounters health-seeking behaviours, the integrity of the establishment is eventually increased because the upsurge in health seeking behaviours will lead to improved benefits. Increased institutional integrity lends itself to the development and execution of guidelines and best regulations supplementary to the positive effects experienced by patients.

Theory critique

The goal of this theory is congruent with those theories represented as middle range theories. The goal of the Comfort Theory is to provide comforting methods to patients in their time of need. Midsection range theories are small in scope and made up of a limited volume of ideas and propositions. These are written in a concrete and specific level. Midsection range theories solve a comparatively tangible and specific happening by talking about what it is, describing why it occurs or predicting how it occurs. This theory points out what comfort is as determined by the patient or family and predicts how it occurs as evidenced by the taxonomic grid. This in addition, secures the theory in its classification.

Clarity and Ease of Theory: Some of the early articles most importantly the concept examination, are difficult to learn but are steady in conditions of definitions, roots, assumptions and propositions (Tomey & Alligood, 2006). The conclusive article explaining the Theory of Comfort is better to read and in consequent articles Kolcaba associate the theory to definite tactics using academics but comprehensible terms. The devices to determine comfort needs are also simple in the number of principles and are easy to utilize. The idea of Comfort is simple because it goes back to basic medical care and the traditional mission of nursing. Its language and application are of low technology, but this does not preclude its utilization in highly technological options (Dowd, 2002). The main thrust of the theory is to come back medical to a practice focused on needs of patients, inside or outside institutional wall space. Its simplicity allows students and practicing nurses to learn and practice the theory easily. All research concepts are defined theoretically and operationally. The diagrams associated with the theory help show the uniformity of the concepts and use of conditions while the ideas of the idea are related in reasonable ways.

Empirical Accuracy: The first part of comfort theory predicts that effective medical interventions offered as time passes, demonstrates enhanced comfort. Kolcaba tested it in experimental design on her behalf dissertation (Kolcaba & Fox, 1999). With this study health care needs were those stressors (comfort needs) associated with a identification of early breasts cancer. The all natural intervention was guided imagery, designed designed for this human population to meet their comfort needs, and the required final result was comfort. The findings revealed a big change in comfort as time passes between women getting guided imagery and the usual health care group (Kolcaba & Fox, 1999). Other empirical lab tests of the first part of Comfort Theory have been conducted by Kolcaba and associates which established significant distinctions between treatment and assessment communities on comfort as time passes. The interventions analyzed were types of immobilization for persons after coronary angiography (Hogan-Miller et al. , 1995), cognitive strategies for persons with urinary frequency and incontinence (Dowd, Kolcaba & Steiner, 2000) and generalized comfort procedures for females during first and second levels of labour (Koehn, 2000). In the Urinary incontinence analysis (Dowd, Kolcaba & Steiner, 2000), enhanced comfort was related to an increase in Health seeking behaviours, encouraging the second part of the comfort theory. The partnership between comfort and institutional integrity has yet to be analyzed. For patients with breast cancer and bladder control problems as well as for those at end of life (Vendlinski & Kolcaba, 1997), the designed comfort tools have exhibited strong psychometric properties which means, that those questionnaires are correct and reliable measurements of comfort and can expose changes in comfort over time. These finding support the theoretical basis for the taxonomic structure of comfort.

Comfort Theory and the metapardigm of nursing: The metapardigm of your discipline has been defined as a assertion or band of statements identifying its relevant phenomena (Fawcett, 1984). At the level of the metaparadigm, these assertions should be global to the self-discipline alternatively than specific to particular philosophies, worldviews, conceptual models or theories. The ideas that comprise the metaparadigm of nursing have been thought as person, environment, health and nursing (Fawcett, 1984). Kolcaba's comfort theory effectively addresses the four principles embracing the metaparadigm of medical. Kolcaba identified the metaparadigm concepts as they correspond to her theory (March & McCormack, 2009). Medical is described as the procedure of evaluating the patient's comfort needs, growing and applying appropriate nursing interventions and analyzing patient comfort pursuing medical interventions. Person is described as the recipient of nursing care and attention; the individual may be a person, family, organization or community. Environment is considered to be the external surroundings of the patient and can be manipulated to increase patient comfort. Finally, health can be regarded as the optimum performing of the individual as they define it. A close analysis of the definitions elicit some questions about the degree to which Kolcaba's (1992) work is fully intertwined with the metaparadigm of nursing (Ferreira, 2004). While Kolcaba does an enough job of talking about medical, its centre and activities this is of the other three concepts are less well developed. Kolcaba's explanation of health as best functioning will not correspond with other concepts in her theory. Functioning was never identified or pointed out in Kolcaba's theoretical meanings. Moreover a notion of comfort in Kolcaba's explanation of Health had not been included and her description of person lacks specs that the human being is perceptual, which must be true if her classification of Health is to hold up. Also, Kolcaba's description of environment is not carefully related with nursing activities. It appears that, at this stage of the theory's development, the ideas of the idea are not tightly grounded in nursing's metapardigm (Ferreira, 2004). However as a middle-range theory, only the segment of nursing this is the focus of the theory should be significantly tackled (Tomey, A. & Alligood, 2006).

