Week 11

Comfort

Learning Objectives

1.Describe and list factors that affect comfort.

2.Explain common physical assessment procedures used to evaluate comfort of patients across the lifespan.

3.Identify priority comfort assessment findings.

4. Differentiate normal comfort assessment findings from abnormal findings.

5. Explain the process for assessment of comfort.

‘Comfort’

*Think about what the word means to you…

Is comfort more than being pain free?

Is comfort only related to the physical body?

Is pain more than physical?

Comfort is much more than the absence of pain…

Comfort Defined:

to give strength or hope to, and to ease the grief of

Comfort is:

the immediate experience of

being strengthened by having needs for

relief, ease, and transcendence (exceeding

usual limits: surpassing) met in four contexts…

Physical

Psychospiritual

Social

Environmental

Psychospiritual- psychological growth and

spiritual attunement

Nurses must assess and promote comfort in all areas,

not just pain relief;

consider the pain of loneliness, fear, loss, and grief.

Lack of rest and sleep can be ‘painful’, and can also wear

down one’s tolerance to pain, creating a vicious cycle

Assessment of comfort…

Pain (Discomfort)• An unpleasant sensory and emotional experience associated

with actual or potential tissue damage (American Pain Society 2003;Gordon, 2003)

• Physical and emotional

• Subjective

• Plays protective role

• Fifth vital sign

• Pain is whatever the experiencing person says it is, existing whenever he/she says it does (McCaffery & Pasero, 1999)

• Relief of pain is a client right

Quick Review of Vital Signs:

*Temperature *Pulse *Respirations *Blood Pressure *Pain Level

Pain is Subjective:perceived by the person

experiencing it; thisperception may be based on prior

experiences

Young children may not have a frame of reference because they have little

experience with pain

Ethnic and cultural values and practices can effect a persons

perception and reaction to pain

People from one culture may have learned to be expressive about pain, whereas people

from another cultural background may have learned

to keep those feelings to themselves and not bother

others.

We all feel pain but may respond differently.

Nurses need to be non-judgmental and become knowledgeable about cultural differences in response to

pain.

Assessment Interview:What do we ask?

To determine the location of pain in the body

Ask: “Where is your discomfort?” or

“Where are you having pain?”

Location Descriptors:Classification of pain based on where it is, may be useful in determining underlying problems or needs.

*Location of pain is very important to note!

•Radiation of PainSpreads or extends to other areas of the bodyExample: Low back pain extends to legs

•Referred PainAppears to arise in different areas of the bodyExample: Cardiac pain may be felt in left shoulder or left arm.

“0” to “10” Scale:

Intensity:

“On a scale of 0-10, with “0” representing no pain and 10 representing the worst pain you have experienced, how would you rate

the degree of discomfort you are having right now?”

Standard 0-10 Scale1-3 = mild pain

4-6 = moderate pain7-10 = severe pain

More on Intensity:

•Categories–Mild–Moderate–Severe

•Somatic– close to surface (skin)

•Visceral- deep (organs)

•Neuropathic– damaged nerves

Important for the nurse to attempt to make the description of pain as

objective and measureable as possible.

(This allows a baseline for assessing improvement)

Wong-Baker FACS Rating Scale:Useful when working with children and

non English-speaking patients

Inspection:What do you see? Many things are

not as they appear, some are more obvious and look painful.

Palpation:may be used if safe and

appropriate

Character/Quality of pain:“Describe how your discomfort/pain feels.”

Is it:

•Burning

•Stinging

•Sharp

•Dull ache• •Deep

•Throbbing

•Cramping

Pattern:

When did or does the pain start? (Onset)

How long have you had the pain or how long does it last? (Duration)

Do you have pain-free periods? When, and for how long? (Frequency)

Types of Pain:

*Acute

*Chronic

Acute Pain:*Sudden onset, usually temporary,

localized has an identifiable cause, less than

6 months

•Warns of actual or potential injury to tissues

•Recurrent Acute Pain-Migraines , Sickle Cell crises

Chronic Pain:*Prolonged pain, usually lasting longer

than 6 months

Examples:•Lower back pain•Neuralgias•Cancer pain•Chronic postoperative pain

Referred Pain Sites

Precipitating Factors:What triggers the pain or

makes it worse?

Alleviating Factors:What measures or methods have you found helpful in lessening, or

relieving your pain?

(ice, heat, rest, elevation, acupuncture, medication)

Associated Symptoms

Do you have any other symptoms before, during, or after your pain?

(nausea, vomiting, dizziness, blurred vision, aura, shortness of breath,

etc.)

Effects of Pain on Activities of Daily Living

(ADL’s)…

*Pain affecting ADL’s often creates discomfort in other areas of a persons life

How does the pain affect your daily life?

*Eating*Working*Sleeping*Bathing*Socially

*Recreational Activities

Past Pain Experiences

“Tell me about past pain experiences you have had and what was done to relieve the pain?”

“How does this pain compare to the other pain experiences you have had?”

Meaning of Pain

“What does having this pain mean to you?”

“Does it signal something about the future or past?” (often goes to fears which may influence seeking of care)

Examples: “My mother died after having pain like this, I don’t want to know if I am going to die. I am afraid to find out.”

“I’ve been cursed”, or “I’m a bad person”. “God is punishing me.”

Coping Resources•“What do you usually do to help you deal with the pain?” (People use all kinds of things.)

*Acupuncture *Alcohol *Tens Unit *Illegal Drugs

(The longer a person is in pain the less tolerant of it they become.)

The following tables and boxes in your text should be read and

studied in preparation for the Final Exam…

Nurses promote comfort and rest in many ways; not just by giving pain medication!

End of Life Comfort As a nurse you need to understand your

own feelings about death, dying and comfort measures. (Ethical issues may arise.)

End of Week 11