The document discusses the origin and development of Katherine Kolcaba's Theory of Comfort. Kolcaba developed the theory based on her experience with her brother's cancer and the comforting actions of nurses. She conducted a concept analysis that examined literature from several disciplines. The theory proposes three types of comfort - relief, ease, and transcendence - within four contexts of human experience. Major influences on the theory included the works of Orlando, Henderson, Paterson and Zderad. The theory provides a useful framework for assessing and meeting patient needs across physical, psycho-spiritual, sociocultural, and environmental domains.
The state of having addressed basic needs for ease, relief, and transcendence met in 4 contexts of experience (physical, psychospiritual, sociocultural, and environmental)
Comfort involves identifying the comprehensive needs of patients, families, and nurses and addressing those needs.
Ergonomics- comfort at the workplace, promotes optimum function or productivity (Kolcaba &Kolcaba, 1991)
NANDA- comfort in terms of pain management
Confortare Latin- to strengthen gently
The state of having addressed basic needs for ease, relief, and transcendence met in 4 contexts of experience (physical, psychospiritual, sociocultural, and environmental)
Comfort involves identifying the comprehensive needs of patients, families, and nurses and addressing those needs.
Ergonomics- comfort at the workplace, promotes optimum function or productivity (Kolcaba &Kolcaba, 1991)
NANDA- comfort in terms of pain management
Confortare Latin- to strengthen gently
Margaret Jean Harman Watson, PhD, RN, AHNBC was born in Southern West Virginia and grew up in the small town of Welch, West Virginia.
1964 – Baccalaureate degree in Nursing (Boulder Campus)
1966 – Master’s Degree in Psychiatric-Mental
Health Nursing (Health Sciences Campus)
1973 – Doctorate in Educational Psychology and Counseling (Graduate School, Boulder Campus)
Metaparadigm and humanistic theory have 4 common points: The (person),which is the patient and the nurse. (Health), which is the situation, (environment), which is what is around you, pass experiences and education, and (nursing) which is the response, and all of the nursing interventions.
Teoría del Confort, elaborada por la Enfermera Especialista en Gerontologia, Mg. y Dra en Enfermeria Katharine Kolcaba.
Se explican
-Conceptual Framework - conceptos principales
-Metaparadigmas
Margaret Jean Harman Watson, PhD, RN, AHNBC was born in Southern West Virginia and grew up in the small town of Welch, West Virginia.
1964 – Baccalaureate degree in Nursing (Boulder Campus)
1966 – Master’s Degree in Psychiatric-Mental
Health Nursing (Health Sciences Campus)
1973 – Doctorate in Educational Psychology and Counseling (Graduate School, Boulder Campus)
Metaparadigm and humanistic theory have 4 common points: The (person),which is the patient and the nurse. (Health), which is the situation, (environment), which is what is around you, pass experiences and education, and (nursing) which is the response, and all of the nursing interventions.
Teoría del Confort, elaborada por la Enfermera Especialista en Gerontologia, Mg. y Dra en Enfermeria Katharine Kolcaba.
Se explican
-Conceptual Framework - conceptos principales
-Metaparadigmas
This presentation explores why a diverse nursing workforce is important for the delivery of quality, patient-centered care, and provides an introduction to the concept of holistic review in admissions. The presentation is intended to prepare nursing deans for participation in a holistic review in nursing workshop provided by AACN.
Agile has become one of today's often used methodology in delivering customer experience via enterprise software and services. This presentation gives an overview of why, what and how to leverage enterprise agile practice to deliver superior CX. Though this presentation targets all agile practitioners and enthusiasts, people responsible and driving agile adoption in their organization in different capacities, may find this a useful summary.
Acceptability of air velocity from a human thermal comfort and safety perspec...WSP
Matthew Legg and Mark Gilbey from WSP | Parsons Brinckerhoff in the UK presented at the ISAVFT 2015 - Symposium on Aerodynamics, Ventilation and Fire in Tunnels, held in Seattle on September 15-17, 2015.
Irrespective of background (be it business, career, academics or any field that requires one to convey/sell ideas, to make a pitch and in general to communicate to a group with people), this is a preparatory (beginner level) material on ever-essential presentation skills.
