Concept analysis: comfort

Author: Janet Peter

Introduction

Comfort is a term that implies numerous aspects, and the meaning depends on how the person needs it to mean. In the nursing profession, comfort is a term that changes and varies depending on the patient. Zajac uses the Caring theory by Kolcaba in stating that the role of a nurse is to assess the kind of comfort needed by the patient and design the comfort measures plan. The nurse has the duty of addressing these needed and after implementing her plan, he will assess these needed and compare them with the baseline (Zajac, 2010). Several aspects for consideration as we compare the most appropriate means of proving the patient with comfort.

Some patients might think that when given medication, it is a form of comforting them. Others will consider the presence of a nurse in their room holding a conversation with them as being the best means of comforting them, rather than being left alone. Also, the term comfort is also used as healthcare organization’s and hospital’s core value. Nurses take all the necessary actions to ensure that patients have comfort as part of their work and common practices which sometimes goes unnoticed.

This paper discusses the comfort theory proposed by Katharine Kolcaba’s so that I concentrate on defining the term comfort. According to Kolcaba, one experiences comfort in three main ways which are: ease, transcendence, and relief. About Kolcaba‘s view Smith (2011) mentions that "comfort can best be defined as an intermediate outcome of experiencing strength after the addressing the needs of transcendence, relief, and ease within the context of physical, socio-cultural, environmental and spiritual "aspects (Smith, 2011, pp. 12). Nurses sometimes find it difficult to establish the right action of comforting a patient. However, Kolcaba believes that through the consistent delivery of support over an extended duration of time, the nurse will master a trend that correlates with an increasing ability to provide various levels of comfort throughout time. In such a process nurses master the desired seeking behaviors of comfort and health which promotes the overall outcomes of a health institution (Kolcaba, 2010).

There is need first to identify what happiness means and determine the necessary steps that have to be for fulfilling this goal so as to undertake a complete concept analysis of comfort. Concept analysis has guidance through the approach proposed by Walker and Avant. Walker and Avant‘s method of concept analysis are a vital approach to describing the information category, and clarification of the meaning of a given concept (ElSadr et al., 2009).. Usually, nurses undertake concept analysis when they feel the need to improve a theory or give more details to a theory. This paper will follow the steps proposed by McEwen & Willis (2011) for carrying out the concept analysis of comfort;

  1. Concept selection
  2. Determining the purpose and aim of analysis
  3. Identify the concept uses
  4. Determine the attributes that define the concept
  5. Recognizing a model case
  6. Finding the alternative cases
  7. Pinpointing the consequences and antecedents
  8. Definition of empirical referents

Purpose/Aim

Concept analysis is for the purpose of determining the meaning and thoughts that patients have concerning their comfort. The purpose can fulfill them through the approach of concept analysis. Finding the actual meaning and feeling is not just directed to the patients but also the entire community as well as families. It is also the search for its meanings from both females and males from all ages. Thus, the overall goal of this concept analysis to be able to provide the best comfort to patient’s, their families, and the whole community by providing them with the best care that they find to be the most comforting.

Literature review

In searching for the relevant sources, databases such as ProQuest, CINHAL and EBSCOhost are used in finding articles that were from 2010 to 2015. The main keywords for establishing the scholarly articles were; patient comfort, comfort in nursing, comfort theory and comfort.

The first article examined if education, job role and experience were affected the nurse’s approach in provides comfort to patients (Jones, 2010). It is a quantitative study surveying more than four hundred nurses working in 5 rural healthcare facilities. The researchers mention the results through the variance analysis and descriptive statistics. The study’s conclusion is that the nurses with more experiences showed a major difference in their comfort degree in proving care to patients than the less experienced nurses (Jones, 2010).

