Introduction
The comfort line theory is a Mid-Range theory applicable in pediatric nursing. It was written by Katherine Kocalba who was born in 28th December 1944 in Cleveland, Ohio. In the year I965, she attained a Diploma in nursing from St. Luke’s Hospital and then proceeded to acquiring a PHD in 1987 from BSN- France Payne Bolton SON. In 1997 she became a Clinical Nursing Specialist and is now currently the Associate Professor at Akron College of Nursing of all the Nursing Emeritus at the university.
She developed the Comfort Theory in the 1990’s mainly directing it for the women who have third stage breast cancer going through chemotherapy and radiation. After a while she tested her theory with other patients ailing from urinary inconsistency and those in critical condition which may lead to loss of life. Katherine’s main target audience was Nursing Research and Theory, Pediatric Nursing, HIV/AIDS, Mental Health Nursing, Gerontological Nursing, Oncology Nursing/Malignancies, Skilled Nursing/Extended Care and Rehab Nursing, Holistic Nursing/Complimentary Therapies, Palliative and Hospice Nursing, Symptom Management and Spiritual Care.
During her free time, she enjoys photography, reading and gardening. She also spends time with her two daughters and eight grandchildren. Katherine is a strong advocate for healthy ways of aging and she insists on that during her day to day activities. There are also other theorists working on the comfort theory like DiMarco (2005), Vendlinski (1997), Panno (2000), Wilson (2004), Wagner & Byrne (2006) and many others but all are in cooperation with Kolcaba.
Theory Description
The meaning of comfort is the feeling of ease or relief. Patient comfort should occur in physical form, socio-cultural, psychological and environmental. If these needs are met depending on the specific context the patient feels relieved and this is how one feels when a form of anxiety is removed. The comfort theory meets the specific attributes of a mid-range theory in that it is a holistic and humanistic theory that a patient requires. It meets the following attributes: It can be applied in many situations easily, the concepts it addresses are related to other health care disciplines, it is practical, depending on its applications the propositions range from associative to casual and assumptions made fit the theory (Kolcaba, 1994).
The theory practices a combination of all the three theories; deductive, inductive and retroductive reasoning. Deductive reasoning is where the statements lead to a certain conclusion like the comfort theory gives quick recovery to a patient that is a certain conclusion because patients require comfort to get resilience to survive an ailment. Inductive reasoning consists of referring the statements to general facts based on a certain statistic for example the hospital can produce the results of patients who undergo the comfort theory and it becomes successful to enable us to make a conclusion based on the statistics. Retroductive reasoning involves events being explained by the mode that produces them. This reasoning is applied when diagnosing patient symptoms to come up with diagnostic decision trees. The comfort theory states that the needs of comfort should be met by nurses in stressful situations. An enhanced comfort lead to strengthening thus it is related to the patients HSR’s (Health-seeking Behaviors).
The theory states that in stressful occurrences unmet needs of comfort are met by the health care team or the nurses. Success of the interventions depends on the improvement of the patient from the previous baseline. The outcome of the comfort is related with the patient looking for behaviors that is health seeking. As soon as a patient practices HSRs they recover faster and are satisfied. Satisfaction of patients promotes better outcomes for the institution and the institution’s integrity because quality of the services is recognized.
The major concepts of the theory include the concept of comfort as a result of the nursing care, the term transcendence which is a comfort state where a patient gets the ability to conquer his or her difficulties, heath care needs which are defined by the patient or his family based on the particular situation, intervening variables are factors that the providers cannot change because they do not have control over them, health seeking behaviors (HSR), institutional integrity which constitutes the financial stability, values and completeness of the health institutions at local, regional, state and national levels and finally the best policies that are procedures created by an institution after the evidence is collected. Katherine analyses this concepts in the theory.
Conceptual analysis started with thorough review of English, Literature, Nursing, Psychology, Medicine, Ergonomics and Psychiatry and all this disciplines concluded that the comfort concept was not clearly defined. They highlighted that the use of the word comfort was extremely varied. Katherine’s definition of comfort said that it is a state of addressing the needs of relief, ease and transcendence met in four major contexts of experience which include socio-cultural, physical, and environmental and psycho-spiritual.
Evaluation
The theory has both implicit and explicit assumptions. It applies both techniques because some concepts in the theory are found in implicit and explicit conditions. Implicit means that some of the concepts are not directly expressed while the term explicit states that some of the concepts are clearly expressed in the theory. The concepts in the theory are related for example nurses should identify a patient’s or family’s comfort needs, nurses should come up with strategies to meet their specific needs, the intervening variables are a determinant when making the strategies, after the strategies are delivered in a supportive manner and they bear fruit hence comfort is achieved. The interventions or strategies are called “Comfort measures”. The nurses and patients decide on the efficient health seeking behaviors. After enhanced comfort is attained patients and families will be motivated to continue with the HSRs to increase the comfort. Satisfaction is derived when comfort is enhanced and the health related outcomes are better. When the nurses, patients and families are fully satisfied with the outcomes public acknowledgement is given to the institution towards their superb health care facilities. This makes the institution successful and popular (Henderson, 1966).
The assumptions behind the theory as earlier stated are both explicit and implicit. There are four major assumptions in this theory the first one being that comfort is a general outcome of efficient nursing care. Comfort is a basic need and therefore human beings cannot live without it and are constantly in search of it wherever it is available. Human beings respond favorably to complex stimuli which are termed as having holistic responses. Nurses are in the best places to identify a patient’s comfort requirements, create the suitable measures to be taken to achieve comfort and analyze the outcomes to enhance the comfort.
