INTRODUCTION

Introduction of comfort theory

The comfort theory is a nursing theory that was 1st developed in the 1990 by Katharine Kolcaba.
Comfort theory is a middle range theory for health practice, education, and research.
Kolcaba`s theory has the potential to place comfort once again in the forefront of health care.
this is the focus of the whole person`s lifestyle, culture, believes, emotion, behaviour and not only
treating the person illnesses this is dynamic care model.

Introduction of Ketharine Kalcaba

Dr. Katharine Kolcaba , RN
Birth-28th dec 1944 in Cleveland Ohio
Diploma in nursing-Luke`s hospital 1965.
PhD and Clinical Nursing Speciality-1997
Katharine kolcaba earned a diploma in nursing from St.Luke`s hospital school of nursing, Cleveland,
Ohio, in 1965; a master`s degree in nursing from case Western Reserve University, Cleveland, in
1987; and Ph.D. in nursing from case Western Reserve University in gerontology and has received
numerous awards and honors.
These include the Marie Haug student Award for excellence in Aging studies from case Western
Reserve University in 1997, links2Go Resource award in 1999 for the comfort line website, the Mary
Hanna Memorial journalism Award from the Comfort American Academy of Perianesthesia nurse in
2003,and the Advancement of Science Award from the American Association of college of nursing 3 rd
Annual Award for excellence in Baccalaureate Gerontology Curriculum.
Dr. Kolcaba is an associate professor at the University of Akron, Ohio, where she teaches an
undergraduate course titled Nursing Care of older Adults and graduate courses in research, theory,
professional roles and domains of nursing knowledge . Her areas of expertise include gerontology,
end-of-life and long term care interventions, comfort studies, instrument development, nursing theory,
nursing research, and magnet status.
Kolcaba 2004 reminds us that Nightingale recognizes that comfort was essential for patients.
Nightingale stated, ‘‘It must never be lost sight of what observation is for. It is not for the sake of
piling up miscellaneous information or curious facts, but for the sake of saving life and increasing
health and comfort’’. Kolcaba points out that Nightingale implies that the relationship between health
and comfort is dependent.

ORIGIN OF COMFORT THEORY

Between 1900 and 1929, comfort was a goal of both medicine and nursing because it was through
that a patient`s comfort led to there recovery. From 1929 through the 1990`s, the focus seems to
decrease. Kolcaba`s theory is unique but has the potential to place comfort in the forefront of health
care once again.
Kolcaba goes on to discuss the concept of comfort in the 20th century context of nursing practice. She
cites Aiken [1908] and Harmer [1928], both of whome speak to the provision of the patient comfort as
a nursing role. Goodnow [1935] develop a chapter of her nursing text to patient comfort. Prior to the
advent of effective analgesic medications, comfort measures were treatment oriented [massage, heat,
compresses, and so on].
While the provision of physical comfort is prominent in the literature, the psychosocial, spiritual realm
is recognized in the expectation that the nurse “comfort’’ and provides “comforting” to the patient. An
overview of the major concept and definition in Kolcaba`s theory can be found in this table –
 COMFORT The immediate experience of being strengthened by
having needs relief, ease, and transcendence addressed
in the four context.[physical, psycho-spiritual, socio-
cultural and environmental].comfort is much more than
the absence of pain and discomfort.

COMFORT CARE A philosophy of health care that addresses physical,

psycho-spiritual, and environmental comfort needs of
patients. Comfort care has three components;
1. An appropriate and timely intervention;
2.A mode of delivery that projects caring and empathy;
3.The intent to comfort.

COMFORT MEASURES Interventions designed to enhance patient

/family/comfort.
COMFORT NEEDS Patients` or families desire for or deficit in relief/ease/
transcendence in physical, psycho-spiritual, socio-
cultural, and environmental contexts of human
experience.
HEALTH-SEEKING Behaviors in which patients or families engage
BEHAVIORS[HSB] consciously or sub-consciously, moving them toward
well-being . HSBs health seeking behavior can be
internal, external, or dying peacefully.
INSTITUTIONAL The quality or state of health care organization as
INTEGRITY complete, whole, sound, upright, professional, and
ethilcal providers of health care .

