Comfort Theory
objecti
ve
1. Discuss a brief history about theorist.
2. Identify the sources of the theory.
3. Critique the theory appropriately.
4. Identify the structural and functional components of
the theory.
history
Katharine Arnold
Born on December 8th 1944, Cleveland,
Ohio.
Married & has two children. as Katharine Arnold
• Diploma in nursing from St. Luke's Hospital School of
Nursing in 1965.
history
• RN/MSN Case Western Reserve University, 1987 .
• PhD. Nursing Case Western Reserve University, 1997.
• Member of the American Nurses Association.
• Currently retired from The University of Akron.
• Kolcaba has focused on volunteering with the American
Nurses Association and the Honor Society of Nursing.
• Published Comfort Theory and Practice: a Vision for
Holistic Health Care and Research
introduction
The comfort theory
• Nursing theory that was first developed in the 1990s by Katharine
Kolcaba.
• It is Middle range theory for health practice, education, and
research.
• She conduct a concept analysis about comfort in nursing,
medicine, psychology, psychiatry, ergonomic and English
dictionaries.
history
She depends on previous studies about the comfort such as:
- Nightingale:
the aim of Nursing observation is saving life and increasing
health and comfort, she focused on environment.
- Harmer:
state that the nursing care provides a general atmosphere of
comfort.
A state of physical ease and freedom from pain
“A person or thing that helps to alleviate a
comfor
difficult situation”
The word comfort can be an
comfor
adjective, noun, or verb.
it is defined by Merriam-
Webster as a “a state or
comfor
situation in which one is
relaxed and does not
experience any or much
physical or emotional pain”
As a verb
"to ease grief or trouble or to give
strength and hope during a time of
1
perceived distress
Kolcaba’s Identified comfort as
“state of being strengthened by having needs met for
relief, ease and transcendence within
the four contextual experiences of physical,
2
psychospiritual, environmental and sociocultural
comfort”
Kolcaba, K. (2003).
Kolcaba had described the
comfort in three Types:
about
need
1. Relief
2. Ease
3. Transcendence.
Three nursing theorist helped Kolcaba to
drive the types of comfort
need
Contexts of Comfort
01 Physical
contex
Environmental
about
02
03 Psycho-spiritual
04 Socio-cultural
related to bodily sensations and homeostasis.
Example :
Pain relief
physic
Regular bowel function
Fluid /electrolyte balance
Adequate oxygen saturation
Turning &positioning
(kolcaba,1994)
The external background of the human
experience
Examples
environmen
about
Temperature
Noise
Color
Light
Views from the window
Access to nature
related to internal awareness of self
Example
about
spiritual
Psycho
Maintaining / improving self esteem
Enhancing independence
Increasing relaxation
Accommodating religious practices
Interpersonal , family & social relationships
, family traditions & rituals
Example
about
cultural
Socio-
Caring attitude
Continuity of care
Information & education
Enhancing family & friend support
Taxonomic Structure
Provides a map of the content of comfort so nurses
can use it to pattern their care for each patient and
family.
Taxonomic
Structure
objective
Determining the existence of unmet
comfort needs in pt. and family
For designing comforting interventions
Taxonomic
objective
Structure
1- Structural Components
1. The need for comfort is basic.
2. Persons experience comfort holistically.
Assumptions
objective
3. Enhanced comfort (when achieved in healthy
ways ) leads to greater productivity
1- Health care needs
Needs for comfort arising from stressful health care
situations that cannot be met by traditional support
system including physical, psychospiritual,
sociocultural and environmental needs.
concept
2- Comfort interventions
Intentional actions designed to address specific
comfort needs including physiological, social, cultural,
psychological, spiritual, environmental and physical
interventions.
A. Technical intervention .
objective
B. Coaching.
concept
C. Comfort food for the
soul.
comfort
objective
A. Technical interventions:
concept
medications , treatments , monitoring schedules ,
insertion of line.
objective
concept
Supportive nursing action to relive anxiety
concept
Supportive nursing action to relive anxiety
3. Intervening variables:
are factors that nurses have little control of and are least
likely to change over time. These influence the over-all
objective
perception of comfort by the patient. Examples of
concept
which are age, prognosis, past experiences and extent
of financial and social support.
Comfort:
The state that is experienced immediately by recipients
of comfort interventions
5-Institutional integrity
-Is comprised of the values, financial stability, and wholeness of
health care organizations at local, regional, state, and national levels.
-These institutions include hospitals, public health organizations,
health centers and nursing homes.
concept
the application of the Comfort Theory does not only improve patient
outcomes but also benefits the institution providing patient care
Best policies are institutionally-developed protocols
and procedures for overall use after collecting sufficient
evidence. On the other hand, best practices are
protocols and procedures developed by an institution for
specific patient and family applications.
