Comfort Care: A Concept Analysis
From a patients' point of view, comfort is multidimensional, characterized by relief from physical discomfort and feeling positive and supported in one's ability to cope with the trials of their illness, injury and/or disability. Nursing is a field driven by the act of providing care and comfort for patients and their families. Comfort is central to patient experience but the concept of comfort is poorly defined (Wensley, Botti, McKillop, & Merry 2017).
Palliative care is an umbrella term for any medical treatment that manages the pain, symptoms, and side effects of a chronic illness. This support can be provided any stage of the illness, alongside curative treatment, such as dialysis, chemotherapy, radiation, blood products, antibiotics and respiratory/circulatory support (Kelley and Morrison 2017). Hospice, by contrast, is a system of interdisciplinary care that provides services ranging from symptom management to bereavement services for patients and their families that generally have less than six months life expectancy (Hui et al 2013). Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis, and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is clear that the person is not going to survive their illness.
Sixty percent of all deaths occur in hospitals, and 80% to 90% of the deaths will be expected (Freeman 2013). A peaceful death may mean something different to one patient than to someone else. Of course, often one doesn’t get to choose. But, avoiding suffering, having your end-of-life wishes followed, and being treated with respect while dying are common hopes. The critical needs of dying people may also include: understanding what can be expected of death, being able to maintain a sense of control and having their wishes given preference, having access to information, and having access to spiritual and emotional support (Chan, Webster & Bowers 2016).
Occasionally, the best care a nurse can provide is providing their patient the ability to have a good death. In a survey of acute care nurses conducted by Becker, Wright, & Schmitt (2016) it was found that dying well was
The concepts of the comfort theory are clearly defined and the relationships are easily understood. This theory is simple and basic to nursing care. The taxonomic structure of comfort facilitates researchers’ development of comfort instruments for new settings (Kolcaba,1991).The first assertion of the theory stating that effective comfort interventions leads to increased comfort for patients , has been tested and supported with women with breast cancer (Kolcaba & Fox, 1999), persons with UI (Dowd, Kolcaba, & Steiner, 2000), persons in hospice (Kolcaba, Dowd, Steiner, & Mitzel, 2004). And stressed college students (Dowd, Kolcaba, Steiner, & Fashinapaur, 2007). Also, the second assertion was supported in the UI study, when patients with enhanced comfort showed increased HSBs.
Caring for patients at the end of life is a challenging task that requires not only the consideration of the individual as a whole but also an understanding of the
The comfort theory is a nursing theory that was first developed in the 1990s by Katharine Kolcaba. The Theory of Comfort considers patients to be individuals, families, institutions, or communities in need of health care (Petiprin, 2015). The environment in which this theory can be applied is in any aspect of the patient, family, or institutional surroundings that can be controlled by a nurse or a patient’s loved one by means to enhance their comfort. Health is considered to be optimal functioning in the patient, as defined by the patient, group, family, or community (Kolcaba, 2005).
Palliative care is a relatively new concept, stemming from the hospice movement of the 1960s. This type of care focuses on the quality of life of its patients at any time in their treatment process. Palliative care is a concept that is often used synonymously with hospice care. Although it can be congregated with hospice care, they are not the same thing. Thus, it can easily be misunderstood. Sherner (2015) explains that both clinicians and people alternate palliative care and hospice. Unfortunately, she says, these people believe that palliative care implies the patient is refusing curative care. The purpose of this analysis is to explore the concept, clarify the meaning, and differentiate the concept of palliative care.
Palliative care, somewhat similar to Hospice care, focuses on relieving or preventing suffering from a life altering illness. The goal for both Palliative and Hospice care is to provide the best possible quality of life to
Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.Palliative care is provided by a specially-trained team of doctors, nurses, social workers and other specialists who work together with a patient’s doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.
