The Concept of Comfort
from the work of Janet Morse, PhD, FAAN, RN

This information is a summary from a presentation by Dr. Janet Morse at the Biennial Sigma Theta Tau International Convention November, 1997.  A more complete discussion may be found in the following article:  Kolcaba, K. (1995). The art of comfort care. Image 27(4), 287-289.

The information presented here is based on an 8 year research project that used both qualitative and quantitative methods to explore to the concept of comfort.   The research involved observing nurses comforting patients in a variety of settings as well as interviews with patients, families and nurses about the concept of comfort.    Dr. Morse asserts that comforting not caring is at the heart of nursing.   After reading this paper come to your own conclusions about this statement.

Comforting is a result of compathy.  Compathy is the nurse's response to patient discomfort arising from physical, psychosocial, and/or spiritual stressors.  It is the physical equivalent of empathy.  The nurse feels another's pain or discomfort.  Initial observations concerning compathy were made in the Neonatal Intensive Care Unit (NICU) where nurse's responses to infants who were intubated and thus unable to vocalize were observed.  The nurses rapidly identified distress and began to intervene using touch and vocalizations. If the infant did not quiet down the nurse continued to try other forms of touch, until the infant quieted or the nurse tried every strategy he knew.

Compathy may overwhelm the caregiver, interfering with the ability to provide comfort. Parents often experience this when their children are ill or injured.   The nurse must occasionally block the compathetic response so he can proceed with necessary but sometimes uncomfortable caregiving procedures.  Shutting out the compathetic response allows the nurse to acknowledge the discomfort and deal with it without being overcome by it.

Not all pain can be avoided. Pain is a concomittant of many procedures for example inserting a naso gastric tube or  an intravenous.  In those instances where discomfort or pain is unavoidable the nurse institutes comforting measures.  Comforting focuses upon reducing pain when possible and enhancing the patient's ability to endure pain or discomfort that can not be reduced or eliminated.   The goal  of comforting is to increase the patient's ability to endure or tolerate pain or discomfort.

How do people get through extraordinary suffering? Dr. Morse found that people in pain focus all their energy on staying in control.  This requires intense concentration and a present-focus.  Nurses can help people endure by implementing comforting strategies. These strategies includes the presence of a single nurse engaging in comfort talk, touch, and face to face contact throughout an episode of acute discomfort.  Comfort talk includes speaking loudly enough to be heard over the other activities in the environment. Using sing-song voice tones, repeating affirmations such as: "it's OK", "You're doing fine", giving information about what is going to happen next, giving commands such as "stay still", "turn over" and caring comments such as "I know it hurts" are all examples of comfort talk.

Dr. Morse's research indicates that comforting must be accompanied by technical excellence. Patients who had nasogastric tubes inserted were studied. When comfort was the primary concern the procedures took longer and patients perceived them to be more uncomfortable.   When the technical expertise was the primary concern the results were similiar. But when comforting behaviors were combined with technical expertise the procedures were completed more quickly and the patients reported less discomfort.

Think about how this concept is useful for your nursing practice?   What are the ways in which you comfort people?