Th Comfort Line | Comfort Theory Topics

Dr. Kolcaba's Personal History

I was born and educated in Cleveland, Ohio. In 1965, I received a diploma in nursing and practiced part time for many years in medical-surgical nursing, long-term care, and home care before returning to school. In 1987, I graduated in the first R.N. to M.S.N. class at the Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU), with a specialty in gerontology. While in school, I job-shared in a head nurse position on a dementia unit. It was in the context of that experience that I began theorizing about the outcome of comfort.

After 5 years I graduated with a master’s degree in nursing and joined the faculty at The University of Akron College of Nursing. I acquired the American Nurses Association (ANA) certification in gerontology and was hired to teach gerontology, both in the classroom and at various clinical locations, including an ACE unit (Acute Care for Elders). It was mandatory that I return to graduate school to pursue a doctorate in nursing, which I did on a part-time basis while continuing to teach. Over the next 10 years, assignments in my doctoral program helped me develop and explicate Comfort Theory. During this time I published a concept analysis of comfort with my philosopher-husband (Kolcaba & Kolcaba, 1991), diagrammed aspects of comfort (Kolcaba, 1991), operationalized comfort as an outcome of care (Kolcaba, 1992a), contextualized comfort in a middle range theory (Kolcaba, 1994), and tested the theory in an intervention study for my dissertation (Kolcaba & Fox, 1999).

We love going to Kiawah Island together, as shown in the photo at the top of the page. In addition to the parish nurse program, I continue to enjoy working with Dr. Bice-Braswell as we engage with students, registered nurses, and managers as they design and conduct comfort studies. Through the The Comfort Line, I like to assist healthcare agencies to implement Comfort Theory on an institutional-wide basis. For questions or suggestions that are not covered in this web site, please e-mail me Dr. Bice-Braswell at braswella@uncw.edu.

When I was a teen, I was moved by a simple poem by Emily Dickenson. I cut it out, framed it cheaply, and hung it in my room. It continued to speak to me as I applied to nursing school, began my practice years in a variety of settings, and settled on gerontology. It spoke to me as I taught students and as I interviewed research participants, all with the goal of promoting comfort in diverse places. And now it seems especially relevant as I volunteer at a homeless shelter, providing hope and friendship along with supplies. Again, physical pain has only a small role in my clients’ comfort status. Rather, they are seeking dignity, acceptance, compassion, strength along with the few supplies. The supplies are really a portal for me to address their other needs. Dickenson’s description of my vision for nursing , and the essence of Comfort Care follows:

If I can stop one heart from breaking,

I shall not live in vain;

If I can ease one life the aching,

Or cool one pain,

Or help one fainting robin

Unto his nest again,

I shall not live in vain.

Emily Dickenson (1830-1886)

References

Kolcaba, K. (2003). Comfort Theory: A holistic vision for health care. Springer.
Kolcaba, K. (2007) www.TheComfortLine.com
Interview with Kolcaba by Martha Alligood. “The Nurse Theorists: Portraits of Excellence,” Volume 3 (2017). A Fitney Production. Available online at fitne.net
Kolcaba’s Comfort Theory: https://nursology.net/nurse-theorists-and-their-work/kolcabas-comfort-theory

Incidental Thoughts

Recipients of Comfort Care:

Patients. I first articulated holistic comfort care for patients in a hospital setting, as described in my book. Most comfort studies being done today are with patients. But let’s not forget…

Their families, who are often equally if not more stressed than their loved one in a health crisis. Nurses know there are many comforting interventions that are done for the families’ benefit, such as comfortable lounge chairs for sleeping when the patient is able to doze. Helping with dietary needs, referrals to social service or a chaplain, explaining complicated procedures or diagnoses, active listening are just a few ways expert nurses address families’ comfort.

Staff. In the latter part of my book, I began to consider the comfort of nurses and auxiliary staff members. Most health care providers and support staff have chosen health care for their careers because they want to help people. They need support and recognition from administrators and mentors for their comforting efforts. Examples of necessary support are predictable hours, an atmosphere of teamwork, workable assignments, strong compensation, and fair benefits for all, predicated on their levels of education and responsibility.

In 2009, March and McCormack published an article in which they advocated for using Comfort Theory as an institution-wide approach. I think this is a great idea because all healthcare disciplines desire to bring comfort to their patients, and the concepts in Comfort Theory are universal.

My Vision for Nursing

When asked to write about “my vision for nursing,” I responded quickly and positively. “It’s my favorite topic and a vision that I have held for years.” It is articulated in the last chapter of my book published in 2003. This present format allows me to be more focused and succinct, always a good thing for a theorist!

So to start us off, I will say simply, that my vision is Comfort Care for All which includes patients (first and foremost), their families, staff, institutions including hospitals, nursing homes, and agencies, student nurses, and communities. I fervently believe that nurses WANT to provide Comfort Care; it is THE reason we choose nursing as our life’s work.

Comfort Care is defined as a philosophy of health care that focuses on addressing comfort needs recipients in four contexts: physical (including homeostatic mechanisms as well as sensations related to medical problems), psychospiritual, sociocultural, and environmental. Comfort Care has three components: (a) and appropriate and timely intervention, (b) a mode of delivery that projects caring and empathy, and (c) the intent to enhance comfort (Kolcaba, 2003, p. 252). It is a pattern for holistic care, but is individualized for each recipient or group. Comfort is also a universal concept, meaning it is understood across most disciplines and cultures.

One can follow the pattern inherent in the comfort grid (see my homepage at TheComfortLine.com) for practice, research, and education. The grid is a 12-cell representation of a complex term or umbrella term under which pain (physical, relief) and anxiety (psychospiritual, relief) are only parts of the whole experience of comfort. The type of comfort named Relief refers to unmet comfort needs, usually of a severe nature. Ease emphasizes the importance of prevention of known risk factors that would keep a person from feeling comfortable. And transcendence addresses the most stubborn cases of persons unable to attain acceptable levels of comfort in any of the cells. The nurse continues to help the patient “rise above” or “bear with” the acute discomfort. The nurse never gives up, and provides hope - however hope is defined with the patient.

In this model of care, administrators have a primary responsibility to provide the resources necessary for nurses to engage in comforting interventions. When the entire agency or institution is engaged in providing comfort care, patients will do better and the facility will benefit from increased patient satisfaction, cost savings, less staff turnover, etc. Please see the conceptual framework for three parts of comfort research on my home page.

Comfort Care can be applied in the community as in the research question, “What features are important in creating a comfortable community?” Comfort Care, whether explicit or implicit, is essential for end of life and palliative care. In mental health, a challenge for providers is to help patients develop healthy self-comforting strategies to take the place of addictive or self-destructive habits. For these patients, physical pain plays a very small part in their comfort status.