The Comfort Theory in Nursing Practice

Theory Background

Theorist’s background

The Comfort Theory was developed by Catherine Kolcaba in the 1990s. In her research, she was trying to find ways the nurses could help create comfort among patients who are under their care. Kolcaba was born in Cleveland, Ohio on 8th December, 1944 (March & McCormack, 2009). In 1965, she graduated from St. Luke’s Hospital School of Nursing with a diploma in nursing. She later went to Payne Bolton School of Nursing where she took her undergraduate degree in nursing. In 1987, Kolcaba graduated from Case Western Reserve University with a master’s degree in nursing (MSN). Ten years later in 1997, she graduated from the same institution with a doctoral degree in nursing. Kolcaba became a clinical specialist in the same year. She specialized in Ontology, Comfort Studies, Long-Term and End of Life Care, and Nursing Theories. She is, therefore, a highly educated and widely experienced specialist on issues about nursing theories and patient comfort. Kolcaba has been studying the concept of patients’ comfort for a long time, and it is through her studies that she developed the Theory of Comfort.

Crucial references for the original work of the theorist

Dr. Kolcaba was highly influenced by the works of Florence Nightingale and she widely used the works of this author as a foundation to most of her writings. Dr. Kolcaba has stated severally that she admired the work of Nightingale, especially her emphasis on the role of nurses in relieving patients of their pain. She used Nightingale’s work as one of the primary references in developing this theory. She argued that it is the responsibility of a nurse to ensure that patients under their care are made as comfortable as can be possible. Dr. Kolcaba relied on the works of other scholars such as Filderman and White (1969) who also talked about the need to make patients comfortable. Authors such as Williams and Shim (1976) also played a critical role in informing the conclusions that Kolcaba made when developing the theory. Authors such as Servillo and Pelosi (2016), and Norlander (2014) have widely used the concepts presented in Comfort Theory. They believe that it is practical and should be embraced by all practicing nurses.

The phenomenon of concern or problems addressed by the theory

In her own words, Kolcaba (2003) defines comfort as “the immediate state of being strengthened through having the human needs for relief, ease, and transcendence addressed in four contexts of experience, which are physical, psycho-spiritual, socio-cultural, and environmental” (p. 78). This scholar noticed that sometimes patients would lose the urge to fight for their lives because they feel they lack support of the people around them. Such frustrations may make it difficult for the patients to make personal effort that is needed to enable or speed up their healing process. Dr. Kolcaba also noted that the conditions of some of her patients were worsened due to socio-economic, environmental, and psycho-spiritual factors. Some of her patients reported that lack of close relationship with the nursing staff made it difficult to share with them their medical concerns, and this affected the process of caring for these patients. These phenomena motivated the scholar to develop a model that would ensure that nursing needs are effectively addressed to promote patients’ healing process.

Theory Description

Reasoning approach used in developing the theory

The theorist used top-down logic (deductive reasoning) to arrive at her conclusion and develop concepts in this theory. She comes up with a conclusion that comfort among patients can be achieved if a number of factors are held true. The scholar gives four premises upon which comfort can be achieved if the conditions are held right. The first one is the physical experience of the patient. The physical experiences of the patient include the manner in which the patient is handled by the nurses and doctors, the medication they get, and necessary medical procedures they receive. The theorist argues that inasmuch as it is important for the medical staff to do the right thing, their actions must be right in the eyes of the patients and people who are related to them. The aim is to make the patient feel taken care of adequately.

The environmental experience is another important factor that the theorist insists should be improved to make the patient feel comfortable. According to the author, the environmental factors such as the quality of air where the patient is taken care of, level of noise and related disturbances, the beds and beddings, lighting and general nature of the room all affect the ability of the patient to achieve comfort (Kolcaba, 2003). The medical staff, especially the nurses, have the responsibility of ensuring that the environment meets the set standards and that the patients are not subjected to factors that may worsen their conditions. In some of the top private hospitals in this country where patients have their own rooms instead of sharing wards, such environmental factors as music, lighting, beddings, and even mode of communication can be modified to meet the expectations of the patient.

