Thursday, July 15, 2010
Far Beyond the Titles
by Diana Marie B. Mendez, RN
Dubai, United Arab Emirates
Nursing is truly a noble profession. Some say it is a job mainly for females probably because the characteristics demanded by the profession are mostly of a girl’s attitude – caring, passionate, thoughtful, gentle, comforting, etc. This is, of course, not so true today as we know a lot of emerging, well-qualified nurse-achievers belonging to Adam’s race. A big hurray for our country as some of the well-known Nursing Board Reviewers and authors are males – Carl Balita, Ray Gapuz, and a lot more. Probably, some of those will come from our batch in UPOU (Yipee!). It is more than the compensation that this occupation pays us for. It is grander than the cleanest, wrinkle-free, immaculate white uniform (or scrubs!) we give justice when we’re in front of the patients and families as we render health education and reinforcements-to convince them to quit smoking and drinking alcohol. It is far beyond the titles RN, NCLEX-RN, MSN, MAN, etc. This entails a great amount of sacrifice and selfless dedication, I believe.
We have been educated and equipped with the finest nursing curriculum. We have been selected and passed the requirements and qualifications of being responsible and safe health care team members. We strive to achieve more than the learning we acquired on our baccalaureate degree, and ponder higher knowledge through continuing education. We serve as the patient advocates. We speak on their behalf. We stand as the patient complements as we were dictated to function according to the patients’ disabilities and what their conditions call for. We desire healing, recovery, health, and comfort for them. We feed them while we, ourselves are NPO (seemingly unnoticed until we’re so starving). We assist them to toilet while we don’t have bathroom privileges (BRPs) during the entire busy 8 or 12-hour shift. We put on them TED stockings or pneumatic compressor devices to prevent DVTs, but we have developed incompetent, spider-like veins on our popliteal sites. We console the relatives when they’re grieving, while we actually lose some important people in our lives on one time or another. We will treat the patients like our own family and give them care that we wish for our loved ones, but it is saddening that some of them will treat us as no more than a servant.
On the same way, we feel inspired when they appreciate our efforts. We rejoice during their littlest achievements on attaining their physiologic needs. We are pleased when they can tolerate CPAP mode after being shifted from Assist-Control during weaning, or when they have been started with sips of water and tolerated it after removal of NGTs, or observe that the operative site is healing nicely without any signs of dehiscence or post-op infections or complications, or when they don’t develop hematoma, active bleeding, neither ecchymosis during and after arterial sheath removal, more if they verbalize that they are comfortable, or that we have comforted them well.
Comfort, a single seven-letter word which denotes a positive outcome of care, is a state of being stress-free, and/or relief from stress or anxieties from the physical, psychospiritual, sociocultural and environmental burdens. It is indeed one of our keys goals on patient care and an indicator of a safe, holistic, and well-structured nursing care. On this light, this blog waves a big recognition of the Comfort Theory, developed by Dr. Katharine Kolcaba, which doesn’t focus mainly on patient comfort but also involves the comfort of the health care providers, including nurses, to achieve institutional objectives like lower costs, improved family and nurses’ satisfaction, early discharge, and low readmission rates (Kolcaba, 2001). With this, may we all find comfort in our profession and on the institution where we are working, so it may reflect on our excellent service and nursing care for the benefit of our patients.
Cheers!!!
Thursday, July 15, 2010
Thursday, July 15, 2010
On Death and Comfort
by Edezer A. Carias, RN
Makati City, Philippines
Did you ever feel pain? If yes, were you able to attend your class or go to work?
Pain is an example of a discomfort that one can experience and may be a barrier in the assumption of one’s tasks and responsibilities. A person cannot fully perform his activities of daily living without being comfortable. Comfort in its broadest sense is a personal experience of being free from any emotional and physical pain. It can also be defined as a state of serenity.
Comfort is universal and it is innate in nursing. This is why Dr. Katharine Kolcaba came up with her Comfort Theory in Nursing. This theory of Dr. Kolcaba is operationalized in nursing practice when nurses continuously engage themselves in providing comforting interventions for their patients. As nurses we give the most comfortable experience for our patients so they will be able to participate in the activities necessary in meeting our nursing goals.
Most of us have had his or her own share of experience applying Dr. Kolcaba’s theory. I’d like to share mine.
Some few years back, when I was working for a small hospital in the province, I was assigned to a 59- year old woman who had Stage IV ovarian cancer. The cancer had already metastasized to her liver since she did not seek any medical treatment when the cancer was in its earlier stage. Her family decided not to let her undergo chemotherapy anymore due to scarcity of funds. As most patients with progressing tumor, she constantly complains of abdominal pain and so goes my comfort measures such as staying with her, encouraging her to verbalize the pain experience, providing massage and back rubs, positioning, diversional activities, adjusting the environment to a comfortable level, administering her pain medications, etc. Every time I am with her trying to relieve the discomfort she is experiencing, I would see in her face the effort to smile at me and say “thank you”. I could sense that somehow my presence is already comforting to her. After a few weeks, she passed away. I felt sad because she was our patient for almost a month and I’ve already established a good nurse-patient relationship with her. I saw how her family grieved and I felt that they also need to be comforted. Losing someone you love is really painful and so goes my comfort measures for the bereaved family. I stayed with them and listened to their concerns after giving my post mortem care. I also gave a back rub to one of her daughter who was crying.
Indeed, providing comfort is essential in our practice. Every patient deserves to experience comfort—for someone who is in pain, someone who is afraid, for someone who is dying, even for someone who experiences loss of a loved one. After all, comfort is linked to caring which characterizes the nursing profession.
Now, when was the last time you made someone comfortable?
