The Comfort Theory by Kolcaba Presented by: Katherine M. Astaneh BSN

2. Meaning of Comfort
―A model of human press is the framework within which
comfort is related to interventions that enhance the state of
comfort desirable subsequent outcomes of nursing care‖
(Kolcaba, 1994, p.1178).
―The theory of holistic comfort is a
component of a normative and
descriptive theory for nursing care‖
(Kolcaba, 1994, p. 1180).
“First meaning:
Comfort — a cause of relief from
discomfort and/or of the state of comfort‖
(Kolcaba & Kolcaba, 1991, p. 1302).
“Fourth meaning:
Comfort — whatever makes life easy
or pleasurable‖ (Kolcaba & Kolcaba, 1991, p. 1302).
.
“Second Meaning:
Comfort — the state of ease and peaceful contentment‖
(Kolcaba & Kolcaba, 1991, p. 1302).
“Third meaning:
Comfort — relief from discomfort‖
(Kolcaba & Kolcaba, 1991, p. 1302).
[The construction of Kolcaba‘s theory
of comfort was the result of different
methods for theory development
applied during different stages of the
process of theory development. In
review, those methods were (1)
inductive explication of the
components of a specific practice, (2)
concept analysis and operationalization
of components that were yet
undefined, (3) deduction from a more
general organizing theory with
relocation of the main concepts, and
(4) retroduction to bring to the model a
concept for outcomes research] (Kolcaba,
2001).

3. [Theoretical Mode
Major Concepts and Definitions used in Conceptual Framework
Health Care Needs are those identified by the patient/family in a particular practice setting.
Comforting Interventions are nursing interventions that are designed to address specific comfort needs of
recipients. This includes physiological, social, financial, psychological, spiritual, environmental, and physical
interventions.
Intervening Variables are interacting forces that influence recipients' perceptions total comfort. This includes
factors such as past experiences, age, attitude, emotional state, support system, prognosis, and finances.
Enhanced Comfort
is an immediate desirable outcome of nursing care, according to Comfort
Theory. When comfort interventions are delivered consistently over time,
they are theoretically correlated a trend toward increased comfort levels over
time, and with desired health seeking behaviors (HSBs).
Health-Seeking Behaviors (HSBs):
The relationships between comfort and health seeking behaviors are entailed
in the second part of Kolcaba's comfort theory.
 Internal: healing, immune function, number of T cells, etc.
 External: health related activities, functional outcomes
Peaceful Death] (Nursing Theory, 2011, para. 3).

4. [Theoretical Model
Major Concepts and Definitions used in Conceptual Framework
continued
Institutional Integrity is defined as the values, financial stability, and
wholeness of health care organizations at local, regional, state, and national
levels.
Best Practices are those protocols and procedures developed by an
institution for specific patient/family applications (or types of patients) after
collecting evidence.
Best Policies are protocols and procedures developed by an institution for
overall use after collecting evidence
 Examples of variables related to this expanded definition of InI
include patient satisfaction (HCHAPS scores!), cost savings,
improved access, decreased morbidity rates, decreased
hospitalizations and readmissions, improved health-related
outcomes, efficiency of services and billing, and positive cost-benefit
ratios. Relationships between Comfort, HSBs, and

5. (Kolcaba, Durr, & Stoner, 2010, figure
FAQ).
(Kolcaba, Durr, & Stoner, 2010, figure FAQ).
(Kolcaba, Durr, & Stoner, 2010, figure FAQ).
(Kolcaba, Durr, & Stoner, 2010, figure FAQ).

6. Major concepts described in the Theory of
Comfort include comfort, comfort care,
comfort measures, comfort needs, health-
seeking behaviors, institutional integrity,
and intervening variables (McEwen & Willis, 2011).
The concepts affect the other through their
relationship. The term used by Kolcaba is
―intra-actional‖. Interventions intended for one
will roll over to all the areas and have a carry-
over effect. (Kolcaba, Durr, & Stoner, 2010, figure FAQ)
(Merkel, 2007)

7. ―What is true comfort? Here I am on the beach:
relief from heat, ease from worry,
transcendence from nature......ahhhh, true
comfort in all four contexts,‖ (Kolcaba, 2012, figure
1).
Branch Davidian
compound; Feb 28, 1994
Winner 66th Academy
Awards March, 94
4/ 22/94 Pres. Nixon
Passes Away
Aug. 1994- Space telescope
Hubble photographs Uranus
with rings
Ferry boat Estonia capsize & sinks
in East Sea, 909 killed-9/28/94
Maltese Falcon auctioned
for $398,590 12/94
"My momma always said that life was like a box of chocolates, you never know what you're gonna get‖ (Tom Hanks, 1994)

