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Kolcaba’s Comfort Theory in Patient Care

Discuss about the Perianesthesia Organization and Administration.

Contemporary nursing may be seen as a conglomeration of certain beliefs, values and practices that may be put into practice within the realm of clinical practice to bring forth the desirable and optimum changes with the objective of providing respite to the distressed patients. Thus various nursing models and theories were introduced with the purpose of aiding in the process of understanding complex phenomenon by means of holistic approach and utilization of these conceptual models and tools. An overview of the real life happenings is generally promoted through these theories and models. In this context, the essential components concerning a nursing model may be appraised as having a set of values and beliefs, a statement in relation to the goal the nursing professional is endeavoring to attain and finally the requisite skills in addition to the knowledge that the nurses must possess to carry out in clinical practice (McEwen, 2013). Moreover, identification of the key concepts pivotal to the nursing profession is indispensable to the achievement of the desirable outcomes. In this regard four key concepts were unanimously decided of comprising the core themes in nursing encompassing the patient or the recipient of the nursing care, environment or the receiver’s specific surroundings, health or the ill or well being state of the client and finally nursing itself in which the nurses resort to providing care and undertake necessary actions on behalf or in co-operation with the patient. Thus it may be said that these theories form the foundations for the nursing practice thereby aiding ion the generation of further knowledge and concepts that would steer changes in a positive manner for future reference. Thus the description, prediction and explanation of the phenomenon relevant to nursing practice are provided by these theories. Emphasis is laid upon considering the various bioethical standards such as autonomy, beneficence, fidelity, freedom, objectivity, self assertion among many, while framing these theories. Critical thinking measures together with abductive reasoning patterns are taken into account to pave the way for decisively making ways for nursing theories (Alligood, 2014). However, in these care settings of clinical care adequate importance and attention paid on the evidence based practice to foster the generation of a suitable practice guideline and consequently theories that may be applicable in other care facilities as well thereby accounting for a closer association between theory and practice. Systematic understanding of the relevant situations and events are the primary objectives of these theories applicable to broader circumstances in clinical settings (Marshall, 2016). Hence the Kolcaba’s Comfort Theory may be mentioned in this regard that acts as a middle range theory in health practice, research and education. The discussions in the following sections will consider the utilities, relevancy and possible applications of the Comfort Theory with respect to the nursing practice especially in coping up with the pain management issues and applicability in the perianesthasia setting.

Applications of Comfort Theory

The various Nursing theories and models that are in vogue in the current clinical settings have many implications in healthcare. One such theory is the Kolcaba’s Comfort Theory that is considered as the middle range theory applicable to the domains concerning education, health practice and research. According to the propositions of this theory comfort is placed at the core of the nursing practice and healthcare and is suggested as the immediate desirable outcome of the nursing care. Holistic learning and acquisition of self emancipating behaviors are emphasized by the nursing professionals to utilize the holistic comfort theory in an effort to advocate optimum patient outcomes maintaining the essential virtues of patient safety and autonomy. The realities of nursing practice are put forward in front of them through the provision of this theory (Goodwin & Candela, 2013). In this regard the Comfort Theory holds immense significance in promoting the best practices in nursing care to foster best possible outcomes in the patient population. The Comfort Theory was first proposed in the 1990s by Katherine Kolcaba. The original definition for comfort attributed to the meaning of strengthening greatly. According to Kolcaba the presumptions of this theory highlighted that the need for comfort is fundamental, individuals normally experience comfort in a holistic manner, self comforting mechanism may be either healthy or unhealthy and rise in productivity is directly related to the enhancement in comfort levels. The nomenclature of comfort may be perceived under various backdrops whereas the general idea of providing relief from any discomfort may be presented from all the possible corners.

The three distinct types of comfort were related to the theory concerning the important aspects of relief, ease and transcendence that in turn were procured from three distinct nursing theories. The work of Orlando (1961/1990) who demonstrated that the nurses were responsible for reliving the needs as depicted by the patients in course of their treatments paved the way for the relief concept pertaining to the Comfort Theory. Further the work by Henderson (1978) lead to the development of the concept of ease relevant to the comfort theory where thirteen basic functions have been identified to be integral to the maintenance of homeostasis. The third aspect of transcendence that forms the core of the comfort theory implies that patients may surpass their difficulties by virtue of receiving help from the nurses and the idea was conceived in the works of Paterson and Zderad (1976).  Literature from numerous disciplines encompassing nursing, psychology, medicine, psychiatry, ergonomics and English were referred to for conducting the concept analysis. Patient comfort is also presumed to take place in four varied contexts associated with holistic human experience relevant to physical, psychospiritual, environmental and sociocultural aspects.

