A Systematic Literature Review Toward the Characterization of Comfort

Application of Kolcaba's Comfort Theory in healthcare promoting adults' comfort: a scoping review

BACKGROUND

Comfort is a primary goal of healthcare. Theory-informed interventions and measurement are essential for comfort enhancement.

OBJECTIVES

To categorise and synthesise the international literature on the application of Kolcaba's Comfort Theory in research and practice aiming to promote adults' comfort.

ELIGIBILITY CRITERIA

Papers reporting the application of Kolcaba's Comfort Theory on adult participants published in English and Chinese.

SOURCES OF EVIDENCE

MEDLINE, CINAHL, APA PsycInfo, Embase, AMED, Web of Science, Scopus, The Cochrane Library, JBI EBP Database, CNKI, Wan Fang; grey literature of Google Scholar, Baidu Scholar and The Comfort Line were searched from January 1991 to January 2024.

CHART METHODS

Following the Joanna Briggs Institute guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist, two reviewers selected papers and extracted data independently using a standardised chart embedded in NVivo software. A thematic synthesis and a descriptive analysis were provided.

RESULTS

The review included 359 papers. Approximately two-thirds (n=216, 60.2%) had been published since 2017. The majority of papers (n=316, 88.0%) originated from China, the USA, Turkey, Brazil and Portugal. The use of Kolcaba's Comfort Theory was dominated in a range of hospital settings (n=263) and with participants suffering neoplasms (n=55). Seven categories of theory application were identified: (I) interventions underpinned by Comfort Theory as the theoretical framework, (II) interventions evaluated by instruments derived from Comfort Theory, (III) descriptive or observational studies of services or practices underpinned by Comfort Theory, (IV) surveys using questionnaires derived from Comfort Theory, (V) questionnaires development or adaption based on Comfort Theory, (VI) qualitative studies interpreted by Comfort Theory and (VII) literature reviews and discussion about Comfort Theory use. The most commonly evaluated interventions included music therapy (n=31), position intervention (n=20) and massage (n=19), and the most commonly used questionnaire was General Comfort Questionnaire (n=109).

CONCLUSIONS

Kolcaba's Comfort Theory has been largely used in interventions and assessments across a wide range of contexts, providing a set of options for practitioners. However, quantifying evidence is needed through further systematic reviews, and continuous development of Comfort Theory is warranted based on the categorisation by this review.

Support network: the challenges of ensuring myocardial infarction patients comfort in the critical care unit: a qualitative study

INTRODUCTION

Myocardial infarction (MI) is a critical emergency condition that affects all aspects of health. Patients with MI need specialized care in the Coronary care unit (CCU). The main goal of care is to ensure their comfort, which can be significantly affected by their illness and hospitalization. This study aims to explore MI patients' perceptions of support network challenges to ensure comfort in the CCU.

METHODS

A qualitative approach was adopted, and semi-structured interviews and notes were used for collecting data between 2020 and mid-2021. The participants were 27 MI patients in our country who had been hospitalized in the CCU of the University Heart Hospital. They were selected using purposive sampling. The data were analyzed using conventional content analysis by Graneheim and Lundman.

FINDINGS

The results of this research were revealed in the form of a "support network" theme comprising five categories: "Physical support", "Mental occupations", "Presence of peers", "relatives support "and "Spiritual strategies".

CONCLUSION

The study results showed that MI patients, in critical condition, receiving care, and hospitalized in the CCU require continuity in their support network to ensure comfort. The inconsistency between the components of each dimension leads to the challenge of ensuring comfort.

Psychometric validation of the Kolcaba General Comfort Questionnaire in critically ill patients

BACKGROUND

There is a lack of validated tools to measure comfort in critically ill patients.

OBJECTIVE

The objective of this study was to evaluate the psychometric properties of the General Comfort Questionnaire (GCQ) in patients admitted to intensive care units (ICUs).

