Jose Antonio Castro III
Laoag City, Ilocos Norte
“Nurses dispense comfort, compassion, and caring without even a prescription.” ~ Val Saintsbury
Public Health Nurses
nurse the communities where they work. In a given day that might include
attending to the needs of a specific individual, but we must be
prepared for any possibility. A case of Hepatitis A, a new arrival to
the country, a child needing immunizations for school, an elder who
needs her blood pressure checked on a regular basis, communicable
disease surveillance, TB case management, or emergency preparedness
planning could be part of my daily assignment. Each individual situation
requires its own level of expertise. Some patients require care for an
indefinite period of time while others will return to their homes, their
care complete after the visit. The public health nurse work assignment
is anything but routine. On the month of June,
one prenatal check-up day in our rural health clinic, I met this mother
who is walking slowly in our door step. Initially, I observe her
posture and figuring out why she is moving that slow. She talks in a
discreet voice like murmuring and often catches her breath. When I was
taking her personal data and patient’s history, I observed that she’s
having a generalized edema, from her feet were obviously swollen,
pitting peripheral edema, up to her neck. She mentioned that she was
just come out from her hospitalization a day before her
clinic visit. She was hospitalized due to her hypertension and her
blood pressure when she was admitted was 200/130, and she feels like
drowning and she can’t even feel her legs. As I go on with my interview,
I knew that she is on her 8 month of pregnancy and I also asked about
her activities prior to her hospitalization. She said that washed their
laundry and after that she swept their living room floor while
babysitting her 5 year old son. Then she suddenly felt that she is
catching her breaths and became cold as the ice. When I got her blood
pressure, it was 170/100, we were alarmed that she might
have another hypertensive attack, but she was just laughing and said
that it was normal to her, her discharged blood pressure was ranging for
150-170 over 90-110. We asked her if she’s taking her maintenance
medicines given by her doctor and she affirmed. We only advised her not
to stress herself and avoid doing strenuous works at home and when she
is resting, she will elevate her feet to reduce her edema on her feet.
We agreed that I will be the one to monitor her blood pressure every
morning before and after her due date and if she will lower down her
blood pressure she will have a normal spontaneous delivery instead of
caesarean section.Every morning, I go
to their house to monitor her blood pressure, her blood pressure ranges
still the same as I got in the clinic. I verified her if she is taking
up her medicines, if she is following our advice not to stress herself
and avoiding strenuous works, elevate her feet when resting and she all
affirmed. I eagerly searched the same cases in the internet, and I read
some articles that relaxation technique and providing all comfort
measures will help lower down high blood pressures. So on the next
morning I begun implementing relaxation techniques and comfort measures
such as playing a instrumental music while she is resting, asking her 5
year old son to sing a song for her and I asked her what else that can
make her relax and feel comfortable and she said she loves to draw. So I
provided her a sketch notebook the following morning where she can draw
anything she wants to draw. Then miraculously, from 170/100, I achieved
her lowest blood pressure of 110/70. From that day her blood pressure
only ranges from 110-130 over 70-90. And her expected due date is on
July 6, 2012. I am hoping that her blood pressure will remain that low until her due date.
Being a nurse is a very special calling, a service characterized by a
trusting and caring relationship which cannot be measured in monetary
terms. Providing nursing care to a sick or well person is not a career
like accountancy or engineering, it is a vocation more like priesthood.
Our relationship to our patients is not a contract. Rather a covenant. A
trusted caring service between us nurses who offers help and a
dependent patient who needs and receives it. Our patients trusts us that
we will be their advocate and will always have their best interest as
our priority. Embodied in this trust are mutual honesty, openness and
understanding, and information that are freely exchange d. We, nurses
and our patients should have a sense of oneness, fulfillment and growth,
assisting each other and at the same time recognizing each other’s
importance, uniqueness, complexity feelings and needs. Each one of us
helps one another and finds a voice that will be heard so that both may
be enriched.
From this experience, I learned that giving relaxation techniques and
providing the best comfort a person can ever feel will lead to a
positive result. I am not saying that these techniques are applicable to
all people but it is worth trying if there situations like this that is
impossible to achieve. I only knew last Saturday, when we were having a
Yahoo Messenger Conferencing about our topic for our blog that these
techniques are also included in Katherine Kolcaba’s Comfort Theory.
Angelita de Torres
Metro Manila, Philippines
Katharine Kalcoba's theory of Comfort is applicable to orthopedic patients because it involves pain management before surgery, after surgery and during rehabilitation. It is about providing a positive or caring attitude towards patient, attending to their immediate need like when patient is in pain. A simple gesture that tells the patient that "I am here for you, not only to provide medical attention but to care for you until you are well physically, emotionally and spiritually” is one example of how to use this theory. This theory is also applicable to cancer patients whose undergoing emotional turmoil related to their medical condition. They go to hospital for treatment, and sometimes just need someone to talk to verbalize their feelings. Sometimes, when patients shout at us, we as nurses should understand that maybe, just maybe the patient is not really mad at us. It's just her way of expressing her anger and frustrations about their medical condition. They go to hospital for treatment, and sometimes just need someone to talk to verbalize their feelings. Sometimes, when patients shout at us, we as nurses should understand that maybe, just maybe the patient is not really mad at us. It's just her way of expressing her anger and frustrations about their medical condition.
