Concept Analysis: Comfort

Kelly Mulholland

Chamberlain College of Nursing

NR 501: Theoretical Basis for Advanced Nursing

Spring 2016

Concept Analysis: Comfort

A concept is an abstract idea or a general belief (Townsend& Scanlan, 2011). Analyzing a concept will clarify the meaning to both authors and learners. This clarity is vital when conduction and presenting research. The concept that will be analyzed in this work will be comfort and Katharine Kolcabas’s comfort theory will be used to examine this concept.  Katharine Kolcabas’s comfort theory will be examined and evaluated using Walker and Avant’s eight steps of concept analysis. The rational for choosing the concept of comfort will be detailed. All possible uses of the concept will be considered. Defining attributes of comfort will be discussed. Followed by identification and explanation of a model case as well as a borderline, related contrary, invented and illegitimate cases.  Antecedents and consequences of this concept will be addressed. Lastly Empirical referents will be identified (Walker and Avant, 2011). 

Purpose of the analysis

            Comfort is a need all humans have from birth.  Comfort is a familiar idea to many people but how comfort is experienced is unique depending on many factors.  Comfort is defined by Oxford Dictionaries (2016), as a “state of physical ease and freedom from pain or constraint; the easing or alleviation of a person’s feelings of grief or distress. Performing a concept analysis of comfort will provide a deeper understanding to the concept which will in turn make it easier to apply it to practice.Nursing care aims to provide immediate relief of discomfort through interventions. Comfort is a priority in nursing care. Her theory describes four elements of comfort; it’s a basic human need, it is experienced holistically, self-comfort may be healthy or unhealthy, if comfort is achieved in a healthful way it could lead to greater productivity for the patient (Oliveira, 2013).

Literature Review

The main goal of a concept analysis is to define its attributes(Townsend& Scanlan, 2011). Delineating attributes is followed by analyzing and reviewing literature for reoccurring themes and ideas in the concept. Despite the fact that the term comfort is common in nursing literature, research on the concept limited. It could be understood that the concept is taken for granted.  Literature on comfort is commonly intertwined in oncology nursing or end of life research studies. Literary review began with Katharine Kolcaba theory of comfort and was uses as a framework of defining parameters and attributes of comfort. Literature was located using online computer databases of CINAHL ESBCO and Pubmed.Ångström-Brännström, Dahlqvist, Strandberg, & Norberg(2014), discusses the importance’sproviding comfort to the patient and family based on the patient’s unique needs. This article details the importance of providing care specific to the needs of a dying child and their family. This article explains ways to provide comfort to the unique needs of a patient. How providing comfort could be a team approach to providing comfort could be useful. Larson (2013)described comfort in terms of relationship. The article was short and concise it also had it made very useful points related to how the patients are more comfortable and confident when they have established a positive relationship with their caregivers. It discussed how imperative it is to build a strong relationship with patients in order to help them achieve comfort Kolcabas’s comfort theory main principles are correlate to the themes of the above two articles and it divides the concept of comfort into physical, psychological, sociocultural, and environmental factors. The purposeful comforting interventions of nurses promote optimal outcomes for patients and their families. This results in patients engaging in health-seeking behaviors which results improves their overall health and comfort (Krinsky, Murillo, & Johnson, 2014).

Uses of the concept

Enhanced comfort is directly related to optimal patient outcomes as well as shorted hospital stays (Fleming, Scanlon, & D’Agostino, 2011).  Patients who report experiencing comfort also provide positive reviews on patient satisfaction surveys. Patient safety and outcomes are a priority for hospital staff and administrators as well as receiving positive reviews on hospital surveys. Improved understanding of comfort will help nurses to better understand and apply their knowledge of the concept to direct practice. Improving comfort for patients will also improve revenue for hospitals.  Also developing a better understanding of the concept of comfort could allow for researcher to create a stronger theoretical foundation (Hou, Zhao, Feng, Cui, Wang, & Wang, 2014).  Presentation of research related to comfort will be better understood after the concept is clarified.

