Theory in Practice:

Kolcabas Theory of
Comfort
By April Greene

Objectives

Describe Katharine Kolcabas Theory of Comfort

Described strategies from Kolcabas theory to empower patients or families at the endof-life
Describe how to engage patients or designated surrogates in active partnerships that
promote health, safety and transcendence at the end-of-life
Described the value of an active partnership with patient or designated surrogates in
planning, implementation, and evaluation of care

Introduction

Katharine Kolcaba first developed the comfort theory in nursing in the 1990s
Comfort exists in 3 forms: relief, ease, and transcendence
There are 4 contexts in which patient comfort can occur: physical, psychospiritual,
environmental, and sociocultural.

3 Forms of Comfort

Relief: relief from conditions that interfere with comfort

Ease: a comfortable state; an enduring state of ease and peaceful contentment
Transcendence: the state of comfort in which patients are able to rise above their
challenges.

4 Contexts of Patient Comfort

Physical: the sensations of ones body

Psychospiritual: pertaining to internal awareness of self, including esteem, identity,
sexuality, meaning in ones life, and ones understood relationship to a higher order or
being
Environmental: external surroundings of the patient
Sociocultural: pertaining to interpersonal, family, and societal relationships

Comfort in End-of-Life

Theory of Comfort

Theory of Comfort
Health Care Needs:needs identified by the patient/family in a particular practice setting.
Intervening Variables:factors that are not likely to change and over which providers have little
control
Comfort: an immediate desirable outcome of nursing
Health Seeking Behavior: internal (healing, immune function, number of T cells, etc.), external
(health related activities, functional outcomes, etc.), or a peaceful death
Institutional Integrity: the values, financial stability, and wholeness of health care organizations
at local, regional, state, and national levels; this includes Public Health agencies, Medicare and
Medicaid programs, Home Care agencies, and Nursing Home consortiums.
Best Policies: protocols and procedures developed by an institution for overall use after collecting
evidence.
Best Practices: protocols and procedures developed by an institution for specific patient/family
applications (or types of patients) after collecting evidence.

Knowledge
Active involvement of the healthcare team, meeting comfort needs
of the patient and family
Assessment of comfort needs: what the patient and family says and
what the nurse observes
Crafting interactions to meet needs based upon assessment
Nursing is in charge of all interventions
Therapeutic use of self and caring
Approach with the intent to comfort and maintain personal,
culturally relevant connection
Regular reassessment
Documentation of routine comfort levels

Skills

Interdisciplinary collaboration
Therapeutic communication: know patient and family values, wishes, and preferences
Assess patient levels of physical and emotional comfort
Institutional integrity
Intervening variables
Taxonomic structure
Questionnaires: general comfort
Incorporate knowledge and individual needs

Attitude
Create a trusting relationship between the nurse and
patient/caregiver. This will provide for optimal care.
Separate holistic comfort (Hospice) from outcome oriented
comfort
Valuing active partnerships between the nurse, patients and
families
Planning: consideration of all aspects of the patient when
developing the plan of care
Implementation: consideration of patient response to measures of
comfort and adjust accordingly to promote comfort
Evaluation: ensure optimal comfort for the paitent and determine
any changes to the plan of care

Reflection
The theory of comfort describes in great detail the importance and necessity of end of life
comfort and care. It does not only involve the patient, but the entire healthcare team and
families as well. End of life comfort and care is not only the patients decision. The familys
input needs to be considered. Although not all forms of comfort can be addressed, a patient
may still be able to feel at ease. End of life isnt easy, but allowing the patient and family to
have the most possible comfort is essential. This theory allows for increased patient and
family satisfaction during an end of life situation. End-of-life patient care should be
personalized to the patient and familys wishes.
Hospice nurses work in regards to this theory every day, but this does not mean that nurses
in other areas of nursing should be not aware of it. Death and dying occurs in every area of
healthcare, even when it is not expected. It is important for every nurse to have an
understanding of proper care of both the patient and family in all endof-life situations.
Combining the Theory of Comfort with other theories would greatly enhance patient care.

References

Kolcaba, K., PhD, RN, Stoner, M., PhD, RN, & Durr, K., MSN, RN. (n.d.).
Comfort Theory and
Practice (2003). Retrieved July 06, 2016, from
http://www.thecomfortline.com/