Orem’s Self Care Deficit Theory and Theory of Comfort- Katherine Kolcaba PO
Based on the reading assignment (McEwen & Wills, Theoretical Basis for Nursing, Unit II: Nursing Theories, chapters 6–9), select a grand nursing theory. CITE THIS SOURCE AS WELL PLUS 3 MORE SOURCES
After studying and analyzing the approved theory, write about this theory, including an overview of the theory and specific examples of how it could be applied in your own clinical setting.
Based on the reading assignment (McEwen & Wills, Theoretical Basis for Nursing, Unit II: Nursing Theories, chapters 10 and 11), select 2 middle-range theories- OREM’S SELF CARE DEFICIT THEORY AND THEORY OF CONFORT-KATHERINE COLCABA
After studying and analyzing the approved theories write about this theory, including an overview of the theories and specific examples of how it could be applied in your own clinical setting.
The following should be included:
An introduction, including an overview of both selected nursing theories
Background of the theories
Philosophical underpinnings of the theories
Major assumptions, concepts, and relationships
Clinical applications/usefulness/value to extending nursing science testability
Comparison of the use of both theories in nursing practice
Specific examples of how both theories could be applied in your specific clinical setting
References: Use the course text and a minimum of three additional sources, listed in APA style
The paper should be 8–10 pages long and based on instructor-approved theories. It should be typed in Times New Roman with 12-point font, and double-spaced with 1″ margins. APA style must be used, including a properly formatted cover page, in-text citations, and a reference list. The proper use of headings in APA style is also required.
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There are several mid-range nursing theories in nursing. Mid-range theories possess a specific focus while offering strong connections between grand nursing theories and nursing. The various concepts in mid-range nursing theories are more verifiable through testing and are less abstract. Middle-range theories provide an easy way of describing, explaining, and predicting various phenomena in clinical practice settings (McEwen & Wills, 2018).
Orem’s self-care deficit theory is an example of a grand nursing theory. Orem’s theory covers a wide scope and provides a general concept applicable to various instances of nursing practice. Orem’s theory highlights different incidences where patients need to bring out the best of themselves despite being ill. This is normally the case in various healthcare settings where patients will be entitled to remaining more independent after receiving adequate care from nurses and physicians (Borji et al., 2017).
On the other hand, Kolcaba’s Theory of Comfort is considered a middle-aged theory. This theory can therefore be applied in specific situations in Healthcare practice research and education. Kolcaba’s Theory of Comfort places comforts at the center of health care practices. According to Kolcaba, comfort will be the immediate desirable outcome of all nursing interventions (Pinto et al., 2017).
Background of the Theories
Orem’s Self Care Deficit Theory
Orem’s theory was developed by Dorothea Elizabeth Orem, who had a distinguished career in nursing. Orem nursing theory views nursing as a discipline entails helping others in the providing and managing of self-care and in improving and maintaining of human functioning at effectiveness of home level. Orem’s theory evaluates the ability of an individual to perform different self-care activities which are described as activities individuals may begin and perform effectively to contribute to personal life, health, and well-being (Younas, 2017). Dorothea Orem published her work titled ‘Nursing: Concepts of Practice’ in 1971, where she outlined her nursing theory. The success of the self-care deficit theory highlighted by Orem in her 1971 work established her as the leading theorist in nursing education and practice (Younas, 2017).
Kolcaba’s Theory of Comfort
Kolcaba drew up the theory of comfort in the 1990s through concept analysis of comfort and examination of literature from different disciplines such as nursing, medicine, psychiatry, ergonomics, psychology, and English. Eventually, Kolcaba developed three forms of comfort, and four contexts of holistic human experience and a taxonomic structure to guide in the measuring, assessing and evaluating the comfort of patients. According to Kolcaba, comfort will therefore be a product of the holistic art of nursing (Pinto et al., 2017).
Philosophical Underpinnings of the Theories
When evaluating Orem’s theory, it is important to consider the philosophical framework on which the theory was built and the pre-existing theoretical foundations. Orem’s theory was established in various stages, with each stage involving creating new sets of tenets through which various theoretical principles would be applied. In this regard, Orem’s theory included three more theories that consider the application of the framework to the various unique needs of patients and making the theory extremely applicable to increasing efficiency (Didisen et al., 2017). Orem’s theory can therefore be viewed as the original theory that led to an increased interest in the establishment of a comprehensive framework related to individual caring of one’s health. The concept of self-care is therefore central to Orem’s theory and includes the behaviors and activities that various patients have to initiate in order to maintain their health at required levels. Although the general assumption is that the need for healthcare will be inherent among everyone, individuals will need directions from various Healthcare providers So that the efforts to maintain proper health levels will have a tangible effect. In Orem’s theoretical framework, the ability of a patient to recognize their own health care needs and cater for them is defined as a health care agency. According to Orem, therapeutic self-care demand will be the different actions that need to be taken so as to meet certain health standards. Self-care requisites is, therefore, the process that is needed to perform various actions related to healthcare (Didisen et al., 2017).
