Lisa B. Flatt, RN, MSN, CHPN

 Kolcaba’s Comfort Theory (2003) provides guidance for the nurse to instruct and educate the patient and family in a holistic manner.  Holistic care: physical, psychospiritual, environmental and social needs  Types of comfort: relief, ease and transcendence

 Relief – state of recipient after need is met  Example: patient states no pain, asleep  Ease – state of calm/contentment  Example: asleep, relaxed expression  Transcendence – state where patient rises above their pain or problems  Example: accepted facts and realistic of condition

 Remove or alleviate painful symptom  Meeting a specific need  Not always complete  Can be partial or temporary

 State of calm, peace, contentment  Able to do ADL’s  Total relief of pain  Relief from situations that are long-term  Does not have to follow pain or discomfort

 Conquering  Pain  Suffering  Certain circumstances  Motivated beyond the ordinary to reach an extraordinary goal  Patient with spinal cord injury, walks again after told they would not

 Physical – go along with the patients diagnosis, ie: pain relief, nausea, pruritis, constipation  Psychospiritual – self esteem, concept of self, relationship with higher being/belief (or having none), self concept, sexuality, meaning of life  Social – interaction with family, work and other relationships  Environmental – noise, temp, H2O, food, shelter, diet, rest, language

Caring (goals to design interventions) Comfort (interventions you take)  How nurses do work  Caring as an outcome  Design nursing interventions via nursing process to meet needs  Efficient & satisfying for caregivers and patients  Better use of existing resources  Nurses use daily  Manage pain; O2; elimination; hydration  Distraction; deep breathing  Comfort measures  Back rub, music, bath, presence, therapeutic touch

 Induction  Building general conclusions from specific observed happenings Interventions nurse performs that define care- constipated and give poop medicine  Deduction  How reach conclusions (assessment)- no poop for 12 days  Retroduction  Evaluations – results and reassessment

Direct what you doIndirect you or others do  Hot or cold fluids  Heat/cold application  Massage  Medications  Meditation/prayer  Distraction  Mouth care  Linen change  Things from home  Positioning  Peaceful environment  Active listening  Support patient and family: identify concerns/fears  May include: MSW, Pastoral care

 Physical  Therapeutic touch, skin care, comfort through warmth, mouth care, ROM  Psychospiritual  Soothing presence  Support during decision-making times  Social interactions  Family interactions  Social interventions  Respect boundaries  Structure and organization in healthcare setting- same page r/t care/communication/disciplines – noise – late night VS- no rest

 Sender – has message that is meaningful to them in a respectful manner  Receiver – gets message the decoder  Encoding – body language, tone of voice, facial expression  Hidden messages – don’t use ‘medical jargon’, education on care  Clarify and restate message ‘answers’  Sender must acknowledge acceptance of ‘answer’

 Intensity of presence  Actions  Open posture, approachable  Facing the person  Bend forward  Eye contact  Cultural appreciation  Calmness and ease

 Develop trust and convey acceptance  Need to be genuine with desire to assist  Influences: age, gender, education, value system, ethical and cultural belief, expectations, preferences

 Concentration  Verbal and non-verbal interactions  Clarify – pt says I want chocolate milk – “Let me understand, you would prefer chocolate milk?”  Reflection – “You sound as if you really like chocolate milk, can you tell me why?”  Restate – “Do you want chocolate milk”  Focus on content – chocolate milk  Open ended questions – “How are you feeling today?”

 Sensitivity to culture, beliefs  Misunderstandings  Lecturing  Stereotyping  Distractions  Lack commitment  Emotions  Interrupting  Poor listening skills

 Gender, age, etc……  Men and women, communicate differently  Women – intimacy, self esteem, decrease differences  Males – independence, establish rank  Stage of growth and development  Infants, teens, adults, aged  Cultures and values  Language and translation  Views  Preferences

 Holistic intervention  Promotes comfort, control, well-being, patient and family participate  Complementary therapy  Accupuncture, massage, accupressure, yoga

 Assessment  Analysis  Planning  Interventions – consider ethical and legal implications  Implementation  Evaluation