KATHARINE KOLCABATHEORY OF CARING
NCM 100 | Theoretical Foundations of Nursing
OUTLINE:
I. CREDENTIALS AND BACKGROUND
II. THEORETICAL SOURCES
III. MAJOR CONCEPTS
A. Health Care Needs
B. Comfort Interventions
C. Intervening Variables
D. Comfort
E. Health-seeking Behaviors
F. Institutional Integrity
G. Best Practices
H. Best Policies
IV. MAJOR ASSUMPTIONS
A. Use of Empirical Evidence
V. LOGICAL FORM
VI. THEORETICAL ASSERTIONS
VII. EXAMPLES OF INTERVENTIONS THAT
HAVE BEEN TESTED RECENTLY
VIII. METAPARADIGM
IX. REFERENCES
X. LEGEND
Black- Book
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CREDENTIALS & BACKGROUND
(1944-PRESENT)
• Born and educated in Cleveland, Ohio.
• 1965, she received diploma in nursing,
& practiced part time in medical-surgical
nursing, & home care.
• 1987, graduated first RN to MSN class
at Case Western Reserve University
(CWRU)Frances Payne Bolton School of
Nursing with a specialty in gerontology
(old age).
• While in school, she job-shared a head
nurse position on a dementia unit. It is
during this time of her practice when she
began theorizing about the outcome of
the patient comfort.
• She joined the faculty University of
Akron College of Nursing after graduating
with her master’s degree in nursing &
gained an American Nurses Association
(ANA) certification in
gerontology.(certified gerontologists)
• Returned to CWRU to pursue her
doctorate in nursing on a part-time basis
while continuing to teach.
• Retired from University of Akron as an
emeritus associate professor.
• Nursing interests include for
interventions for & documentation of
changes in comfort for evidence-
based practice.
• Resides in Cleveland area with her
husband, enjoys being near the
grandchildren.
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• The Comfort Line, her company which
assists health care agencies to implement
the theory of comfort on a system-wide
basis.
• Founder & coordinator of a local parish
nurse program & a member of the A.N.A
Kolcaba.
THEORETICAL SOURCES
• Kolcaba presented her frame work
for dementia care. She asked, “Have
you done a concept analysis of
comfort?”
• This question began her long
investigation into the concept of
comfort.
• The first step, the promised concept
analysis, began with an extensive
review about comfort from the
disciplines of Nursing, medicine,
psychology, psychiatry, ergonomics,
and English language.
• Kolcaba learned that the original
definition of comfort was to
strengthen greatly.
• Nurses were duty bound to attend
to details influencing patient
comfort. The comfort of patient was
nursing’s first and last consideration
o If the patient is in pain, relieve the
pain. If the patient cannot sleep, do
something. If the patient is in an
uncomfortable position, change the
position. Do not wait until the next
hour or until the next shift.
o Good nurses made patients
comfortable, and the provision of
comfort was a primary determining
factor of nurses’ ability and
character
o Nursing care was concerned with
providing a “general atmosphere of
comfort” and that personal care of
patients included attention to
“happiness, comfort, and ease,
physical and mental.” In addition to
rest and sleep, nutrition, cleanliness,
and elimination.
& BACKGROUND
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 KATHARINE KOLCABATHEORY OF CARING
NCM 100 | Theoretical Foundations of Nursing
MAJOR CONCEPTS
Health Care Needs
• are comfort needs arising from
stressful health care situations
that cannot be met by recipients'
traditional support systems.
• The needs may be physical,
psychospiritual, sociocultural, or
environmental.
They become apparent through:
(a) monitoring, verbal or
nonverbal reports,
(b) needs related to
pathophysiological parameters,
(c)needs for education and
support,
(d) needs for financial counseling
and intervention.
Comfort Interventions
• are intentional nursing actions
and referrals designed to address
specific comfort needs of
recipients, including physiological,
social, cultural, financial,
psychological, spiritual,
environmental, and physical
needs.
o Physiological – hunger, thirst, oxygen
o Social – relating with people
Intervening Variables
• are interacting forces that
influence recipients' perceptions
of total comfort.
• consists of past experiences, age,
attitude, emotional state support
system, prognosis, finances,
education, cultural background,
and the totality of elements in the
recipients’ experience.
• Such intervening variables affect
planning and success of patient
care interventions.
Comfort
• Immediate state experienced by
recipients of comfort
interventions. It is the immediate,
holistic experience of being
strengthened when one's needs
area addressed.
• The three types of comfort are
(1) relief (2) ease(3) transcendence
The four contexts are physical,
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psychospiritual, sociocultural,
and environmental.
Health-seeking Behaviors
• compose a broad category of
outcomes related to the pursuit of