Kolcaba utilized logical reasoning to draw up the theory of comfort. Kolcaba argued that we live on deduction induction and reduction in her theory. Kolcaba also relied on a pre-existing framework from the exploration in a personality book written by Henry Murray as her antecedent. In his book, Murray highlighted that psychologists should take time to study the personality of individuals holistically (Pinto et al., 2017). Murray’s observations laid a foundation for the theory of comfort, as comfort is mostly achieved from holistic treatment of the individual. In the formulation of her theory, Kolcaba conducted the concept of analysis of the term comfort. The comfort theory also relies on the metaparadigm propositions of various nursing actions (Oliveira et al., 2020). This is because the theory of comfort tries to evaluate the lack of comfort among an individual and also monitors patients to evaluate actions or implementations that are made. A philosophical claim can therefore be made that the comfort theory is based on human needs. The core components can therefore be explored in the philosophical underpinnings of the theory of comfort. The first component is that cultural and social politics will go a long way in influencing patient expectations. The second is that there will be a significant motivation in human behavior. The comfort needs of various patients will therefore be determined by specific expectations of holistic nursing care is and the competence of such nursing care (Oliveira et al., 2020).
Major assumptions, concepts, and relationships
Orem’s self-care deficit theory makes several assumptions which include that humans need to connect constantly and communicate among themselves and their environment to remain functional and stay alive (Younas, 2017). Orem also makes an assumption that human beings have power to act intentionally in the making of needed judgments and identifying needs. Orem’s theory assumes that adult human beings will experience different actions that involve making function regulating actions and life-sustaining actions for themselves and for others. Orem also provides an assumption that in a group with structured relationships, human beings will allocate responsibilities and tasks of providing care to various group members. Finally, human agency will be exercised in the transmission, discovery, and development and other ways involved in the identification and making input to others and self (Didisen et al., 2017).
Relating to the major concepts of the self-care deficit theory Orem defines nursing as an art that involves a healthcare practitioner giving professional assistance to patients to enable them to meet their self-care needs. On the other hand, Orem defines humans as recipients of care either individually or in social units and will be the material objects for those who provide direct care and nurses. On the other hand, Orem defines the environment as having various features, including the culture, family, and the community (Borji et al., 2017). Orem also views health as being structurally or functionally sound. Health is also a state that will include both the health of groups and individuals and the ability of human beings to symbolize experiences that reflect on oneself and effectively communicate with others according to Orem. Self-care is the performance of activities that individuals initiate or perform in the maintenance of health, life, and well-being (Borji et al., 2017).
According to Orem, all human beings will have self-care agency which is the ability to engage in various self-care activities. The self-care agency of every individual will therefore be affected by the basic conditioning factors. The basic conditioning factors of an individual include gender, health state, developmental state, health care system factors, sociocultural orientation, patterns of living, family system factors, resource adequacy, resource availability, and environmental factors (Didisen et al., 2017). On the other hand, therapeutic self-care demand will be the total Self-care actions that can be performed at a given time to meet the self-care requisites by utilizing different sets of actions, methods, and operations. Self-care deficit will therefore cause the need for nursing. Nothing will therefore be required when an adult or individual is incapable or limited to provide effective and continuous self-care.
The central assumption of Kolcaba’s theory of comfort are that human beings possess a holistic response to complex stimuli. In this regard, comfort will be the desirable holistic outcome to the discipline of nursing. Comfort is also an essential human need that every human being will struggle to meet or have met. By possessing enhanced comfort, patients will be able to engage more in health-seeking behavior of their choice (Sharma & Kalia, 2021).
On the other hand, the major concepts in Kolcaba’s theory of comfort.
Include healthcare needs intervening variables, comfort interventions, comfort, and health-seeking behaviors. Kolcaba defines healthcare needs as the needs of comfort that might not be met by the traditional support system of a given patient. This includes sociocultural needs, psycho-spiritual needs, physical and environmental needs. On the other hand, comfort interventions are the various actions that are designed to address the specific comfort needs of a patient. Intervening variables will be the various forces that will interact to influence the perception of recipients of what is referred to as total comfort (Sharma & Kalia, 2021). These include past experiences, attitudes, support system, emotional state, education, and finances. On the other hand, comfort is the immediate and holistic experience that is normally strengthened when the needs related to ease, relief, and transcendence are addressed. Finally, health-seeking behavior other behaviors that individuals perform to pursue health (Oliveira et al., 2020).
