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Katharine Kolcaba’s Comfort Theory

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Running head: KATHARINE KOLCABA’S COMFORT THEORY

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Running head: KATHARINE KOLCABA’S COMFORT THEORY

Abstract

The paper gives a systematic assessment of the Katharine Kolcaba’s Comfort theory. The basis of the paper is to understand the theorist, and discuss the main concepts related to it. Above all the aim is to identify the theory’s application to clinical situations in institutional settings and its contribution to nursing research and practice. An overview, and the Comfort theory’s propositions, along with its conceptual definitions will be analyzed and studied. Along with certain research articles, Kolcaba’s Comfort theory’s applications, particularly, technical, coaching and comfort food for the soul will be explored. In addition, this paper provides examples where Nurse Practitioners can use Comfort Theory as a framework to provide holistic care to their patients. It is also noticeable that Katharine Kolcaba’s Comfort theory has been used in several institutions by the administration to develop policies and practices, with the interest of improving patient satisfaction and experience during their encounter within the organization.

 Nursing Theory
Nursing Theory

Introduction

Born and educated in Cleveland, Ohio, Katharine Kolcaba, practiced as a nurse on several nursing units for many years. After completing her masters in nursing, and while working on the dementia unit as head nurse, Kolcaba started theorizing about comfort. During her doctoral studies, Kolcaba further developed her comfort theory study and later published a framework for dementia care. Later she added the operationalized comfort as an outcome of care and contextualized comfort in a middle range theory. Subsequently, Kolcaba tested her theory in varied intervention studies, and based on that she polished her theory to include hospital-based outcomes. Katharine Kolcaba has several and extensive publications where she has documented the process of her theory. She also has published a book Comfort Theory and Practice, where she has assembled her series of publications. Kolcaba currently works as a consultant of her own company, The Comfort Line, which advices health-care agencies in application of her Comfort Theory framework if they choose to apply it within their institutions (Smith & Parker, 2015).

Overview of the Comfort Theory

Comfort, according to Kolcaba, is an outcome of an intentional, patient/family based and focused quality care (Smith & Parker, 2015). Based on holistic care, Kolcaba developed four contexts in which patients can experience comfort, i.e. physical, psychospiritual, sociocultural and environmental. The three distinct types of comfort that Kolcaba focused were-Relief, Ease, and Transcendence. Relief is a feeling where a specific need that provides comfort is given. Ease is the state of being calm and content. Whereas transcendence relates to a state where patients can rise above their difficulties irrespective of life’s circumstances with the help of caregiver intervention. All the four contexts and the three types of comfort are interrelated and have to be viewed holistically to get favorable outcomes. Health needs are those that the patients cannot meet on their own which sprout from varied stressful conditions. Comfort interventions are all the steps considered to tackle the specific health needs.

 (“Comfort Theory,” n.d.)

The practical application of Kolcaba’s Comfort Theory was studied in cardiac patients in two case studies (Krinsky, Murillo, & Johnson, 2014). The comfort needs of cardiac patients were defined based on the four domains of Kolcaba’s Comfort theory and the interventions were outlined accordingly centered on the three comfort types. Quiet time intervention which was introduced to these cardiac patients aligned with the Comfort Theory taxonomy framework. Interventions based on physical, psychospiritual, environmental and socio-cultural domains were implemented in the case studies. Improved outcomes were noted in cardiac patients in terms of ease of pain, enhanced sleep, reduced agitation and anxiety, and enriched emotional support through family involvement.

Another study that was conducted at two dialysis centers to determine the relationships between comfort and fluid retention was based on Kolcaba’s Comfort Theory framework (Estridge, Morris, Kolcaba, & Winkleman, 2018). The study found out some interesting facts based on the theory of comfort. The study turned out to be clinically important as patients who pursued comfort interventions showed a greater trend of engaging in healthy behavior. Another fact pointed out was the different comfort needs based on race, religion, gender and lifestyle varied accordingly. In the study the nurses had to investigate distinctive characteristics and comfort needs to plan nursing care based on the comfort theory framework.

