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Memorandum

To:

All Intensive Critical Care Nursing Staff

CC:

Intensive Critical Care Support Staff

From: Maria Hall, ICU Nursing Educator


Date: 11/29/15
Re:

Implementation of Kolcabas Comfort Theory with End of Life Patients

Addressing the Needs of Our dying Patients and their Families


Nursing is a holistic practice providing care to promote healthy outcomes in all realms
of self-including physical, spiritual, social, and environmental. The importance of
treating the whole person is even more apparent during end of life and palliative care. It
is then when there is a shift in thinking from striving for recovery to pausing and
reevaluating care to allow for a peaceful transition into death. The nursing theorist
Katharine Kolcaba uses her comfort theory to aid nurses in guiding patients and their
families through this transition and the many decisions to be made regarding care. The
idea behind theory allows the nurse to develop a plan of care focusing on providing
comfort to the patient as well as their family in the final days of life.
Kolcaba described her comfort theory in terms of types and context of comfort in the
following ways:

November 29, 2015

TYPES:

Relief: the state of a patient who has had a specific need met.

Ease: the state of calm or contentment.

Transcendence: the state in which one rises above one's problems or pain.

CONTEXTS IN WHICH COMFORT IS EXPERIENCED:

Physical: pertaining to bodily sensations and homeostatic mechanisms.

Psychospiritual: pertaining to internal awareness of self, including esteem,


concept, sexuality, and meaning in one's life; one's relationship to a higher order
or being.

Environmental: pertaining to external surroundings, conditions, and influences.

Sociocultural: pertaining to interpersonal, family, and societal relationships. Also


to family traditions, rituals, and religious practices. (Kolcaba & Fisher, 1996,
p.69)

The patient and family are then able to verbalize their needs in order to move through the dying
process and their needs are met through an interdisciplinary team. As each need is met, the

November 29, 2015

comfort level is increased. Patients are able to have a good death or as Kolcaba described
Patients should die like theyre being rocked to sleep in their mothers arms (Kolcaba &
Fisher, 1996, p.69).
Please review the comfort theory in greater depth through the following reference
Reference
Kolcaba, K. Y., & Fisher, E. M. (1996). A holistic perspective on comfort care as an advance
directive. Critical care nursing quarterly, 18(4), 6676.

November 29, 2015

Reflection
In reflecting back on this assignment, I used both the lectures and reading
materials given to me to complete this assignment. I also was able to use my experience
as a nursing student to draw the emotional and intuitive aspects of this assignment. I was
a witness to a sudden death of a DNR patient during my clinical rotation. I was keenly
aware of the team involved in his care and how they worked with each other to offer the
limited assistance they could. I saw the drastic changes in the monitors and the
explanations to the families behind them. The staff was a comfort to the family through
the process and afterward giving a hug, listening and crying through the loss. I also spent
time with hospice nurses both in my clinical rotation and through the death of my
grandmother. I was able to identify on a personal level how important the needs of
families in preparing for the death of their loved one are. I feel these experiences allowed
me to have a better grasp on end of life care because I have seen it and lived through it.
I see how important Kolcabas comfort theory is in end of life care because it
gives nurses a plan of care to follow and allows for the family and patient to be involved
in the process, ensuring a good death. The home hospice nurses exemplified this for
me when seeing patients at home. They truly enveloped holistic care through counseling,
educating, and preparing families and patients for the next step in the dying process. The
nursing practice as a whole is known to be an advocate for patient care. Kolcabas
comfort theory is no different. When the family and or patient changes from aggressive
treatment to comfort care, it shifts the perspective of the interdisciplinary team in that
the goal is changed to a positive transition into death instead of performing procedures to

November 29, 2015

prolong life. The uniqueness of nursing as a holistic discipline allows our knowledge of
treating the whole person to help guide communication among the interdisciplinary team
members in caring for the patient.
As Kolcaba mentioned in her website, there are other theories regarding comfort
which she referenced. Another theory may work better but, I feel the comfort theory is
successful in guiding nurses through the death of a patient. It would be interesting to see
a different theory applied to end of life care and see if the outcomes are improved. If the
outcomes are improved and replicated then a change of practice may be on the horizon.
As evidence based research changes, so should our practice.