Acute hospitals play a significant role in end of life care, it is the place where most people die. Evidence suggests that end of life care in hospitals needs improvement. The purpose of this paper was to investigate patient and family experiences of hospital death, the weaknesses within the hospital setting and possible solutions to improve. A literature search identified common themes, these included:
When a terminally ill patient reaches the end of their life, many of them receive hospice care. Hospice can not guarantee how effective they will be in making that patient comfortable or how they will be able to function. The effectiveness varies from extremely effective care to very ineffective care. With such a wide range of effectiveness, patients begin to become concerned about how they will die. Many people find comfort in taking their own life before the drugs do (Sandburn 50). In Oregon, almost one hundred percent of the patients that requested the life-ending medication were receiving hospice care (Goodale, Grossman, and Grundy 16). Hospice was created with its main goal to comfort patients. Recent statistics show the real comfort has been found in the patient's right-to-die by physician assisted
Many nurses are regularly confronted with the hopelessness and exhaustion of patients and their families making it difficult for them to find balance between the preservation of life and the enablement of a dignified death. Nurses must acknowledge their own feelings of sorrow, fear, dismay and helplessness and recognize the impact of these emotions in clinical decision making. These distressing pressures may cause a nurse to contemplate intentionally assist in ending a patient's life as a humane and compassionate answer, however; the conventional goals and standards of the nursing profession mitigate against it.
In the early part of the 20th century, comfort was the central goal of nursing and medicine. Comfort was the nurse's first consideration. A "good nurse" made patients comfortable. In the early 1900's, textbooks emphasized the role of a health care provider in assuring emotional and physical comfort and in adjusting the patient's environment. For example, in 1926, Harmer advocated that nursing care be concerned with providing an atmosphere of comfort.
The concept of comfort is one that nurses provide every shift; however, it is not always easy to define. Katherine Kolcaba’s Comfort Theory will be used. Walker and Avant’s method for concept analysis will be used. The first step is to select a concept, which is comfort. The next step is determining the purpose of the analysis. The purpose is to define what comfort means and what comfort measures are and how they are used in nursing. The third step is to identify the uses of the concept of comfort. This includes definitions of term comfort and a literature search. The fourth step is to determine the defining attributes of comfort. This allows for insight into the
Comfort is defined by Merriam-Webster’s dictionary (2014) as “a state or situation in which you are relaxed and do not have any physically unpleasant feelings caused by pain, heat, cold, etc.” or as “a state or feeling of being less worried, upset, frightened, etc., during a time of trouble or emotional pain.” Dictionary.com (2014) defines comfort as “a feeling of relief or consolationm” or “a person or thing that gives consolation,”or “ a state of ease and satisfaction of bodily wants, with freedom from pain and anxiety.” Dictionary.com (2014) lists the origin of the word comfort as coming from the 13th century Old French term confort, meaning “source of alleviation or relief.” One can see there are multiple meanings and interpretations of the word comfort. This paper will set forth to discuss the word comfort as a concept and its interpretation and use in many disciplines, including its significance in nursing.
Hospice is a component of palliative care. A person does not necessarily have to be dying in order to see a palliative care specialist. This is where the service is often underutilized in the hospital. In the 18 months I have been a nurse, I have cared for many patients with chronic illnesses who have dealt with symptoms that have severely impacted their quality of life. Most of the time, it seems as though the patient’s care providers are interested in treating the patient’s acute problems. My experience has been that the symptoms are often overlooked or are being treated in a manner that is to the dissatisfaction and discomfort of the patient.
Traditionally, patients died at home with their family members around, but now this trend has shifted. Nowadays in my workplace, seeing patients die alone in the hospital is a common phenomenon. Only present is nursing staff, making sure the dying is comfortable. As Chappell et al (2017) pointed more people will die in institutional care, even though the vast majority of people wishes to die at home (Nyatanga, 2017).
Palliative care is specialized medical care that is working to provide ways and means to alleviate the pain and symptoms of the disease, and also aims to provide psychological, spiritual and social support for people with life-threatening illnesses and their families.