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CHAPTER 33 Katharine Kolcaba 661

Conceptual Framework for Comfort Theory

Best
Practices
Health Enhanced Health
Care Nursing Intervening Comfort Seeking Institutional
Needs Interventions Variables Behaviors Integrity

Best
Policies

Internal Peaceful External
Behaviors Death Behaviors

© Kolcaba (2007)
FIGURE 33-2 Conceptual framework for the Theory of Comfort. (Copyright Kolcaba, 2007. Retrieved from
www.thecomfortline.com.)

patient population to meet their comfort needs, and In each study, interventions were targeted to all
the desired outcome was their comfort. The findings attributes of comfort relevant to the research settings,
revealed a significant difference in comfort over time comfort instruments were adapted from the General
between women receiving guided imagery and the Comfort Questionnaire (Kolcaba, 1997, 2003) using the
usual care group (Kolcaba & Fox, 1999). Kolcaba and taxonomic structure (TS) of comfort as a guide, and
associates conducted additional empirical testing of there were at least two (usually three) measurement
the Theory of Comfort, which is detailed in her book points used to capture change in comfort over time. The
(Kolcaba, 2003, pp. 113–124) and cited on her web- evidence for efficacy of hand massage as an intervention
site. These comfort studies demonstrated significant to enhance comfort is published in Evidence-Based
differences between treatment and comparison Nursing Care Guidelines: Medical-Surgical Interventions
groups on comfort over time. Examples of interven- (Kolcaba & Mitzel, 2008).
tions that have been tested include the following: Further support for the Theory of Comfort was
• Guided imagery for psychiatric patients (Apóstolo found in a study of four theoretical propositions
& Kolcaba, 2009) about the nature of holistic comfort (Kolcaba &
• Healing touch and coaching for stress reduction Steiner, 2000):
in college students (Dowd, Kolcaba, Steiner, & 1. Comfort is generally state-specific.
Fashinpaur, 2007) 2. The outcome of comfort is sensitive to changes
• Hand massage for hospice patients and long-term over time.
care residents (Kolcaba, Dowd, Steiner, & Mitzel, 3. Any consistently applied holistic nursing interven-
2004; Kolcaba, Schirm, & Steiner, 2006) tion with an established history for effectiveness
• Patient-controlled heated gowns for reducing enhances comfort over time.
anxiety and increasing comfort in preoperative 4. Total comfort is greater than the sum of its parts.
patients (Wagner, Byrne, & Kolcaba, 2006)