The field of orthopedics involves the ongoing care and support of those patients experiencing acute bone trauma or chronic bone diseases. It also involves medical treatment and pain management of patients who must undergo surgeries, such as joint manipulations, repairs, or replacements. The nursing care which supports this practice must address all needs which may arise from that repair or other treatment rendered by the physician.
Specialized technical skills, accurately defined interventions, therapeutic nurse-patient communication, positive caregiver attitude, and effective continuity of care are important in the overall care provided by the effective orthopedic nurse (American Society of Registered Nurses, 2008). As an orthopedic nurse, I feel that there is one nursing theory which clearly addresses all of those concepts necessary throughout the provision of high-quality care to my patients. Katherine Kolcaba’s Theory of Comfort identifies comfort of the patient as the focus of nursing care.
It defines comfort as different forms and contexts which require specific interventions. It also analyzes the effects of certain variables, such as communication and knowledge, upon the effectiveness of the comfort state. Kolcaba views comfort as a holistic state which involves the physical and mental well-being of the patient. Appropriate nursing interventions are offered by Kolcaba in order to provide that comfort they. (Current Nursing Organization, 2011). Overview of Practice Setting New Albany Surgical Center is a surgical orthopedic facility which is located in a suburb in central Ohio.
Approximately 20 to 25 orthopedic surgeries are performed daily, five days a week. The facility contains 52 inpatient beds set aside for those patients who are admitted for a few days after hip and knee replacements for teaching and rehabilitation. The population served by this facility is adult, with most of the patients being over 55 years of age. Approximately two-thirds of these patients are over the age of 65. Most of the patients appear to be lower to middle class economically, and either retired or on disability. There is an equal distribution of male to female ratio and the majority of these patients are Caucasian.
Although many of these patients come from the surrounding suburban area, a few patients come from a small Appalachian area in the southern part of the state. Nurse’s Role in Selected Setting I am employed as a Staff Nurse in the inpatient department of this facility. As a Registered Nurse, I am responsible for receiving the post-operative patient from the post-operative department after orthopedic surgery. The main focus for my patient is pain management through ongoing assessment and evaluation. I strive to meet the physical and mental needs of both the patient and family.
I continuously evaluate treatments that I render to the patient to monitor effectiveness. I also report any problems that may occur to the physician so that alternative treatment can be ordered, if necessary. Ongoing teaching is done throughout the patient’s hospital stay so that the patient is optimally prepared to eventually be discharged home or to a rehab facility. Appropriateness of Choice of Nursing Theory According to Kolcaba’s Comfort Theory, humans elicit holistic responses to complex stimuli (Nursing Theory Organization, 2011).
Those responses require interventions by the nurse which address those responses in an equally holistic manner. The in-patient setting within the surgical orthopedic unit seems to exemplify the perfect setting in which to utilize those concepts. Minimizing pain in the post-surgical patient is the main focus of the surgical orthopedic nurse. With pain as the opposite of comfort, the focus of Kolcaba’s theory also seems to be the elimination of the patient’s painful state. In the in-patient environment, the four contexts in which comfort occurs can be easily assessed, adjusted, and manipulated as necessary.
The origin of the patient’s pain is more obvious, so that the interventions utilized to minimize that pain are easily evaluated. Orthopedic nursing interventions are easily exemplified according to the particular form of comfort addressed and the specific context of those needs. The taxonomic structure of the comfort theory is well-suited and easily-applicable to this environment. Relief of pain, or that state in which a certain comfort need is met, can be obtained in the physical context by the administration of a narcotic for the surgical pain.
Relief can be attained in the psychospiritual state through compassion or encouragement by the nurse. Relief in the environmental context is possible through repositioning or back massage. Sociocultural relief is obtained by patient or family members through the nurse offering information or providing education. Ease, or a state of contentment, can be obtained by elevating an edematous extremity. Psychospiritual ease can be accomplished by assisting the patient with deep breathing or by requesting a Chaplain to visit the patient.
