The Comfort Theory

Katharine Kolcaba

By Erin Carline, RN, BSN, CCRN

Who is Katharine Kolcaba?

Born Dec 28th, 1944 in Cleveland Ohio Diploma in nursing- St. Lukes Hospital 1965 BSN- Frances Payne Bolton SON-1987 PhD and Clinical Nursing Specialist- 1997 Currently Associate Professor of Nursing Emeritus at the University of Akron College of Nursing. Teaches on two online theory courses (MSN and DNP levels)

What is the Comfort Theory?

A mid-range theory A humanistic, holistic theory that is based on patient needs Began in nursing

Why, might you ask is this considered a midrange theory?

The comfort theory meets the following criteria for mid range.. 1. Its concepts and propositions are specific to health care disciplines 2. It is readily operationalized 3. It can be easily applied to many situations 4. Propositions can range from causal to associative, depending on their applications 5. Assumptions fit the theory

The Comfort Theory

The theory states that, in stressful healthcare situations, unmet needs for comfort are met by nurses and the health care team. Interventions are successful if enhanced comfort is achieved by the patient compared with a previous baseline. The immediate patient outcome of enhanced comfort is directly and positively related to patients engaging in health seeking behaviors When patients engage in health seeking behaviors, they do better and report high satisfaction in their healthcare High patient satisfaction leads to better institutional outcomes and higher institutional integrity Institutional integrity is conceptualized as the quality or state of health care corporations being complete, sound, upright, honest and sincere.

Conceptual Framework Please refer to handout for definitions

How was the theory derived?

Late 1980s- Diagram her practice for dementia care Presented at conference- feedback Found that the Framework was applicable to many areas Began to study definition of comfort and conceptual linkages

Conceptual Analysis
Concept analysis began with extensive review of literature
Nursing Medicine Psychology Psychiatry Ergonomics English (Even Shakespeare!)

Found that comfort was frequently cited, not never clearly defined.

Definition of Comfort
The use of comfort was extremely varied.

Kolcabas Definition of Comfort

The state of having addressed basic needs for ease, relief, and transcendence met in 4 contexts of experience (physical, psychospiritual, sociocultural, and environmental)

Deductive Stage of Comfort Theory

Resulted in comfort being related to other nursing concepts to produce a theory

Murrays Theory- framework

3 early nursing theorists were used to synthesize or derive the types of comfort

Relief- Orlando Ease- Henderson Transcendence- Paterson and Zderad

Overview of the Theory: Definitions

Relief- The state of having a severe discomfort mitigated or alleviated Ease- The absence of specific disorders Transcendence The ability to rise above discomforts when they cannot be eradicated or avoided

Even more definitions.

Physical- pertaining to bodily sensations and homeostatic mechanisms Psychospiritual- pertaining to internal awareness of the self; including esteem, concept, sexuality, meaning in ones life and ones relationship to a higher order or being Environmental- pertaining to the external background of human experience (temp, light, sound, odor, color, furniture, landscape, etc.) Sociocultural- pertaining to interpersonal, family, and societal relationships, traditions, rituals and religious practice.

 The aspects of comfort are interrelated and the whole is greater than the sum of its parts.

Taxonomic structure
The taxonomic structure enables us to identify comfort needs, design interventions targeted to those needs, and measure the effectiveness of those interventions.

Why is a framework important?

Caring attention to one cell that needs it, in the form of a comfort intervention can enhance total comfort more than could be expected by the nature of the specific comfort measures. When comfort needs are met in one context, total comfort is enhanced in the remaining contexts Placing comfort within a framework or theory provides nurses and team members with rationale for enhancing patient comfort.

Take a peek at your taxonomic structure chart now

Physical comfort needs: physiologic mechanisms that are disrupted. Comfort measures are directed at regaining homeostasis. Ex) fluid and electrolyte balance, oxygenation, pain, nausea, shivering

Psychospiritual needs
The need for inspiration, motivation, and being able to grow through or rise above discomforts that cannot be immediately relieved. Ex: massage, special visitors, caring touch, words of encouragement

Sociocultural needs
Needs for socially sensitive reassurances, support, positive body language, and caring Ex: honoring cultural traditions, assisting with paperwork

Environmental
Include orderliness, quiet, comfortable furniture, minimal odors, safety Ex: decrease noise and lights, allow for uninterrupted sleep.

Conceptual Framework

How does the comfort theory lead to institutional integrity?

When patients have high levels of comfort, they engage in health seeking behaviors When patients engage in HSB, they are more satisfied with their care High patient satisfaction=better outcomes and institutional integrity

But why do nurses care about this?

Rational for enhancing patient care Better pt satisfaction =better nursing care High patient satisfaction leads to competitive edge in negotiations with employers and financial viability for the institution.

Cant get that raise you deserve?

Use the comfort theory! Give them some solid DATA why you deserve more money!

Strengths
Kolcaba is still actively teaching and constantly expanding her theory to new disciplines of nursing The theory is applicable to the modern nursing profession. It is easily searchable, understandable and applicable It uses common, easily observable variables that are easily measured by the nurse and can be used for research and performance review

Collaborative Technologies and Social Media Tools

Kolcaba knows what the modern nurse and nursing student needs to grasp and use a theory.

Facebook! Blog! Webpage! www. thecomfortline.com YouTube Videos!

This is not a theory that was developed hundreds of years ago that you must strain to make applicable to modern healthcare.

Ironically.
Kolcaba has stated that The overall purpose of CT was to highlight the importance of comforting our patients in this high tech world. It is what they want and need from us. Second goal: highlight the importance of nurses to patients comfort -make what nurses do visible in documentation

Thankfully, she enjoys spreading the message of the comfort theory; her goals help her transcend her own discomfort with technology!

Lets tweet about the Comfort Theory!

Write a tweet about how the comfort theory can be applied to YOUR practice OR A definition of the theory
Address tweets to @KathyKolcaba Remember 140 characters or less! Include the hashtag #comfortline

Bibliography

Kolcaba, K.Y., & Kolcaba, R. J. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing. 16 (2): 1301-1310 Kolcaba, K., (2001). Evolution of mid range theory of comfort for outcomes research. Nursing Outlook. 49(2): 86-92 Kolcaba, K., & Wilson, L. (2002). Comfort care: a framework for perianesthesia nursing. Journal of PeriAnesthesia Nursing. 17(2): 102-114 Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort Theory: A unifying framework to enhance the practice environment. Journal of Nursing Administration, 36 (11), 538-544. Comfort Care website: www.thecomfortline.com