Middle Range Theory: Kolcaba’s Comfort Theory

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Middle range nursing theories provide a bridge between grand nursing theories and actual nursing practice. While they contain abstract concepts as grand theories do, their frameworks provide the ability to apply concepts to evidence-based practice more readily than grand nursing theories. The purpose of this essay is to examine a middle range theory and its applicability to clinical nursing practice.

The middle range theory selected to examine within the context of nursing practice is the Comfort Theory, developed by Dr. Katharine Kolcaba. According to the theory, comfort is an immediate and desired outcome from nursing care (Kolcaba, 1994). The theory explains that comfort exists in three forms: relief, ease, and transcendence (Kolcaba, 1994). Relief addresses comfort when a patient’s needs are met, ease refers to contentment, and transcendence refers to a state of comfort in which patients are able to rise above their challenges (Kolcaba, 1994). The theory also addresses four specific contexts for comfort: physical, psychospiritual, environmental, and sociocultural (Wilson & Kolcaba, 2004).

This theory takes a holistic approach to nursing practice and processes, viewing the patient as more than a collection of symptoms or a diagnosis, but an entire person with complex and varied needs. Within this nursing theory, the nursing process assesses the patient’s comfort needs through evidence-based practice, develops and implements an appropriate nursing plan to address those needs, and evaluates the patient’s comfort after implementing the plan (Kolcaba, 1994).

This nursing theory is highly applicable to clinical nursing practice in a variety of settings for a variety of patients. There is a clear link in current literature between a patient’s overall health status and his or her comfort levels. Therefore, including comfort as an integral part of nursing care would logically benefit the patient’s healing process and achieving his or her health goals.

Krinsky, Murillo, and Johnson (2014) show the applicability of Kolcaba’s Comfort Theory to cardiac patients using an intervention referred to as “quiet time.” The authors point out that “[w]ithout realizing it, many nurses may practice within Kolcaba’s theoretical framework to promote patient comfort” (Krinsky, Murillo, & Johnson, 2014, p. 147). This article not only shows the benefits of this type of intervention for improving the comfort levels of patients but that it is easily integrated into nursing practice. Nurses are often concerned about their patients’ comfort levels, and the Comfort Theory provides a framework with which nurses can address these specific types of comfort patients need in nearly any care setting.

One of the benefits of this framework for nursing care is that its adaptability extends not only to a variety of care settings but to the integration of additional nursing theory frameworks. Comfort can be a highly subjective matter, particularly in light of the four contexts identified by Kolcaba. As a result, each patient will require something different to achieve comfort. For example, in the context of sociocultural comfort, a patient may be uncomfortable because of a lack of culturally sensitive care. To correct this discomfort, the nurse would employ a framework of transcultural nursing, ensuring that the patient has culturally sensitive care to meet those specific needs.

While not all nursing theories are applicable in all care settings, Kolcaba’s Comfort Theory is one that has significant applications throughout nursing care. By employing this theory, nurses will not only be equipped to provide for the specific needs of their patients but will be able to be integral in the achievement of their goals and help them work toward health.

References

Kolcaba, K. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19(6), 1178-1184. doi: 10.1111/j.1365-2648.1994.tb01202.x

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

Wilson, L. & Kolcaba, K. (2004). Practical application of Comfort Theory in the perianesthesia setting. Journal of Perianesthesia Nursing, 19(3), 164-173.