Another crucial article was by Khalaila (2014). This study examines the most effective interventions that can be designed by nurses in meeting the needs of families and critically ill adult patients receiving ICU services. The study uses studies published between 2000 and 2013 from CINAHL, Medline, and ProQuest to search for the suitable interventions. In a table format, the researcher organizes an essential interventions and needs at the top of the table and the least important needs at the bottom. The table illustrates the perceptions of families on whether they were meeting these needs. The researchers also use another table in summarizing the interventions found in all studies under their research. These are the intervention for comforting patients and families with members in the ICU. The families have multiple needs such as comfort, support, information and reassurance (Khalaila, 2014). The study concludes that families and healthcare professionals have different opinions on the most important needs for families. The researcher, therefore, gives recommendations that there is the need for critical care nurses to be continuously aware of the needs of family members and that they should provide family -centered care as per the standard of care for ICU patients (Khalaila, 2014).

The last study was from CINAHL which is a qualitative study. The study aims to establish the mewing of nursing care in the provision of the good death from a team of intensive care nurses (Silva, Pereira, and Mussi 2015). Ten nurses with experience in caring for the terminally ill patients in the ICU were for interviewing. The nurses are those specializing in oncology. the results of this study are that good health caring means the focus on promoting comfort as the most vital aspect more than other categories such as emotional and social support, relieving physical discomfort, body positioning and the maintenance of health (Silva, Pereira, and Mussi 2015). Through this finding provision of a good death is all about the promotion of comfort that involves combining therapeutic interventions and sensitivity and rationality in interactions with the health professionals with patients and families while ensuring the maintenance of their dignity (Silva, Pereira, and Mussi 2015).

Uses

Comfort according to Kolcaba is a state of meeting the basic needs of humans through transcendence, relief, and ease (Kolcaba, 2010). In nursing literature, there is no definitive definition of the meaning of comfort that this gives rise to numerous questions on this concept in the nursing profession. The level of comfort is the tolerable level that a patient feels the comfort. In such an instance, it may not mean that there might not be any discomfort at any given time but that the patient can tolerate the state of the situation at that time. A nurse also uses comfort has to determine if an intervention is effective. The standard practice in determining comfort is to let the patient speak out of their pain level on the 0-10 scale. A high level of 9 to 10 shows that the intervention is not working while a level of 3 means that the intervention is suitable for reaching comfort.

Intervention for making the patient attain comfort is changing their positions after every two hours especially if the patient is lying in bed for the long duration of time. Fragala and Fragala (2014), state that, ‘ Position and turning the immobilized patient in bed is crucial to increase their comfort, enhance healing, maintain the integrity of skin and achieve the best outcomes of care (Fragala & Fragala, 2014, pp 268). Another crucial aspect is to determine what the patient wants at any time be it a major issue or the least significant one so as to ensure that the patient achieves comfort.

Defining Attributes

When thinking about comfort, various attributes relate to comfort. These attributes can fall into two major categories which are those involving communication with the patient and the relief of physical symptoms. Kolcaba defines the state of being comfortable with, "feeling a sense of relief from psychological and physical sources that cause the symptoms and anxiety and distract the state of comfort (Kolcaba, 2010).

Thus, an important attribute is to listen to what the patient is saying about his needs, pain and whether or not he is comfortable. Thus, nurses have always to facilitate communication with the patients. Through talking with patients and listening to their needed, they can propose a case plan or the nurses provide them with an explanation of the care processes. Thus, the communication attribute is vital as a way of comforting the patients and identifying their unique needed. In such communications, it is crucial that the nurse is aware of his or her tone of a voice as a vital way of comforting the patient in the best way possible.

Apart from communication, another crucial attribute of achieving comfort is to relief the physical pain that the patient is experiencing. Having pain causes discomfort and shows that something is wrong with the function and structure of the body. Thus, the nurse has to do something in helping the patient relief pain. Planning for the best intervention to relief pain means working with the patient and other caregivers to provide the best measures of pain management. Effective management of care is by a team of nurses, pharmacists, occupational therapies, physical therapists, and others. Their practices overlap as each of these professionals evaluates the therapeutic measures that are effective. They also have to communicate and work with each other as a team.

Model Cases

Kolcaba’s theory of comfort gives nurses a model for comfort especially through the three forms of comfort which are transcendence, ease, and relief. The theory also presents the four concepts of comfort which are socio-cultural, environmental, psycho-spiritual, and physical. This structure serves as a referent for measurement and assessment of determining patient’s comfort.

