comfort

What is comfort? Comfort is a term that has different meanings depending on the person needing it. It’s a concept that changes with each patient in the nursing profession. Zajac describes using Kolcaba’s Theory of Caring by stating the nurse has a role to assess what comfort needs the patient has, design a plan for comfort measures and address those needs, then reassess the patient after implementing your plan and compare to the starting baseline (Zajac, 2010). When figuring out what comfort means to the patient, it could be several things. One of your patients may think by giving pain medication you are comforting them. Others may believe that by being in the room and having a conversation with them is a great way to comfort them instead of them being alone. You may see the term comfort measure as core value for any hospital or health care organization. Actions taken by the nurse to comfort a patient are so common and part of their daily work, that it often goes unnoticed as an intervention for that patient. I have chosen Katharine Kolcaba’s comfort theory to concentrate on the concept of comfort. Kolcaba believed you experienced comfort in three ways: relief, ease, and transcendence. Smith (2011) quotes Kolcaba by saying that, “Comfort is defined as the immediate outcome of feeling strengthened when needs for relief, ease, and transcendence are addressed in the context of experience, physical, spiritual, sociocultural, and environmental” (Smith, 2011, pp.12). Determining what must be done to comfort that patient can be difficult at times. Kolcaba believes by delivering comfort consistently over time, a trend will correlate by increasing comfort levels over time, with desired health seeking behaviors, will promote improved institutional outcomes Kolcaba, 2010). Completion of a concept analysis, on comfort, can be done after identification of what comfort is and by determining what are the steps that must be taken to complete the goal. When you think of a concept analysis you think of Walker and Avant and their approach to a concept analysis. ElSadr et al states that Walker and Avant describe a concept analysis as a way to describe a category of information or concept and to clarify its meaning (ElSadr et al, 2009). A concept analysis is done when a theory needs improvement or more detail. McEwen & Willis (2011) has the steps in conducting a concept analysis as: • Select a concept • Determine the aims or purpose of analysis • Identify all the uses of the concept • Determine the defining attributes • Recognize the model case • Find the alternate cases • Pinpoint the antecedents and consequences • Define the empirical referents Aim or Purpose The purpose of a concept analysis is to determine what the patient’s thoughts or meaning of comfort are by performing a concept analysis approach. This is not limited to just the patient but can include the family or the community as a whole. This can be made up of both males and females and comprised of wide range of ages. The overall goal is to provide comfort to the patient and/or the patient’s family by providing the care they perceive as comforting. Literature Review The databases used for data research were EBSCOhost, CINHAL, and ProQuest setting a date range on articles from 2009 to 2014. Key words used to search scholarly articles were: comfort, comfort in nursing, patient comfort, and comfort theory. The first article I studied examined effective interventions designed to meet the needs of families of critically ill adult patients in the ICU (Khalaila, 2014). A literature search using ProQuest Nursing and Allied Health Source, Medline, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was used to search articles between 2000 and 2013 in this research. The use of static tables were used to organize the five most important and the five least important needs of the family. Tables were also used to show family perceptions of those needs being met. Lastly a table was used to break down all the studies found in the research and show what results were found for interventions used to comfort families of patients in the ICU. In the conclusion the review shows studies have shown that family members of ICU patients have multiple needs such as, support, comfort, reassurance, and information (Khalaila, 2014). It also concluded that healthcare professionals and families differed in their opinions of what were important family needs. It ends with the recommendation that critical care nurses need to continue to be aware of each family members needs and promote family-centered care in the ICU as the standard of care (Khalaila, 2014). Another source found was a study that examined if job role, education or experience changed nurses approach to comfort for a patient (Jones, 2010). It was a quantitative study that surveyed over 400 nurses that worked in five rural facilities. They based the results using des?r?ptive statistics and analysis of variance. In the conclusion, they found that more experienced nurses showed a more significant difference in their degree of comfort provided to their patients (Jones, 2010). The last source to be discussed is a scholarly article about patient perception in comfort, when having to be mechanical ventilated, while using sedatives and analgesics. The aim of the study was to investigate the relationship between stressful experiences and intensive care sedation, including the depth of sedation (Samuelson et al, 2007). During a period of 18 months they selected 313 adults from two general ICU units. Five days after they were discharged they were sent a questionnaire about their stressful situation. 206 of the 313 surveys were returned showing the longer the patient was on ventilation and the patients that had lower amounts of sedation experienced more discomfort and had a worse experience (Samuelson et al, 2007). They conclude with the importance to reassess patients on the vent more frequently to determine what measures are needed to promote more comfort (Samuelson et al, 2007). Uses Kolcaba defines comfort as the state of meeting human basic needs for relief, ease, and transcendence (Kolcaba, 2010). There is a question of what comfort really means in the nursing profession due to the lack of a definitive definition of it in nursing literature. The comfort level can be defined by what is a tolerable level of comfort for the patient. This does not mean that all discomfort is gone but the patient is able to tolerate what is felt. The use of comfort will give the nurse a way to determine the effectiveness of an intervention. A common practice is to ask the patient to rate their level of pain on a scale of 