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A theory of holistic comfort for nursing

Authors:
Katharine Kolcaba at University of Akron; Ursuline College, Cleveland Ohio
Katharine Kolcaba
  • University of Akron; Ursuline College, Cleveland Ohio
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Abstract

Although the construct of comfort has been analysed, diagrammed in a two-dimensional content map, and operationalized as a holistic outcome, it has not been conceptualized within the context of a broader theory for the discipline of nursing. The theoretical work presented here utilizes an intra-actional perspective to develop a theory of comfort as a positive outcome of nursing case. A model of human press is the framework within which comfort is related to (a) interventions that enhance the state of comfort and (b) desirable subsequent outcomes of nursing care. The paper concludes with a discussion about the theory of comfort as a significant one for the discipline of nursing.
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... Os modelos teóricos de enfermagem que foram operacionalizados para a prática clínica dos enfermeiros pré--hospitalares durante o socorro às vítimas de trauma assentaram o seu foco essencialmente na gestão da instabilidade hemodinâmica e controlo hemorrágico (Mota et al., 2019). Teoria do Conforto de Kolcaba, desenvolvida por Katharine Kolcaba, é uma estrutura conceptual que visa melhorar a qualidade dos cuidados de enfermagem, sendo o conforto o conceito teórico central na satisfação (ativa, passiva ou cooperativa) das necessidades humanas básicas, baseada em três tipos de conforto: alívio, tranquilidade e transcendental (Kolcaba, 1994). Este modelo conceptual tem sido adaptado a diversos enquadramentos clínicos (Lin et al., 2023) todavia, acreditamos que a sua utilização para a definição de um modelo de cuidados no atendimento a vítimas de trauma nos cuidados pré--hospitalares pode constituir-se como uma importante ferramenta para melhorar a qualidade no socorro. ...
... Kolcaba criou um quadro conceptual para mostrar como a sua teoria se enquadra no fluxo de cuidados no contexto da prática e descreve-o como o produto de uma prática de enfermagem holística (Kolcaba, 2003). A teoria conceptualiza o conforto como sendo um estado complexo que abrange as dimensões física, psicológica, social e espiritual (Kolcaba, 1994). Elenca três tipos de conforto: conforto alívio, relacionado com a redução ou eliminação do desconforto físico; conforto tranquilidade, direcionado para a promoção de um ambiente que proporcione tranquilidade e bem-estar psicológico; e conforto transcendental que promove o propósito e a paz espiritual (Kolcaba, 2003). ...
... Alicerça-se, ainda, em quatro dimensões fundamentais, (1) a Física, no alívio básico do corpo; (2) a Psicológica e Espiritual, pelo equilíbrio mental e emocional, na procura de propósito e significado da vida; (3) a Social, patente nas relações interpessoais e no apoio social e, por fim, (4) a Ambiental (Gaibor et al., 2021). O conforto físico está relacionado com factores fisiológicos como o repouso e o relaxamento, as respostas à doença, a nutrição e a homeostasia ou até à própria dor, sendo aliás, esta, um dos principais fatores que comprometem o con-Revista de Enfermagem Referência 2024, Série VI, n.º 4: e37070 DOI: 10.12707/RVI24.85.37070 forto físico (Kolcaba, 1994). O conforto psicoespiritual incopora a vertente mental e espiritual, as emoções que definem o sentido de vida do indivíduo, como a autoestima, o auto-conceito e a auto-consciência (Kolcaba, 2003). ...
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... Katharine Kolcaba [9,10], who was the theorist of the Comfort Theory, defined comfort in nursing practices as diagnosing the comfort needs of the individual/family/society, planning nursing interventions for unmet needs, and evaluating the basic comfort levels and the post-application comfort levels. Increasing the comfort of individuals is defined as a nursing initiative in nursing practices. ...
... Increasing the comfort of individuals is defined as a nursing initiative in nursing practices. For this reason, nurses are expected to take precautions to improve the patient's comfort levels in nursing practices such as intramuscular injection applications [1,10]. ...