A presentations of different green buildings & styles that I have seen in my travels. No words, the content & detail would be done by me talking in the Green Architecture Session of a Permaculture Course
This presentation discusses about Electricity Laws and Regulations. It primarily focuses on India, but a reference to other countries is made at few places.
Dr. Katherine KolcabaComfort TheoryChapter 21FloriDustiBuckner14
Dr. Katherine Kolcaba
Comfort Theory
Chapter 21
Florida National University
NGR 5101 – Nursing Theory
Dr. Barry Eugene Graham
Introduction to
Dr. Katherine Kolcaba
Katharine Kolcaba was born and educated in Cleveland, Ohio.
In 1965, she received a diploma in nursing and practiced part time for many years in the operating room, medical–surgical units, long-term care, and home care before returning to school.
In 1987, she graduated with the first RN to MSN class at the Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU), with a specialty in gerontology.
While attending graduate school, Kolcaba maintained a head nurse position on a dementia unit. In the context of that unit, she began theorizing about comfort.
After graduating with her master’s degree in nursing, Kolcaba joined the faculty at the University of Akron (UA) College of Nursing, where her clinical expertise was gerontology and dementia care.
She returned to CWRU to pursue her doctorate in nursing on a part-time basis while teaching full time.
Introduction to
Dr. Katherine Kolcaba (Continued)
Over the next 10 years, she used course work from her doctoral program to further develop her theory. During that time, Kolcaba published a framework for dementia care (1992a), diagrammed the aspects of comfort (1991), operationalized comfort as an outcome of care (1992b), contextualized comfort in a middle range theory (1994), tested the theory in several intervention studies (Kolcaba & Fox, 1999; Kolcaba, 2003; Kolcaba, Dowd, Steiner, & Mitzel, 2004; Kolcaba, Tilton, & Drouin, 2006; Dowd, Kolcaba, Steiner, & Fashinpaur, 2007), and further refined the theory to include hospital-based outcomes (2001).
She has an extensive series of publications to document each step in the process, most of which have been compiled in her book Comfort Theory and Practice (2003). Many publications and comfort assessments also are available on her website at www.TheComfortLine.com. Kolcaba taught nursing at UA for 22 years and is now an associate professor emerita.
Kolcaba still teaches her web-based theory course once a year, and she represents her own company, The Comfort Line, as a consultant. In this capacity, she works with health-care agencies and hospitals that choose to apply comfort theory on an institution-wide basis.
She also is founder and member of her local parish nurse program and is a member of the American Nurses Association and Sigma Theta Tau.
Kolcaba continues to work with students at all levels and with nurses who are conducting comfort studies.
She resides in the Cleveland area with her husband, and near her two daughters, their children, and her mother. One other daughter resides in Chicago.
Overview of the Theory
In comfort theory (CT), comfort is a noun or an adjective and an outcome of intentional, patient/family focused, quality care.
Despite everyone’s familiarity with the idea of comfort, it is a complex term that ...
Feature Article_729 296..304Exploring the influence of gesChereCheek752
Feature Article_729 296..304
Exploring the influence of gestalt therapy training on
psychiatric nursing practice: Stories from the field
Teresa Kelly and Linsey Howie
School of Public Health, La Trobe University, Melbourne, Victoria, Australia
ABSTRACT: Psychiatric nurses interested in extending their interpersonal and psychotherapeutic
skills sometimes undertake postgraduate training in gestalt therapy. Little is known about how this
new knowledge and psychotherapeutic skill base informs their practice. This paper presents the
findings of a qualitative study that aimed to explore the influence of gestalt therapy training on
psychiatric nursing practice. Within a framework of narrative inquiry, four psychiatric nurses trained
in gestalt therapy were invited to tell their stories of training in a gestalt approach to therapy, and
recount their experiences of how it influenced their practice. In keeping with narrative analysis
methods, the research findings were presented as a collection of four stories. Eight themes were derived
from a thematic analysis conducted within and across the four stories. The discussion of the themes
encapsulates the similarities and differences across the storied collection, providing a community and
cultural context for understanding the individual stories.
KEY WORDS: gestalt therapy, holism, psychiatric nursing, psychotherapy, qualitative research.
