Running head: HOW CAN I THINK DIFFERENTLY?

How Can I Think Differently?

A Situation Reviewed by a Classic and Contemporary Theory.

Audrey Meng

Athabasca University
HOW CAN I THINK DIFFERENTLY? 2

Abstract

This paper describes the classic theory of self-care by Orem and the contemporary comfort

theory by Kolcaba. It outlines the three theories of Orem and their relations. It also details

Kolcaba theory with her four contexts amidst the three states of comfort. A situation summarizes

a young 20 years old man journey of his new diagnosed with type 1 diabetes. Similarities and

differences of Kolcaba’s and Orem’s theories are discussed including their critiques. Similarities

include their concept of environment and the need for teaching. On the opposite, they are distinct

with their particular features of their method. The comfort theory demands more time to

elaborate on the taxonomic structure. The self-care theory of Orem stands out more for being

more practical and more straightforward in the situation.

Keywords: Comfort Theory, Kolcaba, Self-care Theory, Orem

HOW CAN I THINK DIFFERENTLY? 3

How can I Think Differently? A Situation Reviewed by a Classic and Contemporary Theory.

Florence Nightingale, pioneer to the first nursing theory. (Dewey, 2018) Around 1950,

more theories followed, creating classic theories and advancing to contemporary theories.

(Dewey, 2018) This scholarly paper introduces a classic theory, Orem's self-care, and the

contemporary Kolcaba's comfort theory. It starts with a description sharing key points of the self-

care theory and the comfort theory. A clinical situation is then described as a resource to observe

the application of both theories sharing their similarities and differences.

Orem’s Theory of Self-Care

A classic nursing theory, Orem's theory of self-care was originated in 1959.

(Lukasavage, 2019) Orem's theory is divided into three theories joined to provide a base for

assessment, identification of a self-care need, communication, care plan development and

evaluation. (Lukasavage, 2019) The primary theory is self-care; the person sustains self-care by

fulfilling their basic needs following Maslow's hierarchy of needs. (Simmons, 2009) When a

person is mentally and emotionally healthy while balancing social life and personal time, it is

seen as someone able to perform self-care. (Lukasavage, 2019) The secondary theory is the self-

care deficit; it includes an individual incapable of implementing self-care to themselves and

requiring nurses' assistance. (Simmons, 2009) The nurses administer care in five helping

methods: acting or performing care for them, guiding them, supporting them, teaching them, and

creating an environment promoting personal development. (Lukasavage, 2019) The third theory

is nursing systems; it joins the creation of the plan in collaboration with the nurses and the

patient. It can be supportive, partial or whole. The nurse also acknowledges the age, gender,

socioeconomic background, family and friend system, and the resources accessible to the
HOW CAN I THINK DIFFERENTLY? 4

patient. (Lukasavage, 2019) Orem's theory of self-care is implemented in various settings at

diverse points in patient health. (Simmons, 2009)

Kolcaba’s Comfort Theory

Kolcaba's comfort theory is a contemporary nursing theory introduced in the 1990s,

based on three states of comfort. (Samonte & Vallente, 2018) The primary state is relief, where a

patient has distinct needs satisfied, and discomfort has been resolved (Kolcaba & DiMarco,

2005). The secondary state is ease, where no discomforts are present. (Kolcaba & DiMarco,

2005) The third state is transcendence, where a patient can “rise above discomforts when they

cannot be eradicated or avoided.” (Kolcaba & DiMarco, 2005, p.188) The three forms of

comforts are combined with four contexts: physical, psychospiritual, sociocultural and

environmental. (Shu Huan, 2017) The physical context refers to the body's functions and

homeostasis. It can be disrupted, for example, due to pain or nausea. (Shu Huan, 2017) The

psychospiritual is more about a patient's self-awareness, confidence, motivation, and personal

identification. (Kolcaba & DiMarco, 2005) The sociocultural is the patient's support system and

beliefs, socioeconomic status related to work and education. (Kolcaba & DiMarco, 2005) The

environment context of comfort is how the setting and background affect their life. (Kolcaba &

DiMarco, 2005) The comfort theory regroups the three forms of comfort and the four contexts in

a taxonomic structure, supporting the creation of a plan.

