HOW CAN I THINK DIFFERENTLY?

Nursing Theories Applied to Practice Scenario

Sanaz Moayeri, Registered Nurse, Patient Care Coordinator, Educator

Athabasca University

NURS 608: Philosophical and Critical Foundations in Nursing

Dr. Mitchell

March 8, 2022
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Abstract

There are many nursing theories, which shape nursing education, and are applied to nursing

practice on the daily basis. By mid 1970s, hundreds of different nursing practice theories had

been developed, which became part of nursing curriculum and foundation of nursing practice

(Dewey, 2020). These theories are taught in nursing schools, in order to build these theories into

nursing practice. One of the main theories that I learned and have incorporated in my practice is

Katharine Kolkaba’s comfort theory, which has had an influence on my epistemological stance

in nursing. In this paper, I will discuss my epistemological nursing stance, as well as introducing

Katharine Kolkaba and her theory of comfort. Also, I will apply Kolkaba’s comfort theory to a

practice scenario relevant to where I practice as a nurse. Lastly, I will discuss strengths and

weaknesses associated with Katharine Kolkaba’s comfort theory.

Keywords: comfort theory, knowledge, nursing

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My Epistemological Nursing Stance

There are lots of facts that may that factor into nursing knowledge. Different academics

have developed theories which form the foundation of nursing knowledge necessary to practice.

Through my recent five years of nursing practice, I have come into the conclusion that having a

solid scientific education based on theories developed by different theorists is the foundational

base of nursing knowledge. Once this sort of knowledge is gained, one can start building clinical

experience to further improve their practice and focus on further developing their nursing skills

and expertise. As Skår (2010) explains, having an understanding and knowledge in nursing is an

important factor involved in the improvement of educational preparation, as well as the quality

of health care provided.

Furthermore, another type of knowledge which I have incorporated into my practice is

ethical knowledge. As Kim (2015) discusses, this type of knowledge is used in decision making,

while keeping the patient’s best interest in mind. I have chosen to incorporate ethical knowledge

into my practice to ensure that I keep my patients’ best interest in mind while providing, as well

as ensuring that their care needs are met. Albert et. al (2020) suggest that it is imperial for

nursing institutions to develop programs which can support nursing students to develop ethical

competence in order to find the courage to confront nursing dilemmas. As a result, ethical

knowledge is an imperative knowledge in the field of nursing.

Moreover, working as a nurse for over five years, I have gained experience in handling

situations that have occurred but not always explained in textbooks. Working in hospital

environment has taught me that no patients are alike, and every individual should be treated

based on their current situation. In every situation that care is provided by nurses, the end goal is

to provide comfort for the patient while providing appropriate treatment; and therefore,
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regardless of one’s years of experience, nurses always keep comfort in mind as an end goal to

accomplish. Hence, one of the main theories I incorporate into my practice is Katherine

Kolkaba’s comfort theory, which is a theory that I learned during my first year of nursing

education.

Comfort Theory by Katharine Kolkaba

Theorist Biography

Katharine Kolcaba, who was born in Cleveland, Ohio and attained her nursing diploma in

1995 (Kolcaba, 2019). She practiced in medical-surgical nursing, as well as long term care

settings for several years, until she decided to return to school. As explained by Kolkaba (2019),

in 1987, she graduated in the first Registered Nurse to Master of Science in Nursing with a

specialty in gerontology at Case Western Reserve University. While in school, she also worked

as a head nurse on the dementia unit, where she started theorizing about providing comfort and

its outcome on the patient’s journey (Kolcaba, 2019). Working closely with her philosopher

husband, she published a concept analysis of comfort (Kolcaba, 2019). Additionally, Kolkaba

diagrammed different aspects of comfort, conceptualized comfort as an outcome of care and

contextualized comfort in a middle range theory. Lastly, she performed an intervention study,

where she tested the theory of comfort. Finally, in 1999, she received her doctorate in nursing

with the comfort theory as her dissertation (Kolcaba, 2019).

Key Elements of Comfort Theory by Katharine Kolcaba

Comfort is described as the outcome of holistic nursing practice (Krinsky et al.,2014).

Nurses enter the field of nursing with the goal of providing comfort to their patients in any given

setting. Creating a healing environment for mental, emotional, and physical well-being of the

patient is considered a key approach in nursing practice. Comfort provides strength and healing
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to the patients. As Kolkaba (2019) explains, the first dimension in Kolkaba’s comfort theory is

for the patient to achieve different comfort levels, such as relief, easy, and transcendence. She

describes four contexts in which patient comfort can occur. These contexts include

environmental, physical, psychospiritual, and sociocultural. The physical context of this theory

focuses on bodily sensations and homeostatic mechanisms, whereas the psychospiritual context

of the theory refers to the internal awareness of self. Furthermore, the environmental context

refers to the external surroundings and conditions, while the sociocultural context of this theory

refers to interpersonal and societal relationships between everyone involved in the patient’s care.

(Krinsky et al., 2014).

Application/Utility of Theory (Practice-based Scenario)

A Woman in her early 40’s was diagnosed with metastatic breast cancer and was given a

prognosis of less than six months. The patient was told that she would not make it to her

daughter’s gradation from kindergarten. Her husband had a hard time accepting the news,

although he would provide her with endless support, and visited the patient with their daughter

on the daily basis.

On a day shift, the nurse enters the room to give the patient her scheduled pain

medication to help manage her pain. Reading the patient’s chart prior to entering the room, she

knows the medical team had a goal of care conversation with the patient, which the patient was

planning to discuss with her husband. When entering the room, the nurse noticed the daughter

sitting on the bed next to the patient, while the husband was having a conversation with the

patient, both being teary eyed. The nurse spent ten minutes in the room, answering the couple’s

questions, and at the end asked for the parents’ permission to take their daughter outside to show

her a movie in the TV room. This allowed the couple to have some alone time to discuss the
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patient’s goal of care and gave them some privacy to plan their short time together.

