Nursing Philosophy: A Theory of Comfort

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Nursing Philosophy: A Theory of Comfort
Nicole Sharrow
Castleton University

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Nursing Philosophy: A Theory of Comfort
Nursing philosophy is the foundation of our profession. It provides the framework from
which we practice and the structure for our beliefs on the person, the environment, and health
(Black, 2017). In this paper, I will discuss my personal nursing philosophy as one of providing
comfort, and I will describe a nursing theory that has informed this philosophy. I will relate my
beliefs on health and illness, as well as my responsibilities as a member of the nursing
profession.
Nursing Philosophy: A Definition
A nursing philosophy is a way of thinking about one’s own nursing practice. It is a
declaration of beliefs, values, and ethics as they relate to the care of our patients. It shapes how
we interact with our patients, our co-workers, and the community (Petiprin, 2016). The
American Nurses Association defines nursing as “…the protection, promotion, and optimization
of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of
suffering through the diagnosis and treatment of human response, and advocacy in the care of
individuals, families, groups, communities, and populations” (ANA, 2017). A nursing
philosophy helps to guide in our daily nursing practice. Nursing as a profession covers a wide
range of roles and responsibilities. A nursing philosophy helps to sift through the many details
and identify what it is about nursing that truly matters.
My Personal Nursing Philosophy
I became a nurse after many years of working in non-profits focused on social change. I
have always found it important to work in a field where I am making a difference, in trying to
make the world a better place. I chose nursing because it seemed a way to make a difference on
an individual, as well as a societal, level. I wanted to improve people’s lives. The definition of

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comfort is to ease grief, reduce distress, and to increase hope and well-being (Merriam-Webster,
2007). As a nurse, I do not “cure” patients. I provide comfort to patients and their families. I ease
their distress and encourage their well-being.
To develop my nursing philosophy, I asked myself, “As a nurse, what are the defining
principles of my practice?” I used the ethical theory of rule deontology to determine the moral
foundations of my nursing practice. Rule deontologists focus on the principles that guide our
actions (Black, 2017). These principles are rules to be followed regardless of the circumstances.
The challenge becomes how to maintain these principles in a therapeutic way. On reflection, I
realized that the principles that felt the most fundamental to me are honesty and advocacy. The
rule of honesty guides my actions in that I will never lie to a patient. The patient looks to me, as
their nurse, as a source of reliable information. To minimize potential discomfort or to downplay
a diagnosis is to violate that trust. For example, a woman is coming in for her first colonoscopy.
She is very anxious because there is a history of colon cancer in her family and she has been
having rectal bleeding. She is also afraid because she has read on the internet that colonoscopies
can be painful. She asks me to reassure her that “it’s not going to hurt, and everything will be
okay”. It would be easy to agree and reassure her to keep her calm during her admission, but it
would be dishonest. Instead, I would use a comforting presence to reassure her that she is going
to be well taken care of. I might say, “sometimes it can be uncomfortable while the doctor is
maneuvering the scope around a turn, but I will be right there with you the whole time. We have
medications we can give you to enhance your comfort, and I will be monitoring you to make sure
you are safe and as comfortable as possible.” Regarding her fears about her prognosis, it would
be dishonest to make a blanket statement that everything is going to be okay, because rectal
bleeding in a person with a family history of colon cancer is in fact an indicator of possible

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malignancy. Instead, I would provide comfort by praising her for her health-seeking behavior of
having the colonoscopy. I reassure her by upselling the endoscopy team and describing the
experience and talent of our doctors and team. I would express to her that this is the exact best
place for her to be to address this issue, and that she will not be alone during her exam, that I will
be with her the whole time. I use a therapeutic presence to enhance patient communication and
provide an explanation of what will be happening to her (Kolcaba, 2010). Even though I have not
given her what she wants by reassuring her “everything will be okay”, I was able to comfort her
and provide her with a sense of ease about her upcoming procedure (March & McCormack,
2009).
To advocate is to support or to speak for (Merriam-Webster, 2007). Advocacy is the
second principle that I use to guide my nursing practice. I work in the operating room and on the
endoscopy unit. Both environments are unfamiliar, strange, and frightening for most patients. In
both areas, there are times when my patients are unable to speak for themselves because they
have had anesthesia or conscious sedation. I feel strongly that it is my duty to “stand for them”
during this vulnerable time. To make sure that their wishes are followed and that they are treated
with dignity and respect. For example, I will make certain that before a procedure, the patient
fully understands the consent they are signing, and that it accurately reflects what is going to be
happening that day. If I sense that the patient might still have questions, or their understanding of
the consent does not completely match what is written, I will delay a case until the surgeon can
speak to the patient and clarify all potential misunderstandings. I may not be able to affect the
patient’s prognosis, but I can influence their comfort by reassuring them and their family that
they will be safe and well taken care of during their procedure.