Thursday, July 15, 2010
by Jane Ivah M. Perez, RN
Caloocan City, Philippines
The application of Comfort Theory in pediatric practice is to strengthen and satisfy pediatric patients, families, nurses as well as the institutions where a culture of comfort is valued. The term comfort covers a wide array of factors which should be considered especially in children. Adaptation is a key factor to which a nurse may be successful in providing physical, socio-cultural, and environmental comfort to a child. It plays a vital role in providing the most appropriate comfort measure to a child, to which care is directed as a personal and intimate approach.
A pediatric nurse now becomes a sensitive instrument to which a child relies on. And being a pediatric nurse, facilitating a supportive and reassuring environment is an input factor in a child’s speedy recovery. I am in a specialized institution that caters pediatric patients who undergo cardiac open and closed surgeries. Children of other ages may already be aware of their present situation especially those who are confined at the Intensive Care Units. Children whose age group are able to express themselves are most likely to ask, “What will happen to me?” and “Will the pain go away?” or similar questions in that context. The approach to which these questions are responded should cover the factors indicated in the comfort theory. Several needs should be considered such as, the physical need in which we take hold on the homeostasis mechanism to which the child is at most comfort. To gratify this need, I as a pediatric nurse recognize physical needs such as pain, itching, vomiting, and others, in which I can relieve the patient’s present condition and re-capture a sense of comfortable state for the child.
Coaching a child on the other hand covers another ground of need which is the sociocultural need. Pediatric ICU patients are more prone to this context due to the limited social interaction of a patient towards his or her family members, relatives and other patients. This is due to the nature and condition to which the child is presently ill, resulting to a low moral and support from his or her group. As a pediatric nurse, I develop that sense of companionship and nearness for the patient so that I could establish trust-based relationship and as well a renewed confidence and morale boost from the interaction that was made. I also apply the sense encouragement and assurance to help in the speedy recovery and a smooth transition from recovering in an ICU set-up towards a new environment in the ward.
The environmental need is also considered an important factor in promoting pediatrics comfort. I always ensure comfortable bed, quiet and calm environment, appropriate lightning and promotion of safety. With this I also believe it helps a lot in the early improvement of a post operative patient.
Assessing comfort as a positive and holistic outcome will contribute in a positive approach to care. This includes comfort theory and its emphasis on the physical, psychospiritual, sociocultural and environmental aspects a need of every pediatric patient.
Makati City, Philippines
Did you ever feel pain? If yes, were you able to attend your class or go to work?
Pain is an example of a discomfort that one can experience and may be a barrier in the assumption of one’s tasks and responsibilities. A person cannot fully perform his activities of daily living without being comfortable. Comfort in its broadest sense is a personal experience of being free from any emotional and physical pain. It can also be defined as a state of serenity.
Comfort is universal and it is innate in nursing. This is why Dr. Katharine Kolcaba came up with her Comfort Theory in Nursing. This theory of Dr. Kolcaba is operationalized in nursing practice when nurses continuously engage themselves in providing comforting interventions for their patients. As nurses we give the most comfortable experience for our patients so they will be able to participate in the activities necessary in meeting our nursing goals.
Most of us have had his or her own share of experience applying Dr. Kolcaba’s theory. I’d like to share mine.
Some few years back, when I was working for a small hospital in the province, I was assigned to a 59- year old woman who had Stage IV ovarian cancer. The cancer had already metastasized to her liver since she did not seek any medical treatment when the cancer was in its earlier stage. Her family decided not to let her undergo chemotherapy anymore due to scarcity of funds. As most patients with progressing tumor, she constantly complains of abdominal pain and so goes my comfort measures such as staying with her, encouraging her to verbalize the pain experience, providing massage and back rubs, positioning, diversional activities, adjusting the environment to a comfortable level, administering her pain medications, etc. Every time I am with her trying to relieve the discomfort she is experiencing, I would see in her face the effort to smile at me and say “thank you”. I could sense that somehow my presence is already comforting to her. After a few weeks, she passed away. I felt sad because she was our patient for almost a month and I’ve already established a good nurse-patient relationship with her. I saw how her family grieved and I felt that they also need to be comforted. Losing someone you love is really painful and so goes my comfort measures for the bereaved family. I stayed with them and listened to their concerns after giving my post mortem care. I also gave a back rub to one of her daughter who was crying.
Indeed, providing comfort is essential in our practice. Every patient deserves to experience comfort—for someone who is in pain, someone who is afraid, for someone who is dying, even for someone who experiences loss of a loved one. After all, comfort is linked to caring which characterizes the nursing profession.
Now, when was the last time you made someone comfortable?
Thursday, July 15, 2010
Gratifying Pediatrics Comfort
by Jane Ivah M. Perez, RN
Caloocan City, Philippines
The application of Comfort Theory in pediatric practice is to strengthen and satisfy pediatric patients, families, nurses as well as the institutions where a culture of comfort is valued. The term comfort covers a wide array of factors which should be considered especially in children. Adaptation is a key factor to which a nurse may be successful in providing physical, socio-cultural, and environmental comfort to a child. It plays a vital role in providing the most appropriate comfort measure to a child, to which care is directed as a personal and intimate approach.
A pediatric nurse now becomes a sensitive instrument to which a child relies on. And being a pediatric nurse, facilitating a supportive and reassuring environment is an input factor in a child’s speedy recovery. I am in a specialized institution that caters pediatric patients who undergo cardiac open and closed surgeries. Children of other ages may already be aware of their present situation especially those who are confined at the Intensive Care Units. Children whose age group are able to express themselves are most likely to ask, “What will happen to me?” and “Will the pain go away?” or similar questions in that context. The approach to which these questions are responded should cover the factors indicated in the comfort theory. Several needs should be considered such as, the physical need in which we take hold on the homeostasis mechanism to which the child is at most comfort. To gratify this need, I as a pediatric nurse recognize physical needs such as pain, itching, vomiting, and others, in which I can relieve the patient’s present condition and re-capture a sense of comfortable state for the child.
