Evidence of Empirical Testing: Comfort Theory

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According to sociologist Merton (1968) middle range theory can be described as a reference for empirical research and produces specific and testable hypotheses (as cited in Lasiuk & Ferguson, 2005, p. 129). Kolcabas Theory of Comfort is a middle range theory developed by Katherine Kolcaba focusing on comfort as the main concept. Several tools have been created to measure comfort such as the General Comfort questionnaire, the visual analog scale, and the Comfort Behaviors Checklist (McEwen & Wills, 2011, p.235). Utilizing these instruments, numerous research studies have been performed to evaluate Kolcabas Theory of Comfort as it applies to nursing practice and nursing education and to provide direction for future research studies. Research studies based on Theory of Comfort have been conducted on many different areas of nursing including labor and delivery, peri-and-intra-operative care, critical care, burn units, gynecological practice, nursing care of persons with mental or hearing disabilities, emergency air transport, and newborn nurseries (Kolcaba & DiMarco, 2005). Comfort theory has been tested and supported in several patient populations, including psychometric and experimental studies in small samples of women with early stages of breast cancer going through radiation therapy (Kolcaba & Fox, 1999), persons with urinary frequency and incontinence (Dowd, Kolcaba, & Steiner, 2000), and persons near end of life (Novak, Kolcaba, Steiner, & Dowd, 2001) (as cited in Kolcaba & DiMarco, 2005).

Comfort Theory
Development | Health Practice/Education | Health Research

Development
Theoretical development of Comfort Theory has been chronicled through several peer reviewed journal articles over the past two decades. Developed from a graduate thesis and dissertation, a concept analysis of comfort blossomed into a middle range theory for health practice, education, and research. Since then, Dr. Katharine Kolcaba has been continually advancing and sharing her theory across the spectrum of health care disciplines. With the help of Kolcaba and other health scientists, comfort is reemerging as an value-added outcome for evidence based practice. Concept Analysis The purpose of this paper was to analyze the semantics and extension of the term 'comfort' in order to clarify its use in practice, theory, and research. Three types of comfort (relief, ease, transcendence) were introduced in this article, as well as four contexts of holistic human experience in differing aspects of therapeutic contexts. Additionally, methods to measure comfort were proposed. Kolcaba, K. Y., & Kolcaba, R. J. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing, 16(11), 1301-1310. Taxonomic Structure Further development led to organizing the three senses of comfort along with the fours contexts into a taxonomic structure. A 3x4 grid with 12 elements encompasses the total domain of patient comfort. When used with other developed tools, the taxonomic structure can be a powerful guide for assessment, measurement, and evaluation of patient comfort. Kolcaba, K. Y. (1991). A taxonomic structure for the concept comfort. Image: Journal of Nursing Scholarship, 23(4), 237-240. Comfort as Process and Product As a holistic trend in health care developed, it was necessary to identify comfort as a product or a process. Various schools of thought and their research approaches to comfort were merged in this article to advance and clarify comfort in literature and practice. A template was provided that guides comfort care practice in a holistic context. Kolcaba, K. (1995). Comfort as process and product, merged in holistic nursing art. Journal of Holistic Nursing, 13(2), 117-131. Theory of Holistic Comfort A broader theory for comfort was introduced in this article by expanding the concept of patient needs using Murrays (1938) theory of human press. Relationships between needs, interventions, outcomes, and comfort were developed into a

diagram or conceptual framework. A discussion centered in Comfort Theory's application in practice was also included. Kolcaba, K. Y. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19(6), 1178-1184. Comfort Empirically Tested The Comfort Theory was analyzed and thoroughly tested in this study focusing on four propositions of comfort and the validity of tools to measure comfort. The methods and results helped to provide empirical evidence for future applications and research. Kolcaba, K., & Steiner, R. (2000). Empirical evidence for the nature of holistic comfort. Journal of Holistic Nursing, 18(1), 46-62. Evolution of the Theory of Comfort After years of refinement, Comfort Theory was applies to institutional integrity. In order to expedite and assist organizations, institutional outcomes were included to explicitly identify practical applications in the health care environment. Kolcaba, K. (2001). Evolution of the mid range theory of comfort for outcomes research. Nursing Outlook, 49(2), 86-92. A Journey through Comfort The author, Katharine Kolcaba, freely expresses her ideas and journey related to the development of Comfort Theory. This resonating book, published in 2003, is versatile for use in all health disciplines. It presents, in one easy-to use text, the various segments of work about comfort. Comfort Theory and Practice (Free Preview)

