The Comfort Theory and
Care of Patients in the
Perioperative Area: Theory
Guiding Practice
Allison Kathleen Peters
University of Central Florida
Background
 Comfort Theory Model Designed by Katherine
Kolcaba
 Looks at the whole person with emphasis on
the manipulation of the environment such as
sound, temperature, furniture
 Comfort needs occur in the mental and
physical contexts of the patient
(Kolcaba, 2001)
 Patients that present to surgery are usually
anxious
 Anxiety produces a physiological rise in
catecholamines (raising blood pressure)
 Also increases cortisol which causes
decreased immunity and healing
 Anxiety caused by waiting for surgical
procedure can cause feelings of
abandonment, fear of anesthesia and of
dying
(McCance & Huether, 2006)
(Gilmartin & Wright, 2008)
Problem
 Heightened anxiety can lead to poor surgical
outcomes
 Decreased healing
 Nurses need to recognize anxiety and provide
comfort measures
Significance
Feelings experienced:
 Uncertainty
 Relationship between danger or threat
 Ambiguousness
 Fear
Intervention:
 Communication
 Control of environmental factors (light, noise,
temperature)
 Patient control (encouraging feedback, using
pain scale, control of environment via RN)
(Kagan & Bar-Tal, 2008)
(Smith & Liehr, 2008)
Specific Aims
 Raise nurse awareness of comfort levels
 Facilitation of comforting environment
through:
Physical Needs: Oxygenation,
thermoregulation, pain relief
Socio comfort: Cultural sensitivity, positive
body language, caring
Environmental: Orderly, quiet, safe
(Kolcaba & DiMarco, 2005)
Theory
• A nursing art entailed by comforting actions
performed by the nurse for enhanced patient
comfort
• Intervention needs to be immediate-time is
the biggest threat
• Focused in nursing
• Can be duplicated in many different practices
(Kolcaba, 2003)
(Smith & Liehr, 2008)
Application of the Theory to
Clinical Problem
 Information given to patient
 Patient verbalizes understanding asks
appropriate questions
 Patient knows what to expect from three
perioperative areas
 Provision of small comfort measures such as
warming
 Not warming can lead to complications such as
impaired wound healing, increased blood loss,
cardiac arrest and increased wound infection
(Burger & Fitzpatrick, 2009).
Summary & Conclusion
• Assisting patient through comfort measures at
a very stressful juncture in life
• No cost to implement comfort measures
• Increase patient satisfaction scores equals
increased revenues to hospital
• Application of nurse’s knowledge & critical
thinking skills
• Promotes healing
• Being connected with the patient
(Buell, 2008)
Reference
•
Burger, L., & Fitzpatrick, J. (2009). Prevention of inadvertent perioperative hypothermia. British Journal of Nursing (BJN), 18(18),
1114. Retrieved from CINAHL Plus with Full Text database.
•
Gilmartin, J., & Wright, K. (2008). Day surgery: patients' [sic] felt abandoned during the preoperative wait. Journal of Clinical
Nursing, 17(18), 2418-2425. Retrieved from CINAHL Plus with Full Text database
.
Kagan, I., & Bar-Tal, Y. (2008). The effect of preoperative uncertainty and anxiety on short-term recovery after elective
arthroplasty. Journal of Clinical Nursing, 17(5), 576-583. Retrieved from CINAHL Plus with Full Text database.
•
•
•
Kolcaba, K., & DiMarco, M. (2005). Comfort theory and its application to pediatric nursing. Pediatric Nursing, 31(3), 187-194.
Retrieved from CINAHL Plus with Full Text database.
•
Kolcaba, K. (2003) Comfort theory and practice. New York, NY: Springer Publishers
•
Kolcaba, K. (2001). Evolution of the mid range theory of comfort for outcomes research. Nursing Outlook, 49(2), 86-92. Retrieved
from CINAHL Plus with Full Text database.
•
McCance, K.L. & Huether, S.E. (2006) Pathophysiology: The biologic basis for disease in adults and children. (5th ed.) St. Louis,
MO: Elsevier Mosby.
•
Smith, M. J. & Liehr, P.R. (2008) Middle range theory for nursing (2nd ed.) New York, NY: Springer.
•
Wagner, D., Byrne, M., & Kolcaba, K. (2006). Effects of comfort warming on preoperative patients. AORN Journal, 84(3), 427.
Retrieved from CINAHL Plus with Full Text database.
•
Walker, J. (2007). Patient information. What is the effect of preoperative information on patient satisfaction?. British Journal of
Nursing (BJN), 16(1), 27-32. Retrieved from CINAHL Plus with Full Text database.