The state of having addressed basic needs for ease, relief, and transcendence met in 4 contexts of experience (physical, psychospiritual, sociocultural, and environmental) Comfort involves identifying the comprehensive needs of patients, families, and nurses and addressing those needs. Ergonomics- comfort at the workplace, promotes optimum function or productivity (Kolcaba &Kolcaba, 1991) NANDA- comfort in terms of pain management Confortare Latin- to strengthen gently

1. Kolcaba Comfort Theory

2. Theorist Background
oBorn Dec 28th, 1944 in Cleveland Ohio
oDiploma in nursing- St. Luke’s Hospital 1965
oBSN- Frances Payne Bolton School of Nuring-1987
oPhD and Clinical Nursing Specialist- 1997
oAssociate Professor of Nursing Emeritus at the
University of Akron College of Nursing.
oTeaches on two online theory courses (MSN and
DNP levels)
oCertified in gerontology
oLinked concepts of Edward Murray’s framework
with other nursing theories
oHer work was rejected for conference
presentation
oUsed her students ideas and observation to
strengthen CT

3. What is comfort?
◦ The state of having addressed basic needs for ease, relief, and transcendence
met in 4 contexts of experience (physical, psychospiritual, sociocultural, and
environmental)
◦ Comfort involves identifying the comprehensive needs of patients, families, and
nurses and addressing those needs.
◦ Ergonomics- comfort at the work place, promotes optimum function or
productivity (Kolcaba &Kolcaba, 1991)
◦ NANDA- comfort in terms of pain management
◦ Confortare Latin- to strengthen gently
Kolcaba & Kolcaba. (1991).

4. TYPES OF COMFORT
◦ Relief – when a particular needs of a
patient is satisfied. Has the same principles
as Orlando’s (1961/1990) need-based
philosophy of nursing.
◦ Ease- state whereby a person is calm and
content: consistent with the 13
fundamental human requirements by
Henderson (1978)
◦ Transcendence- a state in which one
outgrows difficult situations or pain.
Originates from the principles used by
Paterson & Zderad, 1976/1988) to denote
more being.
◦ Green: Relief, Ease,
Transcendence
Kolcaba, K. (1991).

5. CONTEXT IN WHICH THEY
OCCUR
◦ Physical- conducive work environment, adequate
staffing, benefits, retirements, quite environment,
flexible work schedule among others.
◦ Psychospiritual- is when people within themselves
get to know who they are, their sexuality, self-
worth, the essence of one’s life, how one relates to
a higher being.
◦ Social comfort (Sociocultural comfort) – Involves the
interactions with families, society, and interpersonal
relationships, religious practices, rituals, and
traditions within one's family.
◦ Environmental- involves anything around a person
and they include noise, color, temperature,
ambience among others.
Red/yellow/purple: Physical,
Psychospiritual, Sociocultural,
Environmental
Kolcaba, K. (1991).

6. Additional Comfort Measures
◦ Relief- warm blanket to help increase their body
◦ Ease- explain plan of care to decrease anxiety
◦ Transcendence- Coaching patients during labor and delivery
◦ Environment- a private room for a patient during end of life care
◦ the sociocultural and Psychospiritual context- allow chaplains to talk to
patient and family in times of need.
◦ .
Kolcaba, K. (1991).

7. Factors that can affect how a patient perceives total comfort
(Intervening Variables)
past experiences
age
finances
attitude
emotional state
support system
prognosis
Kolcaba, K. (2003).

8. Assumption of Theory
◦ Human beings have holistic responses to
complex stimuli
◦ Comfort is an immediate and desirable
holistic state of human beings that is
germane to the discipline of nursing
◦ Human Beings strive to meet or to have
met their basic comfort needs.
◦ Nurses are to identify comfort needs of
their patients and find ways to address
those needs
Kolcaba, K. (1994).

9. Comfort as it was perceived at the beginning 20th century
 Used in a broad sense and was seen as a definite goal in nursing.
 Was highly appreciated and was considered an exclusive nurses mission
 Ability to provide comfort mainly depended on the skill and character of the nurse.
 Very essential because of there were no curative medical strategies
 Comfort resulted from physical, emotional, and environmental interventions
 Poultices(dressings, icepacks ,etc.) heat, the positioning of a patient in bed
were most common nursing interventions to promote comfort (Mcllveen & Morse,
1995)
 Mental relaxation was achieved through physical and emotional comfort.
 Specific comfort measures orders solely depended on the authority of the
physician
Mcllveen& Morse, 1995

10. The Taxonomic Structure(TS) or A 12
Cell- Grid
Defines the attributes of comfort and is helpful
in deriving the technical definition of comfort.
The TS is used to:
assess comfort needs of patients, families,
and nurses
Plan interventions to address the identified
needs
Informally evaluates the effectiveness of
those interventions to enhance comfort
Measure the desired outcome of enhanced
comfort for research and practice
Kolcaba, K. (1991).

11. Basic Concepts of the Theory
Kolcaba, K. (2002).

12. PROPOSITIONS
Relational statements that connect concepts together.
 The healthcare team and nurses identify the needs of patients and families that have not been met
with the support systems that are available. Nurses also work constructively to make sure they have
the necessary things they would need to perform their work.
 Comfort interventions are designed and coordinated to address those comfort needs that are not
met.
 Intervening variables helps to determine the probability of success and should, therefore, be
considered when planning comfort interventions.
 Enhanced comfort is achieved when effective interventions are provided in a caring manner.
 A desirable and holistic HSBS is agreed by the patients, nurses, and another healthcare team.
 Patient, family members, and nurses become motivated and involve in HSBS when enhanced comfort
is attained.
 Enhanced Health-related Institutions outcome is demonstrated when patient and families become
satisfied with comfort measures they receive through motivations to engage in HSBS
 The healthcare institutions gain recognition from the general public when the patient, family, and
nurses become satisfied with the healthcare delivery system.
Kolcaba, K. (2001).

