Kolcaba's comfort theory -presentation

The state of having addressed basic needs for ease, relief, and transcendence met in 4 contexts of experience (physical, psychospiritual, sociocultural, and environmental)

Comfort involves identifying the comprehensive needs of patients, families, and nurses and addressing those needs.

Ergonomics- comfort at the workplace, promotes optimum function or productivity (Kolcaba &Kolcaba, 1991)

NANDA- comfort in terms of pain management

Confortare Latin- to strengthen gently

1. Kolcaba Comfort Theory

2. Theorist Background Born Dec 28th, 1944 in Cleveland Ohio Diploma in nursing- St. Luke’s Hospital 1965 BSN- Frances Payne Bolton School of Nuring-1987 PhD and Clinical Nursing Specialist- 1997 Associate Professor of Nursing Emeritus at the University of Akron College of Nursing. Teaches on two online theory courses (MSN and DNP levels) Certified in gerontology Linked concepts of Edward Murray’s framework with other nursing theories Her work was rejected for conference presentation Used her students ideas and observation to strengthen CT

3. What is comfort? The state of having addressed basic needs for ease, relief, and transcendence met in 4 contexts of experience (physical, psychospiritual, sociocultural, and environmental) Comfort involves identifying the comprehensive needs of patients, families, and nurses and addressing those needs. Ergonomics- comfort at the work place, promotes optimum function or productivity (Kolcaba &Kolcaba, 1991) NANDA- comfort in terms of pain management Confortare Latin- to strengthen gently Kolcaba & Kolcaba. (1991).

4. TYPES OF COMFORT Relief – when a particular needs of a patient is satisfied. Has the same principles as Orlando’s (1961/1990) need-based philosophy of nursing . Ease- state whereby a person is calm and content: consistent with the 13 fundamental human requirements by Henderson (1978) Transcendence- a state in which one outgrows difficult situations or pain. Originates from the principles used by Paterson & Zderad , 1976/1988) to denote more being. Green: Relief, Ease, Transcendence Kolcaba, K. (1991).

5. CONTEXT IN WHICH THEY OCCUR Physical- conducive work environment, adequate staffing, benefits, retirements, quite environment, flexible work schedule among others. Psychospiritual- is when people within themselves get to know who they are, their sexuality, self-worth, the essence of one’s life, how one relates to a higher being. Social comfort (Sociocultural comfort) – Involves the interactions with families, society, and interpersonal relationships, religious practices, rituals, and traditions within one's family. Environmental- involves anything around a person and they include noise, color, temperature, ambience among others. Red/yellow/purple: Physical, Psychospiritual, Sociocultural, Environmental Kolcaba, K. (1991).

6. Additional Comfort Measures Relief- warm blanket to help increase their body Ease- explain plan of care to decrease anxiety Transcendence- Coaching patients during labor and delivery Environment- a private room for a patient during end of life care the sociocultural and Psychospiritual context- allow chaplains to talk to patient and family in times of need. . Kolcaba, K. (1991).

7. Factors that can affect how a patient perceives total comfort (Intervening Variables) past experiences age finances attitude emotional state support system prognosis Kolcaba, K. (2003).

8. Assumption of Theory Human beings have holistic responses to complex s timuli Comfort is an immediate and desirable holistic state of human beings that is germane to the discipline of nursing Human Beings strive to meet or to have met their basic comfort needs . Nurses are to identify comfort needs of their patients and find ways to address those needs Kolcaba, K. ( 1994).

9. Comfort as it was perceived at the beginning 20 th century Used in a broad sense and was seen as a definite goal in nursing. Was highly appreciated and was considered an exclusive nurses mission Ability to provide comfort mainly depended on the skill and character of the nurse. Very essential because of there were no curative medical strategies Comfort resulted from physical, emotional, and environmental interventions Poultices(dressings, icepacks ,etc .) heat, the positioning of a patient in bed were most common nursing interventions to promote comfort (Mcllveen & Morse, 1995) Mental relaxation was achieved through physical and emotional comfort. Specific comfort measures orders solely depended on the authority of the physician Mcllveen& Morse, 1995

10. The Taxonomic Structure(TS) or A 12 Cell- Grid Defines the attributes of comfort and is helpful in deriving the technical definition of comfort. The TS is used to: assess comfort needs of patients, families, and nurses Plan interventions to address the identified needs Informally evaluates the effectiveness of those interventions to enhance comfort Measure the desired outcome of enhanced comfort for research and practice Kolcaba, K. (1991).

11. Basic Concepts of the Theory Kolcaba, K. (2002).

12. PROPOSITIONS Relational statements that connect concepts together. The healthcare team and nurses identify the needs of patients and families that have not been met with the support systems that are available. Nurses also work constructively to make sure they have the necessary things they would need to perform their work. Comfort interventions are designed and coordinated to address those comfort needs that are not met. Intervening variables helps to determine the probability of success and should, therefore, be considered when planning comfort interventions. Enhanced comfort is achieved when effective interventions are provided in a caring manner. A desirable and holistic HSBS is agreed by the patients, nurses, and another healthcare team. Patient, family members, and nurses become motivated and involve in HSBS when enhanced comfort is attained. Enhanced Health-related Institutions outcome is demonstrated when patient and families become satisfied with comfort measures they receive through motivations to engage in HSBS The healthcare institutions gain recognition from the general public when the patient, family, and nurses become satisfied with the healthcare delivery system.     Kolcaba, K. (2001 ).          

