Nursing practice, as a professional discipline focused on the promotion of human health, derives from a broad pool of knowledge that comprises a plethora of theories, principles, and pieces of research evidence. In fact, theories and models drive the practice of nursing and substantially affect it. Theories significantly vary in degrees of their focus and applicability to certain situations. According to Masters (2015), “the theory that is broad in scope and highly abstract conceptually may be referred to as a grand theory, whereas the theory that has a narrow scope and is more concrete and practical may be referred to as a middle-range theory” (p. 7). Considering these differences, the present paper will have a purpose to examine how grand and middle-range theories may be applied in research, focusing on the discussion of two empirical studies that used Dorothea Orem’s Self-Care Theory and Katharine Kolcaba’s Comfort Theory. As a result of the review, it will be possible to identify the value and utility of the selected theories, as well as their impacts on nursing.
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Grand Nursing Theory: Orem’s Self-Care Theory
In their study, Saeedifar, Memarian, Fatahi, and Ghelichkhani (2018) utilized Orem’s Self-Care Theory to design an educational intervention program aimed to improve self-care capacities of patients with rheumatoid arthritis. The researchers focused on the ability of the selected model to contribute to the reduction of pain – one of the main disease symptoms. Saeedifar et al. (2018) argued that since traditional methods and medications used to treat chronic pain are associated with significant side effects and high costs, self-care promotion can become a safe and effective alternative tool for pain control.
With this in mind, the researchers conducted a randomized clinical trial in which they examined the effectiveness of care systems developed based on such concepts of Self-Care Theory as a self-care deficit and nursing agency. Overall, these concepts suggest that when a person lacks abilities to engage in self-care activities in daily life, their dependence on nursing systems increases (Saeedifar et al., 2018). In other words, in the context of a self-care deficit, there is a need to implement nursing systems that would help patients maintain health and improve their self-care agency. Thus, after examining study participants’ needs (knowledge, attitudes, skills, family support, and others), Saeedifar et al. (2018) created and implemented three different types of care systems – wholly compensatory, partly compensatory, and supportive-educative – that differed in terms of content, intensity, and care duration. As a result, it was revealed that the implementation of the Self-Care Theory increases patients’ perceptions of self-efficacy and engagement in independent disease management. Therefore, it is valid to conclude that the use of Orem’s model for intervention of health-related behaviors, as well as reduction of pain in rheumatoid arthritis, can lead to positive outcomes.
Middle-range Nursing Theory: Kolcaba’s Comfort Theory
In their qualitative study, Bergström, Håkansson, Warrén, and Bjerså (2018) applied Kolcaba’s Comfort Theory to nursing practice in a preoperative environment. The researchers argued that since preoperative experiences are characterized by a high level of distress and anxiety, they may negatively affect the recovery of patients even after the surgery. Considering this, it is pivotal to implement such patient care approaches that can reduce anxiety and provide patients with comfort, and the Comfort Theory can help practitioners to achieve this by offering a model aimed at meeting individuals’ holistic needs.
Kolcaba distinguishes three basic states of comfort: ease, relief, and transcendence (Bergström et al., 2018). Bergström et al. (2018) define ease as “the absence of discomfort,” relief – as “a state where all needs are met,” and transcendence – as “a state of elevating oneself over the current situation despite the presence of discomfort” (p. 163). The goal of nursing is to foster those states by preventing events that may provoke discomfort, assessing patient needs, dressing them effectively through appropriate interventions, and providing psycho-emotional support to individuals through various communication strategies. Based on this, the researchers developed a protocol for the assessment of physical, psychospiritual, environmental, and sociocultural needs of patients that anesthetist nurses working in preoperative environments implemented in the study. The findings revealed that the use of the Comfort Theory allows better identification of individuals’ comfort needs since it encourages nurses to actively evaluate the hospital environment and inquire patients about their feelings and symptoms (Bergström et al., 2018). The research project verified that this theory can inform nurses’ practice and guide them in their decision-making.
Impact on Nursing Practice
The review results make it clear that both of the selected theories can be empirically tested and translated into practice even though it seems that the grand theory can be applied to a greater number of situations because of its conceptual breadth. Saeedifar et al. (2018) focus on a specific population of female patients with rheumatoid arthritis in their research, yet Hartweg (2015) notes in her review of Orem’s theory that it is also effectively examined in a plethora of studies devoted to a large number of patient populations, diseases, and health conditions, including diabetes, obesity, and lymphedema. The theory seems to be particularly useful and valuable in designing educational interventions aimed to increase patient motivation and improve health-literacy (Hartweg, 2015). Thus, it impacts nursing practice by helping practitioners to select the right communication and intervention strategies. In addition, it advances the discipline of nursing by assisting in the identification of links between individual and healthcare variables, such as patient behaviors and nursing care approaches, that define the overall health outcomes.
It is valid to say that the Comfort Theory has the same purposes as Orem’s theory but it provides more specific behavioral prescriptions for nurses by focusing on the promotion of comfort. It also seems that this middle-range theory can be effectively utilized merely when working with hospitalized patients. Nevertheless, its value in the promotion of a better quality of care cannot be underestimated. Moreover, Kolcaba (2015) states that her theory informs practitioners on how to become competent nurses by expanding their knowledge of the holistic care principles and demonstrating the significance of psychological and social factors in human health. This feature of the theory – provision of a specific strategy for the realization of holistic care – defines its contribution to the advancement of the nursing discipline.
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According to Masters (2015), different theories “evolve from a perception of ideal nursing practice” (p. 7). They serve to illustrate desirable professional behaviors and set up objectives, which healthcare practitioners should aspire to achieve in order to improve their performance. As the examples of the analyzed grand theory of self-care and middle-range theory of comfort indicate, theories may also target distinct aspects of nursing. For instance, Orem’s theory addresses individual self-care capacity and suggests ways for its improvement through patient education and other nursing interventions. Kolcaba’s theory is centered on the identification of patient needs and emphasizes the significance of holistic care. The two theories offer different ways to advance the nursing discipline. As the results of the literature review revealed, both of them can be tested through research and used by nurses as a reference in designing various practice strategies. Nevertheless, the grand theory can be applied to a greater number of healthcare scenarios, problems, and populations since it is more abstract, while the range of the middle-range theory application is narrower since it is more specific.
Bergström, A., Håkansson, A., Warrén, S., & Bjerså, K. (2018). Comfort theory in practice-nurse anesthetists’ comfort measures and interventions in a preoperative context. Journal of PeriAnesthesia Nursing, 33(2), 162-171.
Hartweg, D. L. (2015). Dorothea Orem’s self-care deficit nursing theory. In M. C. Smith & M. E. Parker (Eds.), Nursing theories and nursing practice (4th ed.) (pp. 105-132). Philadelphia, PA: F. A. Davis Company.
Kolcaba, K. (2015). Katharine Kolcaba’s comfort theory. In M. C. Smith & M. E. Parker (Eds.), Nursing theories and nursing practice (4th ed.) (pp. 381-391). Philadelphia, PA: F. A. Davis Company.
Masters, K. (2015). Nursing theories: A framework for professional practice (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Saeedifar, E. S., Memarian, R., Fatahi, S., & Ghelichkhani, F. (2018). Use of the Orem self-care model on pain relief in women with rheumatoid arthritis: A randomized trial. Electronic Physician, 10(6), 6884-6891.