comfort theory: a framework for healthy bladders and planning for

Comfort Theory 101

Katharine KolcabaThe University of Akron

College of Nursing

What do we mean by comfort?

• Complex term• Common use• Technical definition

(Kolcaba, 1992)• Strengthening

component (rationale for comforting interventions in both populations)

Dictionary Definitions: Comfort (Webster) • 1. To soothe in distress or sorrow.• 2. Relief from distress (absence of previous

discomfort) (negative sense)• 3. A person or thing that comforts• 4. A state of ease and quiet enjoyment, free from

worry (neutral sense)• 5. Anything that makes life easy • 6. Suggests the lessening of misery or grief by

cheering, calming, or inspiring with hope (positive sense)

• verb, noun, adjective, adverb

ReliefRelief

I need help because I’m lonley.

Ease

I feel totally peaceful.

Transcendence

I did it! (with the help of my coach…)

Research Study: Comfort in LTC setting (Hamilton, 1989)

• Research questions:• What is the residents’ definition of comfort?• What contributes to the residents’ comfort?• What detracts from the residents’ comfort?• How can residents become more comfortable?• (Qualitative study)

Five recurring themes:

Physical Comforthomeostasis, pain relief,

symptom management

• 2001: Data from more than 2.2 million nursing home staff who usually underestimate true pain burden of residents.

• Woefully inadequate pain management among frail and old population of Americans.

• Positioning– Returning to bed when

requested– Better seating

arrangements

But physical comfort and positioning isn’t the only important type of comfort

• There are three more comfort themes that the participants in this study cited…

Comfort theme of self-esteem (psychospiritual)

Comfort theme of approach and attitudes of staff (sociocultural)

Comfort theme of hospital life (environment).

Definition of Holistic Comfort

Relief Ease Transcendence

Physical

Psycho- Spiritual

Socio-Cultural

Environ-mental

(Kolcaba, 2003)

Technical definition of Comfort (cont)

• The state of being strengthened when needs for relief, ease, and transcendence are met in four contexts of experience: physical, psychospiritual, sociocultural, and environmental

• Nice fit with nursing practice and research!

Comfort Theory (3 parts)

• Comforting interventions enhance patients’ comfort.

• Enhanced patient comfort is positively related to engagement in HSBs – Comfort is strengthening

• When patients (and families) engage in HSBs, institutions have better outcomes– Patient satisfaction, nurse retention, costs down

Practical Application• Holistic assessment of patients’ comfort needs

– Use grid as a guide• Holistic interventions to meet those needs.

– Use grid as a guide• Relationship of comfort (holistic outcome) to

health seeking behaviors (HSBs) – External HSBs: e.g. functional status, rehab progress– Internal HSBs: e.g. healing, t-cell counts, etc.– Peaceful death: perfect for hospice and palliative care

• Holistic instruments to determine outcomes

• Institutional outcomes: increased patient satisfaction, decreased cost, decreased readmissions, etc.

• Don’t forget about comfort of nurses!

• Kolcaba, K. (2003). Comfort Theory and Practice. Springer.

• Available at: – www.uakron.edu/comfort– www.SpringerPub.com– www.Amazon.com