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KOLCABA COMFORT
INSTRUMENTS: General Comfort Questionnaire
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(GCQ) - 250 hospital and community participants/48 items- Cronbach's
alpha .90 [See Kolcaba, K (1992). Holistic comfort: Operationalizing....) Advances
in Nursing Science, 15(1), 1-10.]
Click
here for directions on adapting this GCQ for your research question.
The basic GCQ has been filed with the National Quality Measures Clearinghouse
for several years. Shortened GCQ (24 items) The 28-item GCQ
is in the same format as the original GCQ (48 items). That is, both instruments
have a Likert-type format, with six responses ranging from strongly agree to
strongly disagree. Examples of items relating to the four contexts include, “I
have a poor appetite” (physical), “My beliefs give me peace of mind” (psychospiritual),
“My friends remember me with their cards and phone calls” (sociocultural), and
“These surroundings are pleasant” (environmental). Negatively worded items are
reverse scored and a total score is obtained by summing items, with higher
scores indicating better comfort levels. The 28-item GCQ had a Chronbach’s alpha
of .86, .83, and .82 over three measurement points (to measure change over
time). Although these were satisfactory alphas for the sample size of 60 frail
elders, item number 19 (The views are soothing) had negative correlations with
other items and the total instrument. This item would have had poor congruence
with the other comfort items, if views to
which the residents were accustomed were not pleasing. Some
individuals, especially those who are frail, have difficulty with the length of
the instrument. In these instances, the Likert scale with anchors is presented
in large text on 5” x 8” cards and items are read by the data collector, as was
the procedure used in this study.
This excerpt is part of an article by Kolcaba, Schirm, & Steiner in Geriatric Nursing
published in 2006 (see comfort theory page, research).
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Comfort Behaviors Checklist 
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Research with patients near end of life and their family members is in
its infancy as is comfort research with patients who are not cognitively
able to answer questionnaires or visual analog scales or even a simple
rating scale ("Taking everything into consideration, please rate how comfortable
you are right now, with 0 being no comfort and 10 being as comfortable
as possible.") Also, recruitment and data collection with such populations
is fraught with difficulties. For these reasons, I developed an instrument to measure comfort behaviors, which data collectors could
use themselves to rate a patient’s apparent comfort. While not as
desirable as actually asking a patient about his or her comfort, the instrument
can fill a gap regarding data collection in comatose, very frail (as in
terminal), or cognitively limited
patients. Psychometric evaluation of the Comfort Behaviors Checklist revealed
the following inter-rater reliability: 36 rater pairs had less than 10 point
disagreement out of 116 possible points, while 31 rater pairs had less than 5
point disagreement out of 116 possible points. Concurrent validity between
the CBC and the shortened GCQ was .51 in a 36 patients receiving hand massage,
and -.11 in 31 patients receiving no comfort intervention. These results
indicate to me that people can appear comfortable, but there is a whole world of
discomforts that they tend to hide. Therefore, please use the CBC as a last, but
important, research resource for patients who cannot answer VASs or traditional
questionnaires.
Comfort Daisies
This instrument designed for use with young children (not yet tested). [Kolcaba,
K. & DiMarco, M. (2005). Comfort Theory and Its Application to Pediatric
Nursing. Pediatric Nursing, 31(3), 187-194.]
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(Instrument) Perianesthesia Comfort Questionnaire [Wilson,
L. & Kolcaba, K. (2004). Practical application of Comfort Theory in the
perianesthesia setting. Journal of PeriAnesthesia Nursing. 19(3),
164-173. (Invited article)]
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(Instrument) Radiation Therapy Comfort Questionnaire (RTCQ)
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53 women with early breast cancer
- Cronbach's alpha .76 [See Oncology Nursing Forum, 26(1), 1999,
67-72).
Urinary Incontinence and Frequency Comfort Questionnaire (UIFCQ)
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40 men and women with hx. of UI - Cronbach's alpha .82 [Dowd, T., Kolcaba, K., &
Steiner, R. (2001). Using cognitive strategies to enhance bladder control
and comfort. Holistic Nursing Practice, 14(2), 91-103.] End of Life Comfort Questionnaires
Patient:
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- (Instrument)
Family Member:
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(Instrument)
Results with 38 family dyads yielded a Cronbach's alpha of .90 for the Family
Member version and .92 for the Patient version. Note: the family instruments
are designed to measure the comfort of the family member, NOT how they
perceive the patient's comfort. The theory is that if the patient is comfortable,
the family member will be comfortable also (this relationship will be tested).
Psychometric properties best when Likert-type response has 6 choices (not
four) and the VAS is vertical. 5" X 8" cards with response formats useful
to give to patient if you need to read questions.
