nursing theory comparison paper

nursing theory comparison paper

The paper aims to compare a grand and middle-range theory. The chosen grand theory is Dorothea Orem’s Self-Care Deficit Nursing Theory and Kolcaba’s Theory of Comfort. Therefore, the main aim is to discuss, review and compare these theories.

Dorothea Orem’s self-care deficit nursing theory explains how nurses should intervene when helping their patients to maintain autonomy. The theory is a grand nursing theory that has a broad scope that comprises general concepts applicable in any nursing instance. Hence, from the theory’s perspective, nursing should be defined as the assistance provided to the patient population to provide and manage their self-care to enhance their human functioning away from the hospital (Tanaka, 2021). The theory adopts an individualized form that helps these patients to engage in self-care, which means that individual patients can initiate and perform various activities by themselves to maintain their well-being, health, and life. Hence, for adults, nursing requirements arise when they cannot maintain self-care continuously, thus needing assistance in sustaining health and life to recover from an injury or a disease and cope with these prevailing conditions’ effects. However, nursing intervention comes along for the children when their guardians or parents cannot maintain their therapeutic care continuously. Hence, the Orem theory’s scope is broad as it focuses on patients’ general self-care deficit during nursing practice.


The theory of Comfort, a middle-range theory, was developed in the 1990s by Kolcaba. The theory applies to healthcare research, practice, and education and can provide Comfort within the healthcare setting. From the theory’s perspective, Comfort is a factor that nursing care aims as a desirable outcome. The theory came about after Katharine Kolcaba analyzed the comfort concept, which involved various disciplines like medicine, nursing, psychiatry, psychology, English, and ergonomics. From the results obtained, Kolcaba concluded that Comfort is only achieved after engaging in a holistic nursing approach that involves transcendence, ease, and relief. The theory mainly addresses Comfort that patients, their families, healthcare organizations, and the community experience during healthcare practices.

The Selected Theories Background


Dorothea Orem was a daughter to a constructor and a stay-at-home mother and was born in 1914 as the last born. Orem’s entire career has been involved in theory development. Dorothea graduated in 1934 from Washington DC’s Providence Hospital School of Nursing and later graduated in 1945 with a nursing education degree (McEwan & Wills, 2021). Due to her hard work, Dorothea has been awarded numerous honorary degrees. Orem would go for highly valued nursing positions such as dictatorship in nursing departments and nursing schools when filling job positions. Her job also engaged in teaching nursing and biological sciences from 1939 to 1941 (McEwan & Wills, 2021). She was also employed in the United States health department, where she was assigned the role of a Practical Nurse Section curriculum consultant from 1958 to 1960. However, in 1960, she was part of the Local Program for Practical Nurse Exam modification, among other areas that engage with nursing practice. In the nursing field, Orem was one of the most influential thinkers who worked to ensure that she provided her expertise in nursing to enhance nursing practice until her demise in 2007. The theory that boosted Orem’s perspective in nursing is the theory of self-care deficit that she developed in 1971, which is still embraced in nursing schools today (McEwan & Wills, 2021). Despite Orem’s theory being a grand theory, the theory’s perspective is essential since it helps shape the nurses’ holistic approach toward their patients. Hence, Orem’s theory helps the nurses to determine the kind of patient care they need to involve within a given condition that the patient has since it emphasizes the need for the patients to maintain an autonomous state in the self-care processes. That is because Orem feels that the best way for a patient to recover is when they participate in maintaining independence over the patient’s self-care. The theory has been incorporated in Doctor of Nursing Practice programs. Also, it is important to note that the Orem International Society continues to keep its advocacy and research legacy despite being founded in 1991.

