The Background
Theory Description
Katherine Kalcaba is one of the most influential theorists in nursing. On December 28, 1944, she was born in Cleveland, Ohio, United States of America. Kolcaba is a retired associate professor at the University of Akron’s College of Nursing. She has provided national and international consulting services to the College of Nursing and other healthcare organizations. In 1965, Kolcaba graduated with a nursing degree from the University of St. Luke’s School of Nursing. In 1987 Kolcaba was given an RN/MSN courtesy of Case Western Reserve University and a Ph.D. from the same school in 1999. (Kolcaba, 2015). She has been recognized with a number of awards. However, the most recognized one is the Dowd Award for being a credible theorist of the year, which she was presented with in 2006 by Sigma Theta Tau, ranked to the second largest organization in the world, the world’s second-largest nursing organization. It is the most noteworthy of these accolades. Indeed, Kolcaba’s main area of interest is research. She has also carried out several other studies since the early 1990s to gather further proof for the idea or test the hypothesis in real-world clinical circumstances.
The Phenomenon of Concern in Comfort Theory
The theory was created to be a central component in investigating various perceptions of comfort in nursing. These different forms of comfort involve what leads to it, what it constitutes, and what leads to its disturbance (Current Nursing, 2020). Kolcaba published her theory in 1991, and ever since then, she has maintained her research in this line. In 2003, she produced a book that is still her most often referenced work. However, the theorist subsequently has carried out several further research projects, lately of which focused on applying the theory to patients undergoing surgery and those suffering from mental illnesses. The fundamental issue raised by Kolcaba’s idea is still an effort to determine what contributes to patients’ suffering and what increases the comfort of patients.
Description of The Theory
It is crucial to consider a theory’s method of theorizing while examining it, namely, if it uses deductive, retroductive, or inductive forms of reasoning. Retroductive reasoning explains a phenomenon using premises that do not necessarily necessitate it; inductive reasoning transfers from general principles to particular conclusions, and deductive reasoning translates from specific instances to overall conclusions (Lin et a., 2022). To explain complex real-life events, however, pure inductive, retroductive, or deductive procedures are seldom used since such occurrences call for in-depth examination that may incorporate several forms of reasoning. This theory is a form of this analysis since it deals with the difficult and multifaceted idea of patient comfort.
In contrast, the comfort theory applies an inductive form of reasoning, as its foundation is the observation of patients in real-world clinical settings. Kolcaba developed systematic, specific instances that were analyzed further to develop a theoretical roadmap and provide insights into patient comfort by gathering patients’ feedback and attitudes regarding what makes them comfortable and uncomfortable (Lin et a., 2022).
Considering the other, it is also true that a deductive form of reasoning may have been used. According to Lin et al. (2022), the comfort hypothesis is well-liked since it captures what knowledgeable nurses are already aware of: regardless of their circumstances, enhancing the comfort of the patients alongside their families is one of the most critical nursing duties. Thus the systematization of discoveries for the theory is based on commonly accepted principles. This strategy shows that deductive reasoning is utilized since using known premises to define concepts better is an implication of deductive form reasoning.
As seen in Figure 1, the theory itself applies concepts that were not originally created for itself. Nonetheless, it is also important to consider that Kolcaba’s definitions of these terms may differ somewhat from those of other writers. The three factors contributing to increased comfort are the patient’s or family’s healthcare demands, soothing interventions, alongside intervening circumstances. The fact that patients, together with their families, identity and further convey their requirements to the nurse, not the nurse herself, is a crucial component of the first notion.
This is significant because, contrary to the comfort theory, which suggests pursuing patient- and family-defined requirements, certain theories may advise that a nurse determine a patient’s needs based on patient observation. Intervening variables, which Kolcaba describes as “factors that every patient takes to the healthcare situation, that nurses are not able to modify, as well as those which have an influence on the outcome of the treatments,” include a patient’s financial condition and stress level (Nursing Theory, n.d.).
The concept of comfort itself, which Kolcaba describes as the instantaneous sense of being empowered via needing transcendence, relief, and ease, is the most important one in theory and, in his opinion, is what nursing care is all about. It is strictly emphasized that routine comfort measures will motivate patients to look after their health and improve the outcomes within the institution. There is a distinction between an individual’s internal characteristics—such as their immune system, capacity for healing, and physiological characteristics—and their outward (health-seeking) behaviors (Nursing Theory, n.d.). According to Kolcaba, the best policies are described as evidence-based procedures created by a care setting, while best practices are termed as evidence-based procedures for their application to a particular patient in terms of the notions that are impacted by and influence institutional integrity.
Most concepts have specific explanations since Kolcaba strives to clarify in great detail what she believes to be pertinent to the conceptual roadmap (Lin et a., 2022). Nevertheless, the description of comfort terminology by itself is, however, implicit just because the theorist does not define it in absolute terms but instead advises treating this concept as a term that includes a broad range of links to different successful and efficient care delivery and enhances positivity in the experience of the patient.
