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

Example: patient states no pain, asleep
 Ease

– state of recipient after need is met
– state of calm/contentment
Example: asleep, relaxed expression
 Transcendence
– state where patient rises
above their pain or problems

Example: 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
 Conquering



Pain
Suffering
Certain circumstances
 Motivated
beyond the ordinary to reach an
extraordinary goal

Patient 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
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

Caring (goals to design
interventions)
Back rub, music, bath,
presence, therapeutic
touch
Comfort (interventions you
take)
 Induction

Building general conclusions from specific
observed happenings

Interventions nurse performs that define careconstipated and give poop medicine
 Deduction

How reach conclusions (assessment)- no poop for
12 days
 Retroduction

Evaluations – results and reassessment

Hot or cold fluids

Heat/cold application

Massage

Medications

Meditation/prayer

Distraction

Mouth care

Linen change

Things from home

Positioning
Direct what you do
Peaceful environment
 Active listening
 Support patient and
family: identify
concerns/fears
 May include: MSW,
Pastoral care

Indirect you or others do



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, approachable
Facing the person
Bend forward
Eye contact
Cultural appreciation
Calmness 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 translation
Views
 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