Running head: COMFORT CONCEPT ANALYSIS
1
Comfort Concept Analysis
Parita Dhingani
Chamberlain College of Nursing
NR 501: Theoretical Basis for Advanced Nursing
March 2015
COMFORT CONCEPT ANALYSIS 2
Comfort Concep
...
Running head: COMFORT CONCEPT ANALYSIS
1
Comfort Concept Analysis
Parita Dhingani
Chamberlain College of Nursing
NR 501: Theoretical Basis for Advanced Nursing
March 2015
COMFORT CONCEPT ANALYSIS 2
Comfort Concept Analysis
Concept is a general idea of what something is or how it works. To analyze a concept is
to define terms (variables) and to clarify its meanings so that it portrays same understanding
between readers and writers. Conceptual clarity is of utter importance for all kinds of research.
“Walker and Avant were among the first ones to theoretically discuss the concepts of the nursing
science” (Hardin & Bishop, 2010). This paper examines the concept of comfort as stated in
Katharine Kolcaba’s comfort theory. This theory is studied and evaluated using Walker and
Avant’s eight steps of concept analysis. These eight steps are as follows: “1) Select a concept, 2)
Determine the aims or purpose of analysis, 3) Identify all the uses of the concept possible, 4)
Determine the defining attributes, 5) Identify model case, 6) Identify borderline, related,
contrary, invented, and illegitimate cases, 7) Identify antecedents and consequences, 8) Define
empirical referents” (Walker and Avant, 2011). These eight steps process helps understand the
concept of comfort and how it relates to the field of nursing.
Purpose of the analysis
From the time human beings are born, they desire comfort. Although most people are
familiar with the idea of comfort, it is a very complex term with several usages and meanings in
normal language. The original definition of comfort means “to give strength and hope to”
(Merriam-Webster, 2010), however because comfort have many different meanings, it is difficult
for readers to decide if the term is used in context with its ordinary meaning or it implies
something special in nursing sense. The purpose of this analysis is to understand the real
meaning of comfort theory, and to clarify its attributes in daily nursing practice. Katharine
Kolcaba’s comfort theory presents the word comfort as a noun or an adjective and an outcome of
purposeful, patient centered, quality care. Kolcaba (2001) mentions four important points in
COMFORT CONCEPT ANALYSIS 3
explaining the importance of comfort theory. These points being “1) the need of comfort is basic,
2) persons experience comfort holistically, 3) self-comforting measures can be healthy or
unhealthy, and 4) enhanced comfort, if achieved in healthy ways, leads to greater productivity”
(Kolcaba, 2001).
Literature Review
According to Larson (2013), primary accomplishment of a concept analysis is to identify
its attributes. The identification of these attributes is then followed by analyzing and reviewing
the literature for recurring themes, ideas, and/or facts about the concept. The nursing literature
relating to comfort is very limited. Even though the term appears very frequently, it is rarely
studied. The term comfort is usually used in the sense of general knowledge and hence it seems
like the meaning of comfort is taken for granted. Due to the lack of literature on comfort in
general, the criteria for this analysis were extended to include patients with illness other than
cancer. Research was started by considering the theory of comfort by Katharine Kolcaba (2001)
as a primary guideline in defining parameters and attributes of comfort. Literature searched were
performed using online computer databases of CINAHL and PubMed. Hand searched were also
performed to generate lists of other relevant articles of review. Lotzkar (2010) summarized the
role of comfort as what a person believes it to be. This article went in detail on how each
individual have different view on what make them comfortable and why. The article was very
detailed and did bring up good points on tailoring care to suite each individual rather than
following a broad protocol. Larson (2013) described comfort in terms of relationship. The article
was very short but had good points on how patients feel more comfortable and confident when
they have good relationship with their caregivers. It showed how important it is to build
relationship with patients in order to comfort them. Kolcaba’s comfort theory is along the same
COMFORT CONCEPT ANALYSIS 4
lines of the above two articles and it divides the concept of comfort into physical, psychological,
sociocultural, and environmental factors. The intentional comforting actions of nurses strengthen
patients and their families. This leads to them better engaging in health-seeking behaviors, which
in turn improves their overall health and comfort (Kolcaba, 2011).
Uses of the concept
The concept of comfort once evaluated can give researchers the ability to pursue the
study of comfort with strong theoretical base (Kolcaba, Tilton, & Drouin, 2006). Development of
criteria specific to enhancing comfort for each individual or as a group can lead to enhanced
healing and shorter stay in hospitals (Fleming, Scanlon, & D’Agostino, 2011). Clarifying the
concept of comfort will present everyone with a clear understanding of it meaning and its
attributes. This will result in improved caregiver and patient satisfaction, and also improved
revenues for hospitals. Hence comfort can also be viewed as driving force for hospitals to
improve their patient satisfaction rate.
Defining Attributes
Defining attributes are consistently occurring characteristics of a concept that help
differentiate it from others (Walker and Avant, 2011). Looking at Kolcaba’s comfort theory there
are four main attributes that stand out. These attributes are as follows: everyone attains comfort
uniquely through involvements and communication, comfort is what a person believes it is,
comfort is experienced by physical, psychological, sociocultural, and environmental factors, and
the fact that relief ease and transcendence are often achieved through caring relationship with
nurses or other healthcare providers. When comparing these attributes to the ones obtained from
literature review, it can be said that relationships (Larson, 2013) and self-characteristics (Lotzkar,
COMFORT CONCEPT ANALYSIS 5
2010) were the two major attributes that showed up over and over. To sum it up, these attributes
do make a lot of sense, since each individual seeks comfort in their own way based on how their
past experiences have been. An individual’s self-characteristics (i.e. cultural background,
upbringing and state of mind) determines what they feel comfortable with and what comfort
means to them. Also relationships are very important in providing comfort. Whether its
relationship between family members or health-care provider and patient, they serve a big role in
patients’ recovery.
Model Cases
A model case can be defined as a scenario that includes all of the defining attributes of
the concept. Author has option of creating these case from real-life experiences, taking it from
the literature, or creating it from their imagination. (Walker and Avant, 2005) Following case is
based on a real-life experience of a registered nurse student doing her clinical at a pediatric
hospital. Ahmad is a 4 year old Islamic boy admitted to phoenix children’s hospital after he had a
bad fall from a swing at a park and fractured his arm. He also had other traumatic injuries to his
face. He was given morphine for pain relief. The nurse explained every procedure that they are
doing to Ahmad’s parents and also keep them involved by asking them what questions and
concerns they have regarding Ahmad’s injuries. The nurse then assesses Ahmed gently in a soft,
quite voice and also keeps him engaged by talking to him about his stuffed animal that he was
holding. After assessment, the nurse provides Ahmad with a cup of warm milk and dims the
lights in his room. Mother holds Ahmed’s head close to her chest, sings a nursery rhyme and
gently rocks him side to side until he slowly falls asleep. A minister arrived in the room while
Ahmad was sleeping and prays for him along with his parents. In this case, there is a partnership
between caregiver (Ahmad’s mom) and the nurse to provide physical, psychological,
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