Comfort is based on three types: Relief which is where a certain specified type of comfort should be met, ease which is a state of satisfaction or contentment and one achieves calmness and lastly transcendence that is a state where one relives the pain. The theory has in it four metaparadigm concepts that include nursing, patients, environment and health. Nursing involves deliberate assessment of comfort requirements, creating the steps necessary to address the comfort needs, analyzing the patients, families and society’s level of comfort after one has implemented the comfort interventions and comparing them with the previous conditions or baseline (Hamilton, 1989).
A patient is a person with urgent health needs. It could be one individual, a family or a community. The environment consists of external forces like habitat, policies and many others that can be influenced to increase comfort. Health is basically the outcome of the patients that is influenced by availability of comfort. The different needs being met by the theory are physical comfort that entails physiological aspects that have been tampered with. Comfort interventions aspire to improve conditions like oxygenation, homeostasis, fluid and electrolyte balance, shivering, pain and nausea.
The other need is psycho-spiritual comfort which addresses motivation, ability to grow or rise above uncomfortable situations and inspiration though a number of ways encouraging words, caring embrace, massage and special guests. Social needs include being caring, supportive, reassuring and expressing positive body language for example helping out with duties and attending social functions. The final group of needs is environmental which involves fresh air, orderliness, quite environment, comfortable equipment like furniture machines and this can be enhanced through uninterrupted sleep and no noise.
The theory is quite clear and consistent since it has a conceptual framework. The framework is essential in that it takes the attention to one component in the form of a comfort strategy enhancing more comfort than expected. When one’s needs are met in specific area total comfort is promoted in the other areas. Putting comfort in this framework gives nurses and the health team an outlook on how to enhance the patient’s comfort. This implies that the theory is clear and consistent in providing holistic comfort (Kolcaba, 2003).
The concept can be evaluated as follows: Comfort has been defined as the basis of nursing. The concepts behind it are directed towards nursing a patient. The concepts and interventions have been thoroughly tested under many settings hence they are fully operational. The outcomes are operationalized using a taxonomic structure which enables us to find out the needs, design strategies and analyze how effective they are. The theory is flexible and can be used in different situations. Students and researchers should try to incorporate it in micro-level institutions. The interventions range from associative to casual whereby they are generated from the theory and have a wide range.
The assumptions are suited for the theory since it is complete and encourages the patient to participate in health seeking behaviors. The institution’s integrity depends on the outcome of the propositions. This theory is relevant to those who need it for example the nurses who learn and apply it in the daily activities and research. Patients require their nurses to pay keen attention to their comfort needs therefore the theory’s final products are essential to the patients. This theory delegates how nurses can appropriately handle their patients as required providing comfort and giving them satisfaction. In the end the institution will benefit if they treat their patients’ right and the nurses will achieve the goals of their profession of what patients expect from them (Murray, 1938).
Application
The theory guides nursing actions towards health care. There are many types of nursing comfort care interventions for example coaching which involves assisting in getting rid anxiety and instilling hope. This can be done through listening, emotional support, educating and reassurance. Another care intervention is comfort for food for the soul which is not a requirement but it is well appreciated by patients. It constitutes of music therapy, therapeutic touch, being personal with patients and spending some valuable time with them. It targets a memorable connection between the nurse and the patient. It helps them to do what is considered normal through interaction (March & McCormack, 2009).
The last comfort care action is the standard comfort strategy that is designed to monitor physical conditions and maintain them for example oxygenation. It identifies vital signs that should be addressed. The interventions include providing proper medication, hypothermia, lab tests, monitoring pain and repositioning. At times these actions may not completely work and nurses will need to intervene and identify what needs to be done differently to improve the patient’s condition. A nurse should not lose hope since repetitive actions can lead to ultimate improvement (Kolcaba, Tilton & Drouin, 2006).
Comfort theory is applicable in the pediatric sector of nursing in a number of situations. Children and families experience stressful incidents and this is where the comfort line propositions come in. There are several propositions to relieve stress one of them being providing social comfort through preparing them to face pain, social and psycho-spiritual comfort whereby you employ a guardian, parent or caretaker to be present during the painful moment, environmental comfort by creating a special room where children health care and treatment procedures take place it should be suitable and comforting, physical comfort where you handle them comfortingly and with a lot of love and care. Environmental comfort can also be provided by instilling a peaceful, heart-warming and positive environment. After this the pediatric nurse should measure the child’s level of comfort through encouraging the child to talk about it and asking questions or even carrying out lab tests (Puntillo, Stannard & Miaskowski, 2002).
Conclusion
The sole purpose of the comfort theory is providing a positive outcome out of a negative situation. It provides relief, renewed energy and activeness in patients as they undergo stressful ailments like cancer and HIV/AIDS. It is useful in all sectors it is applied and most especially in the topic of discussion, in pediatric nursing. If the procedure can be correctly followed it will lead to the best results. Comfort is longed for by patients and families from any setting in order for them to recover. Comfort reduces the negative sides of ailments and pain from a surgery and it has been proven successful in promoting health seeking behaviors.
This is therefore not the end of nurses creating new ideas to aid in relieving pain they will keep on working on new theories. They will come up with grand ideas and improve on this theory to enhance its effectiveness. In the future we hope to save more lives as we could have done before thanks to the theories coming up and more so due to the use of Katherine Kolcaba’s theory of comfort line. Patients can now recover in a suitable environment, receiving support from their families and nurses which is what they desperately needed.
References
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Henderson, V. (1966). The nature of nursing. New York: Macmillan.
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Murray, H. (1938). Explorations in personality. New York: Oxford Press.
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