Identify the theorists who influenced the development of Comfort theory.


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Chapter 21

Katharine Kolcaba’s Theory of Comfort

 

Developed by S . Gordon (2010)

Updated by D. Gullett (2014)

 

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On completion of this chapter, students will be able to:

Describe Kolcaba’s Theory of Comfort care.

Identify the theorists who influenced the development of Comfort theory.

Define the terms comfort, comforting care, comfort management, and comfort interventions from the perspective of Comfort Theory.

Discuss the meaning of Comfort Theory for practice.

Identify the different tools used to measure comfort.

Discuss the propositions of Comfort Theory and their application to practice.

Define the theoretical definitions of diagram concepts for the Comfort Theory.

 

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Overview of the Theorist

  • Katherine Kolcaba
  • Born/educated in Cleveland, Ohio
  • Received a diploma in nursing
  • Graduated 1st RN-MSN class at Case Western
  • Joined Faculty of University of Akron
  • Associate Professor Emeritus at University Akron

 

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Overview (continued)

  • Practice focused on gerontology and dementia care
  • Framework for dementia care (1992)
  • Diagrammed aspects of comfort (1991)
  • Operationalized comfort as an outcome of care (1992)
  • Published book Comfort Theory and Practice (2003)

 

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Overview of Comfort Theory (CT)

  • Comfort defined as:
  • Noun
  • Adjective
  • Outcome of intentional, patient/family-focused quality care

 

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Comfort: To strengthen greatly

  • The need for comfort is basic.
  • Persons experience comfort holistically.
  • Self-comforting measures can be healthy or unhealthy.
  • Enhanced comfort leads to greater productivity.

 

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Kolcaba Influenced by

  • Orlando
  • Synthesized relief
  • Nurses relieve needs
  • Henderson
  • Synthesized ease
  • 13 basic functions of human beings
  • Paterson and Zderad
  • Transcendence

 

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Four Contexts of Patient Comfort

  • Physical
  • Psychospiritual
  • Sociocultural
  • Environmental

 

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Outcome of Comfort

  • “The immediate experience of being strengthened when needs for relief, ease and transcendence are met in 4 contexts of experience.”

 

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Uses of Comfort Taxonomic Structure

  • Determine the existence and extent of unmet comfort needs
  • Design comforting interventions
  • Create measurements of holistic comfort

 

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Propositions of Comfort Theory

  • Part I
  • Effective comforting interventions result in increased comfort for recipients (patients and families) when compared to a preintervention baseline.
  • Part II
  • Increased comfort of recipients results in their being strengthened for their tasks ahead (health-seeking behaviors).

 

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Propositions of Comfort Theory

  • Part III:
  • Increased engagement in health-seeking behaviors results in increased Institutional Integrity.

 

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Diagram Concepts

  • Health-Care Needs
  • Needs for comfort arising from stressful health-care situations that cannot be bet by recipients’ traditional support systems

 

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Diagram Concepts

  • Comfort Interventions
  • Nursing actions designed to address specific comfort needs of recipients: social, cultural, financial, psychological, environmental, and physical interventions
  • Intervening variables
  • Interacting forces that influence recipients’ perception of total comfort
  • Past experience, age, attitude, emotional state, support system, prognosis , finances, education, cultural background and the tonality of elements in recipients’ experience.

 

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Diagram Concepts (continued)

  • Comfort
  • The state that is experienced immediately by recipients of comfort interventions
  • Holistic experience of being strengthened
  • Health-Seeking Behaviors (HSBs)
  • Broad subsequent outcomes related to the pursuit of health (synthesized by Scholfeldt, 1975).
  • Internal
  • External

 

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Diagram Concepts (continued)

  • Institutional Integrity
  • Corporations, communities, school, hospitals, regions, states, and countries that possess qualities of being complete, whole, sound, upright, appealing, ethical, and sincere
  • Best Practices
  • Health-care interventions that provide the best possible patient/family outcomes based on empirical evidence
  • Best Policies
  • Basic protocols from procedures to access and care delivery systems based on empirical evidence

 

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Types of Comforting Interventions

  • Technical Intervention:
  • Specified by other disciplines
  • Medications
  • Treatments
  • Monitoring schedules
  • Insertion of lines

 

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Types of Comforting Interventions

  • Coaching
  • Supportive nursing actions
  • Active listening
  • Referrals to other members of the health-care team
  • Advocacy
  • Reassurance

 

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Types of Comforting Interventions

  • Comfort Food for the Soul
  • Extra special, holistic and more time-consuming nursing interventions
  • Back or hand massage
  • Guided imagery
  • Music or art therapy
  • Walks outside
  • Special arrangements for family members

 

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How Comfort Theory Lives in Practice

  • Best Practices
  • Electronic Database
  • Best Policies

 

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Tools Used to Measure Comfort

  • General Comfort Questionnaire
  • Comfort Behaviors Checklist
  • Comfort Daisies
  • Verbal Rating Scale
  • Many other tools can be found at the following website http://www.thecomfortline.com/webinstruments.html

 

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Summary

  • “Comfort Theory provides the language and rational to once again claim and document essential nursing activities which are most beneficial to patients and family members in stressful health-care situations.”

 

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References

Kolcaba, K. (1991). A taxonomic structure for the concept comfort. Image: The Journal of Nursing Scholarship,

23(4), 237–240.

Kolcaba, K. (1992a). The concept of comfort in an environmental framework. Journal of Gerontological Nursing,

18(6), 33–38.

Kolcaba, K. (1992b). Holistic comfort: Operationalizing the construct as a nurse-sensitive outcome. ANS

Advances in Nursing Science, 15(1), 1–10.

Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and research (pp. 113–124).

New York: Springer.

Schlotfeldt, R. (1975). The need for a conceptual framework. In: P. Verhonic (Ed.), Nursing Research (pp. 3–

25). Boston: Little, Brown.

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