The clinical applicability of Orem’s self-care deficit theory is in outpatient settings. Healthcare practitioners can therefore evaluate the effectiveness of the theory by comparing the post-discharge outcomes of patients which occur as a result of self-care and the outcomes of patients in healthcare settings that are as a result of patients receiving care from nurses. Such an evaluation can therefore help healthcare practitioners to understand whether patients are able to effectively meet the health care needs of patients (Borji et al., 2017).
The theory of comfort does not highlight a specific evaluation process that can be used in nursing processes. However, following processes, a nurse will know if they have achieved adequate comfort with various nursing assessments. The best way to measure comfort in patients, therefore, is to use the various assessments to evaluate various interventions. However, as a high middle-range theory, the theory of comfort is quite abstract and is difficult to evaluate definitively (Oliveira et al., 2020).
Orem’s theory does not have numerous assumptions and explains its concept clearly, with the main points that are highlighted being self-care needs. All the concepts of Orem’s self-care deficit theory seek to explain how individuals satisfy their self-care needs and causes of self-care deficit.
Kolcaba’s Theory of Comfort possesses the meaning of clarity. However, the conceptual diagram and the propositions in theory are the clearest components. I believe that the theory would have been more understandable if it had been explained in more clear terms.
Comparison of the use of both theories in nursing practice
In nursing practice settings, Orem’s theory can be used by healthcare practitioners to understand the healthcare needs of patients by determining their self-care deficit. Utilizing Orem’s theory, healthcare practitioners can therefore focus on addressing the specific self-care deficit of patients while giving such patients the autonomy to address the health care needs that they possess the ability to address (Didisen et al., 2017). On the other hand, Kolcaba’s Theory of Comfort can be used in nursing practice settings by healthcare practitioners to understand the various interventions that they can adopt to improve the comfort of their patients utilizing Kolcaba’s theory nurses and therefore to understand the main goal of nursing practice is to provide comfort to patients (Oliveira et al., 2020).
Application of theories in my clinical setting
In my clinical setting of an acute care facility, Orem’s self-care deficit theory can be used by healthcare providers to understand the specific needs of various patients and the self-care deficits that make them visit the health care facility. Healthcare practitioners can then focus on the specific Healthcare deficits of the patients in the acute care facility.
On the other hand, Kolcaba’s theory of comfort can be applied in an acute care facility to promote comfort among patients, such as establishing a conducive Healthcare environment that promotes active recovery in patients.
In summary, there are several middle-range nursing theories in nursing. Middle-range nursing theories tend to have a more specific focus and also offer more concrete connections between grand nursing theories and nursing practice. The various concepts of middle-range nursing theories are more verifiable through testing and less abstract. Middle-range theories provide an easy way of describing, explaining, and predicting various phenomena in clinical practice settings. Orem’s self-care deficit theory is an example of a grand nursing theory. Orem’s theory covers a wide scope and provides a general concept that can be applied to all instances of nursing practice. On the other hand, Kolcaba’s theory of comfort is considered a middle-aged theory. This theory can therefore be applied in specific situations in healthcare practice, research, and education. Kolcaba’s theory of comfort, therefore, places comfort at the center of health care practices.
Borji, M., Sharifi, A., Otaghi, M., & Kazembeigi, S. (2017). The Impact of Orem’s Self-Care Model on the Quality of Life in Patients with Type II Diabetes in Ilam. Biomedical and Pharmacology Journal, 10(1), 213–220. https://doi.org/10.13005/bpj/1100
Didisen, N. A., Binay, S., & Yardimci, F. (2017). Orem’s Self-care Deficit Theory and Nursing Care in Relation to Pneumonia: A Case Report. Studies on Ethno-Medicine, 11(4), 311–317. https://doi.org/10.1080/09735070.2017.1357223
McEwen, M., & Wills, E. M. (2018). Theoretical Basis for Nursing (5th ed.). LWW.
Pinto, S., Fumincelli, L., Mazzo, A., Caldeira, S., & Martins, J. C. (2017). Comfort, well-being and quality of life: Discussion of the differences and similarities among the concepts. Porto Biomedical Journal, 2(1), 6–12. https://doi.org/10.1016/j.pbj.2016.11.003
Sharma, M. C., & Kalia, R. (2021). Testing Katharine Kolcaba Theory of Comfort. Journal of Pediatric Surgical Nursing, Publish Ahead of Print. https://doi.org/10.1097/jps.0000000000000320
Younas, A. (2017). A Foundational Analysis of Dorothea Orem’s Self-Care Theory and Evaluation of Its Significance for Nursing Practice and Research. Creative Nursing, Oliveira, S. M. D., Costa, K. N. D. F. M., Santos, K. F. O. D., Oliveira, J. D. S., Pereira, M. A., & Fernandes, M. D. G. M. (2020). Comfort needs as perceived by hospitalized elders: an analysis under the light of Kolcaba’s theory. Revista Brasileira de Enfermagem, 73(suppl 3). https://doi.org/10.1590/0034-7167-2019-0501