Page 109 - Encyclopedia of Nursing Research

76 n CoMFoRT THEoRY

for nurses to practice comforting care would (d) hand massage for persons near end of
demonstrate increased nurse loyalty and life, and (e) generalized comfort measures for
C productivity and less absenteeism because women during first and second stages of labor.
this kind of nursing care is less stressful In each study, interventions were targeted to
and more satisfying, not only for patients/ all attributes of comfort relevant to the research
families but also for nurses. settings. Comfort instruments were adapted
CT focuses on enhancing patient/family from the General Comfort Questionnaire
comfort for altruistic and pragmatic reasons. (Kolcaba, 2003) using the taxonomic structure
Patients/families want to be comforted by of comfort as a guide, and there were at least
nurses in stressful health care situations, and two measurement points, usually three, to
CT reminds nurses about the strengthen- capture changes in comfort over time.
ing aspect of comfort interventions. Because CT guides researchers to test relation-
comfort theoretically is related to subsequent ships between comfort and HSBs. These
desirable health and institutional outcomes, relationships have been consistently pos-
the outcome of enhanced comfort is elevated itive, and comfort has found to be a good
in stature among other more technical and indicator for those who do well in therapy
narrow outcomes. It is a desired, holistic, or new regimens. Therefore, nurses have
value-added, and (often) nursing- sensitive a pragmatic rationale for enhancing their
outcome that is congruent with recent man- patients’ comfort. Third, it guides nurses to
dates to measure nursing effectiveness test relationships between HSBs and insti-
in terms of positive patient/family goals tutional outcomes (such patient satisfaction,
(Magvary, 2002). CT also is nurse-friendly the national and publicized benchmark for
because it places responsibility and incen- “best hospitals”).
tives on health care institutions to provide To demonstrate that providing comfort
working conditions conducive to comfort- is an still an important mission for nursing,
ing care. Improving working conditions is more tests of CT must be conducted. Choices
the underlying rationale for the inception of for desirable HSBs could include increased
the Magnet Status award by the American functional status, increased T-cell count,
nurses Association (Kolcaba, Drouin, & faster progress during rehabilitation, faster
Kolcaba, 2006). Suggestions and rationale for healing, or peaceful death (when appro-
teaching comforting care and using CT as a priate). In addition to meeting benchmarks
framework for ethical decision making are such as higher patient satisfaction scores or
in Kolcaba’s (2003) book and on her Web site decreased nurse turnover, institutional out-
(www.TheComfortLine.com). comes could include decreased length of stay
CT guides nurse researchers to test rela- for hospitalized patients, decreased readmis-
tionships between particular holistic inter- sions for the same or related medical problem,
ventions and comfort. Several empirical tests and general cost–benefit analyses for specific
of the first part of comfort theory (CT) have evidence-based protocols. Improved institu-
been conducted by Kolcaba (2003). These tional outcomes are of interest to administra-
comfort studies demonstrate significant dif- tors, funding agencies, third-party payers,
ferences between treatment and usual care and policy makers.
groups on comfort over time. The following A large number of comfort management
interventions were tested: (a) types of immo- strategies and guidelines have been created
bilization for persons after coronary angio- by Kolcaba, and each component is available
gram, (b) guided imagery for women going on her Web site. These strategies include but
through radiation therapy for early breast are not limited to comfort contracts, comfort
cancer, (c) cognitive strategies for persons rounds, comfort assessments, comfort check-
with urinary frequency and incontinence, lists, comfort instruments for small children