Kolcaba's Comfort theory : Analysis and evaluation Essay

“If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault of not of the disease, but of the nursing. I use the word nursing for want of a better” (Nightingale, 1860, p. 8). While Nightingale stressed the impact of one’s environment to promote healing, Virginia Henderson aimed to establish on the fundamental needs as a knowledge base to guide Professional nursing practice. Henderson emphasized on fourteen components required for effective nursing care which includes: breathing normally, eating and drinking adequately, elimination of body wastes, movement and posturing, sleep and rest, select suitable clothes-dress and undress, maintaining body temperature, keeping body clean and well groomed, avoiding dangers in the environment, communication, worship according to one’s faith, work accomplishments, play or participate in various forms of recreation, and learn, discover, or satisfy the curiosity (Fernandes et al., 2015). Her division of the fourteen components acknowledged patient needs with a holistic approach that is applied through the nursing process in a clinical setting.

Anyone who has spent any time as a hospital patient knows that comfort is not generally going to be found, but instead, a patient may find themselves overwhelmed with anxiety and fear. This uncomfortable feeling may be fueled by uncertainty in many different forms. Patients may be uneasy about upcoming and unfamiliar procedures, they are concerned about recovery from their illness, and /or they may be plagued by thoughts of their mortality. In addition to dealing with these personal thoughts going through the patients’ heads, the patients are also forced to endure a hectic and chaotic hospital environment. They find themselves in a place where their rest is being constantly interrupted by hospital staff checking on their current health status. This could include from simple vital sign checks to uncomfortable and painful invasive procedures such as having chest tubes inserted or removed. In addition, a patient may experience humiliation due to a lack of privacy as well as the lack of freedom due to confinement within their hospital room. The resulting psychological effects can be harsh, creating issues further impeding the healing of the patients. This is a major concern because research has found that recovery and healing is at its optimum within a comfortable setting where resting can take place (Krinsky, Murillo, & Johnson, 2014, p. 147). In compliance with this line of thought, Katharine Kolcaba formulated the Comfort Theory, which holds, “the experience

In the Comfort Theory, proposed by Catharine Kolcaba, the tradition of nursing discipline - deriving theory from former disciplines is examined, and the notion of former healthcare disciplines deriving nursing theory has been recommended. A short literature review of plagiarized theory sets the position to examine the modification of the theory. She describes convenience as one of the mechanisms for the full rehabilitation of the patient, and the personal desire of the patient to recovery across the permanency of the diseases. Holistic comfort has been described as the instant experience of being powered through having the requirements for relief, transcendence, and ease met in the four bases of experience (physical, environmental, psycho-spiritual, and social). Providing comfort is necessary for the care of a patient in the hospital background (March, 2009). Nowadays, comfort is being regarded as the last outcome for the terminally sick patient, and it is not seen as a standard hospital practice, when they prophylactically or for protocol, try to develop the patient’s health status. Theorist Katherine Kolcaba was among the first nurse researchers to advance a theory of comfort to develop patient’s outcomes and satisfaction, and to improve institutional integrity. This paper aims at describing the Comfort Theory, as well as its weaknesses and strengths as a middle-rank theory. It also defines its applications beyond the healthcare background, bases for further

CT has been adopted by many in the healthcare field. Southern New Hampshire Medical Center adopted CT to achieve Magnet Recognition Status. Components of CT have been incorporated in the National Intervention Classification, the National Outcomes Classification, and the North American Nursing Diagnosis Association. The American Society of Peri-Anesthesia Nurses composed Comfort Management, a model initiated by nurses based on CT. The Comfort Questionnaire has been certified by the Agency for Healthcare Research and Quality since 2003. The Comfort Questionnaire has been used in many settings and translated into Spanish, Portuguese, Italian, Turkish, and Farsi. Comfort Theory and Practice: A Vision for Holistic Healthcare and Research has been translated into Japanese, attesting to the theory’s international appeal and utility.

Kolcaba explained three different views of comfort. First meaning, “as the state of having discomfort relieved”, secondly as the “state of ease and peaceful contentment”, third “as relief from discomfort” (Kolcaba, & Kolcaba, 1991). These states of comfort are continuous, interdependent and can overlap (Kolcaba, 1991). A goal of nursing practice, as contained in statements of standards for care, has been generally to help the patient be comfortable or be in a state of comfort (Kolcaba, & Kolcaba, 1991). Patients require comfort care pre-, intra-, and post-operatively. For the surgical patient, comfort care is initiated from admission until discharge. The purpose of this paper is to provide a concept analysis of comfort care with the goal of better understanding of its key attributes in order to clarify its use in nursing practice, theory and research. The defining attributes will be discussed, model cases, and additional cases will be reflected. Antecedents and consequences will also be identified. Finally, the last section of the paper will identify some of the ways that the defining attributes can be measured.

