Sample Research Paper on Theory of Comfort
THEORY of COMFORT
Everyone has experienced some type or degree of pain. Perhaps it may be the most common reason why people seek health care. Despite being one of the most commonly occurring symptoms of the world (Potter & Perry, 2004), pain is also the least understood. The role of the nurse is to provide care for clients in many settings and situations in which interventions are provided to promote comfort. Comfort is a concept central to the art of nursing. A variety of nursing theorists refer to comfort as a basic client need for which nursing care is delivered. The concept of comfort is a subjective as that of pain. Each individual has physiological, social, spiritual, psychological, and cultural characteristics that influence how comfort is interpreted and experienced.
For this paper, a theory of comfort developed by Kolcaba will be discussed. The overview and description of the theory and its application in practice will be discussed. A discussion on pain will also be included since it is difficult to explain what comfort is without knowing what pain is. It is impossible to talk about comfort and not talk about pain. An effective pain management not only reduces physical discomfort for a client but also improves quality of life and promotes earlier mobilization and return to normal activities of daily living.
Nature of Pain
Recorded history allows us to see that pain has been an integral component of the human experience. When a person is in pain, the person will try to find every measure that can lessen that pain and give him or herself comfort. What could be considered as comfort could not be considered comfort to another person. This mirrors that both pain and comfort are subjective. Traditionally, pain has been viewed simply as a symptom of an illness or condition. However, at present, pain itself is considered to be a separate disease and merits special consideration. Knowing that pain affects every aspect of a client’s life, pain management and the provision of comfort from that pain is one of the most researched concepts in nursing (Potter & Perry, 2004).
To help a client gain comfort or relief, the nurse must view the experience through the eyes of the client. Pain is tiring and demands energy from the person experiencing it. It interferes with relationships and the individual’s ability to maintain self-care.
Pain is also complex and involves influences as mentioned in the previous paragraphs. Thus this means that each individual’s pain experience is different. The nurse should then therefore consider all factors that affect he client in pain. This is necessary to ensure a holistic approach to the assessment and care of the client who is in pain or discomfort.
The figure below shows a critical thinking model for comfort assessment.
Comfort has been considered a basic core value of nursing care over the decades, and the term comfort is frequently referred to in the nursing literature as an intervention, using the term "comfort measures," or as a process. Comfort is also referred to as a state. Comfort measures are a means to a state of comfort (outcome); the measures are used to provide relief to decrease distress and may be in the form of symptom management (Siefert, 2002).
In Kolcaba's (1994) taxonomy of comfort, comfort is defined as "the state of having met basic human needs for ease relief, and transcendence." Cameron (1993) defines comfort in terms of individualized actions that work toward health and healing. Comfort is a relative state and may be temporary or lasting. Fleming et al. (1987) defined comfort as minimizing biopsychosocial distress and included activities that would reduce or lessen suffering associated with various aspects of the patient. Kolcaba (1994) specifies that comfort is an outcome defined within the physical, psychospiritual, social, and environmental contexts. Kolcaba also specifies that comfort does not require the complete absence of discomforts but rather a sense of ease.
An awareness and understanding of the definitions, meanings, attributes, and use of comfort are important to develop meaningful nursing interventions and empirical knowledge for use during the trajectory of a patient's illness experience and related treatment. Donahue (1989) expressed that through comfort and comfort measures, nurses are able to provide strength, hope, solace, support, encouragement, and assistance.
The previous paragraphs mirror that the concept of comfort is multidimensional, very individualized, and has been a central focus and desired outcome of nursing care throughout history, yet it is still a vaguely defined concept. Comfort is used as a construct in other nursing concepts, such as caring. However, as a construct or a concept, comfort is usually operationalized in a limited fashion within the various contexts in which it is used.
Provision of comfort is therefore paramount to the practice of nurses and nursing care. However, the approach to meeting needs holistically is often intuitive or based on multidisciplinary rather than on nursing models only.
Description of the Kolcaba Comfort Theory
Kolcaba analyzed the concept of comfort and published a mid-range theory of comfort, suggesting that when comfort is enhanced, patients are strengthened and thus able to engage in health-seeking behaviors. The first article about the Theory of Comfort was published in 1994 by Kolcaba. In 2001, a subsequent article provided an expansion of the theory to include institutional outcomes. In 2003, Kolcaba published a comprehensive book about the development, testing, and application of the theory.
Kolcaba defines comfort as the immediate state of being strengthened by having the human needs for relief, ease, and transcendence (types of comfort) addressed physically, psychospiritually, socioculturally, and environmentally (contexts in which comfort is experienced). This definition emphasizes that although nurses may not be able to fully meet all of their patients’ needs for comfort, they can continue to address them in a proactive fashion throughout the continuum of care.
