Theories in nursing have evolved over the years in a bid to suit the prevailing health conditions in society. Newman’s theory of health as expanding consciousness originated from Roger’s theory of unitary human rights. The grand nursing theory everyone is part of the universal process of expanding consciousness irrespective of whether they are healthy or not. The process of expanding consciousness involves finding the greater meaning of life as they reach new dimensions of interconnectedness with the people around them and the world. This means that people are connected to a more extensive system of the universe. According to Newman, understanding the patterns of people is critical ( Endo, 2017) . This is because disease manifestation is dependent on the patterns of people, and the pathology of illness occurs before the symptoms begin to appear. Even though the disease is removed, it does not change the individual structure. On the other hand, Kolcaba’s theory of comfort explains that relief, ease, and transcendence is essential in stressful conditions. Comfort enhances health-seeking behaviours among patients, their loved ones, and nurses. The middle-range theory of nursing places comforts at the forefront of healthcare ( Puchi, Paravic-Klijn, & Salazar, 2018) . The analysis of Newman’s and Kolcaba’s theories will reveal major assumptions, philosophical underpinnings, clinical applications, and comparisons to determine how they can be used in healthcare.
Background of the Theories
Newman’s grand nursing theory of health as an expanding consciousness originated from Roger’s idea of the theory of unitary human beings. The method was stimulated by the concern that health is not only the absence of disease. Margaret was also influenced by Bentov’s theory of the evolution of consciousness, young’s theory of process, as well as David’s concept of implicate ( Endo, 2017) . Newman developed her theory based on the idea that every person is connected to a universal system irrespective of their state of health. The interaction of people with the universe enables them to evolve their individual patterns. By combining the theories of her influencers, she explains how interaction with the universe helps to shape the health of individuals.
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Kolcaba’s theory of comfort lays the foundation of holistic care by emphasizing on the need to be caring and providing comfort to patients. His approach was derived from Watson’s theory of human care and from her practice as a nurse ( Pinto, Caldeira, Martins, & Rodgers, 2017) . Kolcaba was the head nurse and realized that comfort to patients was largely understudied. Her first publication of the theory was in 1994 which was then expanded in 2001 from where a book was developed in 2003. After its first development in the 1990s, it became popular and tested in numerous studies such as in women with early stages of breast cancer ( Pinto, Caldeira, Martins, & Rodgers, 2017) . The concept of providing care to patients was further tested in different clinical settings, including those near the end of life care. The middle-range theory of nursing considers that the environment can be manipulated to enhance comfort to patients, their loved ones, and others when providing care.
Philosophical Underpinnings of the Theories
Under Kolcaba’s theory of comfort, health care needs arise from stressful health care situations that the natural support system of the body cannot meet. Nurses are required to implement a health care setting and techniques that would meet the needs of the client. Intervening variables should be modified since they cannot be changed to bring comfort to patients. Comfort may be in the form of relief, ease, transcendence, as well as the state in which the physical, sociocultural, psychosocial, and environmental wellbeing has been achieved ( Pinto, Caldeira, Martins, & Rodgers, 2017) . Health-seeking behaviors should also be implemented and can either be internal or external such as therapies. Most importantly, institutions should have integrity to allow patients to do better. The main philosophical underpinning of the theory is to provide a holistic nature of comfort to patients.
The philosophical underpinning of Newman’s theory is the relation of man to the environment. The nursing process is, therefore, an understanding of how man relates to their surroundings. When nurses understand people, they are able to enable them to develop a high level of consciousness. People who develop a high level of consciousness are able to understand their disease, the recovery process, and how it can be prevented. Individuals have a unique pattern where they constantly change over time ( Endo, 2017). Human beings are identified by the patterns they have of consciousness. Since humans cannot be divided into different models based on their health, nurses are required to understand the universal system that is connected to humans in a bid to understand how they would handle patients.