Odette de GuiaNorthern Samar, Philippines
I find Katherine Kolcaba's comfort theory of nursing very helpful in all aspects of nursing. First of all, a quality assessment of patient's needs and problems is very important to be able to formulate intelligent interventions for the welfare of the patient. Meeting the needs of the patient will provide tremendous comfort. Even by just holding their hands and being around to listen to their stories will give them relief from stress. Your presence alone can be of great help to them.
Like for example in my experience here in Kuwait, where most of our patients belong to above average or rich people. They will rush to hospital even for simple pain. They will beg for you to stay with them and never leave them alone. Every time I encounter this kind of patient, I will hug or hold their hands while listening or encouraging them to verbalize their concerns. (Female patients for female Nurses). Eventually, a feeling of relief met even without the Doctor's intervention. The power of touch, the power of listening gives them comfort.
Most of our patients here will come in pain, screaming for help. Being a nurse you're around to offer help by encouraging them to verbalize their problems and not to shout back at them. I always keep myself cool, remain calm and will offer my time to help them. Before they will go out from that room, they will always say, " thank you very much, Im sorry if I behaved like that, if I hurt y ou it’s just that I'm in pain and afraid to die".
They are very thankful and I saw them leaving the door with a smile on their lips. For me, it is an accomplishment, a fulfillment that you make someone happy, and that it test my patience and confidence to give quality nursing care. After all, it’s what nursing is all about. Quality Nursing Care.
Ray Carl CustodioBulacan, Philippines
Nursing Process as a deliberate way of thinking by a nurse using an organized, systematic framework of interrelated activities that is scientific problem-solving approach towards individualized dynamic and continuous interpersonal care for the client’s ever changing responses and needs. Comfort implies a renewal, an amplification of power or sense of control , an invigorating influence, a positive mind-set, and a readiness for action (Kozier, 2004). Kalcoba (1991) cited four phases of nursing process in the theory of Comfort namely Assessment of discomfort, Plan of comfort measure, Intervening the need of comfort and reassessment of comfort level and implementing the action. And described 4 contexts in which patient comfort can occur: physical, psychospiritual, environmental, and sociocultural that shows the diversity and complexity of the theory, which we will be the focus of comfort measures.
Liezel CatubayAbu dhabi, UAE
Vaccination is one of the roles of an ambulatory health nurse. In my 3 years of experience working abroad, I observed that fear of needles is common to everyone regardless of their nationality, race, age and gender. Just the idea of pain, a nurse holding a syringe gives them the uncomfortable feeling but despite of the fear, others can tolerate it well. To some, it’s debilitating to the extent of having emotional stress, panic attacks and most common scenario in the clinic, fainting.
As public health nurse showing caring and compassion is needed. In order to manage this kind of situation, I realized that I am utilizing the theory of comfort. I encouraged clients to verbalize concerns and listen to them intently. Allowing them to express emotions and providing all the information that they need made them feel better. I give them options like holding hands with a significant other, listening to music, deep breathing, and to select desired position according to what will give them the best comfort. Calm them through kind words or funny stories to distract them from their anxiety.
A fall risk brought about by the incidence of fainting is also properly intervened using the theory. An unaided fall may result to a head injury that may arise from a simple vaccination. Through provision of comfort, the client is protected from possible harm.
Apparently, these are small simple acts but a sure way to change the vaccination experience of every client. Some will say, “Thank you very much; I didn’t feel any pain you have a good hand”. Another client once said, “Oh, it was the first time I didn’t pass out, I usually do after an injection. The fear, pain and stress were mask by the measures that we nurses provide and initiates.
Metro Manila, Philippines
Odette de GuiaNorthern Samar, Philippines
I find Katherine Kolcaba's comfort theory of nursing very helpful in all aspects of nursing. First of all, a quality assessment of patient's needs and problems is very important to be able to formulate intelligent interventions for the welfare of the patient. Meeting the needs of the patient will provide tremendous comfort. Even by just holding their hands and being around to listen to their stories will give them relief from stress. Your presence alone can be of great help to them.Like for example in my experience here in Kuwait, where most of our patients belong to above average or rich people. They will rush to hospital even for simple pain. They will beg for you to stay with them and never leave them alone. Every time I encounter this kind of patient, I will hug or hold their hands while listening or encouraging them to verbalize their concerns. (Female patients for female Nurses). Eventually, a feeling of relief met even without the Doctor's intervention. The power of touch, the power of listening gives them comfort.
