Application of Katharine Kolcaba comfort theory
Capstone project
The paper focused on alternatives for the use of sitters in the care of patients, especially those suffering from delirium. Being the capstone project, the focus was on assessing the outcome and patient improvement for the patients that were managed by bedside sitters. There have been several challenges with the use of bedside sitters as some health practitioners have attributed it to slow progress.
Bedside sitters are individuals employed in the hospital facilities to help patients out with their basic care especially for those with chronic long-term conditions (Corella et al.,2017). They ensure continuous monitoring and assessment of the patients and thus they are on the side of the patient to help them out with whatever they might want.
They support the patients and aid them in performing some basic functions like walking and moving around the facility as many of them experience challenges with that. They are hospital caregivers who provide patients with companionship and care for those that require it. They have been applied in healthcare to replace other aspects of healthcare such as restraints, seclusion rooms, and any other measure for dealing with challenging patients such as delirious ones. Some of their main roles include; maintaining patient’s care records, ensuring that they maintain and adhere to the hospital’s policies and regulations, ensuring optimal supervision of patients at all times, assessing their vital signs and providing them with emotional support, detecting any slight changes in the condition of the patients, and alerting the nurses and physicians in case of the changes happening.
Delirious patients are the patients that suffer from delirium. It is a neurological and mental condition that causes disruption in the mental abilities resulting in confusion and reduced awareness of their existing environments. The patients present with symptoms of reduced concentration, easily distracted, poor response to their environment, poor memory, poor thinking, incoherent speech, and inability in writing or speaking. Bedside sitters play the role of the management of the patients as well (Schoenfisch & Pompeii 2015). They are trained volunteers while other are employed as part of the staff by administration. Being, a common condition especially for the elderly, delirium results in declined functional abilities, and increased mortality and morbidity. Delirious patients are at increased risk of hospital falls and poor patient outcomes.
There are various approaches in the management of delirium with some being treatment of reversible conditions and addressing patient’s and care factors. A major approach for the management and prevention is constant observation (CO) which entails continuous monitoring and safety and wellbeing of the patients. The bed side sitters play the role of CO for the care of the ill.
Clinical significance
Even though many of the facilities have applied the bed side sitters in caring for their patients, there has been continuous need for other strategies to improve their management due to various reasons. One of the challenges with their integration in patient care is an increase in the cost of care. Compared to the traditional models of management, bed side sitters are expensive. Even though they have been used in monitoring and prevention of patient falls, the significance is marginal as patient safety outcomes have not yet been met and still remain clinically insignificant.
Various studies have demonstrated that the use of sitters in management of psych and delirious patient to be a costly and ineffective way of patient management. Instead of using technical sitters as part of the management, it was best to apply the trained medical professionals and nurses in caring for the patients (Wood et al.,2018). Thus, the change and improvement would relatively significant. The reason for that is many of the facilities have used family members as part of the sitters to manage the patients.
Some facilities have majorly relied on the bedside sitters leading to shortage of the nurses ultimately. One of the main strategies that have been applied to the reduction of the sitters is the Patient Attendant Assessment Tool (PAAT). Through the use of PAAT there has been a decrease in patient falls and improvement of the outcomes without necessarily using the bedside sitters (Burtson & Vento 2015). Application of nurses as sitters has also had some negative effects that led to deterioration of care. The number of nurses is usually low in almost all facilities and thus, when they are used as sitters some of the patients lack the necessary treatment and care they require as there is a reduction in the nurse patient ratio. Some of them are forced to work overtime as sitters which result to increased work hours and less for rest. They end up making more medical errors which can result to severe outcomes for the patients that they care for. The overall satisfaction of the patients is reduced with increased demand for the nurses.
Theoretical framework
The Comfort Theory is a nursing theory that was developed by Katharine Kolcaba in the 1990s (Kolcaba 2015). The theory is a middle range theory developed for education, health practice, and research. The concept of middle range theories was developed by Meleis through her PhD and masters. They basically explained the transition from one life to another. Through her interest and study on the immigrants, Meleis developed an interest in transition (Im 2014). She tried to study and explain human transition and how all humans experienced their transitions. She conceptualized transition as a core part of nursing. The middle range transition theories were hence developed through research and the study of the human populations.