Defining Attributes

According to Walker and Avant (2011), “Defining attributes are consistently occurring characteristics of a concept that help differentiate it from others.” After a thorough investigation of Kolcaba’s comfort theory there are four prominent attributes that can be identified. The attributes are; everyone will attain comfort in a unique way though involvement and communications, comfort is what a person believes it is, how comfort is experienced is effected by physical, psychological, sociocultural, and environmental factors, also the fact that relief ease and transcendence are often achieved through caring relationship with nurses or other healthcare providers (Krinsky, Murillo, & Johnson, 2014).  After comparing these attributes to the ones found from the literature review, it can be said that relationships (Larson, 2013) and self-characteristicswere the two mainreoccurring attributes. Relationships are defined as the person’s interactions with the people in their environment and self-characteristics are a person’s cultural background and other environmental factors that shape them into who are they are. It is imperative to understand the attributes associated with the concept of comfort because creating clarity and a proper definition will allow the for the comfort work of nurses to be recognized (Oliveira, 2013). These two reoccurring attributes are a good fit because patients will seek and experience comfort uniquely because of prior past experiences and how they perceive the world around them.

Model Cases

A model case can be ascenario that includes all of the defining attributes of the concept. The author can choose to create this form real life experiences, previous reviewed literature, or creating by imagination (Townsend&Scanlan, 2011). This model will be based on a real-life experience of a registered nurse on an assignment in an emergency department. Steven is a 6-year-old Christian child who has been admitted to a Chicagoland hospital after a fall from a tree for a laceration to his face and a severely dislocated shoulder requiring surgical intervention. His pain was treated with morphine. The nurse caring for him explained each treatment and procedure prior to providing them as well as asked the patient and family if they had any questions. The nurse also assessed the family’s responses to ensure they understood what was happening. When examining Steven, the nurse made sure to remain calm and talk softly in language that was age appropriate for him.  The nurse kept him engaged by communicating to the stuffed tiger he was holding in his arm. After the assessment the nurse lowered the lights and proved him with a warm blanket. Stevens mother holds him close to her chest and hums the rhythm of lullabies to him until he slips in to a deep sleep. Prior to surgery the families pastor comes to the patient’s room and they all pray together. In this model case there is a team effort between the hospital staff, family and clergy all who have an important relationship to the patient to promotes comfort. In this case the factors of physical, psychological, sociocultural, and environment are incorporated enhance comfort. Steven and his family are Christian they find comfort in following their cultural belief of having a pastor pray for them during this time of need (Cheraghi, Manookian, & Nasrabadi, 2014).

Alternative Cases

Borderline Case

A borderline case as a scenario includes most of the defining attributes of the concept, but differs considerably in one of them(Townsend&Scanlan, 2011). Now the case of Will shall be examined. Will is a patient of Karen a nurse practitioner at a local primary health practice. Karen has been seeing Will at this practice for several years. Will is a type I diabetic and is coming in to have his hgba1c checked. After some small talk between Will and Karen they go over his test results. Will enjoys talking to Karen and this conversation makes him feel comfortable to talk to her especially about some lifestyle changes he has made. Karen explains to Will that his A1C has risen. Will looks upset and explains that he has made a huge change in his lifestyle and he feels he is eating better that ever. They continue to discuss his current diet. Karen notes that though his diet is low in refined sugars it is high in carbohydrates. Will explains to Karen he has become a Vegan. Karen makes a surprised face and tells will that this type of diet does not include enough protein and it will be hard to lower his carbohydrate in take without proteins from animal sources. Karen continues to stress the importance of eating lean meats in order to meet his daily protein requirements. This makes will uncomfortable so he silently accepts the list of diet recommendations provided by Karen and leaves the office. While at home Will is able to find an appropriate diet for him that conforms to his vegan principles. This example displays all attributes associated with the concept of comfort but Karen did not consider Wills beliefs when creating a treatment plan. Despite the fact that Karen wanted what was best for her patient, ignoring his need for comfort and consideration created a plan that would not work for him. This left Will without a plan he felt comfortable with a had to find his own treatment plan.

Contrary Case

            Contrary cases are examples of what the concept is not (Walker and Avant 2011). In this example Will and Karen will be used again.  In this scenario Will is quickly brought back to the exam room. Karen enters the room and explains they are very busy in the clinic to day and doesn’t have much time to talk. She seems extremely rushed. She tells Will his A1C results and that they are elevated and if he doesn’t want any complications he better change diet. There is no small talk all questions asked by Karen are closed ended which leaves no room for further conversation or education. Within a few minutes the visit is over Karen has moved on to her next patient and Will leaves the office overwhelmed and confused. Will gets home and because he felt so uncomfortable with Karen calls another practice to follow up with these new test results. This example shows the consequences of not providing comfort to a patient even during a routine office visit (Larson, 2013).

