Katherine Kolcaba
Transcript of Katherine Kolcaba
-
8/18/2019 Katherine Kolcaba
1/21
-
8/18/2019 Katherine Kolcaba
2/21
COMFORT THEORY
#C"m$"rt may be a blanket "r breeze%
s"me "intment ere t" s""te my knees&
a listening ear t" ear my w"es%
a pair "$ $""ties t" warm my t"es&
A PRN medicati"n t" ease my pain% s"me"ne t" reassure me "nce again&
A call $r"m my d"ct"r% "r e'en a $riend%
a rabbi "r priest as my li$e nears its end.
C"m$"rt is wate'er ( percei'e it t" be%a necessary ting de$ined "nly by me.)
*S.D. +awrence ,student nurse-
,K"lcaba% //0% p.1-
-
8/18/2019 Katherine Kolcaba
3/21
MOTIVATION AND HISTORICALBACKGROUND C"m$"rt 2e"ry "riginated $r"m a 3asters pr"gram
assignment 4 t" diagram er nursing practice
At tat time% se was a ead nurse "n an
Alzeimer unit
C"m$"rt was te state se wanted er Alzeimer
patient5s t" be in wen n"t participating in
acti'ities "r tasks. C"m$"rt became er $"cus in
nursing practice and researc
C"m$"rt te"ry was later applied t" "ter $ields "$nursing% suc as peri"perati'e care and pediatrics
ttp:66www.tec"m$"rtline.c"m6inde7.tml
-
8/18/2019 Katherine Kolcaba
4/21
ASSUMPTIONS & POINT OF VIEW
Nursing care is m"re e$$icient wen te"ry is
used because care can be deli'ered in an
"rganized manner
Science "$ nursing is ab"ut te c"m$"rt "$patients% $amilies% and nurses
8en nurses pr"'ide c"m$"rt measures% suc
as turning a patient e'ery "urs% te patient
is e7pected t" a'e a p"siti'e "utc"me Care is deli'ered and based "n a umanistic
and "listic appr"ac and patients5 needs
,K"lcaba% 1991-
-
8/18/2019 Katherine Kolcaba
5/21
-
8/18/2019 Katherine Kolcaba
6/21
INFLUENCES ON KOLCABA’SPHILOSOPHY2ree 2ypes "$ C"m$"rt
Relie$* adapted $r"m (da =ean
>rland"5s w"rk: nurses relie'e
patient5s needs
Ease 4 adapted $r"m irginia;enders"n5s w"rk: uman
$uncti"ns necessary $"r
"me"stasis
2ranscendence 4 adapted $r"m
="sepine Paters"n and +"retta
?derad5s w"rk: patients impr"'ewit te elp "$ nurses
,K"lcaba% 1991-
@"ur C"nte7ts "$
C"m$"rt
Pysical Psyc"spiritual
En'ir"nmental
S"cial
-
8/18/2019 Katherine Kolcaba
7/21
CONCEPTS OF COMFORT THEORY K"lcaba rec"gnized tat disc"m$"rt is m"re tan ust a pain$ul
pysical sensati"n "r em"ti"nal pain tat is $elt. (nstead se
c"ncluded tat "ter aspects "$ c"m$"rt "r disc"m$"rt a$$ect "listicbeings.
K"lcaba de$ined te tree types "$ c"m$"rt: Relief * e7perience "$ a patient w" as ad a speci$ic c"m$"rt need met
Eae* a state "$ calm "r c"ntentment
T!a"#e"$e"#e* te state in wic "ne rises ab"'e pr"blems "$ pain
2ese types "$ c"m$"rt are addressed by means "$ te $"ur c"nte7ts: P%i#al* pertaining t" sensati"ns ,pain% c"ld% eat% tingling-% "me"static
mecanisms ,temperature c"ntr"l% bleeding% '"miting* can all disrupt tis area- "r
$uncti"n "$ te immune system.
P#%'(i!i)*al* pertaining t" internal awareness "$ sel$% including esteem%identity% se7uality% meaning in "nes li$e% and "ne5s $eelings "r belie$ in a iger
p"wer "r superi"r being.