We also used a Total Comfort Line (VAS) in the end of life
research cited above. While the Total
Comfort Line is easy to use, it often doesn't achieve statistical significance
when used in research. Therefore, we suggest using a verbal (how do you
rate your comfort on scale from 0-10?) or pictoral version (vertical
orientation, 10 cms. long) of the Total Comfort Line in the clinical setting
to assess comfort and begin conversations about detractors from comfort. [Novak, B., Kolcaba, K., Steiner, R., & Dowd, T. (2001). American
Journal of Palliative Care 18(3), 170-180.] New!! Shortened Hospice Comfort Questionnaire (24 items with strong psychometrics)
To abbreviate the long version, a panel of
eight hospice nurses ranked the 49 items in open discussion and voting,
retaining the top 24 items from the EOL Comfort Questionnaire. Retained items
were compared to the item analysis that was done in the psychometric study. (18)
Retained items were then plotted on the TS of comfort to assure that the content
domain was covered and evenly represented. To score the EOL Comfort
Questionnaire, negatively worded items were reverse scored and summed; higher
scores indicated higher comfort. Psychometric properties were obtained from 34
hospice patients who answered the questionnaire once a week for three weeks.
Patients were assisted when needed with 5” by 8” cards with the response format
printed in large text (20). In this sample, the Cronbach’s alpha of the 24-item
HCQ averaged .65 over three measurement points (T1 = .70, T2 = .67, T3 = .58).
Some of the decrease in Cronbach’s alpha was due to shortening the instrument by
one half. Also, over time, the patients’ cognitive ability declined and they
were apparently more inconsistent in their responses. [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.]
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Healing Touch Comfort Questionnaire
The HTCQ was adapted from
the GCQ. Three experts reviewed it for appropriateness of wording and content,
Eight Healing Touch practitioners distributed the questionnaire to their
clients. 53 persons took the forms home and completed the questionnaires within
several days of the treatment and returned them in the provided self-addressed
envelopes. Cronbach’s alpha was .94 for Total Comfort. Those who had received 5
or more Healing Touch treatments had Comfort scores 13.7 points higher than
those who had received 1-4 treatments.
Further analysis showed that there was a trend to a
curvilinear relationship between no. of treatments and comfort. Comfort seems to
increase slightly as the number of treatments increases until about 20
treatments; then comfort levels off and possibly decline. More information
is needed about this relationship.
Dowd, T., Kolcaba, K., & Steiner, R. (2006)
Development of the Healing Touch Comfort Questionnaire. Holistic Nursing
Practice, 20(3), 122-129.
Click below for a copy of this instrument.
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Verbal Rating Scale
This scale correlates with the Healing ouch Comfort Questionnaire to which it
was compared with a P=.74. See Dowd, Kolcaba, Fashinpaur article of 2007 (full
text available under references). This instrument is more sensitive for research
than visual analog scales and is what I recommend for clinical documentation as
well. Another way to measure comfort in the clinical setting is to ask the
patient to rate his/her comfort from 0 to 10, with 10 being the highest possible
comfort.
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Visual discomfort scale (patient)
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Advance Directives Comfort Questionnaire
(Nurse)
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Comfort with End of Life Planning (Patient)
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OTHER
COMFORT INSTRUMENTS:
Please get permission from the authors listed below to use any of
these instruments.
Childbirth Comfort Questionnaire (Schuiling)
Contact:
kschuili@nmu.edu
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Nurses Comfort
I developed this instrument because of the increased interest in enhancing
practice environments. Comfort Theory has been used as a framework for
addressing the “forces of magnetism” for Magnet Status. When doing so, nurses
can think in terms of their “comfort needs” on their units and in this
institutions. They can make small or large changes on their units, such as
self-scheduling or an improved lounge, and use this instrument for measuring
changes in nurses’ comfort as a result of that change. Note: this instrument has
not been psychometrically tested.
For a definition of Nurses' Comfort, see the page entitled
"Enhancing Your Work Environment"
Contact:
kolcaba@uakron.edu
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General Comfort Questionnaire - Adapted for Deaf Clients
Contact:
dinokattato@hotmail.com
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Immobilization Comfort Questionnaire
Contact: Audrey Booker (no additional information
available at this time)
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Intermountain Healthcare Pediatric Comfort Assessment - Used by permission
Contact:
Joey
Robinson BSN, CNE
Clinical Educator, Surgical Services
PCMC
Tel:
801-662-2882
pcjrobin@ihc.com
PDF Format
Psychiatric Comfort Questionnaire - English
Contact:
PDF Format
FOREIGN LANGUAGE COMFORT INSTRUMENTS:
Please get permission from the authors listed below to use any of
these instruments.
