Comfort Measures
Here is a question you might be asking: “What do comfort measures have to do with critical thinking?” I am so glad you asked!
It basically boils down to this: finding not only the source of discomfort but also to ACTUALLY comfort a patient requires the nurse to identify the problem, to have clinical judgment and to have the ability to provide it to patients in an environment that really isn’t designed for comfort.
It basically boils down to this: finding not only the source of discomfort but also to ACTUALLY comfort a patient requires the nurse to identify the problem, to have clinical judgment and to have the ability to provide it to patients in an environment that really isn’t designed for comfort.
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So why do we (as a whole profession) put so much emphasis on comfort? Because we realize that we are not just dealing with diseases, we are also caring for whole human beings that have needs extending beyond their illnesses. An expert nurse understands that a lot more goes into a patient outcome than just our medical interventions: what the patient brings to the table (emotions, hopes, dreams, engagement, etc.) plays a huge role in how things turn out. It also comes down to the simple fact that we are caring for people in their most vulnerable place and we have a huge potential to positively impact their experience and even their life. |
What nursing has to do… is to put the patient in the best condition for nature to act upon him." |
Comfort measures are frequently perceived as less important interventions, but as you will read here, they are key to the healing process.
Here we will discuss:
- What is comfort? and why do we care?
- Pre-reqs to this skill
- 3 Major Types of Comfort
- A few tips to rock this skill
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What is Comfort?
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Pre-Reqs
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3 Major Types
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3 Tips
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Pro Tips
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Still Unsure?
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I promise this won’t be a lame definition.
For that you have Webster’s, and if you happen to look it up, there is a pervading theme: that is, to alleviate a difficult situation that includes distress, pain, and suffering. For those of us in nursing, its a no-brainer since our profession is based on that principle. But in practice, there is a bit more that goes into it.
Why should we care?
Besides the obvious, there is actually some legitimate reasons why comfort measures are important. We have all been there: drowning from the amount of work we have to do and hating the fact that we have to take all this precious time to brush the patient’s teeth or shave their beard. It’s happened to us all (at least I hope I am not the only one that has dreaded these moments a time or two!)
But we need to care because comfort measures, while seeming less effective than the medical interventions, actually support everything else we are doing for that patient.
Think about it:
Oral care- prevents VAP or HAP
Skin care- prevents HAPU’s and infections and improves patient’s self-esteem
Therapeutic communication- decreases anxiety/anger and increases cooperation and teamwork
Turning the lights down and having quiet hours: allows for rest and sleep, which increase healing capacities.
Coaching the patient: augments pain/anxiety medication we give and may even help decrease the amount needed, boosts participation, increase’s patient’s confidence and drive, etc.
Limiting stimulation: decreases oxygen consumption (important in illnesses such as head injuries) and helps prevent or reverse delirium, etc.
The list goes on and on.
For that you have Webster’s, and if you happen to look it up, there is a pervading theme: that is, to alleviate a difficult situation that includes distress, pain, and suffering. For those of us in nursing, its a no-brainer since our profession is based on that principle. But in practice, there is a bit more that goes into it.
Why should we care?
Besides the obvious, there is actually some legitimate reasons why comfort measures are important. We have all been there: drowning from the amount of work we have to do and hating the fact that we have to take all this precious time to brush the patient’s teeth or shave their beard. It’s happened to us all (at least I hope I am not the only one that has dreaded these moments a time or two!)
But we need to care because comfort measures, while seeming less effective than the medical interventions, actually support everything else we are doing for that patient.
Think about it:
Oral care- prevents VAP or HAP
Skin care- prevents HAPU’s and infections and improves patient’s self-esteem
Therapeutic communication- decreases anxiety/anger and increases cooperation and teamwork
Turning the lights down and having quiet hours: allows for rest and sleep, which increase healing capacities.
Coaching the patient: augments pain/anxiety medication we give and may even help decrease the amount needed, boosts participation, increase’s patient’s confidence and drive, etc.
Limiting stimulation: decreases oxygen consumption (important in illnesses such as head injuries) and helps prevent or reverse delirium, etc.
The list goes on and on.
So what does comfort mean in the context of the nurse-patient relationship? The definition of comfort is so broad and ambiguous, and the PhD’s of the nursing field have yet to make protocols on how to comfort people. Why is that?
Its because the skill of comforting requires a few things:
Its because the skill of comforting requires a few things:
- It requires the nurse to be attuned to each individual patient’s needs and to notice responses to comfort measures (AKA a response-based practice)
- It requires a relationship of trust to develop between that specific nurse and the specific patient and/or family (which entails comfort is a relational skill).
- A nurse must think critically about the needs of the patient because every person’s definition of comfort is unique, and it changes with circumstances (clinical grasp and inquiry).
There are many more types of comfort measures but we’ll narrow it down to the 3 major types.
Comforting of the Physical Body- Includes interventions such as grooming, range-of-motion exercises, back rubs, positioning, skin care, etc.
