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Comfort Theory by: Katharine Kolcaba

Kolcabas Definition of Comfort

The state of having addressed basic needs for ease, relief, and transcendence met in
contexts of experience (physical, pyschospiritual, sociocultural, and environmental)

Internal Evaluation
Major assumptions underlying Kolcabas (1992) theory include:
1. Human beings have holistic responses to multiple, complex stimuli
2. Comfort is a desirable outcome and germane to nursing
3. Human beings strive to meet comfort needs. It is a process that is continuous.
4. Having comfort needs met strengthens patients to engage in health-seeking
behaviors of their own.
5. Patients who are given the power to engage in health-seeking behaviors of their
own have a better perceptions of and about their health care.
6. When an institutions care is based on a system of values that is focused on
the patient or those who receive care, that institution is said to have integrity.

Kolcaba defined the concepts of nursings metaparadigm as follows:
a) Nursing: Intentional assessment of comfort needs, design of comfort measures,
implementation and evaluation of comfort measures. The nurse assesses and reassesses the
patient by asking questions (e.g., Are you comfortable? How do you feel?) or observing (lab
results, wound after a dressing change, or behavioral changes). There is also a comfort
questionnaire available on-line at (Kolcabas web page).
b) Person: all individuals. Patients are care recipients, individuals, families, institutions,
communities in need of health care.
c) Environment: any aspect of patient, family or institution surroundings that the nurse can
manipulate to aide and improve the patients comfort.
d) Health: optimum functioning, as defined by patient, family or community.

Major concepts in Kolcabas theory include the following:
1. Health care needs: Needs related to well-being that cannot be relieved or bettered by the
patients family/support system. Health care needs include physical, psychological, spiritual,
social and environmental needs. The needs are made known by verbal/non verbal
communication or by signs that the nurse monitors.
2. Comfort measures: There are interventions by the nurse that are meant to address specific
comfort needs of the one receiving the care. There are three types of comfort measures:
Technical care: reduce pain and maintain homeostasis
Coaching: relieves anxiety, instills hope, gives reassurance, listens, assists in planning
culturally sensitive measures
Comfort food for the soul strengthens patients in intangible, memorable ways
that patients do not expect. They fortify patients through such actions as back
massage, guided imagery, music therapy, reminiscence and hand-holding.
3. Intervening variables: There are variables that are connected and
communicate with each other to change or influence how the person sees total comfort. These
variables are identified as: past experiences, age, attitudes, state of emotion, system of
support, prognosis, finances and the totality of elements in the persons experience.
4. Comfort: It is the state that is experienced and perceived by the recipients of comfort
measures. The comfort experience can be in four contexts:
Physical: pertaining to bodily sensations that may or may not be
related to medical diagnoses (Kolcaba, 1997)
Psycho-spiritual: Having meaning in life, involves self-awareness,
esteem, sexuality, belief in and relationship with
someone higher or a supreme being
Sociocultural: Relationships that are interpersonal, in the family, or in
the society
Environmental: Pertaining to external surrounding, conditions and
influences, including color, noise, light, temperature,
access to nature and texture.

There are 3 types of comfort:
1.) Relief: how a recipient is when they have had their specific need met; free of discomfort
2.) Ease: state of relaxation or happiness; at ease
3.) Transcendence: the recipient rising above their level of discomfort, trouble or pain;
strengthened, motivated, determined

By having these comforts met, the patient is made stronger immediately or holistically.

5. Health-seeking behaviors: Actions related to the goal of striving for health. These behaviors
can be internal, external or dying in peace. They may be defined by the patient or developed in
consultation with a nurse.
6. Institutional integrity: These are: corporations, communities, schools, hospitals, churches,
reformatories and others that possess qualities or states of being complete, whole, sound,
upright, appealing, honest, and sincere.

Propositional statements from Kolcabas (1992) theory include:
1.) Nurses identify patients comfort needs that have not been met by existing support systems.
2.) Nurses design interventions to address comfort needs of patients.
3.) Comfort needs in one context may influence comfort needs in another.
4.) Expert nurses are expert in comfort care.
5.) One way to enhance comfort is to manipulate the environment.
6.) Intervening variables are taken into account in designing the interventions and determining if
they have probability for success.
7.) If the intervention is effective and delivered in a caring manner, the immediate outcome of
enhanced comfort is attained and the intervention can be called a comfort measure.
8.) Patients and nurses agree upon desirable and realistic health-seeking behaviors (HSB).
9.) If enhanced comfort is achieved, patients are strengthened to engage in HSBs, which further
enhances comfort.
10.) When patients engage in HSBs as result of being strengthened by comfort care, nurses and
patients are more satisfied with health care and demonstrate better health related (diagnosis-
specific) outcomes.
11.) Professional working environment produces better patient and institutional outcomes.
12.) When patients and nurses are satisfied with health care in specific institution, public
acknowledgement about the institution contributions to health in the United States will
contribute to institutions remaining viable and flourishing.