Background
While the concept of comfort in nursing had been explored before, Katharine Kolcaba’s contributions to its research provided healthcare professionals with essential knowledge for future research on the topic. Kolcaba is a professor of nursing at the University of Akron, who formulated the comfort theory and associated measurement tools in the 1990s (Katharine Kolcaba – Nursing theorist, n.d.). Her research sparked numerous studies on patient-nurse interactions that focused on mitigating adverse factors that hindered the efficiency of care processes.
The phenomenon that the theorist describes in her works is patients’ perceptions of comfort. The author analyzes various types of comfort as basic human needs intertwined with the notion of care (Freire et al., 2021). The state of satisfaction with all individuals’ concerns is considered the goal under this model. The translation of the subjectivity of such ideas is what Kolcaba provides through her work.
Description of the Theory
The Kolcaba model is a middle-range nursing theory that focuses on patients’ experiences and perceptions of their care. This structure outlines how comprehensive care processes address an individual’s needs and the paths nurses can take to achieve the desired outcomes for the relief of various types of discomfort (Freire et al., 2021). As shown in Figure 1, the concepts from this model integrate the institutional and personal aspects of care into a unified framework that explains how various factors influence one’s perception of their health.
There are four contexts, including physical, spiritual, social, and environmental, and three forms of comfort, such as relief, transcendence, and calmness, within this theory (Freire et al., 2021). They are connected through internal and external aspects that create unpleasant experiences, describing how each form can be achieved within each dimension.
Evaluation of the Theory
The theory of comfort is easy to comprehend and apply across various healthcare settings due to its streamlined structure. The model clearly and concisely addresses all four metaparadigms, allowing nurses to apply them in practice with minimal adjustments. The patient is seen as the one who seeks relief, while the nurse provides it. One’s health is defined as the absence of discomfort sources, while the environment is the root of both positive and negative effects on one’s health, which nurses strive to manipulate to favor their patients.
There are deficiencies in the theory stemming from its perceptions of patients. As illustrated in Figure 1, patients are driven to seek comfort due to internal and external factors. However, this model does not account for a person’s actual participation in their treatment. Moreover, the theory is challenging to extrapolate to a larger audience for situations where a group of individuals represents patients. Therefore, nurses must consider how these limitations impact their application of Kolcaba’s method in public health initiatives and how patients’ efforts contribute to achieving a state of comfort.
Application of the Theory
The first article explores how education regarding one’s treatment and its impact affects the comfort of hemodialysis patients. The author analyzes how the comfort levels of control and intervention groups change throughout their therapy sessions, depending on their level of knowledge (Vicdan, 2020). The concepts are applied in this study to calculate mean scores for each context and dimension of comfort from Kolcaba’s theory, in correlation with a patient’s education regarding their treatment.
Kolcaba provided the measurement tool, the General Comfort Questionnaire (GCQ), to assess the components of the theory, successfully translating the theory into practice with high validity (Vicdan, 2020). Kolcaba’s model is operationalized through the GCQ, enabling the researcher to identify the most prevalent types of discomfort during hemodialysis.
The second study that utilizes Kolcaba’s theory takes a different approach to applying its concepts, offering a unique perspective on the range of the model’s applications. Instead of using the GCQ, the researchers conducted semi-structured interviews to conduct a descriptive, qualitative analysis of patients’ perceptions of hemodialysis (Freire et al., 2021). The authors use concepts from Kolcaba’s model to derive statements that capture an interviewee’s positive or negative experiences regarding a specific dimension of pain alleviation. This study outlines indicators of each form of comfort, enabling nurses to understand the goals patients pursue or require during their treatment.
As a nephrology nurse, I can apply the theory of comfort to assess factors that prevent patients from achieving a desired state of well-being, using measurement tools to do so. The model’s concepts can be operationalized through the GCQ, which enables quick analysis of one’s subjective experiences via a short survey. In addition to measurements, the theory enables me to formulate clinical questions relevant to specific situations in which it is essential to understand the patient’s well-being. In conclusion, Kolcaba’s theory can be operationalized using both qualitative and quantitative data on an individual’s health status and the effects of nurse-patient interactions on their comfort.
References
Freire, S. D., Silva, R. A., Melo, G. A., Aguiar, L. L., Caetano, J. Á., & Santiago, J. C. (2021). Meaning and dimensionality of state of comfort in patients with chronic hemodialysis kidney disease. Texto & Contexto – Enfermagem, 30.
Katharine Kolcaba – Nursing theorist. (n.d.). Nursing Theory.
Lin, Y., Zhou, Y., & Chen, C. (2022). Interventions and practices using comfort theory of Kolcaba to promote adults’ comfort: An evidence and gap map protocol of international effectiveness studies. Systematic Reviews, 12(33).
Vicdan, A. K. (2020). The effect of training given to hemodialysis patients according to the comfort theory. Clinical Nurse Specialist, 34(1), 30-37.