PRESENTATION BY ERIN CARLINE RN, BSN, CCRN and LIVE TWITTER CONVERSATION with Dr. K! Sharing Best Practices in Comfort Theory For Strength A Special Twitter Conversation By And For Certified Registered Nurse Anesthetists (CRNA) o PRESENTATION BY ERIN CARLINE RN, BSN, CCRN: Mon June 25, 2012 at 4:45pmCST/5:45pmEDT to 5:15pmCST/6:15pmEDT o LIVE CHAT: Mon June 25, 2012 at 5:15pmCST/6:15pmEDT to 5:45pmCST/6:45pmEDT with Dr. K o ONLINE FORUM: Week of June 25, 2012 o SUMMARY ARTICLE: Monday, July 2, 2012 at http://thecomfortline.blogspot.com/ o Twitter https://twitter.com/kathykolcaba o Hashtag #ComfortTheory INTRODUCTION Erin Carline, RN, BSN, CCRN, Goldfarb School of Nursing at Barnes-Jewish College, St. Louis Missouri, presents Comfort Theory to her class of 25 nurse anesthesia and nurse practitioners. Erin will include an interactive conversation with Katharine Kolcaba, RN, MSN, and PhD on Comfort Theory as it pertains to CRNA practice using Twitter to facilitate knowledge sharing, improved practice, and strengthen student engagement! Copyright 2012 Katharine Kolcaba, RN, MSN, PhD. Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works. Katharine Kolcaba, RN, MSN, PhD, The Comfort Line, Chagrin Falls, Ohio 44022. E-mail: kathykolcaba@yahoo.com Phone: 440-655-2098 Web: http://thecomfortline.com/

1. The Comfort Theory
Katharine Kolcaba
By Erin Carline, RN, BSN, CCRN

2. Who is Katharine Kolcaba?
 Born Dec 28th, 1944 in Cleveland Ohio
 Diploma in nursing- St. Luke’s Hospital 1965
 BSN- Frances Payne Bolton SON-1987
 PhD and Clinical Nursing Specialist- 1997
 Currently Associate Professor of Nursing
Emeritus at the University of Akron College of
Nursing. Teaches on two online theory courses
(MSN and DNP levels)

3. What is the Comfort Theory?
 A mid-range theory
 A humanistic, holistic theory that is based
on patient needs
 Began in nursing

4. Why, might you ask is this considered a mid-
range theory?
 The comfort theory meets the following criteria
for mid range…..
 1. Its concepts and propositions are specific to
health care disciplines
 2. It is readily operationalized
 3. It can be easily applied to many situations
 4. Propositions can range from causal to
associative, depending on their applications
 5. Assumptions fit the theory

5. The Comfort Theory
 The theory states that, in stressful healthcare situations, unmet needs
for comfort are met by nurses and the health care team.
 Interventions are successful if enhanced comfort is achieved by the
patient compared with a previous baseline.
 The immediate patient outcome of enhanced comfort is directly and
positively related to patients engaging in health seeking behaviors
 When patients engage in health seeking behaviors, they do better and
report high satisfaction in their healthcare
 High patient satisfaction leads to better institutional outcomes and
higher institutional integrity
 Institutional integrity is conceptualized as the quality or state of health
care corporations being complete, sound, upright, honest and sincere.

6. Conceptual Framework
Please refer to handout for definitions

7. How was the theory derived?
 Late 1980s- “Diagram her practice” for
dementia care
 Presented at conference- feedback
 Found that the Framework was applicable
to many areas
 Began to study definition of comfort and
conceptual linkages

8. Conceptual Analysis
 Concept analysis began with extensive review of
literature
 Nursing
 Medicine
 Psychology
 Psychiatry
 Ergonomics
 English (Even Shakespeare!)
 Found that comfort was frequently cited, not never
clearly defined.

9. Definition of Comfort
The use of comfort was extremely varied.

10. Kolcaba’s Definition of Comfort
 “The state of having addressed basic needs
for ease, relief, and transcendence met in 4
contexts of experience (physical,
psychospiritual, sociocultural, and
environmental)”

11. Deductive Stage of Comfort Theory
 Resulted in comfort being related to other nursing
concepts to produce a theory
 Murray’s Theory- framework
 3 early nursing theorists were used to synthesize or derive
the types of comfort
 Relief- Orlando
 Ease- Henderson
 Transcendence- Paterson and Zderad

12. Overview of the Theory:
Definitions
 Relief- The state of having a severe
discomfort mitigated or alleviated
 Ease- The absence of specific disorders
 Transcendence The ability to rise above
discomforts when they cannot be eradicated
or avoided

13. Even more definitions….
 Physical- pertaining to bodily sensations and homeostatic
mechanisms
 Psychospiritual- pertaining to internal awareness of the
self; including esteem, concept, sexuality, meaning in ones
life and one’s relationship to a higher order or being
 Environmental- pertaining to the external background of
human experience (temp, light, sound, odor, color,
furniture, landscape, etc.)
 Sociocultural- pertaining to interpersonal, family, and
societal relationships, traditions, rituals and religious
practice.