INTRODUCTION
Cognitive behavioural therapies that are validated using
standardized trials, dominate the psychotherapy discourse
in contemporary mental health-care contexts (Hurley
et al. 2006; Yontef & Jacobs 2007). However, standard-
ized trials often do not take into account the interpersonal
nature and ‘whole process of therapy’ (Yontef & Jacobs
2007, p. 354), central to the efficacy of the relational
and experiential psychotherapies, contributing to these
approaches being disadvantaged in the dominant scien-
tific paradigm.
It is timely then to incorporate the art with the
science of mental health care. In psychiatric nursing, the
art lies in the humanistic, interpersonal, and therapeutic
encounter, and the subtle crafts of human-to-human
interconnectedness.
Gestalt therapy is a humanistic, holistic, and relational
psychotherapeutic approach that aligns well with the
humanistic values and interpersonal processes espoused
as central to psychiatric nursing (Chambers 1998; Dziopa
& Ahern 2009; Hurley et al. 2006; Moyles 2003; Peplau
1952; 1962; Welch 2005; Wright 2010).
Psychiatric nurses interested in advancing their psy-
chotherapeutic agency sometimes undertake training
in gestalt therapy. There has, however, been negligible
research into how this training has influenced their
discipline-specific practice. This qualitative study aimed
to explore the influence of gestalt therapy training on the
professional practice of psychiatric nurses.
To begin, an overview of gestalt therapy theory is nec-
essary to provide readers new to the gestalt approach with
a theo ...
Examine changes introduced to reform or restructBetseyCalderon89
Examine changes introduced to reform or restructure the U.S. health care delivery system. In a 1,000-1,250 word
paper, discuss action taken for reform and restructuring and the role of the nurse within this changing environment.
Include the following:
1. Outline a current or emerging health care law or federal regulation introduced to reform or restructure
some aspect of the health care delivery system. Describe the effect of this on nursing practice and the
nurse's role and responsibility.
2. Discuss how quality measures and pay for performance affect patient outcomes. Explain how these
affect nursing practice and describe the expectations and responsibilities of the nursing role in these
situations.
3. Discuss professional nursing leadership and management roles that have arisen and how they are
important in responding to emerging trends and in the promotion of patient safety and quality care in
diverse health care settings.
4. Research emerging trends. Predict two ways in which the practice of nursing and nursing roles will grow
or transform within the next five years to respond to upcoming trends or predicted issues in health care.
You are required to cite to a minimum of three sources to complete this assignment. Sources must be published
within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success
Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the
expectations for successful completion.
Health Care Delivery Models
and Nursing Practice
92
C H A P T E R 5
Narrative Analysis
Approaches
Cigdem Esin
Introduction
This chapter is about using narrative analysis. Like the other approaches described in this book, narrative analysis is an umbrella term that covers a plurality of
methods. The narrative analysis approach takes stories as the unit of analysis. The
stories are usually gathered from the accounts of participants and each approach
focuses on a different feature of the story. Features may be the structure (e.g. Labov,
1972), the content (e.g. Riessman, 1993; Lieblich, Tuval-Mashiach & Zilber, 1998) or
the performative function (e.g. Riessman, 1993; Mishler, 1995; Denzin, 2001), for
example. The chapter begi ...
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Meaning of Comfort
―A model of human press is the framework within which
comfort is related to interventions that enhance the state of
comfort desirable subsequent outcomes of nursing care‖
(Kolcaba, 1994, p.1178).
―The theory of holistic comfort is a
component of a normative and
descriptive theory for nursing care‖
(Kolcaba, 1994, p. 1180).
“First meaning:
Comfort — a cause of relief from
discomfort and/or of the state of comfort‖
(Kolcaba & Kolcaba, 1991, p. 1302).
“Fourth meaning:
Comfort — whatever makes life easy
or pleasurable‖ (Kolcaba & Kolcaba, 1991, p. 1302).
.
“Second Meaning:
Comfort — the state of ease and peaceful contentment‖
(Kolcaba & Kolcaba, 1991, p. 1302).
“Third meaning:
Comfort — relief from discomfort‖
(Kolcaba & Kolcaba, 1991, p. 1302).
[The construction of Kolcaba‘s theory
of comfort was the result of different
methods for theory development
applied during different stages of the
process of theory development. In
review, those methods were (1)
inductive explication of the
components of a specific practice, (2)
concept analysis and operationalization
of components that were yet
undefined, (3) deduction from a more
general organizing theory with
relocation of the main concepts, and
(4) retroduction to bring to the model a
concept for outcomes research] (Kolcaba,
2001).