Relevance

Personal Relevance

While working in the dementia unit, Kolcaba started developing her comfort theory in context of patient experience on that unit. It was during her doctoral degree program that she further expanded on her comfort theory framework and its outcomes. She later tested her theory in several interventions as a topic for her dissertation. Kolcaba confesses that it was Emily Dickenson’s poem that made her define her vision for nursing and comfort care theory (“Comfort Theory,” n.d.). The author, even today, utilizes her theory in her regular visits to homeless shelters, different healthcare organizations, and several research studies incorporating her comfort theory.

Relevance to healthcare

Comfort theory has great implications within todays healthcare scenarios. Most patients and family members are in stressful health related situations, comfort theory can be beneficial to such cases when nursing activities are planned in that direction. Nurses in todays world can take guidance from comfort theory to identify their patients and family needs and address them with interventions based within the comfort theory structure. Institutional administrators should value comfort care and implement policies and make strategies that will encourage nurses and other staff to deliver comfort measures to their clients. Kolcaba has developed several scales for documentation that include, verbal rating scale, a numeric diagram, comfort daises for children, a comfort behaviors checklist and many other questioners (Smith & Parker, 2015).

Relevance to research and practice

Kolcaba’s Comfort Theory has been used as a framework in many research studies. Kolcaba herself has participated and guided researchers through many studies that have applied her theory in different setups. Apostolo and Kolcaba’s guided imagery study for decreasing depression, anxiety and stress in psychiatric patients with depression using comfort theory framework, revealed significant improvement in clinical outcomes (Apostolo & Kolcaba, 2009). Taxonomic structure of Comfort developed by Kolcaba was used to design the interventions for the study. This example and many other studies have proved that utilizing Kolcaba’s Comfort theory can help patients have positive impact in their health behaviors and outcomes.

Summary

Strengths

The biggest strength of Kolcaba’s Comfort theory is its ease of use in any nursing setting. The taxonomic structure provided by Kolcaba is clear and easy to understand and thus helpful for nurses to develop their nursing plan of care accordingly. When nurses implement comfort care plans, patient and family satisfaction improves, thereby engaging them in health seeking behaviors. The comfort theory framework developed by Kolcaba is holistic in nature, thus helping improvise overall patient care. Several health institutions and hospitals are actively implementing comfort theory-based care in hope of improving their HCAHPS scores.

Limitations

Although widely used in hospitals and for research purposes, Kolcaba’s theory has few limitations. Most of the times outcomes are subjective, hence limiting generalizability. Another limitation is the requirement of modification of framework when using in different nursing areas. Comfort theory framework is mostly used in nursing related areas; hence its use is limited to the staff who are educated about it and based on their scope of practice. Kolcaba’s comfort theory is good to be used to define comfort care of patients and families, but it’s difficult to agree whether it can be applicable in all healthcare settings. The topic of comfort is subjective, hence depending on varied patient-nurse ratios it may be difficult and stressful for nurses to implement total comfort-based care.

8

KATHARINE KOLCABA’S COMFORT THEORY

References

Apostolo, J. L., & Kolcaba, K. (2009). The Effects of Guided Imagery on Comfort, Depression, Anxiety, and Stress of Psychiatric Inpatients with Depressive Disorders. Archives of Psychiatric Nursing23, 403-411. http://dx.doi.org/doi:10.1016/j.apnu.2008.12.003

Conceptual Framework for Comfort Theory. (n.d.). Retrieved from https://www.thecomfortline.com

Estridge, K. M., Morris, D. L., Kolcaba, K., & Winkleman, C. (2018). Comfort and Fluid Retention in Adult Patients Receiving Hemodialysis. Nephrology Nursing Journal45, 25-34. Retrieved from https://www.thefreelibrary.com/Comfort+and+Fluid+Retention+in+Adult+Patients+Receiving+Hemodialysis.-a0529947941

Krinsky, R., Murillo, I., & Johnson, J. (2014, February 5). A practical application of Katharine Kolcaba’s comfort theory to cardiac patients. Applied Nursing Research27, 147-150. Retrieved from http://lib.ajaums.ac.ir/booklist/ARN199.pdf

Smith, M. C., & Parker, M. E. (2015). Nursing Theories and Nursing Practice (4th ed.). Philadelphia, PA: F.A. Davis Company.