Clinical Application of Theories

Mr. M. age 20, called the ambulance one morning as he was notably short of breath.

Upon arrival at the emergency department, the patient displayed a blood sugar in the 40’s and

sweet breath. A doctor diagnosed him with type 1 diabetes. He is transferred to the intensive care

unit on an insulin drip for a couple of days, then went to a ward where he must learn to handle an
HOW CAN I THINK DIFFERENTLY? 5

insulin pen. The nurses implement teaching on his diagnosis and his insulin pen. The nurses

referred Mr. M. to an association of young adults living with diabetes.

In this situation, using both theories, the nurses must offer to teach. It is part of comfort

theory as it influences the patient's comfort in the physical and psychospiritual context. Teaching

him for the perspective of Kolcaba will help Mr. M. to reach body homeostasis once he is

discharged and help his confidence and motivation to be able to live with this condition. It is also

part of a sociocultural aspect as such discuss earlier it includes the educations the patients had,

yet we are investing in growing his knowledge. On the opposite, teaching helps to provide self-

care. By provide teaching, Orem's theory provides the patient with one of the five nursing ways

to help. With gaining new knowledge, it allows the patient to attain a level of self-care without

any deficit as he would be able to take care of his condition at home. At first, the nurse might

have to use the nursing systems theory as a whole as she will need to be more present at the

beginning. Once more stable, the nurse-patient relationship will move to partial assistance where

Mr.M. can perform most self-care but need help with his insulin. She will provide teaching on

how to manage his diabetes. Once the teaching is completed, the nursing systems become a

supportive system where Mr. M. is now completely independent in self-care.

Another common feature of both theories is the necessity to formulate a plan. In the

creation of the plan, each theory requires the nurses to take consideration of the background of a

patient in a holistic manner such as the age and patient backgrounds. Orem's plan is conceived on

the self-care deficit to the theory of nursing systems guiding Mr. M. to access the theory of self-

care. As described earlier, Mr. M. and the nurse will go through all three nursing systems from

whole to partial to supportive. That flow of step is the plan, guiding the patient to be able to

perform self-care. In the nursing systems, it is required for the nurse to consider his age, his
HOW CAN I THINK DIFFERENTLY? 6

background, and his resource available. The goal of the environment setting for Mr. M. in the

theory of self-care is to create an environment to aim for personal development. For Kolcaba's,

the plan is developed using the taxonomic structure. A quick draft of the taxonomic structure for

this situation has been shared in figure 1. The environment for Kolcaba in the taxonomic is the

setting he is currently who help with comfort and control his sugar. It is also the background and

where he will be once discharged. Kolcaba’s also observed his sociocultural aspect, finding what

he has as a support system. In the success of both theories, the nurses are guiding Mr. M. with

teaching, considering his background and offering support.

The self-care deficit theory is more natural to engage in this situation and more evident in

allowing Mr. M's independence. Once the diagnosis is done, the nurse knows the patient needs

assistance in the management of his diabetes. Mr. M. is in a phase of self-care deficit as he

cannot manage his diagnosis as a lack of knowledge. While at first, the nurse will act for them,

she will start teaching and guiding home on how to live with his diagnosis. She will support him

all along while creating a good environment. This process begins as soon as the patient enters the

emergency department as we see the patient self-care deficit. The assessment for the patient’s

need in becoming self-care independent is obviously to manage his diabetes. The nurse will be

having a patient-nurse relationship where she helps as a whole at first to transition to support.

In contrast, the comfort theory necessitates an extended assessment to assess comfort in

all four contexts. Once all four context descriptions are determined, the plan can be formulated

following the three states of comfort. As shown in figure 1, some overlap and similarities can be

found. Some relief such as physical body homeostasis regulating the sugar can be done in the

emergency department. The most states of comforts are achieved when an evaluation and a plan
HOW CAN I THINK DIFFERENTLY? 7

is started once on a more stable on a unit such as the critical care unit or the medicine unit. Once

the taxonomic structure is completed, it does offer excellent structure and guidelines. With a total

of twelves cells in the taxonomic structure, it allows a holistic nursing approach. It is helping to

not solely focus on his capacity to take care of his new diagnosis but its wholesome. Within the

comfort theory, referring Mr. M. to the support group can assist him in achieving the

transcendence level of comfort in the environmental and sociocultural context. At first, a support

group can help promote self-care, once more comfortable, he can be able to share with others and

help others in such a way he would reach a transcendence level. Mr. M. would be able to rise

above his diagnosis of diabetes when it can’t be avoided as he is comfortable with his diagnosis,

and he can share with others.

