Contributor: Marta Yarynych
I have worked in a cardiothoracic surgery intensive care unit for about five years. Every day patients are admitted to my team in their immediate postoperative period. Since this is a specific intervention area, each patient can have a different clinical evolution. Fortunately, the vast majority have a linear postoperative course and are discharged to the ward 3 to 4 days after admission to the ICU. When I decided to make this reflection, I chose to address the issue of comfort because I believe it is not only about physical comfort.
According to Kolcaba, the person/family is subjected to various situations in their daily lives and may develop different needs that, in turn, may compromise their well-being. Nurses should identify these needs and intervene by formulating a care plan through the nursing process (Berntzen et al., 2020). Usually, from the first admission, patients are already aware of all the surrounding dynamics. They find themselves confined to a bed from one moment to the next. In addition to all the characteristics of an ICU (lights, alarms, noise, cold), these patients observe other patients in the next bed whose clinical situation may be opposite to their own. The patient was sedated, ventilated, and had complex life support equipment. Inevitably, there is always this coming together of realities in the same physical space. For health professionals, it ends up being a routine because they are already used to having patients of different levels of complexity. But for patients, this confrontation with reality can cause stress on several levels, not only because of their health situation but also because of their perception of the whole environment surrounding them. That said, it is very likely that the patient will not only experience pain due to the surgery and other medical devices. Being in a strange, heavy, noisy environment will cause them different feelings that compromise their comfort.
On the other hand, their autonomy and self-awareness may be compromised. That is why Kolcaba refers in her theory to three states of comfort: relief, tranquility, and transcendence (Smith, 2020). The latter is directly related to 4 different contexts that may affect each state of comfort: environmental, psychospiritual, physical, and sociocultural (Kolcaba, 2007).
According to Faria, Pontífice-Sousa & Gomes (2018), patients may experience several negative feelings that result in discomfort. To this end, nurses must be able to provide care directed not only to physical but also to psychological discomfort (Kolcaba, 2007). According to (Berntzen, Bjørk, Storsveen, & Wøien, 2020), a better understanding of the discomfort in patients admitted to an intensive care unit may help to intervene early and reduce patient suffering.
But what about practice? Do nurses consider other aspects related to comfort than physical pain? In my professional practice, I often observe that comfort is mainly associated with physical pain and comfort regarding body position. The patients in my ICU are primarily elderly, and culturally they are afraid/ashamed to express feelings that may cause discomfort even if they are comfortable. Often, they say they don’t want to be in “trouble.” There are situations in which, only in the presence of the family, it is possible to perceive that the patient has doubts about his clinical condition, regarding the procedures that have been or will be done, and issues related to hospital discharge.
In short, I feel that there is a lack of more profound reflection on the subject by nurses. I observe a more worrying approach with pathophysiological disturbance. Of course, knowledge focused on the patient’s pathophysiology is essential, but caring for the whole person means providing care beyond that. Establishing good communication and getting to know patients better should be as important as performing a particular procedure. Asking if the patient is in pain is insufficient. Ensure appropriate analgesia and make the patient comfortable while resting. Interact with the patient to understand their anxieties and concerns. Encourage him to collaborate in the care while promoting his self-knowledge, self-care ability, and confidence/potential in problem-solving. As a result, it also decreases fears/anxiety about his health situation. Thus, the lovely view has to adopt a holistic style. I believe that complete wellness is the key to a successful recovery.
Berntzen, H., Bjørk, I. T., Storsveen, A.-M., & Wøien, H. (2020). “Please mind the gap”: A secondary analysis of discomfort and comfort in intensive care. Journal of Clinical Nursing, 29(13–14), 2441–2454. https://doi.org/10.1111/jocn.15260
Silva Faria, J. M., Pontífice-Sousa, P., & Pinto Gomes, M. J. (2018). Comfort care of the patient in intensive care – an integrative review. Enfermería Global, 17(2), 477–514. https://doi.org/10.6018/eglobal.17.2.266321
Smith, M. C. (Ed.). (2020). Nursing theories and nursing practice (Fifth edition). F.A. Davis Company.
Kolcaba, K. (2003). Comfort theory and practice. A vision for holistic health care and research. New York: Springer publishing company
About Marta Yarynych
I have been a nurse since 2017 and am work in an intensive care unit at a University Hospital in Lisbon, Portugal. I have been attending the Master’s course in critical care nursing since September 2022 at the Health Sciences Institute of the Portuguese Catholic University (Lisbon). This post was created in the curricular unit of Nursing Theories under the guidance of Professor Zaida Charepe (PhD., Associate Professor).