The Theory of Comfort in Nursing

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Out of the magnitude of the nursing theories which include practice nursing theories, mid-range nursing theories, and grand nursing theories, it appears that mid-range theories deserve more attention and focus. My choice of a mid-range nursing theory is backed by the explanation that mid-range nursing theories tend to be more specific and narrow in the area of their application. Furthermore, mid-range theories serve as a bridge between the nursing practice and the grand nursing theories (Peterson & Bredow, 2008). With this in mind, the mid-range theories offer more than concepts and vague ideas, which are theoretical in nature. Mid-range theories, in my opinion, serve as nursing strategies with a theory-based practical approach that may be effectively applied in various outpatient settings.

The interest in mid-range nursing theories is on the increase, and more and more publications are released dedicated to various theories which are successfully applied in various patient settings. The majority of the mid-range theories are used to foster research and practice, in this light, the paper will focus on the emergence of the mid-range theory and its application as well as approaches relating to its application. For my paper, I have selected, out of many, the theory of comfort, introduced by Katharine Kolcaba.

The theory of comfort was developed by Katharine Kolcaba in the early 90s. Katharine was born on December 8^th, 1944 in Ohio, Cleveland. She went to St. Luke’s Hospital School of Nursing where she obtained her first diploma in 1965. She then proceeded with her education and attended Frances Payne Bolton School of Nursing in Case Western Reserve University in 1987. In 1997, she obtained a PhD. in nursing and was awarded a certificate of authority as a clinical nursing specialist. During her studies, Katharine studied various medical areas including Long Term Care Interventions, Gerontology, Instrument Development, End of Life and Nursing Theory, Research pertaining to nursing and comfort. It was during Kolcaba’s master studies that she took a position of a head-nurse in an Alzheimer’s unit and became interested in the outcomes of comfort, and decided to impart a theoretical shape to the theory of comfort. It was as early as in 1991 that Katharine published her first article ‘An analysis of the concept of comfort’ laying the groundwork for the comfort theory. In 1994, Katharine published another article ‘theory of holistic comfort in nursing’. Working as a university teacher, Katharine published a series of articles, and eventually all her work boiled down to the book, ‘Comfort Theory and Practice: a Vision for Holistic Health Care and Research’ which was published in 2003. In 2007, Katharine retired from the university as a full-time teacher, although she continues to teach part time and does not abandon her research of the comfort theory.

Theoretical development of the theory of comfort has been backed up by a series of peer-reviewed articles published in prominent medical journals over the last 20 years. The theory of comfort has become a foundation for an array of thesis and dissertations, and the concept itself blossomed into a solid middle-range medical theory and research (Peterson & Bredow, 2008). Since the 1990s, multiple nursing books focusing on mid-range theories have been published, and rarely was Kolcaba’s theory of comfort omitted from the scope of multiple mid-range theories.

Having studied Kolcaba’s works on the theory of comfort, it is hard to escape a conclusion that Katharine uses an inductive approach in putting forward her mid-range medical theory. Based on the premise that deductive reasoning is founded on a rule or a law, or a principal for that matter, and then specific examples are presented to ascertain that the theory applies to them. Conversely, inductive reasoning is founded on examples or situations which demonstrate whether the principal will emerge. Kolcaba used an inductive approach, because the fundamental concept of comfort (whether environmental, physical, or cultural) is abstract in nature. Comfort itself is an ambiguous notion, and definitions or views of what it means may vary among patients. Using an inductive approach, Kolcaba discovers the comfort needs of the patient by placing him in a situation where the comfort conditions are created. The patient is relieved of chronic pain, and then the level of comfort, based on patient’s preferences is enhanced. The patient is then encouraged to adopt health-seeking behaviors as advised by the nurse. Certain conditions created for a patient and a series of observations of patient’s reaction allowed Kolcaba, based on inductive approach, to see that the theory of comfort was valid.

It is interesting to trace the roots of the Theory of Comfort in Kolcaba’s work. As Katharine wrote in her article ‘A Taxonomic Structure for the concept comfort’ the ideas behind the theory of comfort, specifically on Relief were adapted from Ida Jean Orlando’s work where the central job of nurses was to relieve the patient’s needs. Virginia Henderson’s work on Ease was used to define the state of calm and contentment, and finally Josephine Paterson and Loretta Zderad’s work on Transcendence and Kolcaba’s interpretation of it as the patient’s ability to rise above problems and pain (Kolcaba, 1991). Eventually, those three pillars were used by Kolcaba in her definition of comfort.

