Theory of Comfort

Theory of comfort, proposed by Katherine Kolcaba, explored and showed an extensive review of
the different kinds of comfort interventions in nursing and in other disciplines, such as in medicine,
psychiatry, ergonomics, and English use of comfort (lingual). For Katherine Kolcaba, the meaning of
“comfort” was to strengthen greatly. She had based her concepts based on the meaning of comfort in
her theory. She had noticed that comfort was no longer the central goal of nursing and medicine. She
made a valiant effort to shift back the focus to comfort and come up with interventions that results to
patient comfort. In order to do that, she had conducted studies in which patients’ level of comfort was
measured by giving interventions that aimed in satisfying the different kinds of comfort. There are three
types of comfort: Relief which is the state of a patient who has had a specific need met, Ease is the state
of calm or contentment and Transcendence is the state in which one rises above one’s problems or pain.
Included in the concepts of the theory is also the context in which comfort occurs, which are physical,
psychospiritual, environment, and social context. All of these factors interact with each other in order to
determine the intervention needed appropriate to the specific type of comfort and in its specific
context.

The data collected was used in formulating evidence-based practices and interventions in order
to give only the best practices to patients. She believed that in order for care to be effective,
interventions to provide comfort must be done in order to achieve the level of care desired and need in
order to promote health. This does not only apply to health promotion but also in peaceful dying of a
patient which can help in easing the terror of death or transcend amidst the pain.

The concept of the theory starts with the patients’ health care needs. Nurses responds to that
by applying nursing interventions that results to the enhanced comfort that allows health seeking
behaviors. This health seeking behaviors results to internal and external behaviors being adjusted and
allows peaceful death. The health seeking behaviors that was the result of the nursing interventions that
contributed to the increase in institutional integrity which is attributed to best practices and best
policies that was obtained through evidence-based practice.

The theory can be related to the current study in a way that the research problem focuses on
giving care that is centered in providing comfort to the patients. The theory relates to the study where it
explores the trends of comfort interventions that the nurse have used that results to the quality care
that the patients receives. These trends are influenced by the taught practices and the standards of
nursing where the goal is to promote the comfort of the patient and to maintain dignity and relieve
them from pain that are hindering with their mental and cognitive capacity in order for them to come of
terms to their fate.

Peaceful End-of-Life Theory

Peaceful End-of-Life Theory, a middle range theory proposed by Patricia A. Higgins and Dana M.
Hansen, was informed from different theoretical frameworks. It is developed from the part of general
systems theory which was based on Donabedian’s model of structure, process, and outcomes. In the
peaceful end-of-life theory, the structure setting is the family system, which is the terminally ill and all
significant others that is receiving care from the healthcare providers, and was described as a process
that promote positive outcomes such as being free from pain, experiencing comfort, experiencing
dignity and respect, being at peace, and experiencing a closeness to significant others and those who
care for the patient. The second theoretical underpinning is the preference theory and was used to
define quality of life. In preference theory, the patient who is receiving care takes part in the decision
making in the care that will be done to improve his or health. By doing this, it had greatly increased
patient compliance and the successful outcomes of improving patient care and experience of comfort.

There are two major assumptions of this theory, first is the occurrence and feelings at the end-
of-life experiencing are personal and individualized. This means that every encounter and giving care to
the patient is always a unique one. Nurses have to stick to patient preferences or adapt to their
interventions to suite the patient’s needs or wants in order to give a successful care. The second
assumption is that nursing care is crucial for creating a peaceful end-of-life experience. The nurses
assess and interpret cues that reflect the person’s end-of-life experience and come up with
interventions to appropriately address the health needs of the patient and allows them to attain or
maintain a peaceful experience, even when the person is dying and cannot communicate verbally.

Ruland and Moore have asserted in their theory that these interventions must be done in order
to provide experience of comfort to the patients allowing them to be at peace and experience of
retaining their dignity and respect, even when dying:

1. Monitoring and administering pain relief and applying pharmacologic and nonpharmacologic
interventions contribute to the patient’s experience of not being in pain.
2. Preventing, monitoring, and relieving physical discomfort, facilitating rest, relaxation, and
contentment, and preventing complications contribute to the patient’s experience of comfort.
3. Including the patient and significant others in decision making regarding patient care, treating
the patient with dignity, empathy and respect, and being attentive to the patient’s expressed
needs, wishes, and preferences contribute to the patient’s experience of dignity and respect.
4. Providing emotional support, monitoring and meeting the patient’s expressed needs for anti-
anxiety medications, inspiring trust, providing the patient and significant others with guidance in
practical issues, and providing physical presence of another caring person if desired contribute
to the patient’s experience of being at peace.
5. Facilitating participation of significant others’ grief, worries, and questions, and facilitating
opportunities for family closeness contribute to the patient’s experience of closeness to
significant others or persons who care.
6. The patient’s experiences of not being in pain comfort, dignity, and respect, being at peace, and
closeness to significant others or person who care contribute to the peaceful end of life.

These theoretical assertions have become the basis of quality care given to the patient, but of
course appropriately, and allows them to experience comfort at the hands of nurses and allows them to
have a peaceful death.

This theory coincide with the study in terms of the nurses’ ability to be unique and adapt
interventions depending on the patients’ preference and the skill of the nurse in identifying cues in
order to give the appropriate intervention needed to provide comfort, especially with patients who are
terminally ill or dying. The knowledge, skill, and experiences greatly affect how the nurse can react to
these cues and how easily can they apply appropriate interventions.
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