Environmental ease can be achieved through music therapy and distraction (Current Nursing Organization, 2011) Transcendence describes that state in which the patient can be removed from the various problems of pain. Physical transcendence can be elicited when the nurse coaches the patient through a painful period. Psychospiritual transcendence is achieved when the nurse provides safety and support to the patient. Environmental transcendence is achieved through the provision of quiet and privacy, when necessary.
Sociocultural transcendence is achieved when the patient is able to practice religious rituals and practices without barriers (Merkel, 2007). Relation of Theory to Nursing Metaparadigms Kolcaba’s Comfort Theory involves assessing the patient to address and evaluate the patient’s comfort needs. Ongoing assessment of treatments provided should be re-assessed for effectiveness, and readjusted as needed. The comfort needs of the patient should be assessed in the four contexts in which comfort occurs. Those contexts are physical, psychospiritual, environmental, and social.
The three different forms of comfort (relief, ease, and transcendence) are, therefore, more fully addressed in relation to those contexts (Kolcaba, 2003). As an orthopedic staff nurse, implementation of the nurse care plan as the patient arrives on the unit is essential to meeting the patient’s comfort needs. Subjective assessment is done by the nurse by asking the patient his level of pain, according to the 0-10 pain scale. Objective assessment is accomplished through direct observation by the nurse, such as vital sign measurements, or auscultation of bowel sounds.
According to Kolcaba, the patient is the needful recipient of nursing care. Other groups or individuals, however, can also be considered recipients in need of that care. On the orthopedic unit, the post-operative patient is obviously the main focus of attention by the nurse. The patient’s family, however, is also in need of comforting interventions such as understanding, education, and therapeutic communication. Through inclusion of the patient’s family in the comfort process, the patient receives additional beneficial effects of holistic treatment (Kolcaba, 2003).
Another nursing metaparadigm in Kolcaba’s Comfort theory denotes the patient’s external environment as an essential aspect to be considered during the provision of comfort. If necessary, that environment is subject to manipulation by the nurse in order to provide optimum care (Kolcaba, 2001). The orthopedic bedside nurse should utilize all of the tools that are available to him or her in order to enhance the comfort state of the patient. Those environmental tools include, not only the physical aspects of a patient’s room, but also those hospital policies which may suggest further tools to provide further comfort.
Dimming the lights in the patient’s room, controlling the noise level on the unit, or even the usage of aroma therapy may enhance the comfort experience of the patient (Merkel, 2007). Process to be Instituted When Implementing Change Assimilation of the concepts of Kolcaba’s Comfort Theory into a specific practice setting will definitely improve the quality of patient care and patient outcomes of that unit. Care must be taken to properly implement these concepts so that disruptions are kept to a minimum. Enlisting various staff members to serve as resource persons will help to keep all staff on the same page.
Education of all staff should be conducted through frequent staff meetings and learning sessions. Chart audits should be conducted to ensure that all staff is compliant with learned protocol. Communication of concepts and protocol to all staff should be accomplished through clinical discussions, bulletin boards, and practice sessions (Merkel, 2007). According to learning theories, new ideas are best assimilated into nursing practice in a contextual manner (McEwen & Wills, 2011, p. 368). The theoretical concepts to be integrated should be applied in the specific way in which it is to be utilized.
For example, concepts proven to be effective in patient teaching should be gradually and creatively introduced to the learner. Providing new information too fast may result in frustration and ultimately in failure. Evaluation of the information being learned and eliciting feedback from the learner of the usage of those concepts will assist in providing further teaching and correction, if needed (McEwen & Wills, 2011). Description of Greatest Learning In completing this assignment, I have learned much about this relevance of comfort in the overall framework of nursing care.
The provision of comfort can actually be considered the foundation of all nursing interventions which support optimal health of the patient. Prior to analyzing Kolcaba’s Theory of Comfort, I also did not realize that the provision of that comfort can be accomplished through very many forms. Those forms are adaptable to various situations and venue. The success of those applied interventions is determined upon the patient’s perception of optimal health and as it relates to the patient’s specific needs.