Kolcaba’s Theory of Comfort in the Operating Room

Chosen Clinical Setting

Surgical interventions are stressful encounters, with most patients expressing postoperative anxiety due to such fears as the success of the procedure and the uneasiness of anesthesia. As a result, many physiological and psychological problems occur, which increase the risk of postoperative complications and adversely affect patient outcomes. In this regard, it is imperative for healthcare practitioners to enhance patient comfort before, during, and after an operation.

Katharine Kolcaba’s theory of care is a useful framework that enhances better preparation, observation, recognition, and provision of the specific needs of surgical patients in a purposeful manner. The theory allows healthcare service providers to maximize patients’ comfort before, during, and after a surgical procedure, which significantly reduces the risk of postoperative complications, boosts patient satisfaction, and improves outcomes (Zeynep et al., 2020).

Context to the Setting

Surgical procedures are complex interventions and often carry a risk of mortality and postoperative complications. They require extensive center and patient preparation to enhance the potential of success, minimize the possibility of adverse outcomes, and facilitate the realization of a smooth procedure.

Nurses play an integral role in ensuring that all preoperative and postoperative procedures and requirements are met. These include such activities as checking for the appropriate consent and managing any distinctive health issue that could interfere with the surgery. For instance, a nurse is obligated to ensure to gather all the essential supplies required for the operation, keeps the room sterilized, and timely patient preparation.

Additionally, the nurses assess the patients before the procedure to ensure that their physical and psychological needs are satisfied before the surgery is conducted. For instance, a preoperative interview between a nurse and a patient would help the former to identify such underlying issues as anxiety and fear over anesthesia and pain after the surgery.

Selected Theory for the Operating Room

Patient comfort is an essential factor in the provision of healthcare and is an immediate objective of nursing care. Katharine Kolcaba developed the theory of comfort to underpin the essence of healthcare providers in placing patient comfort at the forefront.

Kolcaba illustrated that comfort exists in three main forms, including transcendence, relief, and ease (Vo, 2020). She acknowledged nursing as a practice through which nurses assess patients’ comfort needs and develop measures to satisfy such requirements, and reevaluate to ensure the objective has been met. For instance, a nurse should interact with a patient to alleviate their anxiety before surgery and administer pain management strategies after the procedure to minimize discomfort.

Zeynep et al. (2020) and Nyberg et al. (2021) posit that due to the complexity and risks associated with surgeries, nurses should constantly engage with patients to guarantee and enhance their comfort. They argue that such occurrences as fear, anxiety, and pain complicate the recovery process and adversely impact outcomes.

Selected Theory for the Operating Room

Kolcaba’s theory of comfort notes that such comfort is realized through four main contexts. These include environmental, psychospiritual, physical, and socio-cultural. According to the theory, health is the optimal functioning of a patient within the defined scope of individual, family, group, and community.

The ease of comfort entails such activities that alleviate anxiety and generate a sense of contentment, while relief focuses on managing and eradicating the pain. Similarly, transcendence is a supportive strategy through which patients overcome challenges in the course of their care and recovery.

Origin of Katharine Kolcaba’s Theory of Comfort

Katharine Kolcaba developed the theory of comfort after extensively analyzing the existing theories and realizing that the patient’s contentment and relief were not adequately covered. This did not align with the immediate nursing objective of alleviating patients’ suffering (Kolcaba & Kolcaba, 1991).

Patient comfort is an indispensable precursor to the provision of healthcare to patients in stressful situations. It encompasses such aspects as the physical, environmental, social, and psycho-spiritual considerations, which cumulatively contribute to the overall well-being of individuals (Pinto et al., 2017).

Kolcaba noted that a new theoretical framework was necessary to strengthen families and patients for the task ahead.

Concepts Comprising the Theory of Comfort

Concepts Comprising the Theory of Comfort

Kolcaba defines healthcare needs as occurrences that create stressful situations and create the need for comfort. The needs arise in four main domains, including psychospiritual, physical, environmental, and social, and are made apparent through continuous close monitoring.

Nursing interventions constitute the commitments of nursing and healthcare institutions to promote patient care and satisfy their comfort needs (Kolcaba & Kolcaba, 1991). Intervening variables encompass all elements that potentially affect the desired outcomes, including age, emotional state, past experiences, attitude, and support system.

Institutional integrity is the quality considerations that promote the healthcare facilities’ ability to provide evidence for best practices and policies. Such attributes include uprightness, completeness, ethicality, sincerity, and soundness.

Kolcaba’s theory of comfort also integrates patient comfort as a fundamental concept. It refers to the actions and interventions delivered by healthcare workers to recipients. Kolcaba and Kolcaba (1991) contend that it encompasses the holistic experience when patients’ needs are addressed.

The health-seeking behaviors are the actions undertaken by patients in pursuit of better health as defined consultatively by the nurse and the individual.

To realize the best outcomes, healthcare service providers utilize evidence-based interventions along the policies that promote such aspects as access to services by patients.

