Health Care and Theory

¶ … KATHARINE KOLCABA'S COMFORT THEORY Evaluation of K. Kolcaba's Comfort Theory Structure Are the concepts in the theory explicitly and/or implicitly described in the theory? (including the four concepts of the metaparadigm of nursing; nurse/nursing; person/patient; health; environment)? The descriptions of the theoretical concepts of comfort theory are provided below: Nurse/nursing: According to Kolcaba (2003), "The term [nursing] can mean the discipline (noun) or what nursing does (the verb)" (p.

68); Person/patient: Likewise, Kolcaba (2003) notes that "the concept [person] has been utilized as client, patient, family, community, region, or nation" (p. 68). Health: "Health Care Needs" include those identified by the patient/family in a particular practice setting (Kolcaba, 2016, para. 3); Environment: Generally, Kolcaba (2003) describes this concept as "where ever nurses practice" (p. 68). b. Are the relationships of the theory concept relationships explicitly and/or implicitly described in the theory? According to Kolaba (2003), her definition characterizes comfort "as a positive concept and accounts for its many aspects beyond physical comfort" (p. 241).

These additional aspects include both commonly understood issues related to comfort (e.g., physical comfort) as well as psychosocial factors that can contribute to or diminish comfort levels. c. Are the concept relationships capable of describing, explaining, and/or predicting outcomes (applicability of the theory)? The author emphasizes the utility of comfort theory in predicting patient satisfaction and nursing satisfaction levels (Kolcaba, 2016). In addition, comfort theory has been shown to be accurate in predicting that patients receiving comfort-based interventions applied over time will experience enhance comfort levels (Kolcaba, 2003). d.

Is deductive, inductive or retroductive reasoning used in the theory? Given its emphasis on the provision of nursing interventions that enhance patient comfort levels, comfort theory relies on deductive reasoning. e. Is there a model/diagram? Does the model/diagram contribute to clarifying the theory? The author provides several graphic images and diagrams to clarify comfort theory, including the conceptual framework graph shown in Figure 1 below. Figure 1. Conceptual framework for Kolcaba's comfort theory Source: http://www.thecomfortline.com/files/conceptualframework.gif 2. Clarity (lucidity and consistency) a.

Are the definitions of each key term, concept and sub-concept specific or vague? To her credit, Kolcaba is meticulous in provided definitions for all key terms, concepts and sub-concepts. For instance, Dowd (2003) reports that: Some of the early articles, such as the concept analysis piece, are difficult to read but are consistent in terms of definitions, derivations, assumptions, and propositions. The seminal article explicating the Theory of Comfort is easier to read and, in subsequent articles, Kolcaba applies the theory to specific practices utilizing academic but understandable and consistent language.

All concepts are theoretically and operationally defined. (as cited in Kolcaba, 2003, p. 247) b. Is the theory written and presented clearly and understandably? The basic tenets of comfort theory as articulated by Kolcaba (1994, 2001) are written and presented clearly and understandably for the intended audience of nursing and allied healthcare professionals.

For instance, Kolcoba's comfort theory maintains that "patients have explicit and implicit needs for comfort that, if met, motivate them to engage in health-seeking behaviors, thus enhancing the likelihood of better outcomes for both the patients and the institutions" (as cited in Pedrazza & Trifiletti, 2015, p. 346). c.

Are the conceptual relationships specific or vague? Although the conceptual relationships contained in comfort theory are specifically articulated, the author concedes the complexity of these relationships but emphasizes that her definition is positive compared to previous conceptualizations of comfort which were focused on negative factors. For instance, Kolcaba (2003) points out that, "Comfort is a complex concept but, prior to this work, was defined negatively as an absence of discomforts such as pain, nausea, and itching" (p. 241). d.

Are coined words present or absence? If coined words are present, are they explicitly and/or implicitly defined? While the terms "health seeking behavior" and "institutional integrity" are commonly used by practitioners, the author explicitly operationalizes these terms to avoid ambiguity or confusion (Kolcaba, 2016). e. Are there gaps and/or ambiguities in the structure and/or application of the theory? According to Goodwin and Candela (2012), additional research is needed to support the transition from school to practice in the application of comfort theory by newly practicing nurses.

