Transcript File - Megan Reid MSN Portolio

Kathy Kolcaba
Megan Reid and Nichole Potts
October 12th, 2011
Background
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Born in Cleveland, Ohio on Dec 8th
1944
Education
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Diploma
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MSN
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Doctorate
While developing her theory…
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Published a framework for dementia
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Diagrammed the aspects of comfort
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Operationalized comfort as an outcome of care
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Contextualized comfort
She’s still going!
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Associate professor emeritus at UA
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Teaches web-based theory once a year
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The Comfort Line
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Member of ANAN and Sigma Theta Tau
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Lives in Cleveland
Assumptions of Comfort
and Influences for Practice
• Outcome of intentional patient and family focused QUALITY of
care.
• Basic need
• Experienced holistically
• Self-Comforting measures can be healthy or unhealthy
• Enhanced comfort = greater productivity!
Influence of 3 Nursing Theories
• Orlando 1961/1990- relief
• Henderson 1978-ease
• Paterson and Zderad-transcendence
The basis of comfort..
• 4 contexts which comfort is experienced
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Physical
Psycho-spiritual
Sociocultural
Environmental
• When all 4 contexts, as well as the 3 theories of
comfort are met, comfort has been obtained
Taxonomic
Structure of
Comfort
• Determines unmet comfort
needs
• Allows bundling of
interventions in a single
patient interaction
• Aids in creating measures of
holistic comfort for
documentation
Relief
Physica
l
Psychospiritua
l
Environ
mental
Sociocultural
Ease
Transce
ndence
Example
Practical application of
taxonomical structure
Eva is a 12-year old
Hispanic female with
scoliosis. She is
admitted to the PICU
immediately following
a spinal fusion
Propositions of Comfort
Theory
3 intuitive parts
• when comforting interventions are effective results are increased
comfort!
• Increased comfort of patients result in strengthening for their tasks
ahead (Health Seeking Behaviors!)
• Increased patient engagement in Health Seeking Behaviors
strengthens the institution!
STRESS ON DOCUMENTATION!!
To better understand the conceptual framework for Comfort
Theory……..
Comfort Interventions- intentional actions that address
comfort needs of the patient
Intervening Variables- interacting forces that influence the
patients perception of total comfort.
Comfort- experienced as a result of comfort interventions.
Health-Seeking Behaviors- subsequent outcomes related to
the search of health.
Institutional Integrity- possessing the quality of being
complete
Definitions
Health Care Needs- needs for comfort brought forth by
stressful situations
Conceptual Framework
Metaparadigm?
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Health/Illness
Person
Environment
Nursing
Parsimony
Fairly simple theory
Everyone is familiar with the idea of comfort
However, it is a complex term that has several
meanings and usages in ordinary language
Requires specific tools to use – easily accessed
Comfort is a transcultural and interdisciplinary
concern
Application of Theory
Three types of comforting interventions
Technical interventions – specified by nursing
protocols (e.g. medications, treatments,
monitoring schedules, insertion of lines, and so
forth)
Coaching – consists of supportive nursing
actions, active listening, referrals, advocacy,
reassurance
Comfort Food for the Soul – special holistic, more
time-consuming nursing interventions (e.g.
massage, guided imagery, music or art therapy,
special arrrangements for family members)
Expertise Required
Technical Interventions are minimum
expectation of nurses (i.e. “novice” nurse)
Coaching and Comfort Food for the Soul
require “expert” nurses
“Wow moments” strengthen recipients,
nurses creating the moments, and the
nursing discipline as a whole
National Interventions Classification (NIC) and National
Outcomes Classification (NOC), North American Nursing
Diagnosis Association (NANDA)
Policy for Comfort Management by the American Society of
Peri-Anesthesia Nurses (ASPAN)
Applies Comfort Theory throughout patients’ surgical
experiences
Achieved national consensus about the development of
Guidelines for Comfort Management
Used to compliment existing Guidelines for Pain
Management
Initiated by nurses and is now an expectation reviewed
by Joint Commission on recertification
Current Practice
and Research
Mount Sinai Hospital in New York City
Kaiser Permanente Hospital in San Francisco
Southern New Hampshire Medical Center achieved Magnet
Status by adopting Comfort Theory for application
Incorporated into national electronic databases
Comforting interventions, outcomes, and diagnoses
Questionnaire
Evaluation of Theory
 Original focus on gerontology but has been effective when applied
to entire institutions
 Focus not only the patient comfort – but also families, support
systems, and staff
 Few criticisms noted
 May be difficult to apply at times due to patient individuality
 People vary significantly in their personal need or desire for certain
levels of comfort
 Prevention of discomfort is easier to treat than comfort itself
 Provides the language and rationale to document essential nursing
activities
Comfort by S.D. Lawrence
(student nurse)
Comfort may be a blanket or a breeze,
Some ointment here to soothe my knees,
A listening ear to hear my woes,
A pair of footies to warm my toes,
A PRN medication to ease my pain,
Someone to reassure me once again,
A call from my doctor, or even a friend,
A rabbi or priest as my life nears the end.
Comfort is what ever I perceived it to be
A necessary thing defined “only by me”.
References
•Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and
research. New York, New York: Springer Publishing Company, Inc.
•Kolcaba, K., & DiMarco, M. (2005). Comfort theory and its application to pediatric
nursing. Pediatric Nursing, 31(3), 187-94. Retrieved from EBSCOhost.
•Parker, M. E., & Smith, M. C. (2010). Katharine Kolcaba’s comfort theory. In Nursing
theories and nursing practice (3rd ed., pp. 389-401). Philadelphia: F.A. Davis
Company.
•www.thecomfortline.com