Katharine Kolcaba The University of Akron College of Nursing Comfort Theory 101 Katharine Kolcaba The University of Akron College of Nursing

What do we mean by comfort? Complex term Common use Technical definition (Kolcaba, 1992) Strengthening component (rationale for comforting interventions in both populations)

Dictionary Definitions: Comfort (Webster) 1. To soothe in distress or sorrow. 2. Relief from distress (absence of previous discomfort) (negative sense) 3. A person or thing that comforts 4. A state of ease and quiet enjoyment, free from worry (neutral sense) 5. Anything that makes life easy 6. Suggests the lessening of misery or grief by cheering, calming, or inspiring with hope (positive sense) verb, noun, adjective, adverb

Relief Relief I need help because I’m lonley.

Ease I feel totally peaceful.

Transcendence I did it! (with the help of my coach…)

Research Study: Comfort in LTC setting (Hamilton, 1989) Research questions: What is the residents’ definition of comfort? What contributes to the residents’ comfort? What detracts from the residents’ comfort? How can residents become more comfortable? (Qualitative study)

Five recurring themes: Physical Comfort homeostasis, pain relief, symptom management

2001: Data from more than 2.2 million nursing home staff who usually underestimate true pain burden of residents. Woefully inadequate pain management among frail and old population of Americans.

Positioning Returning to bed when requested Better seating arrangements

But physical comfort and positioning isn’t the only important type of comfort There are three more comfort themes that the participants in this study cited…

Comfort theme of self-esteem (psychospiritual)

Comfort theme of approach and attitudes of staff (sociocultural)

Comfort theme of hospital life (environment).

Definition of Holistic Comfort Relief Ease Transcendence Physical Psycho- Spiritual Socio-Cultural Physical: preemptive temperature and pain control (heated IV fluids, gas, analgesia pre-operatively), pain neutralized, correct positioning, Psychospiritual: reassurance, motivation Social/Cultural: advocacy, information, sensitivity Environmental: warmth, pillows for body support Environ-mental (Kolcaba, 2003)

Technical definition of Comfort (cont) The state of being strengthened when needs for relief, ease, and transcendence are met in four contexts of experience: physical, psychospiritual, sociocultural, and environmental Nice fit with nursing practice and research! Throughout lit review, I was struck by the emphasis on holistic care – all the elements of human nature being addressed

Comfort Theory (3 parts) Comforting interventions enhance patients’ comfort. Enhanced patient comfort is positively related to engagement in HSBs Comfort is strengthening When patients (and families) engage in HSBs, institutions have better outcomes Patient satisfaction, nurse retention, costs down

Practical Application Holistic assessment of patients’ comfort needs Use grid as a guide Holistic interventions to meet those needs. Relationship of comfort (holistic outcome) to health seeking behaviors (HSBs) External HSBs: e.g. functional status, rehab progress Internal HSBs: e.g. healing, t-cell counts, etc. Peaceful death: perfect for hospice and palliative care Holistic instruments to determine outcomes

Institutional outcomes: increased patient satisfaction, decreased cost, decreased readmissions, etc. Don’t forget about comfort of nurses!

Kolcaba, K. (2003). Comfort Theory and Practice. Springer. Available at: www.uakron.edu/comfort www.SpringerPub.com www.Amazon.com