Most of our patients here will come in pain, screaming for help. Being a nurse you're around to offer help by encouraging them to verbalize their problems and not to shout back at them. I always keep myself cool, remain calm and will offer my time to help them. Before they will go out from that room, they will always say, " thank you very much, Im sorry if I behaved like that, if I hurt y ou it’s just that I'm in pain and afraid to die".
They are very thankful and I saw them leaving the door with a smile on their lips. For me, it is an accomplishment, a fulfillment that you make someone happy, and that it test my patience and confidence to give quality nursing care. After all, it’s what nursing is all about. Quality Nursing Care.Ray Carl CustodioBulacan, Philippines
Nursing Process as a deliberate way of thinking by a nurse using an organized, systematic framework of interrelated activities that is scientific problem-solving approach towards individualized dynamic and continuous interpersonal care for the client’s ever changing responses and needs. Comfort implies a renewal, an amplification of power or sense of control , an invigorating influence, a positive mind-set, and a readiness for action (Kozier, 2004). Kalcoba (1991) cited four phases of nursing process in the theory of Comfort namely Assessment of discomfort, Plan of comfort measure, Intervening the need of comfort and reassessment of comfort level and implementing the action. And described 4 contexts in which patient comfort can occur: physical, psychospiritual, environmental, and sociocultural that shows the diversity and complexity of the theory, which we will be the focus of comfort measures.
Nursing Process | Application to Comfort Theory |
Assessment
- assessing the patient's comfort needs
- objective- observation of wound healing
- subjective- asking the patient if he or she is comfortable
|
Physical-
Comfort needs real to bodily sensations and the physiologic problems associated with medical diagnosis and condition.
Psychospiritual-
Comfort needs relate to the internal awareness of self, including esteem, concept, sexuality, and meaning in one’s life. They can also include the person’s relationship to a higher or being.
Social-
Comforts needs relate to interpersonal, family and social relationships.
Environmental-
Comfort needs relate to the external background of human experience and can include light, noise, ambience, color, temperature, and natural versus synthetic elements. They may also include culturally specific food and language.
(Kozier, 2004)
|
Planning
- developing a design of comfort measures
| Depending on the area and degree of discomfort will are goals to be achieved. Specific comfort needs of a patient are met as Kalcoba implied, for example, the relief of postoperative pain by administering prescribed analgesia, the individual experiences comfort in the relief sense. If the patient is in a comfortable state of contentment, the person experiences comfort in the ease sense, for example, how one might feel after having issues that are causing anxiety addressed. Lastly, transcendence is described as the state of comfort in which patients are able to rise above their challenges. |
Intervention
- implementing appropriatenursing care plans and addressing those needs
| Comforting actions or measures is providing of either or both direct or indirect interventions to address the discomfort. Indirectly by maintaining the environment suitable for resting, coordinating with other health personnel’s with regards to the activities and supporting the significant others. Those measures are initiated when the nurse perceives that the client is distress or comforting needs is necessary. While on direct comforting is a simple physical action such as holding their hands open cannula insertion, providing warm blanket or applying lotion on dry skin. However knowledge and skills are necessary to perform other comforting measures like, infection, airway clearance, managing pain etc. The measures encompass the clients psychospiritual by talking in soothing manner, acknowledging and accepting their feelings; Socially by encouraging the family and friends to visit regularly and Environmentally by allowing ample light and ventilation. |
Evaluation
- evaluating the patient's comfort after the care plans have been carried out
- reassessment of comfort levels after implementation
| As planned, the discomfort to have ease, relief or transcendence will be our client’s response. We will able to a identify it as objective by observation or subjective as the patient experience the comfort. |
Liezel CatubayAbu dhabi, UAE
Vaccination is one of the roles of an ambulatory health nurse. In my 3 years of experience working abroad, I observed that fear of needles is common to everyone regardless of their nationality, race, age and gender. Just the idea of pain, a nurse holding a syringe gives them the uncomfortable feeling but despite of the fear, others can tolerate it well. To some, it’s debilitating to the extent of having emotional stress, panic attacks and most common scenario in the clinic, fainting.
As public health nurse showing caring and compassion is needed. In order to manage this kind of situation, I realized that I am utilizing the theory of comfort. I encouraged clients to verbalize concerns and listen to them intently. Allowing them to express emotions and providing all the information that they need made them feel better. I give them options like holding hands with a significant other, listening to music, deep breathing, and to select desired position according to what will give them the best comfort. Calm them through kind words or funny stories to distract them from their anxiety.
A fall risk brought about by the incidence of fainting is also properly intervened using the theory. An unaided fall may result to a head injury that may arise from a simple vaccination. Through provision of comfort, the client is protected from possible harm.Apparently, these are small simple acts but a sure way to change the vaccination experience of every client. Some will say, “Thank you very much; I didn’t feel any pain you have a good hand”. Another client once said, “Oh, it was the first time I didn’t pass out, I usually do after an injection. The fear, pain and stress were mask by the measures that we nurses provide and initiates.
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