The comfort theory is one of reassurance which is a distinguishing feature of the nursing profession (Kolcaba 1994). The typical nursing definition of comfort is the satisfaction of health needs that are stressful to the patient (Kolcaba 1994). Comfort has been the signature purpose of the nursing profession since its inception and is used to identify when the appropriate level of care has been given (Kolcaba & Kolcaba 1991). The goal of assuring patient comfort is found throughout all nursing processes and is found in the foundation of all nursing efforts (Kolcaba & Kolcaba 1991). The success of all nursing based interventions are measured by the level of comfort a patient experiences (Kolcaba 2001). Patient needs are driven by the expectation of the nursing profession to provide comfort and the institution’s quality of care is based on whether this has been achieved (Kolcaba 2001).
The Comfort Theory
Dr. Kolcaba developed the comfort theory as a patient centered assumption which is based on three specific aspects: the state of needs being met, the state of contentment, and the ability to rise above problems or pain (Kolcaba, Tilton, & Drouin 2006). Kolcaba & Kolcaba (1991) identify six meanings of comfort: a relief from discomfort, the state of contentment, relief from discomfort, pleasure in life, to strengthen and support, and physical refreshment. Current literature demonstrates that all humans have basic needs and aspirations that are required for to maintain an optimal level of health (Kolcaba 2001). The attainment of all basic needs and additional desires by the patient fulfills the patient’s requirements and creates a sense of fulfillment which leads to a relaxed demeanor (Kolcaba 2001).
Needs are defined as supposed obstacles which create barriers to the achievement of comfort (Kolcaba 1994). The American Nursing Association defined comfort to the geriatric population as placing the emphasis of maintaining a sense of dignity until one reaches death (Kolcaba & Kolcaba 1991). There are four contexts of comfort physical, psychospiritual, sociocultural and environmental; physical is defined as all physiological dimensions, psychospritiual as an internal awareness of self, sociocultural is defined as external relationships, and environmental background of the human experience (Kolcaba, Tilton & Drouin 2006). Comfort is considered to be holistic in nature because it depends on one’s state of mind and requires an action to achieve (Kolcaba 1994). The perception of comfort is an individualized and is based on whether one’s most important needs have been met regardless of external importance (Kolcaba & Kolcaba 1991).
Application of the comfort theory
Mr T. was a patient who was on the long term extended care ward with a long history of type 1 diabetes. Upon presentation to us he already had developed multiple complications from his long standing poorly controlled diabetes. Mr T condition continued to deteriorate rapidly and it was understood that improvement of his functioning was not possible. As Mr T. lost his mental capacities he became more restless when family members were not present during the overnight hours. During his final 4 months of life he was transferred to the long term care section of our facility which was staffed by many of the same nursing staff as the acute care section. Mr. T’s was found to be most comfortable psychologically and glycemic control was best when a family member was present during the over night hours. There was no noticeable difference in his glycemic control or restlessness during waking hours. The nursing staff decided to put Mr T. in a private room where a family member could remain with him during the overnight hours which did appear to comfort him.
The comfort theory proposes that when nurses are permitted to function in a comforting role there is increased job satisfaction and improved patient outcomes (Kolcaba, Tilton & Drouin 2006). Forming brainstorm sessions between staff and administration discussing how to solve unique problems that are not specifically addressed by policy, increases job satisfaction and environment which enhances organizational image to the general population (Kolcaba, Tilton, & Drouin 2006). In Mr. T’s case allowing family members in the room during the overnight hours improved his psychological well being, decreased staff effort, and improved his physical well being additionally the organization’s image received a boost because of the extraordinary measures that were taken to increase the care of this dying patient. The nursing staff also benefited from increased job satisfaction because of one’s belief that an impact on patient welfare was being made.