Application in practice: Comfort Theory provides a framework for specialized medical practice rules, which declare that the provision of alternative care focused to comfort must be explicit and well documented (Di Marco & Kolcaba, 2005). Subsequently, the desirable outcome of comfort relates to engagement in Health Seeking Behaviours (important to patients, family members and the health care team) also to better institutional effects (important to administrators). The use of the idea is building up and fulfilling for clients and family members and nurses, and benefits companies where a culture of comfort is respected. However, the use of comfort theory to practice is complex. It is not self-explanatory as it appears or as it is most likely explained in the theory. The largest challenge to employing this theory is the staffing ratios. Staffing ratios have a primary relation between job oriented nursing and the greater mental and personal contacts that can be offered when caring for fewer patients. The examination of comfort needs is certainly different in non verbal patients just as ITU. Still, nurses are perceptive if a patient is comfortable and possible detractors from comfort when patients seem restless. Families tend to be very helpful in this detective work and their occurrence by themselves is a comfort measure. Using Kolcaba's construction of alternative comfort, nurses can be detailed and consistent in assessing comfort and in developing interventions to enhance the comfort of patient and young families. Nevertheless, compared to other nursing theories, the comfort theory is straightforward to understand and find out because every person knows their own needs for comfort. The need for comfort is innate and therefore the idea of the comfort theory is easier understood. In 1992 Kolcaba developed the General Comfort Questionnaire hence facilitating the evaluation of comfort needs. The questionnaire is based on 24 positive and 24 negative items. The members rate these questions from highly agree to firmly disagree. Higher the rating, higher the comfort obtained. Kolcaba has also offered comfort care themes for use used configurations. Although this theory is quite new, it is being recognised more and more by nursing students and staff who opting for it as a guiding framework for his or her studies and practice such as in labour and delivery (Koehn, 2000), nurse midwifery (Schuiling & Sampselle, 1999), cardiac catheterization (Hogan-Miller, Rustad, Sendelbach & Goldenberg, 1995), critical attention (Jenny & Logon, 1996), hospice (Vendlinski & Kolcaba, 1997), infertility (Schoerner & Krysa, 1996), radiation remedy (Cox, 1998), orthopaedic nursing (Panno, Kolcaba & Holder, 2000), perioperative nursing (Wilson & Kolcaba, 2004) and in hospitalized older (Robinson & Benton, 2002).

Comfort theory as an establishment wide methodology: Kolcaba positions comfort theory within the domain name of medical: however, she hypothesize that in an institution focused on meeting the medical care need of patients, comfort theory may potentially are an institution extensive way (March & McCormack, 2009). Because this variant of Kolcaba's theory is yet to be tested, the benefits can only be speculated. It could be assumed that if Kolcaba's comfort theory is definitely adapted to add all medical providers and put in place as an organization wide platform for practice, that comfort for patients would be enhanced even further. Kolcaba's comfort theory implementation to an institution-wide level, necessitate an alteration to the theoretical framework. Currently, Kolcaba's comfort theory represents the application of 'nursing interventions' thus limiting the implementation of interventions resulting in improved comfort as a function of only those healthcare providers who focus on nursing (Kolcaba, 2003). An adjustment of the term, however to the word 'comfort interventions', extend the potential program of this theory to any medical care practitioner choosing to look at this theoretical composition for practice (March & McCormack, 2009). The involvement strategies emerging from the steady program of comfort theory across disciplines is likely to lead to quality final results for the individual leading subsequently to an increase in patient health seeking behaviours. Kolcaba's theoretical construction keeps that if patients' health seeking behaviours are increased, institutional integrity will result. This therefore may imply that if all healthcare practitioners in a institution delivered attention led by the comfort theory, that institutional integrity would be improved even more greatly than if the idea were used to steer nursing only. Also, structuring a medical care institution around the ideas of the comfort theory would hypothetically improve societal acknowledgement and appreciation of the organization, as well as increase patient satisfaction, because of the aforementioned positive implication of the idea.

Comfort Theory software in Medical Education: Throughout their education medical students are trained for regular hospital activities including essential symptoms, monitoring, physical assessment techniques and giving medications. Maintaining patient's level of privacy and dignity is emphasized during medical courses. In other words before students first lay down their hands to their first patient, educators have included them the science and art work of offering comfort actions. Comfort has always been included in medical education, and Katharine Kolcaba's theory seems simple yet an efficient one to enhance learning. However since Kolcaba's theory is middle range it might not be suitable to guide curricular development as it points out some but not all of medical attention (Ferreira, 2004). It can however offer important content for students of medical to understand at both undergraduate and graduate levels. Comfort Theory offers suggestions for teaching comfort and provides an effective solution to assess and solve holistic comfort needs of patients. Articles that summarize the usefulness of the theory in practice indirectly affirm that the theory pays to for educating students. Cox (1998) found Kolcaba's theory useful as a coaching guide for health care of older adults and that students could conveniently apply Kolcaba's theory in providing nursing care of old adults and addressing holistic comfort needs in seniors in an serious care setting. The idea is not limited by gerontoligical or advanced practice education. It might be difficult to think of a nursing setting or practice where comfort would not be appropriate (Dowd, 2002).

Conclusion

Holistic comfort theory provides a framework for guiding nurses as they assess, plan, provide and assess look after patients while viewing them as whole persons getting together with their environment. Besides guiding nursing practice comfort theory can guide medical education. This theory can be used to guide the coaching of nurses and nursing students to learn how to provide attention that is unbiased of or together with medical practice. In research the theory offers a way to validate that there's been improvement in patient comfort after comforting interventions. During the first ten years of its life, the idea has stood up to preliminary empirical testing. It's been shown in studies that, once the nurse initiates a comfort solution to meet the holistic comfort of the patient, the patient's comfort is increased more than a previous baseline measurement. Also, increased comfort has been correlated with engagement in Health Seeking Behaviours (Dowd, 2002). Kolcaba has made constant and persistent attempts to develop and expand the idea into every area of medical. Through own thinking and discussion with nurses the idea has evolved continually, including care products. Through Kolcaba's prolific writing and lively Internet activities, the idea of Comfort is now known worldwide.

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