Theoretical Development

Nursing Practice and Education

Nursing Research

Instruments available on the web

Theoretical Development

Concept analysis of comfort results in development of three types of comfort, Relief, Ease, and Transcendence. [Kolcaba, K. & Kolcaba, R.(1991). An analysis of the concept of comfort. Journal of Advanced nursing, 16, 1301-1310]. Article available here (MS Word format) Taxonomic structure of comfort further delineates the three types of comfort as occurring in four contexts of experience. This results in a 12-cell "map" of the content domain of comfort. [Kolcaba, K.(1991). A taxonomic structure for the concept comfort. Image: Journal of Nursing Scholarship. 23 (4), 237-240. SEE DIAGRAM #1. Article available here (MS Word format) Distinction and relationship between comfort as verb (process) and comfort as noun or product (outcome). [Kolcaba, K. (1 995). Comfort as process and product, merged in holistic nursing art. Journal of Holistic Nursing, 13 (2), 117-131.] Comfort as it relates theoretically to other nursing concepts. [Kolcaba,K. (1994). A theory of holistic comfort for nursing. Please obtain this journal article if you have trouble downloading the diagram. The midrange Theory of Comfort is entailed in Line 4 of the diagram. Journal of Advanced Nursing, 19, 1178-1184. SEE DIAGRAM #2. Article available here (MS Word format) Theoretical components of holistic comfort tested empirically (i.e. the whole is greater than the sum of its parts, etc.). In Journal of Holistic Nursing, 18(1), March 2000, p. 46-62 (by Kolcaba & Steiner). Article available here (MS Word format) Updated Theory of Comfort to include institutional outcomes. [Kolcaba, K. (2001). Evolution of the mid-range theory of comfort for outcomes research. Nursing Outlook,49(2), 86-92. SEE DIAGRAM #3. Article available here (MS Word format) Kolcaba, K. & DiMarco, M. (2004). Comfort Theory and Its Application to Pediatric Nursing. Pediatric Nursing 31(3), 187-194. Article available here (PDF format) Top of Page

Nursing Practice and Education

Framework of comfort care for practice and nursing education. Single patient comfort care plan. SEE DIAGRAM #4. [Kolcaba, K. (1992). The art of comfort care. Image: Journal of Nursing Scholarship 27 (4), 287-289)]. Definition of proactive comfort care applied to advance directives. Patient/family care plan. SEE DIAGRAM #5. [Kolcaba, K., 1(996). A holistic perspective on comfort care as an advance directive. Critical Care Nursing Quarterly, 18(4),66-76.] Theory of Comfort applied to hospice nursing (anecdotal data). [Vendlinski, S. & Kolcaba, K. (1997). Comfort care: A framework for hospice nursing. The American Journal of Hospice & Palliative Care, Nov/Dec, 271-276.] . Theory of Comfort applied to orthopaedic nursing, really appropriate for any adult setting. [ Panno, J., Kolcaba, K. & Holder, C. (2000). Acute care for elders (ACE): A holistic model for geriatric orthopaedic nursing care. Orthopaedic Nursing, 19(6), 1-9.. Comfort as a desirable goal in hospital outcome research: the reality is that patient comfort, while "nice," will not be highly valued by administrators until we can show that it is related to subsequent desirable outcomes... the health seeking behaviors. Those of special interest to administrators will advance their "bottom line," such as length of stay, patient satisfaction, and hospital readmissions. Testing these relationships (the second part of comfort theory) is a research priority. Application of Comfort Theory to perianesthesia nursing. Kolcaba, K. & Wilson, L. (2002). Comfort Care: A Framework for Perianesthesia Nursing. Journal of PeriAnesthesia Nursing, 17(2), 102-114. Wilson, L. & Kolcaba, K. (2004). Practical application of Comfort Theory in the perianesthesia setting. Journal of PeriAnesthesia Nursing. 19(3), 164-173.  (Invited article) Recently, a full chapter about Comfort Theory was published in Tomey and Alligood's "Nursing Theorists and Their Work", 5th edition, ISBN 0-323-01193-4. Comfort Theory applied to clinical practice guidlines. Click here for full text. Top of Page

Nursing Research

Outcome of comfort is operationalized for nursing research. Results of initial instrumentation study of General Comfort Questionnaire. [Kolcaba, K. (1992). Holistic comfort: Operationalizing the construct as a nurse-sensitive outcome. Advances in Nursing Science, 15 (1), 1-10.] Theory of comfort raises many interesting questions for future holistic research. Relationships can be demonstrated between holistic interventions and comfort (immediate outcome) and health seeking behaviors (subsequent outcome) SEE DIAGRAM #2. [Kolcaba, K. (1 994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19, 1178-1184]. Overview of comfort measurement and building nursing knowledge about comfort [Kolcaba, K & Wykle, M. (1997). Comfort research: Spreading comfort around the world. Sigma Theta Tau: Reflections, 2nd quarter,12-13] and [Encyclopedia of Nursing Knowledge, pp. 102-104]. The outcome of comfort is demonstrated to be sensitive to change over time in two intervention studies. [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.] And [Dowd, T., Kolcaba, K., & Steiner, R. (2000). Using cognitive strategies to enhance bladder control and comfort.Holistic Nursing Practice, 14(2), 91-103]. Novak, B., Kolcaba, K., Steiner, R., & Dowd, T. (2001). Measuring comfort in caregivers and patients during late end-of-life care. American Journal of Hospice and Palliative Care, 18(3), 170-180. Dowd, T., Kolcaba, K., & Steiner, R. (2002). Correlations Among Measures of Bladder Function and Comfort. Journal of Nursing Measurement 10(1), 27-38. 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. Kolcaba, K., Schirm, V., Steiner, R. (2006). Effects of hand massage on comfort of nursing home residents. Geriatric Nursing, 27(2), 85-91. Click below for the protocol for hand massage that was so pleasing to our hospice patients and our nursing home residents (last 2 references). Word Format - PDF format   Top of Page

NOW AVAILABLE ON THE WEB: Instruments to measure comfort

Instruments that have been developed (so far) to measure patient comfort in a variety of settings and ways can be found by clicking here, or returning to the navigation bar and clicking on "Instruments on the Web." If you wish to adapt one of these instruments for a new setting, see the general instructions in the Adapting the GCQ section. If you wish to add your own comfort instrument or one that you found elsewhere, email it to me as an attachment and we will be happy to do so. Top of Page