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Katherine Kolcaba developed comfort theory in early 1990s. She was born in Cleveland, Ohio on 8 December, 1944. She specializes in nursing and her main areas of specialization are End of Life and Long Term Care Interventions, Gerontology, Nursing Theory and Research, Instrument Development, and Comfort Theory. She authored a book known as Comfort Theory and Practice: a Vision for Holistic Health Care and Research. Presently, she is a professor of nursing at University of Akron College of Nursing.

Main Premises of the Theory

According to the comfort theory, comfort is an immediate desirable outcome that should be achieved in a nursing care setting. This theory also argues that when nurses deliver all comfort interventions over time with consistencies, it will cause a trend showing increased levels of comfort of the patients. Major concepts of the comfort theory include health care needs, intervening variables, health seeking behaviors, best policies, best practices, and institutional integrity. Institutional integrity refers to the financial stability, values, and the wholeness that there are in health care organizations. These facts occur in all health care organizations located at regional, state, local, and national levels. Health seeking behaviors can be external, internal, and peaceful death. Internal seeking behaviors include immune functions, numbers of T-cells, and healing. External seeking behaviors include functional outcomes and health related activities. Intervening variables refer to all factors that are expected to remain constant in the nursing care setting. Health care providers do not have any control over such factors. They include an extent of social support, financial situation, and prognosis. Health care needs are all needs that are indentified by a patient or family of a particular patient in any clinical care setting.  

According to Kolcaba, conflict exists in three forms. They include relief, ease, and transcendence. Relief refers to the state that a patient feels when his/her need is met in a particular health care setting. Ease refers to a state of contentment and calmness. Lastly, transcendence refers to a state in which a patient is able to rise above the problems that may be facing him/her. It also refers to a state in which a particular patient is able to rise above his/her pain. Kolcaba also gave four contexts in which comfort occurs. They include physical, psychospiritual, environmental, and social cultural. Physical context relates to the sensations of the body. Environmental context relates to external conditions, surroundings, and influences. Social cultural context relates to the family, interpersonal, and social relations. Lastly, psychospiritual context relates to the internal awareness of a person, self-esteem, and the sexuality of a person.

Comfort theory has several assumptions. Some of these assumptions include that all human beings have holistic responses to stimuli that have a complex nature. Another assumption of this theory is that when comfort needs of a patient are met, patients become strengthened. This theory also assumes that all human beings always strive to meet their needs. They also struggle all the times in order to ensure that they are able to satisfy their basic comfort needs. Another key assumption of this theory is that comfort is critical in the nursing field.

Current Utility of the Theory for Application to Research

This theory can be applied in several ways in nursing research. According to this theory, nursing is defined as the process of investigating comfort needs of patients. It also deals with the development and implementation of necessary nursing interventions and evaluations of patient’s comfort. Considering this fact, researchers always want to establish whether patients experience comfort whenever health care services are delivered to them. Patients experience comfort when they are confident that the services that they expected to receive are delivered to them. Comfort theory also stresses the importance of intentional assessments of all comfort needs and the reassessment of the levels of comfort after they become implemented in a particular health care setting.

This theory has also been used widely while providing care for children. When families of a particular child become stressed because of a particular condition that their child might have, a caregiver provides social comfort by avoiding words such as pain before the child undergoes any medical procedure. In addition, nurses and other physicians provide psychospiritual and social comfort by allowing parents to be present when the child undergoes any medical procedure. Physical comfort to the child can be provided by ensuring that the child is positioned in an appropriate and comfortable manner during the medical procedure that the child may be undergoing. Environmental comfort is provided by ensuring that the atmosphere in which the medical procedure is carried out on the child is conducive and calm.

In a general clinical setting, physical comfort is provided by giving patients appropriate medications. It can be achieved by giving patients repositioning, backrubs, and therapeutic touch. Patients should be given proper medication, for example, adequate anti-anxiety and analgesics. Psychospiritual comfort is given to patients by giving them privacy wherever they request that privacy is awarded to them. Healthcare providers should also encourage all patients that they may be attending to express their feelings in order to recognize this form of comfort. Nurses and other physicians are also supposed to allow their clients to freely practice and express their spirituality in order to award this form of comfort. Social interaction can be provided by interacting freely with the client and allowing the patient to socialize freely with other people in the health care setting.

