Sample Nursing Research Paper on Middle Range Theory: Comfort Theory

Comfort Theory

Katherine Kolcaba came up with comfort theory in 1994 because she figured out that the purpose of nursing is to ensure that patients are provided with all the help they need to be comfortable. This midrange nursing theory aimed at having the nurses prioritize the patients needs when they are under their care to ease them of any discomfort. Katherine was inspired to come up with this theory by her professional background, which involved the study of patient comfort, gerontology and the numerous types of patient care in the final stages of their lives. These studies inspired her to develop the theory of comfort to shed light on better ways to care for patients in the nursing profession (Kolcaba, 1994).

There lacks evidence of whether this theory has undergone any modifications since it was developed in 1994. Nevertheless, Katherine has expounded more on the theory by publishing several research articles detailing the evolution of comfort theory. For instance, in 2001, the author published an article on Nursing Outlook, which builds on the comfort theory and other content in the nursing discipline (Kolcaba, 2001). Nursing Outlook expounded on the comfort theory concerning its operations of the concepts, the investigation of the idea of comfort, and the investigation of comfort theory on its results from other research studies. Nonetheless, the study does not indicate any modifications of comfort theory, just the scrutiny of the development of its concepts (Kolcaba, 2001).

Purpose of Comfort Theory

The main objective of comfort theory was to devise mechanisms of enhancing the care given to patients, especially during the palliative care and other forms of help needed in the final days of a patient (Sell, 2006). This theory provided the groundwork of Katherine’s work which mainly led to the expansion of the structure that defined the process of the patient care. The purpose of the comfort theory intends to enlighten on the idea of the comfort which goes beyond the absence of physical discomfort to the actual mental and psychological comfort of the patients (Kolcaba, 1994). Before Katherine developed this theory, comfort in the nursing profession was viewed just as the absence of discomfort in the physical realm of the patients. However, with the development of this theory, this view has been upgraded by focusing and concentrating on the other more defined dimensions of comfort that include relief, ease, and transcendence. Comfort theory also provides diverse interventions based on wide-ranging elements of a patient’s comfort. These could be based on the aspects of environmental, physical, and psycho-spiritual as identified by Kolcaba (Kolcaba, 1994).

Assumptions of Comfort Theory

Comfort theory assumes that when people are subjected to complex stimuli, they tend to respond holistically as compared to when subjected to a single stimulus that focuses only on the physical comfort. The theory also assumes that the concept of patient care is significant and should not only be seen as necessary in nursing but should also be deep rooted in the nursing discipline and given the priority it deserves. This assumption builds up the view that nurses should put the needs of the patients in the frontline and treat them with a lot of care to ensure their general comfort (Izumi, Baggs, & Knafl, 2010). 

Another assumption of the comfort theory states that since people provide themselves with the best comforting situations they can afford, the nurses should, therefore, concentrate on providing comfort to the patients to quicken their recovery. This assumption draws a generalized view of the fundamental goals of how human beings achieve comfort (Kolcaba, 1994). It assumes that since people seek comfort alongside the pursuit of happiness, it is among the most important goals of achievements of humans to have a healthy life. Thus, comfort should be sought and provided to the patient at all costs to ensure that they have an easy time during their recovery process. Additionally, when comfort is guaranteed, the likelihood of having happy and comfortable patients is very high, resulting in easy time recuperating. The fourth assumption is that the nursing institutions are entrusted with the responsibilities of applying integrity connected with the pursuit of a patient-oriented value system (Kolcaba, 1994). Thus, with this assumption, the nurses should incorporate the theory of comfort in their practice of patient care.

Key Concepts and Propositions of Comfort Theory

The major element of this theory is the dimension of relief which is a significant aspect in the recovery and comfort of the patient. This aspect is the feeling connected with the experience of individuals when they meet their needs (Kolcaba, Tilton, & Drouin, 2006). Some patients are too weak and in pain to state what needs they require the caregivers to look into and help them, and thus, when these requirements are met, the patients experience relief. Another concept of this theory is the aspect of contentment which means that when the caregivers provide the patients with comfort, the patients develop a feeling of contentment (Larrabee, 1996). The other main concept of Kolcaba’s theory is the idea of transcendence which involves the improvement of patients’ capacities to perform in an extraordinary in their recovery process. Thus, the nurses should be in a position to help the patients gain extraordinary powers to perform better in their journey to well-being (Alligood & Marriner-Tomey, 2010).

Besides the concepts of relief, ease, and transcendence, Kolcaba also introduced other ideas that help the patients achieve comfort. These other concepts included the physical components where the nurses should ensure the comfort of the physical aspect of the patients and the psycho-spiritual notion that improves the self-teem of the patients. They also include the social idea that improves the social and cultural relationships of the patients and the environment concept that focuses on the comfort emanating from the patient’s surroundings (Kolcaba, 1994).

