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
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 Call for Manuscripts Nursing Outlook welcomes manuscripts related to nursing education, practice, or research or to health care policy and delivery. Please submit manuscripts to the Editor at the following address: Carole A. Anderson, PhD, RN, FAAN The Ohio State University College of Nursing 1585 Neil Avenue Columbus, OH 43210 For details about the Journal’s editorial policy and manuscript preparation, see the Information for Authors pages. 92 VOLUME 49 • NUMBER 2 NURSING OUTLOOK