REFLECTION OF KOLCABA'S THEORY 2 Abstract The purpose of this paper is to reflect on how Kolcabas Theory of Comfort can be used to create an interdisciplinary care approach for end-of-life and palliative care. It is important as nurses to understand the importance of providing quality care for the patient and the family throughout the end of life process. As a result of this assignment, I found that Kolkabas theory is a good theory to use during the end of life process. The specific strategies described, which include physical, psychospiritual, sociocultural, and environmental, helps determine what the patients and families need in terms of end of life care. After determining what the patient needs, the nurse can develop a plan to provide quality care beyond expectations. I have learned from this assignment the importance of viewing the patient and family as a whole and being culturally competent. During this time, nurses need to put their views aside and do what is best for the patient. REFLECTION OF KOLCABA'S THEORY 3 Reflection of Kolcabas Theory of Comfort The purpose of this assignment is to reflect on how Kolcabas Theory of Comfort can be used to generate a care approach for end-of-life and palliative care. Throughout this reflection, I will describe strategies that empower patients and families particularly related to Kolcabas theory. Next, there will be a reflection on skills needed to engage patients at the end of life. This paper will then discuss planning, implementation, and evaluation care specifically related to end of life. Finally, there will be a reflection of Kolcabas Theory using the LEARN approach. Knowledge The Theory of comfort describes specific strategies to empower patients and families at the end-of- life. Kolcaba and DiMarco (2005), defines comfort as "the immediate state of being strengthened through having the human needs for relief, ease, and transcendence addressed in four contexts of experience (physical, psychospiritual, sociocultural, and environmental)" (p. 187). A taxonomic model was created to use a more holistic approach to ensure that the needs of patients and families were being met by first identifying the need, then designing interventions to meet the need, and lastly determining if the interventions were effective. Kolcabas Comfort Theory looks at three behaviors in which human needs are addressed, which include relief, ease, and transcendence. According to Kolcaba (2005), relief is the state of having your pain mitigated or alleviated (p.187). Ease is the absence of specific discomfort, and transcendence is the ability to rise above discomforts when they cannot be avoided (p. 187). The three behaviors are part of a holistic model that guides care for patients and families at the end of life. When looking at the theory of comfort, Kolcaba then uses those behaviors in combination with four general contexts, which include physical, environmental, sociocultural, and KOLCABA'S THEORY OF COMFORT 4 psychospiritual. The physical context applies to bodily sensations and homeostasis, for example, pain. The psychospiriutal context refers to the awareness of self, esteem, sexuality, and the meaning of life. Environmental looks at the external background of human experience. Light, noise, and temperature have a huge impact on how a person feels. The last context, sociocultural, looks at the interpersonal, family and societal relationships, family traditions, and rituals. Each of these contexts is an important part in the comfort of patients and families when dealing with death and the dying process. Skills By understanding the knowledge behind Kolcabas Theory, I will now discuss the skills needed to engage patients and their families to promote health, safety, and transcendence throughout the end of life. The three skills that Kolcaba highlights include: comforting, coaching, and providing technical care. Each of these care methods is crucial in order to provide the best care for the patient and their family. The first technique for empowering the patient and their family during end of life is technical care, which includes repositioning, monitoring symptoms, and preventing complications. An example of using this skill would be giving the patient Zofran when nauseous. Giving the patients medications for their symptoms in a timely matter makes them feel better and shows the patients and the families that you care about them. When patients are dying, they can sometimes feel short of breath, which is very uncomfortable. Giving the patient oxygen will decrease the discomfort of the patient but also make it easier for the family. Technical skills are very important in the dying process, it makes a huge difference in the way the patient dies and also how the family perceives their death. KOLCABA'S THEORY OF COMFORT 5 Coaching is another technique discussed by Kolcaba. This skill discusses the importance of listening, providing reassurance, encouraging, and creating a plan for optimizing health (Kolcaba 2007). According to Puchalski (2002), It is our responsibility to listen to people as they struggle with their dying. We need to be willing to listen to their anxieties, their fears, their unresolved conflicts, their hopes, and their despairs (p. 290). Communication skills are important for quality end-of-life care. While learning general communication skills, such as therapeutic listening, has been common in nursing education, learning specific communication tools, is imperative at the end of life stage. In a study conducted by Shannon, Long-Suttehul, and Coombs (2011), the tools that were most effective in assisting nursing: Ask-Tell-Ask and Tell Me (p.124). To explain this a little better, the Ask-Tell-Ask phrase reminds nurses to carefully assess concerns before imparting information. The Tell Me provides a tool for encouraging dialogue in challenging situations. Using therapeutic communication skills along with asking questions and encouraging dialogue will encourage patients and families to engage in the care being provided, which is essential. Comforting is the last technique that I will discuss. This technique can be used with patients and their families to empower them by promoting health, safety, and exceeding their expectations when dealing with an end of life event. For patients and families coping with end of life, spirituality has a big impact. According to Puchalski (2002), Spirituality helps people find hope in the midst of despair (p. 290). Spirituality may be one way to provide comfort, some other ways include: making the patient feel cared for, the environment, message, encouragement, and the connection with the patient and family.