Congruence with Nursing Discipline

Comfort theory aims to link the nature of nursing interventions to the needs of the patient that requires the provision of comfort, which in turn impacts on the patients’ well-being and the performance of the nursing care (Meleis, 2007; Jaret, 2008). This theory is comparable to the Nightingale’s environmental theory that relates patients’ recovery to the manipulation of their surroundings (Bowers, Fibich, & Jacobson, 2001). Comfort theory is also similar to the self-care theory that suggests that individuals seek more comfort through self-care (Izumi, Baggs, & Knafl, 2010). This relates to Kolcaba’s theory in that the nurses take the initiative of providing the care that the patients may not be in a position to get on their own.

Kolcaba’s theory relates to the Philosophy and Science of Caring coined by Jean Watson to suggest that a patient needs the harmony of the mind, body, and spirit to improve their recovery. Thus, these two theories look into the importance of comfort in a patient’s spiritual being to enhance the performance of the nursing care. Comfort theory also relates to other disciplines in nursing such as health and the environment. In Science of Unitary Human Beings by Martha E. Rodgers, the theory of Attainment Imogene M. King and Systems Model by Betty Neuman links to Comfort Theory through their idea of improving patient care in the nursing profession.  All these interconnected theories focus on the patient care, their surroundings, their health and the nursing discipline.

Published Research Studies That Have Used or Tested the Theory

Aksoy Derya, Y., & Pasinlioğlu, T. (2015). The Effect of Nursing Care Based on Comfort Theory on Women’s Postpartum Comfort Levels After Caesarean Sections. International journal of nursing knowledge.

The researchers sought to determine the impact of nursing care based on the comfort theory on women in postpartum who had undergone a C-section.  The C-section is usually inevitable in cases where vaginal delivery is considered dangerous for the well-being of the mother and the baby. C-sections have often led to a higher number of maternal deaths, longer hospital stays, and extensive medical intervention. Consequently, there is a need to involve a middle range theory like comfort theory, which is evidence-based to take care of women during the delicate period. This study found that application of comfort theory when caring for these women met their comfort needs and enhanced their levels of postpartum comfort.

Wilson, L., & Kolcaba, K. (2004). Practical application of comfort theory in the perianesthesia setting. Journal of PeriAnesthesia Nursing, 19(3), 164-173.

The authors of this study presented the definitions, varied comforting interventions, and the goal of enhanced comfort in the care industry. The article is proactive and indicates that holistic interventions can be applied to many comfort needs by patients and families in all settings at one time. The article looked at the taxonomic structure of comfort on a 45-year-old colon cancer patient; for instance, relief was given to the patient through efforts to reduce pain, anxiety, and noise from the surrounding, while ease was provided through a comfortable bed, and transcendence was given through the support from family members. The authors also discussed the types of comfort interventions that can be applied to improve the overall comfort of a patient, which include the standard comfort mechanisms that are geared towards the maintenance of homeostasis by monitoring vital signs, lab results, patient assessment, medications, and treatment. The second intervention is coaching, which involves emotional support, reassurance, education and listening to the patient needs, while the third intervention is comfort food for the soul, which is concerned with therapeutic touch, music therapy, spending time together and forming valued personal connections.

Review of a Clinical Case of a Scholarly Article That Is Appropriate for Application of Comfort Theory

MacPhee, R. S. (2005). Use of emergency medical services by the elderly in community and institutional settings (Order No. NR09530). Available from ABI/INFORM Collection. (305393733). Retrieved from http://search.proquest.com/docview/305393733?accountid=45049

This study sought to identify issues, challenges, and concerns that are experienced in the process of transferring an elderly person to an acute care facility by ambulance, and to establish the risk factors linked to the utilization of emergency departments by patients under care in the hospitals and those in long-term care homes, among other objectives.  The elderly populations are the largest seekers and users of acute care hospitals with the rates improving exponentially with age, and they are also the largest users of emergency medical services (EMS) with the rates improving exponentially with age. The elderly patients usually remain in these hospitals as they await transfer to long-term care facilities. This group of the population usually encounters complex problems on the course of transfer, which calls for a theoretical framework to maximize positive care outcomes in the ambulances.

The findings from this study revealed that lack of communication among the care practitioners in long-term care facilities is a significant barrier to giving quality care. If the care practitioners sampled in this study were aware and using the tenets of comfort theory, they would have applied in their daily routines while discussing the best strategies that would bring desired outcomes in patients. By ensuring good communication between them, the practitioners will easily extend communication to their patients and seek information on how they would like to be treated. The study also found that community-dwelling patients have higher acuity levels when they need EMS, which requires the attention of comfort theory. Being sensitive to the guidelines of the comfort theory will ensure that all interventions or actions directed towards the patients give them comfort. This implies that the practitioner will ensure that stretcher beds are comfortable when moving patients to the ambulances and the conditions in the ambulance are also conducive, such that there is no noise, dim or very bright lights, and so on.  After the transfer to the long-term care facility, there should be ongoing communication between the practitioners that will pick the duty of care to ensure that there is no drastic change in the way the patients are talked to, handled, and all their human needs of relief, ease, and transcendence are taken care of.

