Ever since the last century, nursing has becoming a professional discipline and just like every other discipline, it requires some theories to guide it. It has been seen that the nursing theory is split along three levels. One level is grand, then middle-range and then there is the situation specific level (Meleis, 2012). As it would be expected, the grand theory is quite broad and highly abstract. Our basic concern is the middle range theory that is more focused these days and the newest theory to nursing science. These theories are basically an end product of a research study. The narrow range study is even more selective and is solely “based upon research findings” (McKenna, 1997, p. 17).
Just like any other discipline, theories are present in nursing to guide a person about the major goals and objectives of the nursing discipline. It tells the person about certain situations and allows them to guide through research. Research is done as to refute the theory, modify the theory or even completely eliminate the theory (Meleis, 2012). Middle range theories are merely part of the structure of a certain subject area. They go on to afresh the adequate knowledge of that discipline by expanding on specific phenomena that are linked to the healing process.
The more and more that these theories are expanded, the discipline of nursing become more enriched. An example of this is if one takes the study that was conducted on how vulnerability or again forces humans to focus on the meaning of life. This basically builds up on the connections with others and the past, present or future. Ultimately, the result was that self-transcendence is linked to healing or well-being. Now it is known that healing and well-being is a very crucial focus of nursing. Therefore, it is to be placed into action that these theories not only get applied to nursing but to document the significant impact made.
Similar to the example that was discussed earlier, we come to a very important nursing theory known as Kolcaba’s comfort theory. It is observed that Kolcaba’s theory (1992) is based on the earlier works of nurses like Watson (1979) and Orlando (1961). During the 1980’s, a lot of theories revolved around comfort and that is when most of the nurses and doctors began paying attention to this theory. In the early twentieth century, comfort was the major and only goal of nursing and medicine. As it is expected, comfort is the major thing that nurses and doctors aim for. Due to this reason, most of the textbooks and theories targeted comfort. The texts produced went on to ensure that the nurse provides adequate physical and emotional comfort to the patient.
The major concepts of the Theory of Comfort include comfort measures, comfort, comfort care, comfort needs, institutional integrity, health-seeking behaviors and other intervening variables (Kolcaba, 1994). Comfort is the major purpose and objective of this theory. Comfort is merely a state that a person perceives and there are various ways to measure it. A person can experience comfort either by aspects of sociocultural, environmentally, physically or psycho-spiritually. Sociocultural aspects of comfort are received from one’s family, interpersonal and societal relationships (Kolcaba, 1994).
Environmental comfort is described as being the wonderful aspect of a human experience through various lights, sounds, aromas, landscapes and temperatures (Kolcaba, Tilton, & Drouin, 2006). Physical comfort basically is linked to medical diagnosis pertaining to any sensation felt in the body that at one point hurt but are now at ease (Kolcaba, 1994).
The psycho-spiritual comfort is reference to one’s identity, sexuality, or any spiritual relationship with a higher being (Kolcaba, 1994). If one goes into more detail then it is seen that comfort measures are basically the things that the nurse will do in order to respond to the needs of the patient. The three types of comfort measures that are highlighted in this theory include comfort food for the soul, technical care and coaching. It is observed that when the patient is any sort of distress, his mental health suffers a great deal. Kolcaba therefore emphasizes on the importance of relieving mental stress for the patient. This relief is done through actions such as reminiscing, hand holding, back massaging and guided imagery.
The technical care sort of comfort measure is basically done to keep things at a constant level and relieve any pain that the patient has. Lastly, the patient is provided with coaching which goes on to relieve the anxiety and help the patient in making their condition better. The medical needs or health care are needs that require intervention by an expert. In other words, these needs cannot be fulfilled by the family support system. These needs can be social, environmental, spiritual or psychological.
Regardless of what support the family provides, it is crucial for the nurse to monitor all these signs and thus play an important role. Lastly we come to the health seeking behaviors or the institutional integrity. Health seeking behaviors are basically actions linked to the goal that the person wishes to be healthy. Institutional integrity is along the same lines where it talks about the person’s ability to work with the community and the society and walk towards their goal of getting better. It should be noted that the community does go on to play an active role in this scenario. Last but not least; the intervening variables are such that all of these concepts are somehow linked to each other.
Furthermore, this theory supports the notion that the amalgamation of variables such as the prognosis of the disease, family support, age, and attitude affect the person’s ability to view comfort. Apart from the variables, we see that Kolcaba’s theory is based on a grid that has 12 cells (Kolcaba & Fisher, 1996). The three major types of comfort listed in the grid are known as ease, relief and transcendence (Kolcaba, 1994). The four contexts of the theory are namely sociocultural, environmental, physical and psycho-spiritual (Goodwin, Sener, & Steiner, 2007). Structural aspects of the theory
Just like every theory, there are certain assumptions that the theory is based on. The first assumption is that the comfort is a relevant outcome and is quite significant to nursing. The next assumption build up on the earlier one and is that as humans, we work to attain comfort. It is assumed that this proves to be continuous and we continue to work towards it. A human can respond in variety of ways to a given stimuli. Another assumption is that since everyone is different in his or her needs and expectations, every person has a different process to attaining a certain comfort level. It is also assumed that patients who have the ability to actively participate in their healing process have a better outlook and a better approach towards the healing process.
