NUR350 midterm 2 - relational work

comfort

sense of positively and strength characterized by the relief of physical discomfort and integration of positive emotions

- subjective

- multidimensional, dynamic, and transient

need for comfort can occur... (when?)

at any stage of the illness-wellness continuum

common triggers:

- e.g. feeling separated from family, fear or anxiety about health condition

providing comfort

actions that are mobilized with the intent of easing / alleviating / transcending human suffering

- can be simple (e.g. flipping pillow to cool side)

providing comfort is informed by principles of... (3)

empathy, compassion, and care

factors that influence pt's comfort (3)

1. clinical environment

2. healthcare staff

3. pts and their families

- who they are and what is important to them

factors that influence pt's comfort: clinical environment (+ how it affects nurse-pt relationship)

material and cultural/social conditions of the clinical environment contribute its therapeutic effect and situate the nurse-pt relationship

- affects whether pts experience care setting as welcoming and safe

- influences kind of care nurses provide

notion of a therapeutic place is inherently ____

subjective

- influenced by personal history, cultural / spiritual practices and beliefs, social position

- impacted by what is important to you (e.g. natural light, access to outdoors, own clothing/sheets, plants, people)

socio-political realities of place: places are embedded within ___ which create... (+ examples)

broader social structures and institutions;

different experiences for different people as they move through / occupy a space;

- e.g. black men being racially profiled by police; individuals whose appearance don't conform to gender roles using public bathrooms

socio-political realities of place: examples of individuals experiencing racism and profiling in healthcare (4)

1. joyce echaquan

- Indigenous mother whose symptoms were ignored and she died (nurses assumed she was drug seeking)

2. keegan combes

- Indigenous man with developmental differences whose treatment was delayed and he died (nurses delayed treatment and did not report neuro status)

3. brian sinclair

- Indigenous man who died in ER from urosepsis (nurses assumed he was drunk and sleeping, did not check on him for hours)

4. serena williams

- black woman who advocated for herself due to health history but was ignored (almost died after childbirth)

black women are more than ___ more likely to die from childbirth

4x

factors that influence pt's comfort: healthcare staff (considerations for staff) (4)

1. be aware of intersectional nature of identity

- and how privilege and oppression shape personal experiences

2. engage in self-reflexivity (aware of own biases and assumptions)

3. recognize and challenge oppression/discrimination

4. use thoughtful and respectful language

moral courage (+ 5 aspects)

perseverance to stand up for what is right even when it means doing it alone or against others

1. protect

2. believe

3. assess

4. advocate

5. report

___ is a precondition for comfort

sense of safety

(essential to process of curing and healing)

factors that influence pt's comfort: healthcare staff (5 aspects of treatment / pt's perception)

1. engagement and commitment

- committed to not giving up and trying different methods

2. perceived and actual competence

- promotes pt's sense of safety

3. information and participation

- readily sharing info and encouraging involvement

4. symptom management

- e.g. pain

5. holistic care and assistance

factors that influence pt's comfort: pts and their families (2 ways to learn/support)

1. wondering

2. following

exploring who pts are and what they need: wondering

a relational practice of curiosity

- helps to understand pt's unique experience and individual care needs

- helps us to stay open and avoid assumptions

___ is a prerequisite for wondering

humility

- knowing that we don't know everything

- have to learn from pts

examples of wondering language to enact comfort

- how can we make you more comfortable?

- what have you found helpful in alleviating your pain?

- i'm wondering how it feels when ___?

following

practice of listening to, respecting, and acting on what we learn from our pts about who they are and what they want/need

- providing care that is specific to the individual pt

following: actions based on ___

what was learned from wondering

following requires that we pay attention to... (2)

1. the pt's words, voice tone, body language, facial expression, and gaze

2. our own assumptions / feelings about pt issues

- recognizing how our reactions shape what pts are willing to share

necessary touch vs responsive touch

necessary touch: care of the 'fleshy' body

- touching for instrumental reasons

responsive touch: providing comfort

- touching for therapeutic reasons (e.g. holding someone's hand, braiding hair)

touch (+ 3 benefits)

a powerful nonverbal form of communication that is essential to our survival

benefits:

1. helps us feel connected to others

2. can provide a sense of comfort and security

3. can make us feel valued, desired, and seen

touch is an ___ activity

uncertain

- not a universal language with shared meanings

- e.g. hand on arm may be interpreted as comforting presence or 'calm down/stop'

nurses straddle boundary between body-___ and body-___

body-subject and body-object

- seeing someone's personhood while also performing acts where body is seen as an object

care of the ill body is to encounter/engage with the ___, which can evoke feelings of...

abject (things that are repulsive/disgusting);

disgust, shame, guilt, or embarrassment for both the pt and the nurse

considerations for necessary touch (5)

1. touch is never experienced as routine by the person receiving care

2. explain what you're going to do before you do it

3. offer (rather than impose) touch and wait for pt's response

4. tell pt if your touch will inflict pain/discomfort

5. remember that avoidance of touch can create feelings of isolation and stigmatization

kangaroo care (+ benefits)

skin to skin contact for babies

- ideally with birth parent

benefits:

- decreases mortality, pain response to painful procedures, and hospital stay for low-weight/premature infants

- regulates sleep patterns

considerations for responsive touch (2)

1. responsive touch can be nurturing, comforting, and healing, but it can also be intrusive, distracting, and assaultive

2. need to be attentive to following our pt's cues and knowing when, where, how, and how much to touch, and whether to touch at all

always a risk of ___ or ___ of responsive touch

misinterpretation or misunderstanding

- be very conscious of putting your hands on someone

- good intention doesn't always = good results

important aspect of following: we must allow our pts to be ___ as their situations ___

continually 'new'; change over time

- never lose our sense of wonder about them

- don't assume things based on info given