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Running head: THEORY IN PRACTICE 1

Theory in Practice
Sydonie Stock
Ferris State University


Healthcare theories are an important communication tool to use when working with an
interdisciplinary team. Kolcabas Comfort Theory can aid in the continuity of care, not only
from nurse to nurse, but between the healthcare disciplines involved in the patient care. The
Comfort Theory is helpful in providing quality care for end-of-life patients and for any suffering
person. The nurse needs certain knowledge, skills, and attitude to utilize the Comfort Theory.
Involving the patient and family is an important concept in the Comfort Theory and will result in
relief, ease, and transcendence of the patient, bringing comfort to physical, environmental,
psychospiritual, and social stressors.


Theory in Practice
Kolcaba defined comfort as having two parts, varying intensity and the patients
internal or external needs (Vendlinski & Kolcaba, 1997). The Comfort Theory was developed as
an interdisciplinary tool to improve patient comfort (Comfort Theory and Practice, 2003).
Kolcaba realizes that not all discomfort can be eliminated, but steps can be taken to relieve the
Kolcaba divides comfort into three classifications: (1) relief, meeting a specific need, (2)
ease, the patient is calm or content, and (3) transcendence, the patient is able to move past the
discomfort to a more fulfilling state of being (Vendlinski & Kolcaba, 1997). The sources of
discomfort are divided into four categories: (1) physical, (2) psychospiritual, (3) environmental,
and (4) social. The Comfort Theory utilizes a tool called the Comfort Grid, which enables the
nurse or healthcare provider to discuss each category of discomfort with methods of relief, ease,
and transcendence. The purpose of this paper is to examine Kolcobas Comfort Theory and how
it applies to nursing care.
The Quality and Safety Education for Nurses (QSEN) Institute (2014) developed a pre-
licensure competency of Patient Centered Care. The subcategory of knowledge is what a nurse
needs to know to be adept at patient-centered care. One part of this subcategory is knowing how
to empower the patient or family in the health care setting. Kolcabas Comfort Theory includes
the patient and family as active participants in enhancing comfort (Vendlinski & Kolcaba, 1997).
Some people may be uncomfortable with caring for the dying or may lack the knowledge needed
to provide that care; the nurse should guide these family members so everyone experiences the
full benefit of Comfort Theory. This means the nurse must be knowledgeable about the dying

process, comfort needs of the patient and family, and methods of relieving discomfort. Methods
could include something as simple as holding the patients hand or singing to the patient, as in
Vendlinski and Kolcabas (1997) case study. Giving a back rub could provide comfort, or taking
the patient for a walk outside if the patient is able. Comforting methods are unique and should
be individualized to each patient and each family member to have the greatest effect.
The QSEN Institute (2014) developed a subcategory of skills nurses must have to provide
patient-centered care. A skill nurses need is the ability to engage patients and appropriate family
members in healthcare partnership. One way this could be done is by communicating the
patients values, preferences, and expressed needs to others on the healthcare team (QSEN
Institute, 2014). This communication could be accomplished by utilizing the Comfort Grid. The
patient should be asked, or the designated surrogate if the patient is unresponsive, what gave that
person comfort in the past; perhaps family presence, church, music, nature, or reading as a few
examples. If nonpharmacological interventions are discovered, the patients comfort will
increase, promoting health (though not a cure), safety by avoiding the polypharmacy side effects,
and transcendence. The comfort improvement can be measured using an adapted numbers scale,
similar to that of the pain scale (Comfort Theory and Practice, 2003).
Attitude is an important part of patient-centered care (QSEN Institute, 2014). The nurse
must value the input of the patient or surrogate in the planning, implementing, and evaluation of
care (QSEN Institute, 2014). This can be demonstrated through active listening to the patient
and family and including their wishes in the care plan as much as possible. Without the active
participation, or partnership, of the patient and family members, the comfort methods may not be

