1. Katharine Kolcaba’s Theory of Comfort
By: Danielle Loomis
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2. Theory of Comfort
Kolcaba has defined comfort as "the immediate state of being strengthened through having the human needs for relief, ease, and transcendence addressed in four contexts of experience “ (Kolcaba, 2003).
The comfort theory focuses on physical, psychospiritual, sociocultural, and environmental aspects of comfort, to contribute to a well rounded approach to care.
Comfort interventions have three categories: (a) standard comfort interventions to maintain homeostasis and control pain; (b) coaching, to relieve anxiety, provide reassurance and information, instill hope, listen, and help plan for recovery; and (c) comfort food for the soul, those extra nice things that nurses do to make children/families feel cared for (Kolcaba, 2003).
Everyone experiences death at some point in his or her life. Nurses need to be knowledgable on end of life and palliative care in order to improve the quality of the care they give.

3. Nursing Relevance
Everyone experiences death at some point in his or her life. Nurses need to be knowledgable on end of life and palliative care in order to improve the quality of the care they give.
Nurses need to be aware that patients and families deal with traumatic events in a different way. Applying Kolcaba’s Theory of Comfort will allow nurses to provide the best treatment for each individual patient.
By having knowledge of this theory nurses can apply ideas in the plan of care for end of life patients. For patients and families, end-of-life can be very stressful and many do not know what to expect. End-of-life can mean different things based on their cultural beliefs. Nurses can further their knowledge for patients during end-of-life care, which will improve the care given.
“Comfort care is an essential part of medical care at the end of life. It is care that helps or soothes a person who is dying. The goal is to prevent or relieve suffering as much as possible while respecting the dying person’s wishes” (National, 2012).
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4. QSEN Competency
Kolcaba describes comfort as existing in three forms: relief, ease, and transcendence. Having a discomfort alleviated is the state of relief, the absence of specific discomforts is the state of ease, and transcendence is the ability to overcome discomforts when they are unavoidable (Kolcaba & DiMarco, 2005).
These three types of comfort can be met physically, psychospiritually, environmentally, and socioculturally (Kolcaba & DiMarco, 2005).
Kolcaba’s Theory of Comfort can be applied to those receiving palliative or end-of-life care. Over time nurses develop knowledge, skills and attitudes towards end-of-life care.
Nurses must have knowledge on end-of-life stages and care in order to provide quality, effective care to the patients and families going through this process.
The knowledge must reflect evidenced based practice, therapeutic communication, and background on the stages of end-of-life.
Skills must demonstrate genuine, caring touch. This type of environment is delicate and the patients must be treated with respect. Skills in communication not only with the patient but especially with the patients family. Nursing staff must be able to communicate with the family in order to let them know what is going on with the health of their loved one.
Attitudes felt by the nursing staff must be acknowledged. If there are biases towards death or towards the patient and his or her family then the nurse must recognize that they cannot provide the care that is needed.
Care plans are vital ensuring that all needs are met for the patient and their families. This is where healthcare staff can take a step back and evaluate the care that is being given to such a vulnerable population.

5. L: Clinical experience
E: I was assigned to a patient that was not on hospice and was in the hospital passing away. Family members were gathered and the patient was unresponsive. Comfort care was ordered.
A: I learned a lot from the reading about this topic. It is difficult for me to completely understand because I have not had a family member in this situation. However, I have been in an end-of-life situation in the clinical setting. After reading through Kolcaba’s Theory I realize that there were many things the nursing staff I was following was doing that related to Kolcaba’s Theory that I did not recognize at the time. The staff made sure to introduce themselves to the patient even though she was not responsive as well as to the family. We made sure to let the patient know before we performed interventions to reduce her stress and made sure to let the family know they could stay for as long as they wanted. We made sure to keep the patients pain medications on schedule and kept a close eye on the patients vital signs. It was not easy, because it was very uncomfortable to be in this type of situation. I am not comfortable with death and felt very awkward in this situation because I was not sure what to say or how to deal with the emotion in the room.
R: Looking back I would pay more attention to the families needs. We would perform interventions on the patient and tried to keep her as comfortable as possible but did not interact with the family very much. We would ask if they needed anything and would answer questions they had but I feel that we could have made them feel more at home and comfortable than we did. The patient enjoyed having her family around and we needed to do more to make them feel welcome to stay. End-of-life care by the nurse is important in the clinical setting because it sets the tone for the patient and their family. Nurses must realize that each family will react differently to the end of life of their family member and it is important to adapt care to reflect that.
N: This theory perfectly fits in with the end-of-life aspect of healthcare. In the future I would be sure to include the patient and patients family in the planning of care. There may be some aspects of the patients life that need to be addressed before their end of life and it would provide comfort to them to be able to complete unfinished things. I would also be sure to make the patients family feel more comfortable. Instead of trying to “be invisible” in the room to allow them time to themselves I would make sure they know they can always come to me for questions, concerns, and comfort.

6. References
Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and research. New York, NY: Springer Publishing Company.
Kolcaba, K. & DiMarco, M. (2005). Comfort theory and its application to pediatric nursing, Pediatric Nursing, 31 (3),
National Institute on Aging. (2012, September). End of life: Helping with comfort and care. National Institute of Health, Retrieved from and-care/finding-care-end-life

7. In the end, it's not the years in your life that count
In the end, it's not the years in your life that count. It's the life in your years.