Critical Evaluation Of Nursing Theories Essay Example

of Comfort was produced when Katharine Kolcaba led an idea examination of solace that inspected writing from a few controls, including nursing, solution, brain research, psychiatry, ergonomics, and English (Kolcaba, 2003). After the three types of comfort and four settings of all-encompassing human experience were presented, an ordered structure was made to control for the appraisal, estimation, and assessment of patient solace. As per Kolcaba, comfort is the result of all-encompassing nursing workmanship.

Self-efficacy is portrayed as an approach to sort out an individual's judgment of his or her ability to execute a strategy. The Theory of Self-viability expresses that self-adequacy desires and result desires are affected by conduct, as well as verbal support, intelligent considering, physiological sensations and part or self-demonstrating (Riegel, 2012). Through self-assessment an individual judges their capacity to perform and built up self-desires which is outwardly portrayed in the applied model.

In the model, nursing is depicted as the way toward surveying the patient's comfort needs, creating and executing fitting nursing care arranges, and assessing the patient's comfort after the care arranges have been completed. Nursing incorporates the purposeful evaluation of comfort needs, the plan of comfort measures to address those necessities, and the reassessment of comfort levels after execution (Alligood, 2014). Evaluation can be goal, for example, the perception of wound mending, or subjective, for example, inquiring as to whether he or she is comfortably. This essay will discuss the above two theories in more depth discussing the strengths and weaknesses of each theory. Also application of one the theories in my case study.

Summary of Self-efficacy

Self-efficacy refers to an individual's faith in their capacity to perform particular errands (Bandura, 1997). Viability convictions

are critical in the advancement of human ability since they direct a man's considerations, sentiments, wellspring of inspiration and activities (Bandura, 1995). Bandura (1982) confirms that self-adequacy is, hence, a noteworthy indicator of conduct and whether that conducts would hold on in unfavorable times

The self-efficacy theory expresses that "mental methods, whatever their shape, adjust the level and quality of self-viability" (Bandura, 1977, p. 191). The theory perceives the different types of human abilities and recommends those individuals' considerations, convictions and feelings impact their conduct (Bandura, 1997; Resnick, 2009). Musser and Leone (1992) include that the hypothesis puts an accentuation on a man's key part in affecting what they think, feel and do.

The underlying work in the improvement of the theory was embraced to figure out if mental strategies could impact a man's self-viability desires and, eventually, prompt to an adjustment in conduct (Resnick, 2009). Grown-up snake fears were allotted to either member displaying (coordinate contact with a snake), demonstrating (watching others touch a snake) or no treatment bunches for proportional timeframes. It was distinguished that self-viability, surveyed at various times of the treatment time frame, anticipated conduct change in 92% of the aggregate appraisal errands, albeit distinctive medications delivered diverse levels or qualities of self-efficacy (Bandura, 1977; Resnick, 2009)

Analysis and evaluation of the theory

The self-efficacy theory has been evaluated by considering its external Criticisms and internal Criticisms as follows:-

External Criticisms

Complexity: Two main concepts – self-efficacy beliefs and human agency have been used for explanation of this theory making its description simpler (Masters, 2014). Once the concept of self-efficacy has been grasped the theory can be easily understood without much explanation.

Discrimination: McEwen and Wills (2007) recognize

that psychological behavioral speculations, including the social subjective hypothesis, have been utilized all the more frequently as a part of the nursing administration of endless sicknesses in view of their adequacy in changing target practices. Self-adequacy hypothesis began from the social subjective hypothesis and has been exceptionally imperative in different parts of nursing, overwhelmingly in the administration of constant ailments, as has been expressed previously.

