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KATHERINE

KOLCABA
THEORY OF
COMFORT
{

Presented by:
Kristine Cargill R.N.
Emily Dutmers R.N.
Amanda Niedzwiecki R.N.
Stephanie Yohn R.N.

COMFORT THEORY
Comfort may be a blanket or breeze,
some ointment here to soothe my knees;
a listening ear to hear my woes,
a pair of footies to warm my toes;
A PRN medication to ease my pain,
someone to reassure me once again;
A call from my doctor, or even a friend,
a rabbi or priest as my life nears its end.
Comfort is whatever I perceive it to be,
a necessary thing defined only by me.
-S.D. Lawrence (student nurse)
(Kolcaba, 2003, p.1)

MOTIVATION AND HISTORICAL


BACKGROUND

Comfort Theory originated from a Masters program


assignment to diagram her nursing practice
At that time, she was a head nurse on an
Alzheimer unit
Comfort was the state she wanted her Alzheimer
patients to be in when not participating in
activities or tasks. Comfort became her focus in
nursing practice and research
Comfort theory was later applied to other fields of
nursing, such as perioperative care and pediatrics

http://www.thecomfortline.com/index.html

ASSUMPTIONS & POINT OF VIEW


Nursing care is more efficient when theory is
used because care can be delivered in an
organized manner
Science of nursing is about the comfort of
patients, families, and nurses
When nurses provide comfort measures, such
as turning a patient every 2 hours, the patient
is expected to have a positive outcome
Care is delivered and based on a humanistic
and holistic approach and patients needs
(Kolcaba, 1991)

PHILOSOPHIC VALUES ABOUT NURSING


AND KNOWLEDGE DEVELOPMENT

Research has included the care nurses provide


and the comfort or patient outcomes that result
from the care provided
Values the whole person
Prior theories included comfort but had not been
defined yet
Kolcabas definition of comfort (2003): Holistic
comfort is defined as the immediate experience
of being strengthened through having the needs
for relief, ease, and transcendence met in four
contexts of experience (physical, psychospiritual,
social, and environmental) (p.16).

INFLUENCES ON KOLCABAS
PHILOSOPHY
Three Types of Comfort

Relief- adapted from Ida Jean


Orlandos work: nurses relieve
patients needs
Ease adapted from Virginia
Hendersons work: human
functions necessary for
homeostasis
Transcendence adapted from
Josephine Paterson and Loretta
Zderads work: patients improve
with the help of nurses

(Kolcaba, 1991)

Four Contexts of
Comfort

Physical
Psychospiritual
Environmental
Social

CONCEPTS OF COMFORT THEORY

Kolcaba recognized that discomfort is more than just a painful


physical sensation or emotional pain that is felt. Instead she
concluded that other aspects of comfort or discomfort affect holistic
beings.

Kolcaba defined the three types of comfort:

Relief- experience of a patient who has had a specific comfort need met
Ease- a state of calm or contentment
Transcendence- the state in which one rises above problems of pain

These types of comfort are addressed by means of the four contexts:

Physical- pertaining to sensations (pain, cold, heat, tingling), homeostatic


mechanisms (temperature control, bleeding, vomiting- can all disrupt this area) or
function of the immune system.
Psychospiritual- pertaining to internal awareness of self, including esteem,
identity, sexuality, meaning in ones life, and ones feelings or belief in a higher
power or superior being.
Environmental- pertaining to the external background of human experience
(temperature, light, sound, odor, color, furniture, landscape)
Sociocultural- pertaining to interpersonal, family and societal relationships; also
includes family traditions, rituals and religious practices.

(Kolcaba, 2006)

TAXONOMIC STRUCTURE

When combined, the three types of comfort and 4 contexts


create a 12 cell grid, referred to as the taxonomic structure,
which was created by Kolcaba in 1991. This can be used as a
guide when assessing a patients level of comfort.

These aspects of comfort are interrelated with one another.


Kolcaba did not mean for them to be measured exactly because
she felt the process would be time-consuming and inaccurate
(Kolcaba, 2003). However, a pattern of care can be established
whereby patients comfort needs are intuitively assessed in the 4
contexts.
Type of Comfort
Context of
Comfort

Relief

Ease

Transcendence

Physical

Psychospiritu
al

Environment
al

Social

NURSING METAPARADIGM

Now lets look at the four global concepts of


the nursing metaparadigm in relation to
Katherine Kolcabas Comfort Theory.

Human beings
Environment
Health
Nursing

HUMAN BEINGS

This includes all in need of health care- individuals, families


and entire communities or institutions.

The aspect of comfort is an important and innate need to be


attained. All humans deserve to be as comfortable as possible.

Patient focused care is integral to attaining comfort.

When patients are more comfortable, they are more likely to


engage in health seeking behaviors-including internal or
external behaviors or even a peaceful death.

The strengthening properties of comfort produce better


patient outcomes.
(Kolcaba, 2003)

ENVIRONMENT

Manipulation of the external surroundings of the patient to


facilitate comfort. By means of touch, sights, sounds, lighting or
odors to promote a calming, comforting atmosphere. Any way that
the senses can be altered to enhance comfort of the patient
applies.

Having an understanding of the patients cultural, religious or


spiritual preferences and including them in care promotes comfort.

When the words and actions of the nurse are comforting, in


addition to the intent of providing comfort, the interventions are
often perceived more as a comfort measure by the patients
(Kolcaba, 2003).

