A theory is a set of interrelated propositions that are used in guiding practice or explaining certain phenomena. Theories in the nursing profession play a crucial role in this regard. Theories help in explaining phenomena and organizing knowledge in the nursing practice. Additionally, theories help in predicting, explaining, prescribing and describing some aspects in the nursing profession. Through these roles, the theories provide guidance to the profession and help in improving practice and patient outcomes. This paper thus aims at describing, evaluating and discussing Katherine Kolcaba’s theory of comfort.
Theorists name and background
The theory of comfort is a mid-range theory that was developed by Katherine Kolcaba in the 1990s. Katherine Kolcaba was born in 1944 in Ohio in the United States of America and she pursued her first training in nursing by undertaking a diploma course in 1965 at St. Luke School of nursing. In 1987, she graduated from Francis Payne Bolton School of nursing as a registered nurse. She then pursued her masters and PHD in nursing at Case Western Reserve University. In 1997, she graduated with her PHD in nursing and she was also given the clinical nursing specialist certificate of authority. Through her studies, she was able to specialize in a number of areas within the health care field. This areas include the end of life and long term care interventions, nursing research, comfort studies, nursing theory and instrumental development. Kolcaba is presently an associate professor at Akron College of nursing (Nursing Theory 2016).
Since the theory of comfort was developed by Katharine Kolcaba, it has been advanced progressively and shared with other professionals. Moreover, the theory has been shared and applied across the various subsectors of the health care field. The theory has played a vital role in adding value to evidence based practice in nursing. The first work to be published on the theory was done in 1994. Subsequent works were aimed at improving the theory and making it more comprehensive and applicable in the nursing profession. Kolcaba continued her work by making improvements on the theory in the subsequent years. The year 2001, for instance, witnessed the expansion of the theory which led to the introduction of the concept of institutional outcomes. This expansion was followed by the authorship of a book in 2003 that further focused on the comfort theory. The book covered the theory’s application, testing and development. Apart from this advancments, Kolcaba’s other writings on the theory include nursing diagnosis handbook, and comfort theory and practice (Nursing Theory, 2016).
Katherine Kolbars development of theory was influenced by her operations and training in various healthcare settings. Her training and interests in gerontology, end of life, comfort studies and long term care interventions for instance, were instrumental in influencing her development of the theory of comfort in nursing. More importantly, Kolcaba’s teaching in gerontology formed the basis upon which she began developing the theory as she sought to improve the quality of life among this group of patients. Kolchaba’s efforts were geared towards working with the elderly after completion of her studies. It is during this time that she started to integrate the concepts of comfort with the health outcomes of patients. The concepts were, therefore, aimed at end of life and palliative care on gerontology. Her main concern was improving patient’s outcomes, quality of life and patient safety. Through her experience with various patients, Kolcaba realized that comfort can highly influence the quality of life of various patients. This formed the basis and final developments of various aspects of this theory which was first published in an article in 1994.
Kolcaba’s theory of development aims at helping in the alleviation of discomfort and in the promotion of positive health outcomes. The theory is applied in various settings in the health care sector which includes: persons with Alzheimer, pediatric, post-anesthesia nursing, ambulatory care, women and child birth, and hospices. Moreover, it has been applied even among patients experiencing cardiac arrest (Krinsky et al, 2014). The theory in these settings is used in assessing comfort in the patients through the assessment formula. In addition, the theory helps nurses in these settings to develop various interventions in promoting comfort. Finally, the various levels of outcomes posited by the theory are applied to evaluate the effectiveness of the measures employed to ensure comfort in patients.
Theory description
The comfort theory is a holistic and humanistic theory that aims at satisfying the needs of the patient through a focus on offering comfort. Kolcaba viewed comfort as being holistic and existing in three forms. These forms are: ease, relief and transcendence comfort. Relief comfort comes from meeting particular comfort needs of a patient according to their satisfaction. Ease comfort on the other hand is the contentment experienced by the patient after particular needs have been met. The transcendence comfort on the other hand addresses the comfort that enables the patient to overcome their discomfort and rise above their present challenges. In addition to these forms, Kolcaba posited that comfort occurs in four levels: socio-cultural, environmental, physical and psycho-spiritual. These levels are examined when determining the level of comfort among individuals. Physical comfort level examines body sensation such as pain relieve and turning and positioning. Psycho-spiritual level on the other hand looks at the inner self awareness and examines aspects such as self-esteem and sexuality. The environment level focuses on the external environment surrounding the patient. Socio-cultural finally examines the existing relationship between a person and other relations such as family and the societal culture (Cardinal Stritch University Library, 2016).
