The Nursing Theories Comparison

Abstract

Nursing theories are essential elements of the nursing field and practice because they directly shape the overall approach to the issues. The given comparative analysis will primarily focus on Abdellah’s grand nursing theory of patient-centered care and Kolcaba’s middle-range theory of comfort. The former author provides a complete and comprehensive conceptual framework, which encompasses a wide range of dimensions of the field, such as education, care, and practice. In addition, she outlines key problems, which can be resolved by essential skills that need to be adopted by nurses. Kolcaba focuses on the theory of comfort, which sees the given element as a critical part of the patient’s needs. In addition, she proposes eight statements, which can be used to develop a protocol of actionable steps. The main similarity between these two theories is the fact that they focus on human and patient needs. However, the difference lies in the aspects and factors they encompass.

Introduction

The given comparative analysis will primarily focus on Abdellah’s grand nursing theory and Kolcaba’s middle-range theory. The former one is a comprehensive methodological framework on the concept of a patient-centered approach to the field and categorization of 21 main problems. The middle-range model explicitly addresses the notion of comfort and how it is critical for nursing. Although both theories possess a difference in perspective and understanding of a patient’s needs, they have overlapping ideas in patient-centered care and comfort provision.

Background

Abdellah’s grand nursing theory of a patient-centered approach was developed by Faye G. Abdellah. She acquired all her three degrees at Columbia University (McEwen & Wills, 2018). In addition, she underwent a graduate program at Rutgers University to expand the area of her expertise (McEwen & Wills, 2018). One of the major career achievements of the author is the fact that she served as a Chief Nurse Officer and a Deputy U.S. Surgeon General of U.S. Public Health Service until 1993 (McEwen & Wills, 2018). The theory was developed based on her vast experience and observations made through Abdellah’s career life. The idea of comfort was created by Katherine Kolcaba in the 1990s, and she was the pioneer in introducing the concept into the nursing field (McEwen & Wills, 2018). It outlines the essential elements of nursing research, education, and practice, where the central theme is the patient’s comfort. It is important to note that the idea was further developed through the contributions of other experts and Kolcaba herself.

Philosophical Underpinnings

Abdellah’s grand nursing theory’s philosophical underpinnings revolve around the fact that it is a major part of human needs theory. It primarily addresses two main elements, which are practice and education. Although the key directed intention of the approach was based on guiding the process of care provision, it found additional importance in community nursing (McEwen & Wills, 2018). In the case of Kolcaba’s middle-range nursing model, the most vital philosophical underpinning can be found in the notion of comfort. It is considered to be one of the essential client needs, which can significantly reduce negative tensions (McEwen & Wills, 2018). One should note that the concept promotes the view that comfort is an outcome that advances positive behaviors, such as health-seeking ones (McEwen & Wills, 2018). Both ideas are centered around the patient’s needs, which are critical in ensuring the proper care and recovery processes.

Major Assumptions, Concepts, and Relationships

It is vital to understand that both Abdellah’s grand theory and Kolcaba’s middle-range theory possess major assumption points, concepts, and relationships. In the case of the former, she was among the very first nurses who introduced the idea of nursing diagnosis, which was previously considered to be outside the specialists’ responsibilities (McEwen & Wills, 2018). The main goal of the author is to establish an important middle-ground between disease-centered and nursing-centered approaches (Gonzalo, 2019). There are six major assumptions proposed by Abdellah, which involve forming nursing leaders from underserved groups, integration of continuous professional nursing education, and changing nursing education (McEwen & Wills, 2018). They also involve assessing the implications of key issues, such as pollution, racism, poverty, and other relevant problems, appreciating the intertwined connectedness of social issues and social organizations, and changing the nursing field of practice itself. Therefore, the given grand nursing theory can be considered to be a comprehensive guideline that encompasses a wide range of critical areas, such as education, care, environment, and institutions.

In addition, Abdellah’s work addresses the vital issues in nursing by listing 21 Nursing Problems, and the objectives are shown in Table 1. In other words, the author addresses both internal and external factors that influence patient needs. Moreover, the patient-centered grand nursing theory possesses a list of recommended actions for nurses. Abdellah suggests ten essential nursing skills, which must be utilized in the treatment typology (Allam et al., 2016). A nurse should develop and discuss a complete and comprehensive care plan in regards to nursing as well as identify how he or she sees the nursing problems. A specialist should also understand and observe reactions to the treatment plan, which originates from the patient and his or her family (McEwen & Wills, 2018). There is a need to assess the patient over a prolonged period to derive his or her clues and attitudes influencing the overall behavior.