Deltoid muscle intramuscular injection methods examining pain comfort satisfaction and fear in ShotBlocker helfer skin tap and standard techniques
Article
Full-text available
  • Apr 2025
  • BMC Nurs
Background Deltoid Muscle intramuscular (IM) injection is a standard nursing procedure that often causes discomfort and anxiety. Helfer Skin Tap (HST) and ShotBlocker have been introduced to reduce injection-related pain and improve patient experience. Aim This study compares the effects of the deltoid muscle intramuscular injection techniques Helfer Skin Tap, ShotBlocker, and Standard Technique on patients' pain, comfort, satisfaction, and fear levels. Design The study used a single-center, randomized, Controlled interventional study design in which three injection techniques were applied to one group. Participants Forty patients participated in the study. Methods A single-center randomized controlled interventional study was conducted with patients from the Emergency Department of Atatürk University Study Hospital. Data collection tools included forms for sociodemographic characteristics, pain assessment, comfort levels, satisfaction, and fear related to injections. The interventions were applied once daily for three days, and data were analyzed using appropriate statistical methods. Results Compared to the Helfer Skin Tap and Standard Technique, the ShotBlocker technique caused the most minor pain and fear and the highest levels of comfort and satisfaction among patients. Conclusion The findings suggest that the ShotBlocker technique is the most effective in reducing pain and fear while providing the highest comfort and satisfaction levels. This indicates its potential for widespread adoption in clinical practice to improve patient outcomes during deltoid muscle IM injections. Trial registration This research is a randomized controlled study. Therefore, a registration number was applied for at ClinicalTrials.gov. The registration number was obtained with the number “NCT05577832”. (First Posted 13/10/2022) Conclusion and implications for nursing and/or Health policy Due to its superior performance, the ShotBlocker technique should be integrated into nursing education and practice. This technique can improve the quality of patient care and enhance the patient experience during deltoid muscle IM injections.
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... Increasing patients' comfort level while applying nursing interventions is integral to professional nursing care. In the Comfort Theory that Katharine Kolcaba developed, comfort levels are described at three levels: relief, relaxation, and superiority, and are discussed in four dimensions: physical, psycho-spiritual, social-cultural, and environmental [6,7]. In nursing practice, comfort consists of defining the comfort needs of the patient, family, or society, taking precautions for these needs, and evaluating the basic comfort levels after the procedure [6]. ...
... In the Comfort Theory that Katharine Kolcaba developed, comfort levels are described at three levels: relief, relaxation, and superiority, and are discussed in four dimensions: physical, psycho-spiritual, social-cultural, and environmental [6,7]. In nursing practice, comfort consists of defining the comfort needs of the patient, family, or society, taking precautions for these needs, and evaluating the basic comfort levels after the procedure [6]. One expected outcome in nursing practice is to increase the patient's comfort in line with appropriate and realistic goals [7,8]. ...
Development and psychometric validation of the comfort scale for injection
Article
Full-text available
  • Dec 2024
  • BMC Nurs
Background Patients’ comfort level during the injection procedure affects the quality of care. However, the literature does not provide a valid, reliable, and specific measurement tool to measure this level. Objective The present study aimed to develop a valid and reliable measurement tool to determine patients’ comfort levels during the injection procedure. Method The study was designed methodologically. The study data were collected at two Hospitals. The sample consisted of 102 patients in the pilot application stage and 186 patients in the main application stage. The study’s data collection tools were the “Personal Information Form,” “VAS for Comfort,” and the “Comfort Scale for Injection” draft. The obtained data were used for validity and reliability analyses. Validity analyses involved content validity, Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and criterion validity. Reliability was assessed using Cronbach's Alpha and split-half tests. Statistical analyses were performed with SPSS 22 and AMOS. EFA used the KMO test and Bartlett’s Test (KMO = 0.878; p < 0.001), with Varimax rotation, while CFA confirmed the factor structure. Pearson correlation evaluated criterion validity. Results The scale consisted of 10 items and two sub-scales: “Comfort during the Injection Procedure” and “Environmental Comfort.” The “VAS for Comfort” and the scale and its sub-scales showed a positive correlation. The Cronbach Alpha Value of the entire scale was found to be 0.899. Conclusion The data showed that the “Comfort Scale for Injection” is an adequate, valid, and reliable measurement tool for determining patients’ comfort level during the injection procedure. Measuring patients’ comfort levels during injection at regular intervals is recommended, as new studies are planned to increase injection comfort and adapt the “Comfort Scale for Injection” for different languages and cultures.