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Comfort Theory
Kolcaba’s theory developed after a multidisciplinary analysis of the concept of comfort.
She examined the concept of comfort in the literature of several disciplines including nursing,
medicine, psychology, psychiatry, ergonomics, and English (March & McCormack, 2009).
When a patient experiences comfort, they are strengthened and can engage in health-seeking
behaviors. Comfort can occur in three ways: relief, ease, or transcendence. Comfort can also
occur in four contexts: physical, psychospiritual, environmental, and sociocultural (March &
McCormack, 2009). A patient who receives analgesia for pain during a colonoscopy is receiving
relief in the physical context. A patient who is nervous about an upcoming procedure and has
their anxieties addressed is receiving ease in the psychospiritual context. A patient with a poor
prognosis can be strengthened by having family present during meetings with palliative care to
form a treatment plan. This activity will be stressful for the patient, but the sociocultural comfort
provided by family can help them to transcend this distress and face death peacefully (Kolcaba,
2010). Within Kolcaba’s framework, the patient can be the individual, the family unit, the
institution, the community, and the environment (Kolcaba, Tilton, & Drouin, 2006). This is
important because viewing the institution as the patient requires us to consider our co-workers
through the lens of providing comfort. In a high stress profession such as nursing, I think it is
vital to remember to treat members of our team in ways that strengthens them, and us, and
therefore the entire institution.
Kolcaba’s Comfort Theory fits with my personal nursing philosophy because it enables
me to care for patients regardless of their prognosis or present situation. I can provide physical
comfort by warming them as they enter the operating theater. I can provide physical comfort by
making sure they have their glasses readily available when they awaken from sedation to help to

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orient them quickly and reduce anxiety (Kolcaba, Tilton, & Drouin, 2006). I can provide
psychospiritual comfort by addressing their fears about a procedure in a way that does not shy
away from the truth but still provides therapeutic communication and connection. I can provide
environmental comfort by making sure the operating room is ready with all equipment that might
be necessary for their procedure to ensure it goes smoothly. I can provide the comfort of ease to
a patient by advocating for them to make sure they are truly able to give informed consent and
that they understand what is happening to them.
Beliefs About Health and Illness
Health and illness exist on a continuum. The World Health Organization (WHO) defines
health as a “state of physical, mental, and social well-being and not merely the absence of
disease” (Black, 2017, p. 161). Kolcaba defines comfort as “the immediate state of being
strengthened by having the needs for relief, ease, and transcendence addressed in the four
contexts of holistic human experience: physical, psychospiritual, sociocultural, and
environmental” (Kolcaba, 2010). I believe that there is a strong correlation between the WHO
definition of health and Kolcaba’s definition of comfort. When a person is in a state of comfort,
they are more likely to engage in health-seeking behaviors. These can include things such as
increased compliance with a prescribed diet for a patient with severe GERD, or increased
adherence to post-operative physical therapy in a total knee arthroplasty patient (March &
McCormack, 2009). I know that if a patient is upset because of the results of their colonoscopy,
they are less likely to be able to absorb and be compliant with their discharge and follow up
instructions. By providing nursing interventions to provide ease and comfort, it will improve
their outcomes over the long term, regardless of their diagnosis. I would therefore define health
as a state of comfort and ease where the person is able to pursue health-seeking behaviors in

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keeping with their own identified health care needs (Kolcaba, 2010). Conversely, I would define
illness as a state of the absence of relief. A state of dis-ease and distress where the patient is
unable to meet their own health care needs, or perhaps to even be able to define their health care
needs.
Given my beliefs about health and illness, I would say that my role with the public is to
use the nursing process to assess individuals for deficits of comfort, and to plan, intervene and
evaluate ways of addressing these deficits. The overarching goal of any intervention within this
framework is to manipulate the situation in such a way as to relieve, ease, or help the patient
transcend the situation, leading to comfort (March & McCormack, 2009). There are often
variables that as a nurse I cannot control. I do not have control over the amount of family support
a patient has, or what their financial resources are, or what their prognosis is. What I can do is
assess the patient and determine what aspects of comfort I can provide, and do so in a way that
will encourage them to take part in their own well-being.
Sometimes the kind of comfort a patient needs is spiritual in nature. I am not Christian,
but I personally believe that the Divine is infinite, and therefore there are infinite paths
(religions) to access divinity. This belief allows me to respect all religions as equally valid,
because they are all paths to the Divine. I might provide comfort to a patient by fastening their
picture of a saint to their surgical gown in a way that doesn’t compromise the procedure but also
gives ease. I have held hands with a family member while they prayed for their loved one’s
successful outcome. Religion and spirituality are, in my view, health seeking behaviors and it is
my obligation to facilitate their expression in any way I can.
Professional Responsibilities