Identify Nursing Assessments and Interventions That Would Be Necessary to Apply

When attending to the physical comfort needs, the caregiver should ensure relief by giving pain medications to elderly patients to reduce or alleviate pain, both in the care facilities, during transport with the EMS and continuing with treatment after admission in the long-term care facilities. They can ensure ease by Ensuring that the beds of the elderly patients are well kept and comfortable, lifting the legs of the elderly patients suffering from edema, and giving additional pillows to increase comfort for those with back pains to promote ease. Additionally, the caregiver can encourage the elderly patients to rise above their challenges to promote the comfort need of transcendence.

In the context of psycho-spiritual, caregivers can ensure relief by coaching and encouraging the elderly patients to reduce anxiety, offer light exercise sessions like guided breathing and also giving pictures that tell stories of hope to promote ease, and allow spiritual leaders to visit the patients and practitioners also encouraging the elderly patients spiritually.

In terms of the environmental comfort needs, the caregiver can ensure that the surroundings are conducive, free of noise, bright light, hot or cold temperatures to give relief, ensure that there is privacy for the elderly when bathing, changing their clothes, and bed sheets to facilitate ease, and guarantee that that the surroundings are calm and free from outside interference to support transcendence.

Regarding the sociocultural context, the caregiver should offer information or education on the new ways the patients can enhance their comfort (relief), allow family members or close relatives and friends to visit and stay with the patient for a while to encourage ease, and allow the elderly patients to have their own time for prayer and meditation to promote transcendence.

                                                                       Summary               

Comfort theory was established by Dr. Kolcaba, and it focuses on the immediate experience of strengthening patients by providing relief, ease and transcendence in the contexts of the physical, psychospiritual, social and environment of the patients. This theory insists that healthcare providers need to provide comfort to the patients to ensure their optimum function. The theory assumes that the nurses are in a position to identify the patients’ comfort needs, meet those needs and carry out analysis to assess the performance of their interventions for the purpose of enhancing future measures. Additionally, it assumes that individuals have comfort needs and will seek it whenever, it also suggests that patients holistically respond to complex stimuli, and that comfort interventions meet these need and have been effective in the nursing field over the decades. The outcomes of this theory reveal that patients’ needs are satisfactorily met when comfort theory is effectively applied in nursing, thus improving the patient’s recovery and healthcare performance. 

References

Aksoy Derya, Y., & Pasinlioğlu, T. (2015). The Effect of Nursing Care Based on Comfort Theory on Women’s Postpartum Comfort Levels After Caesarean Sections. International journal of nursing knowledge.

Alligood, M. & Marriner-Tomey, A. (2010). Nursing theorists and their work. Maryland Heights, Mo.: Mosby/Elsevier.

Bowers, B., Fibich, B., & Jacobson, N. (2001). Care-as-Service, Care-as-Relating, Care-as-Comfort: Understanding Nursing Home Residents’ Definitions of Quality. The Gerontologist, 41(4), 539-545. http://dx.doi.org/10.1093/geront/41.4.539

Izumi, S., Baggs, J., & Knafl, K. (2010). Quality nursing care for hospitalized patients with advanced illness: Concept development. Research In Nursing & Health, 33(4), 299-315. http://dx.doi.org/10.1002/nur.20391

Jaret, P. (2008). Nurse: A World of Care. Georgia, United States: Emory University.

Kolcaba, K. (1994). A Theory of Holistic Comfort for Nursing. Journal Of Advanced Nursing, 19, 1178-1184.

Kolcaba, K. (2001). Evolution of the mid range theory of comfort for outcomes research. Nursing Outlook, 49(2), 86-92. http://dx.doi.org/10.1067/mno.2001.110268

Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort Theory: A Unifying Framework to Enhance the Practice Environment. JONA: The Journal Of Nursing Administration, 36(11), 538-544. http://dx.doi.org/10.1097/00005110-200611000-00010

Larrabee, J. (1996). Emerging Model of Quality. Image: The Journal Of Nursing Scholarship, 28(4), 353-358. http://dx.doi.org/10.1111/j.1547-5069.1996.tb00387.x

MacPhee, R. S. (2005). Use of emergency medical services by the elderly in community and institutional settings (Order No. NR09530). Available from ABI/INFORM Collection. (305393733). Retrieved from http://search.proquest.com/docview/305393733?accountid=45049

Meleis, A. (2007). Theoretical nursing. Philadelphia: Lippincott Williams & Wilkins.

Sell, C. (2006). A Cup of Comfort for Nurses: Stories of Caring and Compassion. Avon, Mass.: Adams Media.

Wilson, L., & Kolcaba, K. (2004). Practical application of comfort theory in the perianesthesia setting. Journal of PeriAnesthesia Nursing, 19(3), 164-173.