KATHARINE KOLCABA

By: Ashley Harris

Katharine Kolcaba

The Art of Comfort Care “Nursing art is defined and a template is presented for practicing one type of nursing art called comfort care. Propositions for comfort care are derived from a theory of comfort. Benefits are listed for integrating comfort care into practice. Testimony from a student who learned and applied comfort care provides support for its effectiveness as a learning tool. Comfort care is a holistic, individualistic, creative, and efficient model.” Katharine Kolcaba 3

Why I chose this theorist I chose Katharine Kolcaba as my nursing

theorist because it is a theory on comfort. I work with individuals that have intellectual disabilities and most are wheelchair bound. It is my duty to make sure they are as comfortable in all aspects of their life as possible.

Who is Katharine Kolcaba? Katharine Kolcaba is currently an associate

professor at University of Akron. 1

Specialized in Gerontology, End of Life and Long Term Care Interventions, Comfort Studies, Instrument Development, Nursing Theory, Nursing Research 1

In 2003 she published Comfort Theory and Practice: a Vision for Holistic Health Care and Research 2

Her education is as follows: 2 1965 Diploma, St. Luke's Hospital School of Nursing 1987 RN/MSN Case Western Reserve University 1997 PhD. Nursing Case Western Reserve University

The Comfort Theory •The comfort theory is a nursing theory

that was first developed in the 1990s by Katharine Kolcaba.1

Comfort is the immediate experience of being strengthened by having needs for relief, ease, and transcendence met in four contexts (physical, psychospiritual, social, and environmental). 2

The Comfort Theory Relief: The state of a patient who has a

specific need met 2

Ease: The state of calm and contentment 2

Transcendence: The state in which one rises above one's problems or pain 2

The Comfort Theory Key Concepts

Part 1 states that nurses assess the holistic (physical, psychospiritual, sociocultural, and environmental) comfort needs of patients in all settings. Furthermore, nurses implement a variety of interventions to meet those needs and measure or assess patients’ comfort levels before and after those interventions. This part of comfort theory also describes positive and negative intervening patient variables over which the nurse has little control, but that have considerable impact on the success of comfort interventions. Examples of these variables are the patient’s financial situation, cognitive status, extent of social support, and prognosis. 4

The Comfort Theory Key Concepts

Part 2 of Comfort Theory states that enhanced comfort strengthens patients to consciously or subconsciously engage in behaviours that move them toward a state of well-being. These behaviours are called health-seeking behaviours and provide rationale for implementing comfort interventions. For patients in the peri-anesthesia setting, health-seeking behaviours might include decreased blood loss, no complications, increased healing, increased mobility, and the ability to take oral fluids. Health-seeking behaviours are related to what is called institutional integrity in Part 3 of Comfort Theory. 4

The Comfort Theory Key Concepts

Part 3 of comfort theory states institutional integrity is defined as the quality or state of health care organizations in terms of being complete, sound, upright, professional, and ethical providers of health care. It is measured by many indicators, including cost of care; length of stay; staff turnover rate; and patient, nurse, and staff satisfaction. 4

Taxonomic Structure of Comfort

Taxonomic Structure of Comfort continued

Physical: Pertaining to bodily sensations. 2

Psychospriritual: Pertaining to internal awareness of self, including esteem, concept, sexuality, and meaning in one's life; one's relationship to a higher order or being . 2

Environmental: Pertaining to the external surroundings, conditions, and influences.

Sociocultural: Pertaining to interpersonal, family, and social relationships. 2

Conceptual Framework for Comfort Theory

Major Concepts and Definitions used in Conceptual Framework Health Care Needs are those identified by the

patient/family in a particular practice setting. 2 Comforting Interventions are nursing interventions

that are designed to address specific comfort needs of recipients. This includes physiological, social, financial, psychological, spiritual, environmental, and physical interventions. 2

Intervening Variables are interacting forces that influence recipients' perceptions total comfort. This includes factors such as past experiences, age, attitude, emotional state, support system, prognosis, and finances. 2

Major Concepts and Definitions used in Conceptual Framework Enhanced Comfort is an immediate desirable outcome

of nursing care, according to Comfort Theory. When comfort interventions are delivered consistently over time, they are theoretically correlated a trend toward increased comfort levels over time, and with desired health seeking behaviors. 2

Health-Seeking Behaviors (HSBs): The concept of HSBs was first introduced by Scholtfeldt (1975). The relationships between comfort and health seeking behaviors are entailed in the second part of Kolcaba's comfort theory. 2

Internal: healing, immune function, number of T cells, etc. External: health related activities, functional outcomes Peaceful Death

Major Concepts and Definitions used in Conceptual Framework Institutional Integrity is defined as the

values, financial stability, and wholeness of health care organizations at local, regional, state, and national levels. 2

Best Practices are those protocols and procedures developed by an institution for specific patient/family applications (or types of patients) after collecting evidence.

Best Policies are protocols and procedures developed by an institution for overall use after collecting evidence

Metaparadigm concepts as defined by Katharine Kolcaba

Nursing: the intentional assessment of comfort needs of patients, families or communities; design of comfort measures to address comfort needs, including re-assessment of comfort level after implementation of comfort measures, compared to a previous baseline. 2

Patient: an individual, family, or community in need of health care, including primary, tertiary, or preventative care. 2

Environment: aspects of patient/family/community surroundings that affect comfort and can be manipulated to enhance comfort. 2

Health: optimum function of a patient/family/community facilitated by enhanced comfort. 2

Basic assumptions of comfort care

Human beings have holistic responses to complex stimuli. 2

Comfort is a desirable holistic outcome that is germaine to the discipline of nursing. 2

Human beings strive to meet, or have met, their basic comfort needs. 2

When comfort needs are met, patients are strengthened. 2

Comfort questionnaires that have been developed by Katharine Kolcaba

General Comfort 2

General Comfort (short version) 2 Comfort Behaviors Checklist 2

Comfort Daisies (For use with children) 2 Perianesthesia 2

Radiation Therapy 2 Urinary Incontinence 2

End of Life (Patient version) 2 End of Life (Family version) 2 Hospice 2

Healing Touch 2

Advance Directives 2

Nurses 2

Conclusion Holistic comfort is defined as the

immediate experience of being strengthened through having the needs for relief, ease, and transcendence met in four contexts of experience (physical, psychospiritual, social, and environmental). 1

•The theoretical structure of Kolcaba's comfort theory has real potential to direct the work and thinking of all healthcare providers within one institution. 1

References1. Comfort Theory. Retrieved from

http://currentnursing.com/nursing_theory/comfort_theory_Kathy_Kolcaba.html

2. Katharine Kolcaba: Middle range nursing theorist. Retrieved from https://sites.google.com/a/northgeorgia.edu/middle-range-nursing-theorist-presentation/home.

3. Kolcaba, K. (1995). The art of comfort care [Electronic version]. Journal of Nursing Scholarship. 27(4), 287-289.

4. Katharine Kolcaba’s Theory of Comfort. Retrieved from http://nursingtheoryreview.blogspot.com/

Thank You I hope this presentation has been

educating on Katharine Kolcaba’s comfort theory.

It has been very educational for myself and I hope that each and every one of you will be able to take something away from this.