Katharine Kolcaba was born in 1944 in Cleveland, Ohio. In 1965, Kolcaba attained a nursing diploma from a college known as St. Luke’s Hospital School of Nursing and later graduated in 1987 from the Case Western Reserve’s Frances Payne Bolton School of Nursing. As she continued to advance in her education, Kolcaba attained her Ph.D. in Nursing in 1997 and received Clinical Nursing Specialist certification (McEwan & Wills, 2021). Kolcaba mainly specialized in comfort studies, nursing theory, gerontology, instrument development, long-term care, end-of-life interventions, and nursing research. Due to her commendable work in nursing practice, Kolcaba has received numerous awards, the recent one being the Researcher of the Year in 2006 at the Sigma Theta Tau Chapter. After retiring, Kolcaba has focused on engaging the Sigma Theta Tau, Honor Society of Nursing, and American Nurses Association as a volunteer. Among her publications is the comfort theory as a nursing theory is a middle-range theory that was developed in the 1990s. From the theory, Kolcaba explains that patient Comfort exists in three forms: transcendence, ease, and relief. The theory is therefore relevant in nursing practice since it enables nurses to critically assess their patient’s comfort preferences and needs which is also essential when creating the care patients’ care plan to ensure that they meet these needs. That means when the nurses notice a slight change in patients needs they should also ensure that their preferences change.

Philosophical Underpinnings


Dorothea Orem’s theory bases its premise on the ability of human beings to adapt to their environment, making them more independent when managing and rehabilitating healthcare conditions, especially chronic ones. Hence, Orem’s philosophy is that patients wish to care for themselves, meaning there is a high possibility of them recovering when they become dedicated to participating in their health interventions (Tanaka, 2021). Hence, from a reader’s point of view, Orem’s theory proves that nursing is a special ability to provide care to patients, guiding them to achieve effectiveness and autonomy when caring for themselves. Such actions are essential since they help the nurses ensure that they correspond with the nursing care philosophy that aims at achieving optimal health care services that are patient-centered.

Kolcaba’s theory is grounded by the fact that human beings easily respond to stimuli despite the stimuli’ complexity as wholes. The whole response is perceived to be greater than an assessment of different responses separately and later evaluating the effects of such stimuli. That means Kolcaba’s perspective is based on the fact that a patient’s needs result from a situation that may create various stimuli, especially negative tension (Puchi et al., 2018). Hence, once the healthcare providers recognize the prevailing negative tension, they should always focus on the best ways to intervene to present positive outcomes by reducing the tensions. That is because once a patient experiences Comfort, it becomes easy to improve their health-seeking behaviors.

Major Assumptions, Concepts, and Relationships

Orem’s theory was subjected to changes meant to fit within the nursing system and individualistic concept. However, the initial theory is still intact. The main assumptions are that individuals should strive toward being self-reliant and responsible for their health care and the well-being of others in their families. Also, the theory presents patients as being unique, thus needing individualistic care approach, thus projecting nursing as an activity that requires effective interaction between different people. In that case, it is essential to ensure that self-care developmental and universal requisites are attained as crucial ill health and primary care prevention component (McEwan &Willis, 2021). That is because a patient can acquire a better way to address their prevailing health conditions by understanding their current health issues and the potential implications that these issues can have in their lives. That is because such understanding will help these patients develop appropriate self-care behaviors. It is also important to note that the theory assumes that dependent care and self-care are part of the practices that individuals learn within the socio-cultural context. Hence, Orem presents nursing as a combination of different disciplines, including art, technology, and service, while health is more of a state that represents whole or sound functionality and structurally with the environment representing the conditions, elements, and factors. The human concepts represent children, men, and women to represent a single societal unit and act as the material objects for healthcare providers. The nursing definition can refer to the deficit of developmental, universal, and other health-related issues. Such a position makes self-care more of the activities and practices to help individuals maintain their life and overall well-being.


The key concepts that outline Kolcaba’s theory include the aspect of Comfort and holism. However, to understand the concepts outlined by Kolcaba’s theory, it is important to understand Comfort, comfort measures, comfort care, health-seeking behaviors,  comfort needs, intervening variables, and institutional integrity (Puchi et al., 2018). Hence, the main assumption Kolcaba’s theory proposes is the need for the healthcare team and nurses to evaluate the patients’ and their families’ comfort needs. After identifying these needs, the healthcare providers must develop a design that will more effectively coordinate the necessary interventions to address these comfort needs. However, one most important factor that these healthcare providers must consider is assessing the intervening variables. If the intervening variables help the nurses deliver effectively and project care, the possible outcomes will be enhanced, thus improving healthcare outcomes. Some of these intervening variables include patient acuity and adequate staffing. Also, there is a need for the healthcare providers and nurses to ensure that they engage in realistic and desirable health-seeking behaviors such as carrying out evidence-based research to prove nurse productivity, thus attaining the overall comfort and treatment goals. Hence, the major assumption portrayed by Kolcaba’s theory is that when nurses, patients, and their families interact using health-seeking behaviors and are provided with Comfort, the ultimate result is that they will be more satisfied with the current healthcare services, thus promoting improved health-related outcomes. Also, once these nurses, patients, and their families become satisfied with an institution’s healthcare services and delivery, the instance boosts its sustainability and competitiveness. Hence, Kolcaba’s theory proposition may be more effective in policy improvements or evidence-based research to achieve the desired results.

