A Wake-Up Call

When presenting comfort care to students a few years ago, one earnest young man who had some prior experience working in nursing homes raised his hand and asked, "Is this a new concept? I have never seen it being practiced!"
I think his question is a wake-up call to us in nursing practice and education to get back to the basics.

- Dr. Katharine Kolcaba (2003)

Comfort: A Fundamental Need

Long ago, the field of nursing was merely perceived as giving of care to sick individuals. Just like other things, nursing has also evolved as time passed. Its evolution greatly influenced the nursing profession. Decades of study, the traditional type of care given to patients has evolved holistically. 

Pioneered by Florence Nightingale, though was posthumously accredited as a nursing theorist, her nursing contributions had influenced the field of nursing far into holistic and professional level. At that juncture, the provision of care was reinvented which after her, other nursing theories has also been formulated and adapted into the practice of nursing. 
 
According to Tomey and Alligood, nursing theory is a set of concepts, definitions, relationships, and assumptions or propositions derived from nursing models or from other disciplines. This projects a purposive, systematic view of phenomena by designing specific interrelationships among concepts for the purposes of describing, explaining, predicting, and prescribing.

Interestingly, Kolcaba's comfort theory presents the very essence of nursing. Provision of care and comfort are the initial interventions that a nurse does for a sick person. The comfort theory was highly acknowledged because of its universality across all disciplines, widely an extension of other theories and was holistically given emphasis. 

Her theory was derived from her experience in the practice of nursing. In her quest to introduce the concept to students, one young man with previous experience in nursing homes raised one question, "Is this a new concept? I have never seen it being practiced?" Unknowingly, it has been practiced even before the conceptualization of theories but with the advent of advanced technology in treating patients, providing comfort has been set aside and has never been a priority. This serves as an eye opener to all nurses. After all, comfort is one of the fundamental needs of all individuals.

Reference:

Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and research. New York, NY: Springer Publishing Company.

Nursing theory. (n.d.). In Wikipedia. Retrieved July 07, 2010, from http://en.wikipedia.org/wiki/Nursing_theory

Current Nursing. (2010, March 25). Application of theory in nursing process. Retrieved July 07, 2010, from http://currentnursing.com/nursing_theory/application_nursing_theories.html

A Closer Look at Kolcaba's Conceptual Framework

“I hope that nurses will collectively move boldly into a future where knowing about, and doing something about human needs for comfort and relief from pain are clearly within nurses’ realm.” – P. Chinn (Kolcaba, 2003, p.19)

Providing comfort is definitely within the nurses’ realm today. Nurses are the ones in direct contact with their patients, providing relief from certain discomforts, continuously assessing, monitoring and providing care that will ensure the client is at ease. According to Kolcaba, “Comfort is the desirable state that nurses would want for their patients.” 

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Dr. K on Facebook!

Right, you read that right, Dr. Kolcaba is on Facebook! We tried to contact her regarding the theory and good thing she promptly responded.

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You may use this quick link to her Facebook's Comfort Theory in Health Care page.

Nurse's Role

Several nurse theorists have already defined nursing. All of their theories has been tried and tested and it has affected our utilization of nursing services or the standards of care we give to our patients:

“…what nursing has to do…is to put the patient in the best condition for nature to act upon him.” – Florence Nightingale

“The care circle explains the role of nurses, and focused on performing that noble task of nurturing the patients, meaning the component of this model is the “motherly” care provided by nurses, which may include limited to provision of comfort measures, provision of patient teaching activities and helping the patient meet their needs where help is needed.” – Lydia Hall

All of these can be summed up in one word…COMFORT. Comfort is a concept that has a strong association with nursing. The term itself represented a relaxed, healthy, peaceful, and individualized condition. Nurses traditionally provide comfort to patients and their families through interventions that can be called comfort measures. The intentional comforting actions of nurses strengthen patients and their families. When patients and families are strengthened by actions of health care personnel (nurses), they can better engage in health seeking behaviors. 

Reference: 

Kolcaba, K. (2010, May 17). The comfort line: Frequently asked questions. Retrieved from The Comfort Line website: http://www.thecomfortline.com/FAQ.html

Comfort Theory: An Overview

In the light of current nursing shortage, health care system should find the means to address this problem in order to continue achieving the goal, which is to provide the optimum level of health of a person or client. 

During the 1900’s, comfort is considered the goal of both nursing and medicine because it is believed that comfort will lead to recovery. Comfort is a complex term and titled as one of the distinguishing characteristic of the nursing profession yet, it has never been conceptualized, studied and researched in the field.

In this part of the blog, you will notice that we include certain terms about the theory in which you may get confused of but don’t worry because each will be discussed further as you read the other posts in this blog.

Pioneering the work on theory of comfort in nursing is Dr. Katharine C. Kolcaba PhD, RN, an American nursing scholar, a clinical nurse specialist who attained several scholastic awards and achievements. With her collated readings, knowledge, experiences and researches... she was able to provide a holistic definition for comfort not only in nursing but for the whole health care team.

The theory of comfort is one of the many middle range nursing theory because it is focused on a limited dimension of the reality of nursing. It is formulated to provide guidance for everyday practice and scholarly research rooted in the discipline of nursing. 

