nursing service

The Provision of Comfort in Nursing

The nursing service chosen for this study is the provision of comfort. The phrase “comfort” can have many meanings depending on how much one needs it. The concept of comfort varies from patient to patient in the nursing profession. Following Kolcaba’s caring philosophy, Zajac defines comfort by emphasizing the duties that nurses play when offering comfort. Nurses must analyze the patient’s comfort needs, create a plan for comfort measures to satisfy those needs, review the patient after implementing the plan design, and compare the results to the starting baseline (Zajac, 2010). Several things could help one to figure out what comfort means to the patients. Some of the patients think that through giving them pain medication, the nurse is giving them comfort. Other patients believe that being in the clinical rooms and conversing with medical attendants is the way of getting comfort instead of being alone. Therefore, the term comfort is a core value for every hospital and every health care organization. Nurses have common actions to comfort patients and providing comfort to patients is part of the nurse’s daily work though patients go without noticing the intervention offered by nurses to provide comfort to them.

Katharine Kolcaba’s Theory of Comfort

In this research, Katharine Kolcaba’s theory was chosen to concentrate on the comfort concept. According to Katharine Kolcaba, a patient can experience comfort in three ways namely; ease, relief, and transcendence. Comfort is defined as an immediate outcome of feeling that can strengthen after the needs for transcendent, ease and relief are addressed in the context of spiritual, socio-cultural, environmental, physical and experience (Smith, 2011, pp.12). Sometimes, it is a deficit to determine the degree of comfort a person needs however, Kolcaba believed that when comfort is delivered consistently, the trend will be related by increasing the levels of comfort over time, and hence promoting improved institutional outcomes if the desired health-seeking behaviors are followed properly (Kolcaba, 2010). The process of completing concept analysis on comfort can be done by determining the kind of steps that must be taken to complete the goal.

Avant and Walker’s Approach to Concept Analysis

The two scholars Avant and Walker, in their approach concept analysis, help us to complete the excuse of concept analysis. According to (Elsadr et al, 2009), Walker and Vant describe a concept analysis in a way that describes concept or information category to clarify its meaning. When there is a need to improve on the meaning of the theory or clarify the theoretical details of given theory, concept analysis must be properly completed. According to McEwen & Willis (2011), the following steps are followed when conducting a concept analysis. Select a concept, determine the purpose of analysis, identify the relevancy of the concept, recognize the model cases, pinpoint the antecedents and consequences, and define empirical referents.

Aim or Purpose

The main aim of conducting a concept analysis is to determine the thoughts or the meanings attached to the term comfort by various patients. This concept analysis is not limited to patients only but includes families and communities as well. Concept analysis can be made of both females and males with a wide range of age differences. The overall goal is providing the patient or the family with comfort by providing those care activities that patients or families perceive to be comforting.

Literature Review

In this exercise of conducting a concept analysis, databases such as CINHAL, Proquest, and EBSCO host were applied with the year settings ranging from the year 2009 to 2014. During the search process, keywords such as patient, comfort, comfort theory, comfort, and comfort in nursing were considered. The first article (Khalaila, 2014) examines the effective interventions that are designed to meet family needs and expectations of critically ill adult patients. Articles ranging from the year 2000 to 2013 were reviewed from databases such as cumulative index to nursing and allied health literature (CINAHL), Proquest, Nursing and Allied Health Source and Medline. Static tables were used to organize the five most important and the five least needs of the family with adult patients. In addition, tables helped in showing family perceptions of the needs met in the same process of conceptual analysis. Finally, tables were used to indicate a breakdown of all the studies that are found in the research and to show that the research results for the interventions used to comfort the patients’ families in the intensive care unit. After conducting the process of reviewing the literature from the mentioned database, the conceptual analysis found that some studies have concluded that family members of patients in the intensive care unit have multiple needs such as comfort, reassurance, support and information (Khalaila, 2014). The literature review also concluded that families and health care professionals have differing opinions of what family needs were important. According to (Khalaila, 2014), critical care nurses have to be aware of the needs of each family member and promote family-centered care in the ICU as a steward approach to care.

Following the concepts in the source (Jones, 2010), there was a need to examine whether education, job role or experience changed nurses’ approach to comfort for patients. In his research (Jones, 2010) conducted a quantitative study to survey over 400 nurses who worked in rural areas. The results were based on descriptive statistics and analysis of variance. In conclusion (Jones, 2010) found that nurses with more experience have more significant differences in the degree of comfort they provide to their patients.