health as defined by the recipients
in consultation with the nurse.
• The categories were synthesized by
Schlotfeldt (1975) and proposed to
be internal, external, or a peaceful
death.
• Internal behaviors are those we
cannot see, such as surgical healing,
T-cell formation, or electrolyte
balance.
• External behaviors are those we
can see directly, such as ambulation,
or indirectly, such as blood pressure.
Institutional Integrity
• corporations communities,
schools, hospitals, regions, states,
and countries that possess the
qualities of being complete,
whole, sound, upright, appealing,
ethical, and sincere possess
institutional integrity.
Best Practices
• The use of health care
interventions based on evidence
to produce the best possible
patient and family outcomes is
known as best practices.
Best Policies
• Institutional or regional policies
ranging from protocols for
procedures and medical
conditions to access and delivery
of health care are known as best
policies.
MAJOR ASSUMPTIONS
1. Human beings have holistic responses to
complex stimuli.
2. Comfort is a value-added holistic outcome
that is germane to the discipline of nursing.
3. Comfort is a basic human need that
persons strive to meet or have met. It is an
active endeavor.
4.Enhanced comfort strengthens patients to
engage in health-seeking behaviors of their
choice.
5. Patients who are empowered to actively
engage
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 KATHARINE KOLCABATHEORY OF CARING
NCM 100 | Theoretical Foundations of Nursing
in health-seeking behaviors are satisfied
with their healthcare.
6. Institutional integrity is based on a value
system oriented to the recipients of care. Of
equal importance is an orientation to a
health promoting, holistic setting for families
and providers of care.
USE OF EMPIRICAL EVIDENCE
• “The clear message is that
comfort is multidimensional,
meaning different things to
different people”
• The finding revealed significantly
higher comfort over time in
women receiving guided imagery
compared with the usual group.
THEORETICAL ASSERTIONS
3 PROPOSITIONAL ASSERTIONS
(PARTS)
Part 1
➢ States that comforting
interventions, when effective,
result in increased for recipients
(patients & families) compared
with a preintervention baseline.
➢ Care Providers may be
considered recipients if the
institution makes a commitment
to the comfort of their work
setting.
➢ Comfort interventions address
basic human needs, such as rest,
homeostasis, therapeutic
communication, and treatment as
holistic beings.
➢ Comfort interventions are
usually nontechnical and
complement the delivery of
technical care.
Part 2
➢ states that increased comfort of
recipients of care results in
increased engagement in health-
seeking behaviors (goals) that
are negotiated with the
recipients.
Part 3
➢ states that increased
engagement in health-seeking
behavior results in increased
quality of care, benefiting the
institution and its ability to
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gather evidence for best
practices and best policies.
LOGICAL FORM
THREE TYPES OF LOGICAL REASONING
➢ Induction – occurs when
generalization is built from a
number of specific observed
instances
➢ Deduction – occurs when the
specific conclusion is inferred
from general premises or
principles: It proceeds from the
general to the specific.
➢ Retroduction – useful for
selecting new phenomena that
can be developed further and
tested.
METAPARADIGM
Nursing
➢ The intentional assessment of
comfort needs, the design of
comfort interventions, to address
those needs, and reassessment of
comfort levels after
implementation compared with a
baseline.
Person
➢ Recipients of care may be
individuals, families, institutions,
or communities in need of health
care. Nurses may be recipients of
enhanced workplace comfort
when initiatives to improve
working conditions are
undertaken.
Environment
➢ any aspect of patient, family, or
institutional settings that can be
manipulated by the nurses, loved
ones, or the institution to enhance
comfort.
Health
➢ optimal functioning of a patient,
family, health care provider, or
community as defined by the
patient or group.
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 KATHARINE KOLCABATHEORY OF CARING WEEK# 10
NCM 100 | Theoretical Foundations of Nursing Date (12/02/2022) | DEAN GASCO

EXAMPLES OF INTERVENTIONS
THAT HAVE BEEN TESTED RECENTLY

➢ Still-point induction and massage

therapy for patients with chronic
pain
➢ Mindfulness-based stress
reduction for elderly residents in
long term care
➢ Comfort-based nursing care for
women with new cesarean
sections
➢ Use of heated blankets to
enhance comfort of acute
psychiatric patients.
➢ Determination of correlation
between comfort and fluid
retention.
➢ Guided imagery enhanced comfort
among patients receiving
palliative care

END OF TRANSCRIPTION

REFERENCES
➢ Alligood, M. ,Nursing Theorists
and Their Work 10th Edition

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