Comfort Concept in Holistic Care
Comfort In The Concept of Kolcaba
Comfort has been conceptualized as a holistic outcome of nursing care and defined as the experience of having needs for relief, ease, and transcendence addressed or met in four contexts of experience.
The four contexts for experiencing comfort were derived from the literature on holism and were labeled physical, psychospiritual, environmental, and sociocultural ( Kolcaba , 1991).
Relief, ease, and transcendence, three
types of comfort, were derived from a concept analysis of comfort ( Kolcaba
& Kolcaba , 1991).
Comfort And Nursing Care
Comfort care is nursing care that is intended to enhance a patient's comfort beyond its previous baseline.
Comfort care consists of goal-directed, comforting activities (the process of comforting) through which enhanced comfort (the desired end product or outcome) is achieved.
The process is initiated by the nurse after an assessment of the comfort needs of the patient/family.
Because the specified product or goal is enhanced comfort, a successful process is evaluated by comparing comfort levels before and after interventions that are targeted towards comfort.
The process
is incomplete until the product. of enhanced comfort is achieved ( Dretske ,
1988; Kolcaba , 2003).
Theoretical Contribution
Kolcaba (1994, 2003) provides a theoretical framework for practicing comfort care and for generating nursing research about comfort. Briefly, the theory states that interventions should be designed and implemented to address unmet comfort needs of patients and their families.
Because comfort is a basic human need, patients and families often assist nursing efforts towards enhanced comfort. (In fact, some self-comforting measures can be negative, such as alcohol or drug abuse.)
The effectiveness of comforting interventions is perceived in the context of existing intervening variables.
Intervening variables are factors that recipients bring to the situation and upon which nurses have little influence, such as financial status, existing social support, previous experience with health care, and religious beliefs.
Enhanced comfort strengthens patients and their families
during stressful health care situations, thereby facilitating health-seeking
behaviors (HSRs).
Comfort And Internal healing
Schlotfeldt (1975) discussed HSBs in terms of those that are internal (fertility, healing), external (self-care, functional status), or leading to a peaceful death.
Consistent with holism, conscious and subconscious experiences influence motivation for patients/families to engage in HSBs. Because HSBs are constructive, they are reciprocally and positively related to comfort.
Comfort theory states that patient/family comfort is the
immediate goal of comforting interventions, and HSBS, specific to
health-related goals, are subsequent outcomes.
Focus of Comfort Theory
Comfort Theory is focused on enhancing patient/family comfort for altruistic and pragmatic reasons. Patients/families want to be comforted by nurses in stressful healthcare situations.
Because comfort is related to subsequent desirable health and institutional outcomes, the outcome of enhanced comfort is elevated in stature among other more technical and narrow outcomes.
It is a holistic and nursing-sensitive outcome that is
congruent with recent mandates to measure nursing effectiveness in terms of
positive and desirable patient/family goals ( Magvary , 2002).
Comfort Theory And Research
The Theory of Comfort directs research in several ways. First, it guides nurses to test relationships between particular holistic interventions and comfort.
Second, it guides nurses to test relationships between comfort and setting-related HSBs. If the relationship is positive, nurses have a pragmatic rationale for enhancing patient comfort.
Third, it guides nurses to test relationships between HSBs and institutional outcomes.
Qualitative studies have been conducted to determine the nature of comforting nursing actions and what comfort means to patients.
Journal publications by these authors did not define or operationalize the outcome of com fort.
Several empirical tests of Comfort Theory have been conducted by Kolcaba and associates ( Kolcaba , 2003).
These comfort studies demonstrated significant differences between tween treatment and comparison groups on comfort over time.
The following interventions were tested:
(a) types of immobilization for persons after coronary angiogram
(b) guided imagery for women going through radiation therapy for early breast cancer
(c) cognitive strategies for persons with urinary frequency and incontinence
(d) hand massage for persons near end of life
(e) generalized comfort measures for women during.
First and second stages of labor. In each studylism , conscious and subconscious experiences influence motivation for patients/families to engage in HSBs. Because HSBs are constructive, they are reciprocally and positively related to comfort.
Comfort
theory states that patient/family comfort is the immediate goal of comforting
interventions, and HSBs, specific to health-related goals, are subsequent
outcomes.
Interventions were targeted to all attributes of comfort relevant to the research settings, comfort instruments were adapted from the General Comfort Questionnaire ( Kolcaba , 2003), and there were at least two measurement points, usually three, to capture change in comfort over time.
To demonstrate that comfort is an important mission for nursing, additional tests of comfort theory should be conducted, including attention to increased functional status, faster progress during rehabilitation, faster healing, or peaceful death (when appropriate).
Institutional outcomes could include decreased length of stay for hospitalized patients, decreased readmissions, and higher patient satisfaction.
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