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

To identify the common, core elements of patient-centred care in the health policy, medical and nursing literature. Healthcare reform is being driven by the rhetoric around patient-centred care yet no common definition exists and few integrated reviews undertaken. Narrative review and synthesis. Key seminal texts and papers from patient organizations, policy documents, and medical and nursing studies which looked at patient-centred care in the acute care setting. Search sources included Medline, CINHAL, SCOPUS, and primary policy documents and texts covering the period from 1990-March 2010. A narrative review and synthesis was undertaken including empirical, descriptive, and discursive papers. Initially, generic search terms were used to capture relevant literature; the selection process was narrowed to seminal texts (Stage 1 of the review) and papers from three key areas (in Stage 2). In total, 60 papers were included in the review and synthesis. Seven were from health policy, 22 from medicine, and 31 from nursing literature. Few common definitions were found across the literature. Three core themes, however, were identified: patient participation and involvement, the relationship between the patient and the healthcare professional, and the context where care is delivered. Three core themes describing patient-centred care have emerged from the health policy, medical, and nursing literature. This may indicate a common conceptual source. Different professional groups tend to focus on or emphasize different elements within the themes. This may affect the success of implementing patient-centred care in practice. © 2012 Blackwell Publishing Ltd.

One of the roles of qualitative enquiry is the utilization of qualitative methods for the development, refinement or modification of concepts. Yet, to date, there are no criteria for evaluating the adequacy of a concept. In this paper, the anatomy of a concept is presented, methods of concept analysis critiqued, and criteria for evaluation of the level of maturity of a concept suggested. Evaluation of criteria include assessment of: the definition of the concept, the characteristics of the concept, the conceptual preconditions and outcomes, and the conceptual boundaries. The authors argue that evaluation of a concept must necessarily precede concept development research (using a Wilsonian-derived method, a critical analysis of the literature, or qualitative enquiry) and precede more formal research procedures (such as operationalization or identification of the variables).

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.