Reality convergence: It has been expressed before that the hidden supposition of self-adequacy hypothesis is that apparent individual viability impacts the start, diligence and also the push to be placed into deliver conduct. Subsequently, even with troubles, people who question their capacities (low self-viability) tend to abandon their endeavors while those with a solid feeling of self-adequacy would invest more exertion until they can beat those difficulties and accomplish their objective (Bandura, 1982). These perceptions are valid and may clarify why a great deal of fruitful individuals recount stories of troublesome minutes they may have overcome to achieve their status. A study attempted by Masters, (2014). ) affirms that self-viability hypothesis is exceptionally appropriate in accomplishing some nursing objectives.
Pragmatism: A theory is of significant significance to the wellbeing calling when it demonstrates valuable in changing conditions to enhance tolerant results. Use of the self-adequacy hypothesis, all things considered, and clinical settings have been effective. Bandura (1987) utilized it to treat wind fears while Alligood, (2014) have likewise utilized it to advance self-administration of diabetes among restricted wellbeing literates crosswise over various races.

Significance: After Bandura created viability estimation apparatus in 1977, a few others have been produced for efficacies for various errands. This is on account of various concentrates, for the most

part; require diverse estimation instruments (Resnick, 2009). Subsequently, medical attendants watching over various patients with various analyses may need to embrace diverse fitting adequacy measures so as to adequately apply the hypothesis by and by. What's more, the hypothesis stresses on the distinction of patients by setting that diverse individuals have distinctive levels of viability for various assignments (Bandura, 1987). Consequently, medical attendants utilizing the hypothesis give individualistic care in view of their one of a kind adequacy. Henceforth, the hypothesis is critical in nursing.

Utility: Nurses in various care settings have utilized the hypothesis both as a part of research and hone and have thought that it was practicable. Utilized the theory to test the part of self-efficacy in restoration of patients taking after heart surgery (Stump et al, 2012). These and different studies suggest that the hypothesis of self-viability produces speculations that are researchable by attendants.

Internal criticism

Legal development: Its real ideas have been produced and disclosed deliberately to highlight the special part that people play in changing their adverse wellbeing practices (Bandura, 2004). The wellsprings of self-viability and also their novel degrees of impact have been all around clarified. Instruments for measuring self-viability have likewise been produced with Bandura (1987) building up the first. Conclusions have additionally been extremely coherent. As indicated by Bandura (1987), a man's viability desires dependably impact them to set up conduct that, thus, yields a result.

Adequacy: The theory plainly expresses that people have remarkable parts in delivering behavioral change and has inferred that self-efficacy assumes a focal part, both specifically and by means of its impacts on alternate determinants, in foreseeing change in conduct (Bandura, 2004). A meta-investigation by

Krinsky, (2014) to control self- efficacy in assurance inspiration explore recognized that instruction and age may impact self-viability. Be that as it may, they proposed that the discoveries might be theoretical and suggested that further investigation ought to be finished.

Consistency: Definitions of the significant ideas are kept up all through the clarification of the theory. It gives the idea that result anticipation as an idea has been incorporated and twisted to the theory by different authors. Viability desires and result desires have been connected in testing the self-efficacy theory (Resnick et al., 2007; Resnick, 2009). In any case, Bandura (1997) states that the two are distinctive. Result hope and self-adequacy are both indispensable in the social subjective theory yet self-viability was produced into a theory to highlight its focal part in the social psychological theory (Bandura, 2004). Relationship of result desires to adequacy in the self-viability theory is, hence, a misapplication

It has been expressed before that the idea of human organization in the theory creates through the different phases of life and that the phase of its advancement may impact self-viability (Bandura, 1997). It, in this way, creates the impression that the discoveries of Krinsky, (2014) don't recommend that the theory of self-viability is insufficient.

Kolcaba's Comfort Theory

The idea of comfort is not another idea and has been an objective or result of nursing since Florence Nightingale. Solace is a comprehensive result since it assigns a dynamic and multifaceted condition of people. Considering the result of solace requires an intra-actional point of view since mediations that are proposed to upgrade at least one parts of solace in a roundabout way improve different viewpoints (Kolcaba, 1994). Amid

the advancement of the solace hypothesis, Kolcaba led an idea investigation of solace that analyzed writing from a few orders including nursing, solution, brain research, psychiatry, ergonomics and English (Dowd, 2010). This audit affirmed that solace is a positive idea and is connected with exercises that sustain and reinforce patients. Kolcaba showed distinctive part of solace in a two dimensional lattice. Initially, Kolcaba portrayed solace as existing in 3 shapes: simplicity, alleviation and greatness.