3. [Theoretical Mode
Major Concepts and Definitions used in Conceptual Framework
Health Care Needs are those identified by the patient/family in a particular practice setting.
Comforting Interventions are nursing interventions that are designed to address specific comfort needs of
recipients. This includes physiological, social, financial, psychological, spiritual, environmental, and physical
interventions.
Intervening Variables are interacting forces that influence recipients' perceptions total comfort. This includes
factors such as past experiences, age, attitude, emotional state, support system, prognosis, and finances.
Enhanced Comfort
is an immediate desirable outcome of nursing care, according to Comfort
Theory. When comfort interventions are delivered consistently over time,
they are theoretically correlated a trend toward increased comfort levels over
time, and with desired health seeking behaviors (HSBs).
Health-Seeking Behaviors (HSBs):
The relationships between comfort and health seeking behaviors are entailed
in the second part of Kolcaba's comfort theory.
Internal: healing, immune function, number of T cells, etc.
External: health related activities, functional outcomes
Peaceful Death] (Nursing Theory, 2011, para. 3).
4. [Theoretical Model
Major Concepts and Definitions used in Conceptual Framework
continued
Institutional Integrity is defined as the values, financial stability, and
wholeness of health care organizations at local, regional, state, and national
levels.
Best Practices are those protocols and procedures developed by an
institution for specific patient/family applications (or types of patients) after
collecting evidence.
Best Policies are protocols and procedures developed by an institution for
overall use after collecting evidence
Examples of variables related to this expanded definition of InI
include patient satisfaction (HCHAPS scores!), cost savings,
improved access, decreased morbidity rates, decreased
hospitalizations and readmissions, improved health-related
outcomes, efficiency of services and billing, and positive cost-benefit
ratios. Relationships between Comfort, HSBs, and
6. Major concepts described in the Theory of
Comfort include comfort, comfort care,
comfort measures, comfort needs, health-
seeking behaviors, institutional integrity,
and intervening variables (McEwen & Willis, 2011).
The concepts affect the other through their
relationship. The term used by Kolcaba is
―intra-actional‖. Interventions intended for one
will roll over to all the areas and have a carry-
over effect. (Kolcaba, Durr, & Stoner, 2010, figure FAQ)
(Merkel, 2007)
7. ―What is true comfort? Here I am on the beach:
relief from heat, ease from worry,
transcendence from nature......ahhhh, true
comfort in all four contexts,‖ (Kolcaba, 2012, figure
1).
Branch Davidian
compound; Feb 28, 1994
Winner 66th Academy
Awards March, 94
4/ 22/94 Pres. Nixon
Passes Away
Aug. 1994- Space telescope
Hubble photographs Uranus
with rings
Ferry boat Estonia capsize & sinks
in East Sea, 909 killed-9/28/94
Maltese Falcon auctioned
for $398,590 12/94
"My momma always said that life was like a box of chocolates, you never know what you're gonna get‖ (Tom Hanks, 1994)
8. Origin of the Theory
What was going on:
Katherine Kolcaba originally wrote the Theory
of Comfort with Alzheimer‘s and dementia
patients in mind. This is what was going on in
her world and she wanted to help out.
[I borrowed the ideas about Relief, Ease, and
Transcendence. Later, I "borrowed" the contexts
of experience from the literature review about
holism. I put these ideas together in a unique way.
Later, I borrowed the framework for the First and
Second parts of Comfort Theory from Henry
Murray. But I hung nursing concepts on his
abstract framework in a unique way. The idea of
institutional outcomes was unique and was added
through a process Tomey and Alligood call
retroduction] (Kolcaba, Durr, & Stoner, 2010, figure FAQ).
Motivation to write:
[My brother died of cancer when he was 41,
and during his illness I gained more
experience with comforting actions of nurses,
and how to articulate what they did. Because
of that experience and its timing, my
dissertation is about women with breast
cancer, not dementia or gerontology. And I
have done a lot of work with end of life
comfort] (Kolcaba, Durr, & Stoner, 2010, figure FAQ).
[My spirituality, which my mother fostered
and role-modeled for me, has also had a
strong influence] (Kolcaba, Durr, & Stoner, 2010,
figure FAQ).