Antecedents and Consequences

Antecedents are the conditions that must exist prior to the occurrence of a concept(Townsend&Scanlan, 2011). Prior to comfort the most identified antecedent is distress or comfort(Krinsky, Murillo, & Johnson, 2014). Discomfort is commonly connected to an unmet need if the nurse can meet this need the patient will experience comfort. According to Kolcaba (2011), “In order for a person to be in a state of contentment, it not necessary for him/her to be in a prior state of discomfort. “Consequences are the results of the occurrence of the outcomes of the concept (Townsend& Scanlan, 2011). A common consensus among the literature a consequences of comfort will be the associated with the end of discomfort or need will be met. Other consequences will be, a pleasing experience, a feeling cared for (Larson, 2013),also the relief of pain, reduced suffering and a sense of inner peace (Krinsky, Murillo & Johnson, J. 2014).  These consequences can be attributed an end to discomfort and increased quality of life.  Quality of life has four dimensions: physical, psychological, social, and spiritual which need to be addressed in order for comfort to be achieved (Ångström-Brännström, Dahlqvist, Strandberg, & Norberg, 2014). In summary discomfort or an unmet need in one of the dimensions of quality of are comfort antecedents and the consequence of achieving comfort would be an improvement of the quality of life.

Empirical Referents

After identifying the attributes for a concept the next step would be to define Empirical referents. According to Townsend & Scanlan (2011),”categories or classes of phenomena that, by their existence demonstrate the concept itself.”  Comfort is a concept that is at the heart and soul of nursing. It is a priority the nurses provide comfort to patients and their families through interventions. The importance of the concept of comfort is supported by its incorporation into national electronic databases, including the National Interventions Classification (NIC), National Outcomes Classification (NOC), and the North American Nursing Diagnosis Association (NANDA).

Conclusion

After completion of the concept analysis it can be said concretely that comfort is multidimensional. It has been of core of nursing focus though out history, yet is still ambiguously defined. Comfort is used when building other concepts that are important to nursing. There is a definite need to clarify the concept of comfort to facilitate a greater understanding and apply it more efficiently in care settings. An important step that must happed would be to create a list of expected outcomes and attributes that would meet the needs of patients on a multidimensional and holistic level.

References

Ångström-Brännström, C., Dahlqvist, V., Strandberg, G., & Norberg, A. (2014). Descriptions of comfort in the social networks surrounding a dying child. Nordic Journal of Nursing Research & Clinical Studies / Vård I Norden, 34(3), 4-8 5p.

Cheraghi, M. A., Manookian, A., & Nasrabadi, A. N. (2014). Human dignity in religion-embedded cross-cultural nursing. Nursing ethics, 21(8), 916-928. doi:10.1177/0969733014521095

Fleming, C., Scanlon, C., & D’Agostino, N.S. (2011). A study of the comfort needs of patients with advanced cancer. Cancer Nursing, 10, 237-243.

Hou, Y., Zhao, A., Feng, Y., Cui, X., Wang, L., & Wang, L. (2014). Nurses' knowledge and attitudes on comfort nursing care for hospitalized patients. International Journal of Nursing Practice, 20(6), 573-578 6p. doi:10.1111/ijn.12200

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

Larson, P.J. (2013). Comparison of cancer patients’ and professional nurses’ perceptions of important nurse caring behaviors. Heart and Lung, 16, 187-193.

Oliveira, I. (2013). Comfort Measures: A Concept Analysis. Research & Theory for Nursing Practice, 27(2), 95-114 20p. doi:10.1891/1541-6577.27-2.95

Oxford Dictionaries - Dictionary, Thesaurus, & Grammar. (2016). Retrieved May 29, 2016, from http://www.oxforddictionaries.com/

Walker, L. O., & Avant, K. (2011). Strategies for theory construction in nursing (5th ed.). Upper Saddle River, NJ: Pearson Education.

 Townsend, L., & Scanlan, J. M. (2011). Self-Efficacy Related to Student Nurses in the Clinical Setting: A Concept Analysis. International Journal of Nursing Education Scholarship, 8(1), 1-15 15p. doi:10.2202/1548-923X.2223