The Concept Of Comfort Care At End Of Life

The concepts of the comfort theory are clearly defined and the relationships are easily understood. This theory is simple and basic to nursing care. The taxonomic structure of comfort facilitates researchers’ development of comfort instruments for new settings (Kolcaba,1991).The first assertion of the theory stating that effective comfort interventions leads to increased comfort for patients , has been tested and supported with women with breast cancer (Kolcaba & Fox, 1999), persons with UI (Dowd, Kolcaba, & Steiner, 2000), persons in hospice (Kolcaba, Dowd, Steiner, & Mitzel, 2004). And stressed college students (Dowd, Kolcaba, Steiner, & Fashinapaur, 2007). Also, the second assertion was supported in the UI study, when patients with enhanced comfort showed increased HSBs.

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

The purpose of this paper is to examine communication strategies related to palliative and end-of-life care with a focus on Aboriginal clients. Firstly, I will explain the role of cultural competence in the nursing care of an Aboriginal client. Secondly, I will argue the cultural challenges a nurse may face when caring and communicating with Aboriginal clients receiving palliative end-of-life care. Thirdly, I will present solutions to the aforementioned communicative challenges. Lastly, I will discuss the impact I believe this experience may have on my future practice.

The origination of Kolcaba’s theory of comfort stemmed was first established in the 1900’s. Founder, Katherine Kolcaba, concluded that for a positive patient outcome to accomplished, comfort is a crucial obligation.

According to Allen et al. (2012), “millions of people with chronic illnesses endure unrelieved pain, uncontrolled physical symptoms and unresolved psychosocial or spiritual problems.” This issue occurs because palliative care is often considered a form of end-of-life care. Palliative care is a treatment that can be used for patients who suffer from chronic illnesses and diseases while receiving curative treatment. (Horowitz, Grambling & Quill, 2014) purposely states the misconceptions of palliative care and advocated for seriously ill patients that education must bring under control the misconceptions. Some patients do not receive appropriate symptom management because the palliative care treatment needed is often confused with end-of-life care. However, end-of-life care attempts to relieve pain and suffering when a disease is no longer responsive to curative treatment. Pain and suffering could ultimately be controlled or even eliminated through the proper utilization of palliative care. Patients who are not referred to palliative care in a timely manner is more likely to have poor quality of life, uncontrolled symptom management and increased amounts of visits to the emergency room during the disease process. Patients with life limiting illnesses bear the burden of increased discomfort and increased suffering. Nurses experience clinical practice issues and difficulties in the clinical setting during the delivery of comfort and symptom management. These issues

In reviewing the two studies I found, it is very clear there is a difference in quantitative and qualitative studies. To start, Lee et al. (2017) conducted a qualitative study in which the problem statement recognizes that end of life care (EOLC) in dementia patients is less than optimal when compared to cancer patients. The researchers aimed to determine what service managers and frontline staff at different facilities felt were the key aspects in improving EOLC in dementia patients (Lee et al., 2017). As a result, the researchers purpose was to contribute to the current evidence base on good EOLC and interventions to increase quality of care of end of life dementia patients.

My perceptions have changed dramatically since the Clinical 1 rotation. I have noticed that the minute I walk into my patient’s room, I start to collect data. I notice if they are breathing normal, what their skin looks like, what their cognition level is, and what equipment they have in their room. I have started to connect the “puzzle pieces” of the patient’s health, rather than just feeling like I have a bunch of random information. My perception of people has continued to stay the same from Clinical 1. I continue to have an interest in learning about patients and believe that they also have something to teach us. I have learned so much from the patients and it is fun for me to get to know different

Hospice is compassionate care provided to patients facing terminal illness or illness for which there is no cure. These patients are diagnosed with an illness from which they will never recover and usually have a life prognosis of six months or less (Hospice Foundation of America, 2014). The goal of hospice care is improving quality of life and managing the symptoms of disease and the dying process. The care hospice offers is focused on pain management and emotional and spiritual support for both the patient and family (National Hospice and Palliative Care Organization, 2012). Hospice care can be provided in many different settings, often the patient’s own home. Hospice care can also be provided in hospitals, nursing homes, long-term care facilities and free-standing hospice centers and is available to patients of all ages (NHPCO, 2012). A patient receiving care in a hospice program has a team of healthcare individuals that can consist of the patients own physician, nurses, home health aides, clergy, social workers, and speech and physical therapists (NHPCO, 2012). Usually, a care plan is developed by the hospice team and care of the patient is provided by family members with the support of the hospice staff (NHPCO, 2012). Nurses make regular visits to the patient and family and are on call 24/7. Once enrolled in a hospice program hospice covers everything that will be needed to care for you, from medications to manage pain to

The comfort theory is a nursing theory that was first developed in the 1990s by Katharine Kolcaba. The Theory of Comfort considers patients to be individuals, families, institutions, or communities in need of health care (Petiprin, 2015). The environment in which this theory can be applied is in any aspect of the patient, family, or institutional surroundings that can be controlled by a nurse or a patient’s loved one by means to enhance their comfort. Health is considered to be optimal functioning in the patient, as defined by the patient, group, family, or community (Kolcaba, 2005).

