Dr. Katharine Kolcaba is known as one of the first nurse researchers who evolved the theory of comfort in order to improve patient satisfaction and outcomes, together with the overall enhancement of the institutional integrity. Her theory of comfort is a middle range theory. Such theories incorporate a restricted quantity of concepts and appear to have a more restricted scope. Nevertheless, Kolcaba’s theory of comfort is typically categorized as a high middle range theory, which allows considering it as being more abstract and general. Thus, the fact that the theory can be viewed as closely connected to grand theories makes it applicable to a broad scope of responses and experiences in the nursing field. Therefore, the current paper describes, evaluates, and discusses the application of Kolcaba’s nursing mid-range theory, revealing its relevance to the health care system and health care professionals and providers.
Middle range theories incorporate the issues and concepts that are specifically connected to the nursing practice, encompassing the condition of patients, their situation, population, especially location and age, interventions, proposed outcomes, and nursing actions. They also appear to be evolved through the interpretation and observation of lived experiences that are related to nursing and health. In regard to the theory of comfort developed by Kolcaba, it can be stated that the theorist dedicated much time and attention, examining the role of comfort in relationships and outcomes of patients.
Theory/Author Name and Background
Katharine Kolcaba was born in 1944 in Ohio, obtained the diploma in nursing in 1965, and became the Ph.D. in nursing in 1997. The theorist majorly specializes in the end of life care interventions, gerontology, comfort studies, nursing theories, and nursing research studies. Kolcaba initially developed the theory of comfort based on dementia and Alzheimer’s patients. Thus, she started to theorize about the effects of comfort while working in the dementia unit, being a head nurse and obtaining the Master’s degree of Science in Nursing at the Case Western Reserve University. The theorist proceeded to conduct the research while pursuing the doctoral degree at the same time. This interest was initially sparked by her understanding of the fact that comfort appears to be a highly required constituent of the optimal functioning of the patients she cared for in the dementia unit. Since the majority of patients was non-verbal, nurses were supposed to interpret their actions in order to define issues that might have been provoking discomfort, hence resulting in disruptive behaviors. This assessment allowed the implementation of various care plans that aimed at treating underlying problems or enhancing the patient comfort, resulting in enhanced patient care.
The theorist wrote numerous articles concerning other possible nursing scopes that are closely connected to the theory of comfort, including perianesthesia and even hospice nursing. Kolcaba used a preexistent framework for the development of the theory of comfort, which had been evolved by her antecedent Henry Murray in the book entitled Explorations in Personality. This framework can be seen as a perfect starting point and actual foundation for the theory because comfort is best obtained via the holistic treatment. The author started the development of the theory with a concept analysis of the term ‘comfort’ by collecting the definitions from numerous discrepant disciplines. Thus, the theory of comfort, being both a nursing theory and a conceptual framework, was initially evolved in the early 1990’s. Despite the fact that it is comparatively new, this theory has become globally well-known and it challenges nurses through prioritizing patient comfort. The theorist’s work resulted in a number of articles and a book outlining the theory of comfort, its assumptions, the main concepts and their relationships, techniques for measuring comfort in a broad variety of settings and environments, and discussion of the theory’s application in nursing practice.
Historically, Nightingale spoke about comfort when she claimed that observation stood “for the sake of saving life and increasing health and comfort”. In addition, comfort is also outlined by numerous major nursing theorists, including Roy, Orlando, Watson, Henderson, and Paterson and Zderad. Nevertheless, it appears that no one sought to understand the nature of comfort itself. Kolcaba undertook this effort when she performed the analysis of the concept of comfort. In fact, she outlined two major dimensions. The first one incorporates three states, including relief, ease, and transcendence. The second dimension includes contexts in which comfort can actually be achieved, which were derived from the nursing literature on holism. In fact, Orlando initially spoke about the relief, explaining that nursing actions should meet the physical and mental requirements of patients and focus on how the nurse deciphers the patients’ needs. In addition, Henderson outlined thirteen major functions of humans, which are highly required for the homeostasis, and spoke about the concept of ease, stating that the patients recover after discomfort and pain are relieved. Finally, the concept of renewal or transcendence was developed on the basis of Paterson and Zderad’s statement that comfort is the state, during which patients appear to be free and start to plan and control their destiny.