14.  The aspects of comfort are interrelated and
the whole is greater than the sum of its
parts.

15. Taxonomic structure
 The taxonomic structure enables us to identify comfort
needs, design interventions targeted to those needs, and
measure the effectiveness of those interventions.

16. Why is a framework important?
 Caring attention to one cell that needs it, in the
form of a comfort intervention can enhance total
comfort more than could be expected by the nature
of the specific comfort measures.
 When comfort needs are met in one context, total
comfort is enhanced in the remaining contexts
 Placing comfort within a framework or theory
provides nurses and team members with rationale
for enhancing patient comfort.

17. Take a peek at your taxonomic
structure chart now
 Physical comfort needs: physiologic mechanisms
that are disrupted. Comfort measures are directed
at regaining homeostasis.
 Ex) fluid and electrolyte balance,
 oxygenation, pain, nausea, shivering

18. Psychospiritual needs
 The need for inspiration, motivation, and
being able to “grow through” or “rise
above” discomforts that cannot be
immediately relieved.
 Ex: massage, special visitors, caring touch,
words of encouragement

19. Sociocultural needs
 Needs for socially sensitive reassurances,
support, positive body language, and caring
 Ex: honoring cultural traditions, assisting
with paperwork

20. Environmental
 Include orderliness, quiet, comfortable
furniture, minimal odors, safety
 Ex: decrease noise and lights, allow for
uninterrupted sleep.

21. Conceptual Framework

22. How does the comfort theory lead to
institutional integrity?
 When patients have high levels of comfort,
they engage in health seeking behaviors
 When patients engage in HSB, they are
more satisfied with their care
 High patient satisfaction=better outcomes
and institutional integrity

23. But why do nurses care about
this?
 Rational for enhancing patient care
 Better pt satisfaction =better nursing care
 High patient satisfaction leads to
competitive edge in negotiations with
employers and financial viability for the
institution.

24. Can’t get that raise you deserve?
 Use the comfort theory! Give them some
solid DATA why you deserve more money!

25. Strengths
 Kolcaba is still actively teaching and constantly
expanding her theory to new disciplines of nursing
 The theory is applicable to the modern nursing
profession.
 It is easily searchable, understandable and
applicable
 It uses common, easily observable variables that
are easily measured by the nurse and can be used
for research and performance review

26. Collaborative Technologies and
Social Media Tools
 Kolcaba knows what the modern nurse and nursing student needs to
grasp and use a theory.
 Facebook!
 Blog!
 Webpage! www. thecomfortline.com
 YouTube Videos!
 This is not a theory that was developed hundreds of years
ago that you must strain to make applicable to modern
healthcare.

27. Ironically….
 Kolcaba has stated that “The overall purpose of CT was to
highlight the importance of comforting our patients in this
high tech world. It is what they want and need from us.”
 Second goal: highlight the importance of nurses to
patients’ comfort
-make what nurses do visible in documentation
 Thankfully, she enjoys spreading the
message of the comfort theory; her goals
help her “transcend” her own discomfort
with technology!

28. Let’s “tweet” about the Comfort
Theory!
 Write a tweet about how the comfort theory
can be applied to YOUR practice
 OR
 A definition of the theory
 Address tweets to @KathyKolcaba
 Remember 140 characters or less!
 Include the hashtag #comfortline

29. Bibliography
 Kolcaba, K.Y., & Kolcaba, R. J. (1991). An analysis of the concept of
comfort. Journal of Advanced Nursing. 16 (2): 1301-1310
 Kolcaba, K., (2001). Evolution of mid range theory of comfort for outcomes
research. Nursing Outlook. 49(2): 86-92
 Kolcaba, K., & Wilson, L. (2002). Comfort care: a framework for
perianesthesia nursing. Journal of PeriAnesthesia Nursing. 17(2): 102-114
 Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort Theory: A unifying
framework to enhance the practice environment. Journal of Nursing
Administration, 36 (11), 538-544.
 Comfort Care website: www.thecomfortline.com