My mother, Adele, passed away two days ago. She was only 91 years old and due to some unexpected injuries, was beyond life-saving measures. She’d escaped demise throughout her life, surviving two large meningiomas in her brain as well as chronic illnesses. But this blog isn’t about her life, nor her presence in my life. It’s about comfort measures and Katharine Kolcaba’s Comfort Theory, and how that influenced my conceptualization of the care my mother received – and the comfort her caregiver needed as well.

            I’ll call my mother’s nurse, Debbie, a 39-year veteran of nursing who worked on the neurological intensive care unit in an urban hospital. I watched this nurse effortlessly glide between rooms planning her work, the ease of interactions with families and patients, and phoning various departments as she needed supplies brought to the unit. Debbie’s comfort and confidence in her role was evident, and she extended that comfort to us as we waited for the inevitable to occur, my mother’s passing.

            According to Kolcaba’s theory, healthcare needs of the patient and family create comforting interventions along with intervening variables to create enhanced comfort. My family’s goal for my mother was a peaceful death. My older sister had phoned me about Debbie, saying, “she’s good.” My sister had been at my mother’s bedside the previous day, when my mother’s alertness had started to wane. On the second day, it was clear my mother’s labored breathing bode ill. Debbie knew this and was able to answer our questions, offering not so much condolences, but what, in that moment, we needed to be comforted.

            I struck up a conversation with Debbie, who was intervening to help my mother breathe easier, suctioning, irrigating the nasal passages, and ensuring the oxygen tube was patent. Debbie explained what she was doing to help my mother and said she felt so badly that my mother was struggling to breathe. Debbie shared with me that she planned to retire in the next six months after working as a nurse for almost four decades.

            “What,” I asked, “do you plan to do when you retire?”

            She said she liked being by herself and didn’t have any plans. “I don’t need to be around others.”

            “Have you considered teaching?” I asked. “You could help so many young nurses with your knowledge.”

            No, she replied. “I’m done.”

            She said this with a finality and with a hint of something else: a need to be finished because of the toll being a nurse can extract from us. I thought of the mass exodus of nurses and the loss to our profession when someone like Debbie, who was still quite youthful, decided they were “done.” Debbie described the extra work that had been caused by infection control measures due to a local outbreak of a microorganism. Of how when she went home, she thought she could work a few more months, but when she was at work, she knew she couldn’t.

            I listened closely and reflected on what she had communicated to me. I thought of the comfort nurses needed to keep them coming to the bedside for each shift. Debbie’s retirement had little to do with the physical exertion nurses made during their shift. It was due to the mental and emotional labor that a “good” nurse shows to people like me and my mother day after day after day.

            It would be the last time I saw my mother before she passed away, and I was able to say good-bye. I also said good-bye to Debbie and voiced a heartfelt “thank you for all you did.” She nodded, perhaps knowing we would never see each other again. But as strangers, we shared an intimate moment in time when comfort for me and my mother meant a great deal and I hope, in some small way, that my listening and encouraging her to share her life’s work with others, she had found some comfort as well.

References

Kolcaba, K. (1994). A theory of comfort for nursing. Journal of Advanced Nursing, 19, 1178 1184.

Kolcaba, K. (1991). A taxonomic structure for the concept comfort: Synthesis and application. Image: Journal of Nursing Scholarship, 23, 237 240.

Kolcaba, K. (1992). Holistic comfort: Operationalizing the construct as a nurse sensitive outcome. Advances in Nursing Science, 15(1), 1 10.

Kolcaba, K. (2003). Comfort Theory and practice: A vision for holistic health care and research. Springer Publishing Co.