Health Practice and Education

Nursing Care Plan Comfort Care template is demonstrated to enable more efficient, satisfying, and goal directed practice to meet present-day challenges. Kolcaba, K. Y. (1995). The art of comfort care. Image: Journal of Nursing Scholarship, 27(4), 287-289. Advance Directives Comfort Theory is applied to assist the interdisciplinary team through the process of guiding the patient and family in decision making and the dying process. Kolcaba, K. Y., & Fisher, E. M. (1996). A holistic perspective on comfort care as an advance directive. Critical Care Nursing Quarterly, 18(4), 66-76. Pediatric Application of Comfort Theory Current methods approach comfort as relieving discomfort. However, the Comfort Theory presents a framework in which enhanced comfort can be achieved. Kolcaba, K., & DiMarco, M. A. (2005). Comfort theory and its application to pediatric nursing. Pediatric Nursing, 31(3), 187-194.

Hospice Nursing Framework Comfort Theory is particularly useful as a framework for hospice care. A case study demonstrates the usefulness of Comfort Theory and its future application with the hospice discipline.

Vendlinski, S., & Kolcaba, K. Y. (1997). Comfort care: a framework for hospice nursing. American Journal of Hospice & Palliative Care, 14(6), 271276. Orthopaedic Adult Nursing Care

The Acute Care for Elders (ACE) model provides an effective, proactive, inexpensive framework for addressing the complex health needs of older adults. When used in conjunction with the Comfort Theory, the patient's holistic needs are addressed. Panno, J. M., Kolcaba, K., & Holder, C. (2000). Acute Care for Elders (ACE): a holistic model for geriatric orthopaedic nursing care. Orthopaedic Nursing, 19(6), 53-60. Peri-anesthesia Nursing An overview of current comfort theory and a framework for addressing the comfort needs of patients in the perianesthesia setting. Kolcaba, K., & Wilson, L. (2002). Comfort care: a framework for perianesthesia nursing. Journal of PeriAnesthesia Nursing, 17(2), 102-114. Wilson, L., & Kolcaba, K. (2004). Practical application of comfort theory in the perianesthesia setting. Journal of PeriAnesthesia Nursing, 19(3), 164-173.

Wagner, D., Byrne, M., & Kolcaba, K. (2006). Effects of comfort warming on preoperative patients. AORN Journal, 84(3), 427.

Health Research
Operationalizing comfort for use in outcomes research.

Kolaba, K. Y. (1992). Holistic comfort: operationalizing the construct as a nurse-sensitive outcome. Advances in Nursing Science, 15(1), 1-10. Below are some examples of Comfort Theory used in research. For a complete list, please visit Resources > References.

Kolcaba, K., & Fox, C. (1999). The effects of guided imagery on comfort of women with early stage breast cancer undergoing radiation therapy. Oncology Nursing Forum, 26(1), 67-72. 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), 301-306.

Apstolo, 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.

Comfort Theory
Katharine Kolcaba This page was last updated on February 10, 2011

INTRODUCTION

The comfort theory is a nursing theory that was first developed in the 1990s by Katharine Kolcaba. Comfort Theory is &September 9, 2013earch. Kolcaba's theory has the potential to place comfort once again in the forefront of healthcare.(March A & McCormack D, 2009).