Socio-cultural experience is another important area that is often ignored (Kolcaba, 2003). The hospitalized patients need to maintain close relationship with friends and family members to feel loved. They also expect the medical staff to understand their cultural diversity as much as possible. For example, female Muslim patients may not prefer being handled by male nurses, especially if they have to be helped with bathing and changing of clothes. Finally, the psycho-spiritual experience is also very important because it may give the patient energy to fight and achieve quick recovery (Kolcaba, 2003). Psych-spiritual experience is specifically important for near end-life patients such as those who have advanced cancer cases. When all these pre-set conditions are met, then according to this theorist the patients will achieve comfort, even when they are having serious bodily pain. They will feel that they made the right decision to visit these hospitals, and that they will recover from their medical problem.

Major concepts of the theory

In defining the concept of Comfort Theory, the theorist argues that comfort exists in three primary forms which are ease, relief, and transcendence (Kolcaba, 2003). The theorist has made an effort to provide an implicit definition of the three concepts and their practical relevance in a nursing context. These three concepts are sequential, based on how they are defined, starting from relief, to ease, and finally transcendence. Relief is implied to mean a state that is achieved if certain patient’s needs are met. For example, the postoperative relief can be achieved by the administration of prescribed analgesia. The prescription eliminates pain and makes the patient feel comfortable.

Ease is implied to mean a state of contentment that is achieved when the patient’s needs are met. For example, a patient may have anxiety because of the medical procedures that are about to be conducted. They may be worried about the outcome or possible pain that is possible to be experienced during the procedure. However, when the patients get assurance from the medical staff, then their anxiety will be addressed. At such moments, the theorist says that the patient will experience comfort in the ease sense (Kolcaba & Steiner, 2000).

Transcendence, according to Kolcaba (2003), is “the state of comfort in which patients are able to rise above their challenges” (p. 23). This is the highest point of comfort as explained in this theory. At this stage, the patient has received all the assurance he or she needs, the love and care which is necessary, and the motivation to fight. They no longer fear the challenges that may come their way during the medication process. The theorist is very consistent in the use of these terms and concepts in this theory.

Examine the relationships among the major concepts

As explained above, the three concepts of relief, ease, and transcendence are intertwined. Achieving the first concept leads to the next. The patient’s needs should be met for him or her to have some form of relief. In this theory, relief is achieved when primary/physical needs are met. Once the physical needs are met, the patient may also have some concerns about complicated future medication. When these concerns are met, the patient will achieve comfort in ease sense (Perry, Potter, & Ostendorf, 2013). When the physical and psychological issues are met, then the patient will achieve transcendence, a situation where they are ready to face any eventuality in the medication process.

Evaluation

Identifying explicit and implicit assumptions

The Comfort Theory has a number of explicit and implicit assumptions which are worth noting. One of the main explicit assumptions is that the patients achieve comfort if their physical and psychological needs are effectively met. It holds that the ability of patients to feel cared for depends on how the medical staff relates to them, the support received from the friends and relatives, and the nature of environment in which they are confined to for the period of medication. The implicit assumption is that quick recovery of patients is primarily based on how comfortable they are made to feel within a given medical setting. It also implies that medical staff, especially nurses, have a major role to play in creating this comfort in order to speed up patient’s healing process. It is upon these assumptions that the theory was built.

The Four Concepts of the Nursing Metaparadigm

The Comfort Theory has a clear description of the four concepts of the Nursing Metaparadigm. The first concept is the client. The theory revolves around finding comfort for the patient as a way of improving their experience and possibly speeding up the healing process. The second concept is health. This theory emphasizes on the need to give patient’s wellness a priority in order to make them feel comfortable. This involves relieving them from pain and addressing their psychosocial needs. The third concept of this metaparadigm is the environment. The Comfort Theory emphasizes on environmental concerns, especially the need to ensure that patients’ environment is appropriate for their healing process by maintaining cleanliness and eliminating noise or air pollutions. The fourth concept of this metaparadigm is nursing. The theory explains the role of a nurse in ensuring that the patients under their care achieve comfort.