In the main sense, the condition of simplicity, solace does not mean nonappearance of distress but instead this state is with respect to individual attributes(Alligood, 2014). That is, people vary by they way they portray and encounter inconvenience and simplicity. In the second express, the alleviation sense, there is help from conditions that cause or add to inconvenience (Kolcaba, 2003). The last express, the reestablishment sense, alludes to a condition of being fortified and having upgraded forces and inspirational mentalities (Krinsky, 2014). The second measurement of solace is the settings in which comfort happens. The settings were gotten from the nursing writing about comprehensive quality (Kolcaba, 1992). The principal setting is physical, relating to substantial sensations; the second is psych spiritual, relating to the interior consciousness of self, including regard, sexuality, which means throughout one's life and relationship to a higher request or being. The third setting is social, relating to interpersonal, family and social connections and the fourth and last setting is natural relating to light, clamor, feel, shading and temperature (Kolcaba, 2015). At the point when the two measurements are differentiated the outcome is a two-dimensional lattice with 12 aspects of comfort. Things for comfort asses can be created from

every aspect that is important to a particular research address. Making the idea of solace quantifiable Kolcaba collected the reason for the advancement of the theory of comfort.

Kolcaba distributed a center range-theory of comfort in 1994 proposing that when solace is improved, patients are fortified and accordingly ready to take part in wellbeing looking for practices. In 2001, a consequent article gave a development of the theory to incorporate institutional results (Smith et al, 2013). In 2003, Kolcaba distributed a thorough book about the improvement, testing and use of the theory. Kolcaba does not trust that an attention on solace is interesting to nursing while she trusts that her theory can be interdisciplinary and that different callings can join around her theory of comfort giving comprehensive care to patients. One of the principle theory affirmations is that when human services needs of a patient are suitably surveyed and legitimate nursing intercessions are done to address those necessities, considering factors mediating in the circumstance, the result is improved patient comfort after some time. When solace is upgraded, the patient is probably going to expand wellbeing looking for practices. These practices might be interior to the patient (help from agony or enhanced oxygenation), outer to the patient (eg. dynamic support in restoration works out) or a tranquil demise. Moreover, Kolcaba declared that when a patient encounters wellbeing looking for practices, the respectability of the establishment is along these lines expanded in light of the fact that the expansion in wellbeing looking for practices will bring about enhanced results. Expanded institutional honesty fits the improvement and usage of best practices and best strategies auxiliary to the positive results

experienced by patients (Kolcaba, 2015).

Evaluation of Kolcaba's Comfort Theory

The objective of this theory is consistent with those speculations spoke to as mid-range hypotheses. The objective of the Comfort Theory is to give encouraging measures to patients in their desperate hour. Center range hypotheses are restricted in degree and made out of a set number of ideas and suggestions (Kolcaba, 2015). These are composed in a solid and particular level. Center range theory address a generally substantial and particular wonder by portraying what it is, clarifying why it happens or anticipating how it happens. This theory clarifies what comfort is as controlled by the patient or family and predicts how it happens as confirm by the ordered framework. This in addition, secures the theory in its characterization.

Clarity and Simplicity of Theory: Some of the early articles over all the idea examination are hard to peruse yet are reliable as far as definitions, inceptions, suspicions and suggestion (Kolcaba, 2013). The convincing article clarifying the Theory of Comfort is simpler to peruse and in resulting articles Kolcaba relate the theory to positive works on utilizing scholastic yet conceivable dialect. The instruments to evaluate comfort needs are likewise basic in the quantity of ideas and are anything but difficult to use. The theory of Comfort is basic since it does a reversal to essential nursing care and the conventional mission of nursing. Its dialect and application are of low innovation, yet this does not block its utilization in very mechanical settings (Dowd, 2010). The primary purpose of the theory is to return nursing to a practice concentrated on requirements of patients, inside or outside institutional dividers. Its straightforwardness permits

understudies and honing medical caretakers to learn and hone the theory effectively. All exploration ideas are characterized theoretically and operationally. The charts connected with the theory demonstrate the consistency of the standards and utilization of terms while the ideas of the theory are connected in coherent ways.