The adaptation model is used virtually in every nursing field more so in oncology treatment, hospice care, long-term cardiac care, and pediatric care. (Dewey, 2016) There are “five main concepts the adaptation theory and they consist of the health, the person, the nurse, the adaptation, and the environment” (Badr, 2014). In the adaptation theory there are four modes the physiological-physical mode, the self-concept-group identity mode, the role function mode, and the interdependence mode (Petiprin, 2016). The physiological-physical mode is comprised of the basic needs such as nutrition, rest, activity, protection, oxygenation, and elimination. The self-concept mode is focused on the spiritual and psychological integrity along with the sense of meaning, unity, and purposefulness in the universe. The role function mode the roles that a person occupies in society achieving the need for social integrity. The interdependence mode is the development and structure of individuals and groups the purpose of people’s close relationships and potential of adaptation of their relationships (Gonzalo,

In the early part of the 20th century, comfort was the central goal of nursing and medicine. Comfort was the nurse's first consideration. A "good nurse" made patients comfortable. In the early 1900's, textbooks emphasized the role of a health care provider in assuring emotional and physical comfort and in adjusting the patient's environment. For example, in 1926, Harmer advocated that nursing care be concerned with providing an atmosphere of comfort.

Patients and family members in medical intensive care units experience pain and anxiety while overcoming illness and disease. Nightingale was one of the first nurses to recognize that the relationship between health and comfort is strong and direct (Peterson & Bredow, 2013, p. 194). Kolcaba’s theory of comfort addresses the need for nurses to provide patients and families with relief, ease, and transcendence to facilitate health-seeking behavior (McEwen & Wills, 2011, p. 234). The purpose of this paper is to evaluate Kolcaba’s theory of comfort (CT) using the Synthesized Method described by McEwen and Wills (2011) and to describe how this theory can be applied in practice.

Kolcaba middle-range comfort theory was presented in the early 1990s, and it included three technical senses of comfort; relief, ease, and transcendence (Kolcaba, 2003). The nurse needs to identify the specific discomfort and the support required. After a nurse has identified and provided comfort interventions, the patient will move through the three technical senses. Kolcaba coined the patient’s comfort needs are met as the relief phase. She describes the next stage as ease and is reach once the patient is content.

Comfort is defined by Merriam-Webster’s dictionary (2014) as “a state or situation in which you are relaxed and do not have any physically unpleasant feelings caused by pain, heat, cold, etc.” or as “a state or feeling of being less worried, upset, frightened, etc., during a time of trouble or emotional pain.” Dictionary.com (2014) defines comfort as “a feeling of relief or consolationm” or “a person or thing that gives consolation,”or “ a state of ease and satisfaction of bodily wants, with freedom from pain and anxiety.” Dictionary.com (2014) lists the origin of the word comfort as coming from the 13th century Old French term confort, meaning “source of alleviation or relief.” One can see there are multiple meanings and interpretations of the word comfort. This paper will set forth to discuss the word comfort as a concept and its interpretation and use in many disciplines, including its significance in nursing.

The model that is utilized in this paper is based upon Katherine Kolbaca's comfort theory. Those living with chronic illness face ongoing battles in their pursuit of comfort and wellbeing. The comfort theory is a middle-range nursing theory developed by Katherine Kolbaca (Kolbaca, 2011). This theory is looking into patient’s specific needs and asserts that providing comfort to all patients is an integral part of nursing care and should be a priority. The main objective of Dr. Kolcaba theory was to improve patient’s satisfaction and outcomes (Kolcaba, 2011).

The developmental stages of the mid range theory of comfort are discussed in this article, which includes its philosophic orientation and its inductive, deductive, and retroductive reasoning. Other steps that are described are the concept analysis of comfort, the operationalization of the outcome of patient comfort, the application of the theory in previous nursing studies, and the evaluation of the current theory as it has been adapted for outcomes research. This article is a guide that shows how a concept grows, becomes embedded in theory, is tested, and is adapted for the rapidly changing health care environment. The theory of comfort

Transcendence is the ability for patients to use their sense of comfort to rise above any struggles and conflicts they may be facing (Petiprin, 2016). Overall, Kolcaba defines her theory and comfort in general as "the immediate state of being strengthened through having the human needs for relief, ease, and transcendence addressed in four contexts of experience (physical, psychospiritual, sociocultural, and environmental)” (Kolcaba & DiMarco, 2005). By using this theory in a hospital environment, Kolcaba hoped that comfort levels would be increased for all patients, staff and visitors and that patient health would improve as a result of this theory implementation (Boudiab & Kolcaba, 2015).

Healthcare industry today had shown a remarkably change and far advanced. Nurses being the highest number in healthcare industry are required to be more artfully that ever before. Nurses need to practice efficiently and effectively in delivering high quality of care. Nursing profession is an art and sciences, both are integrated to enable nurses to better meet present day challenges. One major component in the nursing art is ‘comfort care’, presented in a manner that is easy to understand and put into practice. Researchers had argued that comfort care is resourceful, individualized, holistic and gratifying to patients as well as nurses. It is believed that comfort care assist in organizing and improve practice, especially during times of rapid

During my nursing student stint as we were exposed to different hospitals, I have always encountered on chartings the phrase “kept safe and comfortable”. As I practice my profession, questions arises what comfort really means and its diverse perspectives. Being a ward nurse, aside from moving my patients towards health; providing holistic nursing care and client satisfaction is my utmost concern. Leininger (1991) believed comfort to be a function of nursing while Gropper (1992) embraced yet another approach to the delineation of comfort and proposed that comfort is a basic human need pursued by all human