Problem or Issue in Practice That is an Area of Concern to You

What is a Problem?

The problem in practice that is of great concern to me is poor patient satisfaction in nursing care. Poor patient satisfaction occurs when patients strongly feel that they did not receive the services that they had expected to receive in a particular health care setting. In some instances, patients end up feeling that doctors did not listen to the concerns that patients might have presented to them leading to poor patient satisfaction. Doctors argue that they may fail to fulfill the demands of patients due to several reasons. Although patient autonomy is critical, physicians argue that they are not obliged to fulfill any demand that they may be given by the patient concerning test, treatment, or a particular medication. In some instances, doctors argue that a particular medical procedure that a patient may have requested may not be valid considering all scientific methods that may be present. Doctors also argue that some of the subjective judgments that patients may require to address may be incorrect. Due to this, doctors may not fulfill these needs making the patient unsatisfied.

Patients also become dissatisfied when they feel that physicians do not conduct follow-up activities after they are discharged from hospital. According to research, follow-up is the most critical step that is missed in the service recovery cycle of patients. However, this step is crucial to the overall satisfaction of a patient. Doctors and nurses may forget to engage in follow-up calls in order to establish whether the progress of their patient has been positive. Follow-up procedures are also important since a physician is able to obtain feedback regarding the quality of services that a particular patient may have received while receiving patient care (Irwin Press, 2006). Poor patient satisfaction may also be caused by the fact that a particular hospital may fail to conduct process review and performance tracking assessments in order to improve patient care. Improvement in the level of patient satisfaction can be achieved when procedures and operational processes are constantly reviewed, so that they can be adjusted to align with the needs of patients.   

One of the strategies that hospitals and other health care services can adopt to improve their levels of patient satisfaction is conducting Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Hospitals and other health care facilities that score low in this survey do not communicate clearly with their patients. This mostly happens when the tools of communication adopted by a particular hospital are poor. For example, the staff in a hospital may only use single modes of communication instead of using multiple communication modes. Researchers have established that patients become satisfied when instructions given to them are both written and repeated verbally to enhance the level of their understanding. In case a patient is not fluent in English or any other language, hospitals should have interpreters who are able to explain to the patients important discharge information.

Patients also become dissatisfied when they feel that they were not given proper patient education while receiving medical care in a particular health care setting. All hospitals should ensure that they give patients appropriate education regarding their medication, condition, follow-up plans, and post discharge plans. This is because they are unable to understand their condition and strategies that they can adopt in order to improve their medical condition. Due to this, hospitals are always encouraged to educate their patients during transitions of care. Patient education is especially critical during transition from hospital setting to home or long-term care (Shelton, 2000). This will help to reduce any anxiety that patients may have because of not understanding things that they are supposed to do during the process of post discharge.

Poor patient satisfaction is harmful to healthcare settings due to several reasons. Talented staff in a hospital may move to other hospitals that have higher patient satisfaction scores. This is because a nurse feels motivated when he/she knows that the services that he/she offers to patients are appreciated by clients that he/she serves. Patient loyalty also becomes low when they are not satisfied with the level of services that they receive from a particular clinical care setting. This makes them opt to seek services in other health care institutions, so that they are able to receive the quality of services that they want. It makes hospitals lose their patient base.

Significance of the Problem

The problem of poor patient satisfaction is significant since it will help hospitals to appreciate the importance of maintaining high levels of patient satisfaction. Patient satisfaction is important since it helps to increase retention rates of patients. This is because satisfied patients are always loyal to their health care providers. In addition, patient satisfaction helps to ensure that hospitals conduct adequate word of mouth advertising. When patients are satisfied after being given quality care, they usually tell their friends about the experience that they received from a particular health care institution. It will help to increase the number of referrals that a particular hospital receives, thus ensuring that the client base of a hospital increases. This will help in improving overall billings that a hospital receives. Hospitals are also able to reduce their malpractice costs if they have many satisfied patients. It is common for hospitals to face many lawsuits that originate from patients who feel that they did not receive services that they ought to have received. In most instances, patients file malpractice lawsuits because of poor communication that makes a hospital face the risk of having malpractice lawsuits. Due to this, hospitals have to try hard to ensure that they communicate empathically concerning complex issues that may affect patient’s health outcomes.

