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How Can I think Differently?

Nursing Theories Applied to Practice Scenario

Nicole Montgomery

Faculty of Health Disciplines, Athabasca University

NURS 608: Philosophical Foundations of Nursing

Professor Kathryn Crooks

November 10, 2020

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Abstract

Hildegard Peplau's Theory of Interpersonal Relations is one of the original and classical nursing theories.

Kathrine Kolcaba's Comfort Theory (CT) is recognized as a modern mid-range nursing theory. The two

theories when compared and contrasted to each other demonstrate how nurses can use theories in

practice. The similarities between the two theories, when applied to a practice scenario, reveal the

manner in which a patients health and experience with the healthcare environment exhibit holistic care.

Similarly, the differences between the two express a wider gap between classical and contemporary

nursing theory.

Keywords: Theory, nursing, practice, Peplau, Kolcaba, classical, contemporary

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How Can I Think Differently? Nursing Theories Applied to Practice Scenario

        The organization Breastcancer.org (2015) discusses two studies indicating initiating palliative care

earlier rather than later for terminally ill patients resulted in less depression and longer life. Mr. P is the

patient in the following scenario; he was terminally ill with cancer. Nurses may unknowingly use nursing

theories in their day to day practice. In the following paper, I will discuss Hildegard Peplau's Theory of

Interpersonal relations, and Kathrine Kolcaba's Comfort Theory (CT).  Further, I will compare and

contrast the two theories used, and show how nursing theories can be used in practice.

Scenario

For me, it was a typical workday, but for Mr. P, it was a turning point for his cancer care. The

oncologist ordered palliative nursing care. I assessed his vital signs, cardio/respiratory, cognition,

elimination, nutrition, skin, pain and overall, well-being each visit. With the progression of Mr. P's

cancer, so did his symptoms. I taught Mr. and Mrs. P about managing his symptoms and advocated for

more interdisciplinary services in his home when they were needed. One of the services was the

palliative community doctors; they ordered and increased the medications' doses for his nausea and

pain to keep him comfortable. Through the nurse-patient relationship that was created, Mr. and Mrs. P

were able to communicate their needs, worries and concerns. At one point, Mr. P became unconscious,

and he was unable to speak anymore. I only used objective assessments from that point on. While

holding Mr. P's hand, I said my goodbyes to him and his wife. His wife thanked me for the nurse-patient

relationship between us and how much it meant to him.  

Theories

Hildegard Peplau established her Theory of Interpersonal Relations in 1952. Peplau's theory has

four components; person, environment, health and nursing. She believed for the nurse-patient

relationship to develop, it needed to have different stages. The stages are stranger, teacher, resource

person, counsellor, surrogate and leader (Purdy & Popan, 2018). Furthermore, in her theory, she
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explained that there are phases. They are orientation, working and resolution (Purdy & Popan, 2018).

The working phase has two sub-phases, identification and exploitation (Senn, 2013, p. 32).

        Kathrine Kolcaba formulated the CT in the 1990s, and it prioritizes the patients' comfort based on

the nurses' assessment (Samonte & Vallente, 2020). Kolcaba believes the patients' comfort exists in

three forms, relief, ease and transcendence, and comfort can be provided in four therapeutic contexts,

psychospiritual, physical, environmental and sociocultural (Samonte & Vallente, 2020). Kolcaba states

that once the patient's health care needs are met, the patient has heightened comfort, from this, the

patient is likely to have health-seeking behaviours (as cited by March & McCormack, 2009, p. 77). Health

seeking behaviours can occur in three ways, internal and external to the patient or a peaceful death

(March & McCormack, 2009, p. 77).  

Similarities

        Both Peplau's and Kolcaba's theories improve patients' health and experiences. Zarea et al. (2014,

p. 161) research show that patients have less anxiety and depression when using Peplau's therapeutic

communication model. Similarly, Lima et al. (2016, p. 2) showed that Kolcab's theory increases patients'

comfort levels. Mr. P verbalized he had less anxiety, and he felt his needs were met, which occurred

because of the nurse-patient relationship. Comfort was achieved by Mr. P having relief from his nausea

and ease from his pain. From this, he had health-seeking behaviours, and the behaviours led to his

peaceful death. 

        Furthermore, Peplau's and Kolcaba's theories are holistic. Peplau's theory for therapeutic

communication is through the nurse-patient relationship and is described as holistic (Deane & Fain,

2015, p. 35). The relationship was built through communication; because of this, Mr. P and his wife felt

they could discuss any concerns such as physical and emotional needs and any financial issues. Koehn

also described Kolcaba's theory as holistic because it meets the needs providing comfort for the body,

mind, and spirit and meets comfort needs, creating a whole person response (2000, p. 66). Mr. P had
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comfort in the four contexts, physical by the alleviation of the symptoms he had from cancer,

psychospiritual through his understanding of his life; environmental comfort was achieved through

dying at home. Lastly, he had sociocultural comfort through his family and interpersonal relationships. 

Differences

        Peplau's theory is a theory based on communication within the relationship. When or if the patient

is unable to communicate, then this approach is not applicable. This was the case when Mr. P's disease

progressed; he became unconscious, leaving me unable to implement the theory any further. In

contrast, a nurse can use the CT through objective assessments and interventions. This can be done by

assessing vital signs and monitoring the patients' pain level and physical touch (Wilson & Kolcaba, 2004,

p. 169). I implemented comfort interventions to Mr. P by holding his hand while saying my goodbyes

and monitoring his pain by objective means. 

        Lastly, compared to Kolcaba's theory, Peplau's theory does not have a framework. Peplau's theory is

not incremental, but it does explain how therapeutic relations are built. Each relationship is different, so

not all stages and phases are used. I was not a surrogate for Mr. P, and when making the relationship,

some of the stages and phases overlapped. Meanwhile, Figure 1 from Estridge et al. depicts the

framework of Kolcaba; it shows how health-seeking behaviours are achieved (2018, p. 26). In Mr. P's

scenario, his health care needs were met, which led to heightened comfort, causing him to have health-

seeking behaviours; the behaviour was his peaceful death.

Conclusion

The goal of care is quality of life with palliative patients, and this is through managing symptoms

(Rome et al., 2011, p. 349). Comfort and great nurse-patient relationships can help the patient have a

quality of life. Peplau's classic Theory of Interpersonal Relations and Kolcaba's contemporary Comfort

Theory are the two theories that are used in Mr. P's scenario. The scenario shows that nursing theories
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can be used in practice; the similarities and differences between them can help a nurse understand what

occurred within the scenario with Mr. P.

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References

Breastcancer.org. (2015, March 25). Starting palliative care earlier rather than later benefits caregivers

and people with advanced stage disease. https://www.breastcancer.org/research-news/early-

palliative-care-beneficial

Cancer care Ontario. (2013, April). Palliative care collaborative care plans CCPs condensed version.

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Dean, W. H., & Fain, J. A. (2016). Incorporating Peplau’s theory of interpersonal relations to promote

holistic communications between older adults and nursing student. Journal of Holistic Nursing,

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Estridge, K. M., Morris, D. L., Kolcaba, K., & Winkelman, C. (2018). Comfort and fluid retention in adult

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