Relevance 15

a. Personal relevance if

any of the author

described (connect the

theorist to the theory)

b. Relevance to

healthcare and the

client discussed

(connect the theory to

healthcare today)

c. Application to research and/or

practice provided

(connect the theory to

current research/practice)

d. Use at least two peer-

reviewed/research articles that

detail the nursing theory being

applied in clinical

practice/research, and

summarize key findings of both

articles including results and

implications for future practice

Summary

• Include theory strengths and

limitation in the

summary

5

Format

• Precise APA style,

headers and

professional writing

5

Total 35

Research Paper Rubric

Outstanding

(35)

Very Good (33) Good (30) Unacceptable

(25)

Integration of

Knowledge

The paper

demonstrates

that the author

fully

understands and

has applied

concepts learned

in the course.

Concepts are

integrated into

the writer’s own

insights.

The writer

provides

concluding

remarks that

show analysis

and synthesis of

ideas

The paper

demonstrates

that the author,

for the most part,

understands and

has applied

concepts learned

in the course.

Some of the

conclusions,

however, are not

supported in the

body of the

paper

The paper

demonstrates

that the author,

to a certain

extent,

understands and

has applied

concepts learned

in the course

The paper does

not demonstrate

that the author

has fully

understood and

applied concepts

learned in the

course.

Topic Focus The topic is

focused

narrowly enough

for the scope of

this assignment.

A thesis

statement

provides

direction for the

paper, either by

statement of a

position or

hypothesis

The topic is

focused but

lacks direction.

The paper is

about a specific

topic but the

writer has not

established a

position.

The topic is too

broad for the

scope of this

assignment.

The topic is not

clearly defined

Depth of

Discussion

In-depth

discussion and

elaboration in all

sections of the

paper.

In-depth

discussion and

elaboration in

most sections of

the paper.

The writer has

omitted pertinent

content.

Quotations from

others outweigh

the writer’s own

ideas

excessively.

Cursory

discussion in all

the sections of

the paper or

brief discussion

in only a few

sections

Cohesiveness Ties together

information

from all sources.

Paper flows

from one issue

to the next

without the need

for headings.

Author’s writing

demonstrates an

understanding of

the relationship

among material

obtained from all

sources

For the most

part, ties

together

information

from all sources.

Paper flows with

only some

disjointedness.

Author’s writing

demonstrates an

understanding of

the relationship

among material

obtained from all

sources.

Sometimes ties

together

information

from all sources.

Paper does not

flow.

Disjointedness is

apparent.

Author’s

writing does not

demonstrate an

understanding of

the relationship

among material

obtained from all

sources.

Does not tie

together

information.

Paper does not

flow and appears

to be created

from disparate

issues.

Headings are

necessary to link

concepts.

Writing does not

demonstrate

understanding

any relationship

Spelling and

Grammar

Minimal spelling

and/or grammar

mistakes

Some spelling

and or grammar

mistakes.

Noticeable

spelling and

grammar

mistakes.

Unacceptable

number of

spelling and/or

grammar

mistakes

Sources More than 5

current sources,

of which at least

3 are peer

review journal

articles or

scholarly books.

Sources include

both general

background

5 current

sources, of

which at least 2

are peer-review

journal articles

or scholarly

books.

Fewer than 5

current sources

or fewer than 2

of 5 are peer-

reviewed journal

articles or

scholarly books.

All web sites

utilized are

credible.

Fewer than 5

current sources

or fewer than 2

of 5 are peer-

reviewed journal

articles or

scholarly books.

Not all web sites

utilized are

credible, and/or

sources and

specialized

sources.

Special-interest

sources and

popular

literature and

acknowledged as

such if they are

cited.

All web sites

utilized are

authoritative.

All web sites

utilized are

authoritative.

sources are not

current.

Citations Cites all data

obtained from

other sources.

APA citation

style is used in

both text and

bibliography

Cites most data

obtained from

other sources.

APA citation

style is used in

both text and

bibliography.

Cites some data

obtained from

other sources.

Citation style is

either

inconsistent or

incorrect.

Does not cite

sources.

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