Contributor: Judith Paré PhD, RN
In 2016, the Massachusetts Coalition for Serious Illness Care (MCSIC) was formed through a collaboration of local healthcare, advocacy, and academic institutions. The mission of the organization is “to strengthen the communication, collaboration, and connection between the healthcare system and communities, and between patients and clinicians, to support what matters most to everyone seeking care, especially people living with serious illness” (MCSIC, 2022). The MCSIC convened a nursing taskforce comprised of faculty and community leaders to strengthen nurses’ abilities and confidence to provide high-quality, inclusive, and equitable care for people living with serious illness in Massachusetts. The goal of this group was to be a leader in preparing and educating all nurses in palliative care and serious illness communication.
In 2022, a working group* of nurse educators, researchers, specialists in the fields of palliative and end-of-life care, and the coalition’s deputy director was formed from members of the Coalition to review resources that would enhance the ability of nursing faculty to infuse information about the needs of persons living with serious illnesses into nursing curricula. The working group collaborated for six months to share reviews, critiques, and recommendations of resources–both in print and web-based– to share via a newly launched online portal. The collaborative welcomes reader feedback regarding the website and any recommendations for additional resources. All working group members shared the common goal that creating a resource for faculty will allow them to share the knowledge, skills, and attitudes with students who will be challenged by providing care to persons with serious illnesses in various healthcare settings for various lengths of time. The aim of a holistic presentation of resources continues to be shared by the members of the group and that underpinning can be witnessed in the dynamic and multifaceted resources that are now available to meet the needs of patients living with serious illnesses.
Members of the working group took great care to ensure that resources aligned with the American Association of Colleges of Nursing (AACN) revised Essentials (2022). An additional aim of the group was to confirm that published resources would address issues that nursing graduates will need to be familiar with when sitting for the revised National Council Licensure Examination (NCLEX-RN). The initial process of compiling resources is now complete, and the members of the working group are pleased to share this resource and are comforted with the knowledge that this information will enhance the practice of faculty, students, and working professionals. It is noteworthy that the process utilized by the working group’s application of the knowledge that exists within this resource can be closely aligned with Kolcaba’s Theory of Holistic Comfort.
Kolcaba’s Holistic Comfort Theory
In 1991, Katharine Kolcaba first shared the Kolcaba middle-range comfort theory with her nursing colleagues when she conducted a concept analysis to examine the literature of various disciplines about comfort (Kolcaba & Kolcaba, 1991). Kolcaba described the concept of comfort as a fundamental need of all human beings for relief, ease, or transcendence that may result from stressful healthcare situations. The stressors experienced by patients with serious illnesses and their care providers require nurses to prioritize their physical, emotional, and spiritual needs to achieve relief, ease, or transcendence from days, weeks, and even years of providing care. The theory has a foundation in Nightingale’s (1859) environmental principles of providing care and has been utilized extensively to demonstrate how the movement of care and the care environment can influence patient care within a healthcare organization (Selanders, 1998).
Basic Assumptions of the Holistic Theory of Comfort
The three basic assumptions of Kolcaba’s Comfort theory are 1) persons have holistic responses to multifaceted stimuli; 2) comfort is a sought-after holistic outcome that fits with the discipline of nursing; and 3) human beings attempt to meet or have met, their basic comfort needs (Kolcaba, 1994). Nurses who are providing care for persons with serious illnesses may practice in acute, chronic, or home-based settings. The delivery of comfort care is a dynamic process that requires nurses to have confidence and competence in the provision of comfort to individuals who range in age from neonates to older adults. Nurses who practice holistic care that provides for the physical, emotional, and spiritual needs of persons living with serious illnesses must have the knowledge, skills, and attitudes necessary to deliver comfort care, particularly to those who may not be able to orally respond to that care. Kolcaba (1994) explained, “the nurse can look for external signs of comfort/discomfort and promote greater comfort when possible to enhance healing or a peaceful death” (p. 1180).
Conclusion
Although the MCSIC working group did not declare a theoretical foundation for their work, reflectingon the processes and outcomes of the group’s work demonstrates a multifaceted, holistic approach to the collaboration that emphasized comfort and respect for all participants. The basic assumption of the theory of holistic comfort can provide a foundation for ongoing dialogue between members of the MCSIC working group as the website grows and reaches a wider audience. In November 2022, members of the collaborative expressed their level of comfort and satisfaction with the website and the processes that were used to complete assigned tasks. However, members of the group have decided to continue to meet on a quarterly basis to evaluate the utility of the website and the currency of its resources. The participants volunteered to bring new and emerging resources for review to group members so that the rich relationships that have been established through a foundation of comfort will continue to be enhanced. Kolcaba (1994) stated that clinicians have the ability and desire to effect comfort and assist patients who desire comfort. The MCSIC collaborative is evidence of a unique alliance between academicians, nurse leaders, and patient advocates that has produced an outcome that will support the realities of comfort for nurses and persons who are living with serious illnesses.
*The members of the working group are Stephanie H. Chan, Priscilla Gazarian, Jennifer D. Morgan, Raeann Leblanc, Jane Flanagan, Amanda Murphy, and Judith Pare.
The collaborative welcomes reader feedback regarding the website and any recommendations for additional resources
References
American Association of Colleges of Nursing ([AACN] 2022). The Essentials. Retrieved from:
https://www.aacnnursing.org/Essentials
Kolcaba, K. Y., & Kolcaba, R. J. (1991). An analysis of the concept of comfort. Journal of Advanced
Nursing, 16(11), 1301–1310. https://doi.org/10.1111/j.1365-2648.1991.tb01558.x
Kolcaba KY. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing Science, 19(6), 1178–1184. https://doi.org/10.1111/j.1365-2648.1994.tb01202.x
Massachusetts Coalition for Serious Illness Care (MCSICC) (2022). About Us. Retrieved from:
https://www.maseriouscare.org/about-us
Nightingale, F. (2003). Notes on nursing (Barnes & Noble Library of Essential Reading): What it is, and
what it is not. Barnes & Noble Inc.
Selanders, L. C. (1998). Florence Nightingale: The Evolution and Social Impact of Feminist Values in
Nursing. Journal of Holistic Nursing, 16(2), 227–243. https://doi.org/10.1177/089801019801600211
About Judith Paré
Judith Paré PhD, RN, is an experienced nurse educator who joined the University of Massachusetts as an adjunct Associate Clinical Professor in 2017. On June 1, 2021 Judith assumed her role as Clinical Professor & Program Director for the Accelerated Bachelor of Science in Nursing Program for the Manning College of Nursing and Health Sciences. Her areas of expertise include the rural nursing, psychiatric nursing, and community health. Judith is a published author and a national speaker in the fields of Alzheimer care and the lived experiences of rural and remote nurses. Judith’s writings include multiple publications focusing the lived experiences of rural and remote nurses. Recently, Judith collaborated on two chapters in the sixth edition of Winters, C. Rural nursing: Concepts, theory, and practice, which was released in September, 2021.