1. The COMFORT Framework: An Initiative for a Narrative Nursing Practice Kimberly Frier

2. The COMFORT Initiative Authors: Elaine Wittenberg-Lyles, PhD; Joy Goldsmith, PhD; Sarah L. Ragan, PhD Working with: Betty Ferrell, PhD, MA, FAAN, FP CHPNCN Purpose: Nursing Communication Curriculum Propose a Narrative Nursing Practice Origins:Biopsychosocial Model Narrative Medicine/Narrative Competence Communication Theory Rationale:Believe in a Narrative Nursing Practice Practice Narrative Nursing Believe this communication focus improves patient/family outcomes & improves clinician collaboration

3. COMFORT ( ACRONYMN) C OMMUNICATION O RIENTATION & OPPORTUNITY M INDFULNESS F AMILY O VERSIGHT R EITERATIVE & RADICALLY ADAPTIVE MESSAGES T EAM

4. RELATIONSHIPS CONCEPTS INTERRELATED ACRONYM DEVELOPED FOR NURSING COMMUNICATION CURRICULUM NARRATIVE MEDICINE/NURSING PRACTICE INCORPORATES ACTIVE LISTENING TO STORIES (NARRATIVES), HEARING THE MEANING BEHIND THE WORDS, IDENTIFYING THE EMOTIONS EXPRESSED IN THE STORY, INTERPRETING THE MESSAGES, AND REFLECTION AND RE-AUTHORING THE STORY DEPENDING ON THE SITUATION REQUIRES MINDFUL SELF MONITORING; INCLUDING OPENNESS, CURIOSITY, USE OF SELF INCORPORATES PRESENCE/WITNESSING

5. ASSUMPTIONS Nursing Education is deficient in required communication curriculum Nursing needs collaborative communication skills A Patient-Centered Approach aligns nursing & patients needs & values Narrative competence is an exemplar of a patient-centered approach Patient interactions are a complex relational process A Narrative Nursing Practice champions relationships between clnicians, patients, family, and teams to create a collaborative environment for integrated care Collaborative environment for integrated care creates improved health outcomes and shared decisions with patients and families.

6. COMFORT MODEL

7. COMFORT CONCEPTS

8. CRITICAL REFLECTION ClarityComplexityGenerality in ScopeAccessible Significance/Practic al Communication, Family, Team are reasonably clear 7 major conceptsBroad Measurement tools for some aspects of communication skills IOM report for Quality Outcomes; Emphasis on Patient-Centered Care/Communicatio n 2 sub concepts of health literacy & presence Communication in clinical practice Orientation & Health Literacy have initial clarity Quite complex Change in nursing practice? Amount of talk; eye contact; clarification of understanding/kno wledge; ability to adapt to changes in interaction Narrative Medicine emphasis; Narrative competence to develop empathy Needs simplicity Mindfullness, Oversight, Reiterative messages requires more definition/explanati on Authors may change the title of some concepts or combine Shared decision making Concepts need qualitative/explorat ory research to better define measurement Nursing presence Collaborative relationships Mindfulness practice Holistic care

9. CONCLUSION/QUESTIONS