KP

COMFORT Powerpoint 2024

Concept of Comfort

  • Comfort Theory: Developed by Katharine Kolcaba.

  • Types of Comfort:

    • Physical Comfort: Related to bodily sensations and homeostatic mechanisms.

    • Psychospiritual Comfort: Related to individual self-awareness and relationship to a higher being.

    • Sociocultural Comfort: Related to family and social relationships.

    • Environmental Comfort: Related to external surroundings.

Normal Presentation of Comfort

  • Physiology Review: Understanding normal physiological states.

  • Maslow’s Hierarchy of Needs: Basic needs must be met for overall comfort.

  • Subjective Measures:

    • Understanding the patient’s normal: Each patient’s perception of comfort varies.

  • Objective Measures:

    • Sympathetic nervous system responses.

    • Presence or absence of pain.

    • Degree of sleep and rest achieved.

    • Balance of nutrition and fluids.

    • Perception of safety, privacy, and dignity.

    • Sensory perceptions: heat/cold, odor, noise.

    • Body language indicators.

Alterations to Comfort

  • Sources of Discomfort:

    • Physical:

      • Pathophysiological problems impacting comfort.

    • Emotional:

      • Grief, loneliness, depression as sources of discomfort.

    • Psychospiritual:

      • Issues with forgiveness, self, and spiritual beliefs.

    • Sociocultural:

      • Alteration in body image due to societal pressures.

    • Environmental:

      • Factors such as pollution, extreme weather, room temperature, and lack of privacy.

Alterations and Manifestations

  • General Impact of Illness: Disease, injury, or illness affects comfort.

  • Basic Alterations:

    • Pain, fatigue, sleep-rest disorders, particularly at end-of-life.

  • Subjective Symptoms: Includes both acute and chronic pain, dyspnea, fatigue, nutrition and GI issues, and sleep disturbances.

  • Emotional Discomfort: Includes feelings of shame, anger, embarrassment, withdrawal, avoidance, and flat affect.

  • Psychospiritual Discomfort: Involves feelings of worthlessness, frustration, depression, confusion, and being lost.

Sociocultural Discomfort

  • Impact on Relationships: Conflicts with family, healthcare providers, and others.

  • Cultural Conflicts: Conflicts arise between individual beliefs and societal values, potentially leading to stigmatization.

  • Caregiver Burden: Stress felt by caregivers of patients.

  • Discrimination: Racial or cultural discrimination impacting comfort.

  • Environmental Discomfort: The immediate setting and its factors such as noise, safety, temperature, and cleanliness.

Genetic Considerations & Nonmodifiable Risk Factors

  • Genetics: Influences vulnerability to diseases affecting comfort.

  • Pain Perception: Some genetic disorders impact pain perception.

  • Sleep Disorders: Genetic mutations can be associated with sleep disorders.

  • Psychiatric Conditions: Many psychiatric disorders have genetic components influencing discomfort.

Health Promotion

  • Lifestyle Changes: Educating patients to reduce pain, depression, and fatigue through:

    • Sleep hygiene practices.

    • Fostering psychosocial well-being.

  • Personal Preferences: Respecting individual lifestyle habits concerning nutrition, substance use, and occupational stressors.

Assessment

  • Observation and Patient Interviews: Look for obvious signs of discomfort, including:

    • Current problems.

    • Complaints related to discomfort and pain scales.

  • Patient History:

    • Lifestyle and occupational history influencing comfort levels.

Physical Examination

  • Guidelines: Vary by age, ethnicity, and severity of discomfort.

  • Key Observations:

    • Body posture, gait, facial grimaces, verbal complaints, and guarding behaviors.

    • Focus on onset, causes, length, relieving factors, and worsened conditions.

Diagnostic Tests

  • Tests for Underlying Causes:

    • X-Rays.

    • Blood tests.

    • Sleep studies.

Interventions

  • Promote Sleep Hygiene:

    • Regular sleep-wake patterns.

    • Bedtime rituals and restful environments.

    • Schedule hospital activities to align with patient sleep patterns.

    • Minimize environmental stimuli in hospital settings.

Promote Psychosocial Well-Being

  • Strategies:

    • Encourage laughter and a positive attitude.

    • Offer opportunities for participation in enjoyable activities.

    • Foster interactions with family and friends and support groups.

Teach Relaxation Techniques

  • Goals: Reduce stress, induce sleep, alleviate pain, and calm emotions.

  • Main Techniques:

    • Breathing exercises, muscle relaxation, visualization or imagery, movement techniques.

    • Additional methods include massage, acupuncture, meditation, biofeedback, and thermal stimulation.

Collaborative Therapies

  • Pharmacologic Interventions: Medication administration.

  • Nonpharmacologic Approaches: Various therapeutic options:

    • Acupuncture, nutritional and herbal remedies, biofield therapy, exercise programs, and physical therapy.

    • Includes pain clinics, aquatic therapy, and mobile health applications, as well as considerations for medical marijuana.

Lifespan Considerations - Infants and Toddlers

  • Communication of Discomfort: Usually expressed through crying.

  • Parental Input: Elicit descriptions from parents on how the infant exhibits pain.

  • Comforting Methods: Holding, rocking, and soothing with gentle words. Note: Many pain medications lack dosing instructions for children under 2 years.

Lifespan Considerations - Children

  • Engaging the Child: Involve children in describing discomfort and consult parents.

  • Anxiety Reduction: Explain procedures to decrease child's anxiety, using parental demonstrations if relevant.

  • Comforting Techniques: Use hugs, holding hands, and providing treats.

Lifespan Considerations - Adolescents

  • Interaction Approach: Treat adolescents as adults; engagement may sometimes be rejected.

  • Discomfort in Adults: Importance of listening carefully and providing comfort through knowledge about conditions, tests, treatments, and addressing inquiries.

Lifespan Considerations - Pregnant Women

  • Anxiety: Particularly prevalent among first-time mothers.

  • Education: Take time to explain expectations and care guidelines.

  • Recommendations: Self-care tips on physical activity, nutritional advice, and sleep hygiene.

Lifespan Considerations - Older Adults

  • Chronic Conditions: More probable in seniors requiring regular appointments.

  • Communication: Clear explanations and written instructions for procedures and medications at every visit.

  • Mobility Support: Assistance required for comfort during movement.

Lifespan Considerations - End of Life

  • Pain Management: Ensure adequate pharmacologic pain relief.

  • Emotional and Spiritual Care: Facilitate visits from spiritual leaders or family.

  • Support Services: Refer family to grief counseling and respect decisions regarding end-of-life care.