The Comfort Theory Comfort is the immediate state of being strengthened through having the human needs for

relief, ease, transcendence met in 4 contexts of experience - physical, psycho-spiritual, socio-cultural, and environmental. Kathy Kolcaba, RN MSN PhD, author, Comfort Theory and Practice: A Vision for Holistic Health Care Research. Comfort Theory Propositions o The theory states that, in stressful healthcare situations, unmet needs for comfort are met by nurses o Nursing interventions are successful if enhanced comfort is achieved by patient compared with a previous baseline o The immediate patient outcome of enhanced comfort is directly and positively related to patients engaging in health seeking behaviors. o When patients engage in health seeking behaviors, they report high satisfaction in their healthcare. o High patient satisfaction leads to greater institutional outcomes and better institutional integrity

Copyright 2012 Katharine Kolcaba, RN, MSN, PhD. Creative Commons 3.0 AttributionNoncommercial-No Derivative Works. The Comfort Line, Chagrin Falls, Ohio 44022. E-mail: kathykolcaba@yahoo.com Phone: 440-655-2098 Web: http://thecomfortline.com

o Institutional integrity is conceptualized as the quality or state of health care corporations being complete, sounds, upright, honest and sincere.

Figure No. 1 Conceptual Framework. Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort theory: a unifying framework to enhance the practice environment. Journal of Nursing Administration, 36(11), 538-544. Comfort Theory Concepts Health Care Needs are those identified by the patient/family in a particular practice setting. Intervening Variables are those factors that are not likely to change and over which providers have little control (such as prognosis, financial situation, extent of social support, etc). Comfort is an immediate desirable outcome of nursing care, according to Comfort Theory. Additionally, when comfort interventions are delivered consistently over time, they are correlated with a trend toward increased comfort levels over time (the first part of Comfort Theory), with desired health seeking behaviors (HSBs), and with improved institutional outcomes.
Copyright 2012 Katharine Kolcaba, RN, MSN, PhD. Creative Commons 3.0 AttributionNoncommercial-No Derivative Works. The Comfort Line, Chagrin Falls, Ohio 44022. E-mail: kathykolcaba@yahoo.com Phone: 440-655-2098 Web: http://thecomfortline.com

Health Seeking Behavior (HSBs): The concept of HSBs was first introduced by Scholtfeldt (1975). HSBs can be internal (healing, immune function, number of T cells, etc.), external (health related activities, functional outcomes, etc.), or a peaceful death. The relationships between comfort and health seeking behaviors are entailed in the second part of Kolcaba's Comfort Theory. Institutional Integrity (InI) is defined by Kolcaba (2007) as the values, financial stability, and wholeness of health care organizations at local, regional, state, and national levels. In addition to hospital systems, the definition of institutions includes Public Health agencies, Medicare and Medicaid programs, Home Care agencies, Nursing Home consortiums, etc. Examples of variables related to this expanded definition of InI include patient satisfaction (HCHAPS scores!), cost savings, improved access, decreased morbidity rates, decreased hospitalizations and readmissions, improved health-related outcomes, efficiency of services and billing, and positive cost-benefit ratios. Relationships between Comfort, HSBs, and InI constitute the third part of the theory. Best Policies are protocols and procedures developed by an institution for overall use after collecting evidence. Best Practices are those protocols and procedures developed by an institution for specific patient/family applications (or types of patients) after collecting evidence.

Copyright 2012 Katharine Kolcaba, RN, MSN, PhD. Creative Commons 3.0 AttributionNoncommercial-No Derivative Works. The Comfort Line, Chagrin Falls, Ohio 44022. E-mail: kathykolcaba@yahoo.com Phone: 440-655-2098 Web: http://thecomfortline.com

Comfort Theory Taxonomic Structure

Figure No. 2 Taxonomic Structure. Kolcaba, K. Y. (1991). A taxonomic structure for the concept comfort. Image: Journal of Nursing Scholarship, 23(4), 237-240. Relief: The state of having a severe discomfort mitigated or alleviated Ease: The absence of specific discomforts. To experience ease a patient does not have to have previous discomfort Transcendence: The ability to rise above discomforts when they cannot be eradicated or avoided. Physical: Pertaining to bodily sensations and homeostatic mechanisms. Psycho-spiritual: pertaining to internal awareness of the self, including esteem, concept, sexuality, meaning in ones life and ones relationship to a higher order or being.
Copyright 2012 Katharine Kolcaba, RN, MSN, PhD. Creative Commons 3.0 AttributionNoncommercial-No Derivative Works. The Comfort Line, Chagrin Falls, Ohio 44022. E-mail: kathykolcaba@yahoo.com Phone: 440-655-2098 Web: http://thecomfortline.com

Environmental: pertaining to the external background of human experience (temperature, light, sounds, odor, color, furniture, landscape, etc.). Socio-cultural: pertaining to interpersonal, family, relationships, traditions, rituals, and religious practices. Summary The aspects of comfort are interrelated and the whole is greater than the sum of its parts. Therefore, a total Comfort Score, rather than individual parts, is consistent with this holistic concept. Comforting interventions are delivered in an intentional way. If one cell receives compassionate attention, the total patient response may be greater than would be expected by the nature of the specific comfort intervention. and societal

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Copyright 2012 Katharine Kolcaba, RN, MSN, PhD. Creative Commons 3.0 AttributionNoncommercial-No Derivative Works. The Comfort Line, Chagrin Falls, Ohio 44022. E-mail: kathykolcaba@yahoo.com Phone: 440-655-2098 Web: http://thecomfortline.com