8. Origin of the Theory
What was going on:
Katherine Kolcaba originally wrote the Theory
of Comfort with Alzheimer‘s and dementia
patients in mind. This is what was going on in
her world and she wanted to help out.
[I borrowed the ideas about Relief, Ease, and
Transcendence. Later, I "borrowed" the contexts
of experience from the literature review about
holism. I put these ideas together in a unique way.
Later, I borrowed the framework for the First and
Second parts of Comfort Theory from Henry
Murray. But I hung nursing concepts on his
abstract framework in a unique way. The idea of
institutional outcomes was unique and was added
through a process Tomey and Alligood call
retroduction] (Kolcaba, Durr, & Stoner, 2010, figure FAQ).
Motivation to write:
[My brother died of cancer when he was 41,
and during his illness I gained more
experience with comforting actions of nurses,
and how to articulate what they did. Because
of that experience and its timing, my
dissertation is about women with breast
cancer, not dementia or gerontology. And I
have done a lot of work with end of life
comfort] (Kolcaba, Durr, & Stoner, 2010, figure FAQ).
[My spirituality, which my mother fostered
and role-modeled for me, has also had a
strong influence] (Kolcaba, Durr, & Stoner, 2010,
figure FAQ).
[Also, my husband has always been a huge
supporter and brain stormer about Comfort
Theory] (Kolcaba, Durr, & Stoner, 2010, figure FAQ).
.
(Kolcaba, Durr, & Stoner, 2010, figure FAQ)

9. Origin of the Theory con’t
―To describe the origin or development of Comfort Theory, Kolcaba conducted a concept analysis of
comfort that examined literature from several disciplines including nursing, medicine, psychology,
psychiatry, ergonomics, and English‖ ("Nursing Theory," 2011, para. 4). ―First, three types of comfort
(relief, ease, transcendence) and four contexts of holistic human
experience in differing aspects of therapeutic
contexts were introduced‖
(Nursing Theory," 2011, para. 4) .
A taxonomic structure was
developed to guide for
assessment, measurement, and
evaluation of patient comfort‖
("Nursing Theory," 2011, para. 4).
U.S. and Allies at war with
Iraq (Jan. 15, 91)
Warsaw Pact
dissolves military
alliance
(2/ 25/ 91)
Cease-fire ends
Persian Gulf
War; UN forces
are victorious
(April 3, 91)
Last of the three
U.S. hostages freed
in Lebanon to
come home on:
(Dec. 2–4, 91)
World History. (1991) Retrieved from http://www.infoplease.com/ipa/A0005273.html#ixzz2aiQe4ax2
(Kolcaba, Durr, & Stoner, 2010, figure resources)

10. Origin of the Theory con’t
Major influences in the development of
Comfort Theory:
[Relief: Ida Jean Orlando (1961 / 1990)
Nursing Process Theory
Ease: Virginia Avernal Henderson
(1978) Need Theory
Transcendence: Josephine Paterson
& Loretta Zderad (1976 / 1988) Humanistic
Nursing Theory
Framework for Comfort
Theory: Murray (1938) Henry Murray
designed a conceptual framework
diagrammed in three lines. Comfort theory
takes that framework to another level to
include a fourth line. This fourth line is the
framework for the comfort theory].(Kolcaba, Durr, & Stoner, 2010, figure FAQ).

11. Origin of the Theory
Sept. 11, 2001
“When the second plane hit the south tower of the
World Trade Center in New York City
the loaded Navy hospital ship was deployed immediately.
The name of the ship was ... Comfort”.
(Comfort Care in Nursing Blog, 2011, figure 1)

12. Usefulness of the Theory
―
,‖ (Kolcaba, 1994, p. 1180).
(Kolcaba, 1994, p. 1181)

13. Usefulness of Theory
 ―Physical: pertaining to bodily
sensations and homeostasis
 Pain relief
 Regular bowel function
 Fluid/electrolyte balance
 Adequate oxygen Saturation
 Turning & positioning‖
 (Merkel, 2007, p. 3)

