Evolution of the Mid Range Theory of Comfort for Outcomes Research Katharine Kolcaba, PhD, RN, C
The developmental stages of the mid range theory of comfort are discussed in this article, which includes its philosophic orientation and its inductive, deductive, and retroductive reasoning. Other steps that are described are the concept analysis of comfort, the operationalization of the outcome of patient comfort, the application of the theory in previous nursing studies, and the evaluation of the current theory as it has been adapted for outcomes research. This article is a guide that shows how a concept grows, becomes embedded in theory, is tested, and is adapted for the rapidly changing health care environment. The theory of comfort also offers a way to reconceptualize nurse productivity.
hether theories are grand or mid range (MR), they organize disciplinary thinking and influence practice and research. By definition, grand theories are abstract, complicated, and removed from practice. They are not meant to be easily grasped or tested. Compared with grand theories, MR theories contain fewer concepts and relationships, are adaptable to a wide range of practice and experience, can be built from many sources, and are concrete enough to be tested.1 For these reasons, MR theories are particularly cogent as nursing science addresses the challenges of the 21st century. Foreseeable challenges that the discipline faces in the 21st century include (1) moving beyond descriptive studies to testing relationships between nursing care and desirable outcomes in large populations of patients, (2) building scientific evidence to validate the impact that nursing has on the outcomes that patients care about, (3) conceptualize nursing productivity based on these outcomes, and (4) being ready with theory-based data to support policy formulation that is relevant and visionary. MR theories are helpful for meeting these challenges because they are concrete, adaptable, and easy to use. MR theories also direct the questions to be asked and facilitate significant, positive outcomes because of the congruency that working within a theory necessitates. There are many methods by which MR theory may be produced: armchair theorizing, theorizing from practice, induction, deduction, retroduction, substruction from existing Katharine Kolcaba is an associate professor at the University of Akron College of Nursing, Akron, Ohio.
theory or practice guidelines, or from a combination of these strategies.1 In this article, the evolution of one MR theory, the theory of comfort, will be discussed. The theory states that, in stressful health care situations, unmet needs for comfort are met by nurses. Nursing interventions are successful if enhanced comfort is achieved by patients compared with a previous baseline. The immediate patient outcome of enhanced comfort is theoretically strengthening.2 Thus, enhanced comfort is directly and positively related to patients engaging in health-seeking behaviors (HSBs), called subsequent patient outcomes. Further, when patients are able to engage in HSBs, they report that their satisfaction with health care is high. High patient satisfaction leads to a competitive edge in negotiations with employers and financial viability for the institution(s) involved. Variables that are related to this competitive edge, and which are related to institutional integrity, are called institutional outcomes. This theory is humanistic, holistic, and based on patient needs. The history of how this MR theory was developed is presented.
The theory states that, in stressful health care situations, unmet needs for comfort are met by nurses. PHILOSOPHIC ORIENTATION Kim3 classifies nursing theories into 3 categories on which theorists base their work: (1) human needs, (2) adaptation, and (3) the health/illness continuum. In the first category, clients are viewed in terms of the state that they are in with respect to what they need or...
References: 1. Whall A. The structure of nursing knowledge: analysis and evaluation of practice, middle-range, and grand theory. In: Fitzpatrick J, Whall A, editors. Conceptual models of nursing: analysis and application. 3rd ed. Stanford (CT): Appleton & Lange; 1996. p. 13-24. 2. Kolcaba K. A theory of holistic comfort for nursing. J Adv Nurs 1994;19:1178-84. 3. Kim HS. Introduction. In: Kim HS, Kollak I, editors. Nursing theories: conceptual and philosophical foundations. New York: Springer; 1999. p. 1-7. 4. Fortin J. Human needs and nursing theory. In: Kim HS, Kollak I, editors. Nursing theories: conceptual and philosophical foundations. New York: Springer; 1999. p. 23-54. 5. Kolcaba R. The primary holisms in nursing. J Adv Nurs 1997;25:290-6. 6. Nightingale F. Notes on nursing. London: Harrison; 1859. 7. Bishop S. Logical reasoning. In: Tomey A, Alligood M, editors. Nursing theorists and their work. St. Louis (MO): Mosby; 1998. p. 43-54.
comfort Box 2. Assumptions underpinning the theory of comfort
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VOLUME 49 • NUMBER 2
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