After the introduction of the three forms of comfort and the four contexts relevant to all round human experience, a taxonomic structure was laid down in order to assist in evaluation, measurement and assessment of patient comfort where comfort was perceived as the product of holistic nursing approach.  As per the propositions mad in the Comfort Theory patients are understood as individuals, families, institutions or communities requiring healthcare (Kolcaba, 2015).  In an effort to enhance the comfort, environment is generally considered as any aspect concerning the patient, family or institutional surrounding that may be manipulated by a nurse or a family person. Conversely health is also defined as the optimal functioning in the patient as described by patient, family, group or community. Identification of the broader approach pertaining to the care offered to the patients and their families was done through the usage of the enhanced comfort theory in a study carrying out family experience survey in the surgical intensive care unit. The questionnaire for the survey was prepared in compliance with the theoretical basis provided by the Comfort theory emphasizing upon the four aspects of comfort and the survey findings were carefully analyzed for the purpose of identifying and implementing suitable interventions in keeping with the issues raised in the study (Twohig et al., 2015). In order to cater to the needs of the veteran’s healthcare, comfort theory is prominent to confer daily patient and family care, discharge planning and follow up in several settings in addition to the strategies needed to improve institutional integrity and branding (Boudiab & Kolcaba, 2015). Similar sort of applications may be suited in the cases of the perianesthesia setting to optimize patient outcomes through proper detection of comfort interventions thereby accounting for holistic comfort management in the concerned individuals (Wilson & Kolcaba, 2004). Therefore the work and perception of the healthcare professionals may be profoundly impacted within the realm of one institution by means of the theoretical structure of the Kolcaba’s Comfort Theory.

Kolcaba’s Comfort Theory highlights the efficacy of the theoretical aspect of comfort where the immediate state of being strengthened by means of possessing the human needs for relief, ease and transcendence addressed through addressing of four contexts of experience involving physical, psychospiritual, environmental and sociocultural contexts. In the nursing practice, this theory is applicable to various settings depending upon the case scenarios. Assessments of the patient’s comfort needs and consequently improvisation and implementation of the suitable nursing care plans as well as the evaluation of the patient’s comfort after the care plans are executed are the primary objectives in nursing. Purposeful evaluation of the comfort needs in conjunction with the designing of comfort measures in order to address those needs followed by reassessment of comfort levels post implementation phase also falls under nursing goals. Assessments are generally carried out in two forms which include both objective and subjective patterns of analyses. Objective assessment mainly considers observational analysis while subjective assessment seeks to address the comfort level in the patient through questionnaire sessions. A pilot study aimed to explore the family relationships at the end of life and examined the relations among factors such as relatedness states, perceived comfort and life closure. Thus comfort was identified as a crucial factor that was intimately associated with the levels of involvement and relationship among the participant group and the end of life patients exhibited preference towards interactions that involved minimal effort (Hansen et al., 2015).

Applications of Comfort Theory may be understood through its utilizations in the gynecological settings in the healthcare facility. A study was conducted to determine the impact of nursing care depending upon comfort theory applicable to women’s postpartum comfort levels after Caesearean sections. The results of the study concluded that nursing care focusing on comfort theory effectively cater to the needs of the women who underwent C-sections thereby offering scopes for improvement of postpartum comfort levels. Thus the nursing care outcomes relevant to this specific population may be found to harbor positive consequences that may be further corroborated to other studies concerning similar populations as well (Aksoy Derya & Pasinlio?lu, 2015). Another study highlighted on the issue of management of postpartum pain with the purpose of successfully reliving the pain in the concerned women through the usage of most appropriate complement and dosing schedule of medications in addition to non-pharmacologic comfort methods. Attention was also given so that the woman remained fully aware and awake in the process to car for the newborn. Thus the holistic outcomes of the comfort theory were well applicable to this condition where all requisite needs for relief, ease and transcendence in the context of the physical experience of pain. Hence evidence based pain management strategies comprising of both the pharmacologic and non-pharmacologic interventions were assessed under the light of the comfort theory referring to the common sources of postpartum pain (Eshkevari, Trout & Damore, 2013). Further study emphasized on the pain relief strategies within the hospital setting through the utilization of the non-pharmacologic interventional approach to reduce pain during labor thereby providing comfort and care to the women and their infants without causing any harm (Chaillet et al., 2014).