Major Assumptions, Concepts, and Relationships
Newman’s grand nursing theory has several assumptions with regards to healthcare. According to Newman. Health includes conditions described as illness or pathology. The pathological state is considered to be a manifestation of the patterns of an individual. This means that the patters of people or their relationship to the environment influences pathology or illness. Therefore, the patterns of a person occur first and are considered to be primary before structural and functional changes begin to occur. This means that a person will start showing symptoms of an illness after the body is affected by interactions with the environment. Removal of a disease will not change the pattern of a person. In other words, if a person is cured of an illness, it does not mean that they will change their patterns or interactions with the environment. Therefore, if an illness is what makes a person aware and alert about their wellbeing, the pathology is considered to be health. Therefore, health is an expansion of consciousness. An individual will only be health-conscious once they suffer from an illness.
Kolcoba’s middle-range theory of comfort assumes that human response to external stimuli as wholes. The whole response is more significant than what would be expected. It would require clinicians to examine the separate responses and their stimuli differently and then add the effects of those responses. Whole individuals do not disappear into larger wholes. Healthcare providers asses the comfort needs of both their patients and family members and addresses them adequately. They design interventions that meet those needs that are not met by the existing support group. Comfort is first measured before the interventions are implemented. If comfort is enhanced, families are often engaged in health-seeking behaviors both internal and external. They would likely adhere to their treatments (internal) and follow up with their therapies (external). At the same time, when the positive behaviors are enhanced, the integrity of the institution is enhanced.
Clinical Applications/Usefulness
The theory of Comfort was developed from several disciplines that included nursing, medicine, psychology, and psychiatry. The three forms of comfort were also formed alongside four contexts of holistic human experience to assess and evaluate the comfort of patients. If a patient receives pain medications, he would feel relieved, which is a form of care. He would also have ease by halving reduced anxieties and calmness. In turn, the patient experiences transcendence where they are able to rise above their challenges. This means that comfort is achieved a patient and their family members gain relief, ease, and transcendence ( Puchi, Paravic-Klijn, & Salazar, 2018) . However, this can only be achieved when done in the physical, psychospiritual, environmental, and sociocultural. According to Kolcoba, comfort is a product of holistic nursing. This means that individuals need to be completely whole to be considered healthy. Health is encompassed in the overall wellbeing of people.
The theory of comfort applies to healthcare by proving holistic care to those in need. They consider patients to be individuals, families, institutions, as well as communities. Their surroundings can, therefore, be manipulated by nurses and other health care providers to provide comfort to patients. Good health of a patient means that the family and community are also healthy. Therefore, nurses are required first to assess the individual needs of their patients. The assessment would act as a guide to developing a care plan that would meet those unique needs. The interventions are then reassessed to ensure that they meet the needs of their patients ( Puchi, Paravic-Klijn, & Salazar, 2018). Assessment can be an objective such as the observation of a wound. Interventions would then be wound care and repositioning. At the same time, nurses would also have to review and evaluate whether their interventions are effective and patients are receiving adequate care.
The theory of comfort also addresses vital elements in modern nursing. Modern nursing practice seeks to provide holistic care to patients. Care is not only viewed from the physical perspective but also considered to be a socio-cultural and psychological phenomenon. One cannot be deemed to be well if one of those dimensions are not met sufficiently. Intervening factors such as prognosis or finance may not change with the provision of care. Nonetheless, the theory of comfort ensures that health-seeking behaviors of patients and their families that are achieved by having comfort work in a constant effort to maintain their overall health.
According to Newman, health and illness are synthesized as health. On one hand, there is all illness, and on the other, the disease is absent. The human is unitary and is identified by their patterns of consciousness. The grand nursing theory seals the partnership between nurses and patients. Nurses help patients achieve higher levels of consciousness. The expanding consciousness is achieved when people get ill and become more aware of their wellbeing ( Younas & Parveen, 2017). Higher levels of consciousness are also achieved from evolving patterns of their interactions with the environment. The grand nursing theory is beneficial in modern nursing since it can be applied through creating caring environments.
