TRIPLE

N’s

PRESENTED BY:Linda AkioyameLaura Dunwell

Crystal JohnsonKathlyn MillareChristina PorterWhitney Slater

Trung TuDaryl Yann

Nursing Theorists

Margaret A. Newman (October 10, 1933 to present)

• Education:• Bachelor’s degree in home economics and

English from Baylor University of Waco, Texas , in 1954

• 2nd bachelor’s degree in nursing from University of Tennessee in Memphis in 1962

• Master’s degree in medical-surgical nursing and teaching from University of California, San Francisco, in 1964

• PhD in nursing science and rehabilitation nursing from New York University in New York City in 1971

BIOGRAPHY

BACKGROUND

• 1978: Invitation to speak at a conference in New York on nursing theory

• 1978 to 1982 - Participated as a member of the nurse theorist task force with NANDA

• 1985 - Traveling research fellow and presented many papers on her theory of health as expanding consciousness

• 1989 & 1990 - Principal investigator exploring the theory and structure of a professional model of nursing practice

• Consultant for her theory of health in more than 40 states & 8 countries

• Has served on several editorial review panels• Currently on advisory board of Advances in Nursing

Science

Awards and Recognition

• Fellow in the American Academy of Nursing and has been honored as an outstanding alumnus by both the University of Tennessee and New York University in 1975 and 2002

• Admitted to hall of fame at University of Mississippi School of Nursing in 1988

• Distinguished Scholar in Nursing Award from New York University in 1992

• Founders Award for Excellence in Nursing Research from Sigma Theta Tau International

• E. Louise Grant Award for Nursing Excellence from the University of Minnesota in 1996

• Named Who’s Who in America in 1996

Images of Nursing at the time theories were developed

• In the late 70s to the 80s, The public image and popular opinion of nursing was that of “traditional womanhood”.

• Nursing was seen as the narrowing of personal ambition and acceptance of the stricture of sex role specialization.

Images of Nursing at the time theories were developed

• The image of nursing perceived by Margaret Newman was that of healer; to make people well, and to prevent people from getting sick.

Images of Nursing at the time theories were developed

• Margaret felt that the role of a nurse was mainly to assist people in utilizing the power within them.

• Newman states, “The task of nursing is not to try to change the pattern of another person, but to help client recognize their own patterns,” which opens the way for transformation to occur.

Theory of Health as Expanded Consciousness

“Every person in every situation, no matter how disordered or hopeless it may seem, is part of

the universal process of expanding consciousness- a process of becoming more

oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with

other people and the world.”

Alfred Rogers - Theory of Unitary Beings

• Consciousness: the ability of a system (human being) to interact with the environment

• This consciousness is part of a larger, undivided pattern of an expanding universe.

• Foundation for viewing health and illness as a unitary process moving through variations in order and disorder

Paradigm Shift

• From treatment of symptoms to a search for pattern.• From viewing disease and disruption as negative to viewing

them as part of the self-organizing process of expanding consciousness.

• From viewing the nursing role as addressing the problems of disease to assisting people to get in touch with their own pattern of expanding consciousness.

Today’s Healthcare Environment

• Finding your best self no matter what the situation…• Old rules vs. New rules

Imagine, “the emanating waves that appear when two pebbles are thrown into water. As the waves radiate...they meet and interact...[forming] an interference pattern.”

Nursing Practice

• Newman believes that, “the goal of nursing is not to make people well, or to prevent their getting sick, but to assist people to utilize the power within them as they evolve toward higher levels of consciousness.”

• Maintaining a direct on-going relationship• Movement and time are an essential part of nursing

intervention• Applications in clinical management

EDUCATION

• Newman suggests that nursing education should, “revolve around pattern as a concept, substance, process, and method.” Education by this method would enable nursing to be an important resource for the continued development of health care.

RESEARCH

• Pattern recognition allowed researchers to study patterns of patients with the following conditions and treatment:– Rheumatoid arthritis– Coronary heart disease– COPD– HIV & AIDs– Older wife caregivers of husbands with dementia– Use of music and treating chronic pain– Women who successfully lose weight and maintain the

loss– Family members living through sudden death of a child

BIOGRAPHY

Katharine Kolcaba• December 8, 1944 in Cleveland, OH• Received diploma in 1965 from St. Luke’s

School of Nursing• Practiced med-surge, long-term, and

home-care part time while raising 3 daughters• Obtain MSN degree in 1987• After graduation, she joined the University of

Akron College of Nursing while pursuing her doctorate.