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... Increasing patients' comfort level while applying nursing interventions is integral to professional nursing care. In the Comfort Theory that Katharine Kolcaba developed, comfort levels are described at three levels: relief, relaxation, and superiority, and are discussed in four dimensions: physical, psycho-spiritual, social-cultural, and environmental (Kolcaba, 1994;Krinsky et al., 2014). In nursing practice, comfort consists of de ning the comfort needs of the patient, family, or society, taking precautions for these needs, and evaluating the basic comfort levels after the procedure (Kolcaba, 1994). ...
... In the Comfort Theory that Katharine Kolcaba developed, comfort levels are described at three levels: relief, relaxation, and superiority, and are discussed in four dimensions: physical, psycho-spiritual, social-cultural, and environmental (Kolcaba, 1994;Krinsky et al., 2014). In nursing practice, comfort consists of de ning the comfort needs of the patient, family, or society, taking precautions for these needs, and evaluating the basic comfort levels after the procedure (Kolcaba, 1994). One expected outcome in nursing practice is to increase the patient's comfort in line with appropriate and realistic goals (Kolcaba et al., 2006;Krinsky et al., 2014). ...
Development of Comfort Scale for Injection
Preprint
Full-text available
  • Aug 2024
Background Patients’ comfort level during the injection procedure affects the quality of care. However, the literature does not provide a valid, reliable, and specific measurement tool to measure this level. Objective The present study aimed to develop a valid and reliable measurement tool to determine patients’ comfort levels during the injection procedure. Method The study was designed methodologically. The study data were collected at two Hospitals. The sample consisted of 102 patients in the pilot application stage and 186 patients in the main application stage. The study’s data collection tools were the “Personal Information Form,” “VAS for Comfort,” and the “Comfort Scale for Injection” draft. The obtained data were used for validity and reliability analyses. Results The scale consisted of 10 items and two sub-dimensions: “Comfort during the Injection Procedure” and “Environmental Comfort.” The “VAS for Comfort” and the scale and its sub-dimensions showed a positive correlation. The Cronbach Alpha Value of the entire scale was found to be 0.899. Conclusion The data showed that the “Comfort Scale for Injection” is an adequate, valid, and reliable measurement tool for determining patients’ comfort level during the injection procedure. Measuring patients’ comfort levels during injection at regular intervals is recommended, as new studies are planned to increase injection comfort and adapt the “Comfort Scale for Injection” for different languages and cultures. Clinical trial number not applicable.
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... Another study also determined that physical comfort was more elevated in mothers who had given birth vaginally [33]. Physical comfort is associated with bodily perceptions, including physiological factors like nutrition, excretion, rest, and hemodynamics that affect the individual's physical condition [34]. The worse a person's physical condition gets, the lower their level of physical comfort. ...
... The combined results of the studies examined in the meta-analysis showed that cesarean delivery reduced sociocultural postpartum comfort, and the outcome was found statistically insignificant. Factors that constitute sociocultural comfort include family traditions/customs, religious beliefs, benefiting from financial support, and interpersonal communication [5,34]. In this context, information and counseling should be given to the individuals to create sociocultural care, and it should be ensured that they receive care, social support, discharge, and education, taking into account their family traditions and habits [5,35]. ...
The effect of mode of delivery on postpartum comfort level and breastfeeding self-efficacy: a systematic review and meta-analysis
Article
Full-text available
  • Sep 2024
Objective This study was conducted to determine the effect of the mode of delivery on maternal postpartum comfort level and breastfeeding self-efficacy. Methods The study was conducted as a systematic review and a meta-analysis. Searching was performed from March to July 2022, on PubMed, National Thesis Center, Dergi Park, Google Scholar, Web of Science, and EBSCO search engines and we included studies from the last 10 years. The Joanna Briggs Institute Critical Appraisal tools used in cross-sectional studies were employed to appraise the methodological quality and performed meta-analyses using a random-effects model for all outcomes. Study data consisted of continuous variables calculated by Mean Difference. Results From 3732 records received, 21 cross-sectional studies involving 5266 participants were determined to be eligible. Meta-analysis results showed that cesarean section reduced postpartum comfort, albeit not statistically significant (MD: -0.87 95%: -1.98–0.24, Z = 1.53, p = 0.44), whereas the combined results of breastfeeding self-efficacy showed that delivery type did not affect breastfeeding self-efficacy. Conclusion The results of this review have clinical implications for postpartum caregivers, as the effects of mode of delivery on postpartum comfort and breastfeeding self-efficacy have been well documented in previous studies. The authors recommend caregivers plan maternal care to increase their comfort, taking into account the factors that may affect postpartum comfort in the light of evidence-based practices.
