The advances in science and technology translates to higher life expectancy. Hence, the
populations aging in a society that can prolong life and delay death provides a chance to predict
the gradual increase in the pervasiveness of degenerative and incapacitating diseases. In addition,
recently the process of end-life has shifted from the home context to hospital environments. In
this context, there has been a steady increase of palliative care units with the objective of
offering the greatest comfort and dignity achievable for patients and their families concerning the
life-threatening condition. Nonetheless, patients with severe conditions still endure discomfort.
This may be attributed to the fact that patients have numerous comfort needs that exceed the
physical symptom interventions. However, research continues to emphasize attainment of
physical comfort while little attention is directed to other factors that contribute to patients’
wellbeing. Kolcaba proposes the Theory of Comfort, a middle-range theory that applies in a
clinical setting to enhance patient wellbeing. Kolcaba's theory is based on patient needs and
comfort management, where the patient and the family are accorded specialized care to improve
the quality of life. Kolcaba's theory's dominant focus is comfort administration to ease distress,
get rid of pain, and lessen severity of symptoms and mitigate stress among patients with
protracted disorders such as cancer (Kolcaba, 2018). In this regard, this paper will include a
description of the theory, rationale for selecting, theory application in the nursing practice, the
barriers to implementation, and the strategies for overcoming these challenges to evaluate its
suitability in solving practice problems.
Katharine Kolcaba's Theory of Comfort is a novel development that offers a holistic and
foundational approach to comfort management, which is essential to address patients' varying
health needs. Initially, Kolcaba considered that patients exhibit holistic reactions to a composite
stimulus (Kolcaba, 2018). As such, comfort becomes a necessary holistic outcome that tries to
fulfill the comfort demands of patients. The responsibilities for nursing officials is to assess the
comfort needs of their patients and enhance their capacity improve their health status and achieve
Kolcaba's definition of comfort emerges in three fronts: relief, ease, and transcendence.
These aspects prevail in the physical, sociocultural, environmental, and psycho-spiritual contexts
(Kolcaba, 2018). Patients can attain satisfaction and contentment when they are relieved from
distress. For instance, patients can experience relief from pain by taking a pain suppressor.
Another form of comfort is ease from baggage, especially when the patient feels anxious
(Kolcaba, 2018). In this case, nursing professionals focus on eliminating the factors that are
causing anxiety. When patients achieve ease, they tend to be content with health practices and
their environment's different aspects. Lastly, transcendence helps patients to overcome their
challenges to restore a state of wellness and satisfaction (Kolcaba, 2018). Succinctly, the patient
achieves a state of contentment and satisfaction if the comfort questions are adequately
addressed. Thus, the comfort theory assumes a patient-centered approach in care to enhance the
care patients receive.
However, despite the universality of the theory to various facets of the nursing practice, it
has a lower level of abstraction and is limited in scope. As a middle range theory, Kolcaba’s is a
framework that carries a smaller scope compared to grand nursing theories. However, they
include fewer testable concepts and relationships from different sources. Kolcaba's comfort
theory fits the description of a middle range theory as she explicitly describes different concepts
and their relationships. Besides, these concepts are applicable in various contexts, including
hospices, peri-operative, pediatric care, and palliative care. Indeed, the prominence of theory in
scholarly efforts is due to its application to different situations since development in the 1990s.
The Rationale for Selecting this Theory
The rationale for selecting Kolcaba's Comfort Theory is that it meets the criteria proposed
by Chinn and Kramer for evaluating a nursing theory. These theorists propose the evaluation of
concepts for clarity, simplicity, and generality. They also emphasize the significance of
determining the empirical precision of philosophies (Chinn & Kramer, 2013). Since nursing's
goal is to enhance the quality of life, Kolcaba’s Comfort theory can be used in a range of
contexts to elevate the patient's status. The simplicity of Kolcaba's theory makes it easy to
comprehend among healthcare providers. Besides, the empirical precision of the theory has been
tested and verified. Kolcaba also develops numerous questionnaires to evaluate patients' comfort
(Kolcaba, 2018). These questionnaires help nursing professionals to visualize comfort in a
holistic approach. In addition, they are vital when burses are assessing the patient’s comfort
scores before and after interventions.
Another inspiration for selecting this theory is that it carries practical applicatiosn to the
field of nursing. Kolcaba discusses ease, relief, and transcendence as the main forms of comfort
(Kolcaba, 2018). Recovery nurses prescribe pain suppressors lessen pain for patients. In addition,
they utilize various strategies to eliminate the factors that cause discomfort among patients
besides enabling them to overcome these challenges. Kolcaba posits that comfort is holistic,
distinguishing the three types of comfort (Kolcaba, 2018). She identifies that pain and anxiety
prevent patients from experiencing comfort. However, she is cognizant that comfort does not
imply the total absence of discomfort.
Utilizing the comfort theory promotes healthcare professionals understanding of the
different concepts and their relationships. Due to its simplicity, the theory is widely adopted to
influence patient care (Coelho et al., 2018). Additionally, the theory can be generalized to fit
different situations to provide a clear framework that nurses can use to address patients' health
needs. The questionnaire bit is also crucial as it allows nurses to evaluate the effectiveness of
interventions and make appropriate adjustments to enhance the care plan (Coelho et al., 2018).
