Unrelieved Pain: Kolcaba’s Comfort Theory

Unrelieved Pain: Kolcaba’s Comfort Theory

            The knowledge of the different theoretical frameworks is critical for nursing practitioners when choosing the types of interventions to apply in improving the quality of care and patient outcomes. The grand, middle-range and nursing practice theories help the nurse to discover new and creative ways of transforming patient care. The adaptation of the constructs and concepts of nursing theories to the different nursing situations facilitates effective responses to the everyday healthcare issues affecting individuals, families and the society. Katharine Kolcaba developed the Theory of Comfort, a middle-range nursing theory, to help nurses to deliver and evaluate patient comfort effectively and consistently. The theory considers that the delivery of holistic nursing care should involve the deliberate assessment of the patient’s comfort needs, the design and implementation of evidence-based comfort measures and the ongoing reassessment of the applied interventions (Smith & Parker, 2015). It describes three types of comfort and the multiple contexts in which comfort occurs. The types and contexts of the comfort are interrelated and must be addressed simultaneously for the nurse to meet the patient’s comfort needs. Although the Comfort Theory is applicable to many clinical settings and situations, the theory has found the greatest application in the delivery of palliative care. The examination of the problem of unrelieved pain among terminally-ill patients, its impacts on the concerned persons and the application of the Comfort Theory in resolving the problem is critical to the delivery of holistic palliative care.

Unrelieved Pain

            Unrelieved pain affects a considerable percentage of patients with progressive life-limiting conditions. According to Marie (2013), the problem affects more than 40 percent of the patients in the intermediate and advanced stages of terminal illnesses. About 30 percent of cancer patients who have completed treatment suffer chronic pain. According to Reis-Pina, Lawlor and Barbosa (2017), more than 20 percent of the cancer patients with chronic pain are undertreated. The main concern in the management of chronic pain in terminally-ill patients regards the application of a multidimensional approach that goes beyond the standard pharmacological interventions.

            The concept of unrelieved pain is important to the comprehensive assessment and management of the distressing symptoms in patients at the end of life.  The stubborn pain hinders the patient’s response to treatment and accelerates the disease progression. The patients with untreated or undertreated pain cannot transition into the comfortable and dignified end-of-life stage. The unrelieved pain not only affects the recipient of the palliative care but also his family and the healthcare providers. The misdiagnosis and mistreatment of pain worsen the patient’s physical, psychosocial and spiritual distress. It increases the likelihood of the onset or reoccurrence of negative thoughts and feelings that influence the patient’s perception of the irrelevance of the applied interventions and noncooperation with the palliative care providers.  Unrelieved pain has adverse effects on the health and wellbeing of the patient’s family. Watching a parent, sibling or child in constant pain and suffering causes grieve, feelings of helplessness and hopelessness and anger and resentment towards the palliative care providers. The patient’s unresponsiveness to pain causes anxiety, frustration, stress, depression and burnout by the health care providers (Dahlin, Coyne, & Ferrell, 2016). These negative feelings and experiences hinder the nurse’s ability to make an objective assessment of the patient’s needs and design and implement the appropriate interventions. The challenges of developing pain management interventions are worsened by the weakening relationship between the nurse and the patient’s family. This outcome hinders collaborative decision-making and supportive approaches.

Application of Comfort Theory

            The Theory of Comfort emphasizes the provision of deliberate, systematic and judicious relief, ease and transcendence in the physical, psychospiritual, sociocultural and environmental contexts. The nurse should implement three categories of comfort interventions upon the identification of the patient’s comfort needs. These interventions are the standard comfort, coaching and comfort for the soul (Snowden, Donnell, & Duffy, 2014). The Theory of Comfort provides a great guide for the assessment and management of unrelieved pain in terminally ill patients. The nurse should conduct the systematic identification and assessment of the comfort needs of the patient with the obstinate pain. The healthcare provider should use the taxonomy of comfort needs to develop a comprehensive list of all the patient’s needs and concerns. The pain assessment should entail the determination of the location, intensity, duration and nature of the pain and other associated factors and symptoms. The nurse should use the Brief Pain Inventory (BPI) to develop a multidimensional perspective on the pain. Some of the baseline needs of the patient with unrelieved pain include the relief of the physiological and psychospiritual distress and the provision of social support and a therapeutic physical environment.

            The assessment of the comfort needs should guide the applied pharmacological and non-pharmacological interventions. The primary comfort interventions for the patient with unrelieved pain should offer physical and psychological relief and comfort for the patient. The nurse should use the multimodal analgesia approach to enhance the outcomes of the pharmacological interventions through the blockage of pain at the different locations along the pain pathway. A combination of an NSAID, opioid and Paracetamol enables the healthcare provider to maximize the benefits of the different mechanisms of action of each drug in pain control (Marie 2013, p. 3). The drugs should be administered at the given intervals until the pain is relieved. On the other hand, the non-pharmacological interventions should include the CAM modalities of pain management. The nurse should combine mind-body practices, manipulative body-based practices and the manipulation of energy fields.  These strategies help to calm, comfort and empower the distressed patient. They include techniques such as muscle relaxation, yoga, meditation, massage therapy and acupuncture. Furthermore, the nurse should support physical contact between the patient and his family and friends. The non-pharmacological techniques support the patient’s ability to cope with the pain and suffering and embrace a peaceful death by giving meaning to their experiences and life (Moore, 2013). The third element of the comfort interventions is the provision of comfort for the soul. The nurse should apply the therapeutic use of the self to comfort and calm the patient. She should also provide a therapeutic physical environment through creative means such as pictures, paintings and music.

 Conclusion

            The effective diagnosis and management of unrelieved pain are critical in the delivery of holistic palliative care. The Theory of Comfort provides theoretical propositions that the palliative care nurse can adapt to the management of unrelieved pain. The types, contexts and categories of comfort described by the theory highlight the need for a multidimensional pain management strategy that includes pharmacological and non-pharmacological interventions. The interventions should be guided by the ongoing assessment of the patient’s comfort needs. This theory application paper has helped me to understand the importance of the therapeutic use of the physical environment in managing patients’ pain. This aspect of nursing care seems to have been neglected in traditional healthcare settings.  Additional research on the importance of the therapeutic physical environment in helping terminally-ill patients transcend their painful memories and experiences is crucial.