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662 UNIT V Middle Range Nursing Theories

Tests on the data set from Kolcaba and Fox’s (1999) 3. Comfort is a basic human need that persons
earlier study of women with breast cancer supported strive to meet or have met. It is an active endeavor
each proposition. Other areas of study included in the (Kolcaba, 1994).
Kolcaba website are burn units, labor and delivery, in- 4. Enhanced comfort strengthens patients to engage in
fertility, nursing homes, home care, chronic pain, pedi- health-seeking behaviors of their choice (Kolcaba &
atrics, oncology, dental hygiene, transport, prisons, deaf Kolcaba 1991; Kolcaba, 1994).
patients, and those with mental disabilities. 5. Patients who are empowered to actively engage in
health-seeking behaviors are satisfied with their
Major Assumptions health care (Kolcaba, 1997, 2001).
6. Institutional integrity is based on a value system
Nursing oriented to the recipients of care (Kolcaba 1997,
Nursing is the intentional assessment of comfort 2001). Of equal importance is an orientation to a
needs, the design of comfort interventions to address health-promoting, holistic setting for families and
those needs, and reassessment of comfort levels after providers of care.
implementation compared with a baseline. Assessment
and reassessment may be intuitive or subjective or
both, such as when a nurse asks if the patient is com- Theoretical Assertions
fortable, or objective, such as in observations of The Theory of Comfort contains three parts (proposi-
wound healing, changes in laboratory values, or tional assertions) to be tested separately or as a whole.
changes in behavior. Assessment is achieved through Part I states that comforting interventions, when
the administration of verbal rating scales (clinical) or effective, result in increased comfort for recipients
comfort questionnaires (research), using instruments (patients and families), compared to a preinterven-
developed by Kolcaba (2003). tion baseline. Care providers may be considered re-
cipients if the institution makes a commitment to the
Patient comfort of their work setting. Comfort interventions
Recipients of care may be individuals, families, institu- address basic human needs, such as rest, homeostasis,
tions, or communities in need of health care. Nurses therapeutic communication, and treatment as holistic
may be recipients of enhanced workplace comfort when beings. Comfort interventions are usually nontechni-
initiatives to improve working conditions are under- cal and complement the delivery of technical care.
taken, such as those to gain Magnet status (Kolcaba, Part II states that increased comfort of recipients of
Tilton, & Drouin, 2006). care results in increased engagement in health-seeking
behaviors that are negotiated with the recipients.
Environment Part III states that increased engagement in health-
The environment is any aspect of patient, family, or seeking behaviors results in increased quality of care,
institutional settings that can be manipulated by benefiting the institution and its ability to gather evidence
nurse(s), loved one(s), or the institution to enhance for best practices and best policies.
comfort. Kolcaba believes that nurses want to practice com-
forting care and that it can be easily incorporated with
Health every nursing action. She proposes that this type of
Health is optimal functioning of a patient, family, comfort practice promotes greater nurse creativity
health care provider, or community as defined by the and satisfaction, as well as high patient satisfaction. In
patient or group. order to enhance comfort, the nurse must deliver the
appropriate interventions and document the results
Assumptions in the patient record. However, when the appropriate
1. Human beings have holistic responses to complex intervention is delivered in an intentional and com-
stimuli (Kolcaba, 1994). forting manner, comfort still may not be enhanced
2. Comfort is a desirable holistic outcome that is ger- sufficiently. When comfort is not yet enhanced to its
mane to the discipline of nursing (Kolcaba, 1994). fullest, nurses then consider intervening variables to