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This presentation illustrates the establishment of a College of Nursing, Center for Gerontological Health Nursing and Advocacy through parmering with a federally funded Administration on Aging (AoA) demonstration project. The mission of the Gerontology Nursing Center is to advance knowledge about appropriate and effective health promotion and health care interventions for elders. This goal will be carried out in the AoA project by addressing health care and quality of life for elders in the areas of urinary incontinence and anticipatory guidance for end-of-life care. The presentation highlights the education, research, and service activities that are being carried our in the project and how health care issues and advocacy of elders are addressed. Also presented are expected outcomes for the project that included creation of an online learning environment for education and training of nursing personnel; access to the most recent best practice information for urinary incontinence and end-of-life care; and collaboration and networking between academic and practice settings.

Three nursing interventions to increase total comfort and reduce stress-related events in young college students experiencing stress were compared. Healing Touch, coaching, and a combination of both, were compared to a waitlist. On comfort and stress, Healing Touch had better immediate results, while coaching had better carryover effects. [ABSTRACT FROM AUTHOR]

This study provided preliminary evidence for internal consistency reliability (Cronbach alpha = .94) of the newly developed Healing Touch Comfort Questionnaire. Fifty-six Healing Touch (HT) recipients (51 women and 5 men with a mean age of 51) completed the questionnaire. Participants with more than 4 HT treatments had higher comfort levels than those with fewer than 4. [ABSTRACT FROM AUTHOR]

Although written protocols currently are directed more to pain relief than to the comfort of each child, there is increasing interest in pediatric literature about comforting strategies for children and their families. However, pediatric nurses/researchers currently utilize measures of discomfort that designate a neutral sense of comfort as in the absence of a specific discomfort. Assessing comfort as a positive, holistic out-come is important for measuring effectiveness of comforting strategies. Comfort Theory (Kolcaba, 2003), with its inherent emphasis on physical, psychospiritual, sociocultural, and environmental aspects of comfort, will contribute to a proactive and multifaceted approach to care. The framework of Comfort Theory for pediatric practice and research is easy to understand and implement. The application of the theory is strengthening and satisfying for pediatric patients/families and nurses, and benefits institutions where a culture of comfort is valued. Moreover, comfort is a transcultural and interdisciplinary concern. [ABSTRACT FROM AUTHOR]

Objective: Describe the first stages of the cross-cultural adaptation process of the General Comfort Questionnaire for myocardial infarction patients in intensive care units., Method: This is a study of qualitative and quantitative research and analysis techniques. Conceptual, item, semantic and operational equivalence was performed. Fifteen items were added to the original instrument to better represent the comfort experienced by myocardial infarction patients in intensive care units. The content validity index was applied to analyze the answers of the experts; it was considered adequate above 0.78., Results: Some changes suggested by the experts for better understanding were adopted. All items were kept, obtaining a scale of sixty-three items. In the pre-test conducted with 30 subjects, the instrument was considered adequate to the target audience., Conclusion: The adapted version of the General Comfort Questionnaire for people with myocardial infarction is adequate to the target audience.

Guided imagery (GI) is a nonpharmacological intervention that is increasingly implemented in different clinical contexts. However, there have been no studies on the effect of GI on the comfort of inpatients of palliative care (PC) units. Therefore, the aim of this study was to evaluate the effects of GI on the comfort of patients in PC. A 1-group, pretest-posttest, pre-experimental design was used to measure differences in heart rate, respiratory rate, pain, and comfort in patients (n = 26) before and after a 2-session GI program. The intervention featuring GI increased comfort, measured by an Abbreviated Holistic Comfort Scale and the visual analog comfort scale (P < .001), and decreased heart rate (P < .001), respiratory rate (P < .001), and pain, as measured by the (numerical) visual analog pain scale (P < .001). This study demonstrates that the use of an intervention featuring GI increases the comfort of oncology patients admitted to a PC unit. The use of GI by nurses is inexpensive, straightforward to implement, and readily available and may result in the provision of comfort care.