E"+i!'",e")al* pertaining t" te e7ternal backgr"und "$ uman e7perience,temperature% ligt% s"und% "d"r% c"l"r% $urniture% landscape-
S'#i'#*l)*!al* pertaining t" interpers"nal% $amily and s"cietal relati"nsips& als"
includes $amily traditi"ns% rituals and religi"us practices.,K"lcaba% //
-
8/18/2019 Katherine Kolcaba
8/21
TA-ONOMIC STRUCTURE 8en c"mbined% te tree types "$ c"m$"rt and c"nte7ts
create a 1 cell grid% re$erred t" as te ta7"n"mic structure%
wic was created by K"lcaba in 1991. 2is can be used as aguide wen assessing a patient5s le'el "$ c"m$"rt.
2ese aspects "$ c"m$"rt are interrelated wit "ne an"ter.
K"lcaba did n"t mean $"r tem t" be measured e7actly because
se $elt te pr"cess w"uld be time*c"nsuming and inaccurate
,K"lcaba% //0-. ;"we'er% a pattern "$ care can be establisedwereby patients c"m$"rt needs are intuiti'ely assessed in te
c"nte7ts.
Context of
Comfort
Type of Comfort
Relief Ease Transcendence
Physical
Psychospiritu
al
Environment
al
Social
-
8/18/2019 Katherine Kolcaba
9/21
NURSING METAPARADIGM
N"w lets l""k at te $"ur gl"bal c"ncepts "$
te nursing metaparadigm in relati"n t"
Katerine K"lcaba5s C"m$"rt 2e"ry.
;uman beings En'ir"nment ;ealt
Nursing
-
8/18/2019 Katherine Kolcaba
10/21
HUMAN BEINGS. 2is includes all in need "$ ealt care* indi'iduals% $amilies
and entire c"mmunities "r instituti"ns.
2e aspect "$ c"m$"rt is an imp"rtant and innate need t" be
attained. All umans deser'e t" be as c"m$"rtable as p"ssible.
Patient $"cused care is integral t" attaining c"m$"rt.
8en patients are m"re c"m$"rtable% tey are m"re likely t"
engage in ealt seeking bea'i"rs*including internal "r
e7ternal bea'i"rs "r e'en a peace$ul deat.
2e strengtening pr"perties "$ c"m$"rt pr"duce better
patient "utc"mes.
,K"lcaba% //0-
-
8/18/2019 Katherine Kolcaba
11/21
ENVIRONMENT. 3anipulati"n "$ te e7ternal surr"undings "$ te patient t"
$acilitate c"m$"rt. y means "$ t"uc% sigts% s"unds% ligting "r"d"rs t" pr"m"te a calming% c"m$"rting atm"spere. Any way tat
te senses can be altered t" enance c"m$"rt "$ te patient
applies.
;a'ing an understanding "$ te patient5s cultural% religi"us "rspiritual pre$erences and including tem in care pr"m"tes c"m$"rt.
8en te w"rds and acti"ns "$ te nurse are c"m$"rting% in
additi"n t" te intent "$ pr"'iding c"m$"rt% te inter'enti"ns are
"$ten percei'ed m"re as a c"m$"rt measure by te patients,K"lcaba% //0-.
Eliminate negati'ity in te en'ir"nment i$ p"ssible* pr"m"te
p"siti'e tinking and attitudes.
-
8/18/2019 Katherine Kolcaba
12/21
HEALTH. Acc"rding t" Katerine K"lcaba ,//0-% #;ealt is c"m$"rt) ,p.
0-
2e "ptimum le'el "$ $uncti"ning tat is appr"priate $"r and
de$ined by eac indi'idual patient.
2" be in g""d ealt a patient must attain wat 2;E! c"nsider
teir igest degree "$ c"m$"rt. C"m$"rt is a p"siti'e% dynamic
state and te ealt care team can d" m"re t" enance
c"m$"rt i$ tey g" bey"nd te treatment "$ disc"m$"rts and
pysical ealt ,K"lcaba% //0-.
8en "ne "$ te c"nte7ts "r 0 types "$ c"m$"rt is n"t
balanced "r being met% te patient may n"t be at teir igest
le'el "$ wellness "r ealt al"ng te ealt c"ntinuum.
-
8/18/2019 Katherine Kolcaba
13/21
NURSING. C"ntinual% acti'e use "$ te nursing pr"cess t" assess te c"m$"rt
"$ te patient and address teir needs t" attain c"m$"rt.
Assessing and reassessing weter te inter'enti"ns implemented
were success$ul in impr"'ing te c"m$"rt "$ te patient.
Pr"'iding c"mpetent empatetic% c"mpassi"nate% skilled and"listic nursing care t" eac patient% wit"ut in$licting udgment.