Coaching a child on the other hand covers another ground of need which is the sociocultural need. Pediatric ICU patients are more prone to this context due to the limited social interaction of a patient towards his or her family members, relatives and other patients. This is due to the nature and condition to which the child is presently ill, resulting to a low moral and support from his or her group. As a pediatric nurse, I develop that sense of companionship and nearness for the patient so that I could establish trust-based relationship and as well a renewed confidence and morale boost from the interaction that was made. I also apply the sense encouragement and assurance to help in the speedy recovery and a smooth transition from recovering in an ICU set-up towards a new environment in the ward.
The environmental need is also considered an important factor in promoting pediatrics comfort. I always ensure comfortable bed, quiet and calm environment, appropriate lightning and promotion of safety. With this I also believe it helps a lot in the early improvement of a post operative patient.
Assessing comfort as a positive and holistic outcome will contribute in a positive approach to care. This includes comfort theory and its emphasis on the physical, psychospiritual, sociocultural and environmental aspects a need of every pediatric patient.
Thursday, July 15, 2010
"Cure Sometimes, Treat Often, Comfort Always"
by Alexis Ray B. Janolino, RN
San Pablo, Laguna, Philippines
"Cure sometimes, treat often, comfort always,"
- A quotation stated by Hippocrates, which is applicable to the experience I had when I was a volunteer nurse at a District Hospital in our province.
I was on clinical duty in the Emergency Room, and then suddenly, a patient escorted by the policemen was in need of medical attention. He was sent to the hospital because he was having projectile hematemesis due to esophageal varices. Tuberculosis was also confirmed. No one wanted to attend his needs because the vomitus was all over the place, he was having an infectious disease and he had a poor hygiene. Honestly, I was also reluctant to give care as well, because of his condition and during that time I had just started as a Volunteer Nurse. But because of the eagerness to learn and seek for experiences, I did it.
“Start IV line!”, “Administer oxygen via nasal cannula!” those were some of the orders coming from the ER doctor who seemed not wanting to get near the needing patient. It made me realized in the first place this is the oath I took for this career. And basically, the man was not just needing for cure...he was also needing comfort...from the health care providers, especially from a nurse like me. I attended him ensuring that he was having the comfort even though he was handcuffed and accompanied the police. I tried making a follow up to check for his condition, but apparently, he died on the next day.
This is the story that constantly reminds me the difference between the cure and comfort, the significance its especially in health status of our country, which comfort is something that anybody can give but nurses must do as part of our care.
Wednesday, July 15, 2010
A Fulfilled Vocationby Adrian G. Domingo, RN
Valenzuela City, Philippines
Being a nurse is a 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 architecture, 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 exchanged. 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 find a voice that will be heard so that both may be enriched.
We all know that our primary role is to utilize the nursing process in every event of our lives. I worked in the hospital for more than a year and I started as a volunteer then subsequently hired as a regular staff nurse. I am thinking all night how was I able to apply the comfort care theory of Dr. Katharine Kolcaba. Until one morning before I go to work, I saw my neighbor asking me for medications and treatment of her burn. She accidentally poured her coffee over her arms.
I am the morning duty nurse when the ER nurse Oliver called the Medical ward to inform us that there is an admission. The case: 3rd degree burn 60% BSA. As I see the patient, I can see it in his eyes that he is really in severe and excruciating pain. He came in restless accompanied by his relative. Emergency measures are done. Intravenous therapy is started to correct any electrolyte imbalance. Many medications are ordered both oral and IV antibiotics and pain relievers. As I see him, as if I am also feeling the pain. He screams and really wants to cry. I hope I can do something at that point in time to ease the pain and to lessen the burden.
Valenzuela City, Philippines
Being a nurse is a 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 architecture, 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 exchanged. 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 find a voice that will be heard so that both may be enriched.
We all know that our primary role is to utilize the nursing process in every event of our lives. I worked in the hospital for more than a year and I started as a volunteer then subsequently hired as a regular staff nurse. I am thinking all night how was I able to apply the comfort care theory of Dr. Katharine Kolcaba. Until one morning before I go to work, I saw my neighbor asking me for medications and treatment of her burn. She accidentally poured her coffee over her arms.
I am the morning duty nurse when the ER nurse Oliver called the Medical ward to inform us that there is an admission. The case: 3rd degree burn 60% BSA. As I see the patient, I can see it in his eyes that he is really in severe and excruciating pain. He came in restless accompanied by his relative. Emergency measures are done. Intravenous therapy is started to correct any electrolyte imbalance. Many medications are ordered both oral and IV antibiotics and pain relievers. As I see him, as if I am also feeling the pain. He screams and really wants to cry. I hope I can do something at that point in time to ease the pain and to lessen the burden.
“Nurse AD, I can’t sleep at night. The pain worsens at night and it really pisses me off”
“I think your air conditioning unit doesn’t work well”
“I hope this suffering will end”
“Why me?”
“I can’t even imagine how I look with these scars as a result of this accident”
“I think your air conditioning unit doesn’t work well”
“I hope this suffering will end”
“Why me?”
“I can’t even imagine how I look with these scars as a result of this accident”
My patient is a fire dancer and one night during his performance, he accidentally slipped the fire to his body and caused him to be brought in the hospital because the damage is severe.
