A Theory of Holistic Comfort for Nursing

A Theory of Holistic Comfort for Nursing

Abstract

Comfort is one of the significant influences on the experience of a patient despite the environmental and health condition. However, there is no consensus on its definition by past researchers. This research is, therefore, aimed at understanding comfort from the experience of patients undergoing care and the nurses who actively play the role of ensuring that comfort. The research will include both theoretical and qualitative analyses of studies that have advanced knowledge of the Theory of Holistic Comfort in Nursing.

A Theory of Holistic Comfort for Nursing

Introduction

To understand Clinical nursing care, the research paper seeks to first define the meaning of clinical from the Greek word klinos. Klinos means reverence or inclination and consideration of the suffering a patient undergoes. Clinical nursing care, therefore, involve viewing the sick as beings with several dimensions, including Physical, social, spiritual, and emotional aspects. It also involves putting into consideration individuals’ unsafe conditions, which compromises their general health and cause discomfort. Additional, it takes into account the perception of the sick individual under care.

Nursing involves sensitive and prompt healthcare provision that meets the patients’ needs by promoting their wellbeing and comfort (Lima et al. 2017, p1). The health care provides both emotional and physical support with an aim to assist patients in adapting to the condition they are in. Nursing care also helps caregivers handle health problems that affect patients by ensuring technical competence and encouraging a sense of humanity.

In nursing care theory, diagnoses, care prescriptions, and scientific support for any nursing action is described. The theories serve as a means of assisting nurses in identifying solutions addressing problems that the patients present. Numerous models verifying the application of nursing care exist, which gives nurses the option of choosing which of the models effectively address the aforementioned challenges by critically selecting them and their use to different clinical contexts.

Literature Review

Different nursing and health care literature in electronic databases such as Pub Med and google scholar were reviewed to obtain relevant information on holistic comfort for nursing. The literature covered included sociology, nursing, and psychology disciplines. The study examined both qualitative and quantitative research. Studies were excluded based on language and nurse involvement in performing comfort intervention procedures. The exclusion was based on the rationale that the theory only applied to nursing procedures, and therefore, procedures performed by other healthcare providers did not apply to the study. Additionally, the study was patient-focused nursing interventions. Therefore comfort measures that could not be performed by the nurses were not relevant to the study proposed.

Generally, the Pediatric population studied did not clearly define the concepts of holistic comfort. Most research viewed comfort as the opposite of anxiety, pain, distress, and fear. The conclusion came from the fact that the mentioned words had a relationship with comfort in most of the reviewed literature. Comfort studies covering comfort resulting from entertainment, therapy, and caregiver facilitated processes offered knowledge on pain, fear, and distress reduction procedures but failed to touch on historical concepts of comfort.

Historical Perspective of Comfort

Holistic nursing comfort has significantly changed for the last five decades. However, the meaning and understanding are still lacking clarity, and most comfort concepts discussed in the previous literature is viewed as an evolving issue (Bice, 2015, p24).  Over the years, the definition of comfort has had minimal consensus even though there has been a consensus that it’s a basic need and has to be addressed first before addressing the healing process(Williams et al. 2017, p2). A holistic theory developed by Katharine Kolcaba and several other authors focused their studies on the adult population. Most recommendations from these writers mainly included the integration of comfort theory into nursing practice. Kolcaba, in her work, defined comfort as experience in which an individual gets immediate strength through relief, ease, and transcendence (Bice, 2015, p24).

The literature revealed that comfort theory clarification and development in nursing started in 1990. However, the comfort and comfort idea intervention dated back to the environmental theory by Florence Nightingale. In the theory, Nightingale discusses the passage that speaks about the fresh air a patient needs to breathe, similar to the air outside. The passage mentions air free from toxins and smell and temperature that is not very cold. In the past 30 years, the researcher has discovered the concept of comfort as an issue that required investigation, analysis, and precise interpretation.

