NUR 501 Module 3 Assignment Middle Range Theory Utilization & Application Paper

Nurses work in diverse healthcare settings, encountering patients with varying needs. Nurses’ professional and ethical obligation underlines the need for a detailed assessment of the needs and an effective response through holistic care. Nursing theories provide frameworks for implementing and evaluating patient care. Middle-range theories are more specific in focus and verifiable than grand nursing theories, allowing them to offer more concrete connections between theory and practice (Smith et al., 2023). Understanding their application and relevance in the clinical practice can help nurses deliver excellence, irrespective of the setting. The purpose of this paper is to explore a middle-range theory with particular attention to its utilization and application in practice.

Components of the Theory

Nursing practitioners and researchers develop theories based on their experiences with patient care and a critical evaluation of interventions that improve outcomes. Katharine Kolcaba developed the Theory of Comfort (TC) in 1994 based on the observed or provided patient care in various settings like the operating room, medical/surgical units, and long-term facilities (Vo et al., 2020; Schmidt & Brown, 2024). The theory’s basic components include elements that enhance comfort: relief, ease, and transcendence. From Kolcaba’s perspective, comfort is the holistic experience acquired after the relief, ease, and transcendence needs are addressed (Lin et al., 2023; Martin et al., 2022). Relief denotes the unmet comfort needs that are typically severe. Hence, relief occurs when a comfort need is met. The element of ease stresses the need to prevent issues that make someone uncomfortable; thus, it is associated with calmness and contentment. Transcendence means a care experience that enables the person to overcome health problems or pain.

Kolcaba suggested that holistic care that enhances comfort is implemented under four domains: physical, psychospiritual, sociocultural, and environmental. According to Lin et al. (2023), the physical domain is primarily about bodily sensations and functions, while the psychospiritual aspect represents elements such as self-esteem, life meaning, and connection to a higher power. The third domain, sociocultural, refers to someone’s relationships with others, mainly family and friends. The environmental domain represents the external world, like nature (Vo et al., 2020). The needs under each domain should be addressed to enhance comfort.

The comfort theory’s philosophical underpinnings are that humans respond to multidimensional stimuli holistically, and comfort is the outcome of the holistic process that influences healthy choices. In this case, patients and their families are motivated to engage in health-seeking behaviors once their comfort is enhanced. The desire to engage fully in healthy choices may occur consciously or subconsciously, provided that a stimulus (comfort) is present.

Structural Aspects of the Theory

Kolcaba’s theory is established on the Conceptual Framework for Comfort Theory (Appendix A). The framework proposes that the process of achieving positive patient outcomes starts with healthcare professionals (HCPs) assessing the patients’ or family members’ comfort needs (Lin et al., 2023). The detailed assessment of these needs guides HCPs in designing appropriate interventions while considering intervening variables. In a clinical setting, intervening variables are factors that nursing professionals cannot easily change, such as financial resources and the patients’ extent of social support (Lin et al., 2023). Next, HCPs evaluate comfort before and after implementing the interventions. Adherence to this process promotes health-seeking behaviors and enhances the institution’s integrity. Dominant markers of improved integrity include a higher value, financial stability, and the wholeness of an institution at the community, state, and national levels.

Application in a Practice Area

Patients visiting the emergency unit have complex physical and mental health needs. Their conditions are characteristically painful, necessitating a caring and comfortable care environment. Kolcaba’s comfort theory helps to answer various questions regarding care for critically ill patients. For instance, TC helps nursing professionals design care that will effectively respond to the stressful experiences of children and adults during emergency room visits. As Freire et al. (2020) noted, integrating the theory into inpatient care can help nursing practitioners to create comfort and behaviors that make patients and their families comfortable. Importantly, TC helps to answer the question of how nurses can structure the care process to prevent adverse physiological complications and ensure improvements in the patient’s mental and physical health.

Emergency care necessitates a holistic procedure to promote healing and encourage health-seeking behaviors. Given this, Lin et al. (2023) stressed the need for nurses to implement solutions that relieve patients and help them identify the causes of their discomfort and overcome it. As nurses design interventions to address patient needs, they should strive to address needs to accomplish relief, ease, and transcendence, as the TC proposes. The TC framework suggests a procedural approach where the critical outcome (comfort) is measured before and after the intervention (Lin et al., 2023). A similar approach is appropriate in emergency settings to ensure the desired health goals and guide nurses in making the necessary treatment adjustments as situations prompt. The outcome-driven nature of TC and its focus on comfort validate its applicability in emergency settings.NUR 501 Module 3 Assignment Middle Range Theory Utilization & Application Paper

A theory’s strengths and weaknesses help healthcare practitioners determine its relevance and appropriateness in practice. A key strength of the TC is its observable and easily measurable variables. Therefore, it is easy to implement and evaluate. Besides, comfort is a critical component of patient care needed for patients in all settings. However, which is a considerable limitation, it is challenging to determine whether all patients seek and approve genuine encounters that enhance comfort (Vo et al., 2020). Despite the differences in patient values and preferences, TC application promotes positive care experiences in general.