10. If the level is high, such as a 10 and later the level is a 3, then a level of comfort has been reached. Another common practice is turning a patient every two hours to ensure comfort for the patient as they lay for long periods of time in the bed. Fragala & Fragala states “Turning and positioning in bed is essential for immobilized patients to increase comfort, maintain skin integrity, enhance healing, and achieve care outcomes” (Fragala & Fragala, 2014, pp 268). Determining what the patient may want, big or small, is important to provide comfort for the patient. Defining Attributes There are multiple attributes that can be defined when you think of comfort. I have narrowed my attributes through these sources to two: physical symptom relief and communication with the patient. Kolcaba talks about states of comfort as, “a sense of relief from physical and psychological sources of anxieties and symptoms as a state of comfort” (Kolcaba, 2010). Listening to a patient is an important attribute to help facilitate communication with the patient. By listening to the patients’ needs and talking to them to explain the plan of care or to describe to them the process that is going to take place allows for great communication and comfort for the patient. Knowing and being aware of your tone of voice is also important to convey your information in a way that is comforting to the patient. Model Cases Katharine Kolcaba theory of comfort provides nurses with a nursing model for comfort. It encases three forms of comfort: relief, ease, and transcendence. It is also presents four concepts of comfort: physical, psychospiritual, environmental, and sociocultural. With this a structure was created to serve as a reference for the assessment and measurement of the patients comfort. If the needs of the patient are achieved then the patient will experience a sense of relief or comfort. A patient whose pain is relieved due to the administration of pain medicine is a form of comfort due to relief. Ease can be identified by pleasure as method of comfort. Transcendence can be described by a patient completing a goal that is set for them and reaching a state of comfort. Alternative Cases Two other concepts related to comfort are providing symptom relief and well-being measures. These are alternate ways to provide comfort for a patient. Symptom relief is as simple as helping a patient out of bed and helping them walk down the hall and back. This allows relief from being cramped up from being in the bed all the time. Interventions such as this can be considered well-being measures also due to giving the patient comfort by allowing them to stretch and walk. By enabling them and helping them to walk down the hall you are comforting the patient and promoting the patients well-being. Antecedents and Consequences The most common antecedent to comfort is the concept of discomfort. Discomfort can also have many definitions depending on the person defining it. Most common definitions will describe it as a state of suffering or being in a state of distress. One must know what discomfort feels like to know if comfort has been achieved. There isn’t much literature that mentions consequences to comfort. One that comes to mind may be a person who is against taking pain medication but does to decrease their pain and feel comfort. Empirical Referents An article that I found talks about ethnically diverse students who face unique challenges in addition to the universal stressors of nursing school while trying to become nurses (Zajac, 2010). This article talks about by using the experience of comfort that Kolcaba describes in the theory of comfort, may provide ease, relief, and transcendence of the discomfort experienced by diverse nursing students (Zajac, 2010). Another article that gives an example of comfort is an article by Lawson. It talks about the experiences of taking care of dying patients and focuses on one particular time when a nurse had to take care of a rapidly declining patient that was dying (Lawson, 2010). The author talks about being there for the patient’s son and comforting him throughout the process. This is a great example of showing comfort for the family. The nurse sat and listened to stories the son had about his mother and helped him to cope with her dying. Conclusion Comfort can be defined multiple ways depending on the person who is defining it. The concept analysis presented shows the importance of the meaning of comfort for the nursing profession. Studies can be done to determine a uniform measure of comfort for all people. Determining a patients distress or discomfort and establishing an intervention to hel that patient, which will allow the best comfort measure for the nurses patients. Reference ElSadr, C. B., Noureddine, S., & Kelley, J. (2009). Concept analysis of loneliness with implications for nursing diagnosis.International Journal of Nursing Terminologies and Classifications, 20(1), 25-33. Fragala, G., & Fragala, M. (2014). Improving the safety of patient turning and repositioning tasks for caregivers. Workplace Health & Safety, 62(7), 268-73 Jones, R.A. (2010). Patient education in rural community hospitals: registered nurses’ attitudes and degrees of comfort. The Journal of Continuing Education in Nursing. 41(1). 41-48. Khalaila,R. (2014). Meeting the needs of patients’ families in intensive care units. Nursing Standard, 28(43), 37-44. Kolcaba, K. (2010). An introduction to comfort theory. In the comfort line. Retrieved July 30, 2014, from http://www.thecomfortline.com/ Lawson, S. (2010). COMFORTING A GRIEVING RELATIVE MADE ME SEE NURSING’S VALUE. Nursing Standard, 24(22), 29 McEwen, M. & Willis, E.M. (2011). Theoretical Basis for nursing 3rd edition. Philadelphia, PA: Lippincott Williams& Wilkins. Samuelson, K., Lundberg, D., & Fridlund, B. (2007). Stressful Experiences in relation to depth of sedation in mechanically ventilated patients. Nursing in Critical Care, 12(2), 93-104. Smith, S. S. (2011). Holistic comfort and bereavement of families receiving prenatal hospice support during the loss of an unborn child with lethal anomalies. (Order No. 1499628, Gardner-Webb University). ProQuest Dissertations and Theses, , 70. Retrieved from http://search.proquest.com/docview/895062601?accountid=147674. (895062601). Zajac, L. K. (2010). The culture care meaning of comfort for ethnically diverse pre-licensure baccalaureate nursing students in the educational setting. (Order No. 3439986, University of Northern Colorado). ProQuest Dissertations and Theses, , 132. Retrieved from http://search.proquest.com/docview/852625749?accountid=147674. (852625749). SIMILAR WORK BUT ORIGINAL REQUIRED