Besides Kolcaba, others also carried studies to conceptualize comfort. One such author was Morse, who studied comfort while conducting an analysis of what reconstitute science and the individual practices of looking after themselves. This concept explained the act by humans to comfort and its relationship to nursing. In another study by a different author covered the needs of the older individuals and the role nursing played towards promoting comfort.  One other researcher investigated the perception of comfort by patients with chronical diseases which built up Jones’ work. In 1990 Andrews and Chrzanowski investigated the effects of upright positioning against recumbent positioning on the comfort level of women in labor during childbirth.

One other researcher argues that even though the reason for nursing was mainly to provide comfort, helping the patients to attain, it was not entirely possible. This propelled another researcher to investigate the comfort of the nurses and their ability to make decisions based on moral principles. For this research, the major finding showed that nurses served the primary function of communication and mediation by applying patient comfort and their own comfort criteria to make choices they deemed good and morally acceptable in nursing.

Comfort Studies

This research review two significant pieces of research conducted by Kolcaba by focusing on cognitive strategies, end of Life Comfort, and hands-on comfort to establish the theory of holistic comfort for Nursing. The theory was developed through concept analysis of comfort carried a literature review from different subjects such as nursing, ergonomics, and psychology. After analysis, Kolcaba introduced used four contexts of holistic experience and introduced three forms of comfort (Nursing). Kolcaba defined comfort as a product of Holistic Nursing.

In an investigation by Kolcaba on “effects of guided imagery on women with early-stage breast cancer” who were at the time undergoing radiation treatment, participants self-reported their comfort levels in three various stages of treatment. The study established that the participants who received imagery comfort intervention registered level of comfort that had significantly increased over the treatment duration. A similar study with women who had urinary bladder syndrome yielded same results imagery comfort intervention in another study using a like intervention and generating similar. Studies targeting adults were numerous compared to those targeting children. Previous research showed that the disparity resulted from an unclear or limited understanding of holistic comfort and a lack of holistic procedural comfort designated for children. However, Kolcaba and other researchers found that their theory propositions yielded positive results essential for the operationalization of those theories in adults.

Method

Research methodology resorted to qualitative literature to understand the perspective of patients on nursing comfort. The databases were searched with keywords comfort, holistic, procedures, and Comfort theory. The keywords were used due to their relation to holistic nursing care. The keywords were used as one single search or sometimes a combination of the words. On the other hand, comfort studies involved a search, inclusion, or exclusion of peer-reviewed articles published within the last five-year period.

Literature included was based on past research that targeted the development of comfort concept. The study included inquiries analyzing comfort concepts and concepts that investigated different patients’ and nurses’ perspectives. The research excluded were ones that had no relevance to healthcare, did not include the perspective of patients, and did not use quality data. Research abstracts and titles underwent eligibility criteria with date restrictions.

Data

Used data was drawn from features and definitions of comfort concepts. The data also included comfort conditions, comfort characteristics, and outcomes of previous studies. The research also extracted data detailing the patient’s perceptions and experiences, the factors that influence these experiences and interventions targeting to improve these factors.

Results

Electronic searches under keyword nursing comfort theory in google scholar database returned 262,000 research articles. Search applying all inclusion criteria, including the date range between 2014 and 2019 and article titles with the keywords returned nine articles. The searches on the PubMed database with the same keywords returned 220 results. Applying search criteria, which include a review article, 191 articles were excluded. Three articles were excluded when full-text review criteria were used. Further publication dates spanning the last five years returned five articles meeting all the search criteria.

Out of 14 qualitative research 10, studies were explored focusing on nursing comfort was explored from both the patients’, nurses’, and researchers’ perspective. The setting for the studies analyzed included the emergency departments, pediatric wards, surgical and medical wards in residential care, and general medical facilities. One study focused on the child’s comfort while the other studies majorly focused on the comfort of adult patients. Two of the studies explored the perception of nurses about comfort and comforting behaviors between patients and nurses. Two of the studies focused majorly on the patient’s perspective of comfort based on the quality of care, trust developed, and spiritual considerations.

