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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 metExample: patient states no pain, asleep
Ease – state of calm/contentmentExample: asleep, relaxed expression
Transcendence – state where patient rises above their pain or problemsExample: 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
ConqueringPainSufferingCertain circumstances
Motivated beyond the ordinary to reach an extraordinary goalPatient 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
InductionBuilding general conclusions from specific
observed happenings Interventions nurse performs that define care-
constipated and give poop medicine
DeductionHow reach conclusions (assessment)- no
poop for 12 days Retroduction
Evaluations – results and reassessment
Direct what you do Indirect 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, approachableFacing the personBend forwardEye contactCultural appreciationCalmness 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 translationViews
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