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664 UNIT V Middle Range Nursing Theories

was state-specific, if comforting interventions were changes in comfort over time (Dowd, Kolcaba,
implemented over time, the overall comfort of pa- Steiner, et al., 2007). A list of effective comforting in-
tients could be enhanced over time. In this deductive terventions for each patient/family member is readily
stage of theory development, she began with abstract, available and communicated.
general theoretical construction and used the socio- Perianesthesia nurses have incorporated the The-
logical process of substruction to identify the more ory of Comfort into their Clinical Practice Guidelines
specific (less abstract) levels of concepts for nursing for management of patient comfort. In this setting,
practice. comfort management specifies (1) assessing patients’
comfort needs related to current surgery, chronic
Retroduction pain issues, and comorbidities; (2) creating a comfort
Retroduction is useful for selecting phenomena that contract with patients prior to surgery that specifies
can be developed further and tested. This type of effective comfort interventions, understandable and
reasoning is applied in fields that have few available efficient comfort measurement, and the type of post-
theories (Hardin & Bishop, 2010). Such was the case surgical analgesia preferred; (3) facilitating comfort-
with outcomes research, which now is centered on col- able positioning, body temperature, and other factors
lecting databases for measuring selected outcomes related to comfort during surgery; and (4) continuing
and relating those outcomes to types of nursing, med- with comfort management and measurement in the
ical, institutional, or community protocols. Murray’s postsurgical period (Wilson & Kolcaba, 2004).
twentieth-century framework could not account for
the twenty-first–century emphasis on institutional and Education
community outcomes. Using retroduction, Kolcaba Goodwin, Sener, & Steiner (2007) described guide-
added the concept of institutional integrity to the lines for applying the Theory of Comfort in acceler-
middle-range Theory of Comfort. Adding the term ated baccalaureate nursing programs. The theory
extended the theory for consideration of relationships proved to be easy for faculty to understand and apply
between health-seeking behaviors and institutional and provided an effective method to role-model a
integrity. In 2007, the concepts of best practices and supportive learning partnership with the students.
best policies were linked to institutional integrity. The- The Theory of Comfort is included in Core Concepts
ory-based evidence organizes the knowledge base for in Advanced Practice Nursing(Robinson & Kish, 2001).
best practices and policies (see Figure 33–2). The theory is appropriate for students to use in any
clinical setting, and its application can be facilitated
Acceptance by the Nursing Community by use of Comfort Care Plans available on Kolcaba’s
website.
Practice Recently, Goodwin, Sener, and Steiner (2007) uti-
Students and nurse researchers have frequently selected lized the Theory of Comfort as a teaching philosophy
this theory as a guiding framework for their studies in in a fast-track nursing education program for stu-
areas such as nurse midwifery (Schuiling, Sampselle, & dents with baccalaureate degrees in other disciplines.
Kolcaba, 2011), hospice care (Kolcaba, Dowd, Steiner, The taxonomic structure and conceptual framework
et al., 2004), perioperative nursing (Wilson & Kolcaba, guided ways of being a comforting faculty member.
2004), long-term care (Kolcaba, Schirm, & Steiner, The theory provided ways for students to obtain relief
2006), stressed college students (Dowd, Kolcaba, from their heavy course work by facilitating questions
Steiner, et al., 2007), dementia patients (Hodgson & to their clinical problems, maintaining ease with their
Andersen, 2008), and palliative care (Lavoie, Blondeau, curriculum through trusting their faculty members,
& Picard-Morin, 2011). and achieving transcendence from their stressors with
When nurses ask patients or family members to use of self-comforting techniques. The authors antici-
rate their comfort from 0 to 10 before and after an pate “that this adaptation may assist students to trans-
intervention or at regular intervals, they produce form into professional nurses who are comfortable
documented evidence that significant comfort work is and comforting in their roles and who are committed
being done. A verbal rating scale is sensitive to to the goal of lifelong learning” (p. 278).