Running head: KOLCABAS THEORY

Theory in Practice Reflection: Kolcabas Theory Ferris State University Dan Herbert, Erin White, Nicole McDonald and Tyler Baerwolf

KOLCABAS THEORY Theory in Practice Reflection: Kolcabas Theory According to Smeltzer, Bare, Hinkle and Cheever (2010), comfort is a sense of emotional, physical, and spiritual well-being and relative freedom from distress (p. 39). The Theory of Comfort developed by Katharine Kolcaba, describes comfort as existing in three forms: relief, ease, and transcendence (Nursing Theory, 2013). A patient feels relief when given pain medication because they are comfortable (Kolcaba & DiMarco, 2005). When a patients questions are answered after receiving information about their condition, they will feel a sense of comfort and be at ease (Kolcaba & DiMarco, 2005). Comfort in the form of transcendence can be met when a patient encounters a challenge and learns how to find the means to overcome it (Kolcaba & DiMarco, 2005). Each of these types of comfort can be met

physically, psychospiritually, environmentally, and socioculturally (Kolcaba & DiMarco, 2005). The purpose of this assignment is to reflect how Kolcabas Theory of Comfort can be used to create an interdisciplinary care approach for end-of-life and palliative care (Bishop, 2014, p. 6). According to Smeltzer, Bare, Hinkle, and Cheever (2010), palliative care is a comprehensive care for patients whose disease is not responsive to cure; care also extends to patients families (p. 398). Hospice is a form of palliative care which works to improve qualityof-life for patients and families during their journey toward the end of life (Smeltzer, Bare, Hinkle & Cheever, 2010). Hospice care can take place in a hospital, a long-term care setting, or at home (Smeltzer, Bare, Hinkle & Cheever, 2010). Kolcabas Theory of Comfort is in direct correlation of palliative care to provide holistic care to the patient and their family members during this time. Nurses develop knowledge and skills throughout their careers to provide appropriate care for these patients and their families. Expected nursing knowledge should be to assist the patient and family with coping and provide

KOLCABAS THEORY them with coping strategies (Smeltzer, Bare, Hinkle & Cheever, 2010). Nurses should utilize therapeutic communication while providing care. The nurse should turn the patient to promote skin integrity and teach the family about these methods (Smeltzer, Bare, Hinkle & Cheever, 2010). It should be expected that the nurse will treat the patients pain, and encourage family to ask for medication if they feel the pain is not being relieved. The nurse should encourage the family members to participate in the patients care as much as possible and promote comfort. One role of the nurse is to promote autonomy of the patient in decision-making about their care (Smeltzer, Bare, Hinkle & Cheever, 2010). Communication with the patient and family is vital in order to answer any questions they have and ease their uncertainty. During palliative care the nurse role is to coordinate services provided to the patient and family. Along with the nurse, there are also many other disciplines involved in the palliative care of a patient. A plan of care for an end-of-life patient may include respiratory therapy to decrease discomfort from breathing while enabling the patient to participate in activities. Chaplain or other religious services may be requested by patient and their family to assist with

coping and acceptance of the disease. Social work is also involved in the plan of care in order to help the patient and family develop coping mechanisms to process the impending loss. Social workers can inform the patient and family of support groups and community resources and help coordinate decisions about power of attorney documents and funeral arrangements. Respite care may be part of the care plan to allow family members the time to take care of themselves, highlight their own needs, and to ensure the family does not become overwhelmed. A physician will be involved to continually assess the patients status, order medications, thoroughly answer questions about the disease, and be available to the family. A certified nurse aide will also be involved to assist with bathing, personal hygiene, turning, activities of daily living, and ensuring

KOLCABAS THEORY the familys needs are met. Physical therapy and occupational therapy will assist the patient in performing passive range of motion exercises to promote mobility, decrease contractures, and

maintain optimal level of physical function. The physical therapist will also continuously assess the patient for needs of assistive devices or mechanical lifts as the disease progresses. A dietician would be part of the interdisciplinary team to ensure nutritional needs are being met; to address issues such as appetite loss, nausea or vomiting and weight loss; and to improve quality of life (Smeltzer, Bare, Hinkle & Cheever, 2010). Speech therapy is involved in the care plan to continually assess swallowing abilities as the disease progresses and work to prevent aspiration and secondary complications. Kolcabas Comfort Theory should be utilized as the standard for patients receiving palliative care because comfort is essential in order for the other care modalities to be carried out successfully. This theorys main concern involves palliative care; when a patient is given a terminal diagnosis many aspects of their life are going to change. The patient may have pain and feelings of loss, but this theory aims to improve comfort among these patients and help give some of that control back to improve quality of life. Kolcabas theory promotes a holistic method of care in which all the varying types of discomfort are addressed (Kolcaba, 2010). According to the Comfort Theory, comfort is an immediate desirable outcome of nursing care (Nursing Theory, 2013). Kolcabas Comfort Theory can be applied in any patient care setting, and when applied successfully it leads to positive patient experience ratings (Kolcaba, 2010). Kolcabas Comfort Theory is a useful tool for nurses to utilize in the healthcare setting as it allows for patients to receive desirable care. The nurse working together with members of the interdisciplinary team including: religious services, social workers, respite care, physicians, support staff, physical and occupational therapy, dieticians, and speech therapists, allows patients

KOLCABAS THEORY and families to receive quality palliative care. Through implementing Kolcabas Comfort Theory, the patient is able to experience an increased quality of life.

KOLCABAS THEORY References Bishop, R. (2014). Nursing theory 4. Retrieved from

http://www.ferris.edu/HTMLS/colleges/alliedhe/docs/nursing/NURS_451_Nursing_Theo ry_4.pdf Kolcaba, K. & DiMarco, M. (2005). Comfort theory and its application to pediatric nursing, Pediatric Nursing, 31 (3), 187-194. Kolcaba, K. (2010). The comfort line. Retrieved from http://www.thecomfortline.com/index.html Nursing Theory. (2013). Retrieved from http://www.nursing-theory.org/theories-andmodels/kolcaba-theory-of-comfort.php Smeltzer, S. C., Bare, B. G., Hinkle, J. L., and Cheever, K. H. (2010). Brunner and Suddarths textbook of medical-surgical nursing. (12th ed.). Philadelphia: Wolters Kluwer / Lippincott Williams & Wilkins.