The Concept

MAJOR CONCEPTS
(Metaparadigm Concepts)

Person/Client 

         Patient can be considered as individuals, families, institutions or communities in need of health care including primary, secondary and tertiary or preventive care.


Health 
          The optimum functioning of the patient. Health is defined as “the person's state of well-being, which can range from high-level wellness to terminal illness. It is considered to be optimal functioning as defined by the patient, group, family or community.
Nursing

           Nursing is described as a process of assessment, setting of goals,implementing interventions in reference to the patient's comfort needs; it also involves continuous reassessment in order to evaluate patient's comfort after the nursing interventions. Assessment may be objective, such as observing improvements of vital signs or subjective as patient's verbalization of level of comfort.

Environment

             Anything in the surroundings that a nurse or loved ones can manipulate/utilize to enhance comfort of the patient-it may be family or institutional surroundings.

• Environmental comfort "Pertaining to external surroundings, conditions, and influences." (Kolcaba, 1997)
• Decreasing the level of noise, cleanliness of the room which includes the rest of the hospital staff in maintaining the cleanliness of the patient's room.
• Integrating old patterns of social graces and behaviors so that patients could fit with other residents during special programs.

KEY CONCEPTS

• Health Care Needs - Deficits in any context of comfort that arise from stressful health care situations and which the patient’s natural support system cannot meet.
• Nursing Interventions- Comfort measures that nurses design and implement that are targeted to the health care needs. These interventions have the explicit goal of enhancing the patient's immediate comfort and/or facilitating subsequent desirable health seeking behavior.
• Intervening Variables - Factors that each patient brings to the health care situation, that nurses cannot change, and that have an impact on the success of the interventions.
• Health - Seeking Behaviors - Internal or external behaviors in which the patient engages that facilitate health or a peaceful death (Schlotfeldt, 1975). They can be internal (healing, T-cell formation, oxygenation, etc.) or external (observable behaviors such as working in therapy, length of stay in hospital, ambulation, functional status
• Institutional Integrity- Stability and ethics of nay hospital, health care system, region, state, or country. When institutions do better, patients do better and visa versa.
• Comfort- The immediate experience of being strengthened  through having the needs for relief, ease, or transcendence met in the physical, psychospiritual, environmental, and social contexts of experience.
• Comfort Care- A nursing art that entails the process of comforting actions performed by a nurse (Morse, Bottorff, and Hutchinson, 1994) and the outcome of comfort that is brought into being (Kolcaba, 1992).
• Comfort Measure- Any action taken to promote the soothing of a patient, such as a back rub, a change in position, the prewarming of a stethoscope or bedpan, or administration of selected medications or treatments.

THE TAXONOMIC STRUCTURE

 OF COMFORT

3 FORMS OF COMFORT
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)
Example: The relief of postoperative pain by administering prescribed analgesia, the individual experiences comfort in the relief sense.	Example: The feeling one might have felt after having issues that are causing anxiety addressed, that person experiences comfort in the ease sense	Example: Eventual acceptance of a death of a love one.

CONTEXTS IN WHICH COMFORT IS EXPERIENCED
PHYSICAL	Physical: pertaining to bodily sensations and homeostatic mechanisms.
PSYCHOSPIRITUAL	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.
SOCIOCULTURAL	Sociocultural: pertaining to interpersonal, family, and societal relationships. Also to family traditions, rituals, and religious practices.
ENVIRONMENTAL	Environmental: pertaining to external surroundings, conditions, and influences.