lisa b. flatt, rn, msn, chpn. kolcaba’s comfort theory (2003) provides guidance for the nurse to...

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