Discuss the clarity of the theory

Comfort Theory has a very clear concept and its aim is stated without any ambiguity. It states clearly that it is important to ensure that a patient is made comfortable as a way of speeding up their recovery. It is consistent in explaining the physical, psycho-spiritual, environmental, and socio-cultural contexts under which a patient should be made comfortable. According to Kolcaba (2003), it is common to find cases where one or more aspects of a patient’s comfort are ignored. When this happens, then cases where patients reject some form of medication can be witnessed. Such incidences may have serious consequences on the medical condition of the patient. It shows lack of trust between the medical staff and the patient in question. However, when the needs are met and transcendence is achieved, then the patient will be capable and ready to overcome any challenge that may arise during the medication process. In her own words, the theorist says that when transcendence is achieved, the patient rises above any challenges because of the unique sense of satisfaction and comfort that they have (Kaplow & Hardin, 2007).

Application

How the theory would guide nursing actions

The Comfort Theory, when applied correctly, can guide nursing actions. The theory gives four areas of concern that nurses should observe very closely to ensure that they deliver excellent work when handling their patents. First, it talks about the physical experience. A nurse must understand that in most of the cases the patients have physical discomfort that needs to be addressed. The nurses need to monitor their patients very closely in order to deal with such physical discomfort. Psycho-spiritual needs of the patients are often ignored by most of the nurses because they consider it to be a work of the religious leaders. However, the Comfort Theory explains that this is another important need of the patients that should be taken seriously. The spiritual nourishment is sometimes the ingredient that a patient needs to get a fighting spirit. If the nurses cannot provide this, then they should coordinate with spiritual leaders who can do such tasks regularly to motivate the patients. On the issue of the environment, the theory categorically explains that nurses should maintain a high level of cleanliness in the hospitals at all times. Air and sound pollution should be eliminated or kept at the minimum level possible. Finally the theory talks about the socio-cultural experiences where nurses are expected to understand the diversity of their patients and find the ways of handling them in a manner that befits their cultural practices and beliefs.

Describe specifically how you can use this theory in your area of nursing

As a practicing nurse, I can use this theory to enhance my service delivery to the patients in the wards. I now understand how important it is to look at the four main contexts of comfort which include physical, psycho-spiritual, environmental, and socio-cultural. In my practice, I will try to make sure that my patients are comforted and motivated. I will always strive to ensure that my patients achieve transcendence. This will make it easy for the other medical staff to help them using various medical procedures which are necessary.

References

Filderman, P., & White, F. (1969). Contact lens practice and patient management. Hoboken, NJ: Chilton Book Co.

Kaplow, R., & Hardin, S. R. (2007). Critical care nursing: Synergy for optimal outcomes. Sudbury, MA: Jones and Bartlett.

Kolcaba, K. (2003). Comfort theory and practice: a vision for holistic health care and research. New York: Springer Publishing Company.

Kolcaba, K., & Steiner, R. (2000). Empirical evidence for the nature of holistic comfort. Journal of Holistic Nursing, 18(1), 46-62.

March, A., & McCormack, D. (2009). Nursing Theory-Directed Healthcare: Modifying Kolcaba’s Comfort Theory as an Institution-Wide Approach. Holistic Nursing Practice, 23(2), 75-80.

Norlander, L. (2014). To comfort always: A nurse’s guide to end-of-life care. Indianapolis, IN : Sigma Theta Tau International.

Perry, A., Potter, A., & Ostendorf, W. (2013). Clinical nursing skills & techniques. London, England: McMillan.

Servillo, G., & Pelosi, P. (2016). Percutaneous tracheostomy in critically ill patients. New York, NY: Springer.

Williams, M. H., & Shim, C. (1976). Asthma: Discussions in patient management. Flushing, N.Y: Medical Examination Pub. Co.

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