There are multiple approaches to providing nursing care, and different practitioners and theorists can offer a vast array of models that organize knowledge and practices into systematic understandings of what nurses do and how they should do it. To better understand the role of nursing models and theories in nursing care, two theories can be compared. One of them is the comfort theory, and its application was observed; the other one is the nurse as wounded healer theory, and its application is recommended. Several studies associated with these theories were reviewed to explain the theories and show how they can be used by nurses.
Review of the Comfort Theory
The first theory chosen for comparison is the comfort theory developed by Katherine Kolcaba. The theory addresses the concept of comfort as one of the main considerations for health care providers. It is recognized that providing comfort should be a major purpose of nursing care along with ensuring patient safety and increasing patient satisfaction. A large portion of the theory is dedicated to defining comfort.
It is acknowledged that comfort is rather a challenging notion, and it should be addressed through a wide range of considerations associated with patients’ experiences, physical environment, and understanding of their treatment (Smith & Parker, 2015). First of all, Kolcaba establishes that there are three contributors to patient comfort: health care needs of a patient, comforting interventions, and intervening variables.
Identifying patient needs is the first step toward applying the theory to nursing practice (“Introduction,” n.d.). In studies dedicated to exploring Kolcaba’s theory, it is stressed that the main sources of reliable information about patient needs are patients themselves, i.e. the nurse’s perception of what a patient needs or what nursing interventions should be applied to his or her case should be achieved through communicating with this patient and should not be solely based on nurse’s observations. Second, comforting interventions are any measures a nurse can take to improve patient experiences and meet the needs identified in the first step.
Finally, the theory acknowledges that there may be factors that a nurse cannot address or alter within the framework of care he or she provides. These factors are called intervening variables, and they primarily encompass the state of the patient before he or she started receiving nursing care, his or her financial situation, the patient’s background, the level of support received from families and communities, and similar factors that a nurse cannot change or affect.
In their exploration of Kolcaba’s theory, Smith and Parker (2015) note that this theory is popular because “it describes what expert nurses already know: One of the most important missions for nursing is still to bring comfort to our patients and families, no matter what their circumstances are” (p. 390).
Therefore, it can be assessed that the theory did not signify a breakthrough in the theoretical understanding of nursing care; rather, it presented a model in which known concepts and previously discussed knowledge were summarized into a system and organized in a way that allows a better understanding of connections among them. For example, Kolcaba established that enhanced comfort, which is the primary goal of applying the theory to practice, is interrelated with health-seeking behaviors of patients, and such behaviors, in turn, are interrelated with institutional integrity. The latter concept is understood by Kolcaba as a combination of best policies and best practices.
Krinsky, Murillo, and Johnson (2014) used this theoretical framework in their study of patients who had symptoms associated with discomfort caused by cardiac syndromes, and the use of discomfort as a central concept in this study allowed the authors to provide practical recommendations based on Kolcaba’s theory for promoting patient comfort. Particularly, the authors described “four contexts of comfort: physical, psychospiritual, environmental and sociocultural” (Krinsky, et al., 2014, p. 147).
Similar to Smith and Parker (2015), the authors state that many nurses may use the same considerations in their practice without being aware of Kolcaba’s theory. However, Krinsky et al. (2014) conclude that applying the theory to nursing practice can be beneficial; particularly, as part of their narrow study, they find that the theory provides a valuable perspective on quiet time interventions for cardiac patients.
The experience of seeing the comfort theory in action allows recognizing that the main advantage of applying the theory is acknowledging that comfort is, in fact, an integral need of patients. It might have been previously thought that pain and discomfort are inevitable in treatment, but today, this idea is obsolete, and nursing care providers should focus on making patient experiences as comfortable as possible. There are many ways to do it, but what is important is the idea: a nurse should be dedicated to patients’ comfort, not only their safety and clear understanding of their treatment.