The comfort theory developed by Kolcaba studies the obstructions and problems in a healthcare situation, such as chronic illness or pain that may prevent a patient from achieving a state of comfort (Kolcaba, 1994). The theory describes comfort as an immediate, desirable atmosphere for the patient that needs to be created in a nursing care setting. In her later paper, published in 2001, Kolcaba expands the definition of comfort as a state where basic human needs for ease of being, state of relief, and transcendence are met (Kolcaba, 2001). The four concepts of comfort defined by Kolcaba are placed in four contexts: 1. Physical – which relates to a patient’s sensations which may depend on cold and heat levels, disruptions, bleeding, etc. 2. Psychospiritual which relate to how a patient identifies his place in a community, that includes his esteem, beliefs, his power and authority, and community’s respect. 3. Environmental, relating to the immediate surroundings of a patient, such as light, sound, noise level, furniture, view from the windows, etc. and finally 3. Sociocultural relating to patient’s relations with his family and society at large (Kolcaba, 2006).

Kolcaba wrote that patients have implicit and explicit comfort needs, and when they are attained, patients are motivated to adopt life-seeking behaviors and take up a new health routine (Kolcaba, 2001).

The fundamental values and beliefs underlying the theory of comfort stem from Kolcaba’s assumption that patient needs if met encourage them to achieve better results in rehabilitation and follow a new life routine. The second assumption underlying the theory states that patient needs are governed by his expectations, and patients expect nursing care to be within competence. Finally, when nurses provide better comfort conditions for the patient, better results are achieved leading to overall patient satisfaction and financial stability of the medical institution (Kolcaba, 2001).

Concepts and ideas that provide a foundation for the theory of comfort stem from comfort needs, comfort intervention, enhanced comfort levels, and health-seeking behaviors. These concepts are aligned with mid-range theories, as they are well-defined and specific. All of the above concepts are relevant to patients, families, and nurses (Peterson & Bredow, 2008).

Despite a wide range of nursing theories, there are four basic nursing metaparadigms that address the patient as a whole (Peterson & Bredow, 2008). The first one relates to the patient’s health and patients as human beings. The second deals with the environment in which the patient is placed, and the surroundings that affect the patient. The third one relates to a patient’s health component, exploring how a person’s physical, emotional, social well-being is incorporated in health care. The final metaparadigm deals with the nursing concept which involves application of knowledge, skills, technology, and expertise that is used in achieving the best outcome for a patient.

It is interesting to place the four nursing metaparadigms into the dialogue with Katharine Kolcaba’s comfort theory. The first one relates to ‘human beings’, the theory of comfort is directly aligned with this metaparadigm as comfort is essential to all people. Kolcaba notes that patients who are more comfortable are more likely to adopt healthy behaviors (Kolcaba, 2001).

The second metaparadigm dealing with the environment is directly linked to Kolcaba’s theory of comfort. Improving the patient’s surroundings may lead to enhancing the patient’s comfort level. When a nurse works to eliminate negativity in the surrounding environment, it results in patient’s positive thinking and better attitude to life and health as a whole.

The third ‘health’ metaparadigm is closely linked to the theory of comfort as well. Kolcaba (2003) says “health is comfort” (p.35). It explicitly implies that health does not exist without comfort and any illness, even a minor ailment, will disrupt a patient’s comfort level. Comfort provides a positive state for a patient and results in quicker rehabilitation process, quicker discharge, reduced number of re-admissions, and increased patient satisfaction with care provided (Peterson & Bredow, 2008).

The fourth, and the final ‘nursing’ metaparadigm, is in direct context of Kolcaba’s comfort theory. The comfort theory encourages nurses to address the patient’s needs to achieve a better comfort level. Kolcaba wrote that providing nursing care for the patient needs to transcend the medical application (Kolcaba, 2001). Aside from skilled medical services, a nurse needs to provide compassionate care to patient and seek to establish and maintain a strong-nurse-patient relationship based on trust and mutual understanding of the patient’s goals and objectives. Only by meeting the patient’s comfort needs and goals, may the nurse envisage that the rehabilitation process will be more successful. As seen from Kolcaba’s works, the four fundamental nursing paradigms are aligned with the theory of comfort.