METHODOLOGY

A total of 580 patients were recruited, randomising the sample into two homogeneous subgroups of 290 patients for exploratory factor analysis and confirmatory factor analysis, respectively. The GCQ was used to assess patient comfort. Reliability, structural validity, and criterion validity were analysed.

RESULTS

The final version included 28 of the 48 items from the original version of the GCQ. This tool was named the Comfort Questionnaire (CQ)-ICU, maintaining all types and contexts of the Kolcaba theory. The resulting factorial structure included seven factors: psychological context, need for information, physical context, sociocultural context, emotional support, spirituality, and environmental context. A Kaiser-Meyer-Olkin value of 0.785 was obtained, with Bartlett's sphericity test (0.000) being significant, and the total variance explained was 49.750%. The Cronbach's alpha was 0.807, with subscale values ranging from 0.788 to 0.418. Regarding convergent validity, high positive correlations were obtained between the factors and the GCQ score, the CQ-ICU score, and the criterion item GCQ31: "I am content". In terms of divergent validity, correlations were low with the APACHE II scale and with the NRS-O except for physical context (-0.267).

CONCLUSION

The Spanish version of the CQ-ICU is a valid and reliable tool to assess comfort in an ICU population 24 h after admission. Although the resulting multidimensional structure does not replicate the Kolcaba Comfort Model, all types and contexts of the Kolcaba theory are included. Therefore, this tool enables an individualised and holistic evaluation of comfort needs.

Measuring Gatekeeper Instructor Comfort to Inform Suicide Prevention Train-The-Trainer Recruitment & Training in Agricultural Communities

Farmers experience psychological distress and suicide at consistently higher rates than workers in other industries. A gatekeeper is an individual who has been trained to recognize warning symptoms of possible suicidal ideations in others. Gatekeeper programs are recognized by the federal Substance Abuse and Mental Health Services Administration as a best practice for suicide prevention. While gatekeeper programs offer promise to addressing the increasing worldwide suicide rate, how to develop these networks in communities with largely ingrained stigma and taboo related to mental health and suicide remains unanswered. Three of this study's researchers were part of the development and pilot of an agricultural community gatekeeper program and questioned how gatekeeper instructor psychological comfort could be conceptualized and operationalized for the purpose of informing gatekeeper instructor recruitment and training. After a thorough review of the literature, the researchers constructed a conceptual developmental model of gatekeeper instructor comfort and created a Gatekeeper Instructor Comfort Measure instrument which was then piloted with Kentucky K-12 and university agricultural educators. The researchers of this study employed the Rasch model to determine whether the developmental model of gatekeeper instructor comfort held together empirically. Infit and outfit mean squares (0.73 to 1.33) indicate that the items measure one construct, or are unidimensional, while person reliability and separation statistics indicate that the Gatekeeper Instructor Comfort Measure is composed of enough items to differentiate respondents into almost four strata of gatekeeper comfort. The Gatekeeper Instructor Comfort Measure's fit to the Rasch model indicates that the instrument meets the requirements of invariant measurement and should serve as a useful measure for other researchers. The instrument's item difficulty hierarchy also serves as a guide for those training gatekeepers on how to target different gatekeeper outcomes sequentially or developmentally. Researchers recommend restructuring item responses to enable greater discrimination between categories and then piloting the instrument again with a more diverse sample. The revised measure could be used pre- and post-gatekeeper instructor training to determine the impact of training on gatekeeper comfort.

Goals of Care Among Parents of Children Receiving Palliative Care

Importance

While knowing the goals of care (GOCs) for children receiving pediatric palliative care (PPC) are crucial for guiding the care they receive, how parents prioritize these goals and how their priorities may change over time is not known.

Objective

To determine parental prioritization of GOCs and patterns of change over time for parents of children receiving palliative care.

Design, Setting, and Participants

A Pediatric Palliative Care Research Network's Shared Data and Research cohort study with data collected at 0, 2, 6, 12, 18, and 24 months in hospital, outpatient, or home settings from April 10, 2017, to February 15, 2022, at 7 PPC programs based at children's hospitals across the US. Participants included parents of patients, birth to 30 years of age, who received PPC services.