Successful hemodialysis treatments for patients with renal failure depend on patient adherence to prescribed treatment regimens. Lack of adherence may contribute to patient discomfort between hemodialysis treatments. This article reports a descriptive, correlational feasibility study that utilized Kolcaba's Comfort Theory as a framework. The purpose of the study was to determine a potential relationship between comfort and fluid retention (a proxy for adherence) in adults with end stage renal disease receiving hemodialysis. A convenience sample of 51 patients receiving hemodialysis was studied. Comparisons of patient weight gain between hemodialysis treatment sessions measured fluid retention by proxy. Results indicated no significant relationship between the variables of comfort and adherence to fluid restrictions. However, this finding has potential to support clinical practice to minimize weight gain to sustain comfort. Awareness of comfort as a consideration for adherence to prescribed treatment regimens may help nurses coach individuals to improve treatment adherence., Competing Interests: The authors reported no actual or potential conflict of interest in relation to this continuing nursing education activity., (Copyright© by the American Nephrology Nurses Association.)

Purpose: To assess the difference in the level of comfort between psychiatric inpatients who received a warmed blanket and psychiatric inpatients who did not receive a warmed blanket., Design and Methods: A descriptive pilot study from a convenience sample of 37 psychiatric patients aged 18-59. Subject's level of comfort was measured with Kolcaba's verbal rating scale (VRS)., Findings: Independent t-tests showed that the VRS mean score was lower in the control group (6.81) than the experimental group (7.29)., Practice Implications: Comfort is central to nursing and there has been little research regarding the effects of warm topical applications in the psychiatric hospital setting. Warmed blankets are not routinely offered to patients in the psychiatric setting. The use of warmed blankets may increase patient comfort., (© 2015 Wiley Periodicals, Inc.)

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., (Copyright 2016 PBJ-Associação Porto Biomedical/Porto Biomedical Society.)

The health care needs of veterans, especially those who have served in combat zones and their families are complicated, challenging, and interrelated. Physical limitations impact mental health, and mental health problems affect every aspect of adjustment to civilian life. Comfort theory offers a simple and holistic pattern for identifying needs, creating interventions to meet those needs, and evaluating the effects of those interventions. The aim of this article is to demonstrate how comfort theory has been applied throughout 1 Veterans Administration System to fulfill the goal of providing quality veteran-centric care. The application of comfort theory to daily patient and family care, discharge planning, and follow-up in various settings, as well as ways to enhance institutional integrity and branding are discussed.

Purpose: The aims of this study were to perform a cross-cultural adaptation and to assess the psychometric properties of the Portuguese (Brazil) version of the Holistic Comfort Questionnaire-caregiver (HCQ-caregiver) in a sample of family caregivers (FCs) of palliative care (PC) cancer patients., Methods: The HCQ-caregiver was applied by a trained interviewer to a sample of 150 FCs of PC patients with advanced cancer; 50 participants were subjected to a retest 2 to 7 days after the initial test. The mean score, ceiling and floor effects, and skewness of each HCQ-caregiver item were measured. The instrument's internal consistency was assessed by means of Cronbach's alpha, and the test-retest reliability was assessed using the intraclass correlation coefficient (ICC). The convergent validity was assessed through the correlation between HCQ-caregiver and quality of life scores. Scores on the HCQ-caregiver were compared (discriminant validity) as a function of treatment setting and FC's self-perception of emotional health., Results: A ceiling effect was found in 19 items, four of which exhibited maximum response rates above 90 % and inadequate results regarding skewness. Cronbach's alpha was 0.858, and the ICC was 0.961. The scores on the HCQ-caregiver exhibited moderate-to-strong correlations with the scores of quality of life. The FCs' perceptions of comfort did not differ as a function of the treatment setting but were greater when the FCs had a better self-perception of their emotional health., Conclusions: The present study demonstrates the validity and reliability of the Brazilian version of the HCQ-caregiver.

Purpose: Comfort and hope have been identified as important components in the care of perianesthesia patients. The purpose of this study was to explore the relationship between comfort and hope in the preanesthesia stage in patients undergoing surgery., Design: A descriptive cross-sectional survey was conducted with 191 surgical patients., Methods: Data were collected using the Perianesthesia Comfort Questionnaire and Herth Hope Index., Findings: Direct and significant relationships were observed between comfort and hope (P≤.001, r=0.65). Also, significant relationships were observed between educational level and marital status with comfort (P≤.01). The relationship between educational level and hope was significant (P≤.001). Significant relationships were also observed between gender and marital status with hope (P≤.01)., Conclusions: Overall, this study showed that a significant relationship exists between comfort and hope. Additionally, some demographic characteristics influenced comfort and hope in these patients. Health care providers should arrange the environment in a way that allows the surgical patients to experience comfort and hope and recognize the impact of personal characteristics when caring for surgical patients, particularly in the preanesthesia stage., (Copyright © 2014 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Cross-sectional study, carried out at the outpatient clinic of an oncology hospital. Data were collected from 88 caregivers of cancer patients using the Caregiver General Comfort Questionnaire (GCQ) to assess the caregivers' comfort. The caregivers' GCQ score mean was 203.9; better comfort scores was associated with age, care time and current occupation; positive aspects of comfort were related to the fact that caregivers felt loved, to patients' physical and environmental comfort and to caregivers' spirituality. 203.9; better comfort scores were associated with age of the caregiver and current occupation; positive aspects of comfort were related to the fact that caregivers felt loved, to patients' physical and environmental comfort and to caregivers' spirituality. Caregivers, who didn't have a paid job or leisure's activities showed a worse GCQ. The GCQ scale can help to identify factors that interfere in caregivers' comfort, as well as needs that can be modified through health professionals' interventions.