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... 19 Comfort is defined as a sense of relief and relaxation when a stressful health condition arises in a patient. 36 In the study carried out by Tosun et al, 28 it was found that as the immobilization duration increases after lower extremity surgery, the level of immobilization comfort decreases. The results of this study suggest that patients feel relieved by focusing their attention on the stress balls during the 10-hour immobilization period after angiography. ...
The Effect of Stress Ball Use on Immobilization Comfort, Pain Level, and Vital Signs in Patients After Coronary Angiography
Article
  • Apr 2025
  • J CARDIOVASC NURS
Background Coronary angiography is an invasive procedure that can lead to changes in patients' pain levels, vital signs, and comfort levels. Objective The objective of this study is to investigate the effect of stress ball use on immobilization comfort, pain level, and vital signs in patients after coronary angiography. Methods This randomized controlled study was conducted between April and July 2024 in the cardiology clinic of a training and research hospital. The intervention group (n = 35) used a stress ball, whereas the control group (n = 35) was given standard care. Data collection was conducted using the “Patient Information Form,” “Visual Analog Scale,” “Immobilization Comfort Scale,” and “Vital Signs Monitoring Form.” Results The immobilization comfort level of the intervention group was significantly different from that of the control group ( P = .042; η ² = 0.023) ( P < .05). Similarly, the pain intensity averages during and after the procedure in the intervention group were significantly different from the control group ( P < .001, P < .001; η ² = 0.464, η ² = 0.528) ( P < .001). Respiratory rates of the intervention group were lower than those of the control group during and after the procedure, with a significant difference and effect between the 2 groups ( P = .031, P = .048; η ² = 0.216, η ² = 0.282) ( P < .05). Conclusions Using a stress ball after coronary angiography was found to be an effective method for improving immobilization comfort, reducing pain, and lowering respiratory rates.
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... No âmbito dos cuidados em saúde, a concetualização e operacionalização de conforto, foi protagonizado por Kolcaba (2003;1994;1991), através do desenvolvimento de uma teoria de médio alcance como resultado positivo dos cuidados de enfermagem. O mesmo autor define conforto como a satisfação (ativa, passiva ou cooperativa) das necessidades humanas básicas de alívio, tranquilidade e transcendência. ...
Ebook Cuidadores informais em Portugal Formação ao longo da vida
Book
Full-text available
  • Jun 2024
Obra publicada após desenvolvimento de dois cursos conducentes a microcredenciais no âmbito do Plano de Recuperação e Resiliência, na Escola Superior de Saúde do Instituto Politécnico de Santarém, dirigidos a profissionais de referência dos cuidadores informais e aos próprios cuidadores. PALAVRAS -CHAVE Cuidador informal Literacia em saúde Narrativa
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Comfort Need of Hospitalised Patients With Covid‐19 During Isolation Precaution: A Qualitative Study
Article
Full-text available
  • Nov 2024
Aim This study aimed to explore the experiences of hospitalised patients with Covid‐19 in terms of the meeting of their comfort needs and the source of discomfort during isolation precautions. Design Qualitative descriptive phenomenological approach was applied in this study. Methods There were 16 hospitalised patients with Covid‐19 and 11 nurses who were thoroughly interviewed. Content analysis was conducted to examine the data of the interviews and then managed using Atlas ti‐9 software. Results Five central themes were identified that describe the comfort needs and the source of discomfort, as follows: (1) nursing professionalism; (2) physical discomfort; (3) psychological responses; (4) poor sleep quality; and (5) spiritual adaptations. Public Contribution The study promoted further explanation about comfort need in patients with Covid‐19 in isolation room. This study also highlighted that nursing care played a pivotal part in assisting patients to reach their highest comfort level.