3aintaining a str"ng% trusting nurse*patient relati"nsip and
in'"l'ing te patient in meeting teir c"m$"rt needs and g"als
will make te pr"cess m"re success$ul.
,K"lcaba% //
-
8/18/2019 Katherine Kolcaba
14/21
INTERPRETATION & INFERENCE (nter'enti"ns $"r te patient are based "n
needs "$ te patient as well as $amily needs
C"m$"rt needs are intermi7ed. 3eeting "neneed may% in turn% $ill an"ter need
8en c"m$"rt needs are $ul$illed% te
patient $eels sa$e and well cared $"r.
,K"lcaba% 199-
-
8/18/2019 Katherine Kolcaba
15/21
IMPLICATIONS &CONSE/UENCES
8en c"m$"rt tasks suc as cleaning up r""m
"r straigting seets are pre$"rmed% patients
$eel cared $"r.
Patients w" a'e less stress a'e better"utc"mes
Nurses $eel m"re "b satis$acti"n because
e'en te smallest tasks bring c"m$"rt t"
teir patients.
-
8/18/2019 Katherine Kolcaba
16/21
EVALUATIONCla!ifi#a)i'" 'f
O!i0i"
Katerine5s pil"s"py e'"l'ed $r"m "lism% uman
needs and 3urray5s 2e"ry "$ ;uman Press ,190F-and was designed "nly $"r nursing ,K"lcaba% //0
pp.
-
8/18/2019 Katherine Kolcaba
17/21
-
8/18/2019 Katherine Kolcaba
18/21
PRACTICE
2eC"m$"rt2e"ry
A$+a"#e$Di!e#)i+e1 guide t"
make decisi"nsab"ut care and pain
management,endlinski G
K"lcaba% 199H-
;ealty ladderPr"gram $"r Irinary
(nc"ntinence in"lder adults ,Scirm
et al.% //-
Pe$ia)!i#*assistingte cild wit sel$c"m$"rting acti"nssuc as #r"cking)
,K"lcaba G Di3arc"%
//-
P#%ia)!i# N*!i"010*i$e$ i,a0e! )'!elie+e $e(!ei'"
a"$ i"#!eae #',f'!)2A(')'l' & K'l#a3a4
56678
Pe!ia"e)%eia*Clinical Practice
Juidelines,retrie'ed $r"mttp:66www.aspan."rg6
-
http://www.aspan.org/Portals/6/docs/ClinicalPractice/Guidelines/http://www.aspan.org/Portals/6/docs/ClinicalPractice/Guidelines/http://www.aspan.org/Portals/6/docs/ClinicalPractice/Guidelines/http://www.aspan.org/Portals/6/docs/ClinicalPractice/Guidelines/
-
8/18/2019 Katherine Kolcaba
19/21
CASE STUDY
C'")e9) 'f
C',f'!)
T(e 'f C',f'!)
Relie$ Ease 2ranscendence
P%i#al
P#%'(i!i)*al
E"+i!'",e")al
S'#i'#*l)*!al
15 year old female, diabetic patient as admitted to the hospital for asecond time in one month ith hyper!lycemia" She as found to be cryin!and ithdran, curled up in the fetal position in the dar#" Sta$ is
concerned because she does not ant to participate in administerin!insulin, chec#in! her blood su!ars, and meal plannin!" She indicates thatshe feels di$erent than everyone else and ants to be able to eathatever she ants"
-
8/18/2019 Katherine Kolcaba
20/21
REFERENCES:
Ap"st"l"% =.+.A.% G K"lcaba% K.% ,//9-. 2e e$$ects "$ guided
imagery "n c"m$"rt% depressi"n% an7iety% and stress "$ psyciatric
inpatients wit depressi'e dis"rders. Archives of PsychiatricNursing, 23,
-
8/18/2019 Katherine Kolcaba
21/21
REFERENCES:3arc% A.% 3cC"rmick% D. ,//9-. Nursing te"ry*directed
ealtcare m"di$ying k"lcaba5s c"m$"rt te"ry as an
instituti"n*wide appr"ac. "olistic Nursing Practice 23,-% pp.
H*F/. Retrie'ed $r"m Pub3ed
Scirm% .% aumgardner% =.% D"wd% 2.% Jreg"r% S.% G K"lcaba% K.%
,//-. NJNA. De'el"pment "$ a ealty bladder educati"npr"gram $"r "lder adults. eriatric Nursing, 2,-% pp 0/1* 0/