5-Institutional integrity
-Is comprised of the values, financial stability, and
wholeness of health care organizations at local,
concept
regional, state, and national levels.
-These institutions include hospitals, public health
organizations, health centers and nursing homes.
the application of the Comfort Theory does not only
improve patient outcomes but also benefits the
institution providing patient care
Best policies are institutionally-developed protocols and
procedures for overall use after collecting sufficient
concept
evidence.
best practices are protocols and procedures developed
by an institution for specific patient and family
applications.
Metaparadigm Concepts
Nursing:
Is the intentional assessment of comfort needs
objective
Design of comfort measures to address those needs
concept
Re-assessment of comfort levels after implementation
compared with the baseline
Assessment can be achieved through the administration
of visual analogs scales.
Client, Patient:
Recipient of care, can be individual, families,
or communities in need of health care.
objective
concept
Health:
Is optimal functioning as defined by the
patient or groups of patient family or
community.
Environment
Is any aspect of patient, family, or institutional
surrounding that can be manipulated by nurses or
loved once to enhance comfort.
objective
concept
Nursing problems
It implicit, the nurse is judge always to make her
patient comfortable all the time, and the comfort
is physical and mental, and our responsibility as a
nurses does not end with the physical part.
Importance of comfort theory
Guides nurses to detect comfort need of pt. and family .
objective
Describes how to care and how to be a nurse , what is
important to pt. and family , and factor facilitate the
healing.
Instruments
There are many suggestion for documentation on
instrument section at Kolcaba website as :
Verbal rating scale .
Numeric diagram.
Comfort daisies for children .
Comfort behaviors checklist for non verbal or
unresponsive Pt .
Questionnaires.
Testing of the theory
• After Kolcaba developed her theory, she tested it in
an experimental design.
• She collected the sample which are women with
early breast cancer associated with stressors.
• The holistic intervention was Guided Imagery (GI)
to meet their comfort needs.
• The finding reveals a significant different in
comfort between the women receiving GI and the
usual care group.
Theory Analysis &Critiquing
Relationship between structure and function:
A. Clarity
end
B. Simplicity
C. Consistency
D. Relevance
E. Generality
(Parker and Smith, 2010)
Their is continuum ranging from high to low of the
concept.
Straight forward and clear in the statement to
promote care and comfort to patient
Defines the terms used and gives examples on how to
Clarity
objective
use each aspect in the practical health field .
Demonstrated in a series of environments, pediatrics ,
end of life situations , wound care , post operation
situations.
Clear definition of comfort which has been presented
by Kolcaba is vital to consider the fact that the
definition change with time.
Work in progress with numerous amount of
literature pertaining to practice.
Written in simple language and easily explainable .
simplicity
Simple because it is arranged in a visual framework
objective
that outline the progression of actions
Simple and basic theory that can be applied to a
variety of situations easily because it addresses the
basic need of a patient .
There is a congruence between the concepts of the
comfort theory e.g. “comfort, comfort measures, and
health seeking behavior” and their application on the
real world.
Consistency
There is a congruence between assumptions and concept
definitions
Congruence between the assumption and propositions
Congruence between concepts and propositions.
General enough to apply to various practical settings
and population.
Generality
Can be applied to increase quality of life and pt well-
being.
Can applied to other field beside nursing like
education , counseling , and therapy .
Some of the concepts depict a poor relationship with each
other , for example : her definition of health as the optimal
functioning is not in line with other theoretical concepts.
“person” as one of the concepts of the theory, has not been given
a detailed definition.
Weakness
Kolcaba does not give detailed information on how the health
seeking behaviors in question are applicable to local clinics
insurance companies , work places, and other institutions of
health care.
It does not expound on how the comfort measures are
applicable in other environments other than the hospital
settings .
Practice research Administration
1 2 3
NATIONA
Labor
app
and influence Technical
L
delivery decision intervention
( Koehn making
2000)
1- Nursing Practice:
The comfort theory is still new.
Recognized increasingly to use as a studies
frame such as:
Nursing midwifery (Schilling & Sampselle ,1999)
Labor and delivery ( Koehn 2000)
Cardiac catheterization ( Hogan -Miller, Rustad ,
Sendelbeat & Goldenberg,1995).
(Parker and Smith, 2010)
2- Nursing research:
Nurses can provide evidence to influence
decision making at institutional community
levels thought comfort studies that demonstrate
the effectiveness of holistic care.
Kolcaba developed a General Comfort
Questionnaire to measure holistic care by using
the taxonomic structure of comfort.
3- Administration:
Comfort theory need to be implemented,
documented and reinforcement strategies
Administrator show value to this kind of care
If administrator do not take this
responsibility ,practicing nurse can be self
advocate according to comfort theory
Technical intervention should be documented
as usual check list sheet.
Documentation verbal rating scale.
Thank
you
