Kolkaba- A lecture about her theory in nursing PDF

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Kolkaba, is a nursing theorist who contributed in the field of nursing...

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The Comfort Theory By Dr. Katherine Kolkaba RN

needs for relief, ease, and transcendence met in four contexts (physical, psychospiritual, social, and environmental).

The Nursing Theorist. Dr. Katherine Kolkaba RN            

Founder of Comfort Theory in Nursing Married with two children and eight grandchildren Birthdate: December 28, 1944 Education: Diploma, St. Luke's Hospital School of Nursing, 1965 RN/MSN Case Western Reserve University, 1987 PhD. Nursing Case Western Reserve University, 1997 The Nursing Theorist Employment History: Co-Chair of the Theory Development Research Section Midwest Nursing Research Society Semi retired from The University of Akron, Associate Professor of Nursing, Emeritus Status Consultant, The Comfort Line Field of expertise: gerontology, end of life and long term care interventions, nursing theories, nursing research, comfort studies, instrument development, magnet status and enhancing the work environment for nurses

Health Seeking Behavior (HSBs): 

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Types of comfort Comfort as a product of holistic nursing art. ( Kolcaba K, 1995)   

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First proposed comfort as nurse sensitive outcome in 1992. A midrange theory A humanistic, holistic theory that is based on patient’s need.

Conceptual Framework of the Theory Major Concepts of the theory  

Health Care Needs: identified by the patient/family in a particular practice setting. Comfort is the immediate experience of being strengthened by having

Relief – the state of having a specific comfort need met. Ease – the state of calm or contentment. Transcendence – the state in which one can rise above problems of pain.

Context of Comfort  

The Comfort Theory 

Institutional Integrity - the values, financial stability, and wholeness of health care organizations at local, regional, state, and national levels. Best Policies are protocols and procedures developed by an institution for overall use after collecting evidence.

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Physical – bodily sensations, homeostatic mechanisms, immune function, etc. Psychospiritual – internal awareness of self, including esteem, identity, sexuality, meaning in one's life, and one's understood relationship to a higher order or being. Environmental – the external background of human experience such as temperature, light, sound, odor, color, furniture, landscape etc. Sociocultural – interpersonal, family, and societal relationships such as finances, teaching, health care personnel, family traditions, rituals, and religious practices etc.

The Metaparadigm Concept

 Nursing: the intentional assessment of comfort needs, design of comfort measures to address those needs, and reassessment of patients,' families, or community comfort after implementation of comfort measures, compared to a previous baseline. The goal of nursing: providing comfort.  Patient: an individual, family, community in need of health care.

or

 Environment: exterior influences (physical room or home, policies, institutional, etc.) which can be manipulated to enhance comfort.  Health: optimum function of a patient/ family/ community facilitated by attention to comfort needs. Four Broad Assumptions & Theoretical Assertions  Human beings have holistic responses to complex stimuli.  Comfort is a holistic outcome of effective nursing care.

Propositions of Comfort Theory  Nurses identify comfort needs of patients and family members.  Nurses design interventions to meet identified needs.  Intervening variables are considered when designing interventions.  When interventions are delivered in a caring manner and are effective, and when enhanced comfort is attained, interventions are called “comfort measures” Conclusion Applicable to all areas of the healthcare field, nursing practice, nursing education, nursing research to:  improve societal acceptance  appreciation of the institution,  increase patient satisfaction  comforting the learner or student in an educatio nal environment.  test the benefits of comfort on learning.

 Human beings have a need for comfort and will seek comfort wherever possible.  Nurses are in a position to identify the comfort needs of their patients, design comfort measures, and assess outcomes to support enhanced comfort.

If enhanced comfort is achieved, nurse, patients and family members are more: engage

in

health-seeking

 Diploma in nursing- St. Luke’s Hospital 1965  BSN- Frances Payne Bolton SON-1987  PhD and Clinical Nursing Specialist- 1997

 satisfied with health care and have better health-related outcomes.  Contributes to help the institution remain viable and flourish.  agree on desirable healthseeking behaviors.

Who is Katharine Kolcaba?  Born Dec 28th, 1944 in Cleveland Ohio

Propositions of Comfort Theory

 likely to behaviors.