Review of the Nurse as Wounded Healer Theory
The second theory chosen for comparison is the theory of the nurse as wounded healer developed by Marion Conti-O’Hare. Unlike many other nursing theories, including Kolcaba’s comfort theory, the nurse as wounded healer theory focuses on the personal experiences of a nurse (Christie & Jones, 2012).
The theory’s major premise is that there are two outcomes of an individual’s attempts to cope with trauma. On the one hand, an individual may fail to successfully address the effects of trauma, in which case pain remains unresolved, and consequences can be observed in the individual’s behavior for a long time (Schwab, Napolitano, Chevalier, & Pettorini-D’Amico, 2016). On the other hand, an individual may successfully address the effects of trauma, in which case he or she overcomes previous experiences, and they no longer produce adverse effects.
According to Conti-O’Hare, in the latter case, an individual does not only effectively cope with trauma but also acquires the ability to help others cope with their trauma, too. Based on this recognition, it is recommended for nurses to rely on personal experiences of coping with diseases, injuries, and discomfort in their provision of nursing care. Christie and Jones (2012) explore the issue of lateral violence, i.e. “a deliberate and harmful behavior demonstrated in the workplace by one employee to another” (p. 5), and propose Conti-O’Hare’s perspective to address the issue.
The article explains how the experience of resolving personal and professional pain can help create an environment that disenables violence; also, it is suggested that the same technique can be applied to other cases, including various areas of health care. The authors stress that nurses should demonstrate the wounded healer attitude not only to patients but also to themselves and to one another, which is another distinctive feature of the theory in comparison with other nursing care theories.
Conchar and Repper (2014) address a different area of health care: mental health. They stress that the concept of a wounded healer is ancient and observed across cultures; in health care, and mental health services particularly, the concept is especially relevant today due to the practice of involving people with the experience of resolving or addressing personal mental health issues in the process of providing mental health services to patients. A major component of the study’s findings is that nurses with previous traumatic experiences that have been successfully resolved do have different approaches to their work of providing care to patients because their work is more meaningful for them.
The two sources confirm the benefits of applying the nurse as wounded healer theory, but the theory remains questionable today. Particularly, it is still debatable whether a nurse should rely on personal experiences not associated with his or her work in providing care to patients. Kolcaba does not stress personal experience and claims that the needs of patients should be understood through communicating with them; Conti-O’Hare, on the other hand, claims that the experience of overcoming personal trauma should assist nurses in identifying patients needs and providing nursing care.
Along with the comfort theory, the nurse as wounded healer theory can be used to improve practice, as the theory essentially encourages nurses to base the care they provide on techniques previously learned in successful experiences of overcoming trauma and resolving health-related issues.
Conclusion
Kolcaba’s comfort theory explores the concept of comfort and suggests that nurses should heavily rely on communicating with patients when identifying patients’ needs. Conti-O’Hare’s nurse as wounded healer theory suggests that nurses should instead rely more extensively on their experiences of successfully resolving the effects of trauma. The first theory was observed in practice, and the second is recommended, as it is believed that, by combining patient communications and personal experiences, nurses can develop effective tools for helping patients overcome any difficulties they may face during their treatment.
References
Christie, W., & Jones, S. (2012). Lateral violence in nursing and the theory of the nurse as the wounded healer. Online Journal of Issues in Nursing, 19(1), 5-9.
Conchar, C., & Repper, J. (2014). “Walking wounded or wounded healer?” Does the personal experience of mental health problems help or hinder mental health practice? A review of the literature. Mental Health and Social Inclusion, 18(1), 35-44.
Introduction. (n.d.). Web.
Krinsky, R., Murillo, I., & Johnson, J. (2014). A practical application of Katharine Kolcaba’s comfort theory to cardiac patients. Applied Nursing Research, 27(2), 147-150.
Schwab, D., Napolitano, N., Chevalier, K., & Pettorini-D’Amico, S. (2016). Hidden grief and lasting emotions in emergency department nurses. Creative Nursing, 22(4), 249-253.
Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: F. A. Davis.