Design Intervention that 'fits' the Theory

 Report Findings in at least One Published Article that Addressed this Practice Problem/Issue

Medscape Education published a research on ways to adopt in order to improve the levels of patient satisfaction. From its research, it argues that poor patient satisfaction can be solved in heath care institutions by ensuring that good communication exists between patients and the physician. Patients become satisfied when they perceive that they have a strong connection with the physician that attends to their health needs and concerns. One of the ways of creating strong perception between patients and physicians is through the engagement of social talks. Studies among Japanese cancer out patients have revealed that social talks ensure that high perceptions are created. These patients argued that social talks helped to ensure that “partnership building approach” existed between patients and physicians. Patients suffering from severe chronic obstructive pulmonary diseases argued that their perceptions became high when they felt that physicians listened to their needs. In addition, these patients argued that their perceptions also became high when physicians attended to all concerns that they had.

The research by the Medscape Education also reveals that empathy leads to an increase in patient satisfaction. In order for physicians to create empathy with patients, they need to respond to the emotional state of patients. It also calls for assisting patients in dealing with any emotional needs that they may have or needs that may be affecting them. Studies have also revealed that empathy is created when doctors and other physicians show a strong sense of caring towards their patients. This research quoted a study conducted by Zacharie on Danish patients. Zacharie surveyed about 454 oncology outpatients. The variables investigated under this study were self-efficacy, patient distress, and the perception of communication behaviors of physicians. From this study, it was clear that most patients became satisfied with how their medical needs were handled. In addition, patient empathy and attentiveness determined the level of patient satisfaction. Moreover, patient distress was correlated negatively with empathy and how attentive physicians were.

Several physical verbal behaviors help to ensure positive interpersonal relations exist between patients and physicians ensuring high patient satisfaction levels. One of these behaviors is being attentive while taking the medical history of patients. This will help to ascertain that doctors are able to know all critical information about a particular patient. Doctors are also supposed to listen to and answer to all questions that patients may have, so that they are able to address all issues that patients may have presented. Physicians are also encouraged to engage in non-verbal behaviors in order to increase the level of patient satisfaction. Examples of non-verbal behaviors that physicians can engage in include having a less mutual gaze towards their patients. They should also consider uncrossing their arms and lengths. In order to promote exchange of information with patients, physicians are supposed to clarify all the statements that they give to patients. Moreover, they need to address needs, problems, daily lives, and emotions of patients.

Report Findings in at least One Published Text or Article that Addressed How the Theory Could Be Useful in Practice in General.

One published text has provided an application of comfort theory in practice. Marie was diagnosed with acute lymphatic leukemia. She was an 11-year-old Chinese patient admitted in a semi private ward. However, she looked sad and cried constantly before she received her chemotherapy. Physicians determined that the main reason that she was sad was that she was not given adequate relief described in the comfort theory. Considering physical comfort, her mouth was sore. In addition, she had constipation and neuropathy. Her environmental context was also not that favorable since she was placed in a cold room. Her social cultural context was also not that favorable since she did not have any family members around to take care of her. She was also not at ease since she could not communicate effectively as she only knew how to speak the Chinese language. She was also not given adequate privacy in her hospital ward. The physician knew that addressing the terms and context of the comfort theory would help in ensuring that Marie was happy and comfortable while receiving treatment in this hospital. At first, they created ease by educating Marie the techniques that she could use to accept and anticipate the social stigma that she could be face like baldness or skin problems that could affect her because of chemotherapy. Her bed was also changed and she ended up sleeping in a comfortable resting position. Due to this, relaxation and her sleep were enhanced. This helped in ensuring that her physical context was favorable reducing the chances of fatigue affecting her.