Exposures

Analyses were adjusted for demographic characteristics, number of complex chronic conditions, and time enrolled in PPC.

Main Outcomes

Parents' importance scores, as measured using a discrete choice experiment, of 5 preselected GOCs: seeking quality of life (QOL), health, comfort, disease modification, or life extension. Importance scores for the 5 GOCs summed to 100.

Results

A total of 680 parents of 603 patients reported on GOCs. Median patient age was 4.4 (IQR, 0.8-13.2) years and 320 patients were male (53.1%). At baseline, parents scored QOL as the most important goal (mean score, 31.5 [SD, 8.4]), followed by health (26.3 [SD, 7.5]), comfort (22.4 [SD, 11.7]), disease modification (10.9 [SD, 9.2]), and life extension (8.9 [SD, 9.9]). Importantly, parents varied substantially in their baseline scores for each goal (IQRs more than 9.4), but across patients in different complex chronic conditions categories, the mean scores varied only slightly (means differ 8.7 or less). For each additional study month since PPC initiation, QOL was scored higher by 0.06 (95% CI, 0.04-0.08) and comfort scored higher by 0.3 (95% CI, 0-0.06), while the importance score for life extension decreased by 0.07 (95% CI, 0.04-0.09) and disease modification by 0.02 (95% CI, 0-0.04); health scores did not significantly differ from PPC initiation.

Conclusions and Relevance

Parents of children receiving PPC placed the highest value on QOL, but with considerable individual-level variation and substantial change over time. These findings emphasize the importance of reassessing GOCs with parents to guide appropriate clinical intervention.

Interventions and practices using Comfort Theory of Kolcaba to promote adults' comfort: an evidence and gap map protocol of international effectiveness studies

BACKGROUND

Comfort is a primary patient objective and central to patient experience, and thus, maximising comfort is a universal goal for healthcare. However, comfort is a complex concept that is difficult to operationalise and evaluate, resulting in a lack of scientific and standardised comfort care practices. The Comfort Theory developed by Kolcaba has been the most widely known for its systematisation and projection and most of the global publications regarding comfort care were based on this theory. To develop international guidance on theory-informed comfort care, a better understanding about the evidence on the effects of interventions guided by the Comfort Theory is needed.

OBJECTIVES

To map and present the available evidence on the effects of interventions underpinned by Kolcaba's Comfort theory in healthcare settings.

METHODS

The mapping review will follow Campbell Evidence and Gap Maps guideline and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Protocols guidelines. An intervention-outcome framework has been developed based on Comfort Theory and the classification of pharmacological and non-pharmacological interventions via consultation with stakeholders. Eleven electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, AMED, Cochrane Library, JBI Library of Systematic Reviews, Web of Science, Scopus, CNKI and Wan Fang) and grey literature sources (Google Scholar, Baidu Scholar and The Comfort Line) will be searched for primary studies and systematic reviews between 1991 and 2023 written in English and Chinese as the papers regarding Comfort Theory were first published in 1991. Additional studies will be identified by reference list review of included studies. Key authors will be contacted for unpublished or ongoing studies. Two independent reviewers will screen and extract data using piloted forms with discrepancies resolved by discussion with a third reviewer. A matrix map with filters of study characteristics will be generated and presented through software of EPPI-Mapper and NVivo.

DISCUSSION

More informed use of theory can strengthen improvement programmes and facilitate the evaluation of their effectiveness. Findings from the evidence and gap map will present the existing evidence base for researchers, practitioners and policy-makers and inform further research as well as clinical practices aiming at patients' comfort enhancement.

Nurses' healing presence: A panacea for the comfort of acute coronary syndrome patients in CCU, A qualitative study

AIM

The study aimed to explain the acute coronary syndrome (ACS) patients' perception of the nurse's healing presence in their comfort in the critical care unit.

DESIGN

This descriptive qualitative study was conducted from December 2020 to September 2021.