[Also, my husband has always been a huge
supporter and brain stormer about Comfort
Theory] (Kolcaba, Durr, & Stoner, 2010, figure FAQ).
.
(Kolcaba, Durr, & Stoner, 2010, figure FAQ)
9. Origin of the Theory con’t
―To describe the origin or development of Comfort Theory, Kolcaba conducted a concept analysis of
comfort that examined literature from several disciplines including nursing, medicine, psychology,
psychiatry, ergonomics, and English‖ ("Nursing Theory," 2011, para. 4). ―First, three types of comfort
(relief, ease, transcendence) and four contexts of holistic human
experience in differing aspects of therapeutic
contexts were introduced‖
(Nursing Theory," 2011, para. 4) .
A taxonomic structure was
developed to guide for
assessment, measurement, and
evaluation of patient comfort‖
("Nursing Theory," 2011, para. 4).
U.S. and Allies at war with
Iraq (Jan. 15, 91)
Warsaw Pact
dissolves military
alliance
(2/ 25/ 91)
Cease-fire ends
Persian Gulf
War; UN forces
are victorious
(April 3, 91)
Last of the three
U.S. hostages freed
in Lebanon to
come home on:
(Dec. 2–4, 91)
World History. (1991) Retrieved from http://www.infoplease.com/ipa/A0005273.html#ixzz2aiQe4ax2
(Kolcaba, Durr, & Stoner, 2010, figure resources)
10. Origin of the Theory con’t
Major influences in the development of
Comfort Theory:
[Relief: Ida Jean Orlando (1961 / 1990)
Nursing Process Theory
Ease: Virginia Avernal Henderson
(1978) Need Theory
Transcendence: Josephine Paterson
& Loretta Zderad (1976 / 1988) Humanistic
Nursing Theory
Framework for Comfort
Theory: Murray (1938) Henry Murray
designed a conceptual framework
diagrammed in three lines. Comfort theory
takes that framework to another level to
include a fourth line. This fourth line is the
framework for the comfort theory].(Kolcaba, Durr, & Stoner, 2010, figure FAQ).
11. Origin of the Theory
Sept. 11, 2001
“When the second plane hit the south tower of the
World Trade Center in New York City
the loaded Navy hospital ship was deployed immediately.
The name of the ship was ... Comfort”.
(Comfort Care in Nursing Blog, 2011, figure 1)
12. Usefulness of the Theory
―
,‖ (Kolcaba, 1994, p. 1180).
(Kolcaba, 1994, p. 1181)
13. Usefulness of Theory
―Physical: pertaining to bodily
sensations and homeostasis
Pain relief
Regular bowel function
Fluid/electrolyte balance
Adequate oxygen Saturation
Turning & positioning‖
(Merkel, 2007, p. 3)
―Psycho-spiritual:pertaining
to internal awareness of self,
esteem, sexuality, meaning in
one‘s life
Maintaining/improving self esteem
Enhancing independence
Increasing relaxation
Accommodating religious practices‖
(Merkel, 2007, p. 3)
―Environmental: the
external background of the
human experience
Temperature
Noise
Color
Light
Views from the window
Access to nature‖
(Merkel, 2007, p. 3)
―Socio-cultural interpersonal, family &
societal relationships, family traditions &
rituals:
Caring attitude
Continuity of care
Information & education
Enhancing family & friend support
Cultural customs‖ (Merkel, 2007, p. 3)
14. Usefulness of Theory
The Taxonomic Structure of
Comfort
Comfort Daisies
The Theory of Comfort can
be used as the framework for
patients‘assessments.
―Assessment is achieved
through the administration of
verbal rating scales (clinical)
or comfort questionnaires
(research), using instruments
developed by Kolcaba‖ (Tomey
& Alligood, 2010, p.711). Pain scales
are used to rate levels before
and after medications to get
a base and acquire a fixed
level. The GCQ is based on
the Likert scale ranging from
―strongly agree to strongly
disagree‖ (Kolcaba, 1992, p.8).
(Kolcaba, Durr, & Stoner, 2010, figure resources (all the above)
Comfort Behaviors
Check off List
15. Case Scenerio:
Comfort Theory In Use
Setting: 72 year old female from Nursing home. Patient is admitted with acute mental status change.
Patient is dehydrated and results are back with a positive UTI.