Katherine Kolcaba’s Comfort Theory fits best with my philosophy of nursing and my current work environment. As a hospice nurse comfort is the top priority. The goal of hospice care is to provide comfort and dignity at the end of life. The technical term for comfort for health care is the immediate state of being strengthened by having the needs for relief, ease, and transcendence addressed in the four context of holistic human experience: physical, psychospiritual, sociocultural, and environment. The change goal would be to implement Kolcaba’s taxonomic structure of comfort as a way for the hospice unit staff to measure comfort.

In nursing, the goal of care is usually to restore the patient back to the highest level of health possible. In some cases, however, the goals of care change when a curative approach is no longer appropriate. The new goals of care could simply be palliation and pain control rather than a restoration back to full health. This type of care is called palliative care. Palliative care is not the same as end-of-life care, but the two go hand-in-hand at times. The goal of end-of-life care is a “good” death, good being defined by the patient. Palliation is part of that “good” death. Both palliative care and end-of-life

End-of-life care encompasses the aspects of helping patients and their families through the demise process, pain management, culturally sensitive practices and during ethical decision-making process (Hebert, Moore & Rooney, 2011). However that was not the case in the story of the 20-year-old Hailu, a college a freshman from the University of Nevada who was at the center of end of life controversial with St Mary’s hospital Nevada who in April 2015 was placed on life support following complications (decreased blood volume and lack of oxygen to the brain) from anesthesia after surgical procedure to remove her appendix. Hailu, in May, was declared brain dead by the doctors with no possibility of recovery and proposed on removing the life support

The concept of comfort is one that nurses provide every shift; however, it is not always easy to define. Katherine Kolcaba’s Comfort Theory will be used. Walker and Avant’s method for concept analysis will be used. The first step is to select a concept, which is comfort. The next step is determining the purpose of the analysis. The purpose is to define what comfort means and what comfort measures are and how they are used in nursing. The third step is to identify the uses of the concept of comfort. This includes definitions of term comfort and a literature search. The fourth step is to determine the defining attributes of comfort. This allows for insight into the

Comfort is defined by Merriam-Webster’s dictionary (2014) as “a state or situation in which you are relaxed and do not have any physically unpleasant feelings caused by pain, heat, cold, etc.” or as “a state or feeling of being less worried, upset, frightened, etc., during a time of trouble or emotional pain.” Dictionary.com (2014) defines comfort as “a feeling of relief or consolationm” or “a person or thing that gives consolation,”or “ a state of ease and satisfaction of bodily wants, with freedom from pain and anxiety.” Dictionary.com (2014) lists the origin of the word comfort as coming from the 13th century Old French term confort, meaning “source of alleviation or relief.” One can see there are multiple meanings and interpretations of the word comfort. This paper will set forth to discuss the word comfort as a concept and its interpretation and use in many disciplines, including its significance in nursing.

The case study based on the palliative patient Mrs. Mavis looks at issues both the family and the patient are dealing with in regards to the end of life treatment Mrs. Mavis is receiving. Mrs. Mavis is a palliative patient, currently unconscious, who is dying and only wants comfort measures within her nursing care. This was made clear through her advanced care directive, which was made weeks before beginning to receive her end of life care. Mrs. Mavis’ comfort measures include pain relief, hygiene and keeping her comfortable. Mrs. Mavis’ family want her to have fluids and medications to help improve her health. They also want oxygen and pain relief to help with her breathing. Issues such as educating and supporting the family, pain management, the effectiveness of having an advanced care directive and pain assessment will be evaluated to determine the best effective interventions for Mrs. Mavis and her families care. Interventions that will be discussed through-out this essay include the use of analgesia medication, the use of subcutaneous injections and syringe drivers, emotional support for the family, effective communication, educating the family on Mrs. Mavis’ wishes and the importance of having an advanced care directive. These interventions will be evaluated to ensure they are the best practice for Mrs. Mavis’ care.