 ―Psycho-spiritual:pertaining
to internal awareness of self,
esteem, sexuality, meaning in
one‘s life
 Maintaining/improving self esteem
 Enhancing independence
 Increasing relaxation
 Accommodating religious practices‖
(Merkel, 2007, p. 3)
 ―Environmental: the
external background of the
human experience
 Temperature
 Noise
 Color
 Light
 Views from the window
 Access to nature‖
 (Merkel, 2007, p. 3)
 ―Socio-cultural interpersonal, family &
societal relationships, family traditions &
rituals:
 Caring attitude
 Continuity of care
 Information & education
 Enhancing family & friend support
 Cultural customs‖ (Merkel, 2007, p. 3)

14. Usefulness of Theory
The Taxonomic Structure of
Comfort
Comfort Daisies
The Theory of Comfort can
be used as the framework for
patients‘assessments.
―Assessment is achieved
through the administration of
verbal rating scales (clinical)
or comfort questionnaires
(research), using instruments
developed by Kolcaba‖ (Tomey
& Alligood, 2010, p.711). Pain scales
are used to rate levels before
and after medications to get
a base and acquire a fixed
level. The GCQ is based on
the Likert scale ranging from
―strongly agree to strongly
disagree‖ (Kolcaba, 1992, p.8).
(Kolcaba, Durr, & Stoner, 2010, figure resources (all the above)
Comfort Behaviors
Check off List

15. Case Scenerio:
Comfort Theory In Use
Setting: 72 year old female from Nursing home. Patient is admitted with acute mental status change.
Patient is dehydrated and results are back with a positive UTI.
Nursing Interventions using the Comfort Theory: Are designed to meet the needs of the patient
Physiological, Social, Financial, Psychological, Spiritual, Environmental, and Physical Interventions.
1) Patient: She is trying to get out of bed. She is yelling out, she wants her purse. She is confused and
she doesn‘t know where she is at.
a) Nursing Interventions: Social, Physical Interventions - Put her back in bed, inform the
patient that her purse is not here, it is at home. The RN calls her family to see if someone can
bring the patient her purse, when they come to visit
2) Patient: Again she is trying to get out of bed. She throws back the blankets and tries to sit up and
get out of bed. She continues to yell and beg for her cat, she wants to go home, and she can‘t find her
purse.
b) Nursing Interventions: Psychological, Physical Interventions The RN returns and has a purse
for her out of the lost and found and puts her back in bed. Patient is confused and does not
recognize anyone. Patient is concerned about getting her cats some food.. The RN speaks to her
about her cats and consoles her. She tells the patient that they are being care for and for her not
to worry and the RN stated, she will call her home and check on her cats for her. Patient seems
to calm down after that statement.

16. There are three types of Comfort – 1) Relief- someone who has had a specific
need met 2) Ease – state of calm or contentment 3) Transcendence – someone who
rises above problem or pain.
3) Patient: The patient is confused, saying, ―I don‘t think this is right.‖ The patient is
trying to get out of bed. Patient is trying to get her gown off, to go home. Patient
keeps stating she needs to go home, ―I need to go.‖ Patient is getting more and more
agitated. She is getting more upset about getting her cats some food.
c) Nursing Interventions: Psychological, Physical Interventions, Environmental -
The RN tells the patient she needs to stay in the hospital and she is very sick. RN
talks with the patient, in a soothing tone and consoles her. Tells the patient she will
sit with her and talk. Patient tells RN she is cold. RN puts a warm blanket on the
patient and tells her we will get the heat turned up. Patient still concerned about her
cats, the RN tells patient she has called her home and someone is caring for them
and they have lots of food for them. Patient satisfied with response, warm with the
blanket, and feeling secure in her environment she goes to sleep.
There are four Context of Experience – 1) Physical – pertaining to bodily
sensations 2) Psychospiritual – pertaining to internal awareness of self 3)
Environmental – pertaining to external surroundings 4) Social – pertaining to
interpersonal relationships.
Case Scenerio: Comfort Theory In Use con‘t

17. Theory Testability
“In order to use the theory, three
steps are required:
(a) understanding the technical
definition of comfort and its origins,
(b) understanding the relationships
(propositions) between the general
concepts entailed in the theory
(c) relating the general concepts to
specific problems/settings in order
to enlighten practice and generate
research questions”(Kolcaba & DiMarco,
2005, p. 187) .
Below are some examples of Comfort Theory
used in research :
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.
Apóstolo, K.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.
. (Comfort Care in Nursing Blog, 2011, figure 1)