Objective: The effects of a nursing labor management partnership (NLMP) on nurse turnover and nurse satisfaction were examined., Background: Job satisfaction and retention are among the factors related to the nursing shortage. The NLMP was a specific intervention where nursing leaders, both nonbargaining and bargaining, worked collaboratively to improve patient care and outcomes., Methods: The study was conducted in a large, Magnet-designated urban academic medical center in the Northeastern United States. The hospital has more than 1,000 inpatient beds and more than 2,200 registered nurses, 2,107 of whom are members of a nursing union. Nurse turnover and satisfaction were studied before (2005) and after (2008) the implementation of the NLMP model., Results: There was a significant decrease in nurse turnover and a significant increase in nurse satisfaction (from moderate to high) post-NLMP., Conclusions: This study establishes a basis for further nursing research on the implementation of an NLMP in union environments.

This article describes the efficacy of a guided imagery intervention for decreasing depression, anxiety, and stress and increasing comfort in psychiatric inpatients with depressive disorders. A quasi-experimental design sampled 60 short-term hospitalized depressive patients selected consecutively. The experimental group listened to a guided imagery compact disk once a day for 10 days. The Psychiatric Inpatients Comfort Scale and the Depression, Anxiety, and Stress Scales (DASS-21) were self-administered at two time points: prior to the intervention (T1) and 10 days later (T2). Comfort and DASS-21 were also assessed in the usual care group at T1 and T2. Repeated measures revealed that the treatment group had significantly improved comfort and decreased depression, anxiety, and stress over time.

Objective: To develop and evaluate the psychometric characteristics of the Psychiatric In-patients Comfort Scale (PICS) in hospitalized psychiatric patients., Method: The items of the PICS were drawn from a literature review, existing comfort instruments, suggestions made by experts, and interviews on perceived comfort with 18 hospitalized patients. A pilot study was performed with the first version of the scale, containing 98 items, in a sample of 49 patients. This process resulted in a 51-item version. Internal consistency, construct validity, and concurrent validity were measured in a second sample of 273 patients., Results: Data analysis, factor analysis, and reliability analysis resulted in a 38-item version. The factor analysis indicated a 3-factor structure: relief, ease, and transcendence, which explained 38.64% of the total variance. The comfort dimensions correlated positively with well-being and with positive experiences of suffering and negatively with the remaining dimensions of suffering, supporting concurrent validity. Cronbach's alpha coefficient of the total PICS-38 was 0.89, and the subscales ranged from 0.75 to 0.90., Conclusion: Based on psychometric properties, the PICS is a valid and reliable tool that can be used by nurses to assess comfort in hospitalized psychiatric patients. The items are conceptually grouped in 3 factors corresponding to the states of relief, ease, and transcendence of the comfort structure proposed by Kolcaba.

The application of theory to practice is multifaceted. It requires a nursing theory that is compatible with an institution's values and mission and that is easily understood and simple enough to guide practice. Comfort Theory was chosen because of its universality. The authors describe how Kolcaba's Comfort Theory was used by a not-for-profit New England hospital to provide a coherent and consistent pattern for enhancing care and promoting professional practice, as well as to serve as a unifying framework for applying for Magnet Recognition Status.

THERMAL COMFORT IS ONE DIMENSION of overall patient comfort, and it usually is addressed by covering the patient with warmed cotton blankets. WARMING HELPS A PATIENT maintain normothermia and appears to decrease patient anxiety. AN STUDY WAS CONDUCTED in a preoperative setting to compare the effects of preoperative warming with warmed cotton blankets versus patient-controlled warming gowns on patients' perceptions of thermal comfort and anxiety. BOTH WARMING INTERVENTIONS had a positive effect on patients' thermal comfort and sense of well-being. Patients who used the patient-controlled warming gown also experienced a significant reduction in preoperative anxiety.

