TheoryofComfort

Southwest Baptist University : 

The Theory of Comfort Southwest Baptist University Tedra Estis , Laura Flowers, Lauren Underwood, Amanda Wright

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Introduction: Lauren Underwood (slides 2-14) Theorist Overview: Amanda Wright (slides 15-23) Nursing Theory Metaparadigms : Laura Flowers (slides 24-35) Implications to Nursing: Tedra Estis (slides 36-46) OVERVIEW

Comfort Theory Introduction: 

Comfort theory was created in the 1990’s by Katharine Kolcaba , RN, MSN, PhD. Provides frame-work for patients enhanced sense of well being. Kolcaba believes that comfort is a positive concept with many aspects beyond just physical comfort. ( Kolcaba , 2010) Comfort Theory Introduction

Comfort Theory: 

Comfort Theory Mid-range Theory Nursing practice Nursing education Nursing research ( Kolcaba , 2010)

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All interactions with patients and family members should be therapeutic. Nurses should assess for holistic comfort needs of patients and family members then design interventions to meet them. ( Kolcaba , 2010) Principles of Comfort Theory

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Nursing staff should attempt to comfort patients and family members with a personal touch and sense of cultural awareness. Regularly reassess the comfort needs of patients and family members. ( Kolcaba , 2010) Principles of Comfort Theory cont’

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Principles of Comfort Theory cont’ Document patient and family members comfort levels frequently for efficient care and positive outcomes. ( Kolcaba , 2010)

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Additions to Nursing Practice Advanced directives Nursing care plan Hospice care Adult nursing care Peri -anesthesia nursing ( Kolcaba , 2010)

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“Holistic comfort is defined as the immediate experience of being strengthened through having the needs for relief, ease, and transcendence met in four contexts of experience” ( Kolcaba , 2010, para 4). Comfort Theory Definition

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Nurse identifies the patient’s comfort needs. Interventions are developed for patient. Patient develops enhanced comfort. Finally, either health seeking behaviors are begun or a peaceful death (depending on patient's condition). Steps of Comfort Theory ( Kolcaba , 2010)

Framework for Comfort Theory Development: 

Framework for Comfort Theory Development ( Kolcaba , 2010)

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Types of Comfort Theory Relief Ease Transcendence ( Kolcaba , 2010)

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Physical Psychospiritual Social Environmental Context of Experience ( Kolcaba , 2010)

Comfort Theory’s Taxonomic Structure: 

Comfort Theory’s Taxonomic Structure ( Kolcaba , 2010)

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The Basic Concepts Health Care Needs Intervening Variables Comfort Enhanced Comfort Institutional Integrity Best Policies Best Practice Theory of Comfort ( Kolcaba , 2010)

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According to the Theory of Comfort by Kolcaba , the Health Care needs are the needs that are determined through the patient in need. Health Care Needs ( Kolcaba , 2010)

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Intervening Variables The intervening variables are known as things that are not going to change. These variables include things such as the patients’ prognosis, their money situation, etc. Kolcaba , 2010

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Comfort This concept of comfort is the most important concept of the Theory by Kolcaba “The intentional comforting actions of nurses strengthen patients and their families. When patients are strengthened by actions of health care personnel, they can better engage in health seeking behaviors” ( Kolcaba , 2010).

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After the concept of comfort is established between the nurse and their patient, the next step in the Theory of Comfort is Enhanced Comfort. This concept is achieved immediately after comfort. Providing Enhanced Comfort can lead to the patient obtaining many health seeking behaviors. Enhanced Comfort ( Kolcaba , 2010)

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Institutional Integrity The concept of Institutional Integrity is a concept that is dependent on the nurse and the facility that the nurse is working at. It is our job as a health care professional to bring the best experience to all our patients throughout their stay in our facility. ( Kolcaba , 2011)

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According to the Theory of Comfort, this concept is “defined as the values, financial stability, and wholeness of health care organizations at a local, state and national level” (Kolcaba, 2010). Institutional Integrity cont’

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Best Polices & Best Practices The last two concepts of the theory by Kolcaba is the concepts of best polices and best practice. Best polices is the individual facilities procedures and guidelines that they have established as a whole. These are brought out by the nurses who work for the facility, and should be performed to the best of their ability. ( Kolcaba , 2010)

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Best Polices & Best Practices cont’ Best practices the procedures and protocols that are being performed throughout the institution, however what makes them different than polices is because they are determined on a individual basis for each individual patient throughout the hospital. (Kolcaba, 2010)

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The Theory of Comfort

Comfort theory from the concept of PERSON: 

Comfort theory from the concept of PERSON Persons can be considered as individuals, families, institutions or communities in need of health care. ( Kolcaba , 2010)

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Comfort theory from the concept of Environment Any aspect of the patient, family or institutional surroundings that can be manipulated by a nurse(s) or loved one(s) to enhance comfort. ( Kolcaba , 2010)

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Nursing is described as the process of assessing the patient's comfort needs, developing and implementing appropriate nursing interventions, and evaluating patient comfort following nursing interventions. ( Kolcaba , 2010) Comfort theory from the concept of Nursing

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Comfort theory from the concept of Health Health is considered to be optimal functioning as defined by the person, group, family or community . ( Kolcaba , 2010)

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Kolcaba described comfort as existing in 3 forms: relief, ease, and transcendence . Comfort theory practice in WELLNESS CARE “Positive correlations have been shown between comfort achieved by relaxation and imagery to enhanced immune parameters” ( Kolcaba , 1994).

