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How Comfort Theory Can Help Ease Burnout and Improve Well-Being in Nursing Home Staff

By Faith Carini-Graves, Director of Skill Development, MDS Consultants

The problem:

What does an MDS coordinator, DON, CNA, therapist, nursing home administrator, RN, LPN, activities professional, social worker, and dietitian all have in common? They are all exhausted!

All long-term and post-acute care staff can benefit from improved self-care. Better self-care is needed to recharge and re-energize. Throughout the pandemic, increased worry and strain has contributed to higher rates of staff burnout and turnover in skilled nursing facilities. (White et al., 2021)

Staff have experienced fatigue and burnout from:

  • increased workloads;
  • staff shortages;
  • emotional burden of caring for residents facing significant isolation, illness, and death during the pandemic (White et al., 2021);
  • combative or violent residents;
  • impaired team communication. (Kandelman et al., 2018)

Without healthy habits, there is no way of resolving this tension.

A solution:

Things that promote well-being and happiness in staff:

  • finding meaning in work;
    • connecting with an energy source;
    • nurturing interpersonal connections;
    • developing an attitude of positivity;
    • performing emotional hygiene;
    • valuing one’s own unique approach.

These characteristics have ultimately reduced burnout among direct care staff and nurses! (Wei et al., 2020) But how do we encourage these traits in staff?

There is a nursing practice theory appropriately labeled the “comfort theory” that has often been applied to patient care. This theory is used to focus on patient comfort and overall well-being to promote better patient outcomes. However, nurse leaders can also apply this theory to staff to promote better outcomes. One hospital that used the comfort theory to improve staff comfort found that staff were, “more satisfied, more committed to the institution, and able to work more effectively.” (Kolcaba et al., 2006) This theory ultimately promoted better patient and facility outcomes.

This theory can provide a framework to rejuvenate and reengage staff using a new organizational approach. It could greatly increase job satisfaction and free up staff from worry to enjoy their lives more. Healthcare professionals would then have more energy to devote to patients and their families. The process would begin with interventions from management and administrators. The first step is to assess what would help staff to feel more comfortable in the physical, psychospiritual, social, and environmental areas. Things identified in the study by Kolcaba et al. (2006) include:

  • a safe and clean environment,
  • restful breaks, a peaceful lounge,
  • enough room to work,
  • increased support from management,
  • timely feedback on job performance,
  • strong communication among colleagues,
  • provision of education,
  • team work,
  • respect,
  • transparency and trust building within the organization.

Changes that are made based on individual staff needs and the unique culture of the facility can be very effective in recharging staff. Increased comfort of employees can improve their overall well-being and decrease their suffering from burnout.

Could you see this theory applied where you work? What would make you and your staff more comfortable?

Some practical suggestions:

  • break room goodies
  • redecorating the break room
  • team meetings to share ideas and disseminate information
  • prompt recognition of well-done work
  • work-related support groups
  • educational programs on self-awareness and self-care


Kandelman, N., Mazars, T., & Levy, A. (2018). Risk factors for burnout among caregivers working in nursing homes. Journal of Clinical Nursing, 27(1-2), e147-e153. https://doi.org/10.10.1111/jocn.13891.

Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort theory: A unifying framework to enhance the practice environment. The Journal of Nursing Administration, 36(11), 538-544. https://doi.org/10.1097/00005110-200611000-00010

Wei, H., Kifner, H., Dawes, M., Wei, T., & Boyd, J. (2020). Self-care strategies to combat burnout among pediatric critical care nurses and physicians. Critical Care Nursing, 40(2), 44-53. https://doi.org/10.4037/ccn2020621.

White, E., Wetle, T., Reddy, A., & Baier, R. (2021). Front-line nursing home staff experiences during the COVID-19 pandemic. Journal of American Medical Directors Association, 22(1), 199-203. https://doi.org/10.1016/j.jamda.2020.11.022.

About the writer:

Faith Carini-Graves has worked in skilled nursing facilities since she first became a nurse in 2012. She quickly became an expert in both RAI guidelines and the everyday functioning of nursing facilities. With MDS Consultants, Faith conducts audits, improves quality measures, trains staff, manages MDS systems, teaches webinars, and continues to complete MDS assessments. Faith is licensed as a RN in New York and South Dakota.

On her time off, Faith enjoys a fast-paced life with her three kids—including 5-year-old twins! She also enjoys spending time outside, yoga, reading, and painting!