Although this theory originated in nursing, it is now being applied to all providers in any given institution. The article by March & McCormack (2009) gives some concrete suggestions for how to do this, which are supported by my own experiences in my consulting business. 

Below are the definitions of the major concepts in the theory, followed by a diagram that illustrates their relationships.

Health Care Needs are those identified by the patient/family in a particular practice setting.

Intervening Variables are those factors that are not likely to change and over which providers have little control. (such as prognosis, financial situation, extent of social support, etc).

Comfort is a concept that has a strong association with nursing. Nurses traditionally provide comfort to patients and their families through interventions that can be called comfort measures. The intentional comforting actions of nurses strengthen patients and their families (who can be found in their own homes, in hospitals, agencies, communities, states, and nations). When patients and families are strengthened by actions of health care personnel (nurses!), they can better engage in health seeking behaviors. The positive relationships between these deliberate nursing actions and comfort is entailed in the first part of Kolcaba's mid-range Theory of Comfort.

Enhanced comfort, is an immediate desirable outcome of nursing care, according to Comfort Theory. Additionally, 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).

The concept of HSBs was first introduced by Scholtfeldt (1975). HSBs can be internal (healing, immune function, number of T cells, etc.), external (health related activities, functional outcomes, etc.), or a peaceful death. The relationships between comfort and health seeking behaviors are entailed in the second part of Kolcaba's comfort theory. 

Institutional Integrity (InI) is NEWLY (2007) defined as the values, financial stability, and wholeness of health care organizations at local, regional, state, and national levels. In addition to hospital systems, the definition of  “institutions”  includes Public Health agencies, Medicare and Medicaid programs, Home Care agencies, Nursing Home consortiums, etc. 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 InI constitute the third part of the theory.  Tests of the theory can be on the first part, the second part, the third part, or the whole theory (article). Much excitement has been generated by linking nurse comfort (or nurse satisfaction) or patient comfort to HCHAPS scores, after an institution adopts CT as its model of care.

Best Policies are protocols and procedures developed by an institution for overall use after collecting evidence.

Best Practices are those  protocols and procedures developed by an institution for specific patient/family applications (or types of patients) after collecting evidence.

Note: This is a diagram of Comfort Theory. In my book and early articles about Comfort Theory, there are 3 lines above this diagram  that relate to Henry Murray's original work (1930s), if you wish to trace the theory's historical roots. For definitions of the metaparadigm concepts related to the diagram, click on the diagram itself.

This Web Site brings together current knowledge and experiences with teaching, practicing, and researching comfort. Please e-mail me with any questions, comments, or suggestions for this site. I need your feedback to make this web site more useful for everyone! You can address your comments to any of the categories contained in the theory or any of the pages.

Please visit the Reference Page for articles that can be applied to research, education, or practice. Please send any articles you you wish to be included on this page via e-mail or by snail mail (The University of Akron, College of Nursing, Akron, OH 44325-3701). These will help to build nursing knowledge about the measurement of comfort. 

THANKS for your interest in nursing comfort.