Katherine Kolcaba: The Comfort Theory

Wilby, M.L., (2005). “Cancer Patients’ Descriptions of Comforting and Discomforting Nursing actions”. International Journal for Human Caring, Vol. 9, No. 4.

Practice Theory Explanation

The comfort theory described by Katherine Kolcaba is the middle range theory that has been adopted here. We learn that the cancer patients who are in hospital require complex nursing comforts which cater to the physical, psychological, and spiritual aspects. Patients are physically comforted when their acute symptoms are eliminated through the efforts of the genuinely concerned nurse who also anticipates emotional needs. Frequent reassurance and not being left alone to themselves would add to their

comforts. As long as the patients felt wanted and were not treated as burdens, they were comforted. The research included the investigation of the expectations of comforts from patients who had “lived experiences” of the metastatic illness or cancer in an advanced stage when their comforts mostly depended on the nurses rather than the therapeutic management.

Research Support for Practice Theory

The study defines the themes for comfort, the actions for comfort, the themes that provide the feeling of well-being, the discomforting actions, the emotions which upset the patients, and additional information on what could enhance the comfort of their last days. More than sufficient information has been discussed in this study.. It was noticed that the patients could point out omitted actions of nurses which could have furthered their comfort.

However, they were ready to excuse the nurses for actions which they felt could have been avoided as they conceded that the vast number of comforting services over-ruled any omissions. The research supports the practice theory as the actions to be taken or practiced by the nurses who care for and heal the sick have been expressed by the patients who have experienced nursing care which provided them some comforts and some discomforts. The nursing profession needs to heed the discomforts noted and take care to reduce these or change them into experiences of comfort for future patients.

Middle-Range Theory

This study supports the middle range theory which is more focused than a grand theory and is important for a practice discipline. The practice theory has been derived from the middle range theory. The concept of comfort as proposed by Katherine Kolcaba

is the middle range theory here. The interest of nurses is upheld by the middle-range theories due to their easy applicability in their practice. The lived experiences of the terminal stage patients and their expectations of comfort in this study are good sources of hints for the nursing practice.

Nursing Practice Influence

The concept of comfort is essential to nursing care in clinical settings and the healing process. Whether the comfort that is planned by a nurse for a patient meets the demands of the patient’s concept of comfort still raises doubts. Metastatic cancer patients whose days are numbered carry the burdens of physical pain, fear of terminal illness and death, financial burdens, and image and role changes. The comfort theory explains the essence of what such patients expect of a nurse who is their closest source for relief of discomforts. This study describes the expectations of patients in terms of comfort.

Understanding the needs and attempting to comply suitably would improve the nursing practice and help to provide “efficient holistic and individualized care”(Wilby, p.59) Providing comfortable nursing care in stressful health conditions involves the anticipation of discomfort, managing of physical distress or symptoms, limiting threats and reducing vulnerability.

Nuccio, T. and Nuccio, P. (2009). “Give them comfort: Controlling COPD symptoms at the end of life”. RT magazine.

Practice Theory Explanation

The comfort theory may be the one adopted as this article elaborates on the therapeutic and palliative management of the last days of a COPD patient. Stress has been laid on the therapeutic management of the conditions with COPD. The quality of life in the terminal stages of COPD is to be improved by managing the symptoms of dyspnoea, cough, pain, and confusion which have been described by family members as the distress noted in the last days before death.

Clinicians have been advised to pay special attention not to create more problems. In highlighting palliative care, the authors have mentioned the steps like oxygen therapy, secretion clearance, providing ventilation, pulse oximetry, and capnography monitoring. These are areas where the nurse could play a role under the guidance of the respiratory therapist though the article has not mentioned this. The nurse could also play a strong supportive role for the patient and family in providing reassurance and holistic guidance and preparing the family for the death of their dear one. The practice theory is not sufficiently explained for the nursing practice.

Research Support for Practice theory

Several studies have been mentioned for picturizing the symptoms of the terminal stage of COPD and for showing the efficacy of aerosolized opioids on dyspnoea where some improved it and some did not. No research has been mentioned in detail to support the practice theory.