Use of Theory in Clinical Practice

Theories provide frameworks for structuring patient care, executing processes, and measuring outcomes. Nursing research demonstrates TC as a suitable model for promoting holistic care. In this case, nurses apply it to address the patients’ multidimensional needs as the environmental, social, and physical conditions necessitate. For instance, Freire et al. (2020) evaluated its application in the context of patients with chronic kidney disease. Guided by the fundamental concepts of the TC, care providers addressed issues causing discomfort related to physical, environmental, psychospiritual, and social variables. Freire et al. (2020) found that the approach enabled healthcare professionals to assist patients holistically based on promoting comfort. These findings highlight the significance of TC in clinical settings and why it should be used to maximize patient outcomes.

TC is also applied as a guide for improving the mental health of healthcare practitioners. As Vo et al. (2020) stated, nurses working in demanding work environments, such as caring for COVID-19 patients, experience health issues that can be addressed through interventions that implement the TC recommendations. In this study, the authors highlight some practices for nurses to optimize their mental health following the TC framework. For instance, practicing nurses were advised to take vacations to attain environmental relief, ease, and transcendence. Mediation and engaging in appropriate religious practices were identified as suitable practices for achieving and sustaining psychospiritual transcendence (Vo et al., 2020). Given the critical need for a mentally stable workforce, such practices should be reinforced, and nurses supported accordingly.

Evaluation of Theory

Nursing literature explains the key concepts and domains of the TC straightforwardly. The concepts are explained, and their practice application is demonstrated in detail, making it easy to understand and link with the present patient care. The theory is also demonstrated as universally applicable in clinical practice and with specific procedures that introduce excellent nursing practice (Martins et al., 2022). Regarding anticipated difficulties, there are no specific tools to measure comfort accurately and universally. In this case, it would be challenging to determine whether maximum comfort has been accomplished after a particular intervention or whether some adjustments are necessary. Regarding the strategies to make TC more usable or applicable to practice, Castro et al. (2021) found that an interdisciplinary approach to its implementation in oncology palliative care optimizes patient outcomes. Accordingly, interprofessional collaboration should be stressed when delivering patient care guided by the TC framework.

Conclusion

Patients require high-quality care that addresses their multidimensional needs comprehensively. Nursing theories provide frameworks for structuring patient care to achieve specific outcomes. TC’s fundamental principle is comfort, which is characterized by relief, ease, and transcendence. As discussed in this paper, TC can be applied in emergency care and other settings to maximize comfort in a healing environment. It is also the foundation of holistic care and a guide for mental health promotion among nursing professionals. To make it more applicable to practice, healthcare professionals should embrace an interdisciplinary approach to deliver the best outcomes for patients and families.

 

 

References

Castro, M. C. F. D., Fuly, P. D. S. C., Santos, M. L. S. C. D., & Chagas, M. C. (2021). Total pain and comfort theory: implications in the care to patients in oncology palliative care. Revista Gaúcha de Enfermagem, 42, e20200311. https://doi.org/10.1590/1983-1447.2021.20200311

Freire, S. D. M. L., Melo, G. A. A., Lima, M. M. D. S., Silva, R. A., Caetano, J. Á., & Santiago, J. C. D. S. (2020). Contexts of experience of being (un) comfortable in patients with chronic kidney disease. Escola Anna Nery, 24, e20190326. https://doi.org/10.1590/2177-9465-EAN-2019-0326

Lin, Y., Zhou, Y., & Chen, C. (2023). Interventions and practices using Comfort Theory of Kolcaba to promote adults’ comfort: an evidence and gap map protocol of international effectiveness studies. Systematic Reviews, 12(1), 33. https://doi.org/10.1186/s13643-023-02202-8

Martins, A. G., Sousa, P. P., & Marques, R. M. (2022). Comfort: theoretical contribution to nursing. Cogitare Enfermagem, 27, e85214. http://dx.doi.org/10.5380/ce.v27i0.87723

Sepahvand, F., Valizadeh, F., & Khanjarian, F. (2021). Application of Kolcaba’s theory of comfort for a 12-year-old epileptic adolescent admitted to the emergency room: a case study. Interdisciplinary Journal of Acute Care, 2(1), 31-41. DOI: 10.22087/ijac.2021.146338

Schmidt, N. A., & Brown, J. M. (2024). Evidence-based practice for nurses: Appraisal and application of research. Jones & Bartlett Learning.

