Kolcaba's Theory of Comfort
Kolcaba’s Theory of Comfort was first developed in the 1990s. It is a middle-range theory for health practice, education, and research. This theory has the potential to place comfort in the forefront of healthcare. According to the model, comfort is an immediate desirable outcome of nursing care.
The Theory of Comfort was developed when Katharine Kolcaba conducted a concept analysis of comfort that examined literature from several disciplines, including nursing, medicine, psychology, psychiatry, ergonomics, and English. After the three forms of comfort and four contexts of holistic human experience were introduced, a taxonomic structure was created to guide for the assessment, measurement, and evaluation of patient comfort. According to Kolcaba, comfort is the product of holistic nursing art.
Kolcaba described comfort existing in three forms: relief, ease, and transcendence. If specific comfort needs of a patient are met, the patient experiences comfort in the sense of relief. For example, a patient who receives pain medication in post-operative care is receiving relief comfort. Ease addresses comfort in a state of contentment. For example, the patient’s anxieties are calmed. Transcendence is described as a state of comfort in which patients are able to rise above their challenges. The four contexts in which patient comfort can occur are: physical, psychospiritual, environmental, and sociocultural.
The Theory of Comfort considers patients to be individuals, families, institutions, or communities in need of health care. The environment is any aspect of the patient, family, or institutional surroundings that can be manipulated by a nurse or loved one in order to enhance comfort. Health is considered to be optimal functioning in the patient, as defined by the patient, group, family, or community.
In the model, nursing is described as the process of assessing the patient’s comfort needs, developing and implementing appropriate nursing care plans, and evaluating the patient’s comfort after the care plans have been carried out. Nursing includes the intentional assessment of comfort needs, the design of comfort measures to address those needs, and the reassessment of comfort levels after implementation. Assessment can be objective, such as the observation of wound healing, or subjective, such as asking the patient if he or she is comfortable.
Kolcaba includes definitions of key elements of her nursing theory, as well. Health care needs are defined as those needs identified by the patient and/or family in a particular nursing practice setting. Intervening variables are factors that are not likely to change, and over which health care providers have little control. These variables include prognosis, financial situation, social support, and others. Health-seeking behaviors are the behaviors of a patient in an effort to find health. Institutional integrity is the value, financial stability, and wholeness of health care organizations at the local, regional, state, and national levels. Finally, best policies are protocols and procedures developed by an institution for overall use after the collection of evidence.