Usefulness of Comfort Theory - Research Paper Example

? One of the numerous functionalities of nursing is to ensure that patients are comfortable. The discipline of nursing is relatively new tracing back to 1950s, in this respect several nursing concepts have been proposed and utilized within the nursing sphere in an attempt to guide nurses’ work and improve the general quality of health care provision to patients and place the health care institutions within the societal approval and acceptance stage. Of these borrowed theories in nursing Kolcaba’s Comfort Nursing theory has been relatively instrumental in patient comfort and the healing process. This paper examines comfort theory in the health care program. Attempts have therefore made in this paper to trace the origin of the theory, the three patient comforts of relief, ease, and transcendence have also been explained with their applications to the nursing practice. Further, the paper correlates the four contexts of comfort and integrates this into the larger comfort concept of the model. Other efforts have also been suggested on the relevance and applicability of the theory to the modern nursing practice, while pointing out limitation of the theory and offering suggestions for wider health care application of the theory. This paper sums up the discussions by highlighting the focus of comfort theory and relating it to its proposed modification so that it can enhance health care provision to larger healthcare framework and not just on nursing practitioners. According to Florence Nightingale, the primary concept of nursing is to place a patient in the best possible conditions for nature to act upon them. Virginia Henderson also defines nursing as the unique function of assisting individuals, either well or ill, in performing activities that contribute to enhance health, recovery, or peaceful death that the individual would perform without assistance if they had adequate will, strength, and knowledge. (Kolcaba, 2003) Moreover, these assistive functions are performed in a manner that enables the individual to gain rapid independence. According to research and studies in the past, majority of patients attest to provision of care with kindness by most nurses. The relationship between nursing care and comfort dates back to the early 1900s with the central focus on moral imperative. By 1903s, specialists in the nursing field perceived comfort as a strategy for attaining aspects of nursing care. By 1960s, comfort was a minor goal in nursing care, as physical aspects were dominant while emotional comfort was gaining importance. In 1990, Kolcaba’s Comfort Theory was fully dominant, with emphasis on childbirth pain, pain management, and palliative care and end of life (Kolcaba, 2003). Conditions in the nursing care sector such as loss and suffering of patients with complex medical care, pain scores of 10/10 even with increase in medication, and personal frustration and inability to change the situation contributed to the adoption of comfort as the foundation of nursing care. There exists universal consensus among the health practitioners that nurses’ role entirely should focus on caring for the patients and making them feel comfortable. Comfort for patient’s forms the discussions that Katherine Kolcaba anchors her discussions on Comfort Theory of Nursing. This theory sets out new paradigms in the nursing sector providing new insights into nursing as a profession and expectation of patients when being cared for by nurses. The Comfort Theory: Background From a bibliographical perspective, Kolcaba traces her childhood days to Ohio where she had always wanted to pursue nursing. To actualize her dreams, she took up a volunteering nursing job at Candy stripper at tender age of 14 to gain insights into the nursing profession. Her nursing education traces back to St. Luke’s Hospital School of Nursing and Case Western Reserve University being the first Registered nurse for a Master’s degree with special interest in gerontology in 1975. It is during her post graduate studies that Kolcaba started formulating her principles relating to Comfort theory initially being centered on patient/family relationship. The theory has evolved over the years and continues to be significantly relevant to the modern healthcare programme with the conceptual framework being revised as recent as November 2007. Many researchers agree that the Kolcaba theory exhibits great potential in placing comfort in the forefront for health care provision. The Concept of Comfort Dating back to 1990s, Kolcaba developed her theory as a middle range nursing theory that would find relevance in nursing practice, education, and contemporary research. Examining several literature from related disciplines, Kolcaba, formulated a concept analysis of comfort drawing from a number of disciplines including nursing, psychology, medicine and psychiatry. (March & McCormack, 2009) Kolcaba imperatively defines ‘Comfort’ as a ‘state of ease and quiet enjoyment or the lessening of pain and grief.’ (Kolcaba K. Y., 1994) Comfort is relative. Kolcaba’s Comfort Theory seeks to address human needs, including transcendence, relief, and ease. It takes an individualized (holistic) approach to enhance the feelings of wellbeing and a sense of strength. Moreover, it provides a conceptual framework for nursing care (Kolcaba K. , 2003). According to Kolcaba, comfort exists in three forms; relief, ease and transcendence, which can again occur in four contexts; physical, psychospiritual, environmental and sociocultural. (Kolcaba K. , 2010) Relief comfort is a result of pain management through use of medications. For example, if a patient feels pain, a prescription drug is administered to relieve the pain. Ease comfort places more emphasis on the environment and state of mind of the patient. Kolcaba suggests that if issues of anxiety are exhaustively addressed a person feels at ease. The last form of comfort, the transcendence, is experienced when a patient is able to counteract their challenges experienced after care and recovery. (Kolcaba & Kolcaba, 1991) Contexts of Comfort Theory In her theory, Kolcaba suggests four contextual situations on which the theory is anchored; physical, psychospiritual, environmental and sociocultural. (Kolcaba K. Y., 1994) A Study by (March & McCormack, 2009) restates that Kolcaba defines physical context as any comfort that is experienced on any part of a person’s body. Subsequently, psychospiritual comfort is that which ‘pertains to internal awareness of self, including esteem, identity, sexuality, meaning in one’s life, and one’s understood relationship to a higher order or being.’ (March & McCormack, 2009) Further environmental context is described as comfort that arises from the immediate surroundings of the patient. To sum up this, Kolcaba provides a vivid description of sociocultural comfort as that which ‘pertains to interpersonal, family, and larger societal relationships.’ (Kolcaba, Tilton, & Drouin, 2006) In her model, Kolcaba describes nursing as an ongoing process that aims at determining a patient’s unique personal comfort requirements and developing specific plans to achieve those perceived comfort requirements and evaluating the extent to which these comfort needs have been met. In her theory, Kolcaba puts varied definitions of key elements of her nursing theory as they apply to nursing practice. She defines healthcare needs as those unique needs that have been so indentified by patient in a particular nursing situation. Intervening variables are factors that are beyond manipulation of health care practitioners and the magnitudes of their effects are unlikely to change prognosis, financial implications, and societal support. Further, Health-seeking behaviors describe how a patient behaves when seeking health, while Institutional Integrity refers to the work value and guiding organizational philosophy at various levels of health care provision. Lastly, best policies define procedures that are adapted in the health care program after collection of evidence. Conceptual Framework Explained In her theory, Kolcaba presents a conceptual framework which correlate to the comfort theory. (Kolcaba & Kolcaba, 1991) In the framework, Kolcaba first proposes assessing of appropriate healthcare needs and developing appropriate mechanisms to meet those needs while balancing on the variable, the result she suggests, is an ‘enhanced patient comfort over time’ (Kolcaba & DiMarco, 2005) This then follows a patient’s tendency to seek more health behaviors that may be internal (healing), external (increased patient functioning), or peaceful death. Further, increased display of health seeking behaviors by the patient improves the integrity of the health institution that further culminates into improved outcomes. This then will lead to suggestions and development of best practices and policies. Figure 1: Conceptual Framework for Comfort Theory Comfort Theory in Nursing Practice Kolcaba affirms that her theory is multi-cultural theory that transcends at various levels of nursing healthcare programs, as she positions her theory within the larger sphere of nursing. Kolcaba further asserts that the achieving full benefits of the theory requires to a larger extent commitment to achieving healthcare programs of patients and therefore calls for a institutional wide approach. Research studies conducted in the past to test the efficacy of this approach to nursing confirms a majority of patients affirming to getting better healthcare, these patients rate patients as better listeners, and respectful who are ready to provide individualized attention and healing that would promote healing. Indeed, it makes sense to provide a holistic approach through comfort. Moreover, it supports clinical decision-making, explains nursing care, as well as providing a framework for the nursing practice. In addition, most nurses and patients understand comfort, and parents may be an important part of the nursing care. Comfort is an integral concept for patients seeking to regain former functional levels, those undergoing strenuous therapies, as well as those wish to die in a dignified manner. The physical concept relates to homeostasis and bodily sensation, including regular bowel function, pain relief, adequate oxygen saturation, electrolytes and fluid balance, and positioning and turning. The socio-cultural concept concerns societal, interpersonal, and family relationships, rituals, and family traditions. These include cultural customs, continuity of care, caring attitude, education and information, and enhancing friend and family support. Psycho-spiritual concept revolves around the internal awareness of the meaning of one’s life, self-esteem, and sexuality, including improving and maintaining self-esteem, increasing relaxation, enhancing independence, and accommodating religious practices. The environment concept relates to external background of human experience such as light, color, temperature, noise, access to nature, and view from the window. Comfort Care in Nursing Practice and its significance There