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Florence Nightingale - Environment Theory (Conceptual Model) and Katharine Kolcaba Comfort Theory (Middle Range): Explain How the Two Are Similar and Linked or Build of One Another

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The conceptual and theoretical nursing models help to provide knowledge to improve practice, guide research and curriculum and identify the goals of nursing practice. Nursing knowledge is the inclusive total of the philosophies, theories, research, and practice wisdom of the discipline.As a professional discipline this knowledge is important for guiding practice.

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Kolcaba arrayed different aspect of comfort in a two dimensional grid. First, Kolcaba described comfort as existing in 3 forms: ease, relief and transcendence. In the first sense, the state of ease, comfort does not mean absence of discomfort but rather this state is relative to individual characteristics. That is, persons differ in how they describe and experience discomfort and ease. In the second state, the relief sense, there is relief from conditions that cause or contribute to discomfort. The final state, the renewal sense, refers to a state of being strengthened and having enhanced powers and positive attitudes. The second dimension of comfort is the contexts in which comfort occurs. The contexts were derived from the nursing literature about holism (Kolcaba, 1992). The first context is physical, pertaining to bodily sensations, the second is psychospiritual, pertaining to the internal awareness of self, including esteem, sexuality, meaning in one’s life and relationship to a higher order or being. The third context is social, pertaining to interpersonal, family and cultural relationships and the fourth and last context is environmental pertaining to light, noise, ambience, colour and temperature. When the two dimensions are contrasted the result is a two-dimensional grid with 12 facets of comfort. Items for comfort questionnaires can be generated from each facet that is relevant to a specific research question

Making the concept of comfort measurable Kolcaba assembled the basis for the development of the theory of comfort. Kolcaba published a middle range-theory of comfort in 1994 suggesting that when comfort is enhanced, patients are strengthened and thus able to engage in health seeking behaviours. In 2001, a subsequent article provided an expansion of the theory to include institutional outcomes. In 2003, Kolcaba published a comprehensive book about the development, testing and application of the theory. Kolcaba does not believe that a focus on comfort is unique to nursing while she believes that her theory can be interdisciplinary and that multiple professions can converge around her theory of comfort providing holistic care to patients. One of the main theory assertions is that when healthcare needs of a patient are appropriately assessed and proper nursing interventions are carried out to address those needs, taking into account variables intervening in the situation, the outcome is enhanced patient comfort over time. Once comfort is enhanced, the patient is likely to increase health-seeking behaviours. These behaviours may be internal to the patient (relief from pain or improved oxygenation), external to the patient (eg. active participation in rehabilitation exercises) or a peaceful death. Furthermore, Kolcaba asserted that when a patient experiences health-seeking behaviours, the integrity of the institution is subsequently increased because the increase in health seeking behaviours will result in improved outcomes. Increased institutional integrity lends itself to the development and implementation of best practices and best policies secondary to the positive outcomes experienced by patients.Holistic comfort theory provides a framework for guiding nurses as they assess, plan, provide and evaluate care for patients while viewing them as whole persons interacting with their environment. Besides guiding nursing practice comfort theory can guide nursing education. This theory can be used to guide the teaching of nurses and nursing students to learn how to provide care that is independent of or in conjunction with medical practice. In research the theory provides a way to validate that there has been improvement in patient comfort after comforting interventions. During the first decade of its existence, the theory has stood up to initial empirical testing. It has been shown in studies that, once the nurse initiates a comfort measure to meet the holistic comfort of the patient, the patient’s comfort is increased over a previous baseline measurement.

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The dramatic changes to care delivery services go beyond the healthcare system predetermined by information technology, acute illness treatment and diagnosis, and product line control. The shifting patterns in caring integrate emphasis on healing and support of patients being represented as individuals with deep psychological, social, and cultural backgrounds. The new approaches to health care and nursing as a profession introduce new teaching-learning perspectives. Embedding theory into practice is the major method within which students should incorporate knowledge on nursing and care. At this point, Wade and Kasper (2006) have developed their Nursing Students’ Perception of Instructor Caring Instrument that involves a two-phase system. The first phase defines the concept of nursing students’ attitude to instructors’ caring, as well as develops and reviews the scale items for clarity and appropriateness

The second phase is the actual process of practicing the instrument. Apart from educational applications, Watson’s caring model can be applied to deal with multicultural environments. In this respect, Suliman et al. (2009) asserts that Watson’s concept of caring is a universal phenomenon that could be applied to patients irrespective to their cultural background. At the same time, the model considers it important to pay attention to the cultural diversity as one of factors that nurses should premise their caring. The relevance of Watson’s theory consists in developing the idea of caring as an inherent component of human being. Thus, health care should not premise on conventional approach to treatment that is dictated in textbooks; rather, nurses should be deeply concerned with the feelings and experiences that their patient undergoes during therapeutic interventions and examinations.

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In summary, the Theory of Comfort is a very practical concept as everyone feels better when they are comfortable. Patients and families are more able and willing to absorb information when they are comfortable and focused. This theory provides simple steps to ensure comfort is being delivered. The Theory of Comfort encourages nurses to think more deeply about rather or not their patient is comfortable, along with what is causing discomfort and what is promoting comfort. It also encourages nurses to document the variation of methods in which a patient becomes comfortable in different settings

A basic nursing knowledge such as an associate’s degree is necessary for utilizing this theory, however in order to understand the written theory in its entirety a more advanced knowledge level proves to be a necessity.

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Sitzman, K. (2007). Teaching-learning professional caring based on Jean Watson’s Theory of Human Caring. International Journal for Human Caring, 11(4), 8-16.

Suliman, W. A., Welmann, E., Omer, T., & Thomas, L. (2009). Applying Watson’s Nursing Theory to Assess Patient Perceptions of Being Cared for in a Multicultural Environment. Journal Of Nursing Research (Taiwan Nurses Association), 17(4), 293-300.

Wade, G., & Kasper, N. (2006). Nursing students’ perceptions of instructor caring: an instrument based on Watson’s theory of transpersonal caring. Journal of Nursing Education, 45(5), 162-168.

Watson, J., & Foster, R. (2003). The Attending Nurse Caring Model: integrating theory, evidence and advanced caring–healing therapeutics for transforming professional practice. Journal of Clinical Nursing, 12(3), 360-365.

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