Theoretical development of Comfort Theory has been chronicled through several peer reviewed journal articles over the past two decades. Developed from a graduate thesis and dissertation, a concept analysis of comfort blossomed into a middle range theory for health practice, education, and research. Since then, Dr. Katharine Kolcaba has been continually advancing and sharing her theory across the spectrum of health care disciplines. With the help of Kolcaba and other health scientists, comfort is reemerging as an value-added outcome for evidence based practice.
The purpose of this paper was to analyze the semantics and extension of the term 'comfort' in order to clarify its use in practice, theory, and research. Three types of comfort (relief, ease, transcendence) were introduced in this article, as well as four contexts of holistic human experience in differing aspects of therapeutic contexts. Additionally, methods to measure comfort were proposed.
- Kolcaba, K. Y., & Kolcaba, R. J. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing, 16(11), 1301-1310.
Further development led to organizing the three senses of comfort along with the fours contexts into a taxonomic structure. A 3x4 grid with 12 elements encompasses the total domain of patient comfort. When used with other developed tools, the taxonomic structure can be a powerful guide for assessment, measurement, and evaluation of patient comfort.
- Kolcaba, K. Y. (1991). A taxonomic structure for the concept comfort. Image: Journal of Nursing Scholarship, 23(4), 237-240.
Comfort as Process and Product
As a holistic trend in health care developed, it was necessary to identify comfort as a product or a process. Various schools of thought and their research approaches to comfort were merged in this article to advance and clarify comfort in literature and practice. A template was provided that guides comfort care practice in a holistic context.
- Kolcaba, K. (1995). Comfort as process and product, merged in holistic nursing art. Journal of Holistic Nursing, 13(2), 117-131.
Theory of Holistic Comfort
A broader theory for comfort was introduced in this article by expanding the concept of patient needs using Murrays (1938) theory of human press. Relationships between needs, interventions, outcomes, and comfort were developed into a diagram or conceptual framework. A discussion centered in Comfort Theory's application in practice was also included.
- Kolcaba, K. Y. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19(6), 1178-1184.
Comfort Empirically Tested
The Comfort Theory was analyzed and thoroughly tested in this study focusing on four propositions of comfort and the validity of tools to measure comfort. The methods and results helped to provide empirical evidence for future applications and research.
- Kolcaba, K., & Steiner, R. (2000). Empirical evidence for the nature of holistic comfort. Journal of Holistic Nursing, 18(1), 46-62.
Evolution of the Theory of Comfort
After years of refinement, Comfort Theory was applies to institutional integrity. In order to expedite and assist organizations, institutional outcomes were included to explicitly identify practical applications in the health care environment.
- Kolcaba, K. (2001). Evolution of the mid range theory of comfort for outcomes research. Nursing Outlook, 49(2), 86-92.
A Journey through Comfort The author, Katharine Kolcaba, freely expresses her ideas and journey related to the development of Comfort Theory. This resonating book, published in 2003, is versatile for use in all health disciplines. It presents, in one easy-to use text, the various segments of work about comfort.
Health Practice and Education
Nursing Care Plan
Comfort Care template is demonstrated to enable more efficient, satisfying, and goal directed practice to meet present-day challenges.
- Kolcaba, K. Y. (1995). The art of comfort care. Image: Journal of Nursing Scholarship, 27(4), 287-289.
Comfort Theory is applied to assist the interdisciplinary team through the process of guiding the patient and family in decision making and the dying process.
- Kolcaba, K. Y., & Fisher, E. M. (1996). A holistic perspective on comfort care as an advance directive. Critical Care Nursing Quarterly, 18(4), 66-76.
Pediatric Application of Comfort Theory
Current methods approach comfort as relieving discomfort. However, the Comfort Theory presents a framework in which enhanced comfort can be achieved.
- Kolcaba, K., & DiMarco, M. A. (2005). Comfort theory and its application to pediatric nursing. Pediatric Nursing, 31(3), 187-194.
Hospice Nursing Framework
Comfort Theory is particularly useful as a framework for hospice care. A case study demonstrates the usefulness of Comfort Theory and its future application with the hospice discipline.
- Vendlinski, S., & Kolcaba, K. Y. (1997). Comfort care: a framework for hospice nursing. American Journal of Hospice & Palliative Care, 14(6), 271-276.
Orthopaedic Adult Nursing Care
The Acute Care for Elders (ACE) model provides an effective, proactive, inexpensive framework for addressing the complex health needs of older adults. When used in conjunction with the Comfort Theory, the patient's holistic needs are addressed.
- Panno, J. M., Kolcaba, K., & Holder, C. (2000). Acute Care for Elders (ACE): a holistic model for geriatric orthopaedic nursing care. Orthopaedic Nursing, 19(6), 53-60.
An overview of current comfort theory and a framework for addressing the comfort needs of patients in the perianesthesia setting.
- Kolcaba, K., & Wilson, L. (2002). Comfort care: a framework for perianesthesia nursing. Journal of PeriAnesthesia Nursing, 17(2), 102-114.
- Wilson, L., & Kolcaba, K. (2004). Practical application of comfort theory in the perianesthesia setting. Journal of PeriAnesthesia Nursing, 19(3), 164-173.
- Wagner, D., Byrne, M., & Kolcaba, K. (2006). Effects of comfort warming on preoperative patients. AORN Journal, 84(3), 427.
Operationalizing comfort for use in outcomes research.
- Kolaba, K. Y. (1992). Holistic comfort: operationalizing the construct as a nurse-sensitive outcome. Advances in Nursing Science, 15(1), 1-10.
Below are some examples of Comfort Theory used in research. For a complete list, please visit Resources > References.
- Kolcaba, K., & Fox, C. (1999). The effects of guided imagery on comfort of women with early stage breast cancer undergoing radiation therapy. Oncology Nursing Forum, 26(1), 67-72.
- Schirm, V., Baumgardner, J., Dowd, T., Gregor, S., & Kolcaba, K. (2004). NGNA. Development of a healthy bladder education program for older adults. Geriatric Nursing, 25(5), 301-306.
- Apůstolo, J. L. A., & Kolcaba, K. (2009). The effects of guided imagery on comfort, depression, anxiety, and stress of psychiatric inpatients with depressive disorders. Archives of Psychiatric Nursing, 23(6), 403-411.