Presented by:
Kristine Cargill R.N.
Emily Dutmers R.N.
Amanda Niedzwiecki R.N.
Stephanie Yohn R.N.
“Comfort may be a blanket or breeze,
some ointment here to soothe my knees;
a listening ear to hear my woes,
a pair of footies to warm my toes;
A PRN medication to ease my pain,
someone to reassure me once again;
A call from my doctor, or even a friend,
a rabbi or priest as my life nears its end.
Comfort is whatever I perceive it to be,
a necessary thing defined only by me.”
-S.D. Lawrence (student nurse)
(Kolcaba, 2003, p.1)
Comfort Theory originated from a Masters
program assignment – to diagram her nursing
practice
 At that time, she was a head nurse on an
Alzheimer unit
 Comfort was the state she wanted her Alzheimer
patient’s to be in when not participating in
activities or tasks. Comfort became her focus in
nursing practice and research
 Comfort theory was later applied to other fields
of nursing, such as perioperative care and
pediatrics

http://www.thecomfortline.com/index.html
 Nursing
care is more efficient when theory is
used because care can be delivered in an
organized manner
 Science of nursing is about the comfort of
patients, families, and nurses
 When nurses provide comfort measures, such
as turning a patient every 2 hours, the
patient is expected to have a positive
outcome
 Care is delivered and based on a humanistic
and holistic approach and patients’ needs
(Kolcaba, 1991)
Research has included the care nurses provide
and the comfort or patient outcomes that result
from the care provided
 Values the whole person
 Prior theories included comfort but had not been
defined yet
 Kolcaba’s definition of comfort (2003): “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)”
(p.16).

Three Types of Comfort



Relief- adapted from Ida
Jean Orlando’s work: nurses
relieve patient’s needs
Ease – adapted from Virginia
Henderson’s work: human
functions necessary for
homeostasis
Transcendence – adapted
from Josephine Paterson and
Loretta Zderad’s work:
patients improve with the
help of nurses
(Kolcaba, 1991)
Four Contexts of Comfort




Physical
Psychospiritual
Environmental
Social

Kolcaba recognized that discomfort is more than just a painful
physical sensation or emotional pain that is felt. Instead she
concluded that other aspects of comfort or discomfort affect holistic
beings.

Kolcaba defined the three types of comfort:




Relief- experience of a patient who has had a specific comfort need met
Ease- a state of calm or contentment
Transcendence- the state in which one rises above problems of pain
These types of comfort are addressed by means of the four contexts:




Physical- pertaining to sensations (pain, cold, heat, tingling), homeostatic
mechanisms (temperature control, bleeding, vomiting- can all disrupt this area) or
function of the immune system.
Psychospiritual- pertaining to internal awareness of self, including esteem,
identity, sexuality, meaning in ones life, and one’s feelings or belief in a higher
power or superior being.
Environmental- pertaining to the external background of human experience
(temperature, light, sound, odor, color, furniture, landscape)
Sociocultural- pertaining to interpersonal, family and societal relationships; also
includes family traditions, rituals and religious practices.
(Kolcaba, 2006)

When combined, the three types of comfort and 4 contexts
create a 12 cell grid, referred to as the taxonomic structure,
which was created by Kolcaba in 1991. This can be used as a
guide when assessing a patient’s level of comfort.

These aspects of comfort are interrelated with one another.
Kolcaba did not mean for them to be measured exactly because
she felt the process would be time-consuming and inaccurate
(Kolcaba, 2003). However, a pattern of care can be established
whereby patients comfort needs are intuitively assessed in the 4
contexts.
Context of
Comfort
Physical
Psychospiritual
Environmental
Social
Type of Comfort
Relief
Ease
Transcendence
 Now
lets look at the four global concepts of
the nursing metaparadigm in relation to
Katherine Kolcaba’s Comfort Theory.
 Human
beings
 Environment
 Health
 Nursing

This includes all in need of health care- individuals, families
and entire communities or institutions.

The aspect of comfort is an important and innate need to be
attained. All humans deserve to be as comfortable as possible.

Patient focused care is integral to attaining comfort.

When patients are more comfortable, they are more likely to
engage in health seeking behaviors-including internal or
external behaviors or even a peaceful death.
The strengthening properties of comfort produce better
patient outcomes.
(Kolcaba, 2003)


Manipulation of the external surroundings of the patient to
facilitate comfort. By means of touch, sights, sounds,
lighting or odors to promote a calming, comforting
atmosphere. Any way that the senses can be altered to
enhance comfort of the patient applies.

Having an understanding of the patient’s cultural, religious or
spiritual preferences and including them in care promotes
comfort.

When the words and actions of the nurse are comforting, in
addition to the intent of providing comfort, the interventions
are often perceived more as a comfort measure by the
patients (Kolcaba, 2003).

Eliminate negativity in the environment if possible- promote
positive thinking and attitudes.

According to Katherine Kolcaba (2003), “Health is comfort”
(p. 35)

The optimum level of functioning that is appropriate for and
defined by each individual patient.