Exact Precision: The initial segment of comfort theory predicts that viable nursing mediations offered after some time, shows improved comfort. Kolcaba tried it in test outline for her thesis (Kolcaba, 1987). In this study medicinal services needs were those stressors (comfort needs) connected with a determination of early bosom growth. The all-encompassing intercession was guided symbolism, planned particularly for this populace to meet their solace needs, and the wanted result was solace. The discoveries uncovered a noteworthy distinction in solace after sometime between ladies getting guided symbolism and the standard care amasses (Kolcaba, 1987). Other exact trial of the initial segment of Comfort Theory have been directed by Kolcaba and partners which affirmed huge contrasts amongst treatment and examination assembles on solace after some time.

The mediations tried were sorts of immobilization for people after coronary angiography (Christian & Krumwiede, 2013) subjective systems for people with urinary recurrence and incontinence (Dowd, 2010) and summed up solace measures for ladies amid first and second phases of work (Christian & Krumwiede, 2013). In the Urinary incontinence concentrate on (Dowd, 2010), upgraded solace was identified with an expansion in Health looking for practices, supporting the second part of the comfort. The relationship amongst solace and institutional trustworthiness has yet to be tried. For patients with bosom growth and urinary incontinence and for those at end of life (Kolcaba, 1987), the adjusted comfort instruments

have exhibited solid psychometric properties which implies, that those surveys are exact and dependable estimations of comfort and can uncover changes in solace after some time. These discovering bolster the hypothetical establishment for the ordered structure of solace.

Comfort Theory and the metaparadigm of nursing: The metaparadigm of a teach has been characterized as an announcement or gathering of articulations distinguishing its applicable wonders (Christian & Krumwiede, 2013). At the level of the metaparadigm, these announcements ought to be worldwide to the train as opposed to particular to specific methods of insight, perspectives, theoretical models or hypotheses. The ideas that contain the metaparadigm of nursing have been characterized as individual, environment, wellbeing and nursing (Christian & Krumwiede, 2013). Kolcaba's solace hypothesis effectively addresses the four ideas grasping the metaparadigm of nursing. Kolcaba characterized the metaparadigm ideas as they compare to her theory (March and McCormack, 2009). Nursing is depicted as the way toward surveying the patient's solace needs, creating and executing suitable nursing mediations and assessing understanding solace taking after nursing intercessions.

Individual is depicted as the beneficiary of nursing consideration; the patient might be an individual, family, organization or group. Environment is thought to be the outside surroundings of the patient and can be controlled to expand persistent solace. At last, wellbeing is seen as the ideal working of the patient as they characterize it. A nearby investigation of these definitions inspire a few inquiries concerning how much Kolcaba's (1992) work is completely entwined with the metaparadigm of nursing. While Kolcaba makes a sufficient showing with regards to of depicting nursing, its inside and exercises the meaning of the other three ideas are less very much

created. Kolcaba's meaning of wellbeing as ideal working does not relate with different ideas in her theory. Working was never characterized or specified in Kolcaba's theoretical definitions. Besides a view of comfort in Kolcaba's meaning of Health was excluded and her meaning of individual needs determination that the human is perceptual, which must be valid if her meaning of Health is to hold up. Also, Kolcaba's meaning of environment is not firmly related with nursing exercises. It appears that, at this phase of the theory' advancement, the ideas of the comfort are not solidly grounded in nursing's metaparadigm. However as a center range comfort, just the section of nursing that is the concentration of the comfort ought to be fundamentally tended to (Christian & Krumwiede, 2013).

