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NR 501 Theoretical Framework to Support Evidence-based Practice

NR 501 Theoretical Framework to Support Evidence-based Practice


Comfort is a complex construct in nursing in which nurses claim a disciplinary interest

Nurse practitioner has to consider holistic approach, which includes comfort

It requires a nursing theory, which is universal

Creating the framework for a healthy practice environment and patient comfort is necessary

Comfort includes aspects of patient’s, beliefs, psychology, respect, environment satisfaction,, compassion, relationship and suitable care.

Patient comfort is becoming a higher priority for hospitals, and the reasons are three-fold: It boosts patient satisfaction, improves outcomes and is the right thing to do.

The structure of comfort is complex because it entails a multidimensional, personal experience with differing degrees of intensity. The history of comfort as a Nursing Diagnosis reveals the definitional difficulties associated with this complex construct (Chandra, Raman & Kolkaba, 2016).

It requires a nursing theory that is compatible with an institution’s values and mission and that is easily understood and simple enough to guide practice (Kolcaba, 1996).

Patients take notice of the effort, which benefits the hospital in several ways, including higher patient satisfaction scores that can translate to more revenue.

NR 501 Theoretical Framework to Support Evidence-based Practice

Kolcaba’s Comfort Theory

Comfort Theory Model Designed by Katherine Kolcaba in 1990s.

Kolcaba describes comfort as a relief, ease and transcendence and comfort can occur in the following contexts: Physical, psycho-spiritual, environment, and sociocultural.

Kolcaba related her theory to the four global concepts of human beings, environment, health, and nursing.

Kolcaba identifies comfort as a positive concept and is associated with activities that nurture and strengthen the patients

Model Looks at the whole person  with emphasis on the manipulation of the environment such as sound, temperature, furniture 

Comfort needs occur in the mental and physical contexts of the patient

NR 501 Theoretical Framework to Support Evidence-based Practice

Human Being

Comfort is achieved when the patient’s pain needs are met. For example, in regard to pain medication administration, when the patient receives pain medication, they feel a relief from the medication’s effect on their pain. Relief is achieved. Ease comfort is focused on the psychological state of the patient (Kolcaba, 2007).


A calm and comforting environment will allow the patient’s anxiety level to decrease. The patient’s anxiety level will be reduced and thus resulting in the patient becoming relaxed and comfortable. A quiet and relaxed surrounding can be enhanced by the caring nurse and the patient’s loved ones being near.


After anxiety and pain are addressed, the patient is able to deal with the care they need and the recovery process. According to Kolcaba, health is considered to be optimal functioning, as defined by the patient, group, family, or community (Kolcaba, 2011).

NR 501 Theoretical Framework to Support Evidence-based Practice


The nurse addresses the patient’s comfort needs and creates a care plan. As the patient’s comfort needs change, the nurse interventions are updated. If the patient feels that they are being cared for properly, they will be emotionally and mentally better, which will aid in their recovery (Kolcaba, 2011).

Kolcaba’s Comfort Theory

Kolcaba (2010a,b) created a conceptual framework to show broadly how her comfort theory fits into the flow of care in the practice setting. Comfort was described as the product of holistic nursing practice. Figure illustrates that regardless of the patient and family needs for health care, there is always a place for the assessment and promotion of health care regarding comfort needs.

Comfort is an umbrella term, under which pain and anxiety fit. • Nice fit with holistic nursing practice and research

Nurses assess unmet comfort needs of patients and/or families • Nurses design comforting interventions to enhance comfort of patients and/or families • If intervention is effective, comfort is enhanced 

Enhanced comfort is positively related to engagement in HSBs 

– Comfort is strengthening  

When patients (and families) engage in HSBs, institutions have better outcomes – Patient satisfaction, nurse retention, costs down

First part of the theory – Holistic assessment of patients comfort needs – Use grid as a guide • Holistic interventions to meet those needs. – Use grid as a guide • Measurement of comfort after intervention compared to baseline comfort – Evaluation: did my intervention(s) work?

Second part of the theory – Relationship of comfort(holistic outcome) to health seeking behaviors (HSBs)

•Goals of patient, family, with nurse

External HSBs: e.g. functional status, rehab progress

Internal HSBs: e.g. healing, t-cell counts, etc.

Peaceful death: perfect for hospice and palliative care

Institutional outcomes: •Third part of Comfort Theory

•How did the intervention(s) affect the institution?

–Patient satisfaction, cost/benefit analysis, rankings, reputation, morbidity and mortality stats, staff retention and attendance, etc.

NR 501 Theoretical Framework to Support Evidence-based Practice

Increased Discomfort From Cardiac Syndromes

About 630,000 Americans die from heart disease each year—that’s 1 in every 4 deaths. 

Cardiac Syndrome characterized by angina-like chest discomfort, ST segment depression during exercise, and normal coronary epicardial arteries

Discomfort leads to lower quality of life and higher dissatisfaction

Issues such as physical activity, Sleep deprivation and anxiety needs to be addressed

Patients that present to surgery and cardiac problems are usually anxious and feel discomfort. Discomfort produces a physiological rise in catecholamines (raising blood pressure) 

Also increases cortisol which causes decreased immunity and healing (Yuan, 2014)

Discomfort leads to Anxiety caused by waiting for surgical procedure can cause feelings of abandonment, fear of anesthesia and of dying (Chandra, Raman & Kolkaba, 2016).

Acute coronary syndrome often causes severe chest pain or discomfort. It is a medical emergency that requires prompt diagnosis and care. The goals of treatment include improving blood flow, treating complications and preventing future problems (Yuan, 2014).

