The paper gives a systematic assessment of the Katharine Kolcaba’s Comfort theory. The basis of the paper is to understand the theorist, and discuss the main concepts related to it. Above all the aim is to identify the theory’s application to clinical situations in institutional settings and its contribution to nursing research and practice. An overview, and the Comfort theory’s propositions, along with its conceptual definitions will be analyzed and studied. Along with certain research articles, Kolcaba’s Comfort theory’s applications, particularly, technical, coaching and comfort food for the soul will be explored. In addition, this paper provides examples where Nurse Practitioners can use Comfort Theory as a framework to provide holistic care to their patients. It is also noticeable that Katharine Kolcaba’s Comfort theory has been used in several institutions by the administration to develop policies and practices, with the interest of improving patient satisfaction and experience during their encounter within the organization.
Born and educated in Cleveland, Ohio, Katharine Kolcaba, practiced as a nurse on several nursing units for many years. After completing her masters in nursing, and while working on the dementia unit as head nurse, Kolcaba started theorizing about comfort. During her doctoral studies, Kolcaba further developed her comfort theory study and later published a framework for dementia care. Later she added the operationalized comfort as an outcome of care and contextualized comfort in a middle range theory. Subsequently, Kolcaba tested her theory in varied intervention studies, and based on that she polished her theory to include hospital-based outcomes. Katharine Kolcaba has several and extensive publications where she has documented the process of her theory. She also has published a book Comfort Theory and Practice, where she has assembled her series of publications. Kolcaba currently works as a consultant of her own company, The Comfort Line, which advices health-care agencies in application of her Comfort Theory framework if they choose to apply it within their institutions (Smith & Parker, 2015).
Overview of the Comfort Theory
Comfort, according to Kolcaba, is an outcome of an intentional, patient/family based and focused quality care (Smith & Parker, 2015). Based on holistic care, Kolcaba developed four contexts in which patients can experience comfort, i.e. physical, psychospiritual, sociocultural and environmental. The three distinct types of comfort that Kolcaba focused were-Relief, Ease, and Transcendence. Relief is a feeling where a specific need that provides comfort is given. Ease is the state of being calm and content. Whereas transcendence relates to a state where patients can rise above their difficulties irrespective of life’s circumstances with the help of caregiver intervention. All the four contexts and the three types of comfort are interrelated and have to be viewed holistically to get favorable outcomes. Health needs are those that the patients cannot meet on their own which sprout from varied stressful conditions. Comfort interventions are all the steps considered to tackle the specific health needs.
The practical application of Kolcaba’s Comfort Theory was studied in cardiac patients in two case studies (Krinsky, Murillo, & Johnson, 2014). The comfort needs of cardiac patients were defined based on the four domains of Kolcaba’s Comfort theory and the interventions were outlined accordingly centered on the three comfort types. Quiet time intervention which was introduced to these cardiac patients aligned with the Comfort Theory taxonomy framework. Interventions based on physical, psychospiritual, environmental and socio-cultural domains were implemented in the case studies. Improved outcomes were noted in cardiac patients in terms of ease of pain, enhanced sleep, reduced agitation and anxiety, and enriched emotional support through family involvement.
Another study that was conducted at two dialysis centers to determine the relationships between comfort and fluid retention was based on Kolcaba’s Comfort Theory framework (Estridge, Morris, Kolcaba, & Winkleman, 2018). The study found out some interesting facts based on the theory of comfort. The study turned out to be clinically important as patients who pursued comfort interventions showed a greater trend of engaging in healthy behavior. Another fact pointed out was the different comfort needs based on race, religion, gender and lifestyle varied accordingly. In the study the nurses had to investigate distinctive characteristics and comfort needs to plan nursing care based on the comfort theory framework.
