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Comfort Theory: A Holistic Guide for Practice and Research

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Comfort Theory: A Holistic Guide for Practice and Research

In this course, Comfort Theory is presented as a pattern for providing holistic care to patients and families in all health care settings. For those who are working on clinical ladders or small research proposals in school, Comfort Theory provides a framework to design your study. Comfort Theory is easy to understand and learn because we all are familiar with our own needs for comfort, how comfort strengthens us for difficult tasks ahead, and what kinds of things or actions make human beings more comfortable compared to a previous state. Once the theory is understood, it becomes an intuitive part of nurses' assessment, intervention, and evaluation for either practice or research.

What is a Holistic Theory?

The term holistic is an adjective that describes with wholes or integrated systems rather than their separate parts (Webster, 1979). Therefore, a holistic theory reflects the principle that persons respond as a whole to physical, psychological, spiritual, social, cultural, and environmental stimuli. Whole persons are set within complex systems, such as social and environmental systems, which provide their context for living and experiencing. Persons perceive the complexities of these systems through their senses. This happens simultaneously and their responses are instant, and either inward or outward or both (R. Kolcaba, 1997). Whole persons develop knowledge about the world to form a self-concept and an understanding of their place in the scheme of things. They have memories, personalities, ethics, and feelings and bring these variables to bear on their perceptions of reality.

Assumptions of a Holistic Theory. Assumptions are an author's understanding or perspective about reality. When an author is writing a theory, her audience needs to know where she is "coming from." If a reader does not share the author's beliefs about reality, the reader may not be interested in learning the theory.

Kolcaba's beliefs, which permeate Comfort Theory, are that: 1. Human beings respond to complex stimuli simultaneously. 2. A whole response is greater than what would be expected by examining separate responses to separate stimuli and adding together the effects of those responses. 3.Whole persons do not disappear into ever-larger wholes (Kolcaba, 2003).

Whole Person Interventions and Outcomes. Nurses are beginning to explore the effectiveness of broadly targeted holistic interventions such as progressive muscle relaxation, music and art therapy, massage, guided imagery, and therapeutic touch. These interventions and others are intended to produce a positive whole person response and thus would be measured most accurately by a whole person outcome. A whole person outcome would measure positive or negative inter-related effects between aspects of that person's response. The instantaneous and comprehensive response would be reported as a total response.

Holistic Theory. Theories are useful for describing, understanding, predicting, and improving reality through meaningful and relevant interventions. Theories about health care enable users to subscribe to common beliefs and to pattern their care to bring about desired outcomes. A holistic theory for health care, then, addresses or describes the total, simultaneous effects of holistic interventions that are purposefully targeted to needs of whole persons. To be congruent with a specific holistic intervention, the desired outcome is also holistic. The outcome of holistic comfort, as described and defined below, is a congruent indicator of the effectiveness of holistic interventions.

Three Types of Comfort

Comfort is a complex term that is used frequently in heath care, and especially in nursing. It is also a term that has gained in popularity in all types of American media, possibly as an anecdote to our hectic technological culture. In spite of its traditional association with the mission of nursing, comfort had not been defined for health care prior to Kolcaba's work. This work began with a concept analysis of the term, which is an examination of a word to determine its meanings and how the meanings are connected and organized. A thorough concept analysis results in a precise and scientific definition of the term. The Kolcabas' analysis preceded development of her comfort assessments (questionnaires and scales) and Comfort Theory.

Concept Analysis. In 1986, Kolcaba and her husband (a philosopher interested in semantics and knowledge-building) began a lengthy exploration of dictionary definitions of comfort, looking at both modern and obsolete usages of the term, along with disciplinary usages of comfort. The concept analysis was published in 1991 and presented three technical senses of comfort that were relevant for health care. Those three senses, or types, of comfort were relief, ease, and renewal; the term renewal later was changed to transcendence. Relief was defined as the experience of a patient who has had a specific comfort need met. Ease was defined as a state of calm or contentment and does not necessarily specify a prior need that was relieved. Renewal (transcendence) was defined as the state in which one rises above problems or pain (Kolcaba & Kolcaba, 1991). Transcendence is an important concept for Comfort Theory because nurses can't always alleviate pain and suffering completely. But in these difficult situations, nurses never give up! They attempt to empower or inspire their patients to keep going, work through, or rise above their suffering, at least to a partial extent or to what is possible. Conveying hope, caring, and commitment to the patient and family are vehicles for transcendence and are essential components of Comfort Theory. Thus, the three types of comfort (relief, ease, and transcendence) form the cornerstone of a later structure to define holistic comfort and to build Comfort Theory.

Strengthening Component of Comfort. During the discovery phase of the concept analysis, an important component of comfort emerged from three sources that was to be central to its importance for nursing: its strengthening component. The first source of this component was in its origin which was the Latin word "confortare," meaning to strengthen greatly. The second source was from Paterson, a psychiatric nurse and theorist (Paterson & Zderad, 1976/1988). She stated that comfort freed patients to be all they could be at the time, a belief that conformed to the origin of the term. The third source to speak to the strengthening component of comfort was from the disciplines of ergonomics and psychology. These disciplines were interested in increasing productivity,



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