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Theory in Practice Reflection:
Kolcaba Theory of Comfort
Derek Sibley
Ferris State University
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Theory in Practice Reflection: Kolcaba Theory of Comfort
End-of-life situations are difficult times for everyone involved. Katherine Kolcaba
developed Comfort Theory(2003), to help family, patients, and caregivers work through the
situation at hand while assisting the patient with various aspects of comfort as they near the end
of their lives.
Empowering Patients and Family
According to Vendlinski and Kolcaba (1997), a holistic approach to end of life situations
is necessary to promote comfort. Involving the patient and family in the decision making
process improves the entire comfort care process and enhance the patients comfort (Vendlinski
&Kolcaba, 1997). The standardization of comfort by Kolcaba and her associates in the form of
questionnaires for patient/family, as well as the comfort grid, allow nurses to assess individuals
in the situation. This provides information regarding physical, psychospiritual, environmental,
and social comfort levels(Vendlinski & Kolcaba, 1997). Nurses can then educate, provide
support, or involve other members of the care team to enhance patient or family comfort.
Engaging Patients and Family
End of life situations are extremely sensitive in nature, and the first impression of a nurse
is very important to the family. Care providers should approach the situation with empathy along
with a holistic care plan, so the patient can finish out their life as they wish, with the highest
quality of life possible. Comfort is assessed through questionnaires, which can be read to the
patient, or self administered if possible (Vendlinski & Kolcaba, 1997). These allow nurses to
easily determine comfort levels in each dimension, and the degree at which comfort is obtained.
According to Vendlinski and Kolcaba, there are three states of comfort: relief, ease, and
transcendence. Relief involves having a specific need met, ease is a state of contentment, and
transcendence involves one rising above their issue (1997). Nurses can assist families and
patients to overcome or ease aspects of the situation, even if total relief is not possible
(Vendlinski & Kolcaba, 1997). Analysis of each state of comfort gives nurses the information to
better the environment and increase comfort levels.
Active Partnership
According to Vendlinski and Kolcaba (1997), Comfort care includes constant, active
involvement of the family, with the nurse facilitating as needed. All members of the care team
need to realize that no matter the circumstances, patient and family involvement in care, and
their needs will change throughout the process, as family works through the grieving process and
the patient nears death. Patient or surrogate input must be considered and valued because their
comfort is most important, as the term comfort care implies. When engaging the family and
obtaining their input, many observations can be made about their state of emotions as well as
their thought process. Interventions can then be taylored to each situation to provide enhanced
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comfort (Vendlinski & Kolcaba, 1997).Personalized interventions allow for best quality of care,
and questionnaires assess how interventions are working, as well as if/when they need
modification.
Reflection
My first semester in clinical, I was assigned a comfort care patient near the end of his life.
This elderly gentleman had lived a joy-filled life. As I interacted with the family, I heard stories
and recollections of the fun times they shared. As this was my first experience with a dying
patient, I was overcome with an empathetic sadness. I thought to myself that it must be difficult
to be in this persons position, to have once been strong and kind, and now lying helpless as we
provided care. I made sure to explain all care although the patient was unresponsive, just in case
he could hear. Patient care was much easier than dealing with the family. They were all
overcome with emotion, and I had almost no formal education on how to deal with the situation.
I did my best to provide support and be respectful to everyone, and at the end of the day, I was
thanked for being such a compassionate person.
Elaborate
This assignment was difficult to get started, as I wasn't familiar with Comfort theory or
its application, but after investigation, it is a simple theory. The case study surprised me, in
regards to how much of a difference music can make in someone's last days. It reminded me to
think of every aspect of care and the environment in order to maximize comfort.
Analyze
When the subject of comfort care surfaces, I think of the pain and suffering that is often
involved. Everyone deserves to approach death peacefully and with the greatest level of comfort
possible. I think comfort care protocols are properly designed, allowing patients to finish out life
with a low amount of pain, and not prolonging life in an uncomfortable manner. This method of
care allows the patient to decide when they want to die, to some degree. Patients often hold on to
see that last family member, or see another task completed, so they can die in peace.
I think Kolcaba's Theory is useful as a tool to identify and intervene in situations that will
be beneficial to everyone involved. The advantage of using a theory to communicate needs is it
is a proven method, accurately analyzing various comfort levels, so interventions can be
implemented and comfort levels are increased. The disadvantage to using Comfort Theory and
questionnaires to determine comfort levels, is the nurse may not observe the situation as
carefully, assuming the surveys will tell all. Categorizing comfort levels according to different
contexts more clearly defines which members of the care team need to get involved. As the nurse
is the patient advocate, they can mediate care, and set up appointments with social work, church
services/chaplains, pain management, or other caregivers to enhance comfort for everyone
involved.
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Revise
I feel that Kolcaba's Comfort Theory has a strong base, but not everything can be
measured on paper. It takes a special person to devote themselves to end-of-life care. I feel like
this theories application can be improved upon through nurse education. This is a relatively new
theory, and many nurses may not have adequate knowledge on how to use it for enhancing
comfort and maximizing quality of care. With greater knowledge, nurses will be able to utilize
this theory and its tools to its full extent.





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References
Kolcaba, K. (2003). Comfort theory and practice. The Comfort Line. Retrieved June 20,
2014, from http://www.thecomfortline.com/index.html
Vendlinski, S., & Kolcaba, K. Y. (1997). Comfort care: a framework for hospice nursing.
PubMed: PMID: 9392722





















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