Katharine Kolcaba’s comfort theory focuses on providing comfort as one of the main purposes of nursing care along with patient safety and patient satisfaction. In the theory, a lot of attention is paid to defining the concept of comfort and establishing what contributes to it, what enhances it, and what decreases it. The main idea is that comfort can be enhanced through three processes: identifying patient needs, conducting comforting interventions, and considering intervening variables (“Introduction,” n.d.). Patient needs constitute one of the key issues of the theory, and Kolcaba stresses that the optimal way to identify them is to learn them directly from communication with a patient, i.e. nurses’ understanding of patient needs in a given case should be primarily based on patient feedback and requests, not nurses’ observations or personal experience.
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Another key concept is intervening variables, which are “factors that each patient brings to the health care situation, that nurses cannot change, and that have an impact on the success of the interventions” (“Frequently asked questions,” n.d., para. 17), i.e. such factors as the financial situation of a patient or the level and form of social support. They should be taken into consideration in every particular case because failure to recognize these factors can make enhancing comfort harder.
Origins of the Theory
Kolcaba has been demonstrating an academic interest in the concept of comfort since the late 1980s and achieved considerable results by the early 2000s. Her book A Journey through Comfort was published in 2003; in it, Kolcaba describes the creation of the theory and explains how the theory can be applied to various areas of health care (“Comfort theory,” n.d.).
The author emphasizes that the development of the theory, along with other nursing theories that may draw particular attention to patient comfort, is associated with a significant humanitarian shift in health care. Previously, it was believed that treatment inevitably involved pain, suffering, and discomfort. In the second half of the 20th century, however, it was widely acknowledged that health problems were challenges already, and health care providers should not make them even worse by delivering treatment in a discomforting way. Therefore, there was a need for a new theoretical understanding of key nursing concepts that could emphasize comfort, and Kolcaba developed it.
Comfort theory is a middle-range nursing theory, which means that it deals with both theoretical concepts and applied knowledge. The helpfulness of the theory in nursing care in clinical conditions consists in nurses’ enhanced ability to ensure patient comfort by gaining a more profound understanding of what shapes comfort and what disrupts it.
Theories are proposed to explain phenomena and predict outcomes; in the case of the comfort theory, the phenomenon to be explained is discomfort of a person who receives care, and the outcome to be predicted is comfort enhanced through appropriate interventions. The comfort theory is used to develop further, narrower models for addressing patients’ needs in a particular setting; for example, comfort theory-based “Acute Care for Elders (ACE) model provides an effective, proactive, inexpensive framework for addressing the complex health needs of older adults” (“Comfort theory,” n.d., para. 13).
Kolcaba has received several awards for her research activities, and many works she wrote on the comfort theory allow assuming that she rather positions herself as a researcher than as a theorist. Since the early 1990s, the theory’s author has been conducting studies to test the theory and collect new evidence for it. Most recent studies were dedicated to the application of the comfort theory to preoperative patients and patients with depressive disorders (“Comfort theory,” n.d.). In both cases, it was confirmed that operating within the theory’s framework can help predict what interventions will enhance comfort; however, in both studies, Kolcaba notes that some mechanisms of patient comfort remain not fully understood.
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Many other researchers used the theory in their studies; for example, Krinsky, Murillo, and Johnson (2014) used this theoretical framework in their study of patients who had symptoms associated with discomfort caused by cardiac syndromes, and the use of discomfort as a central concept in this study allowed the authors to provide practical recommendations on the basis of Kolcaba’s theory for promoting patient comfort. Particularly, the authors described “four contexts of comfort: physical, psychospiritual, environmental and sociocultural” (Krinsky et al., 2014, p. 147), which is a concept developed by Kolcaba.
Like all middle-range theories, the comfort theory pursues balance between theorizing and applicability and between comprehensiveness and specificity. It manages to combine them in a way that allows both discussing the theory from the conceptual perspective and using it in practice. The main strength of the theory is that it explains how comfort can be enhanced through promoting best policies and best practices, addressing the needs of patients, and understanding their health-seeking behaviors.
The main weakness, however, is that the theory does not essentially bring anything new to the understanding of care, i.e. the actions that may be proposed by the theory in a given case can be as well proposed by one of many other nursing theories that address patient comfort. A practitioner who decides to use the theory in his or her work may be guided by the desire to make enhancing comfort the main focus of this work, and it is beneficial both for a patient who receives more considerate care and for health care providers who organize the delivery of care in a system with a strong theoretical base.
Comfort theory. (n.d.)
Frequently asked questions. (n.d.)
Krinsky, R., Murillo, I., & Johnson, J. (2014). A practical application of Katharine Kolcaba’s comfort theory to cardiac patients. Applied Nursing Research, 27(2), 147-150.