I formulated nursing diagnoses for my patient:
Altered comfortMy primary goal as a nurse is to relieve and control the pain, provision of non-pharmacological methods to provide comfort and relief. Use of relaxation and diversional activities are also done. By doing these things, my patient would really feel comfortable in a way. My patient is hopeless asking me why him. I explained to him thoroughly the reasons why at certain point of our lives unexpected things really happen. That is because of a reason. Maybe you can not appreciate that reason now because as you go along, your questions will be answered. I told him the importance of praying and believing in God. Another complain is the scars on his body after the accident. I invited some of his friends and relatives to see him and be the one to appreciate the beauty of life after a bad incident. Though he is isolated because of the high risk for infection, I make sure that all the time my patient has someone to talk to. The most important thing is the patient is alive and the people won’t see anything wrong with those scars because it is due to an accident and nobody wants to be involved in an accident. Am I correct? As days go by, my patient becomes irritable and complains everything that he can see around his room. The air conditioning unit, the doors, the curtains and everything. I understand that since my patient has a heavy burden, I always try to build good rapport and to be of help all the time. In connection with the theory of Florence Nightingale and Katharine Kolcaba I manipulated the environment and fixed everything in my patient’s room. I think this will really help. I stretched the bed linens, regulated the temperature of the room and tried to make the room light.
High risk for fluid volume deficit
Acute pain
High risk for infection
Risk for imbalanced nutrition, less than body requirement
My patient stayed in the hospital for more than a week. We had a good nurse-patient relationship. The care is continuous up to discharge. During the discharge of my patient, I can observe that he is more energetic and at ease. I really felt fulfilled and overwhelmed my caring heart and helping hand really made a difference.
As of the moment, I am now working as a clinical instructor and a lecturer in a nursing school. I always make sure that I am teaching the right moves to my students. Even though I am not the one who personally cares to the patients we handle in the area, I try to let my students feel the essence of being a nurse. I teach them make people comfortable psychospiritually, socially, environmentally and physically.
Wednesday, July 14, 2010
A Nurse's Notes on Comfort
by Aileta Gail E. Estalilla, RN
Taguig City, Philippines
I had once a 13-year old patient way back in college who was in a lot of discomfort. He was diagnosed of Complete Spinal Cord Compression (SCC), T8 level secondary to Pott’s Disease with multiple sacral and gluteal ulcers grade 4. I first encountered him during a minor operation for wound debridement where I assisted and then I was assigned to be his nurse during our rotation in the orthopedic ward.
Assessment:
He was immobilized because of the paraplegia, with decubitus ulcers on the sacral, trochanter, knee and heel areas, and with colostomy to colostomy bag and indwelling catheter to urobag. He had dry skin, ecchymosis on pressure points and skin redness on anterior hip and thigh areas. He had high WBC in blood and urine, with recurrent fever and a positive culture for pseudomonas aeruginosa. His motor strength was 5/5 on both upper extremities and 0/5 on both lower extremities (with no movement and muscle wasting, increased on the left). There was negative sensation below the T8 level. He also had kyphos, and bilateral hanging hip.
Assessment shows that my patient was not in pain because of loss of sensation below the T8 level but the discomfort was great. He could not lie on his back. He was experiencing recurrent fever. He could only move his upper extremities and lift his torso. He was also isolated because of the nature of his illness. He had no one to talk to since his father was busy looking for money for his hospital expenses. The room was also starting to really smell bad and the room temperature was hot with only the electric fan providing the ventilation.
Planning:
Reflecting back on my goals and objectives for care, it was pretty much routine: aim for wound healing and preventing further exacerbation/complication, resolution of infection stable vital signs etc… If applying Kolcaba’s Theory of Comfort, these can all be included but in a more organized way where the core is to see to the comfort of the patient first and foremost: patient will achieve physical, psychospiritual, sociocultural and environmental relief/comfort. Interventions will focus on these four contexts.
Comfort Interventions:
To include but not limited to:
Physical:
Assessment shows that my patient was not in pain because of loss of sensation below the T8 level but the discomfort was great. He could not lie on his back. He was experiencing recurrent fever. He could only move his upper extremities and lift his torso. He was also isolated because of the nature of his illness. He had no one to talk to since his father was busy looking for money for his hospital expenses. The room was also starting to really smell bad and the room temperature was hot with only the electric fan providing the ventilation.
Planning:
Reflecting back on my goals and objectives for care, it was pretty much routine: aim for wound healing and preventing further exacerbation/complication, resolution of infection stable vital signs etc… If applying Kolcaba’s Theory of Comfort, these can all be included but in a more organized way where the core is to see to the comfort of the patient first and foremost: patient will achieve physical, psychospiritual, sociocultural and environmental relief/comfort. Interventions will focus on these four contexts.
Comfort Interventions:
To include but not limited to:
Physical:
Assisting body’s natural process of repair by keeping open areas clean, carefully dressing wounds, prevent infection and promote circulation to surrounding areas
Administration of medicines for the infections
Administration of antipyretic drugs
Develop repositioning schedule for patient - position patient for optimum comfort
Using paddings or water bags to relieve further pressure on bony prominences
Promote cooling by providing tepid sponge bath
Promote hydration and optimum nutrition.
Promote patient safety.
Psychospiritual:
Encouraging patient to verbalize feelings and discuss how condition affects self concept
Assisting patient to work through stages of grief and feelings associated with condition
Lending psychological support and acceptance of patient, using touch, facial expressions and tone of voice
Encourage family members to spend more time talking and just being with the patient.
Sociocultural:
Assist significant others in understanding and following medical regimen and developing a program of preventive care and daily maintenance.
Discuss therapeutically issues like stigma, support and burden of the illness.
