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CHAPTER 33 Katharine Kolcaba 665
Research theory that is readily applied in many settings for
An entry in the Encyclopedia of Nursing Research education, practice, and research. Kolcaba devel-
speaks to the importance of measuring comfort as a oped templates for measurement to facilitate appli-
nursing-sensitive outcome (Kolcaba, 2006). Nurses cation of the comfort theory in additional settings.
can provide evidence to influence decision making The comfort management templates she provided
at institutional, community, and legislative levels for use in practice settings have been helpful to stu-
through studies that demonstrate the effectiveness of dents and faculty members. Outcomes of research
comforting care. Kolcaba (2001) called for measure- have demonstrated the appropriateness of her the-
ment of comfort in large hospitals and home care to ory for measuring whole-person changes that were
expand the theory and develop the literature on evi- less effectively captured with other types of instru-
dence-based comfort. ments, as noted in a study of urinary incontinence
Using the taxonomic structure of comfort (see (Dowd, Kolcaba, & Steiner, 2000).
Figure 33–1) as a guide, Kolcaba (1992a) developed The original theoretical assertion (Part 1) of the
the General Comfort Questionnaire to measure holis- Theory of Comfort has stood up to empirical testing.
tic comfort in a sample of hospital and community When a comfort intervention is targeted to meet the
participants. Positive and negative items were gener- holistic comfort needs of patients in specific health
ated for each cell in the taxonomic structure grid. care situations, comfort is enhanced beyond baseline
Twenty-four positive items and twenty-four negative measurement. Furthermore, enhanced comfort has
items were compiled with a Likert-type format rang- been correlated with engagement in health-seeking
ing from strongly agree to strongly disagree, with behaviors (Schlotfeldt, 1975). Empirical tests of the
higher scores indicating higher comfort. At the end of theoretical assertions for the second and third parts of
the instrumentation study with 206 one-time partici- the theory are to be conducted. Outcomes for desir-
pants from all types of units in two hospitals and able health-seeking behaviors could include increased
50 participants from the community, the General functional status, faster progress during rehabilita-
Comfort Questionnaire demonstrated a Cronbach tion, faster healing, or peaceful death when appropri-
alpha of 0.88 (Kolcaba, 1992a). ate. health-seeking behaviors are negotiated among
Researchers are welcome to generate comfort ques- the patient, family members, and care providers. In-
tionnaires specific to their areas of research. The verbal stitutional outcomes would include decreased length
rating scales and other traditionally formatted ques- of stay for hospitalized patients, smaller number of
tionnaires may be downloaded from Kolcaba’s website, readmissions, decreased costs, and achievement of
where she also responds to inquiries in an effort to national awards such as the Beacon Award. Kolcaba
enhance the use of her theory. Instructions for use of the consults with hospital administrators who want to
questionnaires are available on her website. Popularity of enhance quality of care. She views quality care as
the theory seems to be associated with universal recog- comforting actions delivered in an intentional man-
nition of comfort as a desirable outcome of nursing care ner in order to create an environment that leads to
for patients and their families. engagement in health-seeking behaviors.
Kolcaba postulates that intentional emphasis on
and support for comfort management by an institu-
Further Development tion or community increases patient/family satisfac-
Kolcaba has persisted in the development of her the- tion, because persons are healed, strengthened, and
ory from the original conception as the root of her motivated to be healthier. Extending the Theory of
practice, to concept analysis that provided the taxo- Comfort to the community is of current interest. It is
nomic structure of comfort, to development of ways well known that some communities are more com-
to measure the concept, and currently to its use for fortable to live in, grow old in, and go to school in
practice, education, and research. She uses a full array than are others.
of approaches to build her theory. An area of interest for further development is the
The methodical development of the concept re- universal nature of comfort. Currently, the General
sulted in a strong, clearly organized, and logical Comfort Questionnaire has been translated into