Contributor: Carla Alexandra dos Santos Pacheco

I’ve been an operating room nurse for 19 years and from the beginning until today I’ve always made it a point to protect the person in my care. It was beautiful to see, read and feel much of what I put into practice daily in the theories of comfort described by Katharine Kolcaba.

According to Kolcaba, comfort encompasses physical, psycho-spiritual-social and environmental aspects, so we know that comfort is not necessarily the absence of disease but a state of relief and tranquility, even happiness and adaptation to problems (transcendence). Comfort is a need, felt, and seen in the person in front of us. Nursing is the appreciation of comfort needs, the design of comfort measures and the reassessment of comfort levels (Kolcaba, 2003).

Comfort is defined as the condition experienced by people who receive comfort measures, and are the nursing interventions that provide the satisfaction of comfort needs at the physiological, social, psychological, spiritual and physical levels. It is a holistic experience, empowered through the joy and dignity of the needs for three types of comfort (relief, tranquillity and transcendence), in the physical, psychospiritual, spiritual and environmental contexts (Kolcaba, 2010).

Environmental comfort is describe as a state of satisfaction of a person in a given space, in which good psychological, thermal, acoustic, visual, air quality, and ergonomic conditions are provided. And we know that we can provide these conditions in the operating room…all it takes is a little effort in a short period.

Caring for comfort needs has been considered for several decades. Nursing care is related to providing a general atmosphere of Comfort, and the personal care of patients includes attention to be happiness, Comfort, and physical and mental tranquility (Kolcaba 2003).

Nurses also need to feel comfortable and safe in their work environment to provide excellent care. Kolcaba’s Comfort Theory suggests that when nurses’ comfort is valued, they become more committed to the institution, more able to work hard and essentially more satisfied. Thus, the results are improved. Kolcaba (2003), researched what nurses want in their workplaces and identified many factors that can be organized according to comfort contexts as explained in Comfort Theory (physical, psychospiritual, sociocultural, and environmental [organizational structure]).

A day begins like so many others, starting at 8am with the preparation of the material for various surgeries, preparation of the operating room and testing of the ventilators and other equipment.
Another day in which the person admitted to the operating room needs comfort, support, compassion, respect, commitment, involvement, dedication, theoretical knowledge, and differentiated and rigorous techniques. Every day I try to demonstrate that physical, spiritual, social, emotional, and environmental comfort is as important as technical differentiation, with the multidisciplinary team, and the nursing team.

In the operating room patients are overexposed in all these dimensions. They are fragile, in the unknown and with strangers, filled with fear, anguish, and a future that may be uncertain. I ask myself daily: -What does it cost to put a pillow and one, two or three warm sheets on a patient who has just arrived in the operating room? Who has just been transferred to a narrow, cold, and often rigid surgical table!!! And one who is in an unfamiliar environment, helpless, without their clothes and belongings? Have a relaxed conversation that conveys Comfort and confidence that allows the exposure of their doubts, anxieties and fears. Allow a warm and comforting touch, the so-called therapeutic touch.

After prodding for a while, I am finally able to achieve my goals. Pillow placed, and the patient warmed up and made comfortable as far as possible. After a short checklist we enter the operating room. And now it’s time to undress and uncover, and there I go to pull the sheet closer and keep his privacy as integral as possible. And so I am a “nag”, but here, between us, I don’t care what anyone says, I want to maintain the dignity of my patient. The dignity of each human being is intrinsic to him.

One more conquest! Whew…what a simple and challenging task!!!

Now it’s time to proceed with the induction of anesthesia. That great moment of anxiety for a significant number of patients and the very moment when all the professionals start talking. Opening packages of sterile material and metallic boxes… and a loud noise present! It even bothers me, to imagine what the patients feel, them, who besides being in an unfamiliar situation, are about to enter a deep sleep in a very noisy room too. Sometimes it’s necessary to ask for silence… for the sake of all of us and to provide the comfort our patients need.

Environmental and psychosocial comfort are essential factors in the operating theatre. Environmental comfort concerns the environment, conditions and external influences, which should be controlled, where possible, by the operating theatre staff.

The client should be respected in his/her holistic context at any time during the intraoperative period. At any moment of care the nurse should pay attention to the details that influence the client’s comfort. There is nothing concerning the patient’s comfort that is small enough to be ignored. I remain aware that comfort is a desirable outcome in nursing interventions and that comfort provides gains in the human responses of the person who needs it. It is the nursing interventions that help to provide the conditions (physical, psychospiritual, social and environmental) of excellence necessary for an efficient performance, so that all the human responses of that person to the stimulus that will be submitted (anesthesia and surgery) are balanced and allow a good intraoperative homeostasis. It becomes essential to be aware of patient’s comfort in all phases of perioperative care (Wilson and Kolcaba, 2004). More and better comfort measures minimize adverse complications and reduce anxiety levels (Sadati et al., 2013; Potter et al, 2014). Comfort is a state subject to positive or negative changes very abruptly. Because of that, conscious and wise interventions are urgently needed.

And now the time has come to awaken the patient. What to do? Provide the best possible comfort conditions, the best technical conditions and knowledge we have. And then make them very comfortable in their bed. Good recovery!!!

About Carla Alexandra dos Santos Pacheco

I’ve been an operating room nurse for 19 years and from the beginning until today I’ve always made it a point to protect the person in my care. It was beautiful to see, read and feel much of what I put into practice daily in the theories of comfort described by Katharine Kolcaba.

This reflection was carried out in the Curricular Unit of Nursing Theories during the Master’s Degree in Nursing in the Institute of Health Sciences of the Portuguese Catholic University (Lisbon) under the pedagogical supervision of the Professor Zaida Charepe (PhD, Associate Professor).