Kolcaba’s theory of comfort is presented in a lucid and consistent way. The theory was proposed in the early 90s and since then, Kolcaba continued developing, honing and expanding it. The consistency of the theory is backed by multiple studies and interventions undertaken within the frames of the comfort theory. Given an array of articles by Kolcaba dedicated to the theory which have been written over the last two decades, the theory is presented in a clear and lucid manner, allowing medical staff to use it as guidance or a benchmark for their research.

Kolcaba notes that the understanding of comfort and its principals directly guides nursing care (Kolcaba, 1994). The comfort theory may be incorporated in physical, social, and environmental interventions. A patient’s comfort should not be limited to relieving pain and administering a medication only, a series of interventions such as merely helping the patient to reach the bathroom, providing a reassurance about a treatment and rehabilitation, tidying his room, providing him with the information on the course of treatment may all contribute to an atmosphere of nurse-patient trust. According to Kolcaba, the theory of comfort provides guidance for nursing actions and research, because comfort has an outcome that can be measured in terms of better patient rehabilitation (Kolcaba, 1994).

The theory of comfort is directly related to my nursing setting which is a family nurse practitioner or a nurse in an urgent care setting. It is essential that comfort level of the patients is attained to ensure better results and outcomes. Working as a family nurse practitioner, it is crucial that the medical procedures be directed not only to pain relief or prescribing the appropriate medicine, but also to creating a favorable comfort level within the family. When a patient is afflicted with an illness, it is not only he or she who is affected, his family members also need to be considered as a driving force towards patient’s discharge and rehabilitation. Any illness, be it major or a minor ailment, disrupts the comfort level and affects the social identity, patient’s role, financial stability, and plans for the future (Dalteg, Benzein, Fridlund, & Malm, 2011). By applying the theory of comfort to patients, and establishing an atmosphere of trust, I will encourage patients to engage in health seeking behaviors and adopt a healthy life-style.

By integrating a comfort theory into my nursing practice, I will ask patients and families what I can do specifically to make them feel more comfortable. Before providing comfort to patients, it is important to assess their comfort needs. When performing the duties of a family nurse practitioner, I will teach families about comfort so that they may create and maintain a comfort level in their homes. Communication becomes increasingly important in nurse-patient relations, and compassionate care needs to be an integral part in patient care. It is important that each patient receives individualized care where his culture and social surroundings are taken into account. By applying the theory of comfort in a nursing practice, the nurse needs to be engaged in nurse-patient relations at all levels of providing care and comfort.

According to the theory of comfort, patients who need urgent care are more stressed, and therefore, their comfort needs may be met by nurses (Kolcaba, 2001). When a patient is admitted to an urgent care unit, and a surgery is scheduled shortly, enhanced comfort level may help ease the initial distress, help support the patient and ready him for an upcoming surgery or a procedure.

The theory of comfort, developed by Kolcaba and now practiced by thousands of nurses, deserves interest and provides a fertile field for research for all nurse practitioners.

Reference List

Dalteg, T., Benzein, E., Fridlund, B., & Malm, D. (2011). Cardiac disease and its consequences on the partner relationship: A systematic review.European Journal of Cardiovascular Nursing, 10, 140-149. Web.

Kolcaba, K., (1991). A Taxonomic Structure for the concept comfort.Journal of Nursing Scholarship, 23(4), 237-240. Web.

Kolcaba, K., (1994). A theory of holistic comfort for nursing.Journal of Advanced Nursing, 19(6), 1178-1184. Web.

Kolcaba, K., (2001). Evolution of the mid range theory of comfort for outcomes research. Nursing Outlook, 49(2), 86-92. Web.

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

Kolcaba, K., Tilton, C., & Drouin. (2006). Comfort theory: a unifying framework to enhance the practice environment.The Journal of Nursing Administration, 36(11), 538-544. Web.

Peterson, S. J., & Bredow, T. S. (2008). Middle-Range Theories: Application to Nursing Research. Philadelphia, Pennsylvania: LWW.

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The Theory of Comfort in Nursing

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