Long term effects of the comfort theory
Current literature demonstrates that adequate healthcare organization staffing of nursing personnel is essential to providing quality care (Kolcaba, Tilton, & Drouin 2006). The comfort theory seeks to encourage healthcare professionals to minimize the negative aspects of an illness and enhance daily function simultaneously (Kolcaba, Tilton, & Drouin 2006). There are three dimensions of providing comfort care relief, ease, and transcendence (Kolcaba 1994). The first dimension of the comfort theory is the provision of relief which is defined as a specific need met which may vary depending on the patient’s circumstances (Kolcaba 1994). Ease is defined as contentment which allows a person to remain inexplicably calm and transcendence is the enhancement of ordinary powers (Kolcaba 1994). Regardless of the patient desires comfort is paramount to effective nursing care because of the improved physical and psychological performance as demonstrated in Mr. T after the inclusion of family during the over night hours (Kolcaba 1994).
The comfort theory provides many advantages to enhancing nursing practice and improving staff morale (Kolcaba, Tilton, & Drouin 2006). The concept of the comfort theory is easily understood by lay people and healthcare professionals and emphasizes the approach many nurses have to patient care (Kolcaba, Tilton & Drouin 2006). The comfort theory presently guides the actions of healthcare providers and is used as a measurement of quality improvement (Kolcaba, Tilton, & Drouin 2006). Providing comfort care is valued by both healthcare providers and administrators which improves both productivity and satisfaction of staff and patients (Kolcaba, Tilton & Drouin 2006). It also is part of many accreditation bodies as a measure of quality care and is routinely offered as continuing education for nursing personnel (Kolcaba, Tilton & Drouin 2006).
Ultimate effects of the comfort theory on Healthcare
Mr. T provided the catalyst for the development of a palliative care unit at our facility because of the need for specialized personnel to care for the patient who is terminally ill. Kolcaba (1994) identifies three criteria which provide an effective foundation for organizations to use when seek to use the comfort theory in practice: needed in the environment, nursing is able to intervene considering the entire patient, and the interventions have to be perceived as successful and lead to subsequent outcomes. There are three senses of comfort state, relief and renewal and effective nursing care which can be identifies in practice, research and in theory which are helpful in providing that sense of comfort for the patient (Kolcaba & Kolcaba 1991).
When a nurse is using the comfort theory in practice the patient has an increased likelihood to seek healthy behaviors (Kolcaba 1994). When a patient’s perception of comfort has been achieved this implies that negative feelings of the situation have been reduced (Kolcaba 1994). This reduction in negative feelings can increase the likelihood of a patient to engage in behaviors that were successful in reducing the tension (Kolcaba 1994). Repeating this behavior in this scenario can become habit forming which indicates that future comfort theory practices will be well received and can lead to an increase in health seeking behaviors which is closely related to the comfort theory (Kolcaba 1994). Comfort measures can improve a patient satisfaction due to the encouragement the patient receives even though the cause of the physical discomfort is not alleviated (Kolcaba & Kolcaba 1991).
Conclusion
The comfort theory was developed by Dr. Kolcaba and is effective in improving the patient perception of discomfort through patient centered measures. The nursing occupation is naturally accustomed to providing comfort care and developing a relationship with the patient which can have far reaching effects despite any therapies that are prescribed. Dr. Kolcaba’s comfort theory emphasizes the full spectrum of patient needs which improves a patients physical, psychological, and spiritual well being as seen in Mr. T’s case.
References:
Kolcaba, K. (2001). Evolution of the Mid Range of Theory of Conflict for Outcome
Research. Nursing Outlook. 49 86-92.
Kolcaba, K. Y. (1994). A Theory of Holistic Comfort for Nursing. Journal of Advanced
Nursing. 19 1178-1184.
K. Y. Kolcaba, R. J. Kolcaba. (1991). An Analysis of the concept of Comfort. Journal of
Advanced Nursing. 16 1301-1310.
Kolcaba, K, Tilton, C., Drouin, C., (2006). Comfort Theory A Unifying Framework to
Enhance the Practice Environment. Journal of Nursing Administration. 36 (11) 538-544.