The Comfort Theory Katharine Kolcaba By Erin Carline, RN, BSN, CCRN

and

realistic

 Currently Associate Professor of Nursing Emeritus at the University of Akron College of Nursing. Teaches on two online theory courses (MSN and DNP levels) What is the Comfort Theory?  A mid-range theory

 A humanistic, holistic theory that is based on patient needs  Began in nursing Why, might you ask is this considered a mid- range theory?  The comfort theory meets the following criteria for mid range….. 1. Its concepts and propositions are specific to health care disciplines 2. It is readily operationalized 3. It can be easily applied to many situations 4. Propositions can range from causal to associative, depending on their applications 5. Assumptions fit the theory The Comfort Theory  The theory states that, in stressful healthcare situations, unmet needs for comfort are met by nurses and the health care team.  Interventions are successful if enhanced comfort is achieved by the patient compared with a previous baseline.  The immediate patient outcome of enhanced comfort is directly and positively related to patients engaging in health seeking behaviors  When patients engage in health seeking behaviors, they do better and report high satisfaction in their healthcare  High patient satisfaction leads to better institutional outcomes and higher institutional integrity

How was the theory derived?  Late 1980s- “Diagram her practice” for dementia care  Presented at conference- feedback  Found that the Framework was applicable to many areas  Began to study definition of comfort and conceptual linkages Conceptual Analysis  Concept analysis began with extensive review of literature  Nursing  Medicine  Psychology  Psychiatry  Ergonomics  English (Even Shakespeare!)  Found that comfort was frequently cited, not never clearly defined. Definition of Comfort The use of comfort was extremely varied. Kolcaba’s Definition of Comfort  “The state of having addressed basic needs for ease, relief, and transcendence met in 4 contexts of experience (physical, psychospiritual, sociocultural, and environmental)”

Deductive Stage of Comfort Theory  Institutional integrity is conceptualized as the quality or state of health care corporations being complete, sound, upright, honest and sincere. Conceptual Framework

 Resulted in comfort being related to other nursing concepts to produce a theory  Murray’s Theory- framework

 3 early nursing theorists were used to synthesize or derive the types of comfort

expected by the nature of the specific comfort measures.

 Relief- Orlando

 When comfort needs are met in one context, total comfort is enhanced in the remaining contexts

 Ease- Henderson  Transcendence- Paterson and Zderad Overview of the Theory: Definitions  Relief- The state of having a severe discomfort mitigated or alleviated  Ease- The absence of specific disorders

 Placing comfort within a framework or theory provides nurses and team members with rationale for enhancing patient comfort.  Physical comfort needs: physiologic mechanisms that are disrupted. Comfort measures are directed at regaining homeostasis.

 Transcendence The ability to rise above discomforts when they cannot be eradicated or avoided

 fluid and electrolyte balance,

 Physical- pertaining to bodily sensations and homeostatic mechanisms

Psychospiritual needs

 Psychospiritual- pertaining to internal awareness of the self; including esteem, concept, sexuality, meaning in ones life and one’s relationship to a higher order or being  Environmental- pertaining to the external background of human experience (temp, light, sound, odor, color, furniture, landscape, etc.)  Sociocultural- pertaining to interpersonal, family, and societal relationships, traditions, rituals and religious practice.  The aspects of comfort are interrelated and the whole is greater than the sum of its parts. Taxonomic structure  The taxonomic structure enables us to identify comfort needs, design interventions targeted to those needs, and measure the effectiveness of those interventions. Why is a framework important?  Caring attention to one cell that needs it, in the form of a comfort intervention can enhance total comfort more than could be

 oxygenation, pain, nausea, shivering

 The need for inspiration, motivation, and being able to “grow through” or “rise above” discomforts that cannot be immediately relieved.  Ex: massage, special visitors, caring touch, words of encouragement Sociocultural needs  Needs for socially sensitive reassurances, support, positive body language, and caring  Ex: honoring cultural traditions, assisting with paperwork Environmental  Include orderliness, quiet, comfortable furniture, minimal odors, safety  Ex: decrease noise and lights, allow for uninterrupted sleep. Conceptual Framework How does the comfort theory lead to institutional integrity?

 When patients have high levels of comfort, they engage in health seeking behaviors  When patients engage in HSB, they are more satisfied with their care  High patient satisfaction=better outcomes and institutional integrity But why do nurses care about this?  Rational for enhancing patient care  Better satisfaction =better nursing care  High patient satisfaction leads to competitive edge in negotiations with employers and financial viability for the institution. Strengths  Kolcaba is still actively teaching and constantly expanding her theory to new disciplines of nursing  The theory is applicable to the modern nursing profession.  It is easily searchable, understandable and applicable  It uses common, easily observable variables that are easily measured by the nurse and can be used for research and performance review...