A study consisting of the practical application of Kolcaba’s comfort theory dealt with the patients in the cardiac care unit. Various cardiac syndromes lead to the generation of pain in the patients suffering from the condition. The potential effectiveness of the quiet time interventional approach in relation to four contexts ranging from physical, psychospiritual, sociocultural and environmental has been indicated in the investigation. The efficacy of the nursing practice may culminate in fostering patient comfort following explicit application of the concerned theory. Thus the thoughtful consideration of the quiet time intervention may lead to holistic outcomes in the cardiac patients (Krinsky, Murillo & Johnson, 2014). In order to assess the effectiveness of the nurse’s knowledge and beliefs concerning the comfort nursing care relevant to the hospitalized patients a survey was conducted. The survey findings revealed that large differences existed regarding the knowledge between nurses pertaining to the comfort care working across various departments. Further in this respect, continuous educational programs are recommended to enhance the knowledge base in addition to the skills relevant to comfort care (Hou et al., 2014). Thus the multifaceted applicability of the comfort theory correspond to its usage in the departments such as pediatrics, geriatrics, orthopedics, obstetrics and gynecology, cardiology, oncology, perianesthesia, intensive care units and others.

The domain of pain management in clinical practice is an integral part to provide respite to the distressed patients. Pain management is generally considered as an important branch of medicine that adopts an interdisciplinary outlook to ease out the sufferings thereby providing scopes for improving the quality of life in patients who are habituated to sustain their lives in chronic pain. Assessments of pain and designing of the therapeutic doses are considered vital to the roles played by the nurses in a specific clinical setting. An insightful and thorough understanding regarding the knowledge and attitudes regarding the treatment of pain is imperative to facilitate the levels of comfort and enhance the quality of life in the concerned patients. A survey aimed to focus on these vital issues concerning the pain management procedures followed by the practicing nurses in their respective disciplines to mitigate the pain in the relevant population. Pain education must conform to the case suited facilitators and barriers that may aid in filling the deficits in nursing knowledge for pain management. Comfort Theory may thus be suited in the nursing interventions strategy to identify the requisite comfort needs and demands of the patient in the relevant contexts (Craig, 2014). The effects of anesthesia can be handled through effective and safe pain management strategies carried out by the nurses having specialized skills in the said methods. Nurses generally refer to the Comfort Theory whiling improvising the changes necessary to provide respite to the patients addressing the definite comfort needs. A study laid emphasis to this aspect relevant to the postanesthesia patient in order to assess the acuteness of the pain (Buss & Melderis, 2002).

Various studies highlighted the potential benefits of using the Comfort theory in actual practice to relive the patients from chronic pain due to varied health conditions. In this context reference may be made of a study where a qualitative study was conducted to evaluate the effectiveness of the interventions pertinent to the offering of pain relief and solace in patients having chronic pain. Participants were included in two groups, the one involving aromatherapy and music therapy while the other considered massage or cranial still point induction. Statistical analysis exhibited that in case of both the group improvement in both pain and comfort occurred. Thus comfort theory was holistically utilized in strengthening the needs of the patients concerning relief, ease and transcendence aspects (Townsend et al., 2014). Further in another study nurses emphasized on the constructs involving comfort and quality of care as the crucial tools in the overall pain assessment strategy in patients suffering from dementia. The study aimed to investigate the cues and practices followed by the nursing home nurses to detect and subsequently offer the pain alleviating strategies. In this regard the nurses took into consideration not only the comfort as expressed by the residents but also on the family’s level of comfort regarding the pain management especially in cases of the end of life dementia patients. The usage of the discomfort behavior scales in pain mitigation was encouraged (Monroe, Parish & Mion, 2015). More studies have highlighted on utilizing the Comfort Theory for the geriatric patients undergoing treatment in clinical setting. In this regard an investigation focused on using the post operative pain management in the concerned patients to design suitable treatment intervention that might alleviate the pain in the elderly patients thereby making provisions for quicker recovery and relief from pain. Post operative pain assessment harbored the results that both pharmacologic intervention and non-pharmacologic intervention were effective in mitigating pain in the elderly (Sine, 2015). Thus pain and comfort were found to be intimately associated in providing respite to the respective patient population admitted to various departments in a clinical setting.