METHODS

Twenty-seven ACS patients were purposively selected from a cardiovascular university Hospital, Iran. Data were collected through semi-structured interviews (45-60 min). Data analysis was performed based on the contractual content analysis method of Graneheim and Lundman.

RESULTS

In the data analysis, the main theme 'nurses' healing presence' includes two categories: 'Nurse-patient communication' with two subcategories and the category 'Compassionate care' with three subcategories.

Spiritual comfort, spiritual support, and spiritual care: A simultaneous concept analysis

BACKGROUND

Spirituality is a dimension of life and the human being that should be included in holistic healthcare. One major barrier often described by nurses on implementing spirituality in practice relates to perceiving the concept of spirituality as subjective and sharing confounding similarities with other concepts. In this sense, the concepts of spiritual comfort, spiritual care, and spiritual support may require more distinct theoretical definitions aimed at clear and effective nursing interventions within spiritual care.

AIM

To provide a definition of spiritual comfort, spiritual support, and spiritual care.

METHODS

Simultaneous concept analysis (SCA) of three concepts according to Haase et al., which is grounded on Rodgers' evolutionary view. The method was based on a literature review with the search of electronic databases on May 2020. Search and analysis have been blinded conducted by two reviewers.

RESULTS

One hundred thirty-six studies were included in the SCA. Findings suggest that spiritual comfort is an immediate state and an outcome. Spiritual support is related with an intimate and positive relationship with God. Spiritual care is defined as a complex and interactive process. Both spiritual support and spiritual care are grounded in a therapeutic context.

CONCLUSION

This SCA allowed the attributes of each concept to be identified and provides definitions that may facilitate the understanding of these concepts and promote the implementation of spirituality in nursing practice, but which has also led to future research on this topic.

Exploring Ghanaian nurses knowledge and application of bio-ethical principles in postoperative pain management

Managing postoperative pain require good understanding of the bio-ethical principles in order to preserve patients’ rights. Bio-ethical principles in health care include autonomy, beneficence, justice and nonmaleficence. It is important that health care professionals understand that patients in pain have the right to satisfactory management. Good insight on ethical principles and how they relate to pain management places the nurse on a better pedestal to manage postoperative pain effectively. However, there is scanty literature on the level of Ghanaian nurses’ knowledge and application of bio-ethical principles in postoperative pain management. Therefore, the study objectives were to: explore nurses’ understanding of the bio-ethical principles in postoperative pain management; explore how nurses apply bioethical principles in postoperative pain management. The study employed qualitative exploratory descriptive design. Purposive sampling technique was used to recruit participants from the surgical wards. Semi-structured interview guide was designed for data collection. Data saturation was reached at the fourteenth participant. Thematic analysis method was used and themes emerged inductively. Three main themes identified through inductive content analysis of data were: beneficence, autonomy and justice. Findings showed that nurses had some appreciable level of knowledge of the fundamental principles related to ethics and applied them in postoperative pain management. Nurses knew their duties in advocating for patients. Patients rights to refuse treatment was also appreciated by some nurses. Nurses also demonstrated humanity by helping patients financially to settle hospital debts which explicitly shows the empathetic characteristics of nurses. The study concluded that nurses are knowledgeable in bioethical principles underpinning post operative pain management and also applied these principles when caring for surgical patients.

A scale development study: Hemodialysis comfort scale version II

Aim

Aim of this study was to develop a valid and reliable measuring tool in order to evaluate comfort of patients receiving hemodialysis treatment.

Background

There has been available a scale developed to evaluate comfort of hemodialysis patients "HDCS (Hemodialysis Comfort Scale)." Due to HDCS consisted of nine items and evaluated comfort in two sub-dimensions, researchers who developed HDCS, stated that number of scale items and dimensions is not sufficient to fully evaluate comfort. Therefore, (Hemodialysis Comfort Scale Version II) HDCS-II was developed with this research and its development process were discussed in this article.