Kolcaba used inductive, deductive, and retroductive reasoning during the development of the comfort theory. Inductive reasoning is a logical process, during which multiple premises, all assumed as true or found as true in the majority of cases, are combined to obtain specific conclusions. Thus, induction is a type of logical reasoning, in which generalization is induced from numerous peculiar observed instances. The theorist utilized inductive reasoning through the utilization of the past experience in nursing, especially concerning dementia patients, in order to formulate the nursing theory. In addition, during the concept analysis of the term comfort, she looked at literature from multiple disciplines other than nursing, including psychology, medicine, ergonomics, and psychiatry, among others.
Later, she utilized deductive reasoning, during which peculiar conclusions should be formulated from premises that are more general. Thus, this is a stage when the work proceeds from the general to the specific. During this stage, the author related comfort to other nursing concepts while formulating the theory. In fact, Murray’s theory of human press was utilized as a framework for the nursing concept use. The works of other antecedent nursing theorists were utilized to derive the types of comfort. In particular, as mentioned previously, the works of Orlando, Henderson, as well as Paterson and Zderad were used to derive such concepts as relief, ease, and transcendence.
Finally, retroduction is a type of reasoning that actually generates ideas. This stage is beneficial for the phenomena selection, which can be additionally or further tested and developed. The framework used in the theory of comfort could not account for the 21st century, which highlights institutional consequences. Nevertheless, the use of retroduction helped to add the concept of institutional integrity, which can be conceptualized as a healthcare setting that has such qualities as being whole, complete, sound, honest, upright, and sincere.
When discussing the theory, there is a need to identify the major concepts addressed in it. It is obvious from the name of the theory that comfort is one of the major concepts. As it has been mentioned previously, there are three forms of comfort, namely relief, ease, and transcendence. These three concepts can be viewed in the physical, psycho-spiritual, environmental, and socio-cultural contexts. Kolcaba defined relief as the capability of the patient to from stress and anguish caused by disease or injury. Secondly, the concept of ease was outlined as an enduring state of peaceful contentment, synthesizing the initial ideas developed by Henderson. Finally, in regard to the concept of transcendence or renewal, the theorist stated that it incorporates elevated and improved powers, consolidated motivation, and positive attitude and outlooks for meeting the life challenges, which appear to be normal and standard for the selected individual. The author also explained that this is the state, during which the person is capable of rising above the existing issues, problems, or even pain. This definition has been developed based on Paterson and Zderad’s work.
Comfort appears to be highly crucial in the nursing field because the pain relief, ease, and relaxation help the body to heal, leading to better patient outcomes and state of health. On the contrary, in case the patient experiences stress, the overall healing process requires more time, vividly demonstrating that comfort is significant for the enhancement of life and recovering.
Other major concepts that are explicitly addressed in the discussed theory include healthcare needs, comforting interventions, intervening variables, health seeking behaviors, and institutional integrity. Healthcare needs stand for the patient’s need for comfort in strained and difficult healthcare situations. Secondly, comforting interventions originally include nursing interventions that aim at stimulating the patient’s general health and well-being. Next, intervening variables are factors that affect the patients’ perception of comfort, such as the patients’ past experiences, overall healthcare reception, age, financial situation, and extent of social support, among others. Furthermore, the concept of health seeking behaviors, which has been originally generated and designed by Rozella Schlotfedt, stands for the actions that patients take to facilitate health, which include internal and external health seeking behaviors, as well as a peaceful death. Finally, institutional integrity can be defined as a physical setting that appears to have the characteristics of being whole, complete, honest, sound, and sincere.
It is also important to mention that the theory demonstrates a solid focus on the holistic intervention that incorporates three main interventions that are necessary for patient’s comfort. The first one stands for pain management, including the assessment of vital signs, medication administration, assistance in regaining the capability to complete physical tasks, and prevention of negative issues arising. The second intervention concerns coaching, encompassing the assistance in establishing realistic recovery goals, encouragement, as well as the reduction of anxiety, worry, and fear. The last intervention stands for the provision of ‘comfort food’ for the soul, which actually incorporates the traditional nursing conception. This might include music or massage therapy, environmental changes for calmness augmentation, and others. Thus, the analysis of concepts demonstrates that the application of concept combination can help to make a solid difference in the patient’s life and healthcare experience.