The main role played by the middle range transition theories is the explaining of the human transition and describing their experience during transition depending on the type. The basic assumption of the type of theory is that all nursing phenomena undergo a certain type of transition (Im 2014). Some of the transitions that are undergone in nursing are developmental transitions such as pregnancy, motherhood, and fatherhood; health and illness transitions for example admission to critical care and discharge from healthcare facilities; situational transitions like emigration, and organizational transitions such as changes of hospital administrations.
The main role of nursing in middle range transition theories is that it is responsible for facilitating effective transitions. Additionally, each and every transition theory should have specific characteristics that determine its actual genre. Some of the main characteristics include; the type and pattern of transition, properties of the transition experiences, the transition conditions both, the inhibitors and facilitators, the indicators of the process, outcome indicators, and therapeutics.
According to Kolcaba’s theory, nursing has the ability to maintain comfort in the frontline of healthcare. In her theory, she explained that comfort in health is achieved through three forms; ease, relief, and transcendence. Additionally she explained that there are four contexts that determine aspect of healthcare. They include; physical, environmental, sociocultural, and psycho-spiritual (Kolcaba 2015). For relief the theory explains that all patients require alleviation of pain and symptoms. Thus, nurses administer analgesics to patients suffering from pain and other forms of discomfort. The issue of ease is addressed through other perspectives of patient discomfort. Whenever patients feel anxiety, they become relentless and worried about the outcome of their condition. When the problem is addressed through reassuring, they feel free and satisfied and hence they become comfortable. Transcendence is brought about the changes that they experience through management and treatment. Once they start recovering and detect changes in the disease process, they feel satisfaction which guarantees better outcome for all who are sick.
Healthcare needs are those identified by the patients and their families and not as addressed by the healthcare practitioners? In the theory, patients are all individuals, families, institutions, and organizations that are in need of healthcare services (Loannou et al.,2018). The environment is any form of surrounding for the patient and their families that enable modification by the nurses and health professionals thus enabling promotion of their comfort. Hence the state of health is the optimal state of function ability and well-being as defined by the patients and their families.
The theory explains several key elements of nursing and health according to the issue of comfort and attainment of optimum health.
She explains the intervening health variables as factors that are not likely to change even with the participation and contribution of healthcare workers. Some of the variables may include; social support, financial support, prognosis, and environmental factors. Health seeking behaviors have been defined as behaviors and habits by the patients and individuals in an effort to identify health factors. Institutional integrity is the value, attributed financial stability, and completeness of all healthcare organizations at the local, regional, state, and national levels.
Based on the theory of comfort, nursing is all about care of the patient and the ill. Kolcaba describes the profession as the process of assessing the patient’s needs, and then developing and implementing the nursing care plan for the patient, and evaluating of their comfort and satisfaction once the interventions have been implemented. Thus, the bed side sitters are required for assessing and assuring of the patient’s comfort by supporting them in basic care needs. However, based on theory, not all sitters can manage the roles of the nurses as the patients require one who is able to provide comprehensive assessment of their needs, and formulate a proper plan of action. Once the listed interventions are put into practice, the comfort is a guarantee for all of them. Assessment should be both subjective and objective. Only qualified nurses have the ability to identify and recognise the immediate patient needs. Sometimes they may overinflate them and other times they end up not realising the urgency of their needs. For male patients, they like to display their manhood through ignoring some of their pressing matters just to ensure that they do not feel weak and vulnerable. Bed sitters are aides who have been trained whereas others may be volunteers or even family relatives. For hospitals that use their nurses as their bed sitters, there may be adverse effects as there may be experienced shortages. This study tries to consider other alternatives that could be applied instead of using the bedsitters in healthcare. They are mostly used for the mentally ill patients and those with dementia because they require continuous surveillance.
Through the history of nursing, theories have been used to answer questions about the nature, mission, and the goals of nursing. The various visions have been used in the development of theories of nursing. By the year 1990, there was great advancement in the theories leading to the development of middle range theories such as Kolcaba’s Comfort Theory. Through continuous study and research there have been several shortcomings that were identified for grand and middle range theories (Im & Meleis 1999). They have limitations in describing, explaining, understanding, and providing for the explanation of diversities in client’s views and attributes to certain nursing phenomena. Middle range theories have far more assumptions when it comes to the generalization and universalization. Additionally, they overlook some aspects of the patients that the nurses may encounter including the cultural, socio-political, and historical contexts.