Patient comfort is a goal of therapeutic nursing practice and a primary nursing function. Residents in nursing homes have many comfort needs including physical, psychospiritual, sociocultural, and environmental. These comfort needs are addressed by various caregivers including nurses, nursing assistants, and family members. Hand massage is a simple comfort intervention that can be incorporated readily into routine nursing care activities and conveys caring through touch, individual attention, and presence. As an intervention, hand massage promotes comfort and facilitates communication between care recipients and caregivers. The purpose of this study was to test the effectiveness of hand massage as an intervention that affects nursing home residents' comfort and satisfaction. Results are presented for 35 participants who received hand massage and 25 participants in a comparison group. Findings showed no significant differences in comfort levels or satisfaction with care over time. Significant group differences, however, were found for comfort and satisfaction when measured at specific time periods. The discussion highlights these mixed findings and presents implications for further development of hand massage as part of nursing home residents' care.

The Healthy Bladder Program was developed as part of an academic and health care partnership and was designed specifically for older adults residing in independent and assisted living. Program content was based on best practices that can be used by nursing staff to provide information about promoting and maintaining bladder health. One hundred eighty older adults, recruited from long-term care retirement communities, attended the 1-hour program. Findings showed that the program was successful in providing bladder health information that older adults could use immediately; suggestions are given for best practice applications.

Unlabelled: Comfort management is a priority for patients in all settings. Comfort theory provides a foundational and holistic approach to comfort management. This article reviews comfort theory and presents the application of comfort theory in the perianesthesia setting., Objectives: -Based on the content of the following article, the reader will be able to (1) define comfort; (2) identify comfort interventions; and (3) discuss the importance of a goal for enhanced comfort in patients.

The purpose of this study was to test several formats of end-of-life comfort instruments for patients and closely involved caregivers. Kolcaba's Comfort Theory was the theoretical framework utilized. Different response formats for two end-of-life (EOL) comfort questionnaires (for patients and caregivers, respectively), and horizontal and vertical visual analog scales for total comfort (TC) lines were compared in two phases. Evaluable data were collected from both members of 38 patient-caregiver dyads in each phase. Suitable dyads were recruited from two hospice agencies in northeastern Ohio. Cronbach's alpha for the EOL comfort questionnaire (six response Likert-type format) tested during phase I for patients was .98 and for caregivers was .97. Test-retest reliability for the vertical TC line tested during phase I for patients was .64 and for caregivers was .79. The implications of this study for nursing practice and research are derived from the American Nursing Association (ANA) position statement about EOL care, which states that comfort is the goal of nursing for this population. These instruments will be useful for assessing comfort in actively dying patients and comfort of their caregivers as well as for developing evidence-based practice for this population.

The normal aging process brings about inevitable and irreversible changes in physical, psychosocial, and spiritual health. These normal changes are partially responsible for the increased risk of developing health-related problems in the hospitalized elder population. The Acute Care for Elders (ACE) model provides an effective, proactive, inexpensive framework for addressing the complex health needs of older adults. When ACE principles are used for the clinical management of clients with orthopaedic problems, interdisciplinary conferences provide the structure for maintaining the continuity of care. Mobility as well as independent functioning, comfort level, mental status, depression, skin health, nutrition, and response to treatment, are discussed and nurse initiated guidelines for preventive and restorative interventions are implemented. Follow-up phone calls and/or home visits are important indices of thorough discharge planning. The theory of comfort is used to assure that holistic needs are addressed. Nurses who practice the ACE model are excited about demonstrating the highest level of competency in geriatric nursing, whereby patient functioning is maximized, comfort and dignity are promoted, functional decline is prevented, and patients are successfully returned to their homes.

The nursing outcome of holistic comfort encompasses physical, psychospiritual, social, and environmental aspects of human nature. The primary purpose of this study was to test four propositions about the nature of comfort: (a) Comfort has equal proportions of state and trait characteristics; (b) comfort is sensitive to changes over time; (c) when subjects are exposed to an effective intervention, they demonstrate differences in comfort that increase in a linear way compared to a control group; and (d) the whole (total comfort) is greater than the sum of its parts (relief plus ease plus transcendence). A secondary purpose of this study was to present preliminary concurrent validity between two types of comfort instruments, a traditional questionnaire with a Likert-type format and visual analog scales. Findings were positive for all theoretical propositions and moderate concurrent validity between the Radiation Therapy Comfort Questionnaire and the visual analog scale for total comfort was demonstrated.