NR 501 Theoretical Framework to Support Evidence-based Practice


The signs and symptoms of acute coronary syndrome usually begin abruptly. They include:

Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning

Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw

Nausea or vomiting


Shortness of breath (dyspnea)

Sudden, heavy sweating (diaphoresis)

Lightheadedness, dizziness or fainting

Unusual or unexplained fatigue

Feeling restless or apprehensive

Kolcaba’s Comfort Theory for Cardiac Patients

NR 501 Theoretical Framework to Support Evidence-based Practice

It has been shown that rest promotes healing, recovery, and wellbeing

A quiet time intervention for better health

A quiet time intervention has significant potential for not only reducing noxious stimuli but also for creating opportunities for needed privacy and supportive interactions.

Quiet time interventions can prevent stimulation of the sympathetic nervous system that occurs with an environment of constant noise, bright lights, and interruption of sleep, and promote Kolcaba’s form of comfort called relief (Krinsky, Murillo & Johnson, 2014).

Patients’ exposure to increased stimuli and noise levels contributes to agitation. Quiet time can be a designated time in which patients may meditate, pray, rest, or converse with significant others. The resulting restfulness and decreased anxiety supports what Kolcaba’s form of comfort called ease (Krinsky, Murillo & Johnson, 2014).

Dimming the lights in the patient’s room and hallway can reduce unnecessary stimuli. Maintaining correct limits and volume of cardiac monitoring alarms, pulse oximetry, blood-pressure cuffs, and IV pumps can minimize inappropriate alarming. Alarms are addressed quickly, overhead paging and unnecessary conversations in patient care areas are limited, and staff and visitors are asked to speak in low tones. Health care team rounding, consultant visits, routine deliveries, and other services can be scheduled to observe periods of quiet time so as to maximize the patient’s rest time (Krinsky, Murillo & Johnson, 2014).

In the sociocultural domain, quiet time provides an opportunity to assess interpersonal and cultural aspects (Chandra, Raman & Kolkaba, 2016). This is a period of time when the nurse can have an unhurried and meaningful conversation with patients and significant others, and facilitate patient and family needs for information, respect, validation, and emotional support that promote comfort in the form of Kolcaba’s transcendence (Krinsky, Murillo & Johnson, 2014).

NR 501 Theoretical Framework to Support Evidence-based Practice


Kolcaba’s middle range theory identifies a taxonomy of factors to consider in assessment and intervention. Nurses’ practice experiences and anecdotal evidence provide additional insights into what comprises comfort care. Explicit applications of comfort theory can benefit nursing practice. Using comfort theory in research can provide evidence for quiet time intervention with cardiac patients.


NR 501 Theoretical Framework to Support Evidence-based Practice


A Study to Assess the Level of Comfort among Post Operative Children (Age 5-10 Years) by using Katharine Kolcaba Comfort Observation a Checklist and Comfort Daises at Selected Hospital of Punjab (India). (2015). International Journal Of Science And Research (IJSR), 5(5), 1024-1026. doi: 10.21275/v5i5.nov163588

Application of Katharine Kolcaba Comfort Theory in Post Operative Child: Delivering Integrative Comfort Care Intervention by using Theory of Comfort. (2016). International Journal Of Science And Research (IJSR), 5(6), 1714-1720. doi: 10.21275/v5i6.nov164670

Chandra, S., Raman, K., & Kolcaba, K. (2016). Application of Katharine Kolcaba Comfort Theory in Post Operative Child: Delivering Integrative Comfort Care Intervention by using Theory of Comfort. International Journal Of Science And Research (IJSR), 5(6), 1714-1720. doi: 10.21275/v5i6.nov164670

Kolcaba, K., & Fisher, E. (1996). A Holistic perspective on comfort care as an advance directive. Critical Care Nursing Quarterly, 18(4), 66-76. doi: 10.1097/00002727-199602000-00009

Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care research. New York: Springer.

Kolcaba, K. (2010a). Comfort questionnaires. Retrieved from. http://www.thecomfortline.com/resources/cq.html.

Kolcaba, K. (2010b). Conceptual framework for comfort theory. Retrieved from. http://www.thecomfortline.com.

Kolcaba, K., & Fisher, E. (1996). A holistic perspective on comfort care as an advance directive. Critical Care Nursing Quarterly, 18(4), 66–76.

Kolcaba, K., & Kolcaba, R. (1991). An analysis of the concept of comfort. Journal of Advanced Nursing, 16(11), 1301–1310.

NR 501 Theoretical Framework to Support Evidence-based Practice

Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort Theory. JONA: The Journal Of Nursing Administration, 36(11), 538-544. doi: 10.1097/00005110-200611000-00010

Krinsky, R., Murillo, I., & Johnson, J. (2014). A practical application of Katharine Kolcaba’s comfort theory to cardiac patients. Applied Nursing Research, 27(2), 147-150. doi: 10.1016/j.apnr.2014.02.004

Seyedfatemi, N., Rafii, F., Rezaei, M., & Kolcaba, K. (2014). Comfort and Hope in the Preanesthesia Stage in Patients Undergoing Surgery. Journal Of Perianesthesia Nursing, 29(3), 213-220. doi: 10.1016/j.jopan.2013.05.018

Yuan, S. (2014). Fetal cardiac interventions: an update of therapeutic options. Revista Brasileira De Cirurgia Cardiovascular. doi: 10.5935/1678-9741.20140099

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