Promoting Patient Comfort

Goal: The patient experiences relief from discomfort and/or pain without adverse effect.

1. Perform hand hygiene and put on PPE, if indicated.

2. Identify the patient.

3. Discuss pain with the patient, acknowledging that the patient’s pain exists. Explain how pain medications and other pain management therapies work together to provide pain relief. Allow the patient to help choose interventions for pain relief.

4. Assess the patient’s pain, using an appropriate assessment tool and measurement scale (see Fundamentals Review 10-1 through 10-5).

5. Provide pharmacologic interventions, if indicated and ordered.

6. Adjust the patient’s environment to promote comfort.
a. Adjust and maintain the room temperature per the patient’s preference.
b. Reduce harsh lighting, but provide adequate lighting per the patient’s preference.
c. Reduce harsh and unnecessary noise. Avoid having conversations immediately outside the patient’s room.
d. Close room door and/or curtain whenever possible.
e. Provide good ventilation in the patient’s room. Reduce unpleasant odors by promptly emptying bedpans, urinals, and emesis basins after use. Remove trash and laundry promptly.

7. Prevent unnecessary interruptions and coordinate patient activities to group activities together. Allow for and plan rest periods without disturbance.

8. Assist the patient to change position frequently. Assist the patient to a comfortable position, maintaining good alignment and supporting extremities as needed. Raise the head of the bed as appropriate. (See Chapter 9, Activity, for more information on positioning.)

9. Provide oral hygiene as often as necessary to keep the mouth and mucous membranes clean and moist, as often as every 1 or 2 hours if necessary. This is especially important for patients who cannot drink or are not permitted fluids by mouth. (See Chapter 7, Hygiene, for additional information about mouth care.)

10. Ensure the availability of appropriate fluids for drinking, unless contraindicated. Make sure the patient’s water pitcher is filled and within reach. Make other fluids of the patient’s choice available.

11. Remove physical situations that might cause discomfort.
a. Change soiled and/or wet dressings; replace soiled and/or wet bed linens.
b. Smooth wrinkles in bed linens.
c. Ensure patient is not lying or sitting on tubes, tubing, wires, or other equipment.

12. Assist the patient as necessary with ambulation, and active or passive range-of-motion exercises, as appropriate. (See Chapter 9, Activity, for more information about activity.)

13. Assess the patient’s spirituality needs related to the pain experience. Ask the patient if he/she would like a spiritual counselor to visit.

14. Consider the use of distraction. Distraction requires the patient to focus on something other than the pain.
a. Have the patient recall a pleasant experience or focus attention on an enjoyable experience.
b. Offer age or developmentally appropriate games, toys, books, audiobooks, access to television, and/or videos, or other items of interest to the patient.
c. Encourage the patient to hold or stroke a loved person, pet, or toy.
d. Offer access to music the patient prefers. Turn on the music when pain begins, or before anticipated painful stimuli. The patient can close his or her eyes and
concentrate on listening. Raising or lowering the volume as pain increases or decreases can be helpful.

15. Consider the use of guided imagery.
a. Help the patient to identify a scene or experience that the patient describes as happy, pleasant, or peaceful.
b. Encourage the patient to begin with several minutes of focused breathing, relaxation, or meditation. (Refer to specific information in steps 15 and 16.)
c. Help the patient concentrate on the peaceful, pleasant image.
d. If indicated, read a description of the identified scene or experience, using a soothing, soft voice.
e. Encourage the patient to concentrate on the details of the image, such as its sight, sounds, smells, tastes, and touch.

16. Consider the use of relaxation activities, such as deep breathing.
a. Have the patient sit or recline comfortably and place hands on stomach. Close the eyes.
b. Ask the patient to mentally count to maintain a comfortable rate and rhythm. Have the patient inhale slowly and deeply while letting the abdomen expand as much as possible. Have the patient hold his or her breath for a few seconds.
c. Tell the patient to exhale slowly through mouth, blowing through puckered lips. Have the patient continue to count to maintain comfortable rate and rhythm, concentrating on the rise and fall of abdomen.
d. When the patient’s abdomen feels empty, have the patient begin again with a deep inhalation.
e. Encourage patient to practice at least twice a day, for 10 minutes, and then use as needed to assist with pain management (Schaffer & Yucha, 2004).

17. Consider the use of relaxation activities, such as progressive muscle relaxation.
a. Assist the patient to a comfortable position.
b. Direct the patient to focus on a particular muscle group. Start with the muscles of the jaw, then repeat with the muscles of the neck, shoulder, upper and lower arm, hand, abdomin, buttocks, thigh, lower leg, and foot.
c. Ask the patient to tighten the muscle group and note the sensation that the tightened muscles produce. After 5 to 7 seconds, tell the patient to relax the muscles all at once and concentrate on the sensation of the relaxed state, noting the difference in feeling in the muscles when contracted and relaxed.
d. Have the patient continue to tighten-hold-relax each muscle group until the entire body has been covered.
e. Encourage patient to practice at least twice a day, for 10 minutes, and then use as needed to assist with pain management (Schaffer & Yucha, 2004).

18. Consider the use of cutaneous stimulation, such as the intermittent application of heat or cold, or both. (See Chapter 8, Skin Integrity and Wound Care, for additional information on heat and cold therapy.)

19. Consider the use of cutaneous stimulation, such as massage (see Skill 10-2).

20. Discuss the potential for use of cutaneous stimulation, such as TENS, with the patient and primary care provider. (See Skill 10-3.)

21. Remove equipment and return patient to a position of comfort. Remove gloves, if used. Raise side rail and lower bed.

22. Remove additional PPE, if used. Perform hand hygiene.

23. Evaluate the patient’s response to interventions. Reassess level of discomfort or pain using original assessment tools. Reassess and alter plan of care as appropriate.