Compromised urinary bladder syndrome (CUBS), a combination of frequency and incontinence, causes multiple discomforts for community-dwelling adults. A holistic intervention--audiotaped cognitive strategies--was designed to augment the effects of an educational program designed to treat CUBS. CUBS was operationalized with a voiding diary, and comfort related to bladder health was operationalized in a questionnaire. In this quasi-experimental design the outcomes were measured at four time points. Repeated measures multivariate analyses of variance and nonparametric analyses were conducted to assess differences between the two groups. Results indicated that the treatment group had more comfort and improved CUBS compared with the control group.

Purpose/objectives: To measure the effectiveness of customized guided imagery for increasing comfort in women with early stage breast cancer., Design: Experimental longitudinal, random assignment to groups., Setting: Two urban radiation oncology departments., Sample: 53 women (26 in the experimental group, 27 in the control group) aged 37-81; 80% European and 10% African American with stage I or II breast cancer about to begin radiation therapy., Methods: The experimental group was to listen to a guided imagery audiotape once a day for the duration of the study. The Radiation Therapy Comfort Questionnaire was self-administered at three time points: prior to the introduction of intervention and the beginning of radiation therapy (Time 1), three weeks later (Time 2), and three weeks after completing radiation therapy (Time 3). The State Anxiety Inventory was administered at Time 1 only., Main Research Variables: The effect of use of guided imagery on comfort with anxiety as a control variable., Findings: Pooled data indicated a significant overall increase in differences in comfort between the treatment and control group, with the treatment group having higher comfort over time. The data also revealed a significant linear trend in differences between groups. No significant interaction of group and time existed., Conclusions: Guided imagery is an effective intervention for enhancing comfort of women undergoing radiation therapy for early stage breast cancer. The intervention was especially salient in the first three weeks of therapy., Implications for Nursing Practice: Guided imagery audiotapes specifically designed for this population were resource effective in terms of cost, personnel, and time.

Provision of comfort is paramount to the practice of hospice nurses. However, the approach to meeting needs holistically is often intuitive or based on multidisciplinary rather than nursing models. A review of the nursing literature identified only one article describing the application of a nursing framework to hospice nursing practice. The purpose of this article is to describe a theory of comfort care that offers definitions and a grid for the art of comfort care that are relevant to hospice nursing practice. Using Kolcaba's framework of holistic comfort, nurses can be comprehensive and consistent in assessing comfort and in designing interventions to enhance the comfort of patients and families. The content domain of holistic comfort is conceptualized as interrelated parts (types and contexts) as they are experienced simultaneously. The framework of comfort care, which includes, the content domain and the theory of comfort, is explained and applied through the presentation of a hospice case study. Potential application of the framework to hospice research is proposed.

Critical care nurses are frequently involved with patients and families who must choose among the various advance directives. Although "comfort care" is a familiar option, there is a lack of clarity about specific components of comfort as well as the nurse's role as a member of the interdisciplinary team. This lack of clarity can result in disruption of the patient or family decision-making process surrounding impending death. This article defines comfort care as a holistic and positive choice for patients and families among advance directive options. A two-dimensional grid is applied to assist with discussion and decision making regarding the dying process. Methods for applying the framework and developing a care plan are presented in case study format. Practicing these methods will enable critical care nurses and other team members to empower patients and families to work through the dying process with optimal comfort.

Nursing art is defined and a template is presented for practicing one type of nursing art called comfort care. Propositions for comfort care are derived from a theory of comfort. Benefits are listed for integrating comfort care into practice. Testimony from a student who learned and applied comfort care provides support for its effectiveness as a learning tool. Comfort care is a holistic, individualistic, creative, and efficient model.

Although many scholars discuss nursing as an art and science, the practice of nursing art remains unspecified and elusive, especially to learners. Nursing art is the esthetic use by nurses of scientific and humanistic principles of care applied creatively within specific contexts of care. One form of nursing art is called comfort care. Comfort care entails the process of comforting actions and the product of enhanced comfort, both of which have been described in separate programs of research. Because the process of comfort includes the product of comfort, the construct of comfort care designates a necessary merger between the programs of research. A template is presented that guides the practice of comfort care within a context of holistic nursing art.