Environmental:
Working with family and hospital staff to disinfect the room
Promote better ventilation
Promote an environment for resting (noise levels are down, dim lights, cool room temperature).
Evaluation:
It would have been good if I used Kolcaba’s General Comfort Questionnaire to evaluate my nursing interventions. It includes assessments like, “my condition gets me down, this room makes me scared, I am hungry” and etc. I could have translated the tool in Tagalog so that my patient can understand it.
Evaluating the results of my intervention, I was able to see my patient in a much brighter disposition especially since he has someone to talk to. He was a bright child who was forced into an unfortunate and uncomfortable situation by certain circumstances in his life. When I visited him months after that, he was transferred to the pediatric section of the orthopedic ward where he can talk to other children there though he was being evaluated further still by a psychiatrist for being isolated too long. I saw a glimpse of the bright and cheerful child he was supposed to be.
It would have been good if I used Kolcaba’s General Comfort Questionnaire to evaluate my nursing interventions. It includes assessments like, “my condition gets me down, this room makes me scared, I am hungry” and etc. I could have translated the tool in Tagalog so that my patient can understand it.
Evaluating the results of my intervention, I was able to see my patient in a much brighter disposition especially since he has someone to talk to. He was a bright child who was forced into an unfortunate and uncomfortable situation by certain circumstances in his life. When I visited him months after that, he was transferred to the pediatric section of the orthopedic ward where he can talk to other children there though he was being evaluated further still by a psychiatrist for being isolated too long. I saw a glimpse of the bright and cheerful child he was supposed to be.
Wednesday, July 14, 2010
Comfort: Nurse’s First and Last Consideration
by Grepaz Isaac, RN
Quezon City, Philippines
Nowadays, you can see nurses in hospitals receiving a number of patients. Unaware of their actions during initial interaction comfort has been forgotten and out of priority. Instead, nurses hurriedly place patients in a corner and let them wait for their number or names to be called. What has been said is a mirror of the past, because it was a personal experience that happened when I brought my very sick father with a high grade fever of 39 degrees Celsius, very weak and pale. According to Kolcaba (2003), comfort is the first and last consideration that a nurse gives to a patient.
From Kolcaba’s comfort theory, it reminded me how my patients warmly accepted and interacted with me during my on-the-job training at the Armed Forces Medical Center in 2003. I was assigned at neurosurgical ward. At first interaction to the patients, I warmly introduced myself and established rapport. Every visit I did with the patients, I made sure that a warm and pleasant environment of communication is taking place and at the same manner during my standard comfort interventions like assessment, vital signs taking and giving of medications.
Consistently, up to the last phase of intervention or until the discharge of the patient comfort care is given. In retrospect, I saw a very friendly and grateful patient who looks up to nurses with trust and from their face, the smile of a satisfied and contented feeling. A happy and unexplainable feeling also for me that I had shared the best of me as a nurse, a care and compassionate comfort- a nurse’s number one and priority; and the first and last consideration.
What a smile of satisfaction. “Don’t you envy one and feel the same feeling? Or would you wait to become a victim of our own neglected duty?
Satisfaction of NeedsNowadays, you can see nurses in hospitals receiving a number of patients. Unaware of their actions during initial interaction comfort has been forgotten and out of priority. Instead, nurses hurriedly place patients in a corner and let them wait for their number or names to be called. What has been said is a mirror of the past, because it was a personal experience that happened when I brought my very sick father with a high grade fever of 39 degrees Celsius, very weak and pale. According to Kolcaba (2003), comfort is the first and last consideration that a nurse gives to a patient.
From Kolcaba’s comfort theory, it reminded me how my patients warmly accepted and interacted with me during my on-the-job training at the Armed Forces Medical Center in 2003. I was assigned at neurosurgical ward. At first interaction to the patients, I warmly introduced myself and established rapport. Every visit I did with the patients, I made sure that a warm and pleasant environment of communication is taking place and at the same manner during my standard comfort interventions like assessment, vital signs taking and giving of medications.
Consistently, up to the last phase of intervention or until the discharge of the patient comfort care is given. In retrospect, I saw a very friendly and grateful patient who looks up to nurses with trust and from their face, the smile of a satisfied and contented feeling. A happy and unexplainable feeling also for me that I had shared the best of me as a nurse, a care and compassionate comfort- a nurse’s number one and priority; and the first and last consideration.
What a smile of satisfaction. “Don’t you envy one and feel the same feeling? Or would you wait to become a victim of our own neglected duty?
Monday, July 12, 2010
by Giddel Grace G. Guerra, RN
Surigao City, Philippines
In my own definition, comfort is a pleasant condition felt by someone, it of being physically or mentally relaxed. It is sensing happiness or warmth by something or someone.
In our nursing profession, comfort is a vital need to be addressed to our patients. As it is being known that sick people have this feeling of uneasiness, stress and dilemma due to their conditions.
According to Katharine Kolcaba, in her “Comfort Care Theory”, “comfort is the satisfaction of the basic human needs for relief, ease, or transcendence arising from health care situations that are stressful”. She emphasized that stressful situations can cause negative tension to patients. But giving comfort can promote and facilitate health-seeking behaviors, as one proposition notes that “if enhanced comfort is achieved, patients and family members are strengthened to engage in health-seeking behaviors”.
I want to share to you my experience in the nursing field, with regards to giving comfort care to my patients:
“I have been working in a Hemodialysis Unit for over half a year now. As we all now, patients on hemodialysis treatment are experiencing terminal illness. Dialysis treatment is not a process where a patient gets healed by it, but it is just a treatment to prolong patients’ lives. In my seven-month stay in the Hemodialysis Unit, I witnessed how these patients, suffer from their illness. Not being able to eat what they want to eat, drink as many liters of fluid as they want to, and do things just as they want to do.
