Primary author: Betsy Barnett

The Comfort Theory Explained
The Comfort Theory, applied frequently to nursing and nursing practices, plays an integral part for patients who are “working to return to former functional levels,” for patients “going through strenuous therapies,” and for individuals “who want to die in a dignified way” (Merkel, 2007). Furthermore, the Comfort Theory suggests that when patients and their respective families feel comfortable, they are more likely to choose healthy behaviors (Kolcaba, Tilton, & Drouin, 2006). To fully grasp the Comfort Theory, it is important to understand the idea of comfort. While closely related to the term ‘caring,’ the term ‘comfort’ is unique in that it signifies care by a healthcare provider “in response to a patient’s needs”; ‘caring,’ on the other hand, concentrates on the healthcare provider and their desire to aid patients (Morse, 2000). Moreover, the term ‘comfort’ is complex, taking on both physical and mental attributes (Kolcaba & Kolcaba, 1991b). Katherine Kolcaba, who is well published on the Comfort Theory, describes six meanings of ‘comfort,’ ranging from a basic meaning—“a cause of relief from discomfort and/or the state of comfort”—to a more complex connotation—“strengthening, encouragement, incitement; aid, succor, support, countenance” (Kolcaba & Kolcaba, 1991b).

Historically, comfort has played an important role in healthcare and, specifically, an important role in nursing care. Florence Nightingale, in the nineteenth century, asserted that nurses should “put the patient in the best condition for nature to act upon him” (Merkel, 2007). She also explained that nursing observation should be “for the sake of saving life and increasing health and comfort” (Kolcaba & Kolcaba, 1991b). In the early twentieth century, Harmer identified the significance of environmental comfort and described relief of discomfort was critical to nursing practice (Kolcaba & Kolcaba, 1991b). Soon after, Goodnow, in her book The Technic of Nursing, wrote a chapter on patient comfort, claiming that nurses are often judged on their ability to make a patient comfortable (Kolcaba & Kolcaba, 1991b). In the late twentieth century, experts such as Roy, Orlando, Watson, and Paterson have used the concept of comfort in other nursing practices (Kolcaba & Kolcaba, 1991b). Katherine Kolcaba is perhaps the most notable name in history when considering comfort, and, specifically, the Comfort Theory, as she is responsible for developing its constructs and has published many works on the application of the Comfort Theory to the nursing practice.

Although the Comfort Theory is multifaceted, its overall goal is to provide comfort that is individualized to the patient. It also aims to enhance the patient’s feeling of well-being and provide the patient with a sense of support (Merkel, 2007). Furthermore, the Comfort Theory addresses human needs through relief, ease, and transcendence (Kolcaba, 1991a). These senses can be defined as “the state of having a specific discomfort relieved,” “a state of ease or contentment,” and “the state of having been strengthened or invigorated” (Kolcaba, 1991a). To achieve these human needs, the Comfort Theory focuses on the development of two important constructs—contexts of comfort care (physical, environmental, sociocultural, and psychospiritual) and types of care (technical, coaching, and comforting) (Merkel, 2007). Morse (2000) briefly explains the constructs of the Comfort Theory in her following summary: “after assessing the patient, the nurse identifies an appropriate comforting strategy or a combination of strategies, which may be indirect, such as manipulation of the environment (dimming lights or providing a blanket) or direct, such as touch.”

Many healthcare institutions adopt the Comfort Theory as a framework for their practice environment. For example, a not-for-profit New England hospital chose the Comfort Theory as a framework for practice in order to achieve high recognition (Kolcaba, Tilton, & Drouin, 2006). They chose Kolcaba’s theory because “it most represented [their] philosophy of care and values and its effects were [easy] to measure” (Kolcaba, Tilton, & Drouin, 2006). The Comfort Theory was applied to both nurses and patients, as nurses oftentimes neglect the significance of their personal comfort (Kolcaba, Tilton, & Drouin, 2006). This hospital implemented physical, environmental, sociocultural, and psychospiritual comfort for nurses and patients into their nursing philosophy and worked towards branding the hospital as a comfort place (Kolcaba, Tilton, & Drouin, 2006). After putting the Comfort Theory into practice, the hospital “was identified as an exemplar” (Kolcaba, Tilton, & Drouin, 2006).

While the Comfort Theory is strongly associated with nursing, its constructs could certainly be extended into a broader public health prospective. Merkel (2007) describes seven systems of the Comfort Theory—respecting the individual, coordinating care, giving predictive information, providing comfort, relieving fears, involving friends and family, and thinking about an individual on a continuum of life—that many healthcare professionals (from research staff to physicians) could utilize in order to make patients and families feel more at ease. The Comfort Theory is a framework and can be applied to many public health practices.
References

Kolcaba, K.Y. (1991a). A taxonomic structure for the concept of comfort. Journal of Nursing Scholarship, 23(4), 237-240.
Kolcaba, K.Y. & Kolcaba, R.J. (1991b). An analysis of the concept of comfort. Journal of Advanced Nursing, 16, 1301-1310.
Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort theory: A unifying framework to enhance the practice environment. The Journal of Nursing Administration, 36 (11), 538-544.
Merkel, S. (2007). Comfort theory: A framework for pain management nursing practice [PowerPoint Slides].
Retrieved from http://www.aspmn.org/Conference/documents/SandraMerkelFull.pdf
Morse, J.M. (2000). On comfort and comforting. The American Journal of Nursing, 100 (9), 34-38.