Comfort Theory and the Complexities of Health Care for Veterans

Our current featured article addresses the application of nursing theory in practice, demonstrating how Kolcaba’s comfort theory provides an holistic approach for identifying needs, creating interventions to meet those needs, and for evaluating the effects of those interventions. The article is titled “Comfort Theory: Unraveling the Complexities of Veterans Health Care Needs” by Lina Daou Boudiab, MSN, RN and Katharine Kolcaba, PhD, RN. I invite you to download this article while it is featured on the ANS website, and after reading it, return here to enter into discussion of these important ideas.

Author Lina Daou Boudiab provided this message about her work for ANS blog readers:

Lina Daou Boudiab

A holistic approach to patient care has always been a preoccupation of mine since my early days in nursing. I have always been interested in interventions that embraced the art of nursing and extended beyond the physical to address patients’ needs effectively. Kolcaba’s Comfort theory highlights the holistic nature of our experience of health, in terms that make sense to patients and staff alike. It is simple, yet quite comprehensive and highly applicable. It acknowledges the various contexts that play into a person’s experience of comfort and health, valuing the psycho-spiritual, sociocultural, and environmental contexts on an equal footing with the physical.

Often when I discuss Comfort Theory with patients with chronic pain, explaining the difference between comfort and the mere absence of pain and why we would like to focus on comfort, there seem to be a sense of relief and empowerment as they say, “I never thought about it that way.” People seem to be stuck within the constraints of their comfort needs or symptoms, which tend to permeate every level of their being. Chronic pain impacts every context of a person’s comfort, which in turn accentuates the experience of pain. Anxiety and feelings of powerlessness similarly impact the person’s social interactions and heighten their experience of physical symptoms, among others. As I discuss with patients the contexts (physical, psycho-spiritual, sociocultural, and environmental) and aspects (relief, ease, and transcendence) of comfort, I believe there is a sense of hope and empowerment that blossoms, baring the possibility of comfort in their future. They seem to retrieve a sense of self beyond a physical entity with perceived limitations. Comfort Theory empowers staff and patients to invest in practices that would promote comfort in any of the discussed contexts to maintain a state of ease and encourage transcendence into a comfortable, highly functional state of being or, in case of palliative or hospice care, a peaceful death.

Furthermore, Comfort Theory allows us to measure the effectiveness of various comfort interventions, such as body-mind-spirit modalities, comfort rounding, active listening and presencing, among others. Incorporating a verbal rating scale (0-10) of comfort in documentation notes, in addition to that of pain and/or any other symptom, adds to the richness of patient assessment and outcome evaluation of particular interventions.

In our Healing Touch Comfort Clinic, few patients with chronic pain have expressed a change in the quality of their pain (for example from sharp to dull) after receiving healing touch, but still rated their pain at the same level as before the intervention. Nevertheless, they stated that they felt more comfortable and rated their comfort level higher than baseline. Throughout my nursing career, I have taken care of patients who rated their pain as moderate (between 4 and 7 on a 0-10 scale), yet felt it was still acceptable. They preferred the experience the pain over prescribed pain medications and their potential side effects and embraced non-pharmacological interventions to transcend it. I do believe that monitoring pain levels as the sole measure of effective pain management and overall patient comfort is inadequate and does not reflect the holistic nature of comfort nor patients’ individuality and personal preferences. Comfort Theory provides a framework for practice and tools to help us move towards a more effective and inspiring patient-centered model of care, focusing on positive outcomes of enhancing our patients’ comfort and their overall sense of wellbeing.

Disclaimer: The contents of this blog do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.