Comfort Theory: C-T-E Structure

The middle range theory of comfort for education, healthcare practice, and research was developed by Katherine Kolcaba in the 90s. The theory explains that patients are the individuals, communities, families, and/or institutions that require healthcare and the environment is their surrounding or aspects that can be influenced by health professionals to boost patient’s comfort. On the other hand, nursing practice is the act of assessing the comfort requirements of a patient through the development of necessary care plans and evaluation of the patient’s comfort upon utilizing the care plans developed. Rizk (2018) highlights that this theory is highly significant as it emphasizes on the importance of comfort in achieving quality healthcare. This paper will examine the Conceptual-Theory-Empirical (C-T-E) Structure of the middle range theory of comfort, through a 5-level hierarchical structure to unite the views of Katherine Kolcaba into an integrated outlook of the nursing industry and professional practice.

Evaluation of the CTE Linkages

Kolcaba identifies three key aspects that make up the concept of comfort; the aspect of ease, relief, and transcendence (Boudiab & Kolcaba, 2015). The aspect of relief in achieving a patient's comfort is highly significant as it occurs when specific patient needs are attained. For instance, after surgical procedures, patients experience postoperative pain; they will only achieve relief after administering the prescribed analgesia. This means that they will be in a comfortable state of contentment, where the aspect of ease applies. According to Lima et al. (2016), the aspect of ease basically explains the feelings of the patient after successfully countering issues that cause anxiety. It will be very easy for the patients to rise above their challenges after attaining the aspect of ease, a state that Kolcaba explains as transcendence. In nursing practice, the patients will indicate pain, which will be eased by either pharmacological or non-pharmacological treatment options before the patients can be able to tolerate it (wright, 2017). This theory is applicable to perioperative practice since it aims to enhance pain relief and ease, thereby, enabling the patients to rise above discomfort situations. 

Analysis of the Selected Theory

As Owen (2016) explains, the theory of comfort is holistic and humanistic; generally based on the needs of the patients. Boudiab & Kolcaba (2015) further emphasizes that it focuses on the concepts of patient’s comfort care, comfort needs, comfort interventions, comfort place, interventional variables, health-seeking behaviors (HSB), and institutional integrity. Therefore, making it be clearly and consistently applicable in all the nursing settings. Furthermore, its developmental stages entail the philosophic orientation and comfort analysis with basic reasoning of inductive and deductive aspects. 

The framework and the content of the theory focus on the idea of an alternative comfort and adequately reflect on each other, though with a nominal clarity. Kolcaba mentions the six propositions of her theory with a consistent flow, thereby, explaining the contents of the theory. Besides, the assumptions of the work are clear and consistent with holistic treatments and comfort. Generally, the theory is ideally reciprocal and all its parts depend on each other for success. Despite this, its idea of comfort seems less clear with only the conceptual diagrams and the propositions adequately explained. It would be ideal if Kolcaba explained the theory simply.

It is characterized by poor testability as it lacks a specific technique for evaluation apart from the taxonomic structure filled by the practitioners. However, through regular assessments, the nurses will be able to know if comfort is achieved either subjectively or objectively. Through the theory, regular examination of the patient to notice non-verbal pain indicators is the best alternative of measuring a patient’s comfort. As such, this theory is very basic just like many other middle range theories and provides difficult means of evaluating leads to a definitive comfort management method. 

Examination of the Empirical Indicators

The theory has been tested and supported by various literal works that include psychometric and experimental studies (Peterson & Bredow, 2019). The idea of comfort has also been largely discussed as important in achieving quality healthcare. Moreover, various researches are analyzing the theory of comfort and its application in distinct nursing settings, many of which approves its application. Katherine initially targeted dementia healthcare, but as the theory is constructed, it applies to all settings of nursing practice. It is utilized in hospice nursing to provide a broad view on offering alternative comfort to the critically ill and patients in their end of life situations. Consequently, it is utilized by the perianesthesia nursing in helping patients file distinct ways of acquiring comfort. It is diversely applied in nursing settings, including the intra-operative care and radiation therapies, and has been affirmed to work effectively in providing nursing care especially for the mentally ill, the disabled patients, and giving care in newborn nurseries.    

Assessment of the Research Findings

Katherine’s work is a practical notion as human beings will always feel better when in comfortable states. Patients and their families will be better placed to absorb health information when focused and in comfortable states. The theory of comfort offers very basic and simple ways of ensuring the provision of comfort to the patients. In nursing practice, it is a motivation as it encourages the nurses to deeply understand the comfort levels of their patients by analyzing causes of discomfort as well as the significant factors that promote comfort. Consequently, nurses are also able to explore the different methods that promote patient comfort and in diverse settings. For instance, Wright (2017) applied the theory to the PACU and ASC nursing settings and denoted that it improves nursing knowledge on acute postoperative pain management and increases the patient’s satisfaction.

Utility and Soundness of the Practice Theory

It is a significant theory in advancing the disciplines where basic elements, knowledge, nursing practice, and development are essential. Importantly, knowledge is acquired through the development of knowledge as well as sustainable practices. This indicates that knowledge is acquired via personal, empirical, ethical, and nursing practice science. Therefore, this theory is highly significant in nursing practice as it helps in the development of ethical and aesthetical models that are necessary for predicting the implications of certain interventions on patients.


This paper examined the Conceptual-Theory-Empirical (C-T-E) Structure of the middle range theory of comfort by Katherine Kolcaba. The research has ascertained that the theory is an important part of nursing practice both as a motivational factor in the part of the caregivers, knowledge advancement tool for the nurses, as well as in the provision of an effective paradigm of achieving patient comfort. Human beings tend to be active and productive when in a comfortable state, a fact which the theory of comfort aims to solve through its three key parts of relief, ease, and transcendence. It is as such a logical theory in nursing practice despite its limitations of inadequate evaluation methods as well as providing difficult means of evaluating leads to a definitive comfort management method.


Boudiab, L. D., & Kolcaba, K. (2015). Comfort Theory. Advances in Nursing Science38(4), 270-278.

Lima, J. V. F., Guedes, M. V. C., Silva, L. D. F. D., Freitas, M. C. D., & Fialho, A. V. D. M. (2016). Usefulness of the comfort theory in the clinical nursing care of new mothers: Critical analysis. Revista gaucha de enfermagem37(4).

Owen, M. I. (2016). An investigation of palliative care in heart transplant candidates utilizing Kolcaba's Theory of Comfort. Rush University.

Peterson, S., & Bredow, T. S. (2019). Middle range theories: Application to nursing research and practice. Lippincott Williams & Wilkins.

Rizk, S. H. (2018). Toward a Nursing Theory for Providing Transcendent End-of-life Care to Patients and Their Families (Doctoral dissertation, University of Toledo).

Wright, A. P. (2017). Improving acute postoperative pain management using an educational intervention (Doctoral dissertation, Chatham University).