The comfort theory utilizes deductive reasoning since its premises start from general statements narrowing down to specifics. The theory’s first premise postulates that comfort is an essential aspect in nursing care due to the effects it has on individuals. This is a general proposition that the theory makes on matters of comfort. The theory’s propositions further narrows down to the specifics of comfort and the reasons as to why comfort is important.
Major concepts of this theory are varied. The first concept is healthcare needs. Healthcare needs refers to needs that the patient and their families identify with in the healthcare setting. Certain needs are viewed as vital and thus require attention from healthcare personnel as they cause discomfort or distress in the patient. The second concept is comfort. Comfort refers to the desirable health outcomes that result from healthcare interventions which help patients to overcome distress. These outcomes are holistic as they are not concerned with a single area of focus. It comprises physical, environmental, socio-cultural and psycho-spiritual. The third concept is the intervening variables which refers to the factors that healthcare providers lack control over and therefore are unable to influence in ensuring desired outcomes are achieved. The fourth factor is health seeking behavior. Health seeking behavior refers to patient behavior in their search for health in order for them to achieve comfort. The fifth concept -best policies, refers to the protocols and procedures adhered to after evidence has been collected. The final concept of the comfort theory is institutional integrity. This concept is made up of the values espoused by healthcare institutions, its wholeness and financial stability. These values influence the attainment of safety among patients (Nursing Theory, 2016).
The concepts of the theory have been defined explicitly and comprehensively. For example, the concept of institutional integrity has been defined comprehensively by providing the various dimensions of its meaning. Moreover, the definitions provided for the various concepts in the theory by Kolcabas are operational definitions. These definitions of the concepts thus provide insights on how the various concepts will be measured. The concept of comfort for instance is analyzed through the various contexts in which it occurs. The contexts provided by the theory include: psycho-spiritual, socio-cultural, environmental and physical. Moreover, kolcaba has ensured consistence in the utilization of the theoretical concepts throughout the theory through ensuring that the meaning of the diverse concepts is not altered but remains the same throughout the theory.
The propositions of the major concepts exist in an interdependent relationship. The interdependent relationship exists due to the causal effect that each concept has on the other. For instance, healthcare needs, nursing interventions and intervening variables are interdependent. The three propositions thus lead to enhanced comfort. These premises thus depend and complete each other in the theory. More significantly, the conceptual framework of this theory demonstrates the interdependence that is found in these propositions. The conceptual framework starts with the concept of the patient then goes to discomfort. This is followed by comfort interventions which finally influence patient outcomes w1hich is either peaceful death or optimum function.
Evaluation
The theory rests on the following explicit and implicit assumptions. The explicit assumptions of the theory are the following. First, human beings respond to complex stimuli holistically. Second, effective nursing is geared towards ensuring comfort to all people. Third, human beings desire for comfort drives them to seek for comfort whenever they think they may be able to find it. Finally, nurses have the capacity to identify needs of their patients and then develop intervention measures that would ensure comfort. These interventions will be followed by evaluations to assess their effectiveness.
The implicit assumptions are equally varied. To start with, the theory infers that comfort is a very vital aspect of care as it improves the quality of life of the patient. In addition, the needs of the patients are many and cannot be met by traditional intervention measures. Therefore, modern means should be used to assess the situation and then develop interventions. Lastly, comfort measures entail interventions that aim at meeting the patient’s needs.
The theory provides the description of all the four concepts of the nursing meta-paradigm. It explains the concepts in the theory as follows. On the concept of patient, the patient entails all persons in need of positive health outcomes that arise from certain needs. This comprises of the individual, family and the community. The environment refers to all the components that are surrounding and affecting the person. This includes: the physical room, the institution and policies that can be compromised in various ways to ensure comfort of the patient. The health concept is described as comfort on the side of the patient, community and family. Finally, nursing is viewed as the aspect of assessing the patient’s needs, manipulation of interventions and evaluating them to ensure comfort that is achieved (Seyedfatemi et al., 2014).
The theory has clarity on how it has been explained which is evident through its various tenets. The propositions equally displays levels of logic in their presentation. For instance, the theory postulates that for the health needs of a patient to be addressed so that comfort can be enhanced, there is need for nursing interventions which are also influenced by intervening variables. The logical presentation through which Kolcaba has presented the various propositions ensures high levels of clarity are attained. The propositions build on each other as conclusions are derived from general premises made. These have ensured that the theory has high levels of lucidness.
