Kolcaba Comfort Theory

Theorist Background
o Born Dec 28th, 1944 in Cleveland Ohio
o Diploma in nursing- St. Luke’s Hospital 1965
o BSN- Frances Payne Bolton School of Nuring-1987
o PhD and Clinical Nursing Specialist- 1997
o Associate Professor of Nursing Emeritus at the
University of Akron College of Nursing.
o Teaches on two online theory courses (MSN and
DNP levels)
o Certified in gerontology

o Linked concepts of Edward Murray’s framework

with other nursing theories
o Her work was rejected for conference presentation
o Used her students ideas and observation to
strengthen CT
 What is comfort?

◦ The state of having addressed basic needs for ease, relief, and
transcendence met in 4 contexts of experience (physical,
psychospiritual, sociocultural, and environmental)

◦ Comfort involves identifying the comprehensive needs of patients,

families, and nurses and addressing those needs.

◦ Ergonomics- comfort at the work place, promotes optimum function

or productivity (Kolcaba &Kolcaba, 1991)

◦ NANDA- comfort in terms of pain management

◦ Confortare Latin- to strengthen gently

Kolcaba & Kolcaba. (1991).
 TYPES OF COMFORT
◦ Green: Relief, Ease,
◦ Relief – when a particular needs of a
Transcendence
patient is satisfied. Has the same principles
as Orlando’s (1961/1990) need-based
philosophy of nursing.
◦ Ease- state whereby a person is calm and
content: consistent with the 13
fundamental human requirements by
Henderson (1978)
◦ Transcendence- a state in which one
outgrows difficult situations or pain.
Originates from the principles used by
Paterson & Zderad, 1976/1988) to denote
more being.

Kolcaba, K. (1991).
 CONTEXT IN WHICH THEY OCCUR

◦ Physical- conducive work environment, adequate Red/yellow/purple: Physical,

staffing, benefits, retirements, quite environment,
flexible work schedule among others. Psychospiritual, Sociocultural,
Environmental
◦ Psychospiritual- is when people within themselves get
to know who they are, their sexuality, self-worth, the
essence of one’s life, how one relates to a higher being.

◦ Social comfort (Sociocultural comfort) – Involves the

interactions with families, society, and interpersonal
relationships, religious practices, rituals, and traditions
within one's family.

◦ Environmental- involves anything around a person and

they include noise, color, temperature, ambience
among others.

Kolcaba, K. (1991).
 Additional Comfort Measures
◦ Relief- warm blanket to help increase their body
◦ Ease- explain plan of care to decrease anxiety
◦ Transcendence- Coaching patients during labor and delivery
◦ Environment- a private room for a patient during end of life care
◦ the sociocultural and Psychospiritual context- allow chaplains to talk to patient
and family in times of need.
◦ .

Kolcaba, K. (1991).
Factors that can affect how a patient perceives total comfort
(Intervening Variables)

past experiences
age
finances
attitude
emotional state
support system
prognosis

Kolcaba, K. (2003).
 Assumption of Theory

◦ Human beings have holistic responses to

complex stimuli
◦ Comfort is an immediate and desirable
holistic state of human beings that is
germane to the discipline of nursing
◦ Human Beings strive to meet or to have
met their basic comfort needs.
◦ Nurses are to identify comfort needs of
their patients and find ways to address
those needs
Kolcaba, K. (1994).
 Comfort as it was perceived at the beginning 20th century

 Used in a broad sense and was seen as a definite goal in nursing.

 Was highly appreciated and was considered an exclusive nurses mission
 Ability to provide comfort mainly depended on the skill and character of the nurse.
 Very essential because of there were no curative medical strategies
 Comfort resulted from physical, emotional, and environmental interventions
 Poultices(dressings, icepacks ,etc.) heat, the positioning of a patient in bed were
most common nursing interventions to promote comfort (Mcllveen & Morse,
1995)
 Mental relaxation was achieved through physical and emotional comfort.
 Specific comfort measures orders solely depended on the authority of the
physician

Mcllveen& Morse, 1995

 The Taxonomic Structure(TS) or A 12 Cell-
Grid

Defines the attributes of comfort and is helpful

in deriving the technical definition of comfort.

The TS is used to:

 assess comfort needs of patients, families,
and nurses
 Plan interventions to address the identified
needs
 Informally evaluates the effectiveness of
those interventions to enhance comfort
 Measure the desired outcome of enhanced
comfort for research and practice
Kolcaba, K. (1991).
 Basic Concepts of the Theory

Kolcaba, K. (2002).
 PROPOSITIONS

Relational statements that connect concepts together.

 The healthcare team and nurses identify the needs of patients and families that have not been met with the
support systems that are available. Nurses also work constructively to make sure they have the necessary things
they would need to perform their work.
 Comfort interventions are designed and coordinated to address those comfort needs that are not met.
 Intervening variables helps to determine the probability of success and should, therefore, be considered when
planning comfort interventions.
 Enhanced comfort is achieved when effective interventions are provided in a caring manner.
 A desirable and holistic HSBS is agreed by the patients, nurses, and another healthcare team.
 Patient, family members, and nurses become motivated and involve in HSBS when enhanced comfort is
attained.
 Enhanced Health-related Institutions outcome is demonstrated when patient and families become satisfied with
comfort measures they receive through motivations to engage in HSBS
 The healthcare institutions gain recognition from the general public when the patient, family, and nurses
become satisfied with the healthcare delivery system.
Kolcaba, K. (2001).
Who Determines Comfort?