18. Theory Testability con’t
generated research
After the implementation of medications the recipient is reassessed. ―Kolcaba's technical
definition of comfort is the physical, psychological, spiritual, social, cultural, and environmental
aspects of human experience which are perceived simultaneously‖ (Wardell, 2010, para. 1).
Holistic comforting actions are new to be measured in the research field and can be quite
sensitive to the material encountered (Wardell, 2010). ―These comfort outcomes have
been consistently positive and have been found to be reliable predictors for more effective
healing and/or management of chronic health concerns‖ (Wardell, 2010, para. 2).
The General Comfort Questionnaire (GCQ)…
…is designed to measure holistic changes in comfort levels. There are a vast assortment of the
GCQ for various areas and actions. ―Notable are the instruments developed by Kolcaba et. al
such as the Bladder Function Questionnaire, the Healing Touch Comfort Questionnaire, the
Hospice Comfort Questionnaire, and the Radiation Therapy Comfort Questionnaire‖ (Wardell,
2010, para. 3). The results shown by these GCQ‘s have been a tremendous help in research. The
Verbal rating scale is utilized for our practice sessions. (Wardell, 2010).
(Wardell, 2010, para. 1-3)

19. Theory Testability con’t
generated research
―In total, 32 instruments are known adaptations of the GCQ: 14 by Kolcaba et al., 8 adaptations by other
professionals, and 10 foreign language translations‖ (Wardell, 2010, para. 4).
Dowd, T., Kolcaba, K. & Steiner, R. (2000). Cognitive strategies to enhance comfort and decrease episodes of
urinary incontinence. Holistic Nursing Practice, 14(2), 91-102.
Kolcaba, K., Dowd. T., & Steiner, R. (2006). Development of an instrument to measure holistic client comfort as
an outcome of healing touch. Holistic Nursing Practice, 20, (3), 122-129.
Dowd, T., Kolcaba, K., Fashinpaur, D., Steiner, R., Deck, M., & Daugherty, H. (2007). Comparison of healing
touch and coaching on stress and comfort in young college students. PDF Format
Kolcaba, K., Dowd, T., Steiner, R. & Mitzel, A. (2004). Efficacy of hand massage for enhancing comfort of
Hospice Patients. Journal of Hospice and Palliative Care, 6(2), 91-101.
Novak, B., Kolcaba, K., Steiner, R., & Dowd, T. (2001). Measuring comfort in families and patients during end of
life care. American Journal of Hospice and Palliative Care, 13(3), 170-180.
Kolcaba, K. & Fox, C. (1999). The effects of guided imagery on comfort of women with early-stage breast
cancer going through radiation therapy. Oncology Nursing Forum, 26(1), 67-71.
(Wardell, 2010, para. 4)

20. Propositions in Kolcaba‘s middle-range
Theory of Comfort
[Propositions of Comfort Theory
1. Nurses identify comfort needs of patients and family members.
2. Nurses design interventions to meet identified needs.
3. Intervening variables are considered when designing interventions.
4. When interventions are delivered in a caring manner and are effective, and when enhanced
comfort is attained, interventions are called ―comfort measures‖.
5. Patients and nurse agree on desirable and realistic health- seeking behaviors.
6. If enhanced comfort is achieved, patients and family members are more likely to engage in
health-seeking behaviors these further enhance comfort.
7. When patients and family members are given comfort care and engage in health-seeking
behaviors, they are more satisfied with health care and have better health-related outcomes.
8. When patients, families, and nurses are satisfied with health care in an institution, public
acknowledgment about that institution‘s contributions to health care will help the institution
remain viable and flourish]
[These propositions provide a systematic approach to a solution by incorporating a
process that involves identifying a need, addressing that need, identifying
intervening variable, provide appropriate interventions, assessing if the goal is
achieved, and reaffirming the healthy behaviors learned by the client. Essentially,
Kolcaba has developed a nursing process that is specific to her Theory of Comfort]
(Weller, 1999, para. 8).
(Kolcaba, Durr, & Stoner, 2010, figure FAQ).

21. Different Evolution of Experimental and Comparisons Psychiatric
Inpatients on Total Comfort
This quasi-experimental design was used to measure the differences in comfort, depression, anxiety,
and stress between a treatment group and a usual care group (comparison) of short-term psychiatric
inpatients diagnoses with depressive mood disorders.
Psychiatric Inpatients Comfort Scale (PICS), PICS evaluated reliability, construct validity, and
concurrent validity. The PICS is 5-point Likert type scale with 42 items for self-reporting ranging
from 1, “It doesn't correspond to anything that happens with me” to 5, “It totally corresponds to
what happens with me.”
―Depression, Anxiety, and Stress Scales (DASS-21). the authors assessed scale reliability, construct
validity, and concurrent validity. The DASS-21 contained a set of three 4-point Likerttype subscales
for self-reporting. Each subscale consisted of seven items, aimed at assessing depression, anxiety,
and stress] (Apostolo & Kolcaba, 2009).
[Imagery creates a bridge between mind and body, linking perception, emotion, and psychological, physiological, and
behavioral responses.
. Different Evolution of Experimental and Comparisons Psychiatric Inpatients on
Total Comfort
Example Case Study where
Comfort Theory Utilized-
(Apostolo & Kolcaba, 2009)-all cited so
not to loose meaning of test

