Tuesday, July 06, 2010

Comfort Care in Various Healthcare Disciplines

Kolcaba’s comfort theory is not relevant only in the nursing field, but also engages the other healthcare disciplines. When providers of health care are driven to the same goal of making comfort available, the needs of the patient is adequately met. Furthermore, improvements in health seeking behaviors as well as institutional integrity is experienced. The following case sample illustrates comfort care continuity across the various healthcare fields.

Mr. S. is a 45-year-old Canadian man who has just been admitted to the ICU postoperative cardiac surgery. He has had an uneventful coronary artery bypass graft with no complications in the operating room. He is intubated and placed on complete mechanical ventilation. His vital signs are: blood pressure (BP) 150/90 mm Hg, heart rate 86 beats per minute, respiratory rate 12 breaths per minute, and temperature 35.3[degrees]C.

The surgeon caring for Mr. S. is familiar with Kolcaba's comfort theory and structures the orders accordingly. The target systolic BP for Mr. S. is less than 130 mm Hg and the surgeon's postoperative orders include BP medications and intravenous morphine sulfate for pain. In addition, the surgeon prescribes an nonsteroidal anti-inflammatory drug, ketorolac, to be administered to the patient once it has been determined that they are not bleeding excessively and have acceptable renal function. This close attention to treatment of pain represents a comfort intervention instituted by the surgeon that not only addresses a particular healthcare need of the patient but also recognizes the importance the surgeon has placed on of the relief form of comfort. There is a standing order in place for warming patients postoperative coronary artery bypass graft.

The ICU where Mr. S. is admitted has a respiratory therapist (RT) on staff. This RT is aware that mechanical ventilation is very uncomfortable for patients. There is a standing order in the ICU that heart surgery patients may be weaned from the ventilator as tolerated and extubated when stable. Using Kolcaba's theory, the RT decides to wean and extubate Mr S. as soon as possible postoperatively.

The nurse caring for Mr S. also structures patient care using Kolcaba's theory. When Mr S. is beginning to arouse from the anesthesia, he is grimacing and his BP is rising above the target level. Had the nurse not been familiar with comfort theory, she may have chosen to simply treat Mr. S.'s BP with medications designed to target only BP. Because this nurse is accustomed to assessing comfort needs, she recognizes that this patient response is suggestive of increasing pain and administers morphine sulfate as ordered. In addition, Mr. S. is given a warming blanket to increase his body temperature. Both of these interventions represent the nurse helping Mr. S. to achieve comfort in the relief sense.

The next morning, Mr. S. is seen by the ICU physiotherapist, who has also been educated in comfort theory. When assessing Mr. S.'s comfort needs, the physiotherapist recognizes that he is anxious about moving and exercising so soon after surgery. With this in mind, the physiotherapist carefully explains her plan of care to Mr. S. in a calm and unhurried manner. This allows Mr. S. to relax, what Kolcaba has referred to as the ease sense of comfort. He becomes willing and able to work with the physiotherapist in his postoperative exercise routine, thus exhibiting what Kolcaba refers to as health-seeking behaviors, or comfort in the transcendence sense.

The healthcare team worked collaboratively to enhance the patient's comfort during the immediate postoperative period. This, in turn, led to Mr. S. having a successful recovery period with no significant complications.

Because this hospital follows Kolcaba's comfort theory when caring for all of their patients, institutional integrity is enhanced by an overall increase in positive patient outcomes, a decreased hospital length of stay, and continued community hospital support.

March, A., & McCormack, D., (April 2009). Nursing theory-directed healthcare: Modifying kolcaba's comfort theory as an institution-wide approach. Holistic Nursing Practice. 23(2). Retrieved from http://www.nursingcenter.com/prodev/ce_article.asp?tid=851431
Kolcaba, K. (2010, March 4). Conceptual framework for comfort theory. Retrieved from http://www.thecomfortline.com/index.html
Kolcaba, K. (2010, May 17). Types and contexts of comfort. Retrieved from http://www.thecomfortline.com/FAQ.html#types and contexts
Kolcaba, K. (2010, May 17). Definitions, propositions and assumptions for theory. Retrieved from http://www.thecomfortline.com/FAQ.html#definitions


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