Clinical Applications

Orem’s theory is substantial in nursing since nurses interact with daily self-care deficits. Therefore through the theory, it becomes easy for these nurses to formulate solutions for their patients as they address the need for their independence to enable them to control their treatment and rehabilitation. Hence, as a nurse, some of the important factors that one can learn from Orem’s theory include how to address issues like hygiene where the nurse needs to help them maintain their hygiene by providing them with motivation and reminders to such healthcare. The best way to engage them in a continuous and routine hygiene observation is by promoting them to daily washing up and bathing. Another factor to consider is patient grooming, where nurses can recommend more comfortable clothes, increasing the patients’ privacy and regular motivation (McEwan & Willis, 2021). Speech deficit is crucial since nurses should ensure that they engage speech pathologists to identify and find solutions to speech deficit cases that can interrupt patient communication. After patients have been hospitalized for a long, they may develop issues with feeding. However, as the patients recover, nurses must find meaningful ways to help them start feeding them, thus reducing care duties for their families since the patients will be more dependent on their meals. Hence, the main goal that Orem’s theory has is to help the nurses set concerns fostering their patients’ independency.


Kolcaba’s theory is also crucial in nursing practice through its three forms: transcendence, which is a comfort state that enables patients to win over their challenges; ease, which reflects comfort in contentment and relief when the nursing fraternity addresses all the patient’s needs. An example of how nurses use the three contexts is by providing patients that have undergone surgery with pain medication as part of relief comfort. The comfort theory can also be viewed in socio-cultural, environmental, and psycho-spiritual contexts. All these factors revolve around the patient’s environment (Bice & Bramlett, 2019). Therefore, nurses must evaluate patients’ environmental needs to ensure that they favor the patient’s comfort. For instance, nurses may come around patients and families that require the medical procedure to happen in the presence of a religious leader. In that case, the nurse should consult the nursing management to ensure they intervene on time to meet the patient’s comfort and improve their overall well-being. In such a case, Kolcaba’s theory is essential for nurses to ensure that they offer patient-centered healthcare services by engaging individualistic concepts since each patient has a different care approach.

Application to My Practice

As I continue my nursing practice, Orem’s theory will be crucial as I work to enhance care for the elderly. That is because I will need to assess the patient’s conditions to acknowledge their needs effectively. There will also be a need to engage the patients, their families, and other healthcare providers in an effective communication strategy to help coordinate care. That is because the elderly requires clear communication to understand their prevailing conditions and how well they are independent, including what they should avoid. The elderly must understand that they must stay within the home compound to avoid falls that may injure or fracture their bones, thus causing adverse effects. It will also be necessary to ensure that these patients’ care plan is well assessed by involving the patient and their families’ input to make them feel part of the process, thus increasing their chances of adhering to treatment and disease management recommendations

Kolcaba’s theory will be effective in my nursing practice since I will understand the elderly patient’s comfort from their view. For instance, when attending to elderly patients within the end-of-life stage, I will acknowledge that the patients might be anxious about death since they already know that their death may be nearing. Hence, I will need to indulge in evidence-based research reflecting on prior similar cases to get a whole picture of how such patients need to be addressed appropriately, thus providing a holistic approach to them.