I have this, 19-year old female patient once (and that means that she already died, just four days ago. May she rest in peace). She suffered from End Stage Renal Disease secondary to Chronic Glomerulonephritis. In my first day of duty, I can see how she is anxious every time I get near her bed. She saw me as a new stranger in her life. A new nurse who will be puncturing her fragile skin with 16 gauge AV needles. For weeks, I go to her bed, take her vital signs, assess her and even prime her machine. Everytime I try to initiate to insert her AV needles, she always refuses to. One day, I went up to her, and talked to her. I shared stories to her for her not to be anxious. We have gotten to know each other and had talked a lot of things. Every week, whenever I talk to her or even just looking at her, I can see how she worries about her illness. That’s why, whenever she needs something, I was the one who always attend to her. Giving all the comfort care as much as possible. One day, at last, she let me insert the AV needles. I don’t know what went right, that she said that she didn’t feel pain as I inserted the needle. From then on, every week of her treatment, she looks for me and let me insert her needles for her. And whenever, there is a new nurse in our unit, I always introduce them to her, for her not to feel anxious, as what she felt with me before. Since then, she became cooperative and verbalized any concerns she had with her treatment. ”
That is what I have learned by studying Kolcaba’s theory. Providing care is an essential thing that should be rendered to our patients for them to feel comfort. We, nurses are the ones who should provide relief to our patients from certain discomforts, continuously assessing, monitoring and providing care that will ensure them that they are at ease. Though they are experiencing sickness, comfort care helps them to live their lives as normal as possible.
Sunday, July 11, 2010
A Novice Nurse
by Dianne Kristin G. Peña, R.N
Caloocan City, Philippines
You may ask how I apply Dr. Katharine Kolcaba’s Theory of Comfort in this situation. I would say, just provide comfort the simplest way you know how... Honestly, you don’t need to be a nurse... you just have to be YOU. As Kolcaba advocates HOLISTIC COMFORT... let me share to you a glimpse of my nurses’ notes charting...
A Novice Nurse
by Dianne Kristin G. Peña, R.N
Caloocan City, Philippines
What comes in your mind when you hear the word comfort?
State of ease... peace... bliss... serenity... relief...
Giving help... advice... consoling...
Everyone is capable of showing care and giving comfort... whether it is for someone so close to you or even for a bystander needing help or assistance... Giving comfort or showing care is not stated in books, it comes out naturally...
They say, you cannot be a nurse when you don’t know how to care and you don’t care at all... I definitely agree to that... A nurse is always judged by her ability to make her patients comfortable.
As nurses, we are the comfort providers... we don’t simply follow doctors orders and give medications in an instant instead, we dig deeper... we empathize... we do our own interventions within our scope of responsibility giving emphasis on providing simple comfort measures...
In practice, Since I am new to the field (Just graduated last ’09), I haven’t experienced “that” much… However, I am proud to say that I am taking care of one famous person in the field of Philippine medicine... I don’t know if I am allowed to tell this for it can breech the patient privacy and confidentiality (on the world wide web)... Anyway, I might as well share my experience to you since it is very applicable and for academic purposes...
When I first got in as a volunteer nurse at my institution, Who would have thought that I was assigned to be the nurse of Dr. Fe Del Mundo, (Yes, she’s still alive) --- a national scientist, well-known paediatrician, academician and pioneer of many firsts in paediatric medicine in the Philippines. She received numerous awards and recently received a presidential, LAKANDULA AWARD for her outstanding work in medicine. She is now 98 years old turning 99 on November and still strong (compared to other old adults) and still has remarkable “brain power” as I might say. However due to old age, she needs assistance in her ADLs and stuff. I must say, I have the most “SWABE” (smooth-sailing) duty ever whenever I am her NOD.
No toxic consultants... No messy nursing procedures and stuff... No drug calculations... Just her.
You may ask how I apply Dr. Katharine Kolcaba’s Theory of Comfort in this situation. I would say, just provide comfort the simplest way you know how... Honestly, you don’t need to be a nurse... you just have to be YOU. As Kolcaba advocates HOLISTIC COMFORT... let me share to you a glimpse of my nurses’ notes charting...
- Gentle massage rendered as requested
- Accompanied to hear mass at the chapel
- Kept safe and comfortable by raising siderails, positioning the bed on comfortable position, placing pillows on both sides
- Provided additional blanket and adjusted thermostat of Airconditioning unit to provide warmth
- Oriented to time and date of the day
- Encouraged verbalization of feelings
- Conversant about politics with coherence and enthusiasm
- Provided bandana over head and dimmed room light to minimize sensitivity to light and promote sleep
- Endorsed for continuity of care and management
At first, I was very reluctant and half-hearted because I know I will not learn anything significant as to the nursing procedures and all... Less did I know, I have learned the basic and vital skill a nurse has to possess... TENDER, LOVE AND CARE.
There you have it... Dr. Katharine Kolcaba’s Theory of Comfort in my side of practice.
Nurses provide comfort though we ourselves are at times uncomfortable... with that, patients appreciate and remember us, which brings essence and fulfillment to our career.
Saturday, July 10, 2010
"Good Guys" and "Bad Guys"
by Arlyn Grace Ladera, RN
Benghazi, Libya
Hospitalization acts as a chief stressor to all age groups particularly to children. As nurse, I can testify that caring for children during their hospital stay is quite challenging than those with adults, since it is very frightening to this age group. When children are admitted, they feel that they are being deprived of their independence and their sense of alienation is intensified due to the new environment and overwhelming number of fresh faces. Thus, the major goal in caring with these young patients is to provide security as well as comfort.