Middle-Range Theory

The comfort theory can be deemed to support the palliative care that is the main management in a terminal stage of COPD. The terminal stage of COPD is wrought with severe pain, cough, and dyspnoea and is a stressful period for the patients before their death. Keeping the patients as comfortable as possible and allowing them to progress to a peaceful death is compatible with the comfort theory which is a middle-range theory.

Nursing Practice Influence

The comfort theory is the basis of the palliative care that a nurse can provide a patient to improve the quality of his life. The findings of the many studies described in the article indicate how the last stages of a patient with COPD can be made as comfortable as possible. The comfort theory like all middle range theories has a scientific basis and easy applicability in the nursing practice.

Kolcaba, Katherine et al. (2004). “Efficacy of hand massage for enhancing the comfort of Hospice patients”. Journal of Hospice And Palliative Nursing, Vol. 6, No.2.

Practice Theory

The comfort theory is behind this study which discusses hand massaging as a means of providing comfort in the terminal days of patients. Hand massaging has been mentioned as something that nurses or even any nonprofessional caregiver can perform. The explanation does not cover the details of hand massage. However, the message that it can offer plenty of comfort to last-stage patients should signify its importance to nurses and patients alike. Though the practice theory has not been explained to its full extent, the study indicated that the gesture promoted a feeling of well-being in patients and the ability to share their fears with someone they could talk to in a period of relaxation. The period of relaxation removed the need for small talk in most patients as the massaging indicated the genuine concern of the caregiver who promoted the feeling of being wanted.

Research Support for Practice Theory

The study goes into the details of the analysis and indicates that the treatment group which had the massaging had lesser comfort at the beginning of the treatment but went on to have slightly greater comfort than the comparison group but this slight difference was found insignificant. The practice theory has been supported to a certain extent only. The sample was not large enough to draw definite conclusions. The nurses who participated could not complete their data as they were busy with calls. The time frame of 3 weeks was too long where terminal patients are concerned and could be reduced.

Middle-Range Theory

This study supports the middle-range theory of comfort for patients. Hand massage is a comforting intervention for terminal patients who need plenty of reassurance and relaxation to go peacefully onto death from a painful, perhaps dyspnoeic the existence with other terminal symptoms of vomiting, weakness, or semiconsciousness.

The technique is easy to learn and practice on patients. It does not need any expertise. Any caregiver can use it to provide comfort. Moreover, little effort is needed to administer it.

Nursing Practice Influence

The duty of the nurse includes providing relief for suffering, ensuring maximum comfort and raising the quality of life in those last days for the patient, and preparing the family for death. Hand massage, which should be easy to practice, is a method of providing comfort easily and need not hinder the nurse’s precious time. The comfort accorded leads to a holistic and positive outcome. The patient would appreciate the concern and sincerity of the nurse who has taken pains to tend to him. The massage would increase the oxygenation and nutrients to the hand tissues. The release of endorphins could be behind the feeling of mental and physical relaxation.

Kolcaba, Katherine et al. (2005). “Comfort theory and its application to pediatric nursing”. Paediatric Nursing, Vol. 31, No.3.

Practice Theory

The explanations for the practice theory appears to be sufficient for pediatric nursing practice. Kolcaba has identified three comforts of relief, ease, and transcendence. Relief is the alleviation of discomfort. Ease is the absence of discomforts. Transcendence is the ability to compromise with an uncomfortable situation. These comforts occur in 4 types of experiences: physical, psychospiritual, sociocultural, and environmental. 12 possible situations can arise. Placing the child on the 12-cell grid helps the nurse to decide how she is going to proceed to provide comfort: whether she is going to ease the child using a socio-cultural context or aiming to allow transcendence in a psycho-spiritual manner or otherwise.

