N207-Group E

Katharine Kolcaba, Spring 2012

  The following information presented below are bullets of biographical information related to the theorist.

BACKGROUND OF THE THEORIST

• Born in December 28,1944 Katharine Arnold (Kolcaba) born in Cleveland, Ohio

• 1965 Graduated with diploma of nursing from St. Luke’s Hospital School of Nursing

• 1987 Graduated with RN MSN from Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU)

• 1987 Began teaching at The University of Akron College of Nursing

• 1991-2001 Development of Comfort Theory

• 1991 Published article: An analysis of the concept of comfort. Journal of Advanced Nursing.

• Analysis of the word “comfort,” from its Latin roots to the meaning in everyday language. Article also includes how the word has been used in the history of nursing, from Nightingale (1859), Harmer (1926), Goodnow (1935), Orlando (1961), Watson (1979) and Hamilton (1989)

• 1991 Published article: A taxonomic structure for the concept of nursing. Journal of Nursing Scholarship.

• Began development of cell grid diagraming types of comfort and context in which comfort occurs

• 1994 Published article: A theory of holistic comfort in nursing. Journal of Advanced Nursing.

• Began developing a diagram of the aspects of comfort. Article also includes six defining factors that examine why comfort is a significant middle range theory

• 1995 Published article: The art of comfort care. Journal of Nursing Scholarship.

• Describes benefits of including comfort care into practice. Article includes testimony from a student nurse who applied comfort care to practice. Began development of comfort as a standard outcome of nursing

• 1997 Graduated with PhD Nursing from Case Western Reserve University

• 1997 Developed web site called The Comfort Line http://www.thecomfortline.com

• Name comes from a method of determining levels of comfort in children in which a vertical 10cm line is drawn and patients rate their level of current comfort between the statements of “ I feel as comfortable as possible” and “I am as uncomfortable as possible”

• 2000 Published article: Empirical evidence for the nature of holistic comfort. Journal of Holistic Nursing.

• Comfort Theory tested and analyzed for validity

• 2001 Published article: Evolution of the mid-range theory of comfort for outcomes research. Nursing Outlook.

• Article written to be a guide on the evolution of comfort as a theory and describing how comfort can be tested and adapted to the rapidly changing health care environment

• 2003 Published book Comfort Theory and Practice: A Vision for Holistic Health Care and Research

• 2005 Published article: Comfort Theory and its application to pediatric nursing. Pediatric Nursing.

• Article applies Comfort Theory to pediatrics, while explaining the current approach to pediatrics as attempting to relieve discomfort

• 2007 Retired from full time teaching, continues to teach part time while developing and researching Comfort Theory

• At present volunteering with the American Nurses Association and The Honor Society of Nursing

DEFINITION OF COMFORT

     Comfort is the fundamental goal of nursing profession. Each and every time a nurse attends to her patient, comfort is the initial consideration. A nurse is regard as effective when she makes her patient comfortable.Several of the scientific amendments in the medical and nursing practice in the present time have directed more on methods and outcome benefits than on comfort of the patient. Kolcaba defined comfort within nursing practice as “the satisfaction (actively, passively or cooperatively) of the basic human needs for relief, ease, or transcendence arising from health care situations that are stressful.” She explained that client’s needs to take place from a stimulus situation and can cause negative tension. Increasing comfort can result in having negative tensions reduced and positive tensions engaged. Comfort is viewed as an outcome of care that can promote and facilitate health-seeking behaviors. It is speculated that increasing comfort can augment health seeking behaviors, as stated by Kolcaba, “if enhanced comfort is achieved, patients and family members are strengthened to engage health-seeking behaviors.” This can further develop comfort.

According to her theory; patient's comfort existed in 3 forms:

Relief, Ease and Transcedence

Relief: the state of having a discomfort mitigated or alleviated.

Ease: the absence of specific discomfort.

Transcendence: the ability to "rise above" discomforts when they cannot be eradicated or avoided.

DEVELOPMENT OF A THEORY

The following are bullets regarding the important notes on the development of the comfort theory. 

• In the 1980's, a modern inquiry of comfort began. Comfort activities were observed. Meanings of comfort were explored. Comfort was conceptualized as multidimensional (emotional, physical, spiritual). Nurses provided comfort through environmental interventions.
•  It was in this decade that Kolcaba began to develop a theory of comfort when she was a graduate student at Case Western Reserve in Cleveland, Ohio. She is currently a nursing professor at the University of Akron in Ohio
• Kolcaba's (1992) theory was based on the work of earlier nurse theorists, including Orlando (1961), Benner, Henderson, Nightingale, Watson (1979), and Henderson and Paterson. Other non-nursing influences on Kolcaba's work included Murray (1938). The theory was developed using induction (from practice and experience), deduction (through logic), and from retroaction concepts (concepts from other theories).
• ·    The basis of Kolcaba's theory is a taxonomic structure or grid that has 12 cells (Kolcaba, 1991; Kolcaba& Fisher, 1996). Three types of comfort are listed at the top of the grid and four contexts in which comfort occurs are listed down the side of the grid. The three types are relief, ease and transcendence. The four contexts are physical, psycho-spiritual, sociocultural and environmental.

CHARACTERISTICS OF THE THEORY

The following are the characteristics of the Comfort Theory devised by Kolcaba:

1. The theory emphasizes the active participation of the patient and family

The patient and the family's participation are integral in the identification of the needs for comfort or discomforts being experienced. More than the assessment of the needs for comforting measures of intervention, the patient and the family are also actively participating with the plan of care for a more positive outcome and early discharge.

2. Comfort interventions are more inclined with preventing discomforts rather than treating already present discomforts.

The importance of keen observation, identification and understanding of patient's needs for comfort will be a very useful skill for this will permit detection of situations that may further increase or add to present discomforts. Preventing such would be much easier than treating them when they are being expressed.

3. Comfort is measurable on most patient populations.

Comfort can be expressed objectively with the use of scales, subjective expression of comfort can be charted. Through this, comforting interventions can be evaluated for effectiveness.

4. The Comfort Theory aims to promote a value-added outcome rather than a negative one.

Another characteristic is that the comfort theory aims to promote value-added outcomes. Meaning, the goal of the nursing interventions is the alleviation of discomfort and thus increasing comfort. This is a positive connotation compared to nursing researches investigating on what is "lacking" or negative in the nursing practice.