KOLCABA'S THEORY OF COMFORT 6 Attitudes To provide quality care at the end of life nurses must have a good attitude about palliative care. It is important as a nurse to view things through the patients eyes and respect and encourage individual expression of patient values, preferences, and expressed needs. It is not the nurses position to judge or create conflict. According to Cronenwett et.al (2007), the QSEN competency of patient centered care recommends that nurses seek learning opportunities to educate themselves about the end of life process and to accommodate individuals based on their views. Part of the nursing attitude is to recognize that patient expectations influence outcomes in management of pain or suffering. It is the goal of the nurse when providing patient cantered care to disregard their own views if needed to meet the needs of patient and family (p. 123). Reflection Looking back and reflecting on this assignment, I realize that I did not know very much about end of life care. I have not had much experience with dying and how to handle it, but after researching the Kolcaba theory, I now feel like I have the skills and knowledge that I can incorporate into my nursing practice. As I was completing this assignment, I thought a lot about how I would want my family members to be treated going through the end of life process. I feel like this assignment has helped me acknowledge that the care is not only provided to the patient but is equally important to provide care for the family. This was a challenging assignment for me because there are so many aspects of end of life care and I wanted to include everything. Each person is very different, so the care nurses provide needs to be tailored to each individual and family. After researching the Kolcaba theory, along with other nursing journals, I feel confident in providing care to end of life patients and their families by treating the individual in a holistic KOLCABA'S THEORY OF COMFORT 7 manner and using the skills I discussed above to provide quality care. I feel that every situation is going to be different, and I have to use the skills that I have learned to provide patient centered care. Kolcabas theory was very useful in teaching me the knowledge and skills to provide end of life care, I think I just need more hands on experience. The advantage of using Kolcabas theory to communicate patients needs is useful because it takes a holistic approach and touches on every need. I liked how she looked at the physical, psychospiritual, environmental, and sociocultural aspects of care. That gives a more rounded approach when caring for end of life patients. When communicating to an interdisciplinary team, there is an advantage of using a theory because other people of the interdisciplinary team can understand the concepts that provide quality care to patients and families. When nurses apply Comfort Theory, they competently consider in a compassionate way, the uniqueness and complexity of each whole patient within the context of the family system. Thus, the theory offers a proficient way to guide care and communicate to the interdisciplinary team the interventions that work. By having nursing knowledge, you can educate others about the importance of using holistic care at the end of life. I think that if nurses are more compassionate about patient care and the attitude of the nurse will carry over to others. Kolcabas theory includes a wide spectrum of ways to comfort patients and families. Revision of care depends on the individual and what is important to them. When dealing with the end of life process, in the future, I will use Kolcabas theory to empower patients and families. Conclusion By implementing Kolcabas theory, a nurse can effectively provide patient centered care to end of life patients and their families. Using a holistic approach is very important because KOLCABA'S THEORY OF COMFORT 8 everyones needs are different. By assessing needs, implementing a plan, and evaluating the outcomes a nurse can provide quality care that will have a huge impact on the patient and family.
KOLCABA'S THEORY OF COMFORT 9 References Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P.(2007). Quality And Safety Education For Nurses. Nursing Outlook, 55(3), 122-131. Kolcaba, K., & DiMarco, M. A. (2005). Comfort theory and its application to pediatric nursing. Pediatric Nursing, 31(3), 187-194. Puchalski, C. (2007). Spirituality and the care of patients at the end-of-life: an essential component of care. OMEGA: The Journal of Death and Dying, 56(1), 33-46. Shannon, S. E., Long-Sutehall, T., & Coombs, M. (2011). Conversations in end-of-life care: communication tools for critical care practitioners. Nursing in Critical Care, 16(3), 124- 130.