Health and Medicine: Comfort care for all

From the following guest editorial (Lin, C. (2010).Comfort: A value forgotten in nursing. Cancer Nursing, 33(6), 409-410.) compose a response to the following: The author suggests that over the last few decades comfort care has been more closely associated with end of life. Is this so or should comfort care be a “substantive need in all aspects of life” as the author proposes? Consider physical, psychosocial, spiritual and environmental areas of discomfort. Are all comforts needs the same? How does the RN develop a plan to meet the comfort needs of all patients? Is it sensible to consider “comfort” as a core of nursing care to be carried out by the RN? Can care of discomfort be delegated? Should it be? Comfort: A Value Forgotten in Nursing Lin, Chia-Chin PhD, RN Author Information Professor, Director, School of Nursing, Taipei Medical University, Taiwan To cure sometimes; to relieve often; to comfort always. -Hippocrates Comfort is an important nursing issue among cancer patients; it remains a substantive need in all aspects of life, and it should be considered an indispensable constituent of holistic nursing care. Kolcaba and Wykle 1 reminded us that comfortable patients heal more quickly, cope better, can be rehabilitated more thoroughly, and die more peacefully than those who are uncomfortable. Unfortunately, it appears that nurses have become reluctant to associate themselves with this concept. In many people's minds, comfort conjures up notions of femininity, weakness, and subservience.2 The word comfort is defined in the Oxford English Dictionary 3(pp533,534) as "A stage of physical and material well-being with freedom from pain and trouble and satisfaction of bodily needs; relief or support in mental distress or affliction; consolation, solace, soothing; the state of being consoled or the feeling of consolation or mental relief. To soothe in grief or trouble, to relieve of mental distress; to console, solace. Strengthening, encouragement, incitement; and succor, support, countenance." The emphasis on comfort and the role it plays in health care has changed in the last 10 decades. From 1900 to 1929, comfort was the central focus and moral imperative of nursing; from 1930 to 1959, comfort was considered a strategy for achieving fundamental requirements of nursing care; and from 1960 to 1980, comfort fell out of favor, to become only a minor aspect of nursing, and was significant only to people who received no medical treatment.2 During the last 3 decades, comfort has been relegated to end-of-life care where it is equated with the simplest aspects of care, which could just as easily be provided by nonprofessional caregivers. Today, as always, comfort remains a substantive need throughout our lives. Comfort is not a novel idea and has been cited by prestigious and influential leaders such as Florence Nightingale.4 In Notes on Nursing, Nightingale 4 wrote in reference to observation: "It is… for the sake of saving life and increasing health and comfort." However, the concept of comfort is still not revived. In nursing literature, discussions have focused only on abstract explorations of comfort, with a particular emphasis on its role in end-of-life care. The assumption appears to be that comfort becomes important when medical treatments become invalid. We all understand that comfort is a fundamental human need, and the provision of comfort is paramount to nursing practice. Ironically, we have thus far found 2 major phenomena drawn from nursing literature regarding comfort. First, most research has focused on linguistic analysis of the concept of comfort, with few efforts directed toward developing the means by which we could actively promote comfort in our patients. Second, comfort has been promoted primarily for end-of-life care, whereas it remains neglected in other areas. Oncology nurses play an important role in promoting comfort for cancer patients. Research efforts that aim at promoting comfort in patients could contribute significantly to the advancement of nursing care, and several studies recently published in Cancer Nursing have shown great potential to influence the role of comfort in nursing. For example, Dodd et al 5 concluded that a home-based exercise program could be effective in relieving cancer-related fatigue in women during and after chemotherapy. Burns et al 6 discovered that therapeutic music videos could be used in adolescents and young adults during stem-cell transplants for the reduction of anxiety. If we had more translational research on comfort care, we would be better prepared to enhance the comfort of our patients. In conclusion, comfort should not be relegated to end-of-life care. There is a powerful need for an increase in translational research to promote comfort in every stage of patient care. When comfort is emphasized in nursing care and when promoting comfort becomes an important core value of nursing, I believe that nurses will gain more respect from their patients, the families of patients, and our colleagues in the field of medicine.