Despite Orem’s theory encouraging nurses to ensure that patients are more independent when approaching self-care, Kolcaba’s theory provides an effective approach that aims at shaping care toward providing Comfort to the patients. Hence, both theories acknowledge the importance of healthcare providers and their impact on the care process. For instance, when attending to an elderly patient with a chronic condition like an autoimmune issue, the healthcare providers will engage Orem’s theory in educating the patients on how to be independent when managing the condition. The case will also need to engage Kolcaba’s Comfort theory to ensure that the patient achieves the required health outcomes. When evaluating the theories for parsimony purposes, they do not need more money or other resources since they aim to ensure that the patients, healthcare providers, and families adhere to disease interventions.


The paper has addressed two theories, Dorothea Orem’s self-care deficit theory as a grand range theory and Katharine Kolcaba’s theory of Comfort as a middle-range theory. From the perspective of these theories, it is evident that most nursing theories aim at enhancing care quality and patient outcomes. The exploration provided by the two theories shows that despite most theories using different approaches to address healthcare-related issues, they always have similar goals to enhance patients’ health outcomes and well-being. As for Orem and Kolcaba’s theories, it is easy for nurses to combine the theories’ perspectives to ensure that the patients receive holistic and ultimate care. That is because Orem’s theory promotes self-care and autonomy in patients, while Kolcaba’s theory aims to eliminate stress-related issues that may interfere with the patients’ Comfort, derailing their journey to achieve positive outcomes.



 Bice, A. A., & Bramlett, T. (2019). Teaching nurses from a holistic comfort perspective. Holistic Nursing Practice33(3), 141-145. doi: 10.1097/HNP.0000000000000325

McEwan, M., & Wills, E. M. (2021). Theoretical basis for nursing. Lippincott Williams & Wilkins.

Puchi, C., Paravic-Klijn, T., & Salazar, A. (2018). The comfort theory as a theoretical framework applied to a clinical case of hospital at home. Holistic Nursing Practice32(5), 228-239. doi: 10.1097/HNP.0000000000000275

Tanaka, M. (2022, May). Orem’s nursing self‐care deficit theory: A theoretical analysis focusing on its philosophical and sociological foundation. In Nursing Forum (Vol. 57, No. 3, pp. 480-485).

I want every one of you to be rewarded for your hard work on these papers. In order to get the best grade possible, please follow these instructions.
Step One- choose your theories. If they are listed in the reading, consider them approved, no need to send the request to me via the Journal area!!!
1. Based on the reading assignment (McEwen & Wills, Theoretical Basis for Nursing, Unit II: Nursing Theories, chapters 6–9), select a grand nursing theory.
2. Based on the reading assignment (McEwen & Wills, Theoretical Basis for Nursing, Unit II: Nursing Theories, chapters 10 and 11), select a middle-range theory.
Please use these bold headings to organize your paper. You are simply comparing the two theories back and forth.
In your reading, you will find a thorough description of each component below and fully describes what you need to research about your chosen theories to fill in the section.

Overview of your chosen grand theory
Overview of your chosen middle range theory
• You will have a separate paragraph in each section, one for your grand range theory and one for your middle range theory.

Background of the theories
(Grand theory chosen)-
(Middle range theory chosen) –

Philosophical Underpinnings
(Grand theory chosen)-
(Middle range theory chosen) –

Major assumptions, concepts, and relationships
(Grand theory -)
(Middle range theory -)

Clinical applications
(Hint: usefulness/value to extending nursing science testability)
(Grand theory-)
(Middle range theory -)

Application to nursing practice
(Hint: Comparison of how to use of your theories in nursing practice)
(Grand theory-)
(Middle range theory -)

Application to my practice
(Hint: Specific examples of how both theories could be applied in your specific clinical setting)
Grand theory-
Middle range theory –

(Hint: how simple or complex are the theories?
Grand theory-
Middle range theory
Every formal paper must have a formulated conclusion!

• Four References: Course text and a minimum of three additional sources.
• The paper should be 8–10 pages long- not including your Cover and Reference pages.
• Times New Roman,12-point font, and double-spaced with 1″ margins.
• APA format (7th ed.) a properly formatted cover page and reference list. See the link below for 7th edition APA updates!


– Dorothea Orem: The Self-Care Deficit Nursing Theory


– Kolcaba’s Theory of Comfort

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