Timothea Vo, BS, RN, Doctoral Student University of Connecticut UCONN A theory critique using Dr. J. Fawcett's (2005) evaluation criteria

1. Timothea Vo, BS, RN
NURS 6135

2. Katharine Kolcaba
• Middle-range theorist
• Developed her Theory of Comfort (TC) by being deeply immersed in
clinical work, either giving care herself or observing care being given
(Kolcaba & Kolcaba, 1991)
• Clinical positions:
Operating Room
Medical-Surgical
Home Care
Long-term Care

3. Worldview
• Nursing, health, person, environment metaparadigm
• Humanistic nursing theory (Paterson & Zderad, 1976, 1988)

4. Significance
Kolcaba’s Theory of Comfort (1994)
incorporates three concepts of
relief, ease and transcendence
across four dimensions:
Physical
Psychospiritual
Sociocultural
Environmental

5. Parsimony
• Theory’s propositions are parsimonious. Health care providers:
1 assess comfort needs of patients/family members that are not met by
existing support group.
2 design interventions to address those needs.
3 obtain a measurement of comfort before and after interventions are
implemented.
4 If comfort is enhanced, patients/families engage more fully in health
seeking behaviors (internal, external, peaceful death)
5 When health seeking behaviors are enhanced, the integrity of the
institution is enhanced.

7. Comfort Checklist
• Did you ask about your patient’s comfort level before the procedure
(from 1 – 10, with 10 being the highest possible comfort in this
situation)?
• If score is less than 10, did you determine detractors of comfort?
• Did the patient or family identify solutions to states detractors?
• Were those solutions applied partially or fully?
• Did you ask again about your patient’s comfort level before the
procedure?
• Did you ask about your patient’s comfort after the procedure?
• Repeat steps 2-5 as necessary.

8. Internal Consistency
• General Comfort Questionnaire (GCQ)
Cronbach’s alpha = 0.88
• Radiation Therapy Comfort
Questionnaire (RTCQ) – 26 items
derived preliminary content validity
from the GCQ and adapted for use.
Cronbach’s alpha = 0.76
• Comfort is more State than Trait.
• Tested across time points and intra-class
correlations were low.
• LGBTQ Self-Comfort Questionnaire
• Advanced Directives Comfort
Questionnaire (nurses' comfort when
discussing)
• ASPAN (Peri Anesthesia)
• Comfort Behaviors Checklist
• Childbirth Comfort
• Deaf
• Dialysis
• Diabetic
• Healing Touch Comfort Questionnaire
• Numerical Rating of Comfort
• Intubation Comfort​
• Ovarian Cancer Comfort
• Thermal Comfort Inventory

9. Philosophical Assumptions
• Do they all seek and approve such genuine encounters?
• In how many such meetings/encounters can a nurse be involved in
the course of her shift, and is there potential for emotional drainage
leading to nurse burnout?
• “We may not know, for example, what is providing comfort to nursing
clients, how comfort is defined, how it is achieved who is expected to
participate in providing it, what are the different ways in which it is
manifested, and what is feasible and what is not feasible in
comforting patients in various stages of health-illness”
(Meleis, 2018, p. 364)

10. Testability of TC
• Three Comfort interventions:
a Standard comfort interventions
b Coaching
c Comfort “food” for the soul

11. Empirical Adequacy
Koehn (2000) Alternative and complementary therapies for labor and birth
Novak, Kolcaba, Steiner, & Dowd (2001) Measuring comfort in caregivers
and patients during late end-of-life care
Kolcaba, Schirm & Steiner (2006) Effects of hand massage on comfort of
nursing home residents
Kolcaba & Steiner (2016) Empirical evidence for the nature of holistic
comfort
Lorente, Vives & Maria Losilla (2016) Instruments to assess the patient
comfort during hospitalization: a psychometric review protocol
Carvalho, Martins, Gomes, Martins, Abelha & Apóstolo
(2018) Development and psychometric evaluation of the Perioperative
Comfort Scale

12. Pragmatic Adequacy
• Cardiac patients
• Labor and delivery
• Postpartum
• Intensive-Care Unit
• Perianesthesia
• Pediatrics
• Oncology
• Hospital at home
• Veterans
• Palliative care, hospice, and end-of-life care
• Institutions to enhance the practice environment

13. Thank you!

14. References
• Henderson, V. (1966). The nature of nursing. New York, NY: Macmillan Publishing.
• Kolcaba, K.Y & Kolcaba, R.J. (1991). An analysis of the concept of comfort. Journal
of Advanced Nursing, 16(11), 1301–1310.
• Kolcaba, K.Y. (1992). Holistic comfort: operationalizing the construct as a nurse-
sensitive outcome. ANS Advances for Nursing Science, 15(1), 1–10.
• Kolcaba, K. (1994). A theory of holistic comfort for nursing. Journal of Advanced
Nursing. 19, 1178–1184.
• Kolcaba, K. (2001). Evolution of the mid range theory of comfort for outcomes
research. Nursing Outlook, 49(2), 86–92.
• Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health and
research. Springer.
• Kolcaba, K. & Steiner, R. (2016). Empirical evidence for the nature of holistic
comfort. Journal of Holistic Nursing, 18(1), 46–62.

15. References
• Orlando, I.J. (1961). The dynamic nurse-patient relationship, function,
process and principles. New York, NY: GP Putnam.
• Paterson, J.G. & Zderad, L.T. (1975). Humanistic nursing. New York,
NY.: National League for Nursing.
• Paterson, J.G. & Zderad, L.T. (1988). Humanistic nursing (2nd ed.). New
York, NY: National League for Nursing.