Comfort Theory and Nursing Practice

The word “comfort” has been intriguing to nursing as its diverse definition denotes complex and holistic term. A patient might express her gratitude for a well-rounded care and tells that “The nurse comforted me well.” Similarly, the term could also describe a place of solace, free from stress or anxiety, such as “This room is so comfortable. It makes me feel like I never wanna be discharged anymore.” Kolcaba (2003) has defined comfort as "the immediate state of being strengthened through having the human needs for relief, ease, and transcendence addressed in four contexts of experience ". It serves as the positive outcome that is desired to empower the patients and their families to engage in health seeking behaviours (HSBs).

Assessing patients for their level of comfort utilizing a positive, holistic manner is important for measuring effectiveness of comforting strategies. Comfort Theory (Kolcaba, 2003), with its inherent emphasis on physical, psychospiritual, sociocultural, and environmental aspects of comfort, will contribute to a proactive, well diverse and articulated, and multifaceted approach to care. It clearly provides a framework for clinical practice guidelines, which state that the provision of holistic care oriented to comfort must be explicit and well- documented. In turn, the desirable outcome of comfort is related to engagement in HSBs that are important to patients, families, and the health care team and to better institutional outcomes which are important to administrators.

Case Study

Marie, an 11-year-old Chinese female patient, diagnosed with Acute Lymphocytic Leukemia, was admitted in a semi-private ward in the Oncology Unit. She is about to receive her combination chemotherapy when the nurse noticed her alone and crying silently while lying on her bed.

Physical Mouth sores;
Nausea and vomiting;
Comfortable resting position which facilitates sleep and relaxation to deter fatigue Patient resumes most of her ADLs with all the side effects controlled
Psychospiritual Anxiety;
Radiation recall
Anticipation of social stigma towards baldness and skin problems Actual need for reassurance and support from the healthcare team and significant others
Environmental Cold room; Patients were cohorted in a single room Deviation from aseptic technique and standard precaution;
Lack of privacy
Need for calm and positive atmosphere which strictly adheres to infection control guidelines; Need for privacy for personal hygienic routine care
Sociocultural Absence of family Failure of effective communication due to language barrier Need for familial support and reinforcement

Taxonomic Structure of Marie's Comfort Needs

When nurses are committed to provide satisfyingly holistic comfort care, needs for relief, ease, and/or transcendence are identified routinely throughout the practice. Assessment could go back and forth to relief, ease, and transcendence until the main focus of health care will be identified and be addressed. However as the patient’s condition varies, it is essential that the nurse identify correctly which context that the patient and his family’s concerns entails priority of comfort measures. When comfort needs are addressed in one context, total comfort is enhanced in the remaining contexts.

Nurses are the mighty frontliners in the health care institution. As active participants on strenghthening and enhancing comfort of every patients, they engage themselves on activities to achieve and maintain a certain level of their optimal health. They tend to be the advocates of patients, leading them to be the patients’ first link to normalcy once they face a frightening or painful experience. Coaching and reassuring the clients towards recovery, safety, and rehabilitation, and these activities are identified by Scholtfeldt (1975) as health seeking behaviours(HSB). Kolcaba (2001) states that HSBs are further related to desirable institutional outcomes such as decreased cost, improved family and nurse satisfaction, earlier discharge and low readmission rates.

Comfort Interventions
Standard Comfort
  • Assessment for development and complaints of the side effects of the chemotherapy (may use Comfort daisies, Comfort behavior, Checklist, etc.);
  • Frequently check vitals and watch out for fever or signs of nosocomial infections
  • Administer medications or treatments to relieve the side effects of chemotherapy
Nurse/Consultation with family and doctors
  • Avoiding the word "pain" upon assessment, obtaining data, and rendering health teaching for a pediatric patient
  • Initiate patient and family education as needed
Doctors/Nurses Consultation with family
Comfort Food for the Soul
  • Practice guided imagery to eliminate factors that could increase physical discomfort
  • Provide privacy as Marie is entering pubescent stage when she will be concerned about her body image and privacy

Comfort interventions have three categories: (a) standard comfort interventions to maintain homeostasis and control pain; (b) coaching, to relieve anxiety, provide reassurance and information, instill hope, listen, and help plan for recovery; and (c) comfort food for the soul, those extra nice things that nurses do to make children/families feel cared for and strengthened, such as massage or guided imagery. (Kolcaba, 2003)

Kolcaba, K. (1997). The comfort line. Retrieved from
Kolcaba, K. (2001). Evolution of the mid range theory of comfort for outcomes research. Nursing Outlook, 49(2), 86-92.
Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and research. New York, NY: Springer Publishing Company.
Schlotfeldt, R. (1975). The need for a conceptual framework. In P. Verhonic (Ed.) Nursing research (pp. 3-25). Boston: Little & Brown.