13. Who Determines Comfort? Kolcaba, K. ( 2000).

14. Goal of the theory Patient , family members, nurses, and other healthcare workers become satisfied with comfort measures they received in order to engage in HSBs Higher patient or nurse function Faster Discharge Reduces readmissions rate Improved satisfaction with care, Longevity of employment Stronger cost-benefit ratio for the institution Provide a foundation for healthcare to implement comfort model as a unifying framework for care delivery Kolcaba, K. (2003).

15. Nursing Metaparadigm Nursing – comfort needs of patient are addressed through assessment, interventions and evaluation. Person - the patient, family, community or institution. Environment- the external surroundings of the patient Health- highest functional level of the patient. Kolcaba, K. (1991).

16. Comfort or Pain?

17. Diagram Kolcaba, K. (2002).

18. Case Study I MN a male client is operated on for gallstones. On a postoperative night, the nurse finds that the client is not sleeping and is tossing and turning. He had colonoscopy two days ago, and is suspicious of colon cancer because his sister passed away two months ago with colon cancer. No family member has visited him yet since his admission. Patient yells at the nurse as she responds to his call light, “you guys will not shut up for me to sleep and I have been in pain all night. Which nursing action is most appropriate? Using the taxonomic structure, formulate a plan of care for MN. 

19. Taxonomic Structure for MN Relief Ease Transcendence Physical Pain Pain control Patient thinks about pain relief after taking pain medicine Psychospiritual Anxiety Skepticism about prognosis Need for spiritual support Environmental Noise from the nursing station ; bright lights Privacy Need for quiet environmental Sociocultural Absence of family members Allow family to visit patient Need for support from family or loved ones

20. Case Study II JB is a 48-year-old woman admitted for abdominal pain. She suffers from urinary incontinence and is currently using poise pads. She complains of back pain which she states get by doing regular exercises and stretches. JB is diagnosed with bipolar disorder and has a prescription for Latuda. JB is also taking clonazepam and escitalopram. States she has not been able to refill her prescription and is concern her disease might get worse. MS JB complains she has not been sleeping lately because her roommate is always loud and always have her lights on. She is unemployed and lives with her 20 year old daughter. States daughter has not been responding to her phone calls for the past three days.  

21. Taxonomic Structure for JB Relief Ease Transcendence Physical Pain Pain management Patient thinks about pain relief after taking pain medicine Psychospiritual Anxiety, depression Reassurance Need for emotional stability, relaxation Environmental Quite environment Turn off lights, promote quietness Need for quite sleep Sociocultural Financial issues Financial support Need for financial stability

22. Application of Theory in Practice

23. Analysis of Theory using Barnum Internal Criticism Clarity- it is easy to understand Consistency- defined key concepts throughout the theory Adequacy- It’s adequate, no gaps Logically developed External Criticism Reality convergence- represents real world Appropriate in all healthcare settings Complexity- very straight forward Significance- it is very relevant to nursing Discrimination- have precise and clear boundaries Scope of theory- very broad, relevant to nursing practice, nursing education, nursing research and other disciplines Barnum, 1998

24. Limitations Difficult to assess the effectiveness for patient in coma. When resuscitations measures is very critical

25. Conclusion Comfort theory applies to any healthcare environment, healthcare disciplines, or age group, whether home, hospital, or community. For research of practices, the theory can further be defined, at a lower level of abstraction, regarding specific populations. Peterson , S. J., & Bredow, T. S. (2017).

26. Boudiab , L. & Kolcaba, K. (2015). Comfort theory: Unraveling the complexities of Veterans' health care needs. Advances in Nursing Science, pp 1-9. Dowd, T., & Kolcaba, K. (1997). Urinary Incontinence and Frequency Comfort Questionnaire (UIFCQ): Katharine Kolcaba, PhD, The University of Akron, College of Nursing, Mary Gladwin Hall, Akron, OH 44325-3701; [email protected] ; The Comfort Line: http://www.uakron.edu/comfort/ . Estridge , K., Morris, D., Kolcaba, K., & Winkleman , C. (2018). Comfort and fluid retention in adult patients receiving hemodialysis. Nephrology Nursing Journal, 45(1), 25-33. Kolcaba, K. Y. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19(6), 1178-1184. Kolcaba, K. (1991). A taxonomic structure for the concept comfort. The Journal of Nursing Scholarship, 23(4), 237–240 . http://doi.org/10.1111/j.1547-5069.1991.tb00678.x Peterson, S. J., & Bredow, T. S. (2017). Middle range theories: application to nursing research. 4 th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Porter, C. A., Kolcaba, K., McNulty, S. R., & Fitzpatrick, J. J. (2010). The effect of a nursing labor management partnership on nurse turnover and satisfaction. Journal of Nursing Administration, 40(5), 205-210. Sitzman , K., Eichelberger , L. W. (2017). Understanding the works of nurse theorists: A creative beginning (3rd ed.). Burlington, MA: Jones & Bartlett Learning. References

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