It is important to validate conclusions coming from the patient and test generalized statements. A nurse should also identify the plan for therapeutics and make data-based generalizations (McEwen & Wills, 2018). Lastly, the professional must filter relevant information and learn to recognize the patient. In other words, the proper nursing practice needs to be focused directly on the patient, where all of the elements are analyzed to design a correct and sound plan of care.

Table 1. 21 Nursing Problems.

1 “To maintain good hygiene and physical comfort
2 To promote optimal activity, exercise, rest, and sleep
3 To promote safety through prevention of accidents, injury, or other trauma and through the prevention of the spread of infection
4 To maintain good body mechanics and prevent and correct deformities
5 To facilitate the maintenance of a supply of oxygen to all body cells
6 To facilitate the maintenance of nutrition of all body cells
7 To facilitate the maintenance of elimination
8 To facilitate the maintenance of fluid and electrolyte balance
9 To recognize the physiologic responses of the body to disease conditions
10 To facilitate the maintenance of regulatory mechanisms and functions
11 To facilitate the maintenance of sensory function
12 To identify and accept positive and negative expressions, feelings, and reactions
13 To identify and accept the interrelatedness of emotions and organic illness
14 To facilitate the maintenance of effective verbal and nonverbal communication
15 To promote the development of productive interpersonal relationships
16 To facilitate progress toward achievement of personal spiritual goals
17 To create and maintain a therapeutic environment
18 To facilitate awareness of self as an individual with varying physical, emotional, and developmental needs
19 To accept the optimum possible goals in light of physical and emotional limitations
20 To use community resources as an aid in resolving problems arising from illness
21 To understand the role of social problems as influencing factors in the cause of illness” (McEwen & Wills, 2018, p. 140).

In comparison, the major concepts of the middle-range theory by Kolcaba are comprised of seven essential ideas. These include intervening variables, the integrity of institutions, behaviors that promote health, comfort needs, comfort-based care, and comfort itself (McEwen & Wills, 2018). In addition, it is important to point out that eight propositions are in a tight relationship with the notions mentioned above, and they are shown in Table 2. The given statements are designed to ensure that a patient feels comfortable throughout the process of treatment and care. In other words, Kolcaba’s theory puts a great deal of emphasis on the concept because it is paramount in enabling a smooth and healthy recovery process.

Table 2. Eight Proposals.

1 “Nurses and members of the health care team identify comfort needs of patients and family members.
2 Nurses design and coordinate interventions to address comfort needs.
3 Intervening variables are considered when designing interventions.
4 When interventions are delivered in a caring manner and are effective, the outcome of enhanced comfort is attained.
5 Patients, nurses and other health care team members agree on desirable and realistic health-seeking behaviors.
6 If enhanced comfort is achieved, patients, family members, and/or nurses are more likely to engage in health-seeking behaviors; these further enhance comfort.
7 When patients and family members are given comfort care and engage in health-seeking behaviors, they are more satisfied with health care and have better health-related outcomes.
8 When patients, families, and nurses are satisfied with health care in an institution, public acknowledgment about that institution’s contributions to health care will help the institution remain viable and flourish. Evidence-based practice or policy improvements may be guided by these propositions and the theoretical framework” (McEwen & Wills, 2018, p. 245).

Clinical Applications, Usefulness, Value, and Testability

The clinical application, usefulness, and value of both theories can be observed in their way of shaping the standards of nursing practice. Abdellah’s grand nursing theory differentiates nursing functions from nursing diagnosis because the latter was introduced by the author herself (McEwen & Wills, 2018). In other words, she understands that traditional nursing requires a gradual change in all areas, such as education, practice, and care. Abdellah’s theory can be considered as advocacy for improved nursing, which is achieved by expanding the role of a nurse in the conventional healthcare system. Although a patient is always professionally and explicitly assessed by the doctors, she promotes a nurse’s involvement in the process due to the specialist’s close interaction with clients. It is stated that Abdellah’s model is challenging to test because there are no implied relationships within the grand nursing theory (McEwen & Wills, 2018). However, it is highly functional because both personnel and patient satisfaction can be measured to assess effectiveness.

In contrast, Kolcaba’s middle-range theory is more specific because it primarily focuses on comfort. The implication can be observed in the notion that it can generate a protocol for taking certain action steps. The conceptual framework begins with identifying the healthcare needs of both patient and his or her family. The following phase involves integrating comforting interventions in conjunction with intervening variables. The outcome will be manifested in enhanced comfort, which directly promotes health-seeking behaviors. It is comprised of a wide range of external behavioral patterns, peaceful death, and internal behaviors (McEwen & Wills, 2018). The methodological framework also includes institutional integrity, which is in an explicit relationship with outstanding and effective policies and practices.