Marie was also given transcendence by reassuring her that all health needs that she had would be met and attended to by the health staff in the hospital where she received her medical treatment. Standard comfort was given to her by ensuring that she was given adequate medication to help her relive all side effects of chemotherapy that affected her. All the vitals that she had were also adequately checked in order to determine whether she faced the risk of developing nosocomial infections and fever. During all the assessments that she attended after chemotherapy, doctors avoided the word pain at all times. This was in an attempt of ensuring that this patient was at ease and that she did not fear anything. Marie was also given privacy since doctors acknowledged the fact that she was already in her puberty stage and she was therefore concerned about her privacy and overall body image. All these strategies were conducted after considering three comfort interventions described by Kolcaba that include standard comfort interventions, coaching, and comfort food for the soul.

Propose an Intervention You Would Try that Could Use the Viewpoint of the Theory or Some Concept in the Theory

One intervention could be used to solve the problem of poor patient satisfaction based on the comfort theory. Comfort theory suggests the use of coaching intervention to ensure that patients are happy because of the quality of services that may be given to them. Coaching intervention helps to relieve the anxiety that patients may have. If the anxiety that patients may have is eliminated, the level of patient satisfaction will increase because of this. Coaching also stresses the importance of physicians instilling hope in all the patients. If patients are given hope that they will be able to overcome all health challenges that may be affecting them, they will become satisfied since their confidence levels will increase. Coaching also stresses the importance of physicians giving patients adequate information concerning their historical background and medical progress. If patients are able to learn about their overall progress, they will become satisfied since they will be able to know if the medication that they may be taking is successful.

Evaluate Effectiveness of Intervention

Would You Need to Develop an Evaluation Plan?

It is critical to develop an evaluation plan. This is because an evaluation plan would enable hospitals to learn whether the proposed coaching intervention strategy is successful in eliminating poor patient satisfaction that is very common in health care settings. An evaluation plan will also enable hospitals to know whether they need to change the proposed intervention strategy and adopt another strategy that will yield maximum patient satisfaction.

Does a Tool Exist that Measures your Area of Concern, Based on the Theory that Would Be Useful. How Would You Use It?

Several tools exist that would measure the level of patient satisfaction based on comfort theory. One of these tools is the end of life comfort questionnaire of both patients and families. Family questionnaires aim at measuring the comfort of family members. These questionnaires argue that when a particular patient is comfortable, then it is highly likely that family members of this patient will also be comfortable. I would use this tool to determine whether family members are satisfied with the level of services given to their patients since they will translate to the level of patient satisfaction. I would also use verbal rating scale questionnaire. This questionnaire mainly aims at comparing coaching, healing interventions, and comfort towards young patients.

What Would Need to Be Done to Use the Theory as a Base for an Intervention?

Several things need to be done in order to use this theory as a base of intervention. One of the key things that need to be done is educating all nurses and other health care practitioners on the key principles of the comfort theory. Due to this, they will be able to know how to use principles outlined by this theory to promote patient satisfaction. Another key thing that needs to be done is conducting massive patient education. It will help to ensure that patients receive quality services in clinical care settings.

Conclusion

Overall, the application of comfort theory will lead to a reduction in the level of poor patient satisfaction. This is because patients will be able to know that physicians care for all their needs and welfare. Due to this, hospitals will be able to avoid malpractice lawsuits and low patient loyalty. Several links have showed that application of comfort theory has succeeded in creating good communication between patients and physicians. This helps in ensuring that all physicians are able to receive critical information about the history of patients that will help in patient diagnosis. Further research needs to be conducted on the problem of poor patient satisfaction. The number of published research on comfort theory is limited. This affects the study of comfort theory since researchers are not able to get multiple viewpoints on the comfort theory. Although major breakthroughs have occurred concerning strategies that hospitals can adopt in order to ensure satisfaction of patients, more research needs to be performed in order to ensure that this problem is eliminated completely from health care settings. More research also needs to be conducted in order to determine strategies that hospitals need to adopt, so that they fully apply the comfort theory.

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