Materials and Methods

Sample of this methodological research was consisted of 436 chronic hemodialysis patients, treated at five hemodialysis centers between October 2018 and May 2019. In process of creation item pool, comfort theory and literature was examined. The items in the old scale were also revised and included. Thereby a new question pool of 87 items was created. This draft scale was sent for expert opinion. In validity of scale; content validity index, exploratory and confirmatory factor analysis were used. In reliability study; Item analysis, cronbach's alpha reliability coefficient, parallel form reliability and item analysis based on upper-lower group averages were used.

Results

There was consistency between expert views relating to items in scale. According to exploratory factor analysis, scale consisted of six dimensions. Cronbach alpha coefficient of 26-item scale was 0.79. Alpha values of the six factor in scale were, respectively; for physical relief 0.83, for physical ease 0.71, for psychospiritual ease 0.87, for psychospiritual transcendence 0.85, for environmental transcendence 0.82, and for sociocultural ease 0.61.

Conclusion

HDCS-II is a 5-point likert type and consists of 26 items and 6 factors. This scale is a valid and reliable measurement tool that can be used to determine comfort of patients undergoing hemodialysis treatment.

Everyday comforting practices in psychiatric hospital environments: A design anthropology approach

WHAT IS KNOWN ON THE SUBJECT

Comfort as a conceptual and lived experience is essential in psychiatric hospital contexts and for overall mental health wellbeing. Comfort is a valuable aspect when designing hospitals and built environments for psychiatric care.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

This article presents the results from a Design Anthropology study at four Psychiatric Units co-located in a newly built regional hospital based on 126 ethnographic interviews with staff, within which 63 participants mentioned the importance of comfort in generating environments conducive to wellbeing. An in-depth qualitative understanding of comforting practices, as emergent forms of everyday care. These may receive less attention within more established interventions from organisational models of care (e.g., Safewards) and might appear to be implicit gestures of courtesy. However, they contribute to meaningful encounters and contribute to individual and organisational wellbeing in psychiatric care.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

This paper builds on comfort theories and demonstrates implications for practice through ethnographic examples. Comfort, often unnoticed until it is absent, needs to be maintained through continuous "small" but intentional acts of care. These constitute a finely tuned repertoire of everyday comforting practices of care at psychiatric contexts. Corridors and doors are presented as spaces where people have brief interactions that can contribute to everyday comforting experiences. Comfort is discussed in dialogue with existing literatures from psychiatric nursing, healthcare building design and design anthropology. Implicit and improvised practices of care that foster comforting environments have vital potential to support institutionally endorsed models of care (e.g., Safewards). The article proposes that design has a dual role for comforting environments in psychiatric care; (a) through the practice of architectural design and (b) through the practices of staff when creating everyday comforting interactions for wellbeing.

ABSTRACT

INTRODUCTION: Creating a comforting environment is essential for delivering psychiatric care. While healthcare organisations explicitly implement care models and adapt the physical environment, attention to staff's implicit everyday practice is limited.

AIM

Developing a design anthropology approach tailored specifically to the research site, we examine the social and physical environment to unpack how staff integrate both-implicit comforting interventions, and the explicit measures taken by the organisation-into their everyday practices of psychiatric care.

METHOD

Design and sensory ethnography, using extended observations and "walking tours" were undertaken with 126 staff members. A thematic analysis was conducted on all visual and audio material.

RESULTS

Staff's everyday implicit care practices and situated design decisions provide a comforting environment for patients, visitors and staff.

DISCUSSION

Implicit practices combine with an explicit organisational model of care to achieve a comforting environment. The value of design anthropology to uncover these dynamics is emphasized. Comforting practice involving implicit gestures of courtesy, which are infrequently addressed within organisational models of care (e.g., Safewards), are foregrounded.

IMPLICATIONS FOR PRACTICE

Explicit models of care have clear value in generating comfort; however, psychiatric hospital care also benefits from less visible modes of delivering comfort through everyday practices. By acknowledging both explicit and implicit modes of comfort, we can better understand how care models and psychiatric cultures of care are nurtured. Continuous "small" but intentional acts of care (e.g., brief interactions in corridors and at doors) constitute a finely tuned repertoire of everyday comforting practices.

