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Comfort

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Comfort

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  1. Comfort Lisa B. Flatt, RN, MSN, CHPN

  2. Comfort Needs • 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

  3. Types of Comfort defined • Relief – state of recipient after need is met • Example: patient states no pain, asleep • Ease – 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

  4. Relief • Remove or alleviate painful symptom • Meeting a specific need • Not always complete • Can be partial or temporary

  5. Ease • 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

  6. Transcendence • 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

  7. Holistic care Comfort needs • 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

  8. Kolcaba concept comfort vs caring • 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 Caring (goals to design interventions) Comfort (interventions you take)

  9. Kolcaba’s 3 types of reasoning • Induction • Building general conclusions from specific observed happenings • Interventions nurse performs that define care- constipated and give poop medicine • Deduction • How reach conclusions (assessment)- no poop for 12 days • Retroduction • Evaluations – results and reassessment

  10. Comfort measures can be: • 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 Direct what you do Indirect you or others do

  11. Providing Comfort • 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

  12. Caring & Communication • 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’

  13. Physically attending • Intensity of presence • Actions • Open posture, approachable • Facing the person • Bend forward • Eye contact • Cultural appreciation • Calmness and ease

  14. Helping relationship • 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

  15. Active/attentive listening • 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?”

  16. Barriers to communication • Sensitivity to culture, beliefs • Misunderstandings • Lecturing • Stereotyping • Distractions • Lack commitment • Emotions • Interrupting • Poor listening skills

  17. Influencing factors communication • 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

  18. Alternative Therapy • Holistic intervention • Promotes comfort, control, well-being, patient and family participate • Complementary therapy • Accupuncture, massage, accupressure, yoga

  19. Nursing Process • Assessment • Analysis • Planning • Interventions – consider ethical and legal implications • Implementation • Evaluation