Theory Connections
A practical application of Katharine Kolcaba's comfort theory to cardiac patients

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Abstract

Nursing approaches to care as based on Katharine Kolcaba's (2003) middle range nursing theory of comfort are discussed in reference to patients' suffering from symptoms related to the discomfort from cardiac syndromes. The specific intervention of “quiet time” is described for its potential use within this population as a comfort measure that addresses Kolcaba's four contexts of comfort: physical, psychospiritual, environmental and sociocultural. Without realizing it, many nurses may practice within Kolcaba's theoretical framework to promote patient comfort. Explicit applications of comfort theory can benefit nursing practice. Using comfort theory in research can provide evidence for quiet time intervention with cardiac patients.

Section snippets

Case study 1

It has been shown that rest promotes healing, recovery, and well-being (Tullmann & Dracup, 2000). However, the hospital environment presents unique challenges for patients to obtain rest periods. Consider the following case of a patient admitted to the hospital with diagnosis of suspected acute coronary syndrome:

John arrived at the emergency department with complaints of chest pain. He is certain this is the “big heart attack” his father had. He is taken to the main emergency department, which

Comfort theory

Kolcaba, 2010a, Kolcaba, 2010b created a conceptual framework (Fig. 1) 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. Fig. 1 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.

Kolcaba's theory of comfort was first developed in 1991 when she conducted a concept

Comfort theory applied to care of cardiac patients

Kolcaba's Comfort Theory is readily applicable to cardiac patients. Table 1 presents an example of applying comfort theory to the case study of John and his comfort needs. Data from the case study were entered into the 12 cells of the table, organized according to the four contexts of care and the three types of comfort needs. John's specific comfort needs are indicated in the relief column. Entries in the ease column point to interventions for promoting a sense of calm or contentment in John.

Quiet time intervention

A quiet time intervention has significant potential for not only reducing noxious stimuli but also for creating opportunities for needed privacy and supportive interactions. Research findings have shown that quiet time can improve patient outcomes and increase consumer satisfaction with acute care health services, both of which are of increasing importance in the contemporary health care environment (Gardner, Collins, Osborne, Henderson, & Eastwood, 2009). Other research findings indicate that

Case study 2

In contrast to the first case study above, the following case is an example of a patient admitted to the hospital with diagnosis of suspected acute coronary syndrome where the care providers applied quiet time interventions from comfort theory.

James arrived to the Emergency Department with complaints of chest pain. The Emergency Department has a designated chest pain observational unit that is completely separate from the main area. After patients are quickly triaged, they are taken to the

Research implications: Next steps

Quiet time is an intervention that has been evolving in practice but research is needed to validate its usefulness and refine its applications in specific patient settings.

While anecdotal reports of nurse and patient satisfaction with quiet time are positive, systematic study is needed of measurable outcomes in cardiac patients to see if and how it affects patient anxiety, physiologic parameters (heart rate and blood pressure), pain and comfort. Additionally, research into the effects on nurses

Conclusions

Nurses have resources from their theories and their practice to guide research into comfort-focused interventions for patients. Nightingale's ideas provide a significant foundation for considering all dimensions of the patient and environment that relate to comfort. 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. These

Acknowledgments

We would like to acknowledge Dr. Pamela Reed, PhD, RN, FAAN and Dr. Joyce Fitzpatrick, PhD, MBA, RN, FAAN for their support, guidance, patience and useful feedback in the preparation of this manuscript.

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