Philosophical Perspectives

This section contains a brief history of comfort in nursing in a PDF, created by a former student of mine from Turkey. “Sebnem” contacted me and requested a year of shadowing what my research partner and I were doing with Comfort Theory. She was a BSN graduate at the time and now has her PhD, both degrees obtained in Turkey. She is a “comfort warrior” in her homeland, where she teaches nursing, and has several publications to her credit. Her work there is a wonderful example of the cultural universality of Comfort Theory. The other component of this chapter consists of  the philosophical underpinnings of the theory and its definitions. 

Philosophical Perspectives - Definitions

(From Comfort Theory and Practice, Chapter Four)

 

The hierarchy of perspectives for Comfort Theory consist of three levels:

            Person-Based Holism (humans’ bodies have their own natural boundaries)

 

Assumptions of Person-Based Holism:

  1. Human beings respond to complex stimuli as wholes.

  2. The whole response is greater than what would be expected by examining separate responses to separate stimuli and adding together the effects of those responses.

  3. Whole persons do not disappear into every larger wholes.

Note: We analyzed data from one of our studies to show empirical evidence for the holistic nature of comfort. Here is the link to that article.

 

Propositions:  (also see three parts of Comfort Theory, Comfort Theory 101)

  1. Health care providers assess comfort needs of patients/family members that are not met by existing support group.

  2. Health care providers design interventions to address those needs.

  3. Health care providers 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.

Definitions of concepts in Kolcaba’s middle range Theory of Comfort:

  • Health care needs: Deficits in any context of comfort that arise from stressful health care situations and which the patient’s natural support system cannot meet.

  • Nursing interventions: Comfort measures that nurses design and implement that are targeted to the health care needs. These interventions have the explicit goal of enhancing the patient’s immediate comfort and/or facilitating subsequent desirable health seeking behaviors.

  • Intervening variables: Factors that each patient brings to the health care situation, that nurses cannot change, and that have an impact on the success of the interventions.

  • Comfort: The immediate experience of being strengthened through having the needs for relief, ease, or transcendence met in the physical, psychospiritual, environmental, and social contexts of experience [General Comfort Questionnaire].

    • Relief: The state of a patient who has had a specific need met.

    • Ease: The state of calm or contentment.

    • Transcendence:The state in which one rises above one’s problems or pain.

    • Physical: Pertaining to bodily sensations and functions.

    • Psychospiritual: Pertaining to self-esteem, self-concept, sexuality, meaning in one’s life, and one’s relationship to a higher order or being.

    • Environmental: Pertaining to the external.

    • Sociocultural: Pertaining to interpersonal, family, and societal relationships.

  • Health seeking behaviors: Subsequent internal or external behaviors in which the patient engages that facilitate health or a peaceful death (Schlotfeldt, 1975). They can be internal (healing, T-cell formation, oxygenation, etc.) or external (observable behaviors such as working in therapy, length of stay in hospital, ambulation, functional status). [Choose the measure most applicable to your setting. Or, choose specific goals that the patient and family desire.] A peaceful death can be observed (discussed more fully in section Six).

  • Institutional Integrity: Stability and ethics of any hospital, health care system, region, state, or country. When institutions do better, patients do better and visa versa. Can be assessed through HCHAPS, cost/benefit analysis, staff turnover, awards, reputation, etc.

The Holistic Nature of Comfort

It is important to remember that the concept or idea of comfort includes many aspects and these aspects are represented by each cell in the taxonomic structure (grid) seen on the home page. So, relief of pain is one aspect of comfort but not the only aspect. The same is true of anxiety. This holistic nature is also represented by the origami shown below. A nurse friend of mine thought we should create an origami star where the green sections represent the types of comfort, and the other four sections represent the contexts of comfort.  When you play with this origami with your fingers, as I demonstrate in live presentations, you see that the whole (comfort) is dynamic, fluid, and greater than the sum of its parts.

© 1997 - 2019 by Kathy Kolcaba

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