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Slide 1: Katharine Kolcaba’s Click to edit Master subtitle style Comfort Theory of Kara Smail, RN, BSN 12/4/09
Slide 2: Katharine Kolcaba     Born in Cleveland, OH St. Luke’s Hospital School of Nursing in 1965 Med-Surg; Long term care and home nurisng Frances Payne Bolton School of Nursing, Case Western Reserve University, graduated with MSN in 1987 Developed Theory of Comfort over a 10 year period while doing doctoral coursework University of Akron; graduated with PhD in 1997 12/4/09  
Slide 3: Influences on the Theory of Comfort      Florence Nightingale Ida Jean Orlando Virginia Henderson Josephine Paterson Loretta Zderd 12/4/09
Slide 4: The Theory of Comfort  Focuses on how the state of comfort of patients, families and nurses affects a patient’s healing process. 12/4/09
Slide 5: The Main Premise of the Theory of Comfort  “The Theory of Comfort, as applied in a Comfort Place, explicates a philosophy of care whereby holistic comfort needs of patients, families and nurses are identified and addressed.”  Peterson & Bredow, (2009). 12/4/09
Slide 6: Main Concepts of Comfort Theory      Relief Ease Renewal or Transcendence Physical Mental  Peterson & Bredow, (2009). 12/4/09
Slide 7: Four Contexts of Holistic Experience      Physical Psychospiritual Social Environmental All made into a 12 cell grid  Peterson & Bredow, (2009). 12/4/09
Slide 8: Taxonomic Structure of Comfort 12/4/09
Slide 9: Relief  A specific comfort need of a patient is addressed. A specific area of a patient’s body or surroundings is addressed to provide adequate comfort.  12/4/09
Slide 10: Ease  As defined by Kolcaba, “a state of calm and contentment.” Tranquility   Peterson & Bredow, (2009). 12/4/09
Slide 11: Renewal and Transcendence  A patient rises above the pain and discomfort and is completely comfortable. Renewal was the original term of this concept but was later changed to transcendence, which was a term already used in nursing literature. Peterson & Bredow, (2009). 12/4/09  
Slide 12: Physical  Pertains to pain, discomfort, and any imbalance with the five senses.  Peterson & Bredow, (2009). 12/4/09
Slide 13: Psychospiritual  Combination of mental health and tranquility and spiritual well-being Both important in a well balanced life to help the healing process and/or remaining healthy.   Peterson & Bredow, (2009). 12/4/09
Slide 14: Social      Family Friends Co-workers Society Relationships with all of the above  Peterson & Bredow, (2009). 12/4/09
Slide 15: Environmental    Home Work Climate  Peterson & Bredow, (2009). 12/4/09
Slide 16: Additional Concepts       Comfort Needs Comfort Interventions Intervening Variables Enhanced Comfort Health-Seeking Behaviors Institutional Integrity 12/4/09
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Slide 18: Assumptions   Comfort is a desired state Human beings actively try to meet comfort needs. Comfort is more than physical discomforts. Humans have holistic responses to stimuli.   12/4/09
Slide 19: Propositions  When comfort interventions are effective in a caring manner, the outcome of enhanced comfort is obtained. If Health-Seeking Behaviors are successful in increasing the level of comfort, patients, nurses and family members will continue to use them and look for more. Peterson & Bredow, (2009). 12/4/09  
Slide 20: More Propositions  When patients, families and nurses are satisfied with health-care delivery in a specific institution, that institution will be acknowledged. The Theory of Comfort can be applied to any health care setting.   Peterson & Bredow, (2009). 12/4/09
Slide 21: Middle Range Theory of Caring  Kristen Swanson’s Theory of Caring is very similar to Kolcaba’s Theory of Comfort. The Caring Theory has similar assumptions including environment, nursing, person, health, and caring. All of the above assumptions are similar to concepts discussed in the Comfort Theory. Swanson, (1993). 12/4/09   
Slide 22: Analysis and Evaluation   Internal Criticism External Criticism 12/4/09
Slide 23: Internal Criticism      Adequacy Clarity Consistency Logical Development Level of Theory Development 12/4/09
Slide 24: Adequacy  Comfort Theory applies to all health care settings and patient populations. Each concept and context cover all areas of comfort for a patient, family member and nurse.  12/4/09
Slide 25: Clarity    Clearly presented Easy to understand Easy to comprehend instruments used in research 12/4/09
Slide 26: Consistency  The three main concepts (relief, ease and transcendence) were used throughout the literature. The definitions of the assumptions and propositions were mentioned throughout the literature and were consistently used in the research.  12/4/09
Slide 27: Logical Development  Thoroughly discusses the development of theory throughout literature and how the theory evolved. Conclusions derived and supported by years of research and use of tools to support that research. Conclusions also congruent with key concepts. 12/4/09  
Slide 28: Logical Development (con’t)  Nightingale’s definition of comfort and the relationship between health and comfort. 12/4/09
Slide 29: Level of Theory Development  Key concepts are very well defined and specific to various patient populations and health care settings, which fits the criteria for a middle-range theory. 12/4/09
Slide 30: Tautology  There appears to be no repetition that would interfere with the clarity of the theory. Concepts and conclusions clearly defined and pointed out in all literature obtained.  12/4/09
Slide 31: Teleology  Concepts clearly defined without introducing a new set of concepts. Only three main concepts: Relief, Ease, Transcendence and four contexts: physical, social, psychospiritual, and environmental.  12/4/09
Slide 32: External Criticism        Complexity Discrimination Reality Convergence Pragmatic Scope Significance Utility 12/4/09
