Kolcaba’s Theory of Comfort NURS 451 Ferris State University Tracy Stark

Description of Kolcaba’s Theory {Comfort Care Measures ~ No Extraordinary Measures} Kolcaba’s Theory describes comfort existing in three forms: relief, ease, and transcendence. When specific comfort needs of a patient are met, the patient experiences comfort in the sense of relief. Ease addresses comfort in a state of contentment. Transcendence is described as a state of comfort in which patients are able to rise above their challenges. There are four aspects of life that can experience Kolcaba’s forms of comfort Physical: SOB, fatigue, weakness, complaints r/t immobility Psychospiritual: Fear of dying, anticipatory grief of spouse, belief in finality of death, i.e. no afterlife Environmental: Homelike setting valued. Sociocultural: Patient needs, family needs (Nursing Theory, 2013; Vendlinski,& Kolcaba, 1997)

Strategies of Kolcaba’s Theory End-of-Life/Palliative Care Empowerment of patients or families at the end-of-life Active involvement that is facilitated by the healthcare team, strengthened by having comfort needs meet. Comfort needs are assessed subjectively (what patients and families say) and objectively (what the nurse observes). Nursing must account for all intervening variables Interdisciplinary Care Approach Utilizes nursing, physician, respiratory care, social work, case worker, hospice, child life, & religious services. Use therapeutic communication, promote autonomy, reposition as needed, medicine administration for palliative care as needed/requested. Verbal and written communication, using the comfort grid as a framework for interdisciplinary discussion, can promote continuity, consistency and efficiency in the management of emerging comfort needs. Comfort is reassessed to determine effectiveness (Kolcaba & Fisher, 1996; Vendlinski & Kolcaba, 1997)

QSEN Competency Objectives Patient-Centered Care: KSAs Knowledge Active involvement of interdisciplinary team, patient and family. Evaluation and reevaluation accounting for all variables that affect comfort (i.e. physical, psychospiritual, environmental, and sociocultural. Skill As with the interdisciplinary team verbal and written communication can be utilized with patient and families, using the comfort grid as a framework for discussion. This can promote continuity, consistency and efficiency in the management of emerging comfort needs. Attitude Value opinion of all of those involved in care. Take time to explain and discuss aspects of care. Family at bedside at time of death; peace of mind and less misapprehension. Knowledge Describe strategies from Kolcaba’s theory to empower patients or families at the end-of-life Skill Reflect how to engage patients or designated surrogates in active partnerships that promote health, safety and transcendence at the end-of-life Attitude Value active partnership with patient or designated surrogates in planning, implementation, and evaluation of care (Vendlinski & Kolcaba, 1997)

References Kolcaba, K. Y., Fisher, E. M. (1996). A holistic perspective on comfort care as an advance directive. Aspen Publishers, Inc. 18(4) p.66-76 Nursing Theory. (2013). Kolcaba's theory of comfort. Nursing Theory. Retrieved from http://www.nursing- theory.org/theories-and-models/kolcaba-theory-of- comfort.php Vendlinski, S., Kolcaba, K. Y. (1997). Comfort care: A framework for hospice nursing. American Journal of Hospice and Palliative Medicine. 14 (271). doi: 10.1177/104990919701400602