• Developed the “Theory of Comfort”• Completed PhD in 1997• Continues to live in Cleveland, OH with her family and

continues to be active in nursing organizations.

• 1991-92: Pre-doctoral Fellowship in Interdisciplinary Health from CWRU

• 1997: Marie Haug Student Award for Excellence in Aging Studies

• 1997: Honor a Researcher Award• 2003: Mary Hanna Memorial Journalism Award in

recognition for the article “Care of the Perianesthesia Nursing”

• 2003: Advancement of Science Award from Midwest Nursing Research Society, End of Life, and Palliative Care Nursing

Awards and Recognition

• Nurses were invisible in the media• Shortage of nurses• There was a decline enrollment in

nursing schools • Nurses did receive recognition for

their participation with the war in the Middle East.

Public’s View of Nursing during the 1990’s

Kolcaba’s View of Nursing• Kolcaba says that nurses indentified the patient’s lack

of comfort, and implement nursing interventions to address those issues.

• However, with her theory and proper support, patients are engaged in rehabilitation and/or recovery programs, and the institutional integrity enhances as well.

• Kolcaba says that patient needs to have a need for enhanced comfort, that are not achieved by conventional support systems. These needs include physical, psychospiritual, social, and environmental needs.

The Comfort Theory: Intro.Comfort may be a blanket or breeze,Some ointment here to soothe my knees;A listening ear to hear my woes,A pair of footsies to warm my toes;A PRN medication to ease my pain,Someone to reassure me once again;A call from my doctor, or even a friend.A rabbi or priest as my life nears the endComfort is whatever I perceive it to be, A necessary thing defined only by me.

-- S.D. Lawrence SN(Kolcaba, 1995b, p. 289)

Three Types of Comfort• Relief

• Experience of the patient that has had a specific comfort need met

• Ease• A state of calm or contentment

• Transcendence• A state in which one rises above problems or pain

Four contexts of experience– Physical

• Pertaining to bodily sensations, homeostatic mechanisms, immune function, etc.

– Psychosocial• Pertaining to internal awareness of self, including esteem,

identity, sexuality, meaning in one’s life, and one’s understood relationship to a higher order or being.

– Environmental• Pertaining to the external background of human

experience (temperature, light, sound, odor, color, furniture, landscape etc.)

– Sociocultural• Pertaining to interpersonal, family, and societal

relationships (finances, teaching, health care personnel, etc.) also to family traditions, rituals, and religious practices.

Main Concept

• All types of comfort must be met in the four contexts of experience for total comfort to be fulfilled

• Based on this chart, Kolcaba created a The General Comfort Questionnaire

A Copy of Kolcaba’s experiment testing The Comfort Theory• Early stage breast cancer patients undergoing radiation

therapy• Guided Imagery audio tapes that describe radiation

therapy as a “friend” whose healing rays were important for the woman’s health were given to half of the study group.

• The General Comfort Questionnaire, revised to relate to radiation therapy, was given before the start of radiation therapy, in the middle of therapy, and 3 weeks after therapy ended to measure comfort.

• Effects of Guided imagery on Comfort of USN students prior to a presentation

Applying to the Comfort TheoryHealth Care Needs

+ Nursing Interventions

+ Intervening Variables

-> Enhanced Comfort

<-> Health Seeking Behaviors

Comfort needs of USN Students to treat anxiety

+ Guided Imagery

+ Age; Sex; Marital Status; Amount of time practiced; Confidence

-> Comfort related to USN students prior to a presentation

<-> Functional Status;

Outcome of GI on patients

Before RT Middle RT 3 wks post RT0

20

40

60

80

100

120

140

160

Guided ImageryControl

Comfort Theory in Today’s Healthcare Environment

• The concept of The Comfort Theory is nurse-sensitive in today’s healthcare environments, because it is influenced by nursing interventions.

• Basically, we can use the framework of the comfort theory to test if certain nursing interventions we are using are actually helping to improve the patients level of comfort

Compare and Contrast

• Both theorists believe that nursing focuses on helping the patients achieve optimum satisfaction with their current state of health.

• Newman: focuses on holistically empowering the patient to adjust their lifestyle to adapt to an improve way of living

• Kolcaba: focuses on empowering the nurse to provide interventions to help the patient achieve holistic comfort

Questions?

ANNOTATED BIBLIOGRAPHY

Ellis, J. (2004). Nursing in Today’s World: Trends, Issues, & Management. Philadelphia , PA: Lippincott Williams & Wilkins.

