Nursing Theory of Comfort

Introduction

Concept analysis plays a critical role in the development of theories. According to Blessing (2015), Katherine Kolcaba developed the Theory of Comfort when conducting a concept analysis of comfort. She was interested in determining how nurses can ensure that their patients were comfortable for the entire period of medication, especially those who are under severe pain, those planning to go through surgical procedures, and those suffering from terminal diseases. Her concept in this particular study was comfort and what nurses can do to promote it among patients. From this concept, she developed the Theory of Comfort which holds that comfort is a product of holistic nursing art (Sojourner, Grabowski, Chen, & Town, 2011). The theory emphasizes the need for the nurses to address the psychological and physiological problems of the patients to ensure that they are at peace when receiving medication.

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Patients who are at peace with their present conditions respond well to medication and are more likely to cooperate with the medical staff during the medication process (Miller, Tyler, & Mor, 2012). That is why Kolcaba was keen on ensuring that patients under the care of nurses are made comfortable. In this paper, the researcher will analyze this theory and determine how it can be put into practice in a modern nursing environment. The first section of the paper is an introduction, which is followed by an explanation of the concept of comfort and a literature review. The paper then defines the attributes before discussing the antecedents and consequences. The empirical referent is the next section, which is followed by model case and alternative cases. The final section is the conclusion which summarizes the entire data.

Explanation of the Concept

In defining the concept of comfort, Kolcaba explained that nurses ensure that their patients are at peace when receiving medication. Blessing (2015, p. 35) defines comfort as “The immediate state of being strengthened through having the human needs for relief, ease, and transcendence addressed in four contexts of experience, which are physical, psycho-spiritual, socio-cultural, and environmental.” She stated that comfort exists in three forms which are relief, ease, and transcendence. Relief refers to the comfort that a patient gets because the physical pain or discomfort is adequately addressed (Bhattacharyya, 2016). For example, a nurse may administer analgesia to relieve a patient of postoperative pain. Once the patient is relieved of the pain, he or she will become comfortable. Ease is a form of comfort that is achieved if the psychological problems of a patient are addressed (Miller et al., 2012). For instance, a patient may be anxious during preoperative procedures. The nurse is expected to address such anxiety and fears to make the patient strong enough to face the medical challenge ahead. Sometimes the problem may be social. Addressing such problems helps in making the patient achieve internal peace. Transcendence is a form of comfort that is achieved when patients can rise above the challenges that they are facing or about to face (Sojourner et al. 2011). Not all patients often achieve this form of comfort fully, but nurses can help them have some degree of this form of comfort by making them feel that they are stronger than the challenge ahead of them.

In defining the concept of comfort, the theorist defined four premises upon which a patient can achieve comfort (Krinsky, Illouise, & Johnson, 2014). The first context under which comfort can occur is physical as explained in this theory. Physical comfort primarily depends on how nurses and other medical staff handle patients. The perception of the patient or patient’s relative about the quality of medication matters a lot in making the patient comfortable. As such, the medical staff is expected to act cautiously when handling the patient as a way of assuring them that their well-being will be given top priority. The second context is the psycho-spiritual needs. This is very important for terminally ill patients who are trying to find reasons to make them psychologically strong to handle their condition. In some cases, it becomes necessary to involve spiritual leaders to help the patient have some psychological comfort when receiving medication. Environmental factor also plays an important role in helping a patient achieve comfort and according to (Sojourner et al., 2011), it entails the quality of air in the wards, level of noise or related disturbances, lighting in the wards, quality of the beds and beddings, among other environmental factors. Finally, the socio-cultural experience is also given serious consideration, especially the role of family and friends in making a patient feel loved, respected, and cared for by society.

Literature Review

Comfort Theory has attracted the attention of many nursing scholars and practitioners who have been trying to find the best ways of managing their patients. A study by Bhattacharyya (2016) found out that comfortable patients are more responsive to medication than patients who are not. When administering any medication, there is always the participation of three main parties. The doctor is expected to diagnose the disease and prescribe the right medication. The patient is expected to take the medication as per the prescription of the doctor. The nurse is expected to monitor and care for the patient for the time they are hospitalized. When the patient lacks comfort, he or she may fail to actively participate in ensuring that success is achieved (Miller et al., 2012). A patient who has a psychological problem may develop suicidal habits. Such a patient may deliberately refuse to take medication because of the psychological problems that make him feel useless in society. As Blessing (2015) says, patients with suicidal thoughts need psychological comfort more than they need any other form of medication. They need someone to assure them that they have value in life and that their future has better things to offer them than what they are currently facing.