Kolcaba’s Comfort Theory has been constructive in my care for children. I had once a five year old male patient admitted because of acute gastroenteritis. He was clinging to his mother’s arms and crying. I could see in his face that he was terrified being confined in the hospital. Being aware of the child’s comfort needs, I approached and talked to him with a calm soothing voice. At first he was hesitant to let me touch him, but relentless chatting and reassurance made him do so. Prior to getting his vitals, I first showed him the stethoscope and informed him that the particular device will help me hear his heart sounds. He was quite perplexed of what I was talking about. And so, I placed the stethoscope in his ears for him to hear his heart beats. He was quite amazed with it and allowed me to go on with my assessment. Even if I had already established rapport with the child, I still made sure that his mother was present to lessen the patient’s anxiety during the procedure. After the assessment, I gave him the oral medication for his tummy aches. When I was about to do skin testing for his antibiotics, he was crying again upon seeing the syringe I was holding. I explained to him that it won’t hurt that much and that the pierce of the needle was just like an ant's bite. The explanation made him alleviate some of his fears and permitted me to do the skin test. After the procedure, I praised his admirable courage. He gave me a big smile but was still puzzled with the circle I drew on his arms. I explained to him that the circle would help me know if I could give his antibiotics or not. I also told him a short story about the antibiotics as the “good guys”, fighting against the microorganisms that invades his body, who are the “bad guys”. He was quite contented with the tale and verbalized willingness to have his medicines on schedule. Before leaving his room, I made sure that the patient had the extra pillows he was asking for and reduced the noise coming from the television upon his request.
With this particular incident at work, I was able to cater all the comfort needs defined in Kolcaba’s theory. Physical comfort was met through the administration of the pain medication. The presence of the child’s mother, praises and reinforcements of positive coping, encouragement of child’s participation in the procedures and storytelling provided for the child’s social and psychospiritual comfort. Likewise, environmental comfort was met though the provision of quiet and calm atmosphere.Monday, July 05, 2010
Comfort: The Outcome of Nursing Care
by Heherson S. Morales, RN
Jeddah, Saudi Arabia
Since the ER is a fast-paced environment, most of the time the service provided by emergency room nurses are often forgotten. This is how I viewed this nursing specialty before; however, as days of clinical exposure passed by, my view has considerably changed a lot. I used to think that a few minutes or an hour of nurse-patient interaction can never produce a long-lasting impact to patients, but somehow, this way of thinking became an everyday challenge for me prior to starting a shift: how could a nurse in a toxic environment promote a therapeutic relationship with a patient?
Pain is one of the most common reasons for ER visits. It can significantly interfere with a person’s quality of life and general functioning. This unpleasant condition is often neglected by others until it becomes unbearable. I have witnessed various ways of human responses to this kind of discomfort, and I must say pain medications really are a work of wonder. However, pain is not just a physiological response; it also greatly involves the emotional and psychological status of a person.
I once had a 43 year old patient, with history of migraine headache, who presented to the ER with severe headache. The moment she entered the department, her screaming got the attention of all the personnel inside the ER complex. I was advised by the triage nurse that time to ‘double my patience’ since based on the initial triage-nurse-interaction she seemed to be difficult and extremely demanding. She drove her self alone to the hospital.
Signs and symptoms of pain were evident: elevated blood pressure and heart rate, diaphoresis, facial grimacing, and moaning. I immediately assisted her to bed as the physician tried to take the history. During physical examination, she would grasp my arms tightly signifying true distress. I offered my hands to her.
Then the physician ordered medications and went back to the station. I tried to release my hand from her tight grasp to prepare the medications but then she cried, “Nurse, don’t leave me alone here. Ayoko ng mag-isa.” I responded, “Mommy, ako po si Ron, ako yung nurse niyo habang nandito kayo sa ER. I’ll be coming back as soon as I have prepared your medications. I’ll just be on the other side of the door and I’ll keep the door open for you. It won’t take long.” I just sensed that her plea was genuine as she looked directly into my eyes. I immediately felt that aside from her physical symptom there were also other things that were bothering her.
I came back and held her hand again. The moaning was continuous. I explained to her the need for an IV access for fast pain relief. She was hesitant at first because she claimed that she had small veins but I just assured her that the procedure won’t take long, and that I’ll do my best in establishing the venous access. It took me some minutes to calm her down until I finally convinced her to trust me. I was able to gain access and administered all the prescribed medications.
As the medications were starting to take effect, she started sharing her previous hospital experiences, and the reason of refusal to go to the ER for pain management (she preferred to take home remedies not until the pain became unbearable that she rushed herself to the ER that time), it turned out that her family (son and husband) died in the same ER after a vehicular accident a few years back, the reason she feared getting back to the hospital. I just let her verbalized her concerns, and listened. She became much at ease and comfortable as minutes passed by, I assisted her to her position of comfort, and dimmed the light. Since I had to attend to other patients that time, I explained to her that I had to leave her for a while and instead oriented her to the use of the nurse-call button.
I made sure that she’s checked once in a while and that she felt secured while she’s in the hospital. Eventually her vitals normalized and her pain rating improved from an initial 10 to 8, to 5, to 2, and until it was completely gone after 2 hours of ER stay as she declared, “The pain is completely gone. I am much comfortable now. Thank you for staying with me and listening to my drama. Thanks Ron. I really appreciate it.”