Research Support for Practice Theory

The case, that Kolcaba elaborates, indicates how the 12-cell grid helps to provide comfort to a child, thereby showing that the practice theory is supported. Eva is comforted physically by using a psychospiritual method of listening to her complaints

and then uniting her with her parents (socio-cultural). The anxiety about the pump was relieved by a translator (socio-cultural). We understand that the comfort level must be assessed at periodic intervals and remedied accordingly.

Middle-Range Theory

The middle-range comfort theory is supported here. The child is soothed in distress, relieved from distress, comforted, eased from worry and discomfort, misery being reduced, and hope being inspired. Comfort is a holistic complex term. This middle-range theory has several concepts and is very easy to apply. Understanding the definition and applying it to the various situations in pediatrics helps the nurse to practice the art of providing comfort to all patients especially dying ones.

.Nursing Practice Influence

Pediatrics has children of all ages from birth to the age of 12. They could be in various stages of development, maybe underdeveloped or handicapped, or may have some fatal illnesses. The nursing practice in pediatrics could confidently use the 12-cell grid advocated in this article by Kolcaba. This article and the case study of how Eva’s problems were solved have enough material to influence the nursing practice.

Application of the Theory of Comfort to a terminal stage case of leukemia in a ten-year-old child

Mike is suffering from acute myeloid leukemia and has been in the ward for the past two months. The pediatrician gives him about a week or so before he succumbs.

Mike had been diagnosed only three months back. He is extremely weak and pale.

His smiling is seen less now. I used to listen to his footballing stories and how he went for picnics with his friends, of course under the supervision of an elder. He does miss them a lot. His anxiety about whether he would be able to return to his old playing ground pulls at my heart. There is vomiting at times and he has pain all over his body. Infection on his legs which aches too and ulcers in his mouth which make it difficult to swallow put him in a lot of distress. His puffy face and dependent edema worsen the situation.

With the pediatrician’s advice, he has been given intravenous feeding and nothing by mouth. Mike needs attention every few minutes. Being the duty nurse, I make sure that Mike gets enough attention and reassurance from me. His physical pain is relieved by the pain killer injections advised by the doctor. However, these can only be

given at intervals to avoid overdosage. On other occasions, I go up to him and speak to him in a reassuring manner (psychospiritual) and start on one of his favorite subjects. I ask him about how he scored three goals which took his team to success or on his favorite footballer, Maradona. He immediately forgets the pain and starts speaking and elaborating his triumphs, even if in a weak manner. Merely sitting and listening helps him a lot. Once in a while, he wants to see his parents (socio-cultural) or his friends. I oblige as there is no point in sticking to rules, which do not allow visitors to prevent further infection when life itself can no longer be held back through precautions.

I aim to provide maximum comfort to Mike before he leaves. When he vomits, he is given an anti-emetic which the doctor has prescribed. Mike hates silence. He says it is like the graveyard. He is permitted to listen to soft music which does a world of good and deviates his mind from his pathetic condition. My frequent interactions and holding his hands or sharing a joke with him help him keep his spirits up. His favorite television programs also soothes his mind and change his depressed attitude. I am preparing his family members for his impending death. They are to keep smiling and giving hope as this child is not old enough to face death. Their attitude was to speak of what they are planning to do the next day even if they knew there was not to be any.

References

Kolcaba, Katherine et al. (2004). “Efficacy of hand massage for enhancing the comfort of Hospice patients”. Journal of Hospice And Palliative Nursing, Vol. 6, No.2.

Kolcaba, Katherine et al. (2005). “ Comfort theory and its application to paediatric nursing”. Paediatric nursing, Vol. 31, No.3.

Nuccio, T. and Nuccio, P. (2009). “Give them comfort: Controlling COPD symptoms at the end of life”. RT magazine. Web.

Wilby, M.L., (2005). “Cancer Patients’ Descriptions of Comforting and Discomforting Nursing actions”. International Journal for Human Caring, Vol. 9, No. 4.

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NerdyTom. 2022. "Katherine Kolcaba: The Comfort Theory." May 30, 2022. https://nerdytom.com/katherine-kolcaba-the-comfort-theory/.

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