Later, when the nurse returned to the room to check up on them, the patient felt less

stressed as she was able to express her feeling privately with her husband while she felt hopeless.

The nurse’s gesture of allowing privacy for the couple enabled the patient to wrap up the

challenging topics she has in her mind, allowing her to come up with a resolution with her

husband, involving her loved one(s) in the decision-making process.

In this scenario, the nurse used Katharine Kolcaba’s comfort theory to approach this

situation. The patient experienced comfort in the context of psychospiritual context, as she was

given time and privacy with her husband to facilitate her goal of care conversation, while feeling

supported in a secluded area (Earl, 2013). The connection she made with her husband during

their alone time comforted her in the way of feeling supported, making her realize that she was

not alone in this journey. Furthermore, comfort was provided in the physical context needs by

giving the patient pain medication during the visit of her husband; and hence, resulted in

decreasing the patient’s discomfort to give her the ability to focus on her conversation (Earl,

2013). When the patient’s pain is well managed, it allows her to focus better on other factors that

impact her health and well-being. As a result, managing pain is an important factor in providing

care. Lastly, comfort was provided in the environmental context by providing a private, quiet

area for the patient to gather her thoughts together and decide in her own best interest (Earl,

2013). By providing a private, secluded area, the patient can focus and gather her thoughts,

without deciding based on any outside distracting factors.

Strengths and Limitations of Katharine Kolkaba’s Comfort Theory

Strengths
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There are many strengths associated with Katharine Kolkaba’s Comfort Theory. One of

the main strengths is that it is applicable to every aspect of nursing, and therefore,

its generalizability counts as a strength towards this theory. Comfort is one of the basic human

needs, therefore nurses can easily apply it to their practice. Since comfort theory is considered

more abstract and general, it allows for the theory to be applicable to a variety of different patient

populations, and various healthcare settings. Kolcaba and DiMarco (2005) mention that

Kolkabas comfort theory is widely applicable and useful in clinical and healthcare settings.

Furthermore, they mention that experiencing enhanced comfort encourages the patient to engage

in activities considered necessary for achieving health, and hence, resulting in better outcomes.

Another strength of this theory is its applicability to clinical research. Many clinical trials

can be run by assessing client’s response to different stimuli, which could be related to the

environment, spiritual, physical, and sociocultural aspects of care, allowing this theory to be

implemented in a controllable environment.

Limitations

There should be more research done regarding the benefits of applying this theory to

practice by nurses, and the affects it may have on nursing practice; simply because the

application of this theory may result in an enhanced work environment, and better well- being

between patients and healthcare providers (Krinsky et al., 2014). Additionally, this theory has

been designed for applications in specialized areas such as pediatrics and palliative care units;

however, other areas such as bone marrow transplant and cardiac units are not included, which

limits the theory’s applicability to specialized settings.

Furthermore, a patient experiences comfort when they reach the transcendence phase. If a

nurse is not able to accurately assess the patient to define the areas of comfort, the patient may
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not reach the transcendence phase (Kolcaba & DiMarco, 2005). One factor associated with this

limitation can be staffing challenges, which can impose a challenge in implementing this theory.

Since adequate staffing levels is difficult to maintain, increase in nurse-to-patient ratio is noticed,

and therefore, not allowing the nurse to balance his/her time between each patient to ensure this

theory is applied appropriately.

Lastly, another limitation would be budgeting, and costs associated with appropriately

implementing this theory, as education for more novice nurses, as well as appropriate staffing

levels to address every patient’s comfort needs would be needed (Shu Hua, 2017). As we all

know, staffing shortage in the field of nursing has been a major issue, especially during and post

pandemic. As a result, health organizations will have to come up with a staffing strategy in order

to manage costs, and to implement this theory as appropriately as it should be applied.

Conclusion

In conclusion, comfort theory plays a fundamental role for nurses in practice setting to

provide care to their patients. This theory serves as a roadmap in guiding nurses to establish

better connections with their patients, while ensuring that the patient’s basic needs are met. Just

like every other theory, this theory has strengths and limitations associated with it, which are

discussed in this paper. Furthermore, the applicability of this theory was discussed by applying it

to a practice-based scenario, involving a forty-year-old mother, nearing death. It is important for

nurses to have general knowledge and training regarding this theory before applying to their

practice, for them to understand the benefits associated with this theory when providing patient

care. As a result, proper education and training will be needed when this theory is practiced.
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References

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patient care: An integrative review. Nurse Education Today,  88.

https://doi.org/10.1016/j.nedt.2020.104389

Dewey, J., PhD. (2020). Nursing theory. Salem Press Encyclopedia of Health.

Earl, J. (2013, June 29). Concepts and definitions. Katharine Kolcaba: The Comfort Theory.

Retrieved March 6, 2022, from

https://2013upoujohanearlman.wordpress.com/2013/06/27/conceptual-and-definitions/

Kim, H. S. (2015). The essence of nursing practice : philosophy and perspective. Springer

Publishing Company.

Kolcaba K, & DiMarco MA. (2005). Comfort theory and its application to pediatric

nursing. Pediatric Nursing,  31(3), 187–194.

Kolcaba, K. (2019). Personal History. Retrieved from https://www.thecomfortline.com/about

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https://doi.org/10.1016/j.apnr.2014.02.004

Shu Hua NG. (2017). Application of Kolcaba’s Comfort Theory to the Management of a Patient

with Hepatocellular Carcinoma. Singapore Nursing Journal, 44(1), 16–23.

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