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CHAPTER 33 Katharine Kolcaba 667

The Theory of Comfort is dedicated to sustaining In research, the theory provides a way to validate
nursing by bringing the discipline back to its roots. improvement in patient comfort after receiving com-
Documentation of comfort strategies and their effects forting interventions. The concept of comfort accounts
empirically demonstrates the art of nursing. The out- for the aspect of quality that the patient describes as
come of comfort describes the effects of memorable “feeling better.” Kolcaba has made consistent efforts to
helping interactions with nurses that go beyond develop and expand comfort into all realms of health
checklists or physician orders. It encompasses the art care. Through her own thinking and in interaction
and science of nursing. Making electronic data sys- with nurses and other health professionals, the con-
tems inclusive of value-added outcomes such as com- cept has continually evolved into patient and nurse
fort is imperative. Collaboration and the openness of care techniques. Institutions have recognized the value
Kolcaba’s website facilitates dissemination of the the- of designing comfort environments for both their
ory for application. patients and their staff. Through Kolcaba’s publica-
The orientation to patient and family comfort may tions and Internet activities (website), the Theory of
have been present first in nursing, but it has become Comfort is now worldwide.
invisible and perhaps less valued by a health care system
that promotes the use of medications and technology.
Refocusing on patient and family comfort represents a CASE STUDY
return to the roots of nursing and also to the need for A 32-year-old African-American mother of three
empirical evidence. We can demonstrate through re- toddlers who is 28 weeks pregnant is admitted to
search that comfort is foundational to patient recovery, the high-risk pregnancy unit with regular contrac-
to other health-seeking behaviors, and to institutional tions. She is concerned because the plans for her
viability. The focus is applicable to other health care family are not finalized. She has many comfort
professions and ancillary workers. The use of a comfort needs that are diagrammed in Table 33–1. When
framework implemented throughout a hospital facili- nurses assess for comfort needs in any of their
tates everyone being “on the same page.”
patients, they can use the taxonomic structure, or
comfort grid, to identify and organize all known
Summary needs. Using the comfort grid (see Figure 33–1) as
From its inception, the Theory of Comfort has focused a mental guide, nurses can design interrelated
comforting interventions that can be implemented
on what the discipline of nursing does for patients. As in one or two nurse-patient-family interactions.
the theory evolved, the definition derived from con- For this case, some suggestions to individualize
cept analysis expanded to include broader aspects of the types of comfort interventions that might be
the patient such as cultural and spiritual aspects. The considered are presented in Table 33–2.
basic format of the taxonomic structure and concep- For clinical use, the nurse could ask the patient
tual framework remains the same. The development of to rate her comfort before and after receiving the
the General Comfort Questionnaire was important interventions on a scale from 0 to 10, with 10 be-
to validate that the concept can be measured and ing the highest level possible. To determine
documented, it is positive, and it is related to desirable through research if a specific comforting interven-
patient, family, and institutional outcomes. tion enhanced the comfort of a group of patients,
The theory has relevancy for practice and easily
guides nurses in the planning and designing of nurs- a comfort questionnaire could be developed and
administered, assessing each cell in the comfort
ing care in any setting. Its usefulness in education has grid (see Figure 33–1). A Likert-type scale with
been described as providing a framework that enables responses ranging from 1 to 6 would facilitate a
students to organize their assessments and plans of total comfort score. Such a questionnaire could be
care and learn the art of nursing as well as the science. given to the patient before and after the interven-
It is useful for expert nurses in the delivery of care as tions are implemented to demonstrate the level of
they demonstrate what they do beyond the technical effectiveness for the comfort interventions.
aspects of nursing.