Nurses work in diverse healthcare settings, encountering patients with varying needs. Nurses’ professional and ethical obligation underlines the need for a detailed assessment of the needs and an effective response through holistic care. Nursing theories provide frameworks for implementing and evaluating patient care. Middle-range theories are more specific in focus and verifiable than grand nursing theories, allowing them to offer more concrete connections between theory and practice (Smith et al., 2023). Understanding their application and relevance in the clinical practice can help nurses deliver excellence, irrespective of the setting. The purpose of this paper is to explore a middle-range theory with particular attention to its utilization and application in practice.

Components of the Theory

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Nursing practitioners and researchers develop theories based on their experiences with patient care and a critical evaluation of interventions that improve outcomes. Katharine Kolcaba developed the Theory of Comfort (TC) in 1994 based on the observed or provided patient care in various settings like the operating room, medical/surgical units, and long-term facilities (Vo et al., 2020; Schmidt & Brown, 2024). The theory’s basic components include elements that enhance comfort: relief, ease, and transcendence. From Kolcaba’s perspective, comfort is the holistic experience acquired after the relief, ease, and transcendence needs are addressed (Lin et al., 2023; Martin et al., 2022). Relief denotes the unmet comfort needs that are typically severe. Hence, relief occurs when a comfort need is met. The element of ease stresses the need to prevent issues that make someone uncomfortable; thus, it is associated with calmness and contentment. Transcendence means a care experience that enables the person to overcome health problems or pain.

Kolcaba suggested that holistic care that enhances comfort is implemented under four domains: physical, psychospiritual, sociocultural, and environmental. According to Lin et al. (2023), the physical domain is primarily about bodily sensations and functions, while the psychospiritual aspect represents elements such as self-esteem, life meaning, and connection to a higher power. The third domain, sociocultural, refers to someone’s relationships with others, mainly family and friends. The environmental domain represents the external world, like nature (Vo et al., 2020). The needs under each domain should be addressed to enhance comfort.

The comfort theory’s philosophical underpinnings are that humans respond to multidimensional stimuli holistically, and comfort is the outcome of the holistic process that influences healthy choices. In this case, patients and their families are motivated to engage in health-seeking behaviors once their comfort is enhanced. The desire to engage fully in healthy choices may occur consciously or subconsciously, provided that a stimulus (comfort) is present.

Structural Aspects of the Theory

Kolcaba’s theory is established on the Conceptual Framework for Comfort Theory (Appendix A). The framework proposes that the process of achieving positive patient outcomes starts with healthcare professionals (HCPs) assessing the patients’ or family members’ comfort needs (Lin et al., 2023). The detailed assessment of these needs guides HCPs in designing appropriate interventions while considering intervening variables. In a clinical setting, intervening variables are factors that nursing professionals cannot easily change, such as financial resources and the patients’ extent of social support (Lin et al., 2023). Next, HCPs evaluate comfort before and after implementing the interventions. Adherence to this process promotes health-seeking behaviors and enhances the institution’s integrity. Dominant markers of improved integrity include a higher value, financial stability, and the wholeness of an institution at the community, state, and national levels.

Application in a Practice Area

Patients visiting the emergency unit have complex physical and mental health needs. Their conditions are characteristically painful, necessitating a caring and comfortable care environment. Kolcaba’s comfort theory helps to answer various questions regarding care for critically ill patients. For instance, TC helps nursing professionals design care that will effectively respond to the stressful experiences of children and adults during emergency room visits. As Freire et al. (2020) noted, integrating the theory into inpatient care