INTERVENNING Positive or negative factors over which nurses or

VARIABLES institutions have little control, but that affect the
direction and success of comfort care plans or comfort
studies.

In the 1980`s comfort actives were observed. Meaning of comfort began to be explored. This is when
Kolcaba began to develop a theory of comfort when she was a graduate student at Case Western
Reserve in Cleveland, Ohio. Kolcaba`s theory 1992 based on the work of earlier nurse theorists.
Kolcaba developed her nursing theory on 1990`s.
DEFINITION
Holistic comfort is defined as the immediate experience of being strengthened through having the need
for relief, ease, and transcendence met in four contexts of experience {physical, psycho spiritual,
social, and environmental}.
Kolcaba defines comfort as `the immediate state of being strengthened through having the human
needs for relief, ease and transcence addressed 4 contexts of experience,`
According to Kolcaba –comfort can occur in following contexts-
1.Physical
2.Psychospiritual
3.Environmen

4.sociocultural

CONCEPT OF COMFORT THEORY

Kolcaba related her theory to the 4 global concepts of
1.Human beings
2.Nursing
3.Environment
4.Health
.
Human being- person receving care from nurse this can be the patient, family, community or
institution.
Nursing include the use of assessment, intervention and evaluation to address the comfort needs of
patient.
Environment define as the patient`s external surroundings which can be changed to increase comfort
level of patient.
Health is the optimal level of functioning of patient.

Contexts of the human experience of comfort-

The 1st context of the experience of comfort identified by Kolcaba is physcial comfort. She states that
this is the most obvious and most agreed upon context of comfort. Kolcaba synthesized Hamilton`s
1989 finding about comfort and those of later authors into a definition of physical comfort as
“pertaining to bodily sensations and homeostatic mechanisms that may or may not be related t specific
diagnoses” .
The 2nd context that Kolcaba identifies is phycho-spiritual comfort . this context is defined as
“whatever gives life meaning for an individual and entails self estem, self concept, sexuality, and ones
relationship to a higher order or being”.the definition is synthesized from the works of Hamiton
1989,howath 1982, Lanun 1988, and Reed 1987.z
The 3rd context of human experience environmental comfort. This context is defined as “pertaining to
external surroundings, and influences”. This definition is synthesized from the works of Levine,
fuller1978, and Wolanin and Phillips 1981. Include in this definition are color, noise, light, ambience,
temperature, view from window, access to nature and natural versus synthetic elements.
The 4th context is socio-cultural comfort is socio-cultural comfort. Kolcaba defined this as “pertaining
to interpersonal, family, and societal relationship including finances, education and support”. The idea
of culture include family histories, traditions, language, clothes, and customs.

TYPES OF COMFORT
A concept of comfort resulted in the development of three types of comfort relief, ease, and
transcendence termed.
Kolcaba`s theory states that patient comfort exists in three forms-
1.Relief,
2.Ease,
3.transcendence
RELIEF Relief defined as the patient who has had a specific comfort
need met.
EASE Ease is defined as the state of calm or contentment.
TRANSCENDENCE This is defined as a state in which one rises above problems
or pain.

Relief occur when specific comfort need are met, that is the relief of post opretive pain by
administering prescribed analgesia.
Ease occur when the patient reaches a comfortable state of contentment, that is the feeling experience
after addressing issue that cause anxiety.
Transcendence occurs when the patient is able to rise above challenges or pain, that is the act of
listening to his favorite music when nausea despite treatment with antiemetic.

CONTEXTS OF HUMAN EXPERIENCE OF COMFORT-

Identified by Kolcaba synthesized Hamilton`s 1989 finding about comfort and those of later authors
into a definition of physical comfort as “pertaining to bodily sensations and homeostatic mechanism
that may or may not be related to specific diagnoses”

According to Erickson, 2012 –

Modeling is process that helps the nurse to understand the patient personal model, to recognize that
each patient has unique prospective. From the patient`s prospective, the nurse develop an image of the
patient world.

