Most nursing interventions aim to improve patient health outcomes but focus on various factors affecting the patient’s condition. Estridge et al. (2018), in their article, study the effect of comfort on adherence to fluid restriction among dialysis patients. This research is based on Kolcaba’s Comfort Theory, a middle-range nursing theory (Estridge et al., 2018). Therefore, in this post, I will consider Comfort Theory and its aspects through the prism of the nursing metaparadigm to demonstrate the peculiarities of its application in the article.
The authors hypothesized that patient comfort affected fluid retention among adults receiving HD and used Kolcaba’s Comfort Theory to substantiate their assumption. This theory suggests that comfort is central to patients and positively influences well-being and health outcomes. The author of the theory, Katharine Kolcaba, distinguishes three domains and four contexts that affect the patient’s health. The first domain is “relief”, which means meeting the patient’s needs (Vo, 2020). The second domain is “ease,” which refers to a caring experience that induces calmness. The third of “transcendence” is an experience in which caring helps the patient rise above pain or problems (Vo, 2020). These domains can be amplified simultaneously or separately, depending on the needs of the patient.
Moreover, the provision of any of these comfort domains can have an impact on contexts or different states of the individual, such as physical, psychospiritual, environmental, and sociocultural. The physical context describes the functions and sensations of the body, while psychospiritual refers to self-esteem, emotional state, meaning in life, and beliefs (Vo, 2020). At the same time, the environmental context means the external environment and the sociocultural context refers to interpersonal, family, and social relationships. In this way, the nurse can identify and influence the most required domains and contexts for the patient to improve the patient’s comfort and, therefore, health. For example, by providing pain relievers, a nurse can enhance patient comfort in physical and psychospiritual contexts.
Comfort Theory also includes four phenomena of the nursing metaparadigm, focusing on the patient. The four phenomena of the nursing paradigm are defined as person or patient, environment, health, and nursing, and most theories prioritize them in a different order (Deliktas et al., 2019). The patient in the Comfort Theory is individuals, families, or communities that require health care. In the article by Estridge et al. (2018), patients are individuals who need dialysis. The environment in this theory is any aspect of the patient’s or family’s environment that can be altered by a nurse or a significant one to increase the level of comfort. For example, the article refers to the comfort of furniture (Estridge et al., 2018). Health in the Theory of Comfort is described as the optimal functioning of the patient taking into account health problems. In the research, patients have kidney disease; thus, their health is determined by their optimal health indicators for their condition and weight (Estridge et al., 2018). At the same time, nursing provides the necessary means to increase the patient’s comfort.
Therefore, this article demonstrates that nursing theory determines the direction of research related to the specific health problems of patients. Although Estridge et al. (2018) did not find a significant relationship between patient comfort and fluid restriction, and the study allowed them to identify other aspects to be studied. In this way, middle-range nursing theories helped to identify the gaps and direct efforts for their research.
References
Deliktas, A., Korukcu, O., Aydin, R., & Kabukcuoglu, K. (2019). Nursing students’ perceptions of nursing meta paradigms: A phenomenological study. The Journal of Nursing Research: JNR, 27(5), 1-9.
Estridge, K.M., Morris, D.L., Kolcaba, K., & Winkelman, C. (2018). Comfort and fluid retention in adult patients receiving hemodialysis. Nephrology Nursing Journal, 45(1), 25-33, 60.
Vo, T. (2020). A practical guide for frontline workers during COVID-19: Kolcaba’s Comfort Theory. Journal of Patient Experience, 7(5), 635–639.