Traditionally, nursing theories took the form of rules, beliefs and customs (Chinn and Kramer, 2004) without any questioning on routine practice. As a result, the experienced nurse was judged by a combination of a caring outlook and some technicalities which were obtained through hospital-based prentice training (Lasiuk and Ferguson, 2005). Moreover, the nursing discipline relied on few theories which were also borrowed from other disciplines [ibid]. Notwithstanding, a significant revolution in the discipline occurred when the American Nurses Association (in 1965) formally declared theory development as the goal of the profession (Meleis, 1997). Few years after this declaration led to the publishing of grand theories and conceptual models which served as the theoretical foundations of nursing programs.
Current trends toward the development and testing of middle range and practice theories resulted from Meleis’ (1997: 128) impassionate appeal for a “reVisioning” of the goals of nursing research. The nursing discipline requires an integration of theory, practice and research to achieve professional accountability (Gortner, 1973). This is because each is imperative and mutually beneficial. Theory provides a framework for directing practice and research (McEwen, 2007) and can lead to theory generation (Chinn and Kramer, 2004).
I am a general nurse who was recently working at the Komfo Anokye Teaching Hospital. It is the second largest hospital and serves as the main referral centre for the Ashanti Region and some parts of the Eastern, Central, Northern and Western Regions of Ghana (Buabeng, Matowe and Plange-Rhule, 2004). I was working on a general surgical ward dealing with preoperative and postoperative patients. From my practice, I realised that postoperative pain was a common problem among surgical patients in spite of various advances in pain management (Carr and Goudas, 1999, Donovan, 1990 and Long, 2000). In my search for a nursing theory that can be applicable in my clinical setting (surgery), I find Kolcaba’s middle range theory of comfort to be very useful because it deals with the comfort needs of patients.
The aim of the essay is to apply a nursing theory to a phenomenon of interest in my clinical practice. It will commence with a case study from my practice, followed by a critical reflection based on Carper’s epistemological patterns in nursing. The essay will continue with a brief literature review on the main concepts identified in the reflection. Following this, Kolcaba’s Comfort Theory will be described, analysed and applied to my practice area (surgical setting). Finally, the essay will end with my conclusions about this nursing theory.
CASE STUDY (Refer to Appendix 1 for an extended description).
Baba Musah, a 34 year old man was admitted into the ward after an emergency operation of appendicectomy. He was assessed and managed as per the hospital’s protocol for managing postoperative patients. However, he persistently complained of pain, which was accompanied by unstable vital signs. Upon approaching him and discussing some of his problems, he appeared very comfortable. Subsequently, the vital signs stabilised and he verbalised an improvement in his pain.
According to Carper (1978, 1992), there are four ways by which knowledge can be acquired: aesthetically, personally, empirically and ethically.