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Comfort Theory

Dr. Katharine Kolcaba's Theory of Comfort was first definitively defined in An Analysis of the Concept of Comfort, co-authored by her husband, Raymond J. Kolcaba, in 1991. Her book, Comfort Theory and Practice: A Vision for Holistic Care and Research, was published in 2003 and further expanded the Comfort Theory and its applications for nursing practice.

The Theory of Comfort is considered a middle range theory. As opposed to grand theories that are abstract and not easily applied to nursing practice, middle range theories are adaptable to many different applications, yet specific enough to be tested.


Dr. Kolcaba's theory evolved from many years of nursing experience and advanced study and research. From the time of Florence Nightingale to nursing theorists of more recent times, comfort has been described as a part of the art of nursing. In her paper on comfort analysis, Kolcaba provided a detailed and scholarly study of the meaning of comfort and its historical and current connection to nursing. She believes that nurses, as the primary caregivers, are in the position to provide comfort for their patients. Her theory provides the framework that can be used for effective nursing practice.

The three forms of comfort that Kolcaba describes are relief, ease and transcendence. Relief refers to meeting the comfort needs of patients. An example is the administration of pain medications that provide relief of physical discomfort. Ease is the state of comfort that is achieved when patients are contented and anxiety is alleviated. Transcendence occurs when patients are in a state of comfort and can rise above their challenges. These three forms of comfort are met in the physical, psycho-spiritual, environmental and social-cultural experiences. The enhanced comfort levels lead to health seeking behaviors of the patients.

Description of Theory

  • Nursing includes the assessment of patients' comfort needs, applying nursing interventions and assessing patients' comfort after the interventions.
  • The nursing assessment is either objective or subjective. Objective assessment refers to physical healing and subjective assessment refers to emotional, psychological and social issues.
  • There needs to be intentional reassessment of comfort levels after nursing interventions.
  • Health is seen as optimal functioning as defined by patients, families and communities.
  • Patients are defined as persons, families or communities that need health care.
  • The environment is any facet of patients' surroundings that can be improved to increase comfort.

Definitions

  • Health care needs are made known by patients and their families in their particular health care settings.
  • Overriding variables are those conditions that will probably not change and are out of the control of health care providers. Some examples of these conditions are the health prognosis, social support and financial situations.
  • According to the nursing theory, comfort is the primary reason for nursing care.
  • Institutional integrity refers to local, regional, state and national health care facilities and programs. It measures their values, comprehensiveness and financial strength. This includes government programs such as public health agencies, Medicare and Medicaid.
  • Best policies are the procedures and protocols developed by facilities after clinical research and data.
  • Best practices are the procedures and protocols developed by facilities for specific types of patients and families after clinical research and data.
The context and development of the theory can seen best in a review of the articles that Kolcaba published in numerous nursing journals since 1991. Started from a doctoral thesis and dissertation, the concept evolved into the middle range theory for nursing practice, education and research. Through the articles, the Theory of Comfort can be understood by following its development, concept analysis, taxonomic structure, comfort process and product, theory of holistic comfort, empirical testing and evolution.

In 1997, Dr. Kolcaba developed the website, The Comfort Line. It contains comprehensive information about the theory including graphic charts and questionnaires that are very useful in nursing practice. She freely shares information with students, colleagues and researchers and is very accessible through her blog and consultations. It contains a comprehensive list of her many articles and publications. The complete list of the articles also can be found in her book, Comfort Theory and Practice: A Vision for Holistic Care and Research.

Publications related to the Theory of Comfort

  • Kolcaba, K., Schim, V. and Steiner, R. Effects of Hand Massage on Comfort of Nursing Home Residents, Geriatric Nursing, 2006
  • Kolcaba, K., Dowd, T. and Mitzel, A. Efficacy of Hand Massage for Enhancing the Comfort of Hospice Patients, Journal of Hospice and Palliative Nursing, 2004
  • Kolcaba, K., and Wilson, L. Comfort Care: A Framework for Perianesthesia Nursing, Journal of PeriAnesthesia Nursing, 2002
  • Kolcaba, K. and Fox, C. The Effects of Guided Imagery on Comfort of women with Early Stage Breast Cancer Undergoing Radiation Therapy, Oncology Nursing Forum, 1999
  • Kolcaba, K. and Wykle, M. Comfort Research: Spreading Comfort Around the World, Reflections, 1997
  • Kolcaba, K. Y. and Fisher, E. M. A Holistic Perspective on Comfort Care as an Advance Directive, Critical Care Nursing Quarterly, 1996
  • Dossey, B. M. and Kolcaba, K. Holistic Care: Is it Feasible in Today's Health Care Environment?, Nursing Leadership Forum, 2000
  • Vendlinski, S. and Kolcaba, K. Y. Comfort Care: A Framework for Hospice Nursing, American Journal of Hospice & Palliative Care, 1997
  • Stevens, W. K., Hall, E. A. and Kolcaba, K. Burnout: Why do we Blame the Nurse?, American Journal of Nursing, 1996
  • March, A. and McCormack, D. Nursing Theory-Directed Healthcare: Modifying Kolcaba's Comfort Theory as an Institution-Wide Approach, Holistic Nursing Practice, 2009
  • Goodwin, M., Sener, I. and Steiner, S. A Novel Theory for Nursing Education: Holistic Comfort. Journal of Holistic Nursing, 2007

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