Conclusion

In both theories, they use teaching and the creation of a plan to help the patient. As much

as the comfort theory can be more of a holistic approach, it needs a lot of works to complete the

taxonomic structure. Kolcaba’s goal focuses more on the patient level of comfort on a holistic

level as per Orem's theory centres an approach to the ability of self-care. Orem’s theory could be

applied as soon as the patient walk through the emergency door versus Kolcaba’s need to

elaborate on the plan and a plan that correlates more once more stable. As for the ease of use,

Orem is more prolific, yet the combination of both could promote a quick start in helping the

patient in better care. Providing Orem’s care in the emergency and intensive care unit then

following it with Kolcaba’s comfort theory to address all the patient need as holistically as

possible.
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References

Dewey, J. (2018). Nursing theory Salem Press. Retrieved from http://0-

search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=ers&AN=113931

268&site=eds-live

Kolcaba, K., & DiMarco, M. A. (2005). Comfort theory and its application to pediatric

nursing. Pediatric Nursing, 31(3), 187–194. Retrieved from http://0-

search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=rzh&AN=106496

648&site=eds-live

Lukasavage, A. (2019). Self-care deficit nursing theory Salem Press. Retrieved from http://0-

search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=ers&AN=121772

979&site=eds-live

Samonte, P. R. V., & Vallente, R. U.(2018). Comfort theory (nursing) Salem Press. Retrieved

from http://0-

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251&site=eds-live

Shu Hua, N. G. (2017). Application of Kolcaba's comfort theory to the management of a patient

with hepatocellular carcinoma. Singapore Nursing Journal, 44(1), 16–23. Retrieved

from http://0-

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969&site=eds-live
HOW CAN I THINK DIFFERENTLY? 9

Simmons, L. (2009). Dorthea Orem's self care theory as related to nursing practice in

hemodialysis. Nephrology Nursing Journal, 36(4), 419–421. Retrieved from http://0-

search.ebscohost.com.aupac.lib.athabascau.ca/login.aspx?direct=true&db=rzh&AN=105418

792&site=eds-live
HOW CAN I THINK DIFFERENTLY? 10

Figures

Figure 1.

A Taxonomic Structure regarding Mr. M. Situation

Relief Ease Transcendence
Mr. M. can be
comfortable with his
Promoting teaching on
New diagnosis of diabetes, knowledge of
what raises sugar
Physical diabetes, controlling his symptoms of sugar
levels, alimentation, on
blood sugar level. imbalances and ability
using an insulin pen.
to use an insulin pen in
a comfortable method.
Mr. M is encouraged to Mr. M. is more
express his feelings and comfortable now with
questions while his diagnosis and able
Patient is anxious with teaching is done to to cope with diabetes.
Psychospiritual
new diagnosis. alleviate anxiety. He can control his level
Patient is taught coping of anxiety as he now
mechanisms related to understands and knows
stress. when to seek help.
Patient is comfortable
Information is provided living with his new
Patient is worried on to the patient, family diagnosis of diabetes.
how this will impact his and friends involved in Mr. M is part of a
Sociocultural
lifestyle with his family care. A support group is young diabetes group
and friends. found to help him that offers him support
process the transition. while reciprocating his
experience to others.
Mr. M’s levels of sugar
Patient is at risk for Regular assessment of
are under control and
high or low blood sugar blood sugar levels.
he is comfortable with
and its impact. In Assistance in the
Environment the changes he must
hospital environment choices for meals and
make to have his sugar
controlled but will have application of his
stable in his
to adjust once home. learning.
environment
By Audrey Meng.