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658 UNIT V Middle Range Nursing Theories

comfort in a middle-range theory (Kolcaba, 1994), and recovery was achieved (McIlveen & Morse, 1995).
tested the theory in an intervention study (Kolcaba & The nurse was duty bound to attend to details influ-
Fox, 1999). encing patient comfort. Aikens (1908) proposed that
Currently, Dr. Kolcaba is an emeritus associate pro- nothing concerning the comfort of the patient was
fessor of nursing at the University of Akron College of small enough to ignore. The comfort of patients was
Nursing, where she teaches theory to MSN students. the nurse’s first and last consideration. A good nurse
She also teaches theory to DNP students at Ursuline made patients comfortable, and the provision of com-
College in Mayfield Heights, Ohio. Her interests in- fort was a primary determining factor of a nurse’s
clude interventions for and documentation of changes ability and character (Aikens, 1908).
in comfort for evidence-based practice. She resides in Harmer (1926) stated that nursing care was con-
the Cleveland area with her husband, where she enjoys cerned with providing a “general atmosphere of
being near her grandchildren and her mother. She comfort,” and that personal care of patients in-
represents her company, known as The Comfort Line, cluded attention to “happiness, comfort, and ease,
to assist health care agencies implement the Theory of physical and mental,” in addition to “rest and sleep,
Comfort on an institutional basis. She is founder and nutrition, cleanliness, and elimination” (p. 26).
coordinator of a local parish nurse program and a Goodnow (1935) devoted a chapter in her book, The
member of the ANA. Kolcaba continues to work with Technique of Nursing, to the patient’s comfort. She
students conducting comfort studies. wrote, “A nurse is judged always by her ability to
make her patient comfortable. Comfort is both
physical and mental, and a nurse’s responsibility
Theoretical Sources does not end with physical care” (p. 95). In text-
Kolcaba began her theoretical work diagramming her books dated 1904, 1914, and 1919, emotional com-
nursing practice early in her doctoral studies. When fort was called mental comfort and was achieved
Kolcaba presented her framework for dementia care mostly by providing physical comfort and modify-
(Kolcaba, 1992b), a member of the audience asked, ing the environment for patients (McIlveen &
“Have you done a concept analysis of comfort?” Morse, 1995).
Kolcaba replied that she had not but that would be In these examples, comfort is positive and achieved
her next step. This question began her long investiga- with the help of nurses and, in some cases, indicates
tion into the concept of comfort. improvement from a previous state or condition.
The first step, the promised concept analysis, be- Intuitively, comfort is associated with nurturing activ-
gan with an extensive review of the literature about ity. From its word origins, Kolcaba explicated its
comfort from the disciplines of nursing, medicine, strengthening features, and from ergonomics, its direct
psychology, psychiatry, ergonomics, and English link to job performance. However, often its meaning
(specifically Shakespeare’s use of comfort and the is implicit, hidden in context, and ambiguous. The
Oxford English Dictionary [OED]). From the OED, concept varies semantically as a verb, noun, adjective,
Kolcaba learned that the original definition of com- adverb, process, and outcome.
fort was “to strengthen greatly.” This definition pro- Kolcaba used ideas from three early nursing theo-
vided a wonderful rationale for nurses to comfort rists to synthesize or derive the types of comfort in
patients since the patients would do better and the the concept analysis (Kolcaba & Kolcaba, 1991).
nurses would feel more satisfied. • Relief was synthesized from the work of Orlando
Historical accounts of comfort in nursing are nu- (1961), who posited that nurses relieved the needs
merous. Nightingale (1859) exhorted, “It must never expressed by patients.
be lost sight of what observation is for. It is not for the • Ease was synthesized from the work of Henderson
sake of piling up miscellaneous information or curi- (1966), who described 13 basic functions of human
ous facts, but for the sake of saving life and increasing beings to be maintained during care.
health and comfort” (p. 70). • Transcendence was derived from Paterson and
From 1900 to 1929, comfort was the central goal Zderad (1975), who proposed that patients rise
of nursing and medicine because, through comfort, above their difficulties with the help of nurses.