Significance; Comfort is a greatly vital idea of nursing and The Theory of Comfort is intended to convey comfort to patients. The diagrammed applied model gives the least complex clarification to the theory. The metaparadigm ideas are not unmistakably characterized by Katherine Kolcaba; be that as it may she does plainly express the philosophical claim and its ideas. The reasonable structure and precursor learning is insignificantly characterized inside her work, yet they are recognized and referred to.

Case study and application of Kolcaba's Comfort Theory

The use of Kolcaba's Comfort Theory is common in nursing home since nurses "naturally evaluate their patient's physical and mental comfort; the ordered approach gives a structure in which to put the formal or casual appraisal. Since the structure depends on patients' needs, medical caretakers can intercede in particular ways, once a need is distinguished. Medical attendants can likewise survey the viability of their mediations by gaging

the level of comfort accomplished when solace needs are focused on in particular" (Kolcaba, 2003).

The following is an anecdotal account of a cardiovascular surgery patient, Mr S. This case is intended to demonstrate how certain parts of the care of this patient might be done if all health care experts were working cooperatively inside Kolcaba's theoretical structure, and the recommended adaptation is set up. All through the case, comfort of patient will be a critical consideration, demonstrating how Kolcaba's theory of comfort may be applied even in a domain as apparently not comfortable as an intensive care unit (ICU).

Mr. S. is a 45-year-old Canadian man who has quite recently been admitted to the ICU postoperative cardiovascular surgery. He has had an uneventful coronary course sidestep join without any confusions in the working room. He is intubated and put on total mechanical ventilation. His key signs are: pulse (BP) 150/90 mm Hg, heart rate 86 thumps for each moment, respiratory rate 12 breaths for every moment, and temperature 35.3°C.

The specialist looking after Mr. S. knows about Kolcaba's comfort theory and structures the requests in like manner. The objective systolic BP for Mr. S. is less than 130 mm Hg and the specialist's postoperative requests incorporate BP pharmaceuticals and intravenous morphine sulfate for agony. Moreover, the specialist recommends a no steroidal mitigating drug, ketorolac, to be regulated to the patient once it has been resolved that they are not draining exorbitantly and have satisfactory renal capacity. This nearby regard for treatment of torment speaks to a comfort intercession founded by the specialist that not just addresses a specific medicinal services need of the patient additionally perceives the

significance the specialist has set on of the alleviation type of solace. There is a standing request set up for warming patients postoperative coronary supply route sidestep join.

The ICU where Mr. S. is conceded has a respiratory advisor (RT) on staff. This RT knows that mechanical ventilation is exceptionally uncomfortable for patients. There is a standing request in the ICU that heart surgery patients might be weaned from the ventilator as endured and intubated when stable. Utilizing Kolcaba's comfort, the RT chooses to wean and intubate Mr. S. as quickly as time permits postoperatively.

The attendant watching over Mr. S. additionally structures quiet care utilizing Kolcaba's theory. At the point when Mr. S. is starting to stir from the anesthesia, he is scowling and his BP is transcending the objective level. Had the attendant not been acquainted with comfort theory, she may have decided to just treat Mr. S's. BP with pharmaceuticals intended to target just BP. Since this medical attendant is acclimated to evaluating comfort needs, she perceives that this patient reaction is suggestive of expanding agony and regulates morphine sulfate as requested. Also, Mr. S. is given a warming cover to build his body temperature. Both of these mediations speak to the medical caretaker helping Mr. S. to accomplish comfort in the alleviation sense.

The following morning, Mr. S. is seen by the ICU physiotherapist, who has likewise been instructed in comfort theory. While evaluating comfort needs of Mr. SA, the physiotherapist perceives that he is restless about moving and practicing so not long after surgery. In light of this, the physiotherapist deliberately clarifies her arrangement of care to Mr. S. in a quiet and

unhurried way. This permits Mr. S. to unwind, what Kolcaba has alluded to as the simplicity feeling of comfort. He gets to be eager and ready to work with the physiotherapist in his postoperative practice schedule, subsequently displaying what Kolcaba alludes to as wellbeing looking for practices, or comfort in the amazing quality sense.