Kolcaba, K. (2000).
 Goal of the theory
◦ Patient , family members, nurses, and ◦ Longevity of employment

other healthcare workers become

◦ Stronger cost-benefit ratio for the
satisfied with comfort measures they institution
received in order to engage in HSBs
◦ Higher patient or nurse function
◦ Provide a foundation for
◦ Faster Discharge
healthcare to implement comfort
◦ Reduces readmissions rate
◦ Improved satisfaction with care, model as a unifying framework for

care delivery

Kolcaba, K. (2003).
 Nursing Metaparadigm
◦ Nursing – comfort needs of patient are addressed through assessment,
interventions and evaluation.

◦ Person - the patient, family, community or institution.

◦ Environment- the external surroundings of the patient

◦ Health- highest functional level of the patient.

Kolcaba, K. (1991).
Comfort or Pain?
 Diagram

Kolcaba, K. (2002).
Case Study I

◦ MN a male client is operated on for gallstones. On a postoperative night, the nurse

finds that the client is not sleeping and is tossing and turning. He had colonoscopy

two days ago, and is suspicious of colon cancer because his sister passed away two

months ago with colon cancer. No family member has visited him yet since his

admission. Patient yells at the nurse as she responds to his call light, “you guys will

not shut up for me to sleep and I have been in pain all night. Which nursing action is

most appropriate? Using the taxonomic structure, formulate a plan of care for MN.
Taxonomic Structure for MN

Relief Ease Transcendence

Physical Pain Pain control Patient thinks about pain

relief after taking pain
medicine

Psychospiritual Anxiety Skepticism Need for spiritual

about prognosis
support

Environmental Noise from the Privacy Need for quiet

nursing station; environmental

bright lights

Sociocultural Absence of family members Allow family to Need for support from
family or loved ones
visit patient
Case Study II
JB is a 48-year-old woman admitted for abdominal pain. She suffers from urinary incontinence and is

currently using poise pads. She complains of back pain which she states get by doing regular

exercises and stretches. JB is diagnosed with bipolar disorder and has a prescription for Latuda. JB is

also taking clonazepam and escitalopram. States she has not been able to refill her prescription and is

concern her disease might get worse. MS JB complains she has not been sleeping lately because her

roommate is always loud and always have her lights on. She is unemployed and lives with her 20

year old daughter. States daughter has not been responding to her phone calls for the past three days.
 Taxonomic Structure for JB
Relief Ease Transcendence

Physical Pain Pain management Patient thinks about pain

relief after taking pain
medicine

Psychospiritual Anxiety, depression Reassurance Need for emotional

stability, relaxation

Environmental Turn off lights, promote Need for quite sleep

Quite environment quietness

Sociocultural Financial issues Financial support Need for financial stability

Application of Theory in Practice
 Analysis of Theory using Barnum

Internal Criticism
◦ Clarity- it is easy to understand
◦ Consistency- defined key concepts throughout the theory
◦ Adequacy- It’s adequate, no gaps
◦ Logically developed
External Criticism
◦ Reality convergence- represents real world
◦ Appropriate in all healthcare settings
◦ Complexity- very straight forward
◦ Significance- it is very relevant to nursing
◦ Discrimination- have precise and clear boundaries
◦ Scope of theory- very broad, relevant to nursing practice, nursing
education, nursing research and other disciplines
Barnum, 1998
 Limitations

◦ Difficult to assess the effectiveness for

patient in coma.
◦ When resuscitations measures is very
critical
 Conclusion
◦ Comfort theory applies to any healthcare environment,

healthcare disciplines, or age group, whether home,

hospital, or community. For research of practices, the

theory can further be defined, at a lower level of

abstraction, regarding specific populations.

Peterson, S. J., & Bredow, T. S. (2017).

 References

Boudiab, L. & Kolcaba, K. (2015). Comfort theory: Unraveling the complexities of Veterans' health care needs. Advances in Nursing

Science, pp 1-9.

Dowd, T., & Kolcaba, K. (1997). Urinary Incontinence and Frequency Comfort Questionnaire (UIFCQ): Katharine Kolcaba, PhD, The

University of Akron, College of Nursing, Mary Gladwin Hall, Akron, OH 44325-3701; kolcaba@uakron.edu; The Comfort Line:

http://www.uakron.edu/comfort/.

Estridge, K., Morris, D., Kolcaba, K., & Winkleman, C. (2018). Comfort and fluid retention in

adult patients receiving hemodialysis. Nephrology Nursing Journal, 45(1), 25-33.

Kolcaba, K. Y. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing,

19(6), 1178-1184.

Kolcaba, K. (1991). A taxonomic structure for the concept comfort. The Journal of Nursing Scholarship, 23(4), 237–240.

http://doi.org/10.1111/j.1547-5069.1991.tb00678.x

Peterson, S. J., & Bredow, T. S. (2017). Middle range theories: application to nursing research. 4 th ed. Philadelphia: Wolters Kluwer

Health/Lippincott Williams & Wilkins.

Porter, C. A., Kolcaba, K., McNulty, S. R., & Fitzpatrick, J. J. (2010). The effect of a nursing labor

management partnership on nurse turnover and satisfaction. Journal of Nursing Administration,

40(5), 205-210.
THANK YOU!!