The emergency room rarely gets emptied with patients, that is why I always take advantage of the times when we have the least number to take care of, to spend time with patients and listen to their concerns. This short account of a nurse-patient interaction has shown the positive effect of establishing a therapeutic relationship by the provision of comfort measures. In conjunction with pain medications, the mere presence of the nurse, and other interventions such as active listening, back rubs, getting the noise down were effective in decreasing the patient’s level of pain. Pain management is indeed part of comfort management. The medications may act on her physical symptoms but her emotional and psychosocial dimension had to be addressed as well.
The workplace may serve as a huge stressor but it is also where we get relief after hearing appreciative words from patients. Anyway, positive patients’ responses are sometimes enough to release the stress after a stressful shift. The ER may be a fast-paced environment where the nurse-patient interaction may be just for a few seconds or some short period of time, but as long as a nurse has brought comfort to his patients, the care is truly going to be long-lasting. Comfort should always be the outcome of care of nursing measures. A nurse who effectively provided comfort through his comfort measures has been successful in making a difference to a patient’s life. It is through our comfort caring attitude that patients remember and appreciate us.
Monday, July 05, 2010
Clinic Nurse's Use of the Comfort Theory
by Glorie-Ann Maris S. Platon, RN
Biñan, Laguna, Philippines I’ve been working as a clinic nurse for almost four years. The first two years of my practice was spent as a company nurse in Los Banos Laguna and catered it’s employees. The clinic is manned by two nurses, one medical technologist, one rad tech and a physician each day. We served Filipino and foreign patients with different nationalities.
One very well known diabetic patient is Mr. B. A 52 years old, male, an American. I was called to attend to him in his office one afternoon because he did not take his medications again. It shocked me because of all the times I’ve seen him, this is the first time he got really psycho. He won’t let anybody touch him and he was throwing the papers in his messy office, by the way he is an editor of the circulating magazine in the company. Mr. B was jumping up and down and shouting, he’s slamming his books and shouting nonsense.
I talked to him is a strict manner. At first he will not listen but with the help of some of his officemates, we were able to calm him down. They suggested bringing him in the hospital or at the clinic but the patient refused and whenever they point this out, Mr. B starts complaining all over again. I told them that I will be staying there with the patient until his condition stabilizes. I took his vital signs and his blood sugar. He was cold and pale. The RBS revealed 32mg/dl, a value which would really put the patient in delirium. I gave a can of coke which I took from her secretary and he took only sips of it. I talked to him and found out that he lives alone in his house because his family stays in the USA. He said that he missed his family but cannot go on leave because he had so many works to do and said that early that morning he had an argument with one of his colleagues. I really got bored talking to him but had nothing to do but listen. After 10 to 15 minutes I pricked his finger again and I was thankful that his sugar is going up. I took again his vital signs and told him that I will have to return to the clinic but will be going back again after 30 minutes to measure his blood sugar again. I told him to take a rest and if possible to have an appointment with his physician. I went back and took measures again, his sugar went back to normal. The next day, he sent a pizza at the clinic, giving thanks for the measures done the other day.
At the very moment that I went in his office and calmed him down, I have already applied Kolcaba’s theory of comfort. My primary goal is to stabilize the blood sugar, thus, relieving him also with its effects. Taking of vital signs, measurement of blood sugar and the can of Coke were all part of giving physical comfort. Sociocultural comfort is seen when the patient shared his personal feelings about his family and his work, thus, voicing out his stress which might also have contributed to his condition. The goal was met as the patient has stabilized condition when I went back. In conclusion, comfort is a big factor in caring for a patient and it comes in different contexts which include physical, environmental, psychospiritual and sociocultural. Comfort measures can be applied not only in the hospital but in the clinical / industrial setting as well, thus, making it useful in all levels of care.
Monday, July 05, 2010
Nurse! Nurse! by Anna Ria R. Ilac, RN
San Jose del Monte, Bulacan
How many of us would hear the call of a patient or a relative…”Nars! Nars!” in a government hospital or in a sosyal hospital “Nurse, nurse can you attend mr.y in the room?” Our immediate response would be to attend needs of such. The following are just samples of what we encounter in the ward:
- “Nars, kelan ako makakauwi, anong sabi ni doctor?”, as verbalized by some who are too eager to go home after two to three days of being admitted- “Nars, masakit kaya ung gagawin sa akin?” as verbalized by someone who’s going to a procedure- “Nurse, ano sa tingin mo ang lagay ng pasyente?” for some, who are trying to have an idea near the truth of the reality- “Nurse parang hindi umaandar ung oxygen niya”- “Nurse nahihirapan siyang huminga”- “Nurse can I already eat?” after an eight hour fasting for a blood exam- “Nurse, is Dr. T around?
There are also the simpler statements which are not odd that we encounter everyday:
- “Nurse, ung cr naming barado”- “Nurse ung swero ng asawa ko, may dugo eh paki tingin”, which is the best statement among all. Many of us can relate to this one.- “Nars, may walis kayo?”- “Nurse magkano kaya ung bedpan, ung tablet na ganito ganyan..” relatives assuming that we also know these- “Nurse, pahinging gown saka bed sheet”
Calling you frequently gets irritating sometimes that how you wish your name is changed to Nurse instead.
Comfort for many patients do not only require the needs clinically but also constitutes of their everyday needs during their stay in the hospital. As front liners, we cannot just tell them, “Kindly wait for the orderly to attend to your needs” and so on, with their other needs.
In any situation we are the ones being called first. At times we may feel tired already but the calling of being a nurse is there.
The statements above are just a few of what we hear every day. Sometimes it gets funny when you recall them, reality bites. I truthfully feel overwhelmed in times I get extending my care.
Your stories are truly inspiring. :)
ReplyDeleteGreat job! You went an extra mile by presenting a new theory apart from those already done by previous batches. That's thinking and learning beyond the book. Kudos!
ReplyDelete