Theory’s Application to Practice

Katharine Kolcaba’s theory of comfort is applicable in operating room settings due to the invasive and disturbing nature of surgeries, which evoke anxiety, fear, and other depressing feelings among the patient (Bedaso & Ayalew, 2019). Patients with unmanaged high levels of uneasiness, apprehension, and anxiety have increased incidences of complications and register poor outcomes.

Before, during, and after surgical procedures, patient comfort is an integral consideration, and nurses can enhance its realization through the application of Kolcaba’s theory of comfort. For instance, a nurse can engage a patient to alleviate feelings of apprehension and anxiety by encouraging the individual, ensuring optimal operating room temperatures, and administering pain management interventions after the procedure.

How the Six Criteria Helped in Choosing the Theory

Considering the contextual factors, Kolcaba’s theory of comfort is the most appropriate in an operating room setting. The specific components of the theory fit well within the structures and the functioning of an operating room, especially the focus on fulfilling definite human needs (McKenna et al., 2014).

The origin of the theory also supports its applicability within the setting of an operating room. Kolcaba was a practicing nurse when she developed the theory and integrated supportive insights from such disciplines as psychiatry, medicine, psychology, and ergonomics. Additionally, the theory recognizes the discomfort and uneasiness that accompanies surgical procedures and underpins the nurses’ primary historical obligation of ensuring patient comfort.

The behavioral paradigm also positively influences the selection of Katharine Kolcaba’s theory of comfort for application in an operating room. The theory focuses on meeting specific human needs of easiness, contentment, and stress alleviation, which are negatively affected in perioperative processes.

Katharine Kolcaba’s theory of comfort is relatively simple and easy to understand. This makes its comprehension and subsequent application less challenging compared to other theories. For instance, the theory has few underlying concepts which are aptly defined and characterized by simple illustrations.

Additionally, the theory was developed to enhance the provision of services and promote the realization of the nurse’s primary obligation of providing comfort to patients. From this perspective, the theory is designed in a way that facilitates the achievement of specific patient needs.

The concept of understandability reflects the way in which the theory is presented. Notably, Kolcaba’s theory is easy to comprehend and does not entail numerous complex aspects or concepts, which eliminates the potential for confusion and enhances a more precise application.

Why the Theory of Comfort Is Well Suited for the Setting

The theory of comfort is best suited in an operating room since it focuses on ensuring that the patient’s psychological and physical well-being is at optimal levels throughout the entire procedure. For instance, the theory ensures that a nursing practitioner alleviates feelings of anxiety among patients slotted for surgery, which is a prevalent occurrence and adversely affects outcomes and recovery.

Additionally, comfort, as envisaged by Kolcaba, covers all the entire aspects and phases of a surgical procedure, including the pre- and postoperative periods. For instance, following the surgery, a patient requires pain management interventions and skills to help them overcome the challenges that accompany the care and recovery processes.

The theory’s three underlying concepts of ease, relief, and transcendence are indispensable constituents in all surgical procedures. Consequently, the theory contains all the essential elements that support patients undergoing surgery before, during, and after the procedure.

Useful Guide in the Absence of the Theory

In the absence of a nursing theory, evidence-based interventions would be critical in supporting surgical patients. Such an approach would integrate the clinician’s experiences of anxiety and pain management and patient insights and preferences. These are fundamental components that constitute patient comfort, especially in such complex interventions as surgical procedures.

Additionally, nurses have extensive knowledge that provides them will skills and techniques for navigating through complex clinical situations. For instance, constant consultative engagements and interactions with patients would help to provide relief to anxiety and encourage patients to adopt a positive attitude towards an impending surgical procedure.


Bedaso, A., & Ayalew, M. (2019). Preoperative anxiety among adult patients undergoing elective surgery: a prospective survey at a general hospital in Ethiopia. Patient Safety In Surgery, 13(18), 1-8.

Kolcaba, K., & Kolcaba, R. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing, 16(11), 1301-1310.

McKenna, H., Pajnkihar, M., & Murphy, F. (2014). Fundamentals of nursing models, theories and practice (2nd ed.). Wiley-Blackwell.

Nyberg, A., Olofsson, B., Otten, V., Haney, M., & Fagerdahl., A. (2021). Patient safety during joint replacement surgery: Experiences of operating room nurses. BMJ Open Quality, 10(4), 1-7.

Vo, T. (2020). A practical guide for frontline workers during Covid-19: Kolcaba’s comfort theory. Journal of Patient Experience, 7(5), 635–639.

Wensley, C., Botti, M., McKillop, A., & Merry, A. (2017). A framework of comfort for practice: An integrative review identifying the multiple influences on patients’ experience of comfort in healthcare settings. International Journal for Quality in Health Care, 29(2), 151-162.

Zeynep, T., Gozde, T.S., Ikbal, C., & Emel, S. (2020). Pre-operative comfort levels of patients undergoing surgical intervention. International Journal of Caring Nurses, 13(2), 1339-1345.

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