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CHAPTER 33 Katharine Kolcaba 663

explain why comfort management did not work. Such nurses were doing to prevent excess disabilities (later
variables may be abusive homes, lack of financial re- naming those actions interventions) and how to judge
sources, devastating diagnoses, or cognitive impair- if the interventions were working. Optimum function
ments that render the most appropriate interventions had been conceptualized as the ability to engage in
and comforting actions ineffective. Comfort manage- special activities on the unit, such as setting the table,
ment or comforting care includes interventions, com- preparing a salad, or going to a program and sitting
forting actions, the goal of enhanced comfort, and the through it. These activities made the residents feel
selection of appropriate health-seeking behaviors by good about themselves, as if it were the right activity
patients, families, and their nurses. Thus, comfort at the right time. These activities did not happen more
management is proposed to be proactive, energized, than twice a day, because the residents couldn’t toler-
intentional, and longed for by recipients of care in all ate much more than that. What were they doing in
settings. To strengthen the role of nurses as comfort the meantime? What behaviors did the staff hope
agents, documentation of changes in comfort before they would exhibit that would indicate an absence of
and after their interventions is essential. For clinical excess disabilities? Should the term excess disabilities
use, Kolcaba suggests asking patients to rate their be delineated further for clarity?
comfort from 0 to 10, with 10 being the highest pos- Partial solutions to these questions were to (1) divide
sible comfort in a given health care situation. This excess disabilities into physical and mental, (2) intro-
documentation could be a part of the electronic data duce the concept of comfort to the original diagram,
bases in each institution (Kolcaba, Tilton, & Drouin, because this word seemed to convey the desired state
2006). for patients when they were not engaging in special
activities, and (3) note the nonrecursive relationship
between comfort and optimum functioning. This think-
Logical Form ing marked the first steps toward a theory of comfort
Kolcaba (2003) used the following three types of logical and thinking about the complexities of the concept
reasoning in the development of the Theory of Com- (Kolcaba, 1992a).
fort: (1) induction, (2) deduction, and (3) retroduction
(Hardin & Bishop, 2010). Deduction
Deduction occurs when specific conclusions are in-
Induction ferred from general premises or principles; it proceeds
Induction occurs when generalizations are built from from the general to the specific (Hardin & Bishop,
a number of specific observed instances 2010). The deductive stage of theory development
(Hardin & Bishop, 2010). When nurses are earnest resulted in relating comfort to other concepts to pro-
about their practice and earnest about nursing as a dis- duce a theory. Since the works of three nursing theo-
cipline, they become familiar with implicit or explicit rists was entailed in the definition of comfort (Paterson
concepts, terms, propositions, and assumptions that & Zderad, 1975; Henderson, 1966 and Orlando, 1961),
underpin their practice. Nurses in graduate school may Kolcaba looked elsewhere for the common ground
be asked to diagram their practice as Dr. Rosemary Ellis needed to unify relief, ease, and transcendence (three
asked Kolcaba and other students to do, and it is a major concepts). What was needed was a more ab-
deceptively easy-sounding assignment. stract and general conceptual framework that was
Such was the scenario during the late 1980s as congruent with comfort and contained a manageable
Kolcaba began. She was head nurse on an Alzheimer’s number of highly abstract constructs.
unit at the time and knew some of the terms used The work of psychologist Henry Murray (1938)
then to describe the practice of dementia care, such as met the criteria for a framework on which to hang
facilitative environment, excess disabilities, and opti- Kolcaba’s nursing concepts. His theory was about hu-
mum function. However, when she drew relationships man needs; therefore it was applicable to patients who
among them, she recognized that the three terms did experience multiple stimuli in stressful health care
not fully describe her practice. An important nursing situations. Furthermore, Murray’s idea about unitary
piece was missing, and she pondered about what trends gave Kolcaba the idea that, although comfort