This again backs up the assertion that humans should put in their own efforts and ideas that work best towards attaining their comfort level. It is also assumed that if a patient is comfortable, he will work harder towards getting better. In other words, the patient will be more positive on the treatment options that he is getting. Some of the propositional statements this theory includes is that the nurses need to design actions that would further provide the patient with the comfort they need (Kolcaba, 1992).
The theory proposes that comfort requirements in one scenario can overlap and lead to comfort needs in another scenario as well. Manipulation of the environment is a very important route through which adequate levels of comfort can be attained. The theory is very crucial for a nurse to take in consideration the intervening variables that were stated earlier. As mentioned above, intervening variables play a great role in how the patient perceives comfort. Therefore, intervening variables give a good idea about what measures the nurse needs to take.
This theory also proposes that the nurse and the patient should agree on the measures and tips of attaining comfort. Patient’s compliance is increased when patients agree with the methods. It is quite obvious that a patient will not feel comfortable if he/she feels that certain techniques are merely being imposed on him or her. This theory also proposes that a good working environment and good skills are crucial for the maximum effectiveness.
It is observed that this theory is overall very consistent. The structure and the methods are all very simple to grasp and all the terms remain the same in the theory. The concepts that are present in the theory can be related to in a very practical manner. It appears that the entire diagrams and terms are clear. The assumptions that were stated earlier are also present all over the writings and thus go on to make the theory very consistent. The concepts that were stated earlier on are very rigid and do no not confuse the reader. If a person has the basic nursing skills then he or she will have no problems in making use of this theory.
It is seen that Kolcaba’s comfort theory can be applied to wide range of hospital activities. Having the basic nursing knowledge this theory is easy to understand and goes on to cover different topics that are quite relevant to health and ethics. As stated earlier, the major aim of nursing is to provide care and comfort to the patient. This theory is simple and easy to use and that makes it very convenient to be applied in different areas in a successful manner. Application
Application in Practice
There are a number of studies that have been conducted to established ways in which nurses can provide comfort to the patients. As mentioned earlier, the desired outcome of nursing care is comfort and there are many articles in which the researchers have talked about the needs of the patients and the things that alter the comfort of the patients. Kolcaba suggested that the cancer patients who are terminally ill could benefit from comfort care as it pays attention to the perspective and needs of the patients. Through such kind of care, the patient is not only provided with pain relief, but the depression of the patient is also addressed adequately. As Kolcaba mentioned patients that are in the depressed state hunt comfort in the transcendental sense also seeking in the psycho-spiritual sense (Kolcaba, 1992). In some of her works, she has explained the use of the instruments and their application by the nurses.
Kolcaba reckons that the instruments presented by her to evaluate the comfort are significant indicators that are given by the patients, are altered by the kind of nursing care being given to the patient and are associated with the health care system and its integrity. For example, this theory is particularly very significant for application by nurses that interact with the patients before they are being taken to the OR, or when they are in the OR. This is important to reduce the anxiety level, which can hinder the smoothness of any procedure that is being performed. Application in Research
It has been around a decade since this theory has come up to the surface and during this time it has been subjected to empirical testing. Studies have shown that when the caretaker or the nurse starts giving the patient a comfort measure in the form of any intervention, so as to meet the holistic comfort of the patient, the comfort level of the patient is elevated over a former baseline value. At the moment, Kolcaba is devising ways to test the last part of the theory so that she can establish a relationship, if it exists, between the community or institutional setting and patient comfort. She also seeks to demonstrate the extent of the patient satisfaction with the application of this theory in the healthcare system. She wished to do so by making the patients fill out a survey after they are discharged from the hospital. Application in Education
It should be noted here that Kolcaba’s theory is of middle range nature therefore is concrete and more specific than grand theories helping guide-nursing research (Higgins & Moore, 2000); therefore assists within the clinical settings. However, it is also noteworthy that this theory has to offer some very important content for the students of nursing to those of masters, at both the graduate and undergraduate levels. According to the articles that have explained the application of this theory in nursing practice, this theory can prove to be useful for educating students of all levels.
