The Theory of Comfort in Nursing Essay
Out of the magnitude of the nursing theories which include practice nursing theories, mid-range nursing theories, and grand nursing theories, it appears that mid-range theories deserve more attention and focus. My choice of a mid-range nursing theory is backed by the explanation that mid-range nursing theories tend to be more specific and narrow in the area of their application. Furthermore, mid-range theories serve as a bridge between the nursing practice and the grand nursing theories (Peterson & Bredow, 2008). With this in mind, the mid-range theories offer more than concepts and vague ideas, which are theoretical in nature. Mid-range theories, in my opinion, serve as nursing strategies with a theory-based practical approach that may be effectively applied in various outpatient settings.
The interest in mid-range nursing theories is on the increase, and more and more publications are released dedicated to various theories which are successfully applied in various patient settings. The majority of the mid-range theories are used to foster research and practice, in this light, the paper will focus on the emergence of the mid-range theory and its application as well as approaches relating to its application. For my paper, I have selected, out of many, the theory of comfort, introduced by Katharine Kolcaba.
The theory of comfort was developed by Katharine Kolcaba in the early 90s. Katharine was born on December 8th, 1944 in Ohio, Cleveland. She went to St. Lukes Hospital School of Nursing where she obtained her first diploma in 1965. She then proceeded with her education and attended Frances Payne Bolton School of Nursing in Case Western Reserve University in 1987. In 1997, she obtained a PhD. in nursing and was awarded a certificate of authority as a clinical nursing specialist. During her studies, Katharine studied various medical areas including Long Term Care Interventions, Gerontology, Instrument Development, End of Life and Nursing Theory, Research pertaining to nursing and comfort. It was during Kolcabas master studies that she took a position of a head-nurse in an Alzheimers unit and became interested in the outcomes of comfort, and decided to impart a theoretical shape to the theory of comfort. It was as early as in 1991 that Katharine published her first article An analysis of the concept of comfort laying the groundwork for the comfort theory. In 1994, Katharine published another article theory of holistic comfort in nursing. Working as a university teacher, Katharine published a series of articles, and eventually all her work boiled down to the book, Comfort Theory and Practice: a Vision for Holistic Health Care and Research which was published in 2003. In 2007, Katharine retired from the university as a full-time teacher, although she continues to teach part time and does not abandon her research of the comfort theory.
Theoretical development of the theory of comfort has been backed up by a series of peer-reviewed articles published in prominent medical journals over the last 20 years. The theory of comfort has become a foundation for an array of thesis and dissertations, and the concept itself blossomed into a solid middle-range medical theory and research (Peterson & Bredow, 2008). Since the 1990s, multiple nursing books focusing on mid-range theories have been published, and rarely was Kolcabas theory of comfort omitted from the scope of .
Having studied Kolcabas works on the theory of comfort, it is hard to escape a conclusion that Katharine uses an inductive approach in putting forward her mid-range medical theory. Based on the premise that deductive reasoning is founded on a rule or a law, or a principal for that matter, and then specific examples are presented to ascertain that the theory applies to them. Conversely, inductive reasoning is founded on examples or situations which demonstrate whether the principal will emerge. Kolcaba used an inductive approach, because the fundamental concept of comfort (whether environmental, physical, or cultural) is abstract in nature. Comfort itself is an ambiguous notion, and definitions or views of what it means may vary among patients. Using an inductive approach, Kolcaba discovers the comfort needs of the patient by placing him in a situation where the comfort conditions are created. The patient is relieved of chronic pain, and then the level of comfort, based on patients preferences is enhanced. The patient is then encouraged to adopt health-seeking behaviors as advised by the nurse. Certain conditions created for a patient and a series of observations of patients reaction allowed Kolcaba, based on inductive approach, to see that the theory of comfort was valid.
It is interesting to trace the roots of the Theory of Comfort in Kolcabas work. As Katharine wrote in her article A Taxonomic Structure for the concept comfort the ideas behind the theory of comfort, specifically on Relief were adapted from Ida Jean Orlandos work where the central job of nurses was to relieve the patients needs. Virginia Hendersons work on Ease was used to define the state of calm and contentment, and finally Josephine Paterson and Loretta Zderads work on Transcendence and Kolcabas interpretation of it as the patients ability to rise above problems and pain (Kolcaba, 1991). Eventually, those three pillars were used by Kolcaba in her definition of comfort.
The comfort theory developed by Kolcaba studies the obstructions and problems in a healthcare situation, such as chronic illness or pain that may prevent a patient from achieving a state of comfort (Kolcaba, 1994). The theory describes comfort as an immediate, desirable atmosphere for the patient that needs to be created in a nursing care setting. In her later paper, published in 2001, Kolcaba expands the definition of comfort as a state where basic human needs for ease of being, state of relief, and transcendence are met (Kolcaba, 2001). The four concepts of comfort defined by Kolcaba are placed in four contexts: 1. Physical which relates to a patients sensations which may depend on cold and heat levels, disruptions, bleeding, etc. 2. Psychospiritual which relate to how a patient identifies his place in a community, that includes his esteem, beliefs, his power and authority, and communitys respect. 3. Environmental, relating to the immediate surroundings of a patient, such as light, sound, noise level, furniture, view from the windows, etc. and finally 3. Sociocultural relating to patients relations with his family and society at large (Kolcaba, 2006).
Kolcaba wrote that patients have implicit and explicit comfort needs, and when they are attained, patients are motivated to adopt life-seeking behaviors and take up a new health routine (Kolcaba, 2001).
The fundamental values and beliefs underlying the theory of comfort stem from Kolcabas assumption that patient needs if met encourage them to achieve better results in rehabilitation and follow a new life routine. The second assumption underlying the theory states that patient needs are governed by his expectations, and patients expect nursing care to be within competence. Finally, when nurses provide better comfort conditions for the patient, better results are achieved leading to overall patient satisfaction and financial stability of the medical institution (Kolcaba, 2001).
Concepts and ideas that provide a foundation for the theory of comfort stem from comfort needs, comfort intervention, enhanced comfort levels, and health-seeking behaviors. These concepts are aligned with mid-range theories, as they are well-defined and specific. All of the above concepts are relevant to patients, families, and nurses (Peterson & Bredow, 2008).
Despite a wide range of nursing theories, there are four basic nursing metaparadigms that address the patient as a whole (Peterson & Bredow, 2008). The first one relates to the patients health and patients as human beings. The second deals with the environment in which the patient is placed, and the surroundings that affect the patient. The third one relates to a patients health component, exploring how a persons physical, emotional, social well-being is incorporated in health care. The final metaparadigm deals with the nursing concept which involves application of knowledge, skills, technology, and expertise that is used in achieving the best outcome for a patient.
It is interesting to place the four nursing metaparadigms into the dialogue with Katharine Kolcabas comfort theory. The first one relates to human beings, the theory of comfort is directly aligned with this metaparadigm as comfort is essential to all people. Kolcaba notes that patients who are more comfortable are more likely to adopt healthy behaviors (Kolcaba, 2001).
The second metaparadigm dealing with the environment is directly linked to Kolcabas theory of comfort. Improving the patients surroundings may lead to enhancing the patients comfort level. When a nurse works to eliminate negativity in the surrounding environment, it results in patients positive thinking and better attitude to life and health as a whole.