IMPAIRED COMFORT AT THE END OF LIFE: AN ASSOCIATION WITH NURSING DIAGNOSIS AND CLINICAL VARIABLES

ABSTRACT Objective: to analyze the associations between the clinical variables and the Nursing diagnoses of NANDA-I Taxonomy II with the presence of Impaired comfort. Method: a quantitative and analytical study conducted with 66 individuals with end-of-life oncological disease, admitted to a specialized institution in the Federal District, Brazil. Primary data were collected between February and November 2018, which covered social, demographic and clinical variables, in addition to three validated scales to identify Nursing diagnoses. To assess the association of impaired comfort (dependent variable) as a function of the independent variables (Nursing diagnosis and clinical variables), the Mann-Whitney non-parametric test and Pearson's chi-square test were used, considering p< 0.05 as significant. Results: a total of 960 diagnoses were identified in 66 patients. There was a positive relationship with Impaired comfort for the following Nursing diagnoses: Chronic pain; Impaired physical mobility; Self-care deficit (for feeding, bathing, intimate hygiene and dressing); Chronic sorrow and Dysfunctional family processes. The following clinical variables showed a statistically significant relationship regarding impaired comfort: time of palliative care, pain, tiredness, appetite, sorrow, anxiety and well-being. Conclusion: an association of the pain, impaired physical mobility, self-care deficit and chronic sorrow nursing diagnoses with impaired comfort was identified. Among the clinical variables, there was a relationship between time of palliative care and symptoms.

Nursing diagnoses clusters: survival and comfort in oncology end-of-life care

BACKGROUND

Holistic care and nursing diagnoses are essential in end-of-life, since interventions based on these ensure greater patient comfort and quality of life.

AIMS

To identify clusters of nursing diagnoses and repercussions for patient comfort and survival.

METHODS

A prospective cohort of 66 end-of-life patients with cancer was examined. Diagnostic groupings were created based on the Kolcaba's theory of comfort. Pearson's chi-square test and Kaplan-Meier estimator were used to assess the relationship between clusters, comfort, and survival.

FINDINGS

Three diagnostic groups and 23 nurse diagnoses were used. The first and most prevalent diagnosis cluster was related to intestinal tract disorders and sleep. The second was related to neuropsychological characteristics and fatigue associated with lower survival, while the third cluster was related to functionality and perception, which was shown to be associated with less comfort.

CONCLUSION

The three clusters were significantly associated with comfort and survival.

Elucidating the End-of-Life Experience of Persons With Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease that occurs in 4 among 100 000 people in the United States. Individuals with ALS gradually lose their ability to control voluntary muscles, diminishing their ability to communicate. A comprehensive multidatabase search retrieved 31 qualitative research articles that addressed persons with end-of-life experiences with ALS. Inclusion/exclusion criteria were applied and a critical appraisal was applied for the final 8 included articles. First-person data extraction from the final articles represented emergence of 3 themes significant to persons with ALS: decisions for life-sustaining support, coping and fear of what is to come, and communication with providers. Tracheostomy and ventilation as a means of prolonging life were important considerations for individuals with ALS. Persons with ALS struggled emotionally with their sudden loss of control and facing their demise. Some facets in which they did exert control, such as living wills, were hindered by patient and health care provider communication. Effective communication in end-of-life circumstances is paramount to preserving patient autonomy and dignity. This can be achieved by the patients conveying their preferences with respect to end-of-life care in advance, as well the nurses and other health care providers supporting the patients emotionally as they cope with terminal illness. Understanding patients' views regarding end-of-life circumstances is pertinent to nurses and other health care providers as they plan for palliative care.

A framework of comfort for practice: An integrative review identifying the multiple influences on patients' experience of comfort in healthcare settings

Purpose

Comfort is central to patient experience but the concept of comfort is poorly defined. This review aims to develop a framework representing patients' complex perspective of comfort to inform practice and guide initiatives to improve the quality of healthcare.