A patient writes a letter to her nurse thanking her for her effort in the recovery process. She thanks the nurse for enabling her to beat the odds of the coronary artery disease that ended her life. She appreciates the nurse for giving her the will to live and for the enthusiasm she gave her to adapt and accept her situations. The letter goes on to state that she saw the excellence performance of the nurse in areas that physicians could not understand. Such as "always smiling when I lay in the ICU bed, squeezing my hand as you told me all things will be well. You gave me the comfort I ended. "The letter further reads, "I will never forget the joy I felt after you measured my vital signs and gave me a good report. I am confident you are proud of me, and I did not disappoint you. Thank you for washing me with antiseptic and draping me while telling me what I have to expect and handle it. You were there for me when I panic. It ends that, "you softly comforted all the time while monitoring and measure".

The case model has all the three components of comfort which are Transcendence, ease, and relief that occur socially, environmental, psycho- spiritually and physically. Thus, comfort is a holistic outcome, and we see the patient using words such as, "I felt comforted" and this shows that the comforting actions of the nurse worked.

Borderline case

The Borderline case is cases containing some of the vital attributes of the concept of comfort but not all the attributes. In my experience, I encountered a case whereby I was Craig for my patient sharing the room with another patient diagnosed with IV. There was a nurse who came to change the bag and did it efficiently. She always worked with a speedy efficiency. She came in and told the patient that she was changing his IV and did it juts in seconds and rest the pump with no trouble. In doing so, she was just smiling at his patient and made the technological aspect of her job seem so easy. The patient was not critically ill, and he looked pleased and glad to see her. In a matter of two minutes, the nurse was through with him, and she left the room. I could only see the patient’s face changing to that look of being left so fast with an open mouth ready to ask a question. But she had left.

This case clearly shows some aspect of comfort. The patient did not have a chance of asking questions despite the nurse ability in showing a smile of comfort and working efficiently. The nurse, therefore, demonstrates friendliness and technical competence in leaving the patient environment clean and neat. However, she failed in proving social comfort and psycho-spiritual support through giving the patient a chance to ask the question, be listened to and to be shown care.

Contrary case

Suffering is an uncomfortable state, and they are the opposite feelings. Nurses should try to elevate comfort whenever a patient is suffering. A patient suffering from end-stage renal failure has no advance directives or family advocate to help in facilitating for his peaceful death. He frequently slips out and in of consciousness as is organs fail one after another. He has been receiving treatment using the highest procedure, the Continuous Veno-Venous Hemo- filtration. His chances of recovery are statistically very slim, and he is unable from removing himself from such an aggressive care. He also suffers from painful bedsores and his forward lines are clogged and infected. His coherent speck is gone. His environment is noisy and confusing. He slowly suffers his internal desperation and physical pains to death.

In such a case, there is no any element of comfort whatsoever. Instead, all we see is suffering. Such a practice in the nursing and healthcare field is unethical because the patient is left to suffer and his rights for autonomy are disregarding. The nurses are not performing their obligation of elevating suffering.

Consequences and antecedents

The antecedents of comfort are discomfort and suffering or being in a state of distress. To know if comfort is achievable, one has to understand how discomfort feels. Comfort consequences lead to the decrease in pain and feeling comfortable.

Empirical referents

An article was addressing the challenges that ethnically diverse students face as well as common stressors they face in nursing schools (Zajac, 2010).. Kolcaba theory on comfort can provide transcendence, relief, and ease of this discomfort that students experience in trying to become nurses (Zajac, 2010).

The article by Lawson (2010) is about the experience of caring for the dying patients, and it talks about the importance of being there for the patient’s family members in giving comfort.

Conclusion

There are numerous ways of defining comfort. Concept analysis is crucial in nurses to inform their practice such as determining the patient’s needs, identifying those in distress and establishing the right intervention that gives them the intervention they need.

References

ElSadr, C, Kelley J, and Noureddine, S (2009). A concept analysis of loneliness with implications for nursing diagnosis. International Journal of Nursing Terminologies and Classifications, 20(1), 25-33.

Sherry Roberts is the author of this paper. A senior editor at Melda Research in academic writing agencies if you need a similar paper you can place your order for a custom research paper from research paper company.