Comfort Concept in Holistic Care
Comfort In The Concept of Kolcaba
Comfort has been conceptualized as a holistic
outcome of nursing care and defined as the experience of having needs for
relief, ease, and transcendence addressed or met in four contexts of
experience.
The four contexts for experiencing comfort were derived from the
literature on holism and were labeled physical, psychospiritual, environmental,
and sociocultural ( Kolcaba , 1991).
Relief, ease, and transcendence, three
types of comfort, were derived from a concept analysis of comfort ( Kolcaba
& Kolcaba , 1991).
Comfort And Nursing Care
Comfort care is nursing care that is intended
to enhance a patient’s comfort beyond its previous baseline.
Comfort care
consists of goal-directed, comforting activities (the process of comforting)
through which enhanced comfort (the desired end product or outcome) is
achieved.
The process is initiated by the nurse after an assessment of the
comfort needs of the patient/family.
Because the specified product or goal is
enhanced comfort, a successful process is evaluated by comparing comfort levels
before and after interventions that are targeted towards comfort.
The process
is incomplete until the product. of enhanced comfort is achieved ( Dretske ,
1988; Kolcaba , 2003).
Theoretical Contribution
Kolcaba (1994, 2003) provides a theoretical
framework for practicing comfort care and for generating nursing research about
comfort. Briefly, the theory states that interventions should be designed and
implemented to address unmet comfort needs of patients and their families.
Because comfort is a basic human need, patients and families often assist
nursing efforts towards enhanced comfort. (In fact, some self-comforting
measures can be negative, such as alcohol or drug abuse.)
The effectiveness of
comforting interventions is perceived in the context of existing intervening
variables.
Intervening variables are factors that recipients bring to the
situation and upon which nurses have little influence, such as financial
status, existing social support, previous experience with health care, and
religious beliefs.
Enhanced comfort strengthens patients and their families
during stressful health care situations, thereby facilitating health-seeking
behaviors (HSRs).
Comfort And Internal healing
Schlotfeldt (1975) discussed HSBs in terms of
those that are internal (fertility, healing), external (self-care, functional
status), or leading to a peaceful death.
Consistent with holism, conscious and
subconscious experiences influence motivation for patients/families to engage
in HSBs. Because HSBs are constructive, they are reciprocally and positively
related to comfort.
Comfort theory states that patient/family comfort is the
immediate goal of comforting interventions, and HSBS, specific to
health-related goals, are subsequent outcomes.
Focus of Comfort Theory
Comfort Theory is focused on enhancing
patient/family comfort for altruistic and pragmatic reasons. Patients/families
want to be comforted by nurses in stressful healthcare situations.
Because
comfort is related to subsequent desirable health and institutional outcomes,
the outcome of enhanced comfort is elevated in stature among other more technical
and narrow outcomes.
It is a holistic and nursing-sensitive outcome that is
congruent with recent mandates to measure nursing effectiveness in terms of
positive and desirable patient/family goals ( Magvary , 2002).
Comfort Theory And Research
The Theory of Comfort directs research in
several ways. First, it guides nurses to test relationships between particular
holistic interventions and comfort.
Second, it guides nurses to test
relationships between comfort and setting-related HSBs. If the relationship is
positive, nurses have a pragmatic rationale for enhancing patient comfort.
Third, it guides nurses to test relationships between HSBs and institutional
outcomes.
Qualitative studies have been conducted to
determine the nature of comforting nursing actions and what comfort means to
patients.
Journal publications by these authors did not define or
operationalize the outcome of com fort.
Several empirical tests of Comfort
Theory have been conducted by Kolcaba and associates ( Kolcaba , 2003).
These
comfort studies demonstrated significant differences between tween treatment
and comparison groups on comfort over time.
The following interventions were
tested:
(a) types of immobilization for persons after coronary angiogram
(b)
guided imagery for women going through radiation therapy for early breast
cancer
(c) cognitive strategies for persons with urinary frequency and
incontinence
(d) hand massage for persons near end of life
(e)
generalized comfort measures for women during.
First and second stages of
labor. In each studylism , conscious and subconscious experiences influence
motivation for patients/families to engage in HSBs. Because HSBs are
constructive, they are reciprocally and positively related to comfort.
Comfort
theory states that patient/family comfort is the immediate goal of comforting
interventions, and HSBs, specific to health-related goals, are subsequent
outcomes.
Interventions were targeted to all attributes
of comfort relevant to the research settings, comfort instruments were adapted
from the General Comfort Questionnaire ( Kolcaba , 2003), and there were at
least two measurement points, usually three, to capture change in comfort over
time.
To demonstrate that comfort is an important
mission for nursing, additional tests of comfort theory should be conducted, including
attention to increased functional status, faster progress during
rehabilitation, faster healing, or peaceful death (when appropriate).
Institutional outcomes could include decreased length of stay for hospitalized
patients, decreased readmissions, and higher patient satisfaction.