Furthermore, the theory also has both internal and external consistence. External consistence is evident as the views posited by the author of the theory correspond to views espoused by other professionals in the nursing field and also in the ideas postulated by other theories. The main goal of the nursing profession is to ensure positive health outcomes and one way of doing this is by promoting comfort for the patients. On the other hand, the theory’s assumptions and propositions are consistent with the assumptions and this is a clear indication that the theory demonstrates both levels of consistence. Similarly, there is connectedness among the different premises of the theory. Of significance importance, Kolcaba definition and usage of her concepts throughout the theory have remained similar. This consistency also ensures that the clarity of the theory is upheld.
Application
The theory can guide nursing actions in a number of ways. To start with, nurses can use the theory to ensure that they promote transcendence comfort among their patients by assessing providing interventions and evaluating the effectiveness of these interventions. Nurse’s main goal in providing nursing care is to ensure the comfort of their patients as one way of promoting safety and health outcomes. Nurses can also use this theory to guide them in predicting a number of occurrences within their practice. For example, they can use the theory to predict expected outcomes after administering certain interventions to patients. Nurses can also use this theory in their practice in examining the psychological discomfort of their patients towards ensuring their wellbeing this can be done through using the assessing structure which the theory provides. Besides, the theory provides insights into why holistic comfort is important for a patient’s wellbeing. This info can guide nurses’ actions in provision of services to the patients so as to ensure that any discomfort is eliminated and patients gain satisfaction. Through targeting various discomforts, nurses will be able to understand and identify the interventions that are effective and those which are not. Likewise, some minor ailments that are caused by discomforts can be treated through use of alternative interventions without necessarily administering medication. Moreover, the nurses can use the theory in determining the wellbeing of their patients. The wellbeing can be determined through examining the expected outcomes as they are measurable. More significantly, it can help nurses in attaining their goals by ensuring a comfortable, clean and healthy environment. Finally nurses through examining the outcomes discussed in the theory can be able to identify the patient who is experiencing discomfort and thus target them to help them to achieve comfort (Kolcaba, nd).
Application
This theory can be applied in the provision of nursing education through a number of ways. Nursing training aims at promoting comfort among patients and safety. Therefore, for nursing students to enhance this in their future practice, there is the need of equipping them these through effective training so that they will be able to ensure patient safety in all aspects. There is also the need for students to be trained in routine healthcare activities before they can make any encounter to a healthcare setting. The training mainly encompasses training them to have the capacity to assess, monitor and administer interventions to patients. Demonstrations are done during this training at it is essential that the students are comfortable during this kinds of assessment. The holistic principles are also vital in ensuring that nurses identify the importance of advocating for holistic patients outcomes. Holistic principles have been identified to highly influence nurses emphasize on outcomes of their patients and promoting pride in them.
Conclusion
Through the analysis of Kolcabas theory of motivation, it is evident that the theory was thoughtfully developed. The theory not only demonstrates clarity, but also consistency in its formulation. Correspondingly, the nursing theory is developed within the nursing meta-paradigm. The theory can thus be used in healthcare by nurses in diverse ways that help in improving quality of patients. The theory equally enables nurses to assess, administer interventions and evaluate the effectiveness of theses interventions. More importantly the theory can be applied in a number of settings in ensuring that patients attain comfort which is greatly influences their health outcomes.
References
Cardinal Stritch University Library, (2016). Katharine Kolcaba - Theory of Comfort. Retrieved from http://www.stritch.edu/Library/Doing-Research/Research-by-Subject/Health-Sciences-Nursing-Theorists/Katharine-Kolcaba---Theory-of-Comfort/
Seyedfatemi, N., Rafii, F., Rezaei, M., & Kolcaba, K. (2014). Comfort and hope in the preanesthesia stage in patients undergoing surgery. Journal of Perianesthesia Nursing, 29(3), 213-220. doi:10.1016/j.jopan.2013.05.018
Dowd, T., Kolcaba, K., Steiner, R., & Fashinpaur, D. (2007). Comparison of a healing touch, coaching, and a combined intervention on comfort and stress in younger college students. Holistic Nursing Practice, 21(4), 194-202.
Krinsky R., Murillo I. and Johnson J. (2014). A practical application of Katharine Kolcaba's comfort theory to cardiac patients. Applying Nursing Research.,27(2), 147-50. doi: 10.1016/j.apnr.2014.02.004
Nursing Theory, (2016). Kolcabas Theory of Nursing. Retrieved from http://www.nursing-theory.org/theories-and-models/kolcaba-theory-of-comfort.php
Kolcaba, K. (nd). The Art of Comfort. Retrieved from https://www.researchgate.net/profile/Katharine_