All presented concepts are rooted and connected together. In the comfort provision, the author encompasses the necessary and required evaluations, diagnoses, plans, interventions, and assessments. Therefore, the theory connects and incarnates the assessment of the patient’s healthcare needs, comforting interventions, intervening variables that might result in challenges, objectives of improving health seeking behaviors, and sustainment of institutional integrity that stimulates and promotes well-being. In fact, there are innumerable variations of utilizing interventions within discrepant contexts to guarantee the best patient care. Thus, the concepts stream in a linear pattern and appear within a structured model.
In the propositions outlined in the theory of comfort, the author showed the relationship between major concepts. The first proposition demonstrates that nurses are supposed to define patients’ comfort requirements that have not been met by existing support systems. Secondly, nurses have to design interventions to address these requirements. Thirdly, intervening variables should be taken into consideration while creating interventions and mutually agreeing on rational health seeking behavior outcomes. Fourthly, health seeking behaviors should be consolidated by comforting actions. This will stimulate patients’ engagement, leading to the fact that both patients and nurses are more satisfied with health care. Finally, in the case when patients are satisfied with health care, the institution sustains its integrity.
There are four major assumptions that underpin the theory of comfort. The first one states that human beings have holistic reactions to complex and complicated stimuli. The second one demonstrates that comfort is seen as a desirable holistic outcome that is germane to the discipline of nursing. Third, the primary endeavor of every human being is to strive to meet the basic vital needs. Finally, institutional integrity is a descriptive and normative constituent that is grounded on the patient-centered value system.
As it has been mentioned previously, the theory describes four major contexts. Physical context is discussed as the one pertaining to bodily sensations. The psychological context is defined as pertaining to the internal awareness of one’s self, encompassing self-esteem, sexuality, and meaning in the patient’s life. The third context is the socio-cultural one, which can be defined as relating to interpersonal, societal, and personal relationships. Finally, the environmental context can be outlined as pertaining to the external background of human experience. It incorporates light, noise, ambiance, color, and natural versus synthetic elements. Despite the fact that the majority believes that comfort appears to be solidly and strictly a physical experience, Kolcaba highlighted that it is important to stress that it covers a variety of contexts and states that are necessary for the best patient outcomes and results.
The analyzed theory is lucid, clear, and straightforward in the statements to promote and stimulate care and comfort of patients. It vividly outlines the terms utilized and provides examples of how to use each facet in the practical field. In addition, the theory use is demonstrated in various environments, encompassing the end of life situations, pediatrics, postoperative care, wound care, and general nursing care. For instance, in regard to the end of life situation, the author demonstrates that comfort is obviously obtained through the patient’s pain reduction via medications. In the case of a postoperative situation, she states that the nurse might be the healthcare provider who will encourage the patient to ambulate more, thus stimulating the patient to succeed in recovering.
The theory of comfort can be viewed as readily applicable to the nursing discipline and it has a clear framework that is relevant to meeting patient’s needs during a stressful life event. It allows the nurse to take into account the patient input, outline their needs and requirements within the four contexts, address these needs by utilizing specific nursing interventions, and ensure in a cyclic manner that the patient obtains comfort. In essence, the framework provides a process mode for nursing, which is specific to comfort. It is easy for a nurse to understand and use the theory, leading to the fact that it can be easily applied in numerous settings and environments. Comfort stands for positive outcomes that are connected to an improvement in health seeking behaviors and positive institutional outcomes. Thus, nurses can utilize three concepts of comfort provided by the theory in an attempt to move patients toward the transcendence phase. In addition, the theory demonstrates the importance of evaluating physical, psycho-spiritual, socio-cultural, and environmental contexts and needs.
Kolcaba’s theory is beneficial and applicable to clinical nursing practice. The theory utilizes the traditional nursing practice perspective, in which the patient’s requirements and needs come first and the nurse centers care around the patients. Expert nurses can utilize the theory as a guiding tool for their interventions in promoting and stimulating the comfort of their patients. Moreover, the theory will allow them to assess and find the best intervention to care for their clients.
Katharine Kolcaba’s theory of comfort appears to be applicable to all areas of the healthcare field. Despite the fact that her theory is majorly patient-centered, the expansion possibilities can be viewed as endless. The analysis demonstrates that the structuring of the healthcare institution around the concepts of the comfort theory might help to enhance societal reception and acceptance of the institution while, at the same time, elevating the overall patient satisfaction. Kolcaba’s theory is beneficial and applicable to nursing practice. It can serve as a guiding tool for interventions, as it places patient requirements and needs above everything else, stimulating the nurses to focus on the care of patients.