The applicability of the Comfort theory may be extrapolated to the perinesthesia setting where the nursing professionals are actively engaged in providing comfort to the patients. In the standards for care for the nursing practice, comfort has been assigned as a primary goal. Therefore the comfort theory has been utilized in the context where the various interrelated aspects of comfort are addressed to provide holistic solution to the distressed patient. In this regard, attention is given to treat the symptoms of anxiety as it imparts profound impact upon the health and often negatively influence the physiologic functioning in the body (Kolcaba & Wilson, 2002). A study revealed the efficacy of using the Comfort theory to harbor the outcomes pertaining to peripheral intravenous cannulation (PIVC). The study outcomes concluded that both pharmacological as well as non-pharmacological approaches in conjunction with improved awareness among the patients might help to alleviate the pain and anxiety symptoms and thereby reducing the negative experiences to aid in recovery (Tee, Low & Matizha, 2015). Another study explored the relationship between comfort and hope in case of the perianesthesia patients undergoing surgery. Results exhibited that demographic characteristics impacted the comfort and hope in these patients to ensure quicker recovery thereby allowing for careful approaches on the part of the healthcare providers to care for the prianesthesia patients (Seyedfatemi et al., 2014). Further a study focused on identifying the perceptions relevant to the peranesthesia nurses that might either promote or distract from sustaining a satisfying, safe and efficient working environment. The specific domains concerning the distribution, communication, technology utilization and leadership skills need to be readdressed and strengthened to allow for sustainable work surrounding relevant to the perianesthesia setting (Seefeldt et al., 2016). Perianesthesia Nursing curriculum has emphasized on the provision of appropriate care and comfort strategy that may be helpful in providing relief to the patients admitted in the perianesthesia setting by means of working in compliance with respect to certain competencies and desirable skills (Odom-Forren & Clifford, 2015). The competencies defined in these guidelines encompass a wide range of things including the professional competencies, pre-operative assessment competencies, life span competencies, perianesthesia competencies, system competencies as well as education and discharge competencies (Windle & Schick, 2015).

Research provides the framework for the perianesthesia organization and administration. The postanesthesia care unit generally comprise of the preoperative and postoperative areas where the role of the nurses working in collaboration with the physicians and other professionals. The provision of the safe and competent care facility for the distressed patients to prevent and allay the possibility of any discomfort falls under the responsibilities of the attending nurses to ensure recovery and proper treatment modality. Emphasis is laid upon the contexts in which comfort is provided in addition to the aspects of the comfort care to approach the situation holistically (Pasternak, 2016). The demanding nature of the care provision by the nursing professionals in case of the perianesthesia setting calls for certain competency skills involving mentorship, communication, crisis management and competency as an advocate of patient safety. Beyond the critical care skills the nurses are required to have certain soft skills that facilitate the care provision within the perianesthesia specialty (Ead, 2014). Within the realm of the perianesthesia setting, thorough evaluation and assessment concerning the management of pain and comfort is indispensable to improve awareness and likewise ensure the provision of quality healthcare facilities abiding by the numerous education and practices relevant to the perianesthesia setting (Pain et al., 2004).  The use of the questionnaire survey to assess the level of comfort in the patients is also in practice since quite a long time where responses to survey questions are analyzed and evaluated for understanding the effectiveness of the proposed intervention modality. One such study studied the effectiveness of the essential oils of lavender and ginger to promote children’s comfort in perianesthesia setting (Nord & Belew, 2009). Thus the utilization of the comfort theory may be carried out in the perianesthesia setting in both subjective as well as objective manner to redress the situation.