Comfort Care in Various Healthcare Disciplines

Kolcaba’s comfort theory is not relevant only in the nursing field, but also engages the other healthcare disciplines. When providers of health care are driven to the same goal of making comfort available, the needs of the patient is adequately met. Furthermore, improvements in health seeking behaviors as well as institutional integrity is experienced. The following case sample illustrates comfort care continuity across the various healthcare fields.

Mr. S. is a 45-year-old Canadian man who has just been admitted to the ICU postoperative cardiac surgery. He has had an uneventful coronary artery bypass graft with no complications in the operating room. He is intubated and placed on complete mechanical ventilation. His vital signs are: blood pressure (BP) 150/90 mm Hg, heart rate 86 beats per minute, respiratory rate 12 breaths per minute, and temperature 35.3[degrees]C.

The surgeon caring for Mr. S. is familiar with Kolcaba's comfort theory and structures the orders accordingly. The target systolic BP for Mr. S. is less than 130 mm Hg and the surgeon's postoperative orders include BP medications and intravenous morphine sulfate for pain. In addition, the surgeon prescribes an nonsteroidal anti-inflammatory drug, ketorolac, to be administered to the patient once it has been determined that they are not bleeding excessively and have acceptable renal function. This close attention to treatment of pain represents a comfort intervention instituted by the surgeon that not only addresses a particular healthcare need of the patient but also recognizes the importance the surgeon has placed on of the relief form of comfort. There is a standing order in place for warming patients postoperative coronary artery bypass graft.

NARS

This personal blog entry was made way back December 08, 2007... It may be out of place here, but my primary reason of re-posting it is for us to see where we have been through before. It is in our formative years as nurses (student nurses) when our clinical instructors and professors shared to us that nursing care will truly be appreciated once we provide comfort to our patients. Anyway, we all started developing our comfort caring attitude as nurses during our college years. Now, take a glance at our memory lane! 

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Last Friday I applied for my SSS and TIN numbers to finally complete my UST Hospital staff nurse position candidate requirements. I am not yet qualified for the position because I'm still for interview and still a lot more processes and qualifying stuffs to hurdle before making it there. I passed the requirements and my objectives for the day were met. So just to kill the time I decided to pass by SM Manila to take a good look at what they offer during their Friday sale. Only to realize that I'm broke. Huhu.. And I barely have enough money for fare to get home. Oh I just miss my college days... Thinking of my bum status just makes me so devitalized... Edi nag-window shopping nalang ako... :p

While strolling I saw a movie poster featuring some nurses.. So to satisfy my curiosity I went on the 4th level to examine the movie poster. It was Jennelyn Mercado on the title role and some local artists as nurses. It was produced by Carl Balita. And to shorten it all.. I watched the movie.. Haha.. Then the desire to learn about the movie was satisfied.. Take note.. Only the desire to know about the film was satisfied but I'm not claiming that the film satisfied me. (?!)

NARS featured the lives of a group of nursing students on their last year of college on their way to the board examination. The language used was simple but they also used some technical terms in which only individuals in the medical field could relate to such as petechiae, TAHBSO, Billroth, IMCI, etc. Technically, the film making was not so good yet not so bad. Although problems with blocking, lighting, and picture quality were obvious.

Theme-wise, I was so able to relate with their struggles as nursing students, the sleepless nights, the patients hesitant to cooperate with the students, the chismisan in the nurses' station, an inconsiderate clinical instructor, and a lot more. The movie featured numerous issues in the nursing education today but not much effort was given to tackle the issues in profundity. Acting-wise, okay lang...

Each character in the story presented their reason for taking up nursing and believe me you could relate to their reasons. As in I could see my classmates back in college in them especially when answering the question, "Why nursing?" and surely you'd get varied responses.  

I believe I saw a classmate, a board topnocher, Jaimie Mislang, in the movie. It was a clip of the Oath Taking last October 2, 2007 at the Araneta Coliseum. Nakapasa kasi yung mga nursing students ng story sa board exam kaya pinakita yung Oath taking. Eh nakita ko si Jaimie. Ahehehe. I'm uncertain if it really was her with her right hand raised.

Since I was able to relate to some points in the lives of the nursing students and I saw a classmate in the movie, I give 3 out of 5 stars for NARS.

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As of re-posting this entry, July 04, 2010, the DVD version is still available at the PNA Center at Ermita, Manila. 

- Heherson Morales, RN

You Make A Difference

Be moved. Take some minutes off and see and feel how our patients value us. Thank you, nurses.

You'll Be A Great Success

"If" for Nurses

If you can bring a special understanding
To all of those entrusted to your care

And meet their needs, no matter how demanding
With patience and energy to spare;

If you can lend each task your full devotion,
And always try to listen and to cheer,

If you can learn to understand emotion,
And comfort others just by being near;

If you look forward with anticipation
to meeting special challenges each day,

If you keep your faith and dedication
Whenever disappointment comes your way;

If you take pride in giving your profession
The finest skills and talents you possess,

Then all your dreams and goals will find expression
And, as a nurse, you'll be a great success.

~Author Unknown~

Our Beloved Profession