BACKGROUND OF THE THEORIST

Born as Katharine Arnold on December 8th 1944, in Cleveland, Ohio Diploma in nursing from St. Luke's Hospital School of Nursing in 1965

Graduated from the Frances Payne Bolton School of Nursing, Case Western Reserve University in 1987

Graduated with PhD in nursing and received certificate of authority clinical nursing specialist in 1997

Specialized in Gerontology, End of Life and Long Term Care Interventions, Comfort Studies, Instrument Development, Nursing Theory, Nursing Research

Currently an associate professor of nursing at the University of Akron College of Nursing

Published Comfort Theory and Practice: a Vision for Holistic

Health Care and Research CONCEPTS AND DEFINITIONS ( Kolcaba, 2010) Kolcaba described comfort as existing in 3 forms: relief, ease, and transcendence. Also, Kolcaba described 4 contexts in which patient comfort can occur: physical, psychospiritual, environmental, and sociocultural.

Kolcaba described comfort as existing in 3 forms: relief, ease, and transcendence. If specific comfort needs of a patient are met, for example, the relief of postoperative pain by administering prescribed analgesia, the individual experiences comfort in the relief sense.

If the patient is in a comfortable state of contentment, the person experiences comfort in the ease sense, for example, how one might feel after having issues that are causing anxiety addressed.

Lastly, transcendence is described as the state of comfort in which patients are able to rise above their challenges.

Health Care Needs are those identified by the patient/family in a particular practice setting.

Intervening Variables are those factors that are not likely to change and over which providers have little control (such as prognosis, financial situation, extent of social support, etc).

Comfort is an immediate desirable outcome of nursing care, according to Comfort Theory

Health Seeking Behavior (HSBs): Institutional Integrity - the values, financial stability, and wholeness of health care organizations at local, regional, state, and national levels.

Best Policies are protocols and procedures developed by an institution for overall use after collecting evidence.

DEVELOPMENT OF THE THEORY

Kolcaba conducted a concept analysis of comfort that examined literature from several disciplines including nursing, medicine, psychology, psychiatry, ergonomics, and English

First, three types of comfort (relief, ease, transcendence) and four contexts of holistic human experience in differing aspects of therapeutic contexts were introduced. (Kolcaba KY & Kolcaba RJ, 1991)

A taxonomic structure was developed to guide for assessment, measurement, and evaluation of patient comfort. ( Kolcaba, 1991)

Comfort as a product of holistic nursing art. ( Kolcaba K, 1995) A broader theory for comfort was introduced ( Kolcaba KY, (1994).

The theory has undergone refinement and tested for its applicability.

DESCRIPTION OF THE THEORY Nursing

Nursing is described as the process of assessing the patient's comfort needs, developing and implementing appropriate nursing interventions, and evaluating patient comfort following nursing interventions.

Intentional assessment of comfort needs, the design of comfort measures to address those needs, and the reassessment of comfort levels after implementation.

Assessment may be either objective, such as in the observation of wound healing, or subjective, such as by asking if the patient is comfortable.

Health

Health is considered to be optimal functioning, as defined by the

patient, group, family or community Person/Patient

Patients can be considered as individuals, families, institutions, or communities in need of health care.

Environment

Any aspect of the patient, family, or institutional surroundings that can be manipulated by a nurse(s), or loved one(s) to enhance comfort.

CONCLUSION

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) (Kolcaba, 2010)

The theoretical structure of Kolcaba's comfort theory has real potential to direct the work and thinking of all healthcare providers within one institution. (March A & McCormack D, 2009).

REFERENCES

1.

Kolcaba, K. (2010). An introduction to comfort theory. In The comfort line. Retrieved November 10, 2010, from http://www.thecomfortline.com/

2.

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.

3.

Kolcaba, K. Y., & Kolcaba, R. J. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing, 16(11), 13011310.

4.

Kolcaba, K. Y. (1991). A taxonomic structure for the concept comfort. Image: Journal of Nursing Scholarship, 23(4), 237-240.

5.

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

holistic nursing art. Journal of Holistic Nursing, 13(2), 117-131. 6. Kolcaba, K. Y. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19(6), 1178-1184. 7. Kolcaba, K., & Steiner, R. (2000). Empirical evidence for the nature of holistic comfort. Journal of Holistic Nursing, 18(1), 4662. 8. Kolcaba, K. (2003). Comfort theory and practice: a vision for holistic health care and research. Springer Publishing Company, New York.