The effectiveness of the comforting strategies adopted in course of nursing practice during the treatment intervention is imperative to carry out the assessment for the degree of comfort as perceived by the patients. In this regard a holistic approach is advisable to procure the optimum benefits. The Comfort Theory may be applied pertaining to a specific case situation where the four contextual aspects of comfort comprising of physical, psychospiritual, environmental and sociocultural is satisfactorily addressed through fulfillment of the essential needs for relief, ease and transcendence. The health seeking behaviors exhibited in cases of the patients, families and the healthcare provider team will account for generating the desirable outcomes with respect to comfort in the patients. The taxonomic structure will provide a detailed analysis and assessment regarding the comfort needs in the patient thereby paving the ways for deciding and identifying the suitable interventional strategies applicable in the particular scenario. Comfort improvement is only possible in conditions when the nurses succeed in acknowledging the issues prevalent in the patient to improvise and subsequently implement interventional modalities.

Background: Let us assume a scenario in which a 50 years old Mexican male suffering from colorectal cancer is admitted to the surgical intensive care unit after undergoing sigmoidal colon resection surgery.

Comfort theory may be applied in this condition to get an idea about his specific comfort needs relevant to the four given contexts and paying attention to the probable and appropriate comfort care interventions.

RELIEF

EASE

TRANSCENDENCE

PHYSICAL

Pain

Fatigue

Nausea

Promotion of sleep and relaxation without keeping scopes for reducing the fatigue levels.

Side effects due to post surgery medications under control. Patient resumes daily normal activities.

PSYCHOSPIRITUAL

Anxiety

Depression

Vagueness about  prognosis

Requires spiritual therapy.

ENVIRONMENTAL

Noisy ward, exposure to bright lights,

Cold room

 Facilitation of privacy is desirable

The surrounding should be quiet, calm and familiar.

SOCIOCULTURAL

Absence of family, traditional values and cultural sensitive care

Effective communication restricted due to language barrier

Need for support from family or significant other; need for information, consultation

Type of Comfort Care Action / Intervention

Example

Agents

STANDARD COMFORT INTERVENTIONS

Vital signs

Pathological findings

Evaluation of patient

Medications & treatments

Pain management

Nurses/ Consultation with family as well as physicians

COACHING

Emotional guidance and support

Education

Reassurance

Empathic listening

Interpreter for communication

Doctors/Nurses/ Consultation with family

COMFORT FOOD FOR THE SOUL

Therapeutic touch

Quality time investment

Music Therapy (Tse, Chan & Benzie, 2005)

Personal Connections

Food

Ethnic traditions and beliefs

Nurses/ Family

In the pursuit for offering comfort to the patients, the nurses must therefore play an important role to safeguard the requirements of the patients. Post surgery, the need to implement the accelerated post operative recovery programs is desirable to conduct the pain management and care provision suited to the patient’s condition. For achieving the long term prognostic outcomes a multidisciplinary and coordinated effort from al ends concerned encompassing the healthcare professionals, nurses, doctors and ancillary staff is desirable. According to empirical research evidences these programs bore positive results with respect to the perianesthesia care setting (Pasero & Belden, 2006). Thus referring to the comfort needs relevant to the given patient condition the most appropriate and case suited interventional strategies is recommended to cater to the specific requirements and offer relief to the patient.

Conclusion

The integration of the concepts related to comfort is venerable to the nursing practice. Kolcaba’s Comfort Theory contributes holistically to deal with the range of problems associated with a given clinical scenario. The immediate experience of being emancipated through address for the needs of relief, ease and transcendence relevant to four separate contexts involving sociocultural, psychospiritual, physical and environmental aspects is considered in the Comfort Theory. Therefore the theoretical structuring of the Kolcaba’s Comfort Theory presents with immense potential for steering the works and perceptions relevant to the healthcare providers located within one organizational framework. The Comfort Theory accounts for supporting the clinical decision making through address of the basic human needs. Individualized comfort concept is fostered through this theory to promote enhance well being considering the vital components of relief, ease and transcendence. The theory is applicable to various clinical domains and widely in vogue for mitigating the issues of pain management in perianesthesia setting as well. Therefore, nurses and healthcare professionals must be aware and updated regarding the knowledge and care modalities that will offer respite to the distressed patients.

References

Aksoy Derya, Y., & Pasinlio?lu, T. (2015). The Effect of Nursing Care Based on Comfort Theory on Women's Postpartum Comfort Levels After Caesarean Sections. International journal of nursing knowledge.

Alligood, M. R. (2014). Nursing theorists and their work. Elsevier Health Sciences.

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