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“Comfort achieved by relaxation and imagery have desirable effects on blood pressure, pulse and respirations” ( Kolcaba , 1994). Comfort theory practice in WELLNESS CARE cont ’

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Comfort theory practice in WELLNESS CARE cont ’ “In efforts to increase athletic performance and endurance, comfort achieved by imagery was related positively to basketball skills, muscular endurance irrespective of mood state and strength” ( Kolcaba , 1994).

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Comfort theory practice in ILLNESS CARE PHYSICAL: Preemptive temperature and pain control (heated IV fluids, gas, analgesia pre-operatively), pain neutralized, correct positioning. PSYCHOSPIRITUAL: Reassurance, motivation. ( Kolcaba , 2010)

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SOCIAL/CULTURAL: Advocacy, information, sensitivity ENVIRONMENTAL: Warmth, returning to bed when requested, repositioning pillows for comfort. ( Kolcaba , 2010) Comfort theory practice in ILLNESS CARE cont ’

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STRENGTHS/WEAKNESS of the Comfort Theory STRENGTHS: Requires only a simple, common sense approach. Comforting interventions enhance patients’ comfort. When patients’ and families engage in health-seeking behaviors, institutions have better outcomes. ( Kolcaba , 2010)

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STRENGTHS/WEAKNESS of the Comfort Theory cont ’ WEAKNESS: Research on the concept of Comfort is limited and the meaning of Comfort has not been defined. The concept of c omfort might need to be taught to those who do not come by the skill naturally. ( Malinowski, A., & Stamler , L ., 2002 )

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Implications to Nursing Theory of Comfort

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Providing comfort Relief-alleviating the pain or discomfort Ease-the absence of a specific pain Transcendence-being able to work through the pain when the pain cannot be alleviated Comforts ( Kolcaba , 2011)

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Comforts cont’ Relieving pain Single medication modality Massage Slow deep breathing Guided imagery ( Kolcaba , 2011)

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Comforts cont ’ Easing pain Exercise Healthy diet Meditation Music therapy ( Kolcaba , 2011)

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Comforts cont’ Transcendence Support groups Prayer Friends and family support ( Kolcaba , 2011)

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Nursing Implications Clinical areas where research has been done Pediatrics Hospice care Orthopaedic Adult care Peri -anesthesia ( www.thecomfortline.com ) ( Kolcaba , 2010)

Pediatrics: 

Pediatrics Measuring pain FACES FLACC Kolcaba Posies Avoid the word “pain” Use uncomfortable Or hurt (Kolcaba & DiMarco, 2005)

Pediatrics: 

Pediatrics Comforting the infant Cuddling and snuggling, swaddling Thumb sucking or pacifier Feeding Rocking ( Kolcaba & DiMarco , 2005)

Pediatrics: 

Pediatrics Comforting the toddler Parent presence Favorite toy from home Promote routine Allow appropriate choices such as snacks (Kolcaba & DiMarco, 2005)

Pediatrics: 

Pediatrics Comforting the school age child Presence of friends Allowing autonomy as appropriate Verbal reassurance from the nurse Comforts from home: clothes, electronics Availability of the nurse to reassure parents, provide demonstrations of teaching, answer questions ( Kolcaba & DiMarco, 2005)

Pediatrics: 

Pediatrics Comforting the adolescent Providing privacy Reading body language Providing autonomic decision making where appropriate Time for friends (Kolcaba & DiMarco, 2005)

Hospice care: 

Hospice care Define the dying patient’s physical, psychospiritual , environmental, and sociocultural needs Involve the family in the decision making process. Develop patient’s end-of-life goals Implement patient’s plan Evaluate and reassess ( Kolcaba , 2011)

Conclusion: 

Conclusion The Theory of Comfort written by Katharine Kolcaba explores three levels of comfort: Relief , Ease and Transcendence as they affect the physical, psychospiritual , social and environmental aspects of the whole person.

Conclusion cont’: 

Conclusion cont’ Kolcaba teaches effective nursing interventions that continually demonstrate increase in comfort for the patient and the patients’ family. When comfort is established, health seeking behaviors can begin, or plans for a peaceful death.

References: 

References Kolcaba , K.Y. (1994). A theory of holistic comfort for nursing . Journal of Advanced Nursing, 19(6), 1178-1184. Kolcaba, K.Y. (2010) Comfort Line . Retrieved February 5, 2012, from http://thecomfortline.com Kolcaba, K.Y. (2011) Comfort theory. Retrieved February 5, 2012, from Nursing Theories : http// currentnursing_theory / comfort_theory_Kathy_Kolcaba.html

References: 

References Kolcaba , K. & DiMarco , M.A. (2005). Comfort theory and its application to pediatric nursing. Pediatric Nursing . 31(3), 187-194. Kolcaba’s Theory of Comfort (2011). Retrieved February 3, 2012 from http://nursing- theory.org/theories-and-models/kolcaba - theory-of- comfort.php Malinowski, A., & Stamler , L. (2002). Comfort: exploration of the concept in nursing. Journal of Advanced Nursing , 39(6), 599-606.