Nursing Interventions using the Comfort Theory: Are designed to meet the needs of the patient
Physiological, Social, Financial, Psychological, Spiritual, Environmental, and Physical Interventions.
1) Patient: She is trying to get out of bed. She is yelling out, she wants her purse. She is confused and
she doesn‘t know where she is at.
a) Nursing Interventions: Social, Physical Interventions - Put her back in bed, inform the
patient that her purse is not here, it is at home. The RN calls her family to see if someone can
bring the patient her purse, when they come to visit
2) Patient: Again she is trying to get out of bed. She throws back the blankets and tries to sit up and
get out of bed. She continues to yell and beg for her cat, she wants to go home, and she can‘t find her
purse.
b) Nursing Interventions: Psychological, Physical Interventions The RN returns and has a purse
for her out of the lost and found and puts her back in bed. Patient is confused and does not
recognize anyone. Patient is concerned about getting her cats some food.. The RN speaks to her
about her cats and consoles her. She tells the patient that they are being care for and for her not
to worry and the RN stated, she will call her home and check on her cats for her. Patient seems
to calm down after that statement.
16. There are three types of Comfort – 1) Relief- someone who has had a specific
need met 2) Ease – state of calm or contentment 3) Transcendence – someone who
rises above problem or pain.
3) Patient: The patient is confused, saying, ―I don‘t think this is right.‖ The patient is
trying to get out of bed. Patient is trying to get her gown off, to go home. Patient
keeps stating she needs to go home, ―I need to go.‖ Patient is getting more and more
agitated. She is getting more upset about getting her cats some food.
c) Nursing Interventions: Psychological, Physical Interventions, Environmental -
The RN tells the patient she needs to stay in the hospital and she is very sick. RN
talks with the patient, in a soothing tone and consoles her. Tells the patient she will
sit with her and talk. Patient tells RN she is cold. RN puts a warm blanket on the
patient and tells her we will get the heat turned up. Patient still concerned about her
cats, the RN tells patient she has called her home and someone is caring for them
and they have lots of food for them. Patient satisfied with response, warm with the
blanket, and feeling secure in her environment she goes to sleep.
There are four Context of Experience – 1) Physical – pertaining to bodily
sensations 2) Psychospiritual – pertaining to internal awareness of self 3)
Environmental – pertaining to external surroundings 4) Social – pertaining to
interpersonal relationships.
Case Scenerio: Comfort Theory In Use con‘t
17. Theory Testability
“In order to use the theory, three
steps are required:
(a) understanding the technical
definition of comfort and its origins,
(b) understanding the relationships
(propositions) between the general
concepts entailed in the theory
(c) relating the general concepts to
specific problems/settings in order
to enlighten practice and generate
research questions”(Kolcaba & DiMarco,
2005, p. 187) .
Below are some examples of Comfort Theory
used in research :
Kolcaba, K., & Fox, C. (1999). The effects of
guided imagery on comfort of women
with early stage breast cancer undergoing
radiation therapy. Oncology Nursing
Forum, 26(1), 67-72.
Schirm,V., Baumgardner, J.,Dowd, T., Gregor,
S., & Kolcaba, K. (2004). NGNA.
Development of a healthy bladder
education program for older adults.
Geriatric Nursing. 25(5), 301-306.
Apóstolo, K.L.A., & Kolcaba, K. (2009). The
effects of guided imagery on comfort,
depression, anxiety, and stress of
psychiatric inpatients with depressive
disorders. Archives of Psychiatric
Nursing, 23(6), 403-411.
. (Comfort Care in Nursing Blog, 2011, figure 1)
18. Theory Testability con’t
generated research
After the implementation of medications the recipient is reassessed. ―Kolcaba's technical
definition of comfort is the physical, psychological, spiritual, social, cultural, and environmental
aspects of human experience which are perceived simultaneously‖ (Wardell, 2010, para. 1).
Holistic comforting actions are new to be measured in the research field and can be quite
sensitive to the material encountered (Wardell, 2010). ―These comfort outcomes have
been consistently positive and have been found to be reliable predictors for more effective
healing and/or management of chronic health concerns‖ (Wardell, 2010, para. 2).
