Comfort

Concept of comfort is important in nursing and personal life.
Module Objectives and Readings:
- ATI Fundamentals: Chapters 41 and 42
- Lippincott: Chapter 36

Absence of pain and feeling at ease.
Discomfort is a term that covers a lot of things, it is better to ask patients if they are having any pain or discomfort.
Comfort combines no pain and a sense of ease.
Pain can be a good thing as it indicates a serious injury.
Pain and comfort are subjective data because they are what patient say they are.
Comfort needs to be viewed holistically which includes physical, mental, emotional, and spiritual well-being.
Comfort is a basic need.

Domains include:
- Healthcare needs.
- Timing (pain is time-sensitive).
- Control of care by patient and family.
- Privacy.
- Continuity of care.
- Learning and care expectations.
- Nursing interventions (advocate for patient).
- Teaching about pain and comfort.
- Collaboration and case management.
- Variables that intervene with comfort (standardized protocols, monitoring, equipment).
- Communication methods.
- Health-seeking behaviors (internal, external).
- Peaceful death.
- Institutional integrity (best practices and policies).
Including all of these things increases patient satisfaction, contains costs, and decreases readmissions.

Holistic care means a combination of mind and body connection and its dimensions.
Comfort and empathy are the goals of health care and the names of the game as being a nurse.

Physical Comfort: Related to body; provide warmth, adjust pillows, schedule rest and activity.
Psychospiritual Comfort: Awareness of oneself and relationship to a higher being; offer chaplain services.
Sociocultural Comfort: Related to family, societal relationships, and norms; comply with patient's safety and social cultural norms.
Environmental Comfort: Related to external surroundings; adjust room temperature, play music, keep tidy, make sure linens are clean. natural light, and bathroom are clean.
It is important to note that spiritual and cultural are not the same thing.
All types of comfort must be met.

Transduction: Activation of pain impulse; nerves telling you something is wrong; releases chemicals (histamine, substance P, prostaglandins, bradykinins) at nociceptors.
- Stimuli include: Mechanical, thermal, electrical, and chemical.
Transmission: Information forwards from nociceptors to brain.
Pain Threshold: The minimal amount of pain that you can feel for you to be able to say, hey, I'm in pain I have any sort of pain. Anything below that threshold, your body will not respond or it won't classify as pain. Anything that meets that threshold as the minimal amount that you need to have for you and your body to tell you that it's painful.
Pain Tolerance: Subjective; how much pain you can endure.
Modulation: Body contracts reflexively; neuromodulators (endorphins) help lessen pain.

Everyone is at risk.
Infants.
Disease processes (autoimmune, cancer).
Trauma (broken bones, muscles, tendons).
Emotional factors (depression, anxiety).
Occupational injuries.
Surgery.
Age (older adults).
Pain is NOT normal for the aging population.
Under treatment of pain is caused by lack of knowledge, fear, addiction, communication barriers, poverty, rural populations, females, and cultural biases.

Acute Pain:
- Rapid and protective.
- Physiological responses: elevated heart rate and blood pressure, diaphoresis, and anxiety.
Chronic Pain:
- Lasts for 3-6 months- it depends which resource you are looking at.
- Is not helpful and, has no beneficial protective measures.
- People normally experience, depression, anxiety, fatigue, sleep and appetite disturbances.
- People have a decreased level of social function.
- Symptoms tend to go against a normal state of emotion, body and mind.
  - Treatment aims towards symptom relief instead of healing.
  - Patients may be on a scheduled pain medication instead of PRN.
- Chronic Primary: Pain is the problem and it is often dismissed by providers.
- Chronic Secondary: Pain is the symptom of another underlying disease process.
Breakthrough Pain: Occurs after medication is given or in between a time of being able to get a next one.
Idiopathic Pain: Unknown origin.
Central Pain: From damage to the central nervous system.

Somatic: Bones, joints, muscles, skin, connective tissue; sharp pain; responds to mild analgesics; bleeding, cramps, swelling.
Visceral: Organs; dull, achy, referred pain; caused by stretched organ, ischemia, inflammation, distension.
Cutaneous: Injury to skin or subcutaneous tissue.
Neuropathic: Lesion or disease of peripheral or central nervous system; burning, pins and needles, numbness, tingling; often affects extremities in the peripheral (legs, feet).
Phantom Limb Pain: Pain in amputated limb; mirror therapy can be used.
Intractable Pain: Resistant to therapy, affects quality of life.

Infants: Crying, writhing, arching back, body rigidity, grimacing.
Older Adults with Cognitive Impairment: Agitation, decreased energy/appetite, lethargy, deny pain.
Facial grimacing and fetal position symptoms of pain in a patient.
Numeric Pain Scale for children 8-9 years of age and above.
Faces Pain scale for children 3-8 years of age, you can also use this scale at any age. It depends on where you look to treat a patient.

CAM therapies include:
- Homeopathy involves dose of substances or remedies that would produce symptoms of the disease state in a well person to ill clients to bring about healing.
- Acupuncture is based on the idea of pressure points.
- Acupressure is based on the concept of applying pressures to certain areas.
- Naturopathic Medicine can also go not just in like a pharmacological standpoint and it can also go into diet, exercise, the environment, music therapy, art therapy.

Assessment of Self reported pain.
Physical exam to assess vitals, injuries or wounds to better provide pain assessment.
Diagnosing priority problems.
Develop a SMART goal that is measurable and an attainable goal that is also used to guide the patients care.
Implemented non pharmacological interventions that we talked about, such as CAM therapy. The most important Non- pharmacological comfort measures include , repositioning, so pillows, adjust temperature or dim lights, and even try to limit the sounds around patients.
-Implemented different types of pharmacological interventions,
Pharmacological interventions include:
- Opioids (for moderate to severe pain).
- Non opioids, for mild pain such as NSAID or Tylenol.
- Patient controlled analgesia.
Evaluation which helps evaluate smart goals to create effective patient evaluation.

The care is more affective when there is an inter professional collaborated effort which is why a health care approach is required to give the most affective patient based care.