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As a member of the nursing profession, it is my responsibility to provide quality care that
is current and evidence-based. The purpose of evidence-based practice (EBP) is to use the most
current scientific knowledge to inform our nursing process and therefore improve patient
outcomes (Stevens, 2013). The ANA states that a baccalaureate education should be the basis for
professional practice (Black, 2017). A grounding in a BSN degree helps nurses to understand
EBP and to utilize it in their everyday decision making. I initially obtained my ASN in Nursing
ten years ago. I have come to realize that it is my responsibility to broaden my understanding of
nursing to include research, theory, EBP, decision making and leadership. I am doing this by
obtaining my BS in Nursing at Castleton University.
This new understanding of EBP and research has already had implications in my daily
nursing practice. On our Endoscopy unit our patient satisfaction scores about discharge
instructions have been below average. Patients do not feel that we provide education about what
to do if they are in pain when they get home. With the help of my nurse leader, I conducted a
literature review searching for EBP regarding successful discharge teaching. Nursing leadership
supports EBP by allowing me to work on this project during down times and mentoring me
through the process. We are now going to introduce a “teach back” portion of our home care
teaching to give patients a chance to demonstrate what they know and address deficits. I am
currently collaborating with a nurse in Quality Improvement and another in Education to create a
teaching plan for nurses on our unit to coach them with this new aspect of our discharge
protocol. This collaboration will ensure that our teach back method will be based on EBP and be
uniform across the unit. The collaboration is important because the nurses I am working with
have more experience in QI issues and staff training. By working with them, I have access to
their expertise and this increases the likelihood of success on this project. We hope to measure

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outcomes by reexamining our patient satisfaction scores. I would not have felt confident in my
ability to take on this project before entering the BS program.
Resource utilization is an important responsibility for the profession of nursing. The
ANA lists “Resource Utilization” as a standard of professional performance (ANA, 2015).
Among the competencies for this standard are “uses organizational and community resources to
implement inter-professional plans” (ANA, 2015, p. 82). An example of this in my practice is
collaborating with the Bridges and Beyond program through Medicaid. After conscious sedation,
a patient is considered legally impaired and cannot drive themselves home. They also are
considered too impaired to use public transportation unsupervised. Typically, friends or family
will arrange to bring a patient home. But if there is no one to help, this could be a barrier to a
patient that needs an endoscopy screening. Bridges and Beyond is a Medicaid program that has
trained drivers who are able to safely escort people home after a procedure and ensure that they
get home safely.
Nursing ethics are a cornerstone of my professional nursing practice. My approach to the
development of my nursing philosophy was one of rule deontology and defining my foundational
ethics of honesty and advocacy. I believe that every patient has the right to live in a state of
comfort, ease, and dignity, and that it is my ethical responsibility as a nurse to work with patients
and their families to achieve this.
Conclusion
A personal nursing philosophy is declaration of a nurse’s values, beliefs, and ethics about
nursing. Such a philosophy is based on theory, personal beliefs, and experience (Petiprin, 2016).
I have identified with Kolcaba’s Theory of Comfort as the foundation of my personal nursing
philosophy. This theory coincides with my foundational ethics of honesty and advocacy. I can

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relate to her concept of providing comfort, which is defined as the “immediate experience of
being strengthened through having the needs for relief, ease, and transcendence met in four
contexts of experience (physical, psychospiritual, social, and environmental)” (Kolcaba, 2010).
I believe that this concept of strengthening through comfort can also be applied to the self and to
our co-workers and even to the institutions where we work. I will continue to grow
professionally through education and self-care, and I will support my team through collaboration
and ethical practice. I will strengthen my workplace by continuing in my professional
development and working towards improved patient outcomes. I feel to be a nurse is to provide
compassionate, caring, comfort. I strive to be the best in all I do so that I may excel in this
profession.

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