In addition, the relationship between institutional integrity and comfort theory remains understudied (Kolcaba, 2003). f. Is there goodness of fit of concepts and concept relationships within the theory? Based on its strict focus on the multiple factors related to comfort, including relief, ease, and transcendence, there is a strong goodness of fit between the concepts and their corresponding relationships. g. Are the concepts, statements, and assumptions used consistently? Although the author has expanded and refined her original (1991, 1994) definitions over the years, the underlying concepts, statements and assumptions have remained consistent. h.

Is the theory logically organized? Comfort theory is systematically and logically organized and is supported with several graphics and diagrams to illustrate the concepts. 3. Simplicity/Complexity a. What is the number of concepts and/or sub-concepts? The original definition of comfort provided by Kolcaba (1991) was "the state of having met the basic human needs for ease, relief, and transcendence" which can be achieved with respect to the sub-concepts of "physical, psychospiritual, social, or environmental needs that patients may experience in stressful health care situations" (p. 238).

As noted throughout, though, comfort is a complex construct and the number of concepts and sub-concepts that Kolcaba has used to define and describe it have expanded significantly over the past 17 years to include other concepts to produce at 3 X 4 grid containing 12 elements (relief, ease and transcendence versus physical, psychospiritual, environmental and sociolcultural). b. What is the number of concept relationships in the theory? Although a 3 X 4 grid results in 12 main elements, there are literally infinite combinations of relationships between these elements that are unique to each individual. c.

What is the comprehensiveness of the theory? Are the concepts and relationships sufficient to describe, explain, or predict outcomes? Juried clinical studies have shown that comfort theory is effective in predicting that "effective nursing interventions offered over time will demonstrate enhanced comfort [which] has been tested and supported with women with breast cancer and persons with urinary incontinence" (Kolcaba, 2003, p. 248). d.

What is the primary outcome of the theory application regarding describing, explaining, and/or predicting outcomes? The primary outcome of comfort theory in predicting outcomes relates to its pragmatic recognition that patients who are more comfortable in their environment will experience more rapid healing. e. Is the format most parsimonious to get across the message? According to Dowd (2003), "The Theory of Comfort is simple in so far as it harkens to basic nursing care and the traditional mission of nursing.

It is low-tech in language and application, but this does not preclude its usage in high-tech settings" (pp. 247-248). 4. Generality (Can generalizations be made from the theory?) Relates to how the theory can be applied and its level of abstractness. a. Does the theory have specific or general purpose(s) and sub-purpose(s)? According to Kolcaba (2016), comfort theory has specific applications as well as general implications of holistic nursing practice. b.

Does the theory have specific or general concepts and sub-concepts? In 2003, Kolcaba expanded the definition comfort to include the sub-concept of sociocultural comfort. According to Kolcaba, sociolcultural comfort relates to "interpersonal, family, and societal relationships including finances, education, and support" (2003, p. 14). In addition, she also expanded to concept of comfort to include a cultural component that subsumes the sub-concepts of family histories, traditions, language, clothes, and customs (Kolcaba, 2013).

According to Kolcaba, "It may be important for the health care team to facilitate some of these customs during hospital stays or home health care to enhance social comfort" (2013, p. 14). c. How is the generalizability of the theory related to its scope? Are there narrow or broad definitions of terms? It is reasonable to posit that comfort theory is generalizable to all nursing practice settings which can be applied to individual patients, family members and groups (Kolcaba, 2016). 5. Empirical precision a.

Are the concepts and relationships of the theory testable? Are they observable and/or measurable? Although additional research is needed to test the relationship between institutional integrity and comfort theory, the underlying concepts and relationships are testable. For instance, according to Kolcaba (2003), "The taxonomic structure [of comfort theory] enables us to identify comfort needs, design interventions (comfort measures) targeted to those needs, and measure the effectiveness of those interventions" (p. 241). b.

What are the number and type of research studies completed to test theory and/or theory application? To date, a concept analysis, a study concerning comfort as a process and product, an empirical study to evaluate various propositions of comfort and the validity of the instruments used to measure them, its utility in advance directive planning, pediatric applications and its use in hospice settings have been completed (Kolcaba, 2016). 6. Derivable consequences a.

What is the usefulness of theory in research, practice, and education (nursing or other disciplines)? Comfort theory is useful for developing patient-centered practices that focus on ensuring that appropriate comfort measures are provided to all patients according to their unique needs (Kolcaba, 2003). In addition, comfort theory "can be utilized by other health care professionals such as physicians, social workers, psychologists, clergy, nursing assistants, and auxiliary personnel" (Kolcaba, 2003, p. 249). b. What is the number and type of applications of the theory? Given the diversity of the practice.