13. Who Determines Comfort?
Kolcaba, K. (2000).

14. Goal of the theory
◦ Patient , family members, nurses, and
other healthcare workers become
satisfied with comfort measures they
received in order to engage in HSBs
◦ Higher patient or nurse function
◦ Faster Discharge
◦ Reduces readmissions rate
◦ Improved satisfaction with care,
◦ Longevity of employment
◦ Stronger cost-benefit ratio for the
institution
◦ Provide a foundation for
healthcare to implement comfort
model as a unifying framework for
care delivery
Kolcaba, K. (2003).

16. Nursing Metaparadigm
◦ Nursing – comfort needs of patient are addressed through assessment,
interventions and evaluation.
◦ Person - the patient, family, community or institution.
◦ Environment- the external surroundings of the patient
◦ Health- highest functional level of the patient.
Kolcaba, K. (1991).

17. Comfort or Pain?

18. Diagram
Kolcaba, K. (2002).

19. Case Study I
◦ MN a male client is operated on for gallstones. On a postoperative night, the nurse
finds that the client is not sleeping and is tossing and turning. He had colonoscopy
two days ago, and is suspicious of colon cancer because his sister passed away two
months ago with colon cancer. No family member has visited him yet since his
admission. Patient yells at the nurse as she responds to his call light, “you guys will not
shut up for me to sleep and I have been in pain all night. Which nursing action is most
appropriate? Using the taxonomic structure, formulate a plan of care for MN.

20. Taxonomic Structure for MN
Relief Ease Transcendence
Physical Pain Pain control Patient thinks about pain
relief after taking pain
medicine
Psychospiritual Anxiety Skepticism
about prognosis
Need for spiritual
support
Environmental Noise from the
nursing station;
bright lights
Privacy Need for quiet
environmental
Sociocultural Absence of family
members
Allow family to
visit patient
Need for support from
family or loved ones

21. Case Study II
JB is a 48-year-old woman admitted for abdominal pain. She suffers from urinary
incontinence and is currently using poise pads. She complains of back pain which she states
get by doing regular exercises and stretches. JB is diagnosed with bipolar disorder and has a
prescription for Latuda. JB is also taking clonazepam and escitalopram. States she has not
been able to refill her prescription and is concern her disease might get worse. MS JB
complains she has not been sleeping lately because her roommate is always loud and
always have her lights on. She is unemployed and lives with her 20 year old daughter. States
daughter has not been responding to her phone calls for the past three days.

22. Taxonomic Structure for JB
Relief Ease Transcendence
Physical Pain Pain management Patient thinks about pain
relief after taking pain
medicine
Psychospiritual Anxiety, depression Reassurance Need for emotional
stability, relaxation
Environmental
Quite environment
Turn off lights, promote
quietness
Need for quite sleep
Sociocultural Financial issues Financial support Need for financial
stability

23. Application of Theory in
Practice

24. Analysis of Theory using Barnum
Internal Criticism
◦ Clarity- it is easy to understand
◦ Consistency- defined key concepts throughout the theory
◦ Adequacy- It’s adequate, no gaps
◦ Logically developed
External Criticism
◦ Reality convergence- represents real world
◦ Appropriate in all healthcare settings
◦ Complexity- very straight forward
◦ Significance- it is very relevant to nursing
◦ Discrimination- have precise and clear boundaries
◦ Scope of theory- very broad, relevant to nursing practice, nursing
education, nursing research and other disciplines
Barnum, 1998

25. Limitations
◦Difficult to assess the effectiveness for
patient in coma.
◦When resuscitations measures is very
critical

26. Conclusion
◦ Comfort theory applies to any healthcare
environment, healthcare disciplines, or age group,
whether home, hospital, or community. For research
of practices, the theory can further be defined, at a
lower level of abstraction, regarding specific
populations.
Peterson, S. J., & Bredow, T. S. (2017).

27. Boudiab, L. & Kolcaba, K. (2015). Comfort theory: Unraveling the complexities of Veterans' health care needs. Advances in Nursing
Science, pp 1-9.
Dowd, T., & Kolcaba, K. (1997). Urinary Incontinence and Frequency Comfort Questionnaire (UIFCQ): Katharine Kolcaba, PhD, The
University of Akron, College of Nursing, Mary Gladwin Hall, Akron, OH 44325-3701; kolcaba@uakron.edu; The Comfort Line:
http://www.uakron.edu/comfort/.
Estridge, K., Morris, D., Kolcaba, K., & Winkleman, C. (2018). Comfort and fluid retention in
adult patients receiving hemodialysis. Nephrology Nursing Journal, 45(1), 25-33.
Kolcaba, K. Y. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing,
19(6), 1178-1184.
Kolcaba, K. (1991). A taxonomic structure for the concept comfort. The Journal of Nursing Scholarship, 23(4), 237–240.
http://doi.org/10.1111/j.1547-5069.1991.tb00678.x
Peterson, S. J., & Bredow, T. S. (2017). Middle range theories: application to nursing research. 4th ed. Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
Porter, C. A., Kolcaba, K., McNulty, S. R., & Fitzpatrick, J. J. (2010). The effect of a nursing labor
management partnership on nurse turnover and satisfaction. Journal of Nursing Administration,
40(5), 205-210.
References

29. THANK YOU!!