The last source reviewed was about the perception of patients about comfort when having mechanical ventilation while using analgesics sedatives. The purpose of reviewing this source was to investigate the relationship between intensive care sedation and stressful experiences including the depth of sedation in the article by (Samuelson et al, 2007). In this study (Samuelson et al, 2007) conducted a survey of 313 adult patients from two general intensive care units for a period of 18 months. After five days, the patients were discharged and given a questionnaire about their stressful situations. The study found that about 206 surveys were returned indicating that the longer the patient was on ventilation, the more the discomfort. The survey also found that those patients who had lower sedation amounts experienced more discomfort and had worst experience (Samuelson et al, 2007). At the end of the study (Samuelson et al, 2007) concluded with the importance to frequently reassess the patients on the event and determine the measures needed to promote comfort in patients.

Uses

According to (Kolcaba, 2010), comfort is the state of meeting the basic needs for ease, relief, and transcendence. The question of what comfort means in a nursing profession remains unanswered due to lack of definitive definition in the nursing literature. The term comfort is defined by the tolerable degree of comfort the patient needs. However, this does not mean that all the discomfort is gone but it implies the patient is able to tolerate the remaining discomfort felt. After determining the level of comfort a patient needs, nurses can easily determine the effectiveness of an intervention. Usually, the common practice to get the degree of comfort is to ask the patient to rate their level of pain on a scale of 1 to 10. If the level was high, such as 10 and later the level reduced to three, then the patient has reached the level of comfort needed. Alternatively, nurses can turn the patient every two hours and ensure comfort for the patient as they spend a long period in beds. Turning position in beds is essential to help immobilized patients increase comfort, enhance healing, maintain skin, and achieve best care outcomes (Fragala and Fragala, 2014, pp 268). Determining what the patient wants, whether big or small is essential to provide the level of comfort needed by the patient.

Defining Attributes

Several attributes can be used to define comfort according to the level of pain a patient has. From the revised sources, attributes have been narrowed to communication with the patient and physical symptoms relief. According to (Kolcaba, 2010), the state of comfort is getting a sense of relief from the psychological and physical sources of anxieties and symptoms.

During the process of providing comfort, listening to the patient facilitates communications with the patient. By listening to the needs of the patient and talking to them about the pain care or describing to them the subsequent process allows great relief hence provide comfort to the patients. It is also important for nurses to know their tone of voice to convey information in a comforting way to the patient.

Model Cases

Using Katharine Kolcaba’s theory helps nurses to get the model of providing comfort to the patient. The theory encases three comfort forms namely transcendence, ease, and relief. Katharine Kolcaba’s theory also presents four concepts of comfort mainly psych-spiritual social cultural, environmental, and physical comfort. With this theory, Katharine Kolcaba created a structure to serve as a reference for measurement and assessment of the degree of comfort among patients. If the patients’ needs are achieved, it implies the patient can receive; the patient will experience the desired relief or comfort. A patient whose pain is relieved because of the administration of pain medicine takes the form of comfort due to relief. Transcendence is described by the complete goal set by the patient to reach the desired comfort. The degree of ease is identified by pleasure as an alternative method of comfort.

Alternative Cases

Proving symptom relief and well-being measures are also used as alternative ways to provide comfort to the patients. Symptom relief involves helping patients out of bed in various activities such as walking down the hall and going back to the intensive care unit. This also helps patients to be relieved from the stress of being cramped up on the bed all the time. Such interventions are also known as well-being measures since they allow the patient to get comfort from walking and stretching. Thus enabling the patient to stretch and walk promotes comfort and well-being of the patient.

Antecedents and Consequences

The concept of discomfort is the most common antecedent to comfort. Like comfort, discomfort has a number of definitions according to the patient defining it. The most common definition describes the discomfort as being in the state of suffering or distress. Once comfort is achieved, one can easily know what discomfort means. There is little literature describing the consequences of comfort.

Empirical Referents

According to (Zajac, 2010) ethnically, diverse students face unique challenges in addition to universal stresses from the nursing schools while trying to become nurses. In his article (Zajac, 2010) describes the experience of comfort as described by Kolcaba’s theory. Using an experience of comfort provides transcendence, relief, and ease to the discomfort which university students usually experience (Zajac, 2010). An alternative article that describes the concept of comfort is Lawson article of 2010. The article describes the experience of taking care of dying patients and mainly focuses on a particular instance of when the nurse had to take off a dying patient. The author emphasized being there for the patient’s caretaker and comforting him throughout the entire process. The author showed the greatest example of being there for the family and providing comfort to the family members. In this article, the nurse had to sit and listen to the stories the family members had for the mother and helped them to cope with her death.

Conclusion

In conclusion, comfort can be defined in various ways depending on the patient trying to define it. The present concept analysis shows the importance of attaching a particular meaning to the term comfort for the nursing profession since it lacks a definitive literature. Several studies can determine the uniform measure of comfort for all the patients. Nurses can provide the best comfort measure for patients if they determine the level of distress or discomfort the patient have and establish a collective intervention.

Reference

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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,

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).