are three types of comfort care in nursing practice: technical, coaching, and comfort. Technical comfort care involves maintenance of homeostasis, including activities such as observation of side effects, prevention of complications, administration of drugs, and managing and monitoring nausea, pain, and dyspnea among others signs and symptoms (Kolcaba K. , 2003) Coaching comfort care relates to relieving of anxiety and planning for recovery, including providing information and assurance, encouragement, listening and instilling hope, and assisting in the plan for health optimization. Kolcaba’s Comfort Theory is particularly important to patients with Alzheimer’s, women and childbirth, post anesthesia nursing, ambulatory care, pediatrics, and hospice. In patient units, comfort theory is important in identifying opinion leaders and champions through staff involvement. It is also compatible with expectations. Moreover, it is essential in instilling leadership and theory skills as a form of staff education. It also contributes enormously to quality improvement projects such as patients’ satisfaction surveys and chart audit. Additionally, comfort theory in patients units enables integration of nursing practice and theory. It engages nurses in discussion with the families and patients on activities that may enhance comfort to the patients, as well as clinical discussions, teaching families on the importance of comfort, and communication-shift reporting. It also enhances communication with colleagues, particularly in bulletin boards, clinical care, and discussion plans. Comfort theory in systems reflect the dimensions of care that relate to satisfaction of consumers, including coordinate care, respect of individuals, relieving fears, providing pain relief and comfort, providing predictive information, involving friends and families, and conceptualizing a patient as a person in the continuum of life rather than an episode. Kolcaba’s Comfort Theory is an effective approach to pain management, through physical, socio-cultural, psycho-spiritual, and environment perspectives. (Kolcaba K. , 2003) Comfort theory is essential in caring and assessing patients in pain. Kolcaba’s Comfort Theory is a nursing practice framework, applicable to individual units, systems, and practice. Testability of the theory Recent studies reveal that the comfort theory can be applied to varied community, family or even at individual level. Its concepts are propositions are specific to nursing and commonly referred to as ‘the essence of nursing’; the outcome of the theory has been operationalized using the taxonomic structure as a guide for item generation. Moreover, qualitative studies indicate that patients often expect nurses to assist them in meeting their comfort needs, and therefore the theory provides for a nursing sensitive outcome. Notably, this theory has elicited several other studies to justify its findings, notably, Hogan-Miller has extensively used this methodology on her study of ‘immobilization of post angiography patients,’ other studies include; Nurse Midwifery (Schuiling & Sampsell, 1999), Labor and Delivery (Koehn, 2000), Cardiac Catheterization (Hodgan-Miller, Rustard, Sendelbach & Goldenberg, 1995), Critical Care (Jenny & Logan, 1996; Kolcaba & Fischer, 1996), Hospice (Schoerner & Krysa, 1996); perhaps a magnification of its acceptance within the health environment. Limitation of the Comfort Theory A study by (March & McCormack, 2009) faults Kolcaba’s theory as describing application of ‘nursing interventions’ which limit implementation of these interventions only to the nursing providers, they therefore propose a modification of the ‘comfort theory’ to ‘comfort interventions’ which would broaden a multi institutional application of the theory to ‘any health care practitioner who chooses to adapt this theoretical framework of practice.’ (March & McCormack, 2009); potential benefits would be increasing comfort for patients even further, leading to societal acceptance and appreciation of health care institutions. (March & McCormack, 2009) Conclusion Throughout the paper Kolcaba theory has been examined in the context of nursing. The paper has also exploited the origin of Kolcaba theory that sets new paradigm in nursing, further the theory has been examined in the wide nursing sphere, and its impacts on helping organizational development presented. Of significance to this discussion would be adapting comfort theory to a wide health care program with hypothetical basis that the benefits of the theory can be enjoyed in a wide health care fraternity. References Kolcaba, K. (2003). Comfort Theory and Practice: A Vision for Holistic Health Care and Research. New York: Springer Publishing Company. Kolcaba, K. (2010). In The comfort line. Retrieved March 29, 2012, from An introduction to comfort theory, http://www.thecomfortline.com/ Kolcaba, K. Y. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19(6) , 1178-1184. Kolcaba, K. Y., & Kolcaba, R. J. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing, 16(11) , 1301-1310. Kolcaba, K., & DiMarco, M. A. (2005). Comfort theory and its application to pediatric nursing. Pediatric Nursing 31(3) , 187-194. Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort Theory: A Unifying Framework to Enhance the Practice Environment. Journal of Advanced Nursing 36(11) , 538-544. March, A., & McCormack, D. (2009, March/April). Nursing Theory-Directed Healthcare: Modifying Kolcaba's Theory as an Institution-Wide Approach. Holistic Nursing Practice 23 , pp. 75-80. Read More