Caring for the body is one of the ways that help many patients feel connected to their world. By helping them maintain their sense of appearance and normal body-care routines, it provides a sense of normalcy in an otherwise foreign and labile situation. Additionally, seeing the patient as close to their usual self (and physically taken care of) will be comforting to their loved ones. This is especially true in intubated patients who can not care for themselves, and the technology all around them can make them seem like aliens to those that know them.
Comforting Through Connection- This refers to the ability to connect with our patient/family in ways that give them a sense of trust and being cared for. It means engaging with them as people instead of just diseased bodies or sources of data. It includes the way you talk to them, your tone of voice, your ability to listen, etc.
Always remember: a comforting relationship is in and of itself a comfort measure.
Comforting Through the Environment- The average ICU patient does not have very much control of their environment, but guess who does? That’s right! Nurses are the key player in establishing a comforting environment and creating a culture of healing around the patient. This includes environmental factors: lights, noise, people, machinery, cleanliness, etc.
Comforting of the Physical Body- Includes interventions such as grooming, range-of-motion exercises, back rubs, positioning, skin care, etc.
Caring for the body is one of the ways that help many patients feel connected to their world. By helping them maintain their sense of appearance and normal body-care routines, it provides a sense of normalcy in an otherwise foreign and labile situation. Additionally, seeing the patient as close to their usual self (and physically taken care of) will be comforting to their loved ones. This is especially true in intubated patients who can not care for themselves, and the technology all around them can make them seem like aliens to those that know them.
Comforting Through Connection- This refers to the ability to connect with our patient/family in ways that give them a sense of trust and being cared for. It means engaging with them as people instead of just diseased bodies or sources of data. It includes the way you talk to them, your tone of voice, your ability to listen, etc.
Always remember: a comforting relationship is in and of itself a comfort measure.
Comforting Through the Environment- The average ICU patient does not have very much control of their environment, but guess who does? That’s right! Nurses are the key player in establishing a comforting environment and creating a culture of healing around the patient. This includes environmental factors: lights, noise, people, machinery, cleanliness, etc.
Tip#1
Find ways to connect with your patient and their family.
At the start of your shift, introduce yourself, ask how they are doing, etc. This is basically having good manners. At every step of the way during your shift, explain what you are doing or any updates and ask if they have questions or concerns. Ask them about non-hospital stuff, questions that help you get to know them as people (like what do they do for a living, or hobbies or grandchildren, etc.) Patients like to feel like they are seen as PEOPLE and not just sick bodies.
Another thing nurses tend to do a lot is they’ll be looking at the computer or monitors when the patient is talking. Try to engage with them as much as possible when they’re trying to connect with you.
Tip#2
Put some TLC into the environment.
Ever seen those rooms that have supplies on every surface, and machinery in every corner, and linens on every chair? Take a few moments to clean and organize the space around the patient. Get rid of the clutter (which will also help you: bonus!) Ask the patient if the lights are at a comfortable level, if they prefer the door open/closed, etc. Little things add up to the people that are literally spending every hour of every day cooped up in that room. So helping them with the small stuff goes a long way.
Tip#3)
Find ways to augment medication.
A lot of nurses feel that just shoving a bunch of medication into the patient and doing nothing else is an ethical breach, and rightfully so. Start creating the mentality that medication is only one part of the solution. Help the pain medication do its job by adding comfort to the equation. A lot of hospitals have resources to help address the following (such as pain management services, music therapy, social work, etc). Use them!
Pain: provide pillows, dim the lights, limit noise, or provide distraction (your patient will help you figure out which one will work for them).
Anxiety: talk it out with them, try to figure out what concern is causing the anxiety. Provide distraction, do something nice for them, empower them by giving choices, etc.
Insomnia: again, environment can play a big role in this.
Stress: address their stress triggers, or maybe place a consult with chaplain or someone they’d be interested in talking with. Perhaps they are stressed about financing their stay- call a social worker or case manager over to help them get in touch with resources.
Find ways to connect with your patient and their family.
At the start of your shift, introduce yourself, ask how they are doing, etc. This is basically having good manners. At every step of the way during your shift, explain what you are doing or any updates and ask if they have questions or concerns. Ask them about non-hospital stuff, questions that help you get to know them as people (like what do they do for a living, or hobbies or grandchildren, etc.) Patients like to feel like they are seen as PEOPLE and not just sick bodies.
Another thing nurses tend to do a lot is they’ll be looking at the computer or monitors when the patient is talking. Try to engage with them as much as possible when they’re trying to connect with you.
Tip#2
Put some TLC into the environment.
Ever seen those rooms that have supplies on every surface, and machinery in every corner, and linens on every chair? Take a few moments to clean and organize the space around the patient. Get rid of the clutter (which will also help you: bonus!) Ask the patient if the lights are at a comfortable level, if they prefer the door open/closed, etc. Little things add up to the people that are literally spending every hour of every day cooped up in that room. So helping them with the small stuff goes a long way.
Tip#3)
Find ways to augment medication.