In this book, Ellis attempts to capture the a summarized history of nursing including its’ trends, issues, & management primarily focusing on the mid 1900’s to now. Ellis’ book ranges from understanding the healthcare environment to health care finance and control to the political process and the nursing profession.Nursing in Today’s World: Trends, Issues, & Management was really helpful as she provided very in-depth details about the nursing profession in a concise manner. I was very fond of the information she provided about the 1990’s, about how the public portrayed the image of nursing.

Kalisch, B J, & Kalisch, P A. (1983). Anatomy of the image of the nurse: dissonant and ideal models. Truthaboutnursing, 3-23(G-Retrieved from http://www.truthaboutnursing.org/images/kalisch/anatomy_of_the_image_of_the_nurse_ocr.pdf doi: 6556020.

The book depicts the image of nursing perceived by Margaret Newman, which was to make people well, and to prevent people from getting sick, but Margaret felt that the role of a nurse was not simply to heal or prevent sickness, but mainly to assist people in utilizing the power within them. The book also expressed Newman’s belief, which was that the task of nursing was not to try to change the pattern of another person, but to recognize it, as information, that depicts the person as a whole, and relates to it, as it unfolds.

Newman states that to practice her theory of health as expanding consciousness, the nurse must understand their own patterns and values. It is then the nurses responsibility to establish a relationship with the client to help them identify meaningful patterns within their lives. Education should revolve around pattern as a concept, substance, process, and method. Through this, an individual's personal experience will be the core of not just teaching and practice, but research as well. Research is focused around assisting clients in pattern recognition. This method allows the pattern of personal environment to reveal itself without disturbing the unity of the pattern.

Kolcaba, K. (2003). Comfort theory and practice. New York, NY:Springer Publishing Company.

In this nonfictional book written by Katharine Kolcaba, she explains her vision for holistic healthcare and research on Comfort Theory and practice. The book provides a layout for the application of Comfort in practice, education, research, and quality improvement. Dr. Kolcaba explains how comfort incorporates emotional, spiritual, and physical aspects of patient care. The Comfort Theory model offers nurses and other health care team members a guideline for holistic assessment and a design for intervention, evaluation, and for patient care planning. The book Comfort Theory and Practice is a detailed idea of how to approach the element of comfort in today’s healthcare environment. This book was well organized, provided many illustrations to support this theory, yet gave the impression of redundancy. This book was a helpful source for our presentation project.

Kolcaba, k. (2009, December 22). The Comfort line. Retrieved fromhttp://thecomfortline.com/

On this online website written by Katharine Kolcaba, she explains her vision for holistic healthcare and research on Comfort Theory and practice. The website provides a layout for the application of Comfort in practice, education, research, and quality improvement. Dr. Kolcaba explains how comfort incorporates emotional, spiritual, and physical aspects of patient care. The Comfort Theory model offers nurses and other health care team members a guideline for holistic assessment and a design for intervention, evaluation, and for patient care planning. This website is easily accessible and highly user friendly. The website was a helpful source for our presentation project.

Newman, M. A. (2010). Health as expanding the consciousness. Retrieved from http://healthasexpandingconsciousness.org

In her website, Margaret A. Newman attempts to make clear her philosophy of health as expanding consciousness. In the various articles displayed in the website, Newman gives readers a chance to delve into her mind and explore the concepts behind her theory. She provides background about her life, displays her core values about health as an expanding consciousness, gives history about the predecessors who helped influence her theory, posts up-to-date news articles about her work, and provides information about the books she has written.

As an experienced nurse of 48 years, and an extensive life-long learner, Newman was aware of the importance, dedication, and the various aspects of the nursing profession. She clearly states her opinions in a proficient manner, while providing readers with a wealth of knowledge on the topic. Her website is organized with a congruent approach and is likely to help any person interested in researching the topic.

Tomey , A.M., & Alligood, M.R. (Ed.). (2002). Nursing theorists and their work. St. Louis, Missouri: Mosby.

In Katharine Kolcaba’s theory section of the book illustrates her own approach to providing care for her patients which involves the physical, psycho spiritual, social and environmental needs. I found that Kolcaba is simply taking comfort and breaking it down to a science, furthermore combining what previous nursing theorist have already stated into her own words.

This section of the book highlights the significant events of the life of Margaret A. Newman in chronological order which include her education and work background and her accomplishments. These events gave me a general image of what her life involves and her devotion in nursing.