To be in good health a patient must attain what THEY
consider their highest degree of comfort. Comfort is a
positive, dynamic state and the health care team can do
more to enhance comfort if they go beyond the treatment of
discomforts and physical health (Kolcaba, 2003).

When one of the 4 contexts or 3 types of comfort is not
balanced or being met, the patient may not be at their
highest level of wellness or health along the health
continuum.

Continual, active use of the nursing process to assess the
comfort of the patient and address their needs to attain
comfort.

Assessing and reassessing whether the interventions
implemented were successful in improving the comfort of the
patient.

Providing competent empathetic, compassionate, skilled and
holistic nursing care to each patient, without inflicting
judgment.

Maintaining a strong, trusting nurse-patient relationship and
involving the patient in meeting their comfort needs and
goals will make the process more successful.
(Kolcaba, 2006)
 Interventions
for the patient are based on
needs of the patient as well as family needs
 Comfort
needs are intermixed. Meeting one
need may, in turn, fill another need
 When
comfort needs are fulfilled, the
patient feels safe and well cared for.
(Kolcaba, 1995)
 When
comfort tasks such as cleaning up room
or straighting sheets are preformed, patients
feel cared for.
 Patients who have less stress have better
outcomes
 Nurses feel more job satisfaction because
even the smallest tasks bring comfort to
their patients.
Clarification of
Origins
Katherine’s philosophy evolved from holism, human
needs and Murray’s Theory of Human Press (1938)
and was designed only for nursing (Kolcaba, 2003
pp. 60-66). It was just recently that Katherine
thought about a 4th philosophy from nursing
(Kolcaba, 2003, p. 66 para 2).
Henry Murray
 Proposal
for use of
Kolcaba’s Theory in
other healthcare
practices has been
formulated to
change “nursing
interventions” and
redefine as
“comfort
interventions.”
(March &
McCormick, 2009).

Kolcaba expresses her
comfort theory in all 4
concepts of the nursing
metapardigm.
Advanced
Directives- guide to
make decisions
about care and pain
management
(Vendlinski &
Kolcaba, 1997)
PerianesthesiaClinical Practice
Guidelines
(retrieved from
http://www.aspan
.org/)
The
Comfort
Theory
Psychiatric Nursingguided imagery to
relieve depression
and increase comfort
(Apostolo & Kolcaba,
2009)
Healthy Bladder
Program for Urinary
Incontinence in
older adults (Schirm
et al., 2004)
Pediatrics-assisting
the child with self
comforting actions
such as “rocking”
(Kolcaba & DiMarco,
2005)
15 year old female, diabetic patient was admitted to the hospital for a second time in one
month with hyperglycemia. She was found to be crying and withdrawn, curled up in the fetal
position in the dark. Staff is concerned because she does not want to participate in
administering insulin, checking her blood sugars, and meal planning. She indicates that she
feels different than everyone else and wants to be able to eat whatever she wants.
Context of
Comfort
Physical
Psychospiritual
Environmental
Sociocultural
Types of Comfort
Relief
Ease
Transcendence
Apostolo, J.L.A., & Kolcaba, K., (2009). The effects of guided
imagery on comfort, depression, anxiety, and stress of
psychiatric inpatients with depressive disorders.
Archives of Psychiatric Nursing, 23(6), 403-411
Kolcaba. (1991). A Taxonomic Structure for the. Journal of
Nursing Scholarship , 23 (4), pp. 237-240.
Kolcaba, K. (1995). Comfort as process and product,merged in
holistic nursing art. Journal of Holistic Nursing, 128-129.
Retrieved from
http://jhn.sagepub.com/content/13/2/117
Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic
health care and research. p. 9-17, 34-35, 59-68. Springer
Publishing Company: New York.
Kolcaba, K., & DiMarco, M. A. (2005). Comfort theory and its
application to pediatric nursing. Pediatric Nursing, 31(3),
p. 187-194. Retrieved from PubMed
Kolcaba, K, Tilton, C., & Drouin. (2006). Comfort theory: a unifying
framework to enhance the practice environment. The
Journal of Nursing Administration, 36(11), p538-544.
Retrieved from:
http://journals.lww.com/jonajournal/pages/issuelist.aspx
March, A., McCormick, D. (2009). Nursing theory-directed
healthcare modifying kolcaba’s comfort theory as an
institution-wide approach. Holistic Nursing Practice 23(2),
pp. 75-80. Retrieved from PubMed
Schirm, V., Baumgardner, J., Dowd, T., Gregor, S., & Kolcaba, K.,
(2004). NGNA. Development of a healthy bladder education
program for older adults. Geriatric Nursing, 25(5), pp 301306. Retrieved from CINAHL
Vendlinski, S., & Kolcaba, K. Y. (1997). Comfort care: a framework
for hospice nursing. American Journal of Hospice &
Palliative Care, 14(6), 271-276. Retrieved from PubMed
http://www.thecomfortline.com/index.html
http://www.aspan.org
http://nursing-theory.org/nursing-theorists/Katherine-Kolcaba.php