The General Comfort Questionnaire (GCQ)…
…is designed to measure holistic changes in comfort levels. There are a vast assortment of the
GCQ for various areas and actions. ―Notable are the instruments developed by Kolcaba et. al
such as the Bladder Function Questionnaire, the Healing Touch Comfort Questionnaire, the
Hospice Comfort Questionnaire, and the Radiation Therapy Comfort Questionnaire‖ (Wardell,
2010, para. 3). The results shown by these GCQ‘s have been a tremendous help in research. The
Verbal rating scale is utilized for our practice sessions. (Wardell, 2010).
(Wardell, 2010, para. 1-3)
19. Theory Testability con’t
generated research
―In total, 32 instruments are known adaptations of the GCQ: 14 by Kolcaba et al., 8 adaptations by other
professionals, and 10 foreign language translations‖ (Wardell, 2010, para. 4).
Dowd, T., Kolcaba, K. & Steiner, R. (2000). Cognitive strategies to enhance comfort and decrease episodes of
urinary incontinence. Holistic Nursing Practice, 14(2), 91-102.
Kolcaba, K., Dowd. T., & Steiner, R. (2006). Development of an instrument to measure holistic client comfort as
an outcome of healing touch. Holistic Nursing Practice, 20, (3), 122-129.
Dowd, T., Kolcaba, K., Fashinpaur, D., Steiner, R., Deck, M., & Daugherty, H. (2007). Comparison of healing
touch and coaching on stress and comfort in young college students. PDF Format
Kolcaba, K., Dowd, T., Steiner, R. & Mitzel, A. (2004). Efficacy of hand massage for enhancing comfort of
Hospice Patients. Journal of Hospice and Palliative Care, 6(2), 91-101.
Novak, B., Kolcaba, K., Steiner, R., & Dowd, T. (2001). Measuring comfort in families and patients during end of
life care. American Journal of Hospice and Palliative Care, 13(3), 170-180.
Kolcaba, K. & Fox, C. (1999). The effects of guided imagery on comfort of women with early-stage breast
cancer going through radiation therapy. Oncology Nursing Forum, 26(1), 67-71.
(Wardell, 2010, para. 4)
20. Propositions in Kolcaba‘s middle-range
Theory of Comfort
[Propositions of Comfort Theory
1. Nurses identify comfort needs of patients and family members.
2. Nurses design interventions to meet identified needs.
3. Intervening variables are considered when designing interventions.
4. When interventions are delivered in a caring manner and are effective, and when enhanced
comfort is attained, interventions are called ―comfort measures‖.
5. Patients and nurse agree on desirable and realistic health- seeking behaviors.
6. If enhanced comfort is achieved, patients and family members are more likely to engage in
health-seeking behaviors these further enhance comfort.
7. When patients and family members are given comfort care and engage in health-seeking
behaviors, they are more satisfied with health care and have better health-related outcomes.
8. When patients, families, and nurses are satisfied with health care in an institution, public
acknowledgment about that institution‘s contributions to health care will help the institution
remain viable and flourish]
[These propositions provide a systematic approach to a solution by incorporating a
process that involves identifying a need, addressing that need, identifying
intervening variable, provide appropriate interventions, assessing if the goal is
achieved, and reaffirming the healthy behaviors learned by the client. Essentially,
Kolcaba has developed a nursing process that is specific to her Theory of Comfort]
(Weller, 1999, para. 8).
(Kolcaba, Durr, & Stoner, 2010, figure FAQ).
21. Different Evolution of Experimental and Comparisons Psychiatric
Inpatients on Total Comfort
This quasi-experimental design was used to measure the differences in comfort, depression, anxiety,
and stress between a treatment group and a usual care group (comparison) of short-term psychiatric
inpatients diagnoses with depressive mood disorders.
Psychiatric Inpatients Comfort Scale (PICS), PICS evaluated reliability, construct validity, and
concurrent validity. The PICS is 5-point Likert type scale with 42 items for self-reporting ranging
from 1, “It doesn't correspond to anything that happens with me” to 5, “It totally corresponds to
what happens with me.”
―Depression, Anxiety, and Stress Scales (DASS-21). the authors assessed scale reliability, construct
validity, and concurrent validity. The DASS-21 contained a set of three 4-point Likerttype subscales
for self-reporting. Each subscale consisted of seven items, aimed at assessing depression, anxiety,
and stress] (Apostolo & Kolcaba, 2009).
