RW: Enacting Comfort Measures

Question 1

Comfort

Answer 1

Sense of positivity and strength characterized by the relief of physical discomfort and integration of positive emotions
- multidimensional, dynamic and transient

Question 2

Providing Comfort

Answer 2

Actions that are mobilized with the intent of easing/alleviating/transcending human suffering

Informed by principles of empathy, compassion and care

Question 3

Factors that influence patient’s comfort

Answer 3

1. Clinical environment (privacy, ambience, space for family, specific amenities, socio-political dynamics)
2. Healthcare Staff (oppression/discrimination, language, self-reflexivity, competence, participation, safety)
3. Family (presence and involvement)
4. Patient (culturally connected, self-comforting strategies, spiritually connected)

Question 4

Practices of Following (enacting comfort measures)

Answer 4

• providing are that is specific to the individual
• practice of listening to, respecting and acting on what we learn about who they are and what they need or want
• paying attention to voice tone, body language, facial expression and gaze

Question 5

Comforting Nurse work

Answer 5

a. necessary touch
b. responsive touch
c. teaching and coaching
d. spiritual care

Question 6

Touch

Answer 6

A powerful nonverbal form of communication that is essential for our survival

• helps us feel connected
• provide us with comfort and security
• make us feel valued, desired, seen

Question 7

the challenge of touch

Answer 7

An uncertain activity, not a universal language with shared meanings

Interpretation can be shaped by age, gender, culture, spirituality, trauma, etc.

Question 8

Considerations for Necessary Touch

Answer 8

a. Touch is never experienced as routine by the person receiving care
b. Explain what you are going to do before you do it
c. Offer, rather than impose touch and wait for patient’s response
d. If touch is going to inflict discomfort, tell your patient so they know what to expect
e. Avoidance of touch can be experienced as acts of isolation and stigmatization

Question 9

Responsive Touch

Answer 9

Can be nurturing, comforting, healing
(i.e. skin-to-skin)

but can also be intrusive, distracting and assaultive

Question 10

Considerations for Responsive Touch

Answer 10

Attentive to follow:
when to touch
where to touch
how to touch
how much to touch
whether to touch at all

Question 11

Patient Teaching and Coaching

Answer 11

Relationship between personalized provision of information and feelings of comfort
Taking what is foreign and fearful and making it familiar and less frightening

Question 12

Reasons for teaching and coaching

Answer 12

• what to expect
• correct misinterpretations
• offer explanations
• promote self-efficacy

a. how to use new assistive device
b. how to engage in ADLs with differently abled body
c. how to manage side effects
d. what is considered medical emergency
e. alleviate anxiety
f. identify worsening symptoms

Question 13

Considerations for Teaching

Answer 13

a. Timing
b. Cues indicating patient readiness
- emotional/psychological, avoidance vs engagement
- physical
- verbal
c. Cues indicating information overload
d. learning styles (different methods)
e. avoid use of jargon
f. reinforce with written materials
g. check-in/teach back
h. be open to the unexpected

Question 14

Spirituality

Answer 14

Involves meaning-making through intrapersonal, interpersonal and transpersonal connection

“what brings one meaning?”

Question 15

Goal of Spiritual Care

Answer 15

• decrease sense of meaninglessness, purposelessness, or hopelessness
• increase sense of relatedness, forgiveness or acceptance

*not about providing answers

Question 16

Sources of Hope

Answer 16

a. meaningful shared relationship
b. feeling delight/joy/playfulness
c. recalling joyous, meaningful events
d. acknowledging/affirming personhood
e. focus on the possibilities of the short-term goal

Question 17

The Power of Ritual

Answer 17

Rituals provide guidance and create space for meaning-making in moments of great pain and disruption

Question 18

Ritual

Answer 18

Practices to forge connections with others, mobilize a sense of hope, forgiveness or acceptance
- may or may not be formal or religious

I.e. singing a song, meditative silence, visiting a special place