Due to its adaptable features, nurses consider the comfort theory a valuable approach to meeting
patients' diverse comfort demands.
Pain is a major cause of suffering among patients with chronic illnesses, making comfort
management a priority in the care plan adopted for palliative care. The initial step in comfort
management involves assessing for pain (Krinsky et al., 2014. Utilizing Kolcaba's theory, the
various contexts, concepts, and comfort forms become an integral tool for comprehensively
measuring pain intensity, frequency, breakthrough, precipitation, and distribution (Chandra et al.,
2016). The approach also allows for the evaluation of patients' history of the use of analgesics.
When assessing pain, a combination of questions and direct observation can perform a
comprehensive analysis. In conformity with Kolcaba's proposition, the World Health
Organization cancer pain ladder provides an inexpensive and effective pain evaluation resource
and management resource.
The outcomes of the pain assessment inform the intervention measures for the specific
patient. Nurses can enhance the condition for patients suffering intermittent and mild pain by
administering non-opioid-based pain relievers, including acetaminophen, aspirin, ibuprofen, or
paracetamol. If a patient's pain score indicates persistent mild pain, physicians can administer
mild opioids such as codeine (Figueiredo Lima et al., 2016). However, nurses can administer
stronger opioids, such as morphine, for patients with severe pain. The use of opioids to elevate
cancer pain earns support because they are highly effective besides presenting mild side effects.
Healthcare providers can utilize a range of alternative interventions to improve patients’
conditions and promote comfort in palliative care. For example, hormonal therapies, including
anti-androgen for prostate cancer or anti-estrogen drugs, may be applied for breast cancer to
alleviate metastatic pain and enhance patients' quality of life (Coelho et al., 2018). Besides, such
alternative interventions as physiotherapy, psychotherapy, acupuncture, homeotherapy, herbal
medicines, and massage can also be used to effectively manage pain among patients suffering
from chronic pain.
Barriers to Implementation
The comfort theory can be critical to provide guidelines for enhancing nurses' and
patients' comfort and improve care environments. However, in reality, it is difficult to
accomplish comfort intervention due to staffing constraints (Krinsky et al., 2014). Although
facilities may have goodwill to enhance comfort environments in line with the comfort theory,
resources may restrain them. To get around this challenge, hospital managers have to balance
their budgetary allocation for the organization's operations.
Another barrier to implementing Kolcaba Comfort theory is that insurance companies
place limitations on the reimbursements of health services rendered by institutions (Krinsky et
al., 2014). This limitation increases the financial burden for health facilities and cost of care.
Thus, hospitals have to confine their services with their allocation. To circumvent this issue,
healthcare facilities are billing clients for special amenities.
Lastly, due to the enhanced quality of care, facilities are likely to register an increased
number of patients. In this situation, nurses have no alternative but to attend to an increased
patient population (Chandra et al., 2016). Working arrangements where the number of patients
overwhelm the available nursing staff results to pressure and discomfort on the nurses. One way
of addressing this challenge is by increasing the number of healthcare specialists in the facility.
In summary, Kolcaba’s comfort theory assumes critical importance given the practical
applications that it carries for the field of nursing. One of the prominent ways that the Comfort
theory enhances the quality of nursing care is by making it possible to integrate all contexts of
wellbeing including the physical, sociocultural, environmental, and psycho-spiritual. This
integration enables professionals to provide acceptable services and engage patients and their
families in care management. Besides, it is critical to enhance the health outcomes of patient and
promote their comfort. This approach underlines the significance of Kolcaba's Comfort theory in
provide comfort care and comfort management. Besides, comfort is critical to enhancing the
health outcomes by fostering satisfaction and contentment. Thus, nurses must distinguish the
comfort needs of patients to implement suitable interventions. Besides, they must be conscious
of the different forms of comfort, including ease, relief, and transcendence, to deliver quality
care. The proposition is also applicable to other nursing fields such as hospices, pediatric, end of
life, and peri-operative, among others, due to its simplicity and generalization aspects. Also, the
clear definition of concepts and their relationships makes it easy to understand and apply.
Arguably, Kolcaba delivers a proposition that holds the potential to transform patient care
Chandra, S. M., 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-
Coelho, A., Parola, V., Sandgren, A., Fernandes, O., Kolcaba, K., & Apóstolo, J. (2018). The
effects of guided imagery on comfort in palliative care. Journal of Hospice & Palliative
Nursing, 20(4), 392-399. https://doi.org/10.1097/njh.0000000000000460
Figueiredo Lima, J. V., Guedes, M. C., Silva, L. F., Freitas, M. C., & Fialho, A. V. (2016).
Usefulness of the comfort theory in the clinical nursing care of new mothers: Critical
analysis. SciELO – Scientific Electronic Library Online.
Kolcaba, K. (2018). Kolcaba's comfort theory. Nursology. https://nursology.net/nurse-theorists-
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.