A study by Bhattacharyya (2016) looked at the relevance of comfort in managing terminally ill patients. The study found out that terminally ill patients who receive physical, psychological, environmental, and socio-cultural comfort are likely to live longer than their counterparts who lack these forms of comfort. The findings are closely related to the outcome of a study by Laiho (2011) who looked at factors that lead to premature death among terminally ill patients. In this study, depression was found to be the leading cause of numerous other complications among terminally ill patients. The thought that they are destined to die causes them a lot of mental torture that they are unable to think of anything positive about their life other than death. They fail to take care of their health and sometimes become unable to observe nutritional instruction. Life to them becomes meaningless and sometimes they may start finding people to blame for their condition. Sometimes such patients develop severe hatred towards a section of people in the society they believe are partly responsible for their condition. Blessing (2015) says that making patients comfortable is the first step towards putting them on a healing path. Patients who are psychologically settled often register a phenomenon level of successful recovery even beyond the expectations of the medical staff (Krinsky et al., 2014). That is why nurses should give patients’ comfort a priority to ensure that they can overcome their medical condition.

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Defining Attributes

The concept of comfort as defined in Kolcaba’s Comfort Theory has several attributes that a medical practitioner should understand to apply this theory in a practical context. The first attribute of the concept is psychological relief. According to Laiho (2011), depending on the nature of the medical problem of a patient, psychological problems may arise. Patients suffering from some of the leading causes of death such as cardiovascular diseases, cancer, and diabetes often get into depression because death is what comes to their mind as the outcome of their condition. The theory explains that this issue should be adequately addressed because depression may give rise to even worse complications in a patient, making it almost impossible for them to recover. The second attribute of this concept is physical relief. Kolcaba was particularly concerned about the physical pain that patients sometimes undergo when hospitalized. Blessing (2015) says that patients associate medical staff, especially the nurses and doctors, with some form of physical comfort. As such, this theory emphasizes the need for nurses to find ways of bringing relief to patients who have a physical problems. The third attribute of this concept is socio-cultural comfort. This is particularly important for pre-operative patients or patients with a terminal illness. The presence of family members and friends often comforts them and renews their strength to keep on fighting the disease (Krinsky et al., 2014). Sometimes these patients may require the services of a lawyer to help protect their family members. Nurses should try to ensure that these social needs are met to make the patients settled and focused on managing their medical problems.

Antecedents & Consequences

The antecedent that led to the development of the comfort concept was the pain and suffering of the patients in various medical facilities. Katherine Kolcaba developed this concept in the early 1990s. This was after working in various health institutions as a nurse for decades. According to Bhattacharyya (2016), Kolcaba graduated with a diploma in nursing from St. Luke’s Hospital School of Nursing in 1965, a time when some of the modern painkillers did not exist. In her early years as a nurse, she witnessed patients being traumatized by pain as most of the painkillers used at the time were ineffective. According to Laiho (2011), extreme pain may easily cause death even if the patient is being handled by a top doctor. Kolcaba noticed that most of these patients were also traumatized by psychological and socio-economic needs, besides the physical pain that they had to go through. After conducting thorough research, she concluded that it is the cardinal responsibility of nurses is to ensure that patients are as comfortable as possible. As such, she decided to develop a concept that primarily focuses on the comfort of patients when they are hospitalized. That is how the Theory of Comfort emerged.

The consequences of the comfort concept have been overwhelmingly positive to the patients and their loved ones, nurses, and doctors in various ways. To the patients, the concept looks at their comfort from a whole new angle. It has placed a lot of emphasis on their psychological, physiological, and socio-economic well-being. To the nurses, the concept has helped in defining how to deal with patients to make them comfortable. They are now well-informed about the best approach that they can use to enhance the comfort of their patients (Krinsky et al., 2014). Doctors also have a better knowledge of how to deal with issues that affect their patients. The concept has improved nurses in modern healthcare centers, especially among in-patients. The consequence of this concept can also be looked at from the angle of the unique bonding between a mother and a baby. A mother who applies the concept of comfort will be keen to protect the child from any negative environmental forces. Issues such as child abuse, neglect, and development delays will be rare.

