Comfort theory was developed by Dr Kolcaba in 1984. She begins by analyzing the concept, which I think is a very important aspect to understanding the theory. The theory is based on the philosophy of holism. She views the person has a whole, consisting of a mental, emotional and spiritual life. According to Kolcaba comfort is the satisfaction of basic human needs for relief, ease, and transcendence arising from health care situations. After learning this theory I have understood three important aspects of nursing theories.
These aspects are: the terms transcendence and midrange theories and the application of theory in the nursing process. When I first read the articles about the comfort theory I got mixed up. The confusion was brought about by the various terms used in the articles such as classification of patient needs, technical senses of comfort, comfort in the therapeutic context and the aspect of comfort dimensions. The faculty began by asking the class to name and describes the types of comfort and I would not associate the answer with the above terms this made me feel disappointed.
However, as the faculty discussed about the three types of comfort I was able to follow through with her in the lesson. I really liked the way she explained the meaning of transcendence. Previously, I had encountered the word transcendence as I learnt about Watson theory of human caring. As I reflected back about its meaning as used by Watson I got lost in the lecture nevertheless, I got back to the track when the faculty used a clinical experience to describe its meaning.
Kolcoba and Waston theories focus on the person as a whole and the word transcendence is used by both theorists to mean the same.
When I learnt about waston theory I would not differentiate the “spiritual” from “religion” in relation to transcendence. The faculty shared of how she used her counseling skills to help a patient who had given up about her medical condition and wanted to die. This patient died after one year therefore, the nursing outcome of comfort was positive. The intervention helped the patient receive inner strength and was able to rise above the challenge of illness.
From these I understood that, it is not about religion but the nursing comfort measures that bring about the renewal sense of a positive mindset resulting to hope. I internalized about the faculty’s example and I related her story with my experience when I worked in the HIV clinic. Some clients were diagnosed with HIV infection and found to have very low CD4 count. Usually these clients were also having PTB and were very sick. The patients were in the vague of giving up but most of them eventually stabilized with ARVS. I think the care given must have had an element of comfort which helped the patients to transcend their illness.
Initially I had understood the different between a middle range theory and grand theory; however, the midrange theories were not easily distinguishable from the grand theory. For the comfort theory I think kolcaba addresses the issue of comfort in a very simple way. This is a concept that is familiar to both the patient and the nurse. When I studied the five major comfort themes I made a reflection about my hospital of practice. In my province ,my hospital is rated the best public hospital in offering nursing care.
Very close to my hospital is a private hospital, which employs doctors and nurses straight from college. This hospital has also a high turnover since the staff move to the government institution after few years of service in the hospital. Therefore, the competence level of the staff is rated low. However, clients will opt to be nursed in the private hospital instead of the “good” public hospital. When the patients are asked why they prefer the private hospital, they always say that they experience more comfort in the private hospital than the public hospital.
For example pain is well dealt with because all essential drugs are accessible. Their self esteem is high because being in a private hospital is prestigious for them. Positioning in terms of physical placement of their bodies in chairs and beds is comfortable since the furniture is of high quality. Generally nurses in private hospitals are friendly. Lastly the hospital and the surrounding are condusive and also meals are delicious. Therefore, I agree with Kolcaba that comfort should be assessed according to the patient perception.
This is because as much as we feel we are giving the best care to the patients in the public hospital the patients are not satisfied with our services. I have noted with concern that patient come to the public hospital for investigations and diagnosis and once the treatment is commenced they move to the private hospital for care. This is a clear indicator that the aspect of comfort is lacking in the public hospital. On learning about the comfort theory I appreciate the importance of offering comfort to patients by meeting their needs effectively.
Kolcaba asserts that when patient’s needs are met; they get strengthened resulting to increased health seeking behaviors which attribute to positive institutional outcomes. As a nurse manager I feel challenged to advocate the facilitation of comfort measures to patients. I am optimistic that nurses in my hospital will embrace the concept of comfort with ease since it is not a new concept but the essence of nursing which they already know. Finally, as I studied this lesson it was clear to me how to in cooperate the specific theories into the nursing process.
I got confused when we used the nursing diagnosis such as self-care deficit due to…( in Orems theory) and disharmony due to…(in Wastons theory) . I was more confused when I learnt that the NANDA nursing diagnosis of altered comfort was dropped in favor of acute or chronic pain. The faculty clarified that the theories were to aid in assessing the patient holistically since the NANDA focused on the systematic head to toe examination assessment. I now feel confident to use the theories in the implementation of the nursing process and more so the comfort theory.