[Imagery creates a bridge between mind and body, linking perception, emotion, and psychological, physiological, and
behavioral responses.
. Different Evolution of Experimental and Comparisons Psychiatric Inpatients on
Total Comfort
Example Case Study where
Comfort Theory Utilized-
(Apostolo & Kolcaba, 2009)-all cited so
not to loose meaning of test
22. Overall Evaluation
Generalizability
The Comfort theory is a mid range theory, less generalized than the grand
theories yet more concrete and specific. STRENGTHS: Requires only a
simple, common sense approach. Comforting interventions enhance patients‘
comfort. ―When patients‘ and families engage in health-seeking behaviors,
institutions have better outcomes,‖ (Kolcaba, Durr, & Stoner, 2010, figure FAQ). WEAKNESS:
Research on the concept of Comfort is limited and the meaning of Comfort
has not been ‗definitively‘ defined.. Implementation will be used for the
benefit of my patients and personal ease of mind. I personally believe in this
theory and I place into practice comfort theory each and every day with my
patients.
23. A Closer Look at Kolcaba's Conceptual
Framework
Providing comfort is definitely within the nurses‘ realm today. Nurses are the ones in
direct contact with their patients, providing relief from certain discomforts, continuously
assessing, monitoring and providing care that will ensure the client is at ease. According
to Kolcaba, ―Comfort is the desirable state that nurses would want
for their patients,” (Comfort Care in Nursing Blog, 2011)
(Comfort Care in Nursing Blog, 2011, figure 1)
24. References
Apostolo, J. L., & Kolcaba, K. Y. (2009). The effects of guided imagery on comfort,
depression, anxiety, and stress of psychiatric in patients with depressive disorders. Archives
of Psychiatric Nursing, 23(6), 403-411. http://dx.doi.org/10.1016/j.apnu. 2008.12.003
Comfort Care in Nursing Blog. (2011, September 11). Kolcaba‘s activity [Blog comment].
Retrieved from http://comfortcareinnursing.blogspot.com/p/comfort-theory-major
Current Nursing. (2013). Retrieved March 25, 2010, from http://currentnursing.com/
nursing_theory/application_nursing_theories.html
Kolcaba, K. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19,
1178-1184. http://dx.doi.org/10.1111/j.1365-2648.1994.tb01202.x
Kolcaba, K. (2001). Evolution of the mid range theory for outcomes research. Nursing
Outlook, 49(2), 86-92. http://dx.doi.org/10.1067/mno.2001.110268
Kolcaba, K., & DiMarco, M. A. (2005). Comfort theory and its application to Pediatric
nursing. Pediatric Nursing, 32(3), 187-194. Retrieved from http://
www.medscape.com/viewarticle/507387_2
Kolcaba, K., Durr, K., & Stoner, M. [Comfort Line]. (2010, June). FAQ [Blog comment].
Retrieved from http://www.thecomfortline.com
25. Kolcaba, K., & Kolcaba, R. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing,
16(11), 1301-1310. http://dx.doi.org/10.1111/j.1365-2648.1991.tb01558.x
Kolcaba, K. Y. (2012, July 12). True Comfort [Blog comment]. Retrieved from http://
www.thecomfortline.com
McEwen, M., & Willis, E.M. (2011). Theoretical Basis of Nursing, (3rd ed.). Philadelphia: Lippincott.
Merkel, S. (2007). Comfort Theory: A Framework for pain management nursing practice. [PowerPoint
slides]. Retrieved from http://www.aspmn.org/conference/documents/sandramerkelfull.pdf
Nursing Theory. (2011). Retrieved July 14, 2013, from http://nursing-theory.org/theories- and-models/
Kolcaba-theory-of-
Tomey, A. M., & Alligood, M. R. (2010). Nursing theorists and their work. (7th ed.). Maryland Heights,
MO: Mosby Elsevier
Wardell, D. W. (2010). Measurement tools: Comfort touch. American Holistic Nurses Association, 2(2).
Retrieved from http://www.ahna.org/portals/4/docs/Research/eNews/Connections_R-eNews_1-10.htm
Weller, K. [KWeller Nursing Blog]. (1999, Summer). Scholarly [Blog comment]. Retrieved from http://
kweller99.wordpress.com/scholarly-work/
References Cont‘d