Based on the various approaches, the comfort theory has not explained some considerations that may be attributed to specific patients because of their background. Basically they do not guide the patients in caring for the various patients’ diversities (Im & Meleis 1999). Even with the application of the theories, not all nurses who interpret the data in the same manner and thus, the theories should incorporate that in their consideration.
Application of the theoretical framework
The use of bedsitters in healthcare has become a common practice with no significant effects. They are individuals that facilitate the recovery and management of patients in the hospitals. Such patients are those suffering from delirium. Through their support and active participation in patient monitoring, prompt recovery of the patients is guaranteed. However, there are several challenges that have been attributed with bed side sitting hence the need for developing new strategies for coming up with the best alternatives to replace bed side sitting.
According to the conceptual framework for Kolcaba’s comfort theory, the first step of the process is the identification of the patients’ needs. Being bedridden or suffering from dementia, the patients require close monitoring to prevent accidents. Thus, the patients have required someone to watch for them and guide them through self-care and ambulation. The comforting intervention has always been the use of bedside sitters in health facilities. However, due to increased cost and reduced benefits, another method of management was applied as the intervention.
One of the primary alternatives that were identified in trying to manage the issue of bed sitters was use of the PAAT (Burtson & Vento 2015). Based on the assessment tools for the patients with comfort needs, there were various alternatives that may be considered and applicable. They include the use of personal alarms, movement of the patients that require bed sitters closer to the nursing stations, using of beds side rails, considering lowering of the beds with mats that can be used better to prevent falls, family involvements, review of the medications, decreasing overstimulation of the patients and promoting more rest with anxiety alleviation, prompt assessments especially for infections such as urinary tract infections (UTI), involving them in diversional activities to prevent excess physical activity, and mitts.
There are various intervening variables affecting the implementation of the new PAAT tool. The PAAT is a care tool that is used by the nurses to follow up for the patients that requires continuous monitoring. The nurses are allocated each patient for care within their 8hrs of their shift thus there will be no need for bed side sitters. While they conduct their day to day routine at the hospitals, they ensure that they keep monitoring their respective patients. The tool must be completed every 8hrs that they are on shift. Bed sitters are costly to maintain in the healthcare institutions hence many organizations are working towards their elimination in hospitals. Application of the care tool has indicated that there is maintenance of quality care and patient safety even without the application of bed sitters.
With the application of the observation PAAT tool, the patient comfort is achieved as the qualified nurses tend to their needs. They keep surveillance of their movements and progress while under management. Additionally, they monitor progress and make relevant changes regarding to the patient prognosis.
In management of delirious patients, the health seeking behaviors are affected as they cannot actively participate. Nurses have to ensure that they take responsibility and ensure that they help manage their health risk behaviors. For the management it should comprise of practices that help promote health and prevent illness. That should also involve the management of terminally ill patients and promotion of pain care and palliative care. Patients who cannot recover are catered for by the nurses ensuring that they promote good end of life care.
When considering the application of the new form of management, there was need for considering the various hospital policies and regulations. Many private institutions chose to use the sitters even when we educated them on the importance of integrating nursing care with patient monitoring.
Visual depiction and description
Summary
Bed side sitters are individuals employed by hospital institutions or who volunteer to take care of patients by offering continuous monitoring and surveillance. The commonly managed patients are those suffering from mental health illnesses and dementia. Hence, it is common for the aging patients in general wards and nursing care homes. Bed side sitters ensure that they attend to all their needs and support them through their daily activities including ambulation. However, there have been current studies that have been focused on the benefits and the shortcomings of applying bed sitters at the hospitals. Even with their application, there has been no significant improvement on patient safety and outcomes as expected in many organizations. Thus, there has been need for other alternatives to employ in managing such patients.
The Comfort Theory is a theory by Kolcaba that focuses on the importance of ensuring patient comfort at care facilities. It is a middle range theory just like most of the nursing theories that was developed in the 1990s. It is built on the idea of helping nurses with the best approaches for managing patients based on their particular needs. Instead of the use of untrained bed side sitters, nurses have applied the PAAT, a tool that ensures simultaneous monitoring of the patients requiring surveillance as well as conduction of their daily nursing care to other patients. With qualified observation, the outcome for the patients is definitely guaranteed.
References
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