Data sources

CINAHL, MEDLINE Complete, PsycINFO and Google Scholar (November 2016); reference lists of included publications.

Study selection

Qualitative and theoretical studies advancing knowledge about the concept of comfort in healthcare settings. Studies rated for methodological quality and relevance to patients' perspectives.

Data extraction

Data on design, methods, features of the concept of comfort, influences on patients' comfort. Data were systematically coded and categorized using Framework method.

Results of data synthesis

Sixty-two studies (14 theoretical and 48 qualitative) were included. Qualitative studies explored patient and staff perspectives in varying healthcare settings including hospice, emergency departments, paediatric, medical and surgical wards and residential care for the elderly. From patients' perspective, comfort is multidimensional, characterized by relief from physical discomfort and feeling positive and strengthened in one's ability to cope with the challenges of illness, injury and disability. Different factors are important to different individuals. We identified 10 areas of influence within four interrelated levels: patients' use of self-comforting strategies; family presence; staff actions and behaviours; and environmental factors.

Conclusion

Our data provide new insights into the nature of comfort as a highly personal and contextual experience influenced in different individuals by different factors that we have classified into a framework to guide practice and quality improvement initiatives.

Feeling Comfortable: A Humanbecoming Perspective

Feeling comfortable is a universal living experience. From the worldview of the humanbecoming paradigm, concept inventing is an appropriate method to expand understanding and knowledge of universal experiences. The purpose of this article is to provide a synthetic definition of feeling comfortable using the concept inventing process. Through concept inventing, a synthetic definition of feeling comfortable emerged as penetrating quietude amid potential upheaval arising with opportunities and restrictions with envisioning the familiar anew. Further development of the concept through qualitative research is recommended.

Comfort, well-being and quality of life: Discussion of the differences and similarities among the concepts

Highlights

The distinction among the concepts of comfort, well-being and QoL is often unclear.This ambiguity can lead to redundancies, gaps, and knowledge dispersion.The concepts are not surrogate terms but related concepts sharing common attributes.

Aim

To analyze the differences and similarities of the concepts of comfort, well-being and quality of life (QoL).

Methods

Review of concept analysis research on PubMed, Cinahl (full text) and Scielo, using the search terms "Comfort", "Well-being", "Quality of Life" and "Concept Analysis".

Results

Eighteen studies were included. Comfort is a broader holistic concept while well-being is mainly related to psycho-spiritual dimensions. QoL reflects the individual perception of satisfaction with life.

Conclusions

The concepts are not surrogate terms, but related concepts sharing common attributes. Caution should be taken in further research, particularly as regards the correct use and framing of the concepts.

Cultural adaptation and validation of the Portuguese End of Life Spiritual Comfort Questionnaire in Palliative Care patients

Background

Holistic comfort is an important outcome in palliative care and an important goal for patients, relatives and healthcare workers. Holistic comfort considers one's acceptance of life circumstances, support from loved ones and health care professionals, and peaceful resolution of relationships during stressful situations. However, this type of comfort is still difficult to measure, particularly in palliative care patients, as there is a lack of instruments available, especially in the Portuguese language. This study aims to provide an accurate and sensitive instrument to assess the spiritual comfort of Portuguese palliative care patients.

Objective

To perform the cultural adaptation and validation of a Portuguese version of the End of Life Comfort Planning Questionnaire in Palliative Care patients.

Methods

Methodological research, with analytical approach. The translation, synthesis, back translation, review, pretest, semantic evaluation and analysis of the psychometric properties were performed. A total of 141 palliative care patients from acute medical-surgical settings at a central hospital in the north of Portugal were recruited. The Ethics Committee approved the research.

Results

The internal consistency analysis of the adapted instrument resulted in a global alpha value of 0.84 and the factor analysis presented a solution with five factors with rational meaning. The Portuguese version comprised 20 items.

Conclusions

The instrument has good psychometric properties. It was reliable, valid and sensitive to the existence of the spiritual comfort of palliative care patients, and appropriate for further research.