title: A framework of comfort for practice: An integrative review identifying the multiple influences on patients' experience of comfort in healthcare settings.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  CINAHL, MEDLINE Complete, PsycINFO and Google Scholar (November 2016); reference lists of included publications.
  
  
  METHODS
  Qualitative and theoretical studies advancing knowledge about the concept of comfort in healthcare settings. Studies rated for methodological quality and relevance to patients' perspectives.
  
  
  METHODS
  Data on design, methods, features of the concept of comfort, influences on patients' comfort. Data were systematically coded and categorized using Framework method.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Wensley
authors.affiliation: School of Nursing and Midwifery, Deakin University, Epworth Deakin Centre for Clinical Nursing Research, 221 Burwood Highway, Burwood, VIC 3125, Australia.
authors.forename: Mari
authors.initials: M
authors.lastname: Botti
authors.affiliation: School of Nursing, University of Auckland, 89-91 Grafton Rd, Grafton, Auckland 1010, New Zealand.
authors.forename: Ann
authors.initials: A
authors.lastname: McKillop
authors.affiliation: Department of Anaesthesiology, School of Medicine, University of Auckland and Specialist Anaesthetist Auckland City Hospital>, 2 Park Rd, Grafton, Auckland 1023, New Zealand.
authors.forename: Alan F
authors.initials: AF
authors.lastname: Merry
mesh_terms: D005190:Family; D006296:Health Services; D006801:Humans; D000070659:Patient Comfort; D061214:Patient Safety; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D010361:Patients / Q000523:psychology*; D011787:Quality of Health Care
keywords: comfort; cross-cultural issues; leadership; patient experience; patient satisfaction; patient-centred care; qualitative methods; quality improvement; quality indicators; spirituality; training/education