Evaluation
The whole comfort theory is based on the premise that a patient’s comfort is a primary goal of health care excercise, as can be seen from the definitions it defines explained in the theory description. This is significant since not every theory identifies the comfort of the patient as one of the main goals of treatment. For instance, it might be viewed that a medical team’s primary objective is to guarantee that a patient receives treatment that results in excellent health outcomes, notwithstanding the possibility that the patient may also experience pain (Nursing Theory, n.d.). Kolcaba advocates seeing therapy as a process of consistently meeting patients’ needs to prevent them from feeling lost, useless, and sad. Otherwise, treatment results are not good. Interventions cause discomfort.
It is helpful to analyze a nursing theory’s metaparadigm or a collection of overarching ideas to which every other theory that is based on nursing unavoidably alludes while analyzing it. The term “universal” in this context refers to the ideas’ applicability to nursing theories and in different circumstances, not their meanings. In reality, different theories may provide various meanings for the terms to which they all relate, namely terms like “health,” “patient,” and “care (Lin et a., 2022).” Kolcaba explains four metaparadigm ideas in detail. Nursing is the deliberate examination of comfort needs, the development of comfort protocols to address those requirements, and the subsequent evaluation of patient, community, and family comfort contrasted to a baseline.
The second definition of a patient is a person, family, or group needing medical attention. According to this definition, the first and most essential factor in determining whether someone qualifies as a patient is their need for treatment. Families and communities may also meet this requirement. Third, “environment” refers to outside variables, such as institutional support, policies, and physical surroundings. Fourth, health is defined as a patient’s ability to operate at their best (Kolcaba, 2015). Notably, this definition includes the idea of comfort since Kolcaba argues that giving a patient’s comfort requirements the attention they need promotes health.
It might be claimed that certain parts of Kolcaba’s metaparadigm are a little unclear regarding the theory’s consistency. For instance, while a community or a family may be considered, a patient is not made clear (Kolcaba, 2015). Patient-centered care places the patient at the center of health care delivery. It recognizes that the patient’s community and family are the patient’s surroundings, treatment environment, and source of support.
But contrary to Kolcaba’s concept, it does not imply that a family may be treated as a single patient. Additionally, Kolcaba often uses the phrases “patient,” “family,” and “community,” all of which are perplexing given that she already includes family and community in her description of a patient (Kolcaba, 2015). The notions are more consistently specified, nevertheless, transitioning from metaparadigm to theory conceptual framework, which improves the dependability and validity of the theory.
Application
The comfort theory’s most direct and immediate relevance to directing nurses’ activities is that the primary objective of nursing care should be to promote comfort. According to Kolcaba’s concept of comfort, the four scopes of physical experience, environmental, psychospiritual, and social, can satisfy patients’ needs for comfort (Vo T., 2020). The physical perspective links to physiological processes and operations and the patient’s feelings and experiences when receiving therapy and hospital care. It explains how a patient feels.
The psychospiritual perspective reflects the degree to which patients are conscious of their condition and how they comprehend health issues and treatments. The patient’s interpersonal and societal ties are described in the social perspective, sometimes referred to as the “sociocultural setting.” In contrast to the physical context, the environmental context depicts the patient’s immediate surroundings but also considers the patient’s mood, the attitudes of others around him, and the assistance he gets (Vo T., 2020). A nurse should intervene to increase comfort in the four situations listed above.
According to the comfort theory, a nurse should, in practice, categorize a patient’s requirements into the four settings mentioned above by speaking with the patient rather than doing so independently and based only on observations, as is evident from the theory description (Vo T., 2020). This line of action is supported by the realization that different actions are required to address demands in various circumstances.
To improve a patient’s physical or environmental comfort, it may be necessary to make changes in the patient’s room and communicate with the doctor when necessary. For instance, when patients need more medication because they are in excruciating pain or when a nurse wants to suggest a change to the facility’s patient-related policies. The patients’ relatives or the patients themselves may need to be extensively spoken with to improve patient comfort in a psychospiritual or social environment. According to Kolcaba, a nurse who uses this approach will ensure that the patient’s comfort comes first, raising the standard of care overall.
References
Current Nursing. (2020). Comfort theory by Katharine Kolcaba. https://currentnursing.com/nursing_theory/comfort_theory_Kathy_Kolcaba.html
Kolcaba, K. A. T. H. A. R. I. N. E. (2015). Katharine Kolcaba’s comfort theory. Nursing theories and nursing practice, 381-392.
Lin, Y., Zhou, Y., & Chen, C. (2022). Interventions and practices using Comfort Theory of Kolcaba to promote adults’ comfort: an evidence and gap map protocol of international effectiveness studies. https://assets.researchsquare.com/files/rs-1589710/v1/da6f5e7d-a2db-4941-aff1-1a811b6a17cf.pdf?c=1666301569
Nursing Theory. (n.d.). KOLCABA’S THEORY OF COMFORT. https://nursing-theory.org/theories-and-models/kolcaba-theory-of-comfort.php
Vo T. (2020). A Practical Guide for Frontline Workers During COVID-19: Kolcaba’s Comfort Theory. Journal of patient experience, 7(5), 635–639. https://doi.org/10.1177/2374373520968392
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