Urinary Incontinence & Frequency Comfort Questionnaire (TURKISH)
Contact:
zneriman@yahoo.com
PDF Format
Psychiatric Comfort Questionnaire (PORTUGUESE)
Contact:
apostolo@esenfc.pt
PDF Format
*PICS-42 *psychometric properties
Portuguese version:
*Objective. *To develop and evaluate the psychometric characteristics of the
Psychiatric In-patients Comfort Scale (PICS) in hospitalized psychiatric
patients.
*Methods. *The items of the PICS were drawn from a literature review,
existing comfort instruments, suggestions made by experts, and interviews on
perceived comfort with 18 hospitalized patients. A pilot study was performed
with the first version of the scale, containing 98 items, in a sample of 49
patients. This process resulted in a 51-item version. Internal consistency,
construct validity, and concurrent validity were measured in a second sample of
273 patients.
*Results. *Data analysis, factor analysis, and reliability analysis resulted in
a 41-item version. The factor analysis indicated
a 3-factor structure: relief, ease and transcendence, which explained 37.86 % of
the total variance.
Confirmatory Factor Analysis results – Relief; (RMSEA = 0,056; CFI = 0,97 and
AGFI = 0,85); ease: (RMSEA = 0,061; CFI = 0,97
and AGFI = 0,83); Transcendence: (RMSEA = 0,076; CFI = 0,97 and AGFI = 0,77).
The comfort dimensions correlated positively with well-being and with positive
experiences of suffering and negatively with the remaining dimensions of
suffering, supporting concurrent validity. Cronbach's coefficient of the total
PICS-42 was 0. 91, and the subscales ranged from 0.75 to 0.90.
*Conclusion. *Based on psychometric properties, the PICS is a valid and reliable
tool that can be used by nurses to assess
comfort in hospitalized psychiatric patients. The items are conceptually grouped
in three factors corresponding to the states of relief, ease and transcendence
of the comfort structure proposed by Kolcaba.
Reference for this results:
Apóstolo, J. L. A (2007). *O imaginário conduzido no conforto de doentes em
contexto psiquiátrico*. Doctoral Dissertation. Porto, PT: Porto University.
References for a 38 item version:
Apóstolo, J. L. A., Kolcaba, K., Mendes, A. C., & Antunes, M. T. C. (2007).
Development
and psychometric evaluation of the psychiatric in-patients comfort scale (PICS).
*Enfermería Clínica*, *17*(1), 17-23.
Apóstolo, J. L. A., Kolcaba, K., Azeredo, Z. A., Antunes, M. T. C., & Mendes, A.
C. (2007). Avaliação das qualidades psicométricas da escala de avaliação do
conforto em doentes psiquiátricos. *Psychologica*, *44*, 489-504.
Breast Cancer Comfort Questionnaire (PORTUGUESE)
Contact:
apostolo@esenfc.pt
PDF Format
General Comfort in Caregivers of Women with Terminal
Cancer (PORTUGUESE) - Abstract Only
Contact:
derchain@fcm.unicamp.br
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General Comfort Questionnaire (ITALIAN) - Translated by
Valeria Bortolusso, Alessandra Zampieron,
Pierlugi Badon, and Martina Mattiazzi
Contact:
suigi@hotmail.it
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General Comfort Questionnaire (SPANISH)
*This instrument is being validated in the EUE La Fe -Valencia - Spain by
Esperanza Ferrer
Contact:
ferrer_esp@gva.es
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Nurses Comfort Questionnaire (SPANISH)
*This instrument is being validated in the EUE La Fe -Valencia - Spain by
Esperanza Ferrer
Contact:
ferrer_esp@gva.es
PDF Format
Perianesthesia Comfort Questionnaire
(FARSI, from Iran)
Contact:
Rezaei_m@kaums.ac.ir
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Primipara Patients after Perineal
Care (VISAYAN, from the Phillippines)
Developed to compare comfort difference between care given by male and
female nurses.
Contact:
fritzie_ong@yahoo.com
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Aloisio Leoni Schmid (iso@ufpr.br),
architect and lecturer in Brazil, wrote a book called A ideia de
conforto: reflexoes sobre o ambiente construido (ISBN 85-99403-01-X). He
states, "your writings on comfort allowed me to develop a much more consistent
comfort theory for architecture. It helped me understand the links between
comfort functionality and arts in architecture". I have placed this information
here as an added resource for anyone who is interested.
If there are any other comfort instruments out there, please let
me know and if you would like, I'll add them to this list.
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