22. Overall Evaluation
Generalizability
The Comfort theory is a mid range theory, less generalized than the grand
theories yet more concrete and specific. STRENGTHS: Requires only a
simple, common sense approach. Comforting interventions enhance patients‘
comfort. ―When patients‘ and families engage in health-seeking behaviors,
institutions have better outcomes,‖ (Kolcaba, Durr, & Stoner, 2010, figure FAQ). WEAKNESS:
Research on the concept of Comfort is limited and the meaning of Comfort
has not been ‗definitively‘ defined.. Implementation will be used for the
benefit of my patients and personal ease of mind. I personally believe in this
theory and I place into practice comfort theory each and every day with my
patients.

23. A Closer Look at Kolcaba's Conceptual
Framework
Providing comfort is definitely within the nurses‘ realm today. Nurses are the ones in
direct contact with their patients, providing relief from certain discomforts, continuously
assessing, monitoring and providing care that will ensure the client is at ease. According
to Kolcaba, ―Comfort is the desirable state that nurses would want
for their patients,” (Comfort Care in Nursing Blog, 2011)
(Comfort Care in Nursing Blog, 2011, figure 1)

24. References
Apostolo, J. L., & Kolcaba, K. Y. (2009). The effects of guided imagery on comfort,
depression, anxiety, and stress of psychiatric in patients with depressive disorders. Archives
of Psychiatric Nursing, 23(6), 403-411. http://dx.doi.org/10.1016/j.apnu. 2008.12.003
Comfort Care in Nursing Blog. (2011, September 11). Kolcaba‘s activity [Blog comment].
Retrieved from http://comfortcareinnursing.blogspot.com/p/comfort-theory-major
Current Nursing. (2013). Retrieved March 25, 2010, from http://currentnursing.com/
nursing_theory/application_nursing_theories.html
Kolcaba, K. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19,
1178-1184. http://dx.doi.org/10.1111/j.1365-2648.1994.tb01202.x
Kolcaba, K. (2001). Evolution of the mid range theory for outcomes research. Nursing
Outlook, 49(2), 86-92. http://dx.doi.org/10.1067/mno.2001.110268
Kolcaba, K., & DiMarco, M. A. (2005). Comfort theory and its application to Pediatric
nursing. Pediatric Nursing, 32(3), 187-194. Retrieved from http://
www.medscape.com/viewarticle/507387_2
Kolcaba, K., Durr, K., & Stoner, M. [Comfort Line]. (2010, June). FAQ [Blog comment].
Retrieved from http://www.thecomfortline.com

25. Kolcaba, K., & Kolcaba, R. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing,
16(11), 1301-1310. http://dx.doi.org/10.1111/j.1365-2648.1991.tb01558.x
Kolcaba, K. Y. (2012, July 12). True Comfort [Blog comment]. Retrieved from http://
www.thecomfortline.com
McEwen, M., & Willis, E.M. (2011). Theoretical Basis of Nursing, (3rd ed.). Philadelphia: Lippincott.
Merkel, S. (2007). Comfort Theory: A Framework for pain management nursing practice. [PowerPoint
slides]. Retrieved from http://www.aspmn.org/conference/documents/sandramerkelfull.pdf
Nursing Theory. (2011). Retrieved July 14, 2013, from http://nursing-theory.org/theories- and-models/
Kolcaba-theory-of-
Tomey, A. M., & Alligood, M. R. (2010). Nursing theorists and their work. (7th ed.). Maryland Heights,
MO: Mosby Elsevier
Wardell, D. W. (2010). Measurement tools: Comfort touch. American Holistic Nurses Association, 2(2).
Retrieved from http://www.ahna.org/portals/4/docs/Research/eNews/Connections_R-eNews_1-10.htm
Weller, K. [KWeller Nursing Blog]. (1999, Summer). Scholarly [Blog comment]. Retrieved from http://
kweller99.wordpress.com/scholarly-work/
References Cont‘d