CONCEPTUAL MODEL OR MAJOR CONCEPT OF MODE

 The assumption that the theorist makes are the beginning point of the base of the theory. Kolcaba`s
1994 theoretical assumption are following-
1. Human beings have holistic responses to complex stimuli.
2. Comfort is a desirable holistic outcome that is germane to the discipline of nursing.
3. Human being strive to meet, or to have met, there basic comfort needs. It is an active endeavor.
4. Comfort is more than the absence of pain, anxiety, and other discomfort.

Comfort theory can applied to individuals, families, or communities in any setting. Propositions
for the first part of the theory include the following –
HEALTH HEALTH
NURSING INTERVENING ENHANC -ED INSTITUT-
CARE SEEKING
INTERV- VRIABLES COMFORT IONSL
+
NEEDS + - = = =
BEHAVIO-UR
ENTION INTERGR-ITY

1. Nurses identify patient comfort that have not been met by existing support systems.
2. Nurses design interventions to address those needs.
3. Intervening variables are taken into consideration in designing the intervention and in determining
whether they will be successful.
4. If the intervention is appropriate and delivered in a caring manner, the patient experiences the
immediate outcome of enhance comfort. Comfort care entails appropriate intervention delivering in a
caring manner, with the goal of enhanced comfort.
5. Patient and nurse agree upon desirable and realistic HSBs.
6. If enhanced comfort is achieved, patients are strengthened to engage in HSBs that further enhanced
comfort.

FOUR METAPERADIGM
Metaperadigm, research, and practice with the comfort theory both Kolcaba`s webside and her text
provide her definition of the metaperadigm concepts.
While this theory is fairly new, it can be applied to individual, families and communities in any
setting. The concept are clear and easy to define. Nurses are “comfortable” with the idea of comfort
being an integral part of the nursing care. These aspects all promote the use of this mid range theory
by nurses in clinical practice.
NURSING Nursing; the intentional assessment of comfort needs of patients,
family, or communities; design of comfort level after
implementation of comfort measures to address comfort needs,
including reassessment of comfort measures, compared to a
previous baseline.
PERSON Patient; an individual, family, and community in need of health
care, including primary, tertiary, or preventive care.
HEALTH Health; optimum function of patient/family /community
facilitated by the enhance comfort .
ENVIRONMENT Environment; aspects of patient/family/ community surroundings
that affect comfort and can be manipulated to enhance comfort.
USING OF THEORY IN PRACTICE
Giving a patient a warm blancket to help them increase their body temperature after surgery.
Addressing the anxiety of the patient by talking to them.
Providing a private, quit room for a dying patient.
Fallowing patient`s religious rituals.
Maintain privacy and confidenciality.
RESEARCT STUDIES CONDUCTED BASED ON THEORY

RESEARCHERS PUBLICATION DATE SUBJECT

Dowd and other 2007 Stress redusing in college students .
Kolcaba and dimarco 2005 Comfort theory, nursing care of pediatric patient .
Kolcaba and fisher 1996 Comfort care, advance directives and critical care.

KATHRIN KOLCABA`S COMFORT THEORY

Assessment Diagnossis Outcomes Planning Implimentation Evaluation

*Physical;pain from *Real or *Pain relief *Give pain *NSAIDs given *MA indicates
indications in both potential for both medicines, every six hours pain control is
legs; arthritis in discomfort insicional including as she similar to what she
hands. physically, and arthirtic NSAIDs, in requrested . had at home.
*Psycho- psycho- pain. pattern she *Physical thrapy *Able to transfer
spiritual;”will I never spiritully and *Long term determines to help MS learn to from bed ad
be able to fix a meal environment goal able to effetive start transfer toilet/ wheelchair
in my kichen again? ally. care for her limited. teachinique’ safely.
*Environmental;”its home again. *physical
so noisy at night that I Able to activity – bed
don`t sleep well.” sleep seven to wheelchair
*Sociocultural; lives to eight and to toilet
with husband in own hours night. transfers
home with adequate *provid
finances. quieter
environment at
night.