Comfort Theory: End of Life

Care for the Registered

Nurse
Jessica DeRuiter
Ferris State University

Introduction
Purpose: 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(Singleterry, 2014, p. 6).

Objectives:
Describe strategies from Kolcabas theory to empower patients or
families at the
end-of-life (patient-centered care-Knowledge)
Reflect how to engage patients or designated surrogates in active
partnerships that promote health, safety and transcendence at the end-oflife (patient-centered care- Skill).
Value active partnership with patient or designated surrogates in
planning, implementation, and evaluation of care (patient-centered careAttitude) (Singleterry, 2014, p. 6).
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Kolkabas Comfort Theory

Holistic, positive outcome of nursing care (Vendlinski & Kolcaba, 1997, p.

272).
Three elements include: comfort/strength, active participation, the process of
comforting and the outcome of enhanced comfort.

Types of comfort

Relief
Ease
Transcendence

Context comfort occurs

Physical
Psychospiritual
Environmental
Social
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s
Eight Domains: Care of the dying patient
Structure and process of care
Spiritual, religious, and existential aspects of care

Assess patient and family

Assess and encourage practice of beliefs

Physical aspects of care

The management of symptoms, side effects, and pain

Psychological and psychiatric aspects of care

Assess patient and treat any psychological issues

Social aspects of care

Cultural aspects of care

Meet cultural needs of patients and families respectfully

Care of imminently dying patient

Respect the families wishes on how to communicate the

dying process to children, the patient, and patients family.

Develop a plan of care based on the social needs of

the patient and family

Ethical and legal aspects of care

End of Life

The patient chooses their plan of care based on

Nurses Impact

recommendations, the federal and state laws and ,

standards of medical care.

Nurses have a significant and lasting effect on the way in

which patients live until they die, the manner in which the
death occurs, and the enduring memories of that death for the
families (Smeltzer et al., 2010, p. 396).

Interdisciplinary collaboration

Strategies of the Nurse

Empowering patients at the end of life
o Identify comfort needs holistically and design interventions to meet those needs: gathered
objectively and subjectively
o Identify other variables that may affect care
o Assess quality of care through questionnaires, checklists, and patient and family statements and
expressions
o Relieve pain and help provide a means for the best quality of life possible
o Assess and determine needs of the family based on Kolcabas chart.
o Provide bereavement care to the family
o Assess patient and family frequently for stages of dying
o Understand the 5 stages of dying: denial, anger, bargaining, depression, and acceptance

o Assessing the family and goal setting

o
o
o
o

Be aware of the diagnosis, illness stage, and prognosis

Values: what is most important to the patient and family related to treatment options
Preferences: where would the patient like to live, what kind of pain management?
Expected/desired outcomes: What does the patient know, hope for, and understand
about the procedures and illness
o Benefits and burdens: Is there an end point to procedures, medical care, and testing (do
not resuscitate), that the patient would like to quit and switch to comfort care. Are5 there

Partnership

The skills needed to fulfill comfort

Nurses must be comprehensive and

consistent
Much of care is intuitive
Strengthen family and patient

relationships and understanding

Encourage active participation by all

involved- empower patient and

family through education.
Know resources available for

comfort for all involved

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Value
Patient-centered Care: Recognize the patient or designee as the source

of control and full partner in providing compassionate and coordinated care

based on respect for patients preferences, values, and needs (American
Association of Colleges of Nursing [AACN], 2014, p. 4).
Examples
Knowledge: Analyze multiple dimensions of patient-centered care including

patient/family/community preferences and values, as well as social, cultural,

psychological, and spiritual contexts (AACN, 2014, p. 11)
Skills: Based on active listening to patients, elicit values, preferences, and expressed

needs as part of clinical interview, diagnosis, implementation of care plan as well as

coordination and evaluation of care (AACN, 2014, p. 11)
Attitudes: Commit to the patient being the source of control and full partner in his/her

care (AACN, 2014, p. 11)

The nurse must always tend to their emotional needs as well

References
American Association of Colleges of Nursing | Quality & Safety Education for Nurses
(QSEN). (2014). Retrieved from
http://www.aacn.nche.edu/faculty/qsen/competencies.pdf
Singleterry, L. (2014). NURS 451 Nursing Theory 4 [Syllabus]. p. 6.
Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2010).Textbook of Medical Surgical
Nursing. Philadelphia: Wolters Kluwer/ Lippincott Williams & Wilkins.
Vendlinski, S., & Kolcaba, K. Y. (1997). Comfort care: a framework for hospice nursing. The
American journal of hospice & palliative care, 14(6), 271276. (you can find it on
PubMed: PMID: 9392722)

Reflection
L: Theory in practice
E: I felt disappointed in the healthcare team involved in the death of a family
member while researching this topic. The roles of the nurse were not met in my
situation. I dont remember seeing a nurse beyond quick vital signs throughout
the entire process. Knowing the responsibilities of the nurse I can now benefit
from this research when delivering care. I have gone through the death of a
loved one and grieving without support and feel as a nurse I can improve the
process for others. I felt confident in my project as much of the research was
straight forward. This assignment was challenging due to the amount of reading
and objectives to meet. I dont understand how this assignment could be
completed through a poster presentation based on the amount of content
involved. I was surprised to not see research from Kolcabas comfort theory
within the Smeltzer book.
A: I feel nervous when I think about end of life care. Each person grieves
differently and there are a lot of questions from the patient and family directed
to the nurse. I need to be confident in my responses to those questions and not
take comments or actions personally while those involved complete the dying
process. The anger they may express toward me is natural and most likely not
meant to be directed toward me. I believe Kolcabas theory is useful in creating
care plans based on the wide range of needs assessed and met throughout. I
believe people work better when provided with a map and this theory provides a

Reflection cont.
A: The advantage of using the theory is the ability to have a tool to guide you into providing holistic care to all
involved in the situation. The disadvantage is that the map may be difficult to fill in without help from an
experienced member of the team initially. Three types of comfort are met in this theory but the family may
seek more then just relief, ease, and transcendence in their situation. The advantages in communicating it to
an interdisciplinary team are 100% positive all around if the team understands the theory beforehand, The
disadvantage occurs when the team is not familiar with theory or how you obtained your assessments and care
plans. Educating the team on the theory may not be timely enough for the plan and theory to be effective for
the whole team to use. I think nursing knowledge always benefits the communication between team members.
All members make up the team and they all have their own tasks, skills, and language. All need to participate
respectfully to provide quality comfort care, or any care for that matter. The nurse knows things no other
person on the team does based on the amount of time and assessing the nurse spends with the patient and
families- the nursing language can only be helpful to the team, if they are willing to hear it.
R: I think the theory could be improved based on the feelings of those involved. If there are other areas
patients and families need help in related to types of comfort (relief, ease, and transcendence) the theory can
be elaborated on. There is no better theory or approach I can think of that would be better but maybe a couple
that could help. Maslows hierarchy of needs can be used to assess their levels of motivation and Dorothy
Orems theory of self care can be used for the patient and family members to evaluate the need for care and
analyze improvement or decline in patient and family status.
N: The only way I know of how I can improve this process in the future would be to use it. Since I have not yet
used it on my own I cant possibly fully understand it or suggest changes due to my ignorance.