Eliminate negativity in the environment if possible- promote


positive thinking and attitudes.

HEALTH

According to Katherine Kolcaba (2003), Health is comfort (p.


35)

The optimum level of functioning that is appropriate for and


defined by each individual patient.

To be in good health a patient must attain what THEY consider


their highest degree of comfort. Comfort is a positive, dynamic
state and the health care team can do more to enhance
comfort if they go beyond the treatment of discomforts and
physical health (Kolcaba, 2003).

When one of the 4 contexts or 3 types of comfort is not


balanced or being met, the patient may not be at their highest
level of wellness or health along the health continuum.

NURSING

Continual, active use of the nursing process to assess the comfort


of the patient and address their needs to attain comfort.

Assessing and reassessing whether the interventions implemented


were successful in improving the comfort of the patient.

Providing competent empathetic, compassionate, skilled and


holistic nursing care to each patient, without inflicting judgment.

Maintaining a strong, trusting nurse-patient relationship and


involving the patient in meeting their comfort needs and goals
will make the process more successful.

(Kolcaba, 2006)

INTERPRETATION & INFERENCE

Interventions for the patient are based on


needs of the patient as well as family needs

Comfort needs are intermixed. Meeting one


need may, in turn, fill another need

When comfort needs are fulfilled, the


patient feels safe and well cared for.

(Kolcaba, 1995)

IMPLICATIONS &
CONSEQUENCES

When comfort tasks such as cleaning up room


or straighting sheets are preformed, patients
feel cared for.
Patients who have less stress have better
outcomes
Nurses feel more job satisfaction because
even the smallest tasks bring comfort to
their patients.

EVALUATION
Clarification of
Origins
Katherines philosophy evolved from holism, human
needs and Murrays Theory of Human Press (1938)
and was designed only for nursing (Kolcaba, 2003
pp. 60-66). It was just recently that Katherine
thought about a 4th philosophy from nursing
(Kolcaba, 2003, p. 66 para 2).

Henry Murray

USE & CONTENT

Proposal for use of


Kolcabas Theory in
other healthcare
practices has been
formulated to
change nursing
interventions and
redefine as
comfort
interventions.
(March &
McCormick, 2009).

Kolcaba expresses her


comfort theory in all 4
concepts of the nursing
metapardigm.

PRACTICE
Advanced
Directives- guide to
make decisions
about care and pain
management
(Vendlinski &
Kolcaba, 1997)

PerianesthesiaClinical Practice
Guidelines
(retrieved from
http://www.aspan
.org/
)

The
Comfort
Theory

Psychiatric Nursingguided imagery to


relieve depression
and increase comfort
(Apostolo & Kolcaba,
2009)

Healthy Bladder
Program for Urinary
Incontinence in
older adults (Schirm
et al., 2004)

Pediatrics-assisting
the child with self
comforting actions
such as rocking
(Kolcaba & DiMarco,
2005)

CASE STUDY

15 year old female, diabetic patient was admitted to the hospital for a
second time in one month with hyperglycemia. She was found to be crying
and withdrawn, curled up in the fetal position in the dark. Staff is
concerned because she does not want to participate in administering
insulin, checking her blood sugars, and meal planning. She indicates that
she feels different than everyone else and wants to be able to eat
whatever she wants.
Types of Comfort
Context of
Comfort

Relief

Physical

Ease

Transcendence

Psychospiritual

Environmental

Sociocultural

REFERENCES:
Apostolo, J.L.A., & Kolcaba, K., (2009). The effects of guided
imagery on comfort, depression, anxiety, and stress of psychiatric
inpatients with depressive disorders. Archives of Psychiatric
Nursing, 23(6), 403-411
Kolcaba. (1991). A Taxonomic Structure for the. Journal of
Scholarship , 23 (4), pp. 237-240.

Nursing

Kolcaba, K. (1995). Comfort as process and product,merged in


holistic nursing art. Journal of Holistic Nursing, 128-129.
Retrieved from http://jhn.sagepub.com/content/13/2/117
Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic
health care and research. p. 9-17, 34-35, 59-68. Springer
Publishing Company: New York.
Kolcaba, K., & DiMarco, M. A. (2005). Comfort theory and its
application to pediatric nursing. Pediatric Nursing, 31(3),
p. 187194. Retrieved from PubMed
Kolcaba, K, Tilton, C., & Drouin. (2006). Comfort theory: a unifying
framework to enhance the practice environment. The
Journal
of Nursing Administration,
36(11), p538-544.
Retrieved from:
http://journals.lww.com/jonajournal/pages/issuelist.aspx

REFERENCES:
March, A., McCormick, D. (2009). Nursing theory-directed
healthcare modifying kolcabas comfort theory as an
institution-wide approach. Holistic Nursing Practice 23(2),
75-80. Retrieved from PubMed

pp.

Schirm, V., Baumgardner, J., Dowd, T., Gregor, S., & Kolcaba, K.,
(2004). NGNA. Development of a healthy bladder education
program for older adults. Geriatric Nursing, 25(5), pp 301- 306.
Retrieved from CINAHL
Vendlinski, S., & Kolcaba, K. Y. (1997). Comfort care: a framework
for hospice nursing. American Journal of Hospice & Palliative
Care, 14(6), 271-276. Retrieved from PubMed
http://www.thecomfortline.com/index.html
http://www.aspan.org
http://nursing-theory.org/nursing-theorists/Katherine-Kolcaba.php

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