Empirical Referents

According to Bhattacharyya (2016), the concept of comfort is widely practiced all over the world because it has been tested to work. Most of the hospitals all over the world now understand that the psychological, physiological, and socio-economic needs of the patients should be taken care of to ensure that they have a quick recovery. Hospitals currently have two or more official hours when the loved ones can visit their patients to help them meet their socio-economic needs. Blessing (2015) says that the role of psychologists in most healthcare institutions has also become very pronounced because of the need to address the psychological problems of the patients. Some hospitals also allow preachers to visit hospitals, especially upon the request of the patient, for spiritual nourishment. Medical researchers have been working closely with medical practitioners to find the best painkillers that can address patients’ needs. Research by Laiho (2011) found out that the Theory of Comfort is one of the most widely practiced intermediate theories in healthcare institutions around the world.

Model Case

Ms. Joan’s care for her child is a perfect demonstration of the application of Comfort Theory in a home context. Soon after successful delivery, she was discharged from hospitals and given direction on how to care for her child given that it was her firstborn child. Her desire to take care of this child in a special way was caused by the fact that it took her and her husband over three years to get their first child. She knew that her child needed physiological and psychological relief to help it develop quickly. She took two months to take care of her child without allowing the nanny to take an active role in childcare. Socio-cultural needs of the child were met through constant songs meant to soothe it. She had to report back to work after her official leave came to an end. However, she made a special request to be allowed to come to work with her child and nanny because she had a big office. His request was permitted. The consequence was that her child experienced quick development. The little boy did not face many challenges and sicknesses common with children.

Alternative Cases

Borderline

Ms. Jolene had her first child as a result of irresponsible intimacy with a workplace colleague. She realized that she was pregnant after four weeks and had no option but to carry it to term. When the child was born, Jolene made an effort to meet the physiological needs of the child, but given that she was not financially stable, she had to leave the child with house help soon after. The child’s psychological and socio-cultural needs were rarely met because the house help was inept when it came to the handling of children. Jolene often made an effort to spend time with her child, but this was only possible for a few hours. The child suffered from several health problems, but they were addressed in time.

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Contrary

Ms. Murray was a drunkard and a single mother who spent most of her time either at work or in clubs. Her four-month-old daughter was often left at home unattended for the better part of the day because she often dismissed her house helps. This habit started soon after giving birth. In most of the cases, she would feed the little girl in the morning, lay her in bed, and leave for work after locking the door. She would come back at three, feed the little girl, and then go to the club, only to return at about ten at night. The child suffered from numerous complications because she was completely denied comfort.

Conclusion

The concept of comfort has made a significant impact in modern-day nursing. It has become clear to the nurses and other medical practitioners that patients’ comfort is just as important as the medication that they receive. Addressing the psychological, physiological, and socio-cultural needs of patients should be given a priority as a way of ensuring that patients are settled when receiving their medication.

References

Bhattacharyya, S. (2016). Embodied Challenges: Transformative Learning. Journal of Feminist Studies in Religion, 32(1), 131-135.

Blessing, B. (2015). Baby and infant healthcare in Dresden, 1897–1930. Histories of nursing practice, 4(8), 21-34.

Krinsky, R., Illouise, M., & Johnson, J. (2014). A practical application of Katharine Kolcaba’s comfort theory to cardiac patients. Applied Nursing Research, 27(2). 147–150.

Laiho, A. (2011). Academisation of nursing education in the Nordic Countries. Higher Education, 60(6), 641-656.

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Miller, E., Tyler, D., & Mor, V. (2012). National Newspaper Portrayal of U.S. Nursing Homes: Periodic Treatment of Topic and Tone. The Milbank Quarterly, 90(4), 725-761.

Sojourner, A., Grabowski, D., Chen, M., & Town, R. (2011). Trends in Unionization of Nursing Homes. Inquiry, 47(4), 331-342.

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