While working in the dementia unit, Kolcaba started developing her comfort theory in context of patient experience on that unit. It was during her doctoral degree program that she further expanded on her comfort theory framework and its outcomes. She later tested her theory in several interventions as a topic for her dissertation. Kolcaba confesses that it was Emily Dickenson’s poem that made her define her vision for nursing and comfort care theory (“Comfort Theory,” n.d.). The author, even today, utilizes her theory in her regular visits to homeless shelters, different healthcare organizations, and several research studies incorporating her comfort theory.
Relevance to healthcare
Comfort theory has great implications within todays healthcare scenarios. Most patients and family members are in stressful health related situations, comfort theory can be beneficial to such cases when nursing activities are planned in that direction. Nurses in todays world can take guidance from comfort theory to identify their patients and family needs and address them with interventions based within the comfort theory structure. Institutional administrators should value comfort care and implement policies and make strategies that will encourage nurses and other staff to deliver comfort measures to their clients. Kolcaba has developed several scales for documentation that include, verbal rating scale, a numeric diagram, comfort daises for children, a comfort behaviors checklist and many other questioners (Smith & Parker, 2015).
Relevance to research and practice
Kolcaba’s Comfort Theory has been used as a framework in many research studies. Kolcaba herself has participated and guided researchers through many studies that have applied her theory in different setups. Apostolo and Kolcaba’s guided imagery study for decreasing depression, anxiety and stress in psychiatric patients with depression using comfort theory framework, revealed significant improvement in clinical outcomes (Apostolo & Kolcaba, 2009). Taxonomic structure of Comfort developed by Kolcaba was used to design the interventions for the study. This example and many other studies have proved that utilizing Kolcaba’s Comfort theory can help patients have positive impact in their health behaviors and outcomes.
The biggest strength of Kolcaba’s Comfort theory is its ease of use in any nursing setting. The taxonomic structure provided by Kolcaba is clear and easy to understand and thus helpful for nurses to develop their nursing plan of care accordingly. When nurses implement comfort care plans, patient and family satisfaction improves, thereby engaging them in health seeking behaviors. The comfort theory framework developed by Kolcaba is holistic in nature, thus helping improvise overall patient care. Several health institutions and hospitals are actively implementing comfort theory-based care in hope of improving their HCAHPS scores.
Although widely used in hospitals and for research purposes, Kolcaba’s theory has few limitations. Most of the times outcomes are subjective, hence limiting generalizability. Another limitation is the requirement of modification of framework when using in different nursing areas. Comfort theory framework is mostly used in nursing related areas; hence its use is limited to the staff who are educated about it and based on their scope of practice. Kolcaba’s comfort theory is good to be used to define comfort care of patients and families, but it’s difficult to agree whether it can be applicable in all healthcare settings. The topic of comfort is subjective, hence depending on varied patient-nurse ratios it may be difficult and stressful for nurses to implement total comfort-based care.
Apostolo, J. L., & Kolcaba, K. (2009). The Effects of Guided Imagery on Comfort, Depression, Anxiety, and Stress of Psychiatric Inpatients with Depressive Disorders. Archives of Psychiatric Nursing, 23, 403-411. http://dx.doi.org/doi:10.1016/j.apnu.2008.12.003
Conceptual Framework for Comfort Theory. (n.d.). Retrieved from https://www.thecomfortline.com
Estridge, K. M., Morris, D. L., Kolcaba, K., & Winkleman, C. (2018). Comfort and Fluid Retention in Adult Patients Receiving Hemodialysis. Nephrology Nursing Journal, 45, 25-34. Retrieved from https://www.thefreelibrary.com/Comfort+and+Fluid+Retention+in+Adult+Patients+Receiving+Hemodialysis.-a0529947941
Krinsky, R., Murillo, I., & Johnson, J. (2014, February 5). A practical application of Katharine Kolcaba’s comfort theory to cardiac patients. Applied Nursing Research, 27, 147-150. Retrieved from http://lib.ajaums.ac.ir/booklist/ARN199.pdf