Slide 33: Complexity   Easy to read and understand Followed all concepts, contexts and research applications clearly. Three concepts and four contexts all made into a 12 cell grid to make it easy to follow and understand  12/4/09
Slide 34: Complexity (con’t)  Explanations are short and to the point but thoroughly explain a research application or purpose of the theory. 12/4/09
Slide 35: Discrimination   Unique to nursing Nurses care for patients holistically and the Comfort Theory shows that with the four contexts of physical, social, psychospiritual and environment. Boundaries of application are described with the specific patient populations and health care settings. 12/4/09 
Slide 36: Reality Convergence  Assumptions clearly defined and can be applied to any patient population as shown in Kolcaba’s research and literature. Kolcaba has a real perspective on the world of nursing and can easily fit the Comfort Theory into that world. Comfort is a major part in holistic patient care. 12/4/09  
Slide 37: Pragmatic  Variables are measurable using tools such as the General Comfort Questionnaire and Comfort Behaviors checklist Health-Seeking Behaviors Institutional Integrity Many other instruments used in all health care settings in today’s nursing. 12/4/09   
Slide 38: Institutional Integrity 12/4/09
Slide 39: Scope  Although the Comfort Theory can be applied to specific patient populations and settings, it can actually be applied to all patient populations and health care settings. Because it is patient population specific, it is classified as a Middle-Range Theory.  12/4/09
Slide 40: Significance   Very well known across the nursing world. Comfort is a patient outcome in any health care setting, therefore if nurses are providing care based on the comfort theory, the ultimate comfort goal for the patient should either be relief, ease or transcendence. Nurses strive everyday to make their patients comfortable. 12/4/09 
Slide 41: Utility  Kolcaba uses various instruments in her research such as the General Comfort Questionnaire which asks a various number of questions about the patients’ comfort based on the three concepts and four contexts of comfort. This is measured ranging from “strongly agree” to “strongly disagree.” 12/4/09
Slide 42: Utility (con’t)  Kolcaba’s Comfort Theory is taking part in recognitions such as Magnet Status, the AACN Beacon Award and the JCAHO Gold Seal of Approval. Kolcaba is traveling all over the nation to present the Comfort Theory for these particular recognitions.  12/4/09
Slide 43: Utility (con’t)  Kolcaba took part in a research study on the comfort warming of preoperative patients, where other researchers as well as Kolcaba used the comfort theory’s General Comfort Questionnaire as the instrument of choice in the research. The study revealed that comfort warming provided basic comfort and decreased overall anxiety before surgery. 12/4/09 
Slide 44: Utility (con’t)  Kolcaba’s Comfort Theory is also used to decrease stress in college students by the healing touch method, which is one of the methods mentioned in the Comfort Theory. Research has shown that the healing touch has decreased situational stress levels of college students. Kolcaba, (1997). 12/4/09  
Slide 45: Practice Problem  A lack of comfort in an acute care setting due to lack of holistic assessment. A physical, mental, social, and spiritual assessment needs to be made every time a patient is admitted to an acute care setting. Addressing all these needs should increase patient’s comfort. 12/4/09  
Slide 46: Research Article #1  Enhancing ability of nursing students to perform spiritual assessments. Previous research has shown lack of ability of nursing students to perform a spiritual assessment. The article discusses interventions to help students feel more comfortable performing a spiritual assessment and assisting them in doing so. 12/4/09  
Slide 47: Research Article #2  This article discusses the effects of comfort warming on preoperative patients. Concludes that patients have an increased basic comfort and decreased anxiety before surgery as well as a decrease in post-op complications. Wagner, (2006). 12/4/09  
Slide 48: Research Article #3  The third article looks at guided imagery in breast cancer patients receiving radiation therapy. One group did not receive guided imagery while another group did receive the treatment. The Radiation Therapy Comfort Questionnaire was used and concluded that the treatment group showed more comfort using guided imagery. Also the guided imagery is used to help decrease stress levels on college students as mentioned before. Kolcaba, (1997). 12/4/09    
Slide 49: Conclusion  Katharine Kolcaba has done much research on the Theory of Comfort. Benefit to the world of Nursing and overall patient care.  12/4/09
Slide 50: References Hoffert, D., Henshaw, C., & Mvududu, N. (2007). Enhancing the ability of nursing students to perform a spiritual assessment. Nurse Educator, 32(2). Retrieved from www.cinahl.com/cgi-bin/refsvc?jid=276&accno=2009552185 Kolcaba, K. (2002). Comfort Theory & Practice: A Vision for Holistic Health Care & Research. New York City, NY: Springer Publishing Co. Kolcaba, K. (2006, April 06). The Comfort Line. Retrieved from http:www.thecomfortline.com 12/4/09
Slide 51: Kolcaba, K. (1997). Effects of guided imagery on comfort in women with breast cancer choosing conservative therapy. Case Western Reserve University: Research Dissertation, 1. Retrieved from http://ezaccess.libraries.psu.edu/login?url=http://search.ebscohost.com/login Peterson, S., & Bredow, T. (2009). Middle Range Theories: Application to Nursing Research. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. Swanson, K. (1993). Nursing as Informed: Caring for the Well-Being of Others. Journal of Nursing Scholarship, 25(4), Retrieved from http://www.plu.edu~downsel/doc/swansons-theory.pdf 12/4/09
Slide 52: Wagner, D., Byrne, M., & Kolcaba, K. (2006). Effects of comfort on warming preoperative patients. AORN, 84(3), Retrieved from http://www.sciencedirect.com.ezaccess.libraries.psu.edu 12/4/09