Furthermore, the testability aspect of Kolcaba’s theory is plausible through several questionnaires. One can measure the overall impact of the conceptual model by utilizing the tools, such as the Comfort Behaviors Checklist and the Urinary Incontinence and Frequency Comfort Questionnaire (McEwen & Wills, 2018). In addition, there are other alternatives, which involve the Hospice Comfort Questionnaire, the Radiation Therapy Comfort Questionnaire, the Verbal Rating Scale Questionnaire (McEwen & Wills, 2018). A study suggests that the integration of the comfort theory among veterans showed a major improvement in their well-being (Boudiab & Kolcaba, 2015). Therefore, the general testability factor of Kolcaba’s middle-range nursing theory is significant in regards to measuring approaches.

Comparison

Both theories have substantial use in nursing practice, but there is a wide range of inherent differences as well as similarities. One can easily observe that Abdellah’s grand theory encompasses all major aspects of the nursing field, which addresses education, care, and practice. However, Kolcaba’s middle-range model primarily focuses on the issue of comfort. Therefore, the latter methodological framework is more testable, and it can be applied more immediately compared to the grand theory. In addition, the use of Abdellah’s model is more systematic, which seeks to shape the entire field, whereas Kolcaba’s ideas are more precise and can be integrated through a protocol of actionable steps. There are also inherent differences in regards to testability because the middle-range theory can be measured through an array of questionnaires. This is not the case for the grand view, which can only be partially implemented realistically. A thorough use would influence many institutions and establishments, which are outside of the nursing field. The author’s proposals have a possibility of impacting major pollution-causing organizations and the medical field, including doctors.

Examples of Application in My Clinical Setting

In the case of my specific clinical setting, the grand theory can be applied by advocating for the outlined principles. It can be addressed to several parties, which involves the management, doctors, nursing staff, and patients. I can start following Abdellah’s model by accepting and identifying both negative and positive reactions, feelings, and expressions within my clinical setting. For example, if a patient exhibits a displeased attitude toward me, I will adhere to the author’s 21 Nursing Problems by understanding that there is a connection between organic illness and emotions. I can also promote and encourage maintenance through effective non-verbal and verbal communication, and I specifically lack skills and awareness in the former. Another area where I am not sufficiently competent in developing productive interpersonal relationships, which can be achieved through openness and full involvement. I should also be more eager to understand and learn about key influencing factors, which are derived from social problems, as illness catalyzers.

The clinical setting application of Kolcaba’s middle-range theory is more direct and complete. For example, I can integrate the framework by being less reluctant in identifying the healthcare needs of my patients and his or her family. I can also introduce comforting interventions through intervening variables, and such a process can be manifested in communicating with the patient directly regarding his or her comfort needs. Any form of removable disturbances can be effectively removed by me, which will facilitate the proper recovery process. In addition, I can promote health-seeking behaviors among my patients by working on their internal and external behaviors. Lastly, I can advocate for institutional integrity by adhering to sound and plausible policies and practices.

Parsimony

Abdellah’s grand nursing theory is a highly comprehensive conceptual framework. It is comprised of four key parts, which are six major assumptions, 21 Nursing Problems, ten skills for nurses, and ten action steps to understand a patient’s issues. It is stated that the theory is not fully parsimonious due to its complex nature (McEwen & Wills, 2018). In the case of Kolcaba’s middle-range nursing theory, there are eight propositions of the comfort model. They form a basis for developing the conceptual framework of six key elements, starting from identification to institutional integrity.

Conclusion

In conclusion, Abdellah’s grand theory primarily addresses the patient-centered approach, where all aspects of nursing are affected. These include education, care, and practice, which means that the author seeks to introduce systematic changes. She deliberately outlines major problems and recommends key skills that a nurse should possess. Kolcaba’s middle-range theory is a more precise model, which focuses on comfort. It proposes eight statements that promote patient comfort measures, which form a protocol of action steps. Both theories are similar in regards to addressing human needs, but the difference lies in the scope of assumptions and key ideas.

References

Allam, N. A., Megrin, W. A. A., & Alkeridis, L. A. (2016). Faye Abdellah model to banishing social stigma of head lice among school students. Science Journal of Clinical Medicine, 5(1), 1-11. Web.

Boudiab, L. D., & Kolcaba, K. (2015). Comfort theory. Advances in Nursing Science, 38(4), 270-278. Web.

Gonzalo, A. (2019). Faye Abdellah: 21 nursing problems theory. Nurselabs. Web.

McEwen, M., & Wills, E. M. (2018). Theoretical basis of nursing (5th ed.). Lippincott Williams & Wilkins.