addressed or modified as the patients needs change. The Comfort Grid should be updated to
provide continuous interdisciplinary care improvements (Vendlinski & Kolcaba, 1997), and this
cannot be easily accomplished without the patient and family involvement.
This assignment examined how nurses could incorporate Kolcabas Comfort Theory into
end-of-life care. This should be an interdisciplinary approach and include all palliative care, not
only hospice. This project intimidated me in the beginning. A major reason for this fear was the
lack of direction I felt I was given from the course syllabus. A brief rubric was provided along
with multiple resources, however, I was at a loss on what to do with the information provided. I
did not feel confident going into this assignment, and I am still not certain what I have completed
is appropriate. In an attempt to better understand the assignment topic, I first read several of the
resources provided. One fact that I found surprising from my reading was that Hospice programs
cannot accept any terminal patient (Smeltzer, Bare, Hinkle, & Cheever, 2010). I was not
previously aware that a patient had to be diagnosed as end stage, and that many diseases and
disorders do not have that classification.
End-of-life care has never been an area of nursing in which I have had any interest. I cry
too easily and get attached to people too deeply to be able to emotionally cope with losing my
patients, even if the death is expected. While I do not plan to pursue a career in Hospice nursing,
I believe Kolcabas Comfort Theory is useful in all areas of nursing.
Palliative care is defined as the comprehensive symptom management, psychosocial
care, and spiritual support needed to enhance the quality of life for patients (Smeltzer, Bare,

Hinkle, & Cheever, 2010, p. 398). This goes well with Kolcabas physical, psychospiritual,
environmental, and social categories of comfort. Even if the patient is not dying, there could be
discomfort; anxiety about the illness or a new diagnosis, fear of the hospital setting, financial
worries, or a change in family structure due to the hospitalization. Kolcabas Comfort Theory
can be used to bring relief, ease, and transcendence to these patients and families, just as it does
with those receiving end-of-life care.
For the highest quality of care, the entire interdisciplinary team should work under the
same theory. This will improve communication between departments that have varying care
focuses. If the same healthcare theory is used, everyone in the healthcare team will be working
along the same path toward the same goal. This interdisciplinary communication may be
hindered by the use of nursing knowledge. Each discipline has its own professional
knowledge and should not assume the others will understand. For example, a nurse may think
turning the patient to prevent decubitus ulcers is basic nursing knowledge but the team member
from nutrition may not realize the importance of positioning for skin care. Knowledge from each
team member should be presented in a way that is clearly understood by all, because each
member brings an important piece of patient care to the group. Nurses must use the nursing
knowledge of the profession, but when working with other disciplines, the nurse should
communicate in a way that the others will understand.
Kolcabas Comfort Theory could be improved by dissemination to younger nursing
students. In her interview, Kolcaba mentioned working with graduate level nurses and that she
found few bachelorette prepared nurses who understood and utilized nursing theories in their
patient care (Comfort Theory and Practice, 2003). This assignment will help me to remember

and use Kolcabas Comfort Theory in my practice. To improve the utilization of this theory, I
would introduce it in all undergraduate nursing programs. This introduction would take place in
the latter part of the students education. I remember trying to learn theories and theorists in my
first semester of nursing school. At that time, I could not understand why I would need this
knowledge and when it would ever help me with patient care. Now that I have more nursing
knowledge and clinical experience, I can understand the benefit of a nursing theory guiding my
practice. This understanding may improve utilization of theories in the workforce. After
initiating this new dissemination strategy, surveys and interviews would need to be conducted to
evaluate the use of theories in bachelorette prepared nurses. I believe the Comfort Theory is an
appropriate theory for any nurse to use to provide safe and quality care.
This was not the first time I was exposed to the Comfort Theory, though I was not aware
of the theory at that time. When I was working as a certified nurse aide in a nursing home, a
note was placed in a patient record describing ways to relieve the patients anxiety, including
reading passages from the patients bible. I do not know if the person who wrote that note was
aware of the Comfort Theory, but it surprised me to realize what that note was as I learned about
this theory. I enjoyed learning about the Comfort Theory and I plan on working under this
theory in the future.


Comfort Theory and Practice. (2003). The comfort line. Retrieved from
QSEN Institute. (2014). Pre-licensure KSAs: QSEN. QSEN. Retrieved from
Smeltzer, S. C., Bare, B. G., Hinkle, J. L, & Cheever, K. H. (2010). Brunner & Suddarths
textbook of medical-surgical nursing (12
ed.) (Vol. 1) (pp. 396-419). Philadelphia, PA:
Lippincott Williams & Wilkins.
Vendlinski, S., & Kolcaba, K. Y. (1997). Comfort care: a framework for hospice nursing. The
American journal of hospice & palliative care, 14(6), 271276.