Smith, M. J., Liehr, P. R., & Carpenter, R. D. (Eds.). (2023). Middle range theory for nursing. Springer Publishing Company.

Vo, T. (2020). A practical guide for frontline workers during COVID-19: Kolcaba’s comfort theory. Journal of patient Experience, 7(5), 635-639. https://doi.org/10.1177/2374373520968392

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Middle Range Theory Utilization & Application Paper

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Goal:

Analyze and evaluate a middle range theory.  You will select a middle range theory and identify application of nursing theories into clinical practice.
Content Requirements:

1. Components of the theory

• • Discuss the major concepts of the theory
  • Philosophical basis or worldview change, advancing health

1. Structural aspects of the theory

• • Discuss the framework of the theory.

1. Identify an area of your practice where this theory could be applicable

• • What question does the theory help to answer?
  • Describe the area of interest in relationship to the theory/theoretical model.
  • Is it appropriate for the practice setting and is it applicable?
  • Discuss the strength and weakness of the theory. If there is weakness, discuss what makes it difficult to be used in practice.

1. Use of theory in clinical practice.

• • Performing a literature review is essential to completing this section. If there is no literature available about the application of this theory in practice, address reason(s) why based on your findings.

1. Evaluation of theory

• • Is this theory used to understand and apply into practice?
  • What difficulties did you encounter or would anticipate encountering in using this theory?

• • What would make this theory more usable or applicable to practice?

Submission Instructions:

• The paper is to be clear and concise and students will lose points for improper grammar, punctuation and misspelling.
• The paper should be formatted per current APA and references should be current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions.)
• The paper is to be 3 – 5 pages in length, excluding the title, abstract and references page.
• Incorporate a minimum of 3 current (published within last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles and books should be referenced according to current APA style.
• Complete and submit the assignment by 11:59 PM ET Sunday.

Grading Rubric

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Your assignment will be graded according to the grading rubric.

Essay/Paper Rubric
Criteria	Ratings				Points
Identification of Main Issues/Problems	Distinguished – 4 points Identify and demonstrate a sophisticated understanding of the issues/problems.	Excellent – 3 points Identifies and demonstrate an accomplished understanding of most of issues/problems.	Fair – 2 points Identifies and demonstrate an acceptable understanding of most of issues/problems.	Poor – 1 point Identifies and demonstrate an unacceptable understanding of most of issues/problems.	4 points
Analysis and Evaluation of Issues/Problems	Distinguished – 4 points Presents an insightful, thorough analysis and evaluation of issues/problems.	Excellent – 3 points Presents a thorough analysis and evaluation of most of the issues/problems.	Fair – 2 points Presents a superficial or incomplete analysis and evaluation of issues/problems.	Poor – 1 point Presents unacceptable analysis and evaluation of issues/problems.	4 points
Demonstrates a Conceptual Understanding	Distinguished – 4 points Provides a thorough, competent and interpretive responses to all issues/problems, and shows a high level of conceptual understanding.	Excellent – 3 points Provides a competent and interpretive responses to all issues/problems, and shows a moderate level of conceptual understanding.	Fair – 2 points Provides a competent responses to all issues/problems, but lacks interpretation and a moderate level of conceptual understanding.	Poor – 1 point Provides an unacceptable response to all issues/problems, and lacks interpretation and a moderate level of conceptual understanding.	4 points
Use of Citations to Course Readings and Additional Research/Literature	Distinguished – 4 points Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing.	Excellent – 3 points Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.	Fair – 2 points Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing.	Poor – 1 point Ineffectively uses the literature and other resources to inform their work. Unacceptable use of citations and extended referencing.	4 points
Writing Mechanics and APA Formatting Guidelines	Distinguished – 4 points Demonstrate a high level of clarity, precision, and attention to detail. APA style is correct and writing is free of grammar and spelling errors.	Excellent – 3 points Demonstrate a high level of clarity. APA style and writing mechanics need more precision and attention to detail.	Fair – 2 points Demonstrate a moderate level of clarity. APA style and writing mechanics need more precision and attention to detail.	Poor – 1 point Demonstrates issues in writing and communicating clearly. APA style and writing mechanics need serious attention.	4 points
Total Points					20