Comfort theory (nursing)
Comfort theory in nursing is a conceptual framework that emphasizes the importance of patient comfort as a fundamental aspect of care. Introduced by Katharine Kolcaba in the 1990s, the theory defines comfort in three forms: relief, ease, and transcendence. These forms can be applied within four therapeutic contexts: psychospiritual, physical, environmental, and sociocultural. By assessing patient needs through this lens, nurses can create a more holistic approach to recovery, addressing not only physical symptoms but also emotional and social factors impacting well-being.
Relief pertains to alleviating pain or distress, ease involves creating a more supportive environment, and transcendence focuses on helping patients rise above their challenges. The theory acknowledges the influence of external factors, such as financial conditions and family support, on a patient's recovery. Comfort theory encourages collaboration between healthcare providers, patients, and their families to enhance care experiences and outcomes. Ultimately, it aims to balance clinical effectiveness with the compassionate, individualized care that respects diverse cultural perspectives and personal experiences in health care settings.
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Comfort theory (nursing)
Comfort theory is a nursing theory that prioritizes the comfort of patients based on the assessment of nurses. It was first introduced in the 1990s by Katharine Kolcaba and has since been analyzed and further developed in different scientific journals. According to comfort theory, patient comfort exists in three forms: relief, ease, and transcendence. These forms of comfort can be provided in four therapeutic contexts: psychospiritual, physical, environmental, and sociocultural. Using these forms and contexts, nurses can comparatively assess the patient’s requirements for recuperation. Relief addresses the patient’s comfort once medicine is given to alleviate pain, ease speaks of the comfort felt once anxiety is tackled, and transcendence is the comfort found in being able to rise above the patient’s personal and medical challenges. Comfort theory incorporates the health care needs with other intervening variables, or those which the patient or caregiver are unlikely to control or change (financial conditions, medical prognosis, familial support). Comfort theory defines comfort as the immediate anticipated outcome of care. The theory strives to define a balance between institutional integrity of the medical facilities with the comfort and care required for each patient.
Background
Nursing is defined as the assisted care contributing toward health or recovery in a way that recreates the patient’s unaided actions if he or she had the proper strength, will, or knowledge. By doing so, nursing aims to have the patient gain independence by the most efficient means. Nursing initially had a medicinal and moral imperative. In the 1960s, focus shifted toward the physical and emotional comforts of nursing care and, by the 1990s, comfort theory dominated, concentrating on childbirth pain, end-of-life and comforting care, and pain management. In the past, patients would be given all the correct medication required to relieve illness and disease but would still show signs of pain, loss, and suffering, which created feelings of frustration in nurses from the apparent inability to fulfill complete patient recovery.
Care is described by the technical, coaching, and care aspects—the technical aspect of care strives to maintain homeostasis in the body; coaching aids patients in the relief of anxiety on the path to recovery; and care governs all unexpected and external connections. Comfort has several definitions: (1) soothing of distress or sorrow, (2) relief or assistance in distress, (3) a human or thing that brings comfort, (4) a tranquil and quiet state of mind, (5) easiness in life, (6) or the minimization of grief through cheering, calming, and inspiration of hope. In a nursing context, the patient seeking care ultimately defines comfort.
Katharine Kolcaba first led the conceptual analysis of comfort that examined the disciplines of nursing, medicine, psychology, psychiatry, ergonomics, and English, among others. The types of comfort were first examined, along with the holistic human experience in various therapeutic contexts, to develop a taxonomic structure that compares the three forms of the theory with the four therapeutic contexts of patient comfort. The structure allowed easy assessment and measurement of the patient’s comfort levels. Nurses and other practitioners who use comfort theory in their practice are able to deliver a more holistic approach to recovery and clinical decision-making. Rather than focusing only on the medical point of view, comfort theory integrates the patient, family members, and friends in the recovery process.
Overview
Comfort theory encourages the juxtaposition of the four therapeutic contexts of comfort with the three forms of comfort when caring for patients in recovery. For example, patients experiencing pain and nausea require comfort in the form of relief in the physical context. Ease can be introduced as a change to a more comfortable bed and monitoring for homeostasis. Moreover, transcendence is achieved once the patient ponders the limit of pain he or she can endure upon waking, which thus can be addressed by the medical facilitators. Similarly, relief for anxiety is required for the psychospiritual context, relief from noisy intensive care units and cold rooms can be addressed for the environmental context, and care providers can bring sociocultural relief to the patient by being sensitive to and accommodating the patient’s specific cultural traditions and requirements.
The application of comfort theory varies between specific populations—Alzheimer’s patients, patients in hospice care, post-anesthesia patients, newborns and their mothers, pediatric patients, and ambulatory care patients, among others. Comfort theory aims at addressing the sources of pain and anxiety (bedsores, falls, infections) to increase positive outcomes, such as wellness, self-confidence, and patient satisfaction. Throughout the recovery process, both the patients and family members have initial expectations of recovery. It is often through the help of family members and friends that mistakes in examinations, interpretations, and explanations are noticed. In order to produce positive results consistently, a bond of trust between medical facilitators (nurses, doctors, medical staff) and the patients is necessary and can be aided with the help from patients’ relatives and friends.
In accordance with the nursing process, the comfort care plan first identifies the diet and physical background of the patient, all of which require correct and thorough documentation. The patient’s blood sugar is monitored along with a discharge plan with additional follow-ups and home support (recurrent appointments, telephone monitoring, home visits). Patient and family members are educated on correct blood sugar, hunger, and weight monitoring for home care, also called the comfort with care plan. Upon the successful administration of patient home care, outpatient support can be decreased, which may include less frequent appointments (one to two per year), less frequent telephone checks, and visits with practicing registered nurses rather than with the monitoring physician. It is difficult to discern the correct comfort approaches and interventions for a patient without thorough documentation throughout the entire recovery process, as this allows the evaluation of every procedure and method used.
Bibliography
Bailey, Donna W. "Framing Comfort during the Childbirth Process." International Journal of Childbirth Education, vol. 32, no. 4, pp. 11–15.
Kolcaba, Katharine. "Comfort Theory." Current Nursing, 10 Feb. 2011, currentnursing.com/nursing‗theory/comfort‗theory‗kathy‗kolcaba.html. Accessed 26 May 2016.
Kolcaba, Katharine, and Marguerite A. DiMarco. "Comfort Theory and Its Application to Pediatric Nursing." Pediatric Nursing, vol. 31, no. 3, 2005, pp. 187–94.
Merkel, Sandra. "Comfort Theory: A Framework for Pain Management Nursing Practice." American Society for Pain Management Nursing: 2007ConferenceHandouts, ASPMN, 26 Sept. 2014, www.aspmn.org/documents/2007ConferenceHandouts/SandraMerkelFull.pdf. Accessed 27 May 2016.
Wilson, Linda, and Katharine Kolcaba. "Practical Application of Comfort Theory in the Perianesthesia Setting." Journal of PeriAnesthesia Nursing, vol. 19, no. 3, 2004, pp. 164–73.