For instance, Cox (1998) believed that Kolcaba’s theory was helpful when it came to teaching nursing students how to take care of older adults and the students found it very easy to apply this theory while addressing the holistic comfort demands of the elders in a setting that would cater their acute needs. This theory has also been suggested to be beneficial to reduce the stress in students in educational settings. In another article, Kolcaba (1994) has explained her theory in depth and in a way that might suit the students. According to this article, comfort is defined as the characteristic that distinguishes the nursing professions from others (Kolcaba, 1994).
The aforementioned statement makes the application of this theory useful in education. A theoretical work has been presented in this article in which an intra-actional perspective has been used to develop a theory that indicates comfort as being a positive result of nursing. In this article, it was described how an elevation in comfort was an indication of reduction of negative tensions and engagement of positive tensions. It should be remembered here that the facilitator of the results of comfort is the nurse. This is because, according to theory, it has a relationship with external/internal health-seeing attitudes of a peaceful death. Application of Theory to Administration
Interrelated tasking is a key role of the nurse in care of a patient. Nurses ensure that Physical, Occupational and Speech Therapist assist with the patient in guiding towards comfort through their special fields. The Engineering department is called upon for assistance with devices that may assist in comfort. Or a simple movement of the bed for repositioning and comfort can be obtained. Nurses are a major key in the development to the path of comfort. Application of Theory to My Practice
The author has made use of this theory in many cases, although unaware of the fact that this theory actually existed until this class. There are a number of management protocols that involve a hand massage. The author would like to add here that the performance of hand massage on a number of patients has been implemented. Moreover, in some patients, to decrease the stress level and to increase comfort, the author has also performed foot massage on these patients. The female patients to a great extent enjoy such practices and a great degree of relaxation is seen in them when they are being massaged. The reason why the author has been hesitant to perform a hand and foot massage to some of the male patients is that in many cultural settings, such actions are considered a taboo. Even though, it is an extremely simple intervention, it can cause significant change in the behavior and comfort level of the patient.
This theory of comfort is mostly used in the surgery setting at place of employment the author has noticed, since this is one of the settings in which the stress level of the patients is the highest. From the start of the perioperative stage of the surgery, the main concern of the doctors, nurses and healthcare givers should be the mental status of the patient and how the patient is going to react to the surgical procedure. As a nurse, the duty starts at assessment to make sure that the patient is not anxious and is feeling comfortable with the care that is being received. As a result, nurses are to do anything that is in their capability to make sure that the patients have their answers by the nurse, as well as the attendants have sought all the answers to any queries that the patients have sought after.
Keeping in mind that a delay in answer could increase the anxiety and stress level. When taking the patient to the OR, it is the nurse’s duty to make the patient comfortable while he or she is being anesthetized and being positioned for the procedure. To do this, the author always stands beside the patient and keeps analyzing his or her expressions or listens to the noises that are being made by the patient in the operative setting. Once the patient has been through the surgical procedure, the author has to make sure that the patient is feeling comfortable and safe pertaining to the kind of care that he or she is being given. Kolcaba’s theory is a higher thought process of basic nursing with love and care added to the equation.
Nonetheless, it has to be the ultimate goal of any nurse or a healthcare provider to be with a patient who is feeling uncomfortable so that the process of healing could set in and stress could be reduced. As with any other theory, this theory also has some weaknesses. The main weakness of this theory is that since the expectations of every patient are different, the same generalized rules do not work on every patient. Some patients have been going through the disease for such a long time that interventions like hand and foot massage do not work on them.
Moreover, these patients might also react differently to the application of this theory. Apart from this, the measurement of comfort at times becomes a difficult task since it can only be assessed and not measured quantitatively. Patients who come with a psychiatric problem are less likely to benefit from this theory, as most of them are not in the mental state to understand and feel the kind of care that is being given to them. Evaluation
The author believes that if this theory is applied in its true spirit then it can cause a great deal of comfort in the patients. If the nurses understand this theory fully and understand its significance then the patients are to benefit a lot from it. As it has been a very old and popular notion that apart from treatment, will power is also very important for the recovery of the patients. Through the application of this theory, the will power of the patients can be strengthened and therefore they can recover earlier than they normally would. There are no difficult statements in this theory and that is what makes it user friendly. The comfort theory is quite simple and many nurses would agree that they have been applying it without knowing that it exists. The theory contains some very typical things, which need to be followed closely.
First assess the patient, administer either pharmacological or non-pharmacological methods to fix any issues, document your actions, re-assess after a minimal time according to policy, document findings and then proceed with needed further administration or acknowledge actions as appropriate. The only difficulty this author has faced so far in the application of this theory is the difference in reactions of different patients.
The younger generations are least likely to want to go along with the non-pharmacological treatments as the older generation female populations are. One of the ways through which this theory can be made more usable and applicable is its inclusion in the curriculum of nursing. This will make this theory a part of the subconscious of the nurses and therefore they will never forget to apply it.
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