The Comfort Theory and Care of Patients in the Perioperative Area: Theory Guiding Practice Allison Kathleen Peters University of Central Florida

Background  Comfort Theory Model Designed by Katherine Kolcaba  Looks at the whole person with emphasis on the manipulation of the environment such as sound, temperature, furniture  Comfort needs occur in the mental and physical contexts of the patient (Kolcaba, 2001)

 Patients that present to surgery are usually anxious  Anxiety produces a physiological rise in catecholamines (raising blood pressure)  Also increases cortisol which causes decreased immunity and healing  Anxiety caused by waiting for surgical procedure can cause feelings of abandonment, fear of anesthesia and of dying (McCance & Huether, 2006) (Gilmartin & Wright, 2008)

Problem  Heightened anxiety can lead to poor surgical outcomes  Decreased healing  Nurses need to recognize anxiety and provide comfort measures

Significance Feelings experienced:  Uncertainty  Relationship between danger or threat  Ambiguousness  Fear Intervention:  Communication  Control of environmental factors (light, noise, temperature)  Patient control (encouraging feedback, using pain scale, control of environment via RN) (Kagan & Bar-Tal, 2008) (Smith & Liehr, 2008)

Specific Aims  Raise nurse awareness of comfort levels  Facilitation of comforting environment through: Physical Needs: Oxygenation, thermoregulation, pain relief Socio comfort: Cultural sensitivity, positive body language, caring Environmental: Orderly, quiet, safe (Kolcaba & DiMarco, 2005)

Theory A nursing art entailed by comforting actions performed by the nurse for enhanced patient comfort Intervention needs to be immediate-time is the biggest threat Focused in nursing Can be duplicated in many different practices (Kolcaba, 2003) (Smith & Liehr, 2008)

Application of the Theory to Clinical Problem  Information given to patient  Patient verbalizes understanding asks appropriate questions  Patient knows what to expect from three perioperative areas  Provision of small comfort measures such as warming  Not warming can lead to complications such as impaired wound healing, increased blood loss, cardiac arrest and increased wound infection (Burger & Fitzpatrick, 2009).

Summary & Conclusion Assisting patient through comfort measures at a very stressful juncture in life No cost to implement comfort measures Increase patient satisfaction scores equals increased revenues to hospital Application of nurse’s knowledge & critical thinking skills Promotes healing Being connected with the patient (Buell, 2008)

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