The human services group worked cooperatively to upgrade the patient's comfort amid the prompt postoperative period. This, thus, prompted to Mr. S. having a fruitful recuperation period with no huge confusions. Since this clinic takes after Kolcaba's comfort theory when tending to the greater part of their patients, institutional trustworthiness is improved by a general increment in positive patient results, a diminished healing facility length of stay, and proceeded with group doctor's facility bolster.

Conclusion

The self-efficacy theory expresses that "mental methods, whatever their shape, adjust the level and quality of self-viability" (Bandura, 1977, p. 191). The theory perceives the different types of human abilities and recommends those individuals' considerations, convictions and feelings impact their conduct. Holistic comfort theory gives a system to directing medical caretakers as they assess, arrange, give and assess care to patients while seeing them as entire people cooperating with their surroundings. Other than managing nursing rehearses comfort theory can control nursing training. This theory can be utilized to manage the educating of attendants and nursing understudies to figure out how to give mind that is free of or in conjunction with restorative practice.

In research the theory gives an approach to approve that there has been change in patient comfort subsequent to soothing mediations. Amid the primary decade of its reality, the theory has faced starting exact testing. It has

been appeared in studies that, once the medical attendant starts a comfort measure to meet the all-encompassing comfort of the patient, the patient's comfort is expanded over a past pattern estimation. Additionally, improved comfort has been corresponded with engagement in Health Seeking Behaviors (Dowd, 2010). Kolcaba has endeavored steady and tenacious endeavors to create and extend the idea into all ranges of nursing. Through possess speculation and cooperation with attendants the idea has developed constantly, including care items. Through Kolcaba's productive composition and dynamic Internet exercises, the Theory of Comfort is currently known around the world.

References

1. March A, McCormack D (2009). Nursing Theory-Directed Healthcare: Modifying Kolcaba's Comfort Theory as an Institution-Wide Approach. Holistic Nursing Practice; 23:2;75-80.
2. Kolcaba, K. (2003). Comfort theory and practice: a vision for holistic health care and research. Springer Publishing Company, New York
3. Kolcaba, K. (2010). An introduction to comfort theory. In The   comfort line. Retrieved November 10, 2010, from   http://www.thecomfortline.com/
4. Kolcaba, K. Y., & Kolcaba, R. J. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing, 16(11), 1301-1310.
5. Kolcaba, K. Y. (1991). A taxonomic structure for the concept comfort. Image: Journal of Nursing Scholarship, 23(4), 237-240.
6. Kolcaba, K. (1995). Comfort as process and product, merged in holistic nursing art. Journal of Holistic Nursing, 13(2), 117-131.
7. Kolcaba, K. Y. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19(6), 1178-1184.
8. Kolcaba, K., & Steiner, R. (2000). Empirical evidence for the nature of holistic comfort. Journal of Holistic Nursing, 18(1), 46-62.
9. Kolcaba, K. (2003). Comfort theory and practice: a vision for holistic health care and research. Springer Publishing Company, New York.
10. Wechter, S. M., & Averill, J. B. (2010). Kolcaba's comfort theory: Innovation for  pediatric nursing. Communicating Nursing Research, 43, 559?559.
11. Tutton, E., , K. (2003). An exploration of the concept of comfort. Journal of  Clinical Nursing, 12(5), 689?696.
12. Goodwin, M., Sener, I., , S. H. (2007). A novel theory for nursing education:  Holistic comfort. Journal of Holistic Nursing, 25(4), 278?285.
13. Evolution of the mid range theory of comfort for outcomes research. (2001). Nursing  Outlook, 49(2), 86.
14. Parker,
    

M. E. (2006). Perspectives on nursing theory (2nd ed.). In Nursing theories & nursing practice (pp. 4). Retrieved from http://www.netlibrary.com.jproxy.lib.ecu.ed