NUR 700 Discussion 4.1: Story Theory and Clinical Comfort in Nursing
NUR 700 Discussion 4.1: Story Theory and Clinical Comfort in Nursing
Story Theory and Clinical Comfort in Nursing
Story theory, a middle-range nursing theory, can strengthen the care that nurses provide to their patients. Stories are a vital facet of human experience and nursing practice. Story theory depicts a narrative event that transpires through intended nurse-person dialogue (Liehr & Smith, 2018). It strengthens nursing care by improving the bond between practice and research (Liehr & Smith, 2018). Story theory is comprised of three correlated ideas: intentional dialogue, connecting with self-in-relation, and creating ease (Brodziak et al., 2017). Intentional dialogue is the pivotal action between the nurse and the patient that animates the story (Liehr & Smith, 2018). It allows for the nurse to question what is most important about a complex health issue (Liehr & Smith, 2018). Connecting with self-in-relation happens with insightful mindfulness on one’s own experiences (Liehr & Smith, 2018). It is a dynamic course of identifying self as linked with others in an emerging story plot revealed during intentional dialogue (Liehr & Smith, 2018). Creating ease is recalling fragmented story instances to encounter flow all while establishing a grasp on the complete story (Liehr & Smith, 2018). When the different parts of a story come together in a noteworthy way, there is frequently advancement in the direction of solving and answering a health issue. Story theory also brings about listening and true presence (Brodziak et al., 2017). Using story theory with my rehabilitation patients strengthens the care I provide by permitting my patients to transition to further independence. This is achieved by allowing myself to question what it is about the patient’s current diagnosis that matters most to them, reflect on past events that may have contributed to this new diagnosis, and linking those different parts together to create ease of resolving the health issue at hand. I can engage in intentional dialogue about the effects of the patient’s new diagnosis to see if it is the newfound need to rely on others, the inability to express themselves appropriately, or maybe the change in body image that is largely bothering them. I can help them determine which aspect they want most to correct. I can assist the patient to reflect on past decisions and choices that may have led to this key moment in their life, and help them determine new care methods and positive changes they can make to prevent something like this from happening again.
I can recall a specific instance in which I could have used Kolcaba’s Theory of Comfort to care for a patient. The patient was a younger male who was recovering from COVID-19. He spent two months in the intensive care unit prior to being transferred to the rehabilitation hospital that I work at currently. The patient had a tracheostomy, a gastrostomy tube, a stage 3 sacral pressure injury, an unstageable pressure injury to the occipital area, and ‘COVID rash’ covering both lower extremities. The patient also suffered an acute kidney injury now requiring hemodialysis. Kolcaba’s Theory of comfort entails assessing the patient’s comfort requirements, creating and executing suitable nursing care plans, and evaluating the patient’s comfort after the care plans have been carried out (Bice & Kolcaba, 2020). Comfort occurs in three ways: relief, ease, and transcendence (Bice & Kolcaba, 2020). Relief is meeting a patient’s specific physiological comfort needs (Bice & Kolcaba, 2020). Ease addresses comfort in a state of tranquility (Bice & Kolcaba, 2020). Transcendence is described as the state of comfort in which patients are able to overcome their problems (Bice & Kolcaba, 2020). For relief, I helped the patient achieve this through medication administration for pain management. I could have improved his relief by adding extra pillows or an air mattress topper to help reduce pressure on his sacrum. For ease, I helped the patient achieve this by answering questions to decrease his anxiety of the unknown. I could have done a better job on this aspect by holding the patient’s hand, sitting with him so that he did not feel alone, providing a communication board to help him communicate needs due to the inability to speak as a result of the tracheostomy, or by helping him video chat with his family. For transcendence, I do not recall helping the patient achieve this level of comfort. Reflecting back, I could have begun to teach him how to manage his own bolus feeds through his gastrostomy tube, which would have assisted him with overcoming a new challenge in his life. However, I just did the feedings myself, but I now realize, that should have been a teachable moment as well as a moment of transcendence for him. Adding all of these things to my interventions would have improved this patient’s quality of care.
Bice, A. A., & Kolcaba, K. (2020). Katharine Kolcaba’s comfort theory. In M. C. Smith (Ed.), Nursing theories and nursing practice (5th ed., pp. 371–381). F. A. Davis.
Brodziak, A., Wolinska, A., & Myrta, A. (2017). The story theory is a key element of many holistic nursing procedures. Journal of Gerontology & Geriatric Research, 6(6). https://doi.org/10.4172/2167-7182.1000454
Liehr, P. R., & Smith, M. J. (2018). Story theory. In M. J. Smith & P. R. Liehr (Eds.), Middle range theory for nursing (4th ed.). Springer Publishing. https://doi.org/10.1891/9780826159922.0011
I really liked your description of the Story Theory and how it relates to your nursing practice with rehabilitation patients. You mentioned how utilizing intentional dialogue when talking with your patients helps you gain a better picture of their situation. Sometimes what is outwardly apparent is not the biggest health challenge for that patient and being able to sit down and talk with them can help identify what is. As you mentioned, using intentional dialogue with your patients can help identify changes that can be made to patients lifestyles to help combat their specific health challenge. Over the course of your patients’ stay in rehab, have you experienced patients making these positive changes? If so, what steps do you take to help promote these positive changes once you have identified them with the patient?
You gave a really great example of Kolcaba’s Comfort Theory and the ways in which you could have implemented it in your practice with your patient recovering from COVID-19. It sounds like you provided him with great care but you were still able to look back and identify even more ways to make the patient comfortable to promote ease. You mentioned that you did not feel as though you reached a state of transcendence with this patient and looking back on it realized that you may have provided him a higher level of comfort by teaching him how to do his bolus feeds himself. I think this a great example because, while doing something on his own may be anxiety-provoking, it is setting him up for a higher level of comfort when it comes time for his discharge. Perhaps this is something you can incorporate with your future patients who may be in a similar situation so that you can help him/her reach a state of transcendence before they leave rehab.
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