Kathy Kolcaba Megan Reid and Nichole Potts October 12 th, 2011

Background Born in Cleveland, Ohio on Dec 8 th 1944 Education Diploma MSN Doctorate While developing her theory… Published a framework for dementia Diagrammed the aspects of comfort Operationalized comfort as an outcome of care Contextualized comfort She’s still going! Associate professor emeritus at UA Teaches web-based theory once a year The Comfort Line Member of ANAN and Sigma Theta Tau Lives in Cleveland

Assumptions of Comfort and Influences for Practice Outcome of intentional patient and family focused QUALITY of care. Basic need Experienced holistically Self-Comforting measures can be healthy or unhealthy Enhanced comfort = greater productivity! Influence of 3 Nursing Theories Orlando 1961/1990- relief Henderson 1978-ease Paterson and Zderad-transcendence

The basis of comfort.. 4 contexts which comfort is experienced Physical Psycho-spiritual Sociocultural Environmental When all 4 contexts, as well as the 3 theories of comfort are met, comfort has been obtained

Taxonomic Structure of Comfort ReliefEaseTransce ndence Physica l Psycho- spiritua l Environ mental Socio- cultural Determines unmet comfort needs Allows bundling of interventions in a single patient interaction Aids in creating measures of holistic comfort for documentation

Example Practical application of taxonomical structure Eva is a 12-year old Hispanic female with scoliosis. She is admitted to the PICU immediately following a spinal fusion

Propositions of Comfort Theory 3 intuitive parts when comforting interventions are effective results are increased comfort! Increased comfort of patients result in strengthening for their tasks ahead (Health Seeking Behaviors!) Increased patient engagement in Health Seeking Behaviors strengthens the institution! STRESS ON DOCUMENTATION!!

Definitions To better understand the conceptual framework for Comfort Theory…….. Health Care Needs- needs for comfort brought forth by stressful situations Comfort Interventions- intentional actions that address comfort needs of the patient Intervening Variables- interacting forces that influence the patients perception of total comfort. Comfort- experienced as a result of comfort interventions. Health-Seeking Behaviors- subsequent outcomes related to the search of health. Institutional Integrity- possessing the quality of being complete

Conceptual Framework

Metaparadigm? Health/Illness Person Environment Nursing

Parsimony  Fairly simple theory  Everyone is familiar with the idea of comfort  However, it is a complex term that has several meanings and usages in ordinary language  Requires specific tools to use – easily accessed  Comfort is a transcultural and interdisciplinary concern

Application of Theory  Three types of comforting interventions  Technical interventions – specified by nursing protocols (e.g. medications, treatments, monitoring schedules, insertion of lines, and so forth)  Coaching – consists of supportive nursing actions, active listening, referrals, advocacy, reassurance  Comfort Food for the Soul – special holistic, more time-consuming nursing interventions (e.g. massage, guided imagery, music or art therapy, special arrrangements for family members)

Expertise Required  Technical Interventions are minimum expectation of nurses (i.e. “novice” nurse)  Coaching and Comfort Food for the Soul require “expert” nurses  “Wow moments” strengthen recipients, nurses creating the moments, and the nursing discipline as a whole

Current Practice and Research  Mount Sinai Hospital in New York City  Kaiser Permanente Hospital in San Francisco  Southern New Hampshire Medical Center achieved Magnet Status by adopting Comfort Theory for application  Incorporated into national electronic databases  Comforting interventions, outcomes, and diagnoses  National Interventions Classification (NIC) and National Outcomes Classification (NOC), North American Nursing Diagnosis Association (NANDA)  Policy for Comfort Management by the American Society of Peri-Anesthesia Nurses (ASPAN)  Applies Comfort Theory throughout patients’ surgical experiences  Achieved national consensus about the development of Guidelines for Comfort Management  Used to compliment existing Guidelines for Pain Management  Initiated by nurses and is now an expectation reviewed by Joint Commission on recertification

Questionnaire

Evaluation of Theory  Original focus on gerontology but has been effective when appliedto entire institutions  Focus not only the patient comfort – but also families, supportsystems, and staff  Few criticisms noted  May be difficult to apply at times due to patient individuality  People vary significantly in their personal need or desire for certainlevels of comfort  Prevention of discomfort is easier to treat than comfort itself  Provides the language and rationale to document essential nursingactivities

Comfort by S.D. Lawrence (student nurse) Comfort may be a blanket or a breeze, Some ointment here to soothe my knees, A listening ear to hear my woes, A pair of footies to warm my toes, A PRN medication to ease my pain, Someone to reassure me once again, A call from my doctor, or even a friend, A rabbi or priest as my life nears the end. Comfort is what ever I perceived it to be A necessary thing defined “only by me”.

References Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and research. New York, New York: Springer Publishing Company, Inc. Kolcaba, K., & DiMarco, M. (2005). Comfort theory and its application to pediatric nursing. Pediatric Nursing, 31(3), Retrieved from EBSCOhost. Parker, M. E., & Smith, M. C. (2010). Katharine Kolcaba’s comfort theory. In Nursing theories and nursing practice (3rd ed., pp ). Philadelphia: F.A. Davis Company.