Although the construct of comfort has been analysed, diagrammed in a two-dimensional content map, and operationalized as a holistic outcome, it has not been conceptualized within the context of a broader theory for the discipline of nursing. The theoretical work presented here utilizes an intra-actional perspective to develop a theory of comfort as a positive outcome of nursing case. A model of human press is the framework within which comfort is related to (a) interventions that enhance the state of comfort and (b) desirable subsequent outcomes of nursing care. The paper concludes with a discussion about the theory of comfort as a significant one for the discipline of nursing.

Plato's theory about psychodynamic forces is used to develop a holistic model for nursing practice. The dysphoric emotional state of demoralization is conceptualized as an imbalance between Spirit, Appetite, and Reason. Interventions are designed for elderly clients who show objective and subjective signs of demoralization. The objective indicators are measured with the Psychiatric Epidemiological Research Interview (PERI), before and after the implementation of individualized interventions. Results for the 23 subjects who completed the study in an assisted-living environment are suggestive of the effectiveness of basic nursing interventions in remediating the symptoms of demoralization. Plato's model of the psyche is an elegant, yet simple, conceptual tool for understanding the mental health needs of clients.

The structural and semantic complexities of the construct of comfort are explicated and a rationale is presented for operationalizing the construct for holistic nursing practice and research. A review of the literature about comfort provides theoretical support for the concept's taxonomic structure, which was presented in an earlier publication and is modified in the present article. In addition to being useful for generating assessment tools for practice, the taxonomic structure of comfort can be utilized to develop instruments for outcome research.

The Facilitative Environment Framework organizes a holistic gerontological practice. Comfort describes the state of patients when their excess physiological and psychological needs have been met. Patients must be in a state of comfort before they can perform the tasks of optimum function. The Facilitative Environment Framework was applied to a dementia setting, but it is suitable for other gerontological settings as well.

The concept of comfort is an important one for nursing, but because of its complexity, it has not been analyzed, operationalized or structured for nursing science. In this paper, three technical senses of the term are derived from: (a) contemporary and archaic lexical entries; (b) analysis of how the concept is used in contemporary and historical nursing literature; and (c) theoretical support found in the disciplines of nursing and ergonomics. Next, the contexts of patients' needs are explored and four contexts are derived from the nursing literature on holism. When the three senses and the four contexts of needs are juxtaposed, a 3 x 4 grid with 12 elements emerges that encompasses the total domain of patient comfort. Each element describes an aspect of comfort from which empirical indicators, antecedents, consequents and test items can be developed. The grid represents a taxonomic structure of the concept that organizes the meanings of this complex concept. The structure can be used to develop comfort pretests as the nurse assesses possible needs in a given situation and to develop comfort post tests, to assess the effectiveness of comfort measures.

Comfort is a term that has a significant historical and contemporary association with nursing. Since the time of Nightingale, it is cited as designating a desirable outcome of nursing care. Comfort is found in nursing science, for example in diagnostic taxonomies, and in references to the art of nursing, as when practice is described. Roy, Orlando, Watson, Paterson and others use comfort in major nursing theories. The term can signify both physical and mental phenomena and it can be used as a verb and a noun. However, because comfort has many different meanings, the reader has had the burden of deciding if the term is meant in one of its ordinary language senses or if its context reveals some special nursing sense. The purpose of this paper is to analyse the semantics and extension of the term 'comfort' in order to clarify its use in nursing practice, theory and research. The semantic analysis begins with ordinary language because the common meanings of the term are the primary ones used in nursing practice and are the origin of technical nursing usages. Comfort is discussed as the term is found in nursing, including texts, standards of care, diagnoses and theory. An account of patient needs assessment is used to cull three technical senses of the term from its ordinary language meanings. After contrasting these senses in order to justify their separateness, they are shown to reflect differing aspects of therapeutic contexts. Defining attributes of the three senses are then explicated and presented in table format. The last section of the paper addresses some of the ways that the extensions of the senses can be measured.

1. Assessment of older adults with behavior problems considers factors contributing to the behavior; potential psychosocial interventions; patient characteristics influencing medication action; and medication characteristics influencing therapeutic and adverse effects. 2. Anxiety, agitation, and other behavioral problems in demented patients might arise from their inability to verbally express complaints such as pain and discomfort. 3. Although constant blood levels of medication are most effective for ongoing management of behavior problems, as needed doses can be used to establish the optimal dosing schedule. 4. Medications in low doses can be used to improve the patient's response to psychosocial interventions for behaviors such as anxiety, agitation, depression, and sleep disorders; but they should not be used as the only intervention.