Newman’s theory of health as an expanding consciousness lays the foundation to the concept of transformative care in modern practice. Patients have a greater need to connect with nurses now as opposed to the past. However, nurses are not always fully available due to their busy schedules. Based on the theory, nurses formulate interventions that enable them to identify the needs to be met ( Younas & Parveen, 2017) . Nurses are also required to allow patients to get meaning of their life in their difficult situations. Eventually, nurses and patients will grow during those difficult times.
Patients are alert when faced with a health problem. They become more aware of their wellbeing and how they are supposed to relate to their environment in promoting their overall health. Nurses, through their role of education, are required to educate their patients and create plans for them to improve their lives irrespective of whether they are in the hospital or not. The care plans will increase their awareness or expand their consciousness and engage in healthy behaviors that promote their overall wellbeing. Nursing as a process is seen when nurses enter into a chaotic period with their patients ( Younas & Parveen, 2017) . The process also involves both the nurses and patients engaging in a meaningful process of mutual relationship. In the end, both nurses and patients become more aware of the disease and health as their conscious level expands. Therefore, nursing interventions requires actions that are not centered around the patient pattern.
Comparison of Both Theories
The grand nursing theory of health as an expanding conscious revolves around patients and nurses having mutual relationships. The theory requires nurses to teach and educate their patients to become more aware of their illnesses. They are also required to learn more about their health status and overall wellbeing as they learn ways of improving themselves ( Sitzman, 2017). This means that people need to be ill in order to realized and improve their wellbeing.
The middle-range theory of comfort works to meet the needs of patients in a holistic manner. The theory addresses the needs of patients that are not met by ensuring that they are provided with comfort in the physical, psychological, environmental, and sociocultural domains. The theory seeks to provide holistic care based on the underlying principle that health is not only focused on the body but is also concerned with other aspects of life ( Sitzman, 2017) . A person is the embodiment of different factors connected with each other.
Despite the differences, both theories are similar since they are concerned with improving the wellbeing of their patients. The theories reflect on the relationships between the environment and people ( Sitzman, 2017) . The grand nursing theory of health being an expanding consciousness explains how patients are connected to the environment. On the other hand, the middle-range theory of comfort illustrates how humans rely on four dimensions including the environment to find comfort.
Specific Examples
The grand nursing theory includes nursing using interventions and teaching plans to help diabetic patients change their lifestyles. Patients are taught to improve their overall wellbeing. At the same time, nurses learn how to manage their conditions. On the other hand, the theory of comfort involves nurses changing the hospital setting, such as repositioning patients after two hours to prevent them from getting pressure ulcers. The interventions provide relief from pain, ease from anxiety, and enables patients to gain transcendence to rise above their situations.
Parsimony
The simplest explanation of both the grand nursing and middle-range theories is that humans have an interrelationship with the environment. Healthcare is also holistic and ensures that patients get comfort in all dimensions of their lives while being more aware of their condition. The two theories transform nursing by ensuring that patients get all-round care.
Conclusion
Health care is holistic, and the application of nursing theories is essential. Newman’s theory of health as an expanding consciousness explains how people should awaken their knowledge and interact with nurses to understand and improve their wellbeing. On the other hand, Kolcoba’s theory of comfort emphasizes that people should be provided with comfort as part of the overall care provision.
References
Endo, E. (2017). Margaret Newman's theory of health as expanding consciousness and a nursing intervention from a unitary perspective. Asia-Pacific journal of oncology nursing , 4 (1), 50.
Pinto, S., Caldeira, S., Martins, J. C., & Rodgers, B. (2017). Evolutionary analysis of the concept of comfort. Holistic nursing practice , 31 (4), 243-252.
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 practice , 32 (5), 228-239.
Sitzman, K. (2017). Understanding the work of nurse theorists: A creative beginning.
Younas, A., & Parveen, S. (2017). Finding Patterns of Meaning: Margaret Newman’s Theory of Health as Expanding Consciousness.