A lot of nurses feel that just shoving a bunch of medication into the patient and doing nothing else is an ethical breach, and rightfully so. Start creating the mentality that medication is only one part of the solution. Help the pain medication do its job by adding comfort to the equation. A lot of hospitals have resources to help address the following (such as pain management services, music therapy, social work, etc). Use them!
Pain: provide pillows, dim the lights, limit noise, or provide distraction (your patient will help you figure out which one will work for them).
Anxiety: talk it out with them, try to figure out what concern is causing the anxiety. Provide distraction, do something nice for them, empower them by giving choices, etc.
Insomnia: again, environment can play a big role in this.
Stress: address their stress triggers, or maybe place a consult with chaplain or someone they’d be interested in talking with. Perhaps they are stressed about financing their stay- call a social worker or case manager over to help them get in touch with resources.
PRO-TIP #1
When your hands are tied:
When patients verbalize a need, listen and acknowledge their need. If you can’t fix their problem, offer alternative solutions. You’ll find that most of the time, if patients feel like you want to address their needs, it doesn’t matter if it you end up fixing it or not (like those times when they’re maxed out on pain meds). If you offer alternatives, like a heat/cold therapy or pillows or whatever, often times they’ll be just as grateful).
PRO-TIP #2
Coordinate care to minimize disruption and boost rest.
This is very true for all the night-shifters. People need their rest and sleep, yet we must do our job. So try to coordinate care and assessments with all the disciplines (like lab, respiratory therapy, etc) so that the patient isn’t constantly being woken up.
But this does apply to day shift as well. It can be exhausting for patients when one thing after another happens. The morning time is brutal for them because first we come in, then all the doctors, then physical therapy comes, then lab comes to draw, then the speech therapist comes, then they have to go to CT.. that’s a lot! Especially if they got no sleep the night before. Gauge your patient’s energy level and if possible, try spacing things out so they don’t get worn down.
Early mobility, safely eating, or even breathing takes a lot of energy. Sometimes your patient will be on the edge in many regards, and pushing too hard will send them in the wrong direction. Be conscientious.
When your hands are tied:
When patients verbalize a need, listen and acknowledge their need. If you can’t fix their problem, offer alternative solutions. You’ll find that most of the time, if patients feel like you want to address their needs, it doesn’t matter if it you end up fixing it or not (like those times when they’re maxed out on pain meds). If you offer alternatives, like a heat/cold therapy or pillows or whatever, often times they’ll be just as grateful).
PRO-TIP #2
Coordinate care to minimize disruption and boost rest.
This is very true for all the night-shifters. People need their rest and sleep, yet we must do our job. So try to coordinate care and assessments with all the disciplines (like lab, respiratory therapy, etc) so that the patient isn’t constantly being woken up.
But this does apply to day shift as well. It can be exhausting for patients when one thing after another happens. The morning time is brutal for them because first we come in, then all the doctors, then physical therapy comes, then lab comes to draw, then the speech therapist comes, then they have to go to CT.. that’s a lot! Especially if they got no sleep the night before. Gauge your patient’s energy level and if possible, try spacing things out so they don’t get worn down.
Early mobility, safely eating, or even breathing takes a lot of energy. Sometimes your patient will be on the edge in many regards, and pushing too hard will send them in the wrong direction. Be conscientious.
If you are unsure about when comfort measures are needed, simply just ask your patients or their family, “What can I do to make you more comfortable?”
If they are the type that don’t like to disclose what they need, observe your own discomfort. Are you comfortable with them not having bathed in 5 days or brushed their teeth for a week or with that goop in their eyes? Would it make you more comfortable to see them in a clean room with clean bedding? Some people perceive needing/asking for comfort as being weak, so you might need to take the initiative by doing what you can (unless they refuse, of course.)
Having said that, be aware not to be too intrusive. Be available, but do not hover. Do this by gauging the patient’s response.
Despite our best intentions, it is not always possible to comfort someone. All we can do is try our best, to have courage to think outside the box and to go the extra steps when we can.
If they are the type that don’t like to disclose what they need, observe your own discomfort. Are you comfortable with them not having bathed in 5 days or brushed their teeth for a week or with that goop in their eyes? Would it make you more comfortable to see them in a clean room with clean bedding? Some people perceive needing/asking for comfort as being weak, so you might need to take the initiative by doing what you can (unless they refuse, of course.)
Having said that, be aware not to be too intrusive. Be available, but do not hover. Do this by gauging the patient’s response.
Despite our best intentions, it is not always possible to comfort someone. All we can do is try our best, to have courage to think outside the box and to go the extra steps when we can.
30-Second Summary
- To comfort is to attempt to alleviate varying types of suffering. It is important to do because it makes the medical interventions we are doing work better and prevents further problems.
- You will need to establish a good relationship with your patient/family by building trust. You will also need to use your clinical inquiry to figure out what measures are needed and by having a response-based practice, it will help you understand which ones work.
3 Tips to improve this skill:
- Connect with your patient and family
- Make the environment comfortable and create a culture of healing around the patient.
- Do non-pharmacological interventions to augment medication (so that the med is more effective).