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Kolcaba’s Comfort Theory

Lim, Anton Steve P.


Mrs. Carmela S. Malaza R.N


Kolcaba’s Comfort Theory
Personal Background

 Born as Katharine Arnold on December 8th 1944, in Cleveland, Ohio

 Married with two children and eight grandchildren
 Founder of a local parish nurse program
 Member of the American Nurse's Association
 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
 Diploma in nursing from St. Luke's Hospital School of Nursing in 1965
 Graduated from the first RN to MSN class at 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
 1991-92: Pre-Doctoral Fellowship in Interdisciplinary Health, CWRU Internal
 1997: Marie Haug Student Award for excellence in aging studies
 1997: Honour a Researcher Award
 2003: Mary Hanna Memorial Journalism Award in recognition for the article
Care of the Perianesthesia Nursing
 2003: Advancement of Science Award from Midwest Nursing Research
Society, End of Life and Palliative

Comfort Theory and Care

Comfort Care is a nursing art that entails the process of comforting actions
performed by a nurse for a patient. According to comfort theory, patients
experience comfort needs in stressful health care situations. Patients and their
families/support groups meet some needs but other needs remain unmet. These
needs can be identified by a nurse who then implements comfort measures to meet
the needs. Enhanced comfort readies the patient for subsequent healthy behaviors
or a peaceful death. Comfort measures can provide relief, help ease a distress or
help support the patient to transcend the experience or condition.

Comfort Needs are assessed in four contexts of patient’s experience:

 Physical: pertaining to bodily sensation and physiologic problems associated
with medical diagnosis

 Psychospiritual: pertaining to the internal awareness of self, including

esteem, concept of sexuality, and meaning in one’s life; this can also
encompass one’s relationship to a higher order or being

 Environmental: pertaining to the external background of human

experience; encompasseslight noise, ambiance, color, temperature, and
natural versus synthetic elements

 Social: pertaining to interpersonal, family and societal relationships

Relief Ease Transcendence

Physical-bodily Opioid for postop pain Elevate leg for edema Coaching for labor pain
and physiologic
Psychospiritual- Coaching and Chaplain, deep Support for giving
internal encouraging- breathing, guided control and feeling safe.
awareness, self-esteem, imagery
spiritual relationship

Environmental-light, Reposition due to Distractions during a Privacy and quiet for a

noise, immobility procedure, music dying patient
color, temperature

Sociocultural- Information and Interpreter, family Religious practice or
interpersonal, education visiting and presence rituals
family and society

Types of Comfort Care

Technical: Pain relief, positioning, monitoring
Coaching: Relieve anxiety, provide information, instill hope, and plan for recovery
Comforting: Things that make patients/families feel cared for, strengthened and

 Kolcaba explains that comfort has long been associated with nursing and
typically has been a leading theme. Of course greater comfort is good for the
patient and assists with enhancing the patient’s well being, but nurses’
efforts to extend comfort to patients carry implications beyond an immediate
improvement in the patient’s outlook and that of his family. “When patients
and families are strengthened by actions of health care personnel (nurses!),
they can better engage in health seeking behaviors”.

 The Theory integrates “simultaneous physical, psychospiritual, sociocultural,

and environmental aspects of comfort.

 The second facet of the theory focuses on health Seeking Behaviors (HSB’s).
HSBs can be internal (healing), external (health related activities), or even a
peaceful death among terminal patients. HSBs of specific groups of any size-
whether large of small- are positively related to the third aspect of kolcaba’s
theory of comfort, Institutional Integrity (lnl).

 This third aspect of kolcaba’s theory of comfort was newly defined in 2007
and is “defined as the values, financial stability, and wholeness of health care
organizations at local, regional, state, and national levels” (kolcaba, 2008).

Comfort Theory and Practice

Holistic Approach

All Patients

Distress: 4 Contexts

Comfort Interventions

Patient Outcomes

Optimum Function Peaceful Death

Use and Acceptances in the field of Nursing

 Intentional assessment of comfort needs, the design of comfort measures to

address those needs, and the reassessment of comfort levels after
 Assessment may be either objective, such as in the observation of wound
healing, or subjective, such as by asking if the patient is comfortable.
 According to Kolcaba, health is considered to be optimal functioning, as
defined by the patient, group, family or community
 According to Kolcaba, patients can be considered as individuals, families,
institutions, or communities in need of health care.
 Any aspect of the patient, family, or institutional surroundings that can be
manipulated by a nurse(s), or loved one(s) to enhance comfort

Carlson, K.L., Broome, M. & Vessey, J.A. (2000). Using distraction to reduce reported
pain, fear and
behavioral distress in children and adolescents: A Multisite Study. JSPN, 5(2):75-85.

Morse, J. & Proctor, A. (1998). Maintaining patient endurance: the comfort work of
trauma nurses.

Clinical Nursing Research, 7(3):250-274.

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

Kolcaba, K. Y. (1995). The art of comfort care. Image: Journal of Nursing Scholarship,

Kolcaba, K., Schirm, V., & Steiner, R. (2006). Effects of hand massage on comfort of
nursing home
residents. Geriatric Nursing, 27(2): 85-91.

Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort theory: A unifying framework to
enhance the
practice environment. The Journal of Nursing Administration, 36(11): 538-543.

Kolcaba, K. (2010). An introduction to comfort theory. In The comfort line.

Retrieved November 10, 2010, from