Discussion

Most studies reflected on the comfort theory and the philosophy behind the support changes in clinical nursing care for families, communities, and individuals.  For comfort to be, there must be an absence of suffering, concern, and pain (Mendes et al. 2016, p2).  Researchers and theorists concluded that patients, no matter which disease they are suffering from, hope to receive individually customized, culturally sensitive, and skilled health care from caregivers. It necessitates nursing that care be directed to address both the psychological and physical needs of the patient. To ensure comfort, the care should also target the needs expressed by the patient while undergoing care. The study helped us understand comfort theory by reflecting on the nursing care that is conducted individually, resulting from caregivers understanding the needs of each patient. Due to this, Nurses have to develop the appropriate skill set to be able to understand and create a relationship between concepts, practices, and knowledge of Nursing theory. The skills will also help them apply the theories in their professional practice and produce comfortable care for their patients.

Comfort is, therefore, as a result of nursing care, while comfort needs are deficiencies that patients identify as a result of stresses caused by negative health situation (Barbosa et al. 2014, p852). To achieve comfort, the actions of the nurse is determined by the measures of comfort to meet healthcare needs. Consistent implementation of the nursing actions has a direct correlation hence improving comfort.

Previous research defined a patient as an individual, group of individuals, including family or community who require healthcare. A nurse, on the other hand, is an individual who carries the health assessment to determine the comfort needs and determine which actions to implement to meet the comfort needs. Health is the patient’s condition in relation to an individual’s ideal function facilitated by actions that address comfort needs.

Concepts of Nursing Theory

There are key concepts that stand out from the research on nursing theory. These concepts include comfort, comfort measures, health-seeking behaviors, Intervening variables, and Institutional integrity (Lima et al. 2016). Comfort, as explained earlier, is just the desired outcome due to nursing, which provides holistic strengthening experience through the satisfaction of the need for pain relief, transcendence, and tranquility in the social, cultural, physical contexts.

The next concept focuses on the patient’s comfort needs, which are basically identified by the patient as opposed to the nurse’s assumption. These needs are determined by the patients’ or the patient’s family’s practices and spiritual context. Comfort measures, frequently defined as interventions undertaken by the nurse to address the patients identified needs. The measures focus on social, financial, spiritual, physical, and psychological needs. Health seeking behavior is a concept representing different subsequent health-related outcomes. The outcomes depend on the definitions provided by the patient in consultation with the nurse administering the care. Intervening variables in nursing are the factors that do not change, and both the nurse and the patient have very little to no control over. Such factors may include social support, prognosis, and financial status.

Comfort Dimensions

Research reviewed that comfort forms a significant part of most patients’ experience during care. Comfort occurred as a result of pain relief, relief from physical discomfort, and many other factors that varied from the current frameworks focusing on the experience of patients. The research found that comfort crosses numerous dimensions. It also identified that it would form an important determinant of success in any healthcare approach. The first dimension is the physical dimension, which includes relief, ease, and transcendence. The second dimension forms the context in which comfort occurs and mostly constitutes psychological, environmental, and psychiatric factors.

Limitations and Implications

The first online search was comprehensive, but the research was limited because some studies relevant to the research might have been missed, especially those that are dated before 2014. Secondly, in trying to stick to the objective of the study, some of the complexities of the data might have been lost in the course of analysis. Isolation of these important areas might have cause variation from the common conclusion that comfort results from lack of illnesses and extend to other factors. However, the limitations also may require further study to create a better theoretical framework that considers comfort based on culture.

Conclusion

This research, which majorly focused on both the patients’ and nurse’s perspectives of comfort during care, majorly formed the basis for judging the patients’ experience and overall perception of comfort. The study also managed to identify several other influences of comfort that could be modified into a nursing framework to help guide practices in the nursing profession and improve the quality of interventions that promote comfort. Comfort, however, majorly depended on the context, which subsequently dictates that decisions to improve comfort in the nursing practice must take into account the perspectives of the patient under the influence of culture, spirituality and healthcare conditions.

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