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Konfor Teorisinden Erken Doğum Sonu Döneme Bakış: Olgu Sunumu
Article
  • Jan 2024
Doğum sonrası yaşanan rahatsızlıkların giderilmesi için, ebe ve hemşireler tarafından etkinliği kabul edilen alternatif ve tamamlayıcı terapiler beden, zihin ve ruh dengesine dayanır. Katherina Kolcaba'nın bütünsel konfor teorisi, doğum yapan kadınların konfor bakımında hemşirelere alternatif ve tamamlayıcı terapileri kullanma konusunda rehberlik edecek bir çerçeve olarak önerilir. Bu olguda konfor kuramına göre sezaryen sonrası ebelik/hemşirelik bakımı verilerek annenin postpartum konforunun değerlendirilmesi ve kurama dayalı bakımın pratikte kullanımı sunulmuştur. Erken doğum tehdidi ile 38. haftada sezaryen planlanan kadına; doğum sürecinde alınan anamnez ve yapılan gözlemlere dayalı Katherina Kolcaba’nın konfor teorisi temel alınarak taksonomik sınıflandırma yapılmıştır. Taksonomik sınıflandırma da, fiziksel, psikospiritüel, çevresel ve sosyokültürel başlıkları altında Nanda’ya göre hemşirelik tanıları konulmuştur yapılmıştır. Sınıflandırma eşliğinde anneye hemşirelik bakımı verilmiştir. Postpartum 48 saat sonunda “doğum sonu konfor ölçeği” kullanılarak annenin konfor düzeyi ölçülmüştür.Konfor kuramı temelli bakım yaklaşımı, annenin doğum sonu ebeveynlik rollerine uyumunun ve sezaryen ameliyatı sonrası konforun artırdığı görülmüştür. Kuramın klinikte sistematik olarak uygulanabilir olduğu düşünülmektedir.
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Promoting patient-centered care in CAR-T therapy for hematologic malignancy: a qualitative meta-synthesis
Article
Full-text available
  • Aug 2024
  • SUPPORT CARE CANCER
Background CAR-T therapy has emerged as a potentially effective treatment for individuals diagnosed with hematologic malignancies. Understanding patients’ unique experiences with this therapeutic approach is essential. This knowledge will enable the development of tailored nursing interventions that align with the increasing importance of patient-centered care. Objective To examine and synthesize qualitative data on patients and their family caregivers’ experiences during the treatment journey. Design We conducted a systematic review and qualitative meta-synthesis. Eligible studies contained adult patient or family caregiver quotes about experiences of CAR-T therapy, published in English or Chinese in a peer-reviewed journal since 2015. Data sources included MEDLINE, CINAHL, Embase, PsycINFO, Web of Science, Scopus, Cochrane Library, CNKI, and WanFang. Methods Systematic search yielded 6373 identified articles. Of these, 12 reports were included in the analysis, which covered 11 separate studies. Two reviewers independently extracted data into NVIVO 12.0. Qualitative meta-synthesis was performed through line-by-line coding of full text, organization of codes into descriptive themes, and development themes. Results The qualitative meta-synthesis yielded eight primary themes. Noteworthy revelations from patients and their family caregivers regarding the CAR-T therapy journey encompassed various aspects. Prior to CAR-T therapy, patients experienced a lack of actual choice, struggled with expectations for treatment outcomes, and encountered intricate emotional experiences. During or immediately after CAR-T therapy, patients reported both comfortable and uncomfortable experiences. Additionally, patients emphasized that concerns regarding treatment efficacy and adverse reactions intensified treatment-related distress. After CAR-T therapy, significant changes were observed, and the burden of home-based rehabilitation. Additionally, we found factors contributed to the high CAR-T therapy cost. Conclusions To ensure the safety and sustainability of CAR-T therapy, it is crucial to address the physical and psychological aspects of the patient's experience. Effective communication and comprehensive management are highly valued by patients and their caregivers. Further research should investigate ways to reduce burdens and develop self-management education programs for patients and their families.
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American Nurses Association position statement on promotion of comfort and relief of pain in dying patients
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