Assessing comfort as a positive, holistic outcome is important for measuring effectiveness of comforting strategies. Comfort Theory (Kolcaba, 2003), with its inherent emphasis on physical, psychospiritual, sociocultural, and environmental aspects of comfort, will contribute to a proactive and multifaceted approach to care (DiMarco, 2005). The framework of Comfort Theory for nursing practice and research is easy to understand and implement.
The Theory of Comfort is a midrange theory for nursing practice and research. It is a mid-range theory because of the limited number of concepts and propositions, low level of abstraction, and ease of application to actual practice (Kolcaba, 2003). In order to use the theory, three steps are required: (a) understanding the technical definition of comfort and its origins, (b) understanding the relationships (propositions) between the general concepts entailed in the theory, and (c) relating the general concepts to specific pediatric problems/settings in order to enlighten practice and generate research questions (DiMarco, 2005).
Application in practice
The application of theory to practice is multifaceted. It is not as easy as it sounds or as it is probably explained in the theory. The application of the theory is strengthening and satisfying for clients and families and nurses, and benefits institutions where a culture of comfort is valued. Moreover, comfort is a transcultural and interdisciplinary concern (DiMarco, 2005).
Using Kolcaba’s framework of holistic comfort, nurses can be comprehensive and consistent in assessing comfort and in designing interventions to enhance the comfort of patients and families. In 2006, the comfort theory was used in practiced by Kolcaba and fellow nurses in a study. Comfort Theory was chosen because of its universality. The authors describe how Kolcaba's Comfort Theory was used by a not-for-profit New England hospital to provide a coherent and consistent pattern for enhancing care and promoting professional practice, as well as to serve as a unifying framework for applying for Magnet Recognition Status.
However, compared to other nursing theories, the comfort theory is easy to understand and learn because every person is familiar with their own needs for comfort. The need for comfort is innate and thus the concept of the comfort theory is easier understood.
Comfort Theory has been tested and supported in several patient populations, including psychometric and experimental studies in small samples of women with early stage breast cancer going through radiation therapy, persons with urinary frequency and incontinence, and persons near end of life. Other nurse researchers have utilized the theory in settings such as labor and delivery, peri- and intra-operative care, critical care, burn units, gynecological practice, nursing care of persons with mental or hearing disabilities, emergency air transport, and newborn nurseries. Perianesthesia nurses have also developed clinical practice guidelines and advanced care competencies (Wilson & Kolcaba, 2004).
Overview of Kolcaba's theory
An orientation to Comfort Theory (Kolcaba, 2003), with its inherent emphasis on simultaneous physical, psychospiritual, sociocultural, and environmental aspects of comfort, will contribute to a well-articulated, multifaceted approach to nursing education, practice, and research. Kolcaba provides a definition of comfort that appreciates the holistic nature of human beings—that individuals have mental, spiritual, and emotional lives, which are intimately connected with their physical bodies.
Kolcaba identifies 3 types of comfort. The first type, relief, is the state of having a specific discomfort relieved. In the perianesthesia setting, some of the common discomforts to which this relates are pain, nausea, cold, or anxiety. The second type of comfort is ease and refers to a state of contentment for the patient. This can refer to comfort needs arising from a patient’s previous experience with a particular need or by virtue of the patient’s diagnosis or prognosis. For example, patients with uncertainty regarding their diagnosis may need emotional support to achieve comfort in this area. Nurses can prevent or minimize these needs, often without patients realizing that they are doing so, thus keeping patients in a state of ease. The third type of comfort is transcendence, which encompasses the need for inspiration, strengthening, and motivation. Nurses often focus on meeting the needs of transcendence when they are unable to fully meet the other types of comfort needs for their patients. For example, they may assist patients in the use of distraction and relaxation breathing when nausea persists despite treatment with antiemetics
The focus of comfort theory is on four aspects of comfort, as previously stated: physical comfort, psychospiritual comfort, environmental comfort and sociocultural comfort.
Anxiety related to surgery and the aftermath of care is a major detractor from psychospiritual comfort. Other detractors in this context are confusing, incomplete, or negative information; questionable or threatening diagnoses; fear; and the prospect of a change in routine or health status. Detractors from sociocultural comfort include isolation from family, disregard for cultural traditions, uncaring or anxious nursing behaviors, fragmented care, lack of nursing care when desired, poor social support, and limited resources for ongoing care at home after discharge.
Factors in the environment that detract from patients’ comfort are cold, noise, chaos, endless bright lights, bad odors, lack of privacy, and uncomfortable stretchers, chairs, and beds. Unmet safety needs can detract from comfort and include a lack of properly functioning equipment, security problems, security hazards, inaccurate care, poor aseptic/sterile technique resulting in nosocomial infections, and medication or treatment errors. Freeing patients from restraints and restrictive devices such as intravenous lines, invasive monitors, and sensors as soon as possible is a goal to which nurses can strive to achieve by obtaining orders for intermittent saline locks, noninvasive monitors, and intermittent, rather than continuous, monitoring when appropriate.
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