Therese Dowd

Measuring comfort in caregivers and patients during late end-of-life care:

The purpose of this study was to test several formats of end-of-life comfort instruments for patients and closely involved caregivers. Kolcaba’s Comfort Theory was the theoretical framework utilized. Different response formats for two end-of-life (EOL) comfort questionnaires (for patients and caregivers, respectively), and horizontal and vertical visual analog scales for total comfort (TC) lines were compared in two phases. Evaluable data were collected from both members of 38 patient-caregiver dyads in each phase. Suitable dyads were recruited from two hospice agencies in northeastern Ohio. Cronbach’s alpha for the EOL comfort questionnaire (six response Likert-type format) tested during phase I for patients was .98 and for caregivers was .97. Test-retest reliability for the vertical TC line tested during phase I for patients was .64 and for caregivers was .79. The implications of this study for nursing practice and research are derived from the American Nursing Association (ANA) position statement about EOL care, which states that comfort is the goal of nursing for this population. These instruments will be useful for assessing comfort in actively dying patients and comfort of their caregivers as well as for developing evidence-based practice for this population.

Efficacy of Hand Massage for Enhancing the Comfort of Hospice Patients

There is a need to develop and test interventions for patients near end of life that are comforting, easy to learn and administer, and require little effort on the part of recipients. This experimental study tested the efficacy of bilateral hand massage for enhancing hospice patients’ holistic comfort as measured with the Hospice Comfort Questionnaire (HCQ). We hypothesized that, over 3 time points, patients who received hand massage would have higher comfort and less symptom distress than a comparison group. Participants were randomized into treatment (received the intervention twice weekly for 3 weeks) or comparison groups (received the intervention once at the study’s end). Findings indicated that patients receiving hand massage had increased comfort over time, while symptom distress remained flat in both groups. However, findings were insignificant. Ethical and practical issues experienced in this study are discussed.

Using cognitive strategies to enhance bladder control and comfort.

Compromised urinary bladder syndrome (CUBS), a combination of frequency and incontinence, causes multiple discomforts for community-dwelling adults. A holistic intervention--audiotaped cognitive strategies--was designed to augment the effects of an educational program designed to treat CUBS. CUBS was operationalized with a voiding diary, and comfort related to bladder health was operationalized in a questionnaire. In this quasi-experimental design the outcomes were measured at four time points. Repeated measures multivariate analyses of variance and nonparametric analyses were conducted to assess differences between the two groups. Results indicated that the treatment group had more comfort and improved CUBS compared with the control group.

Comparison of a healing touch, coaching, and a combined intervention on comfort and stress in younger college students.

Three nursing interventions to increase total comfort and reduce stress-related events in young college students experiencing stress were compared. Healing Touch, coaching, and a combination of both, were compared to a waitlist. On comfort and stress, Healing Touch had better immediate results, while coaching had better carryover effects.

Development of the healing touch comfort questionnaire.

This study provided preliminary evidence for internal consistency reliability (Cronbach α = .94) of the newly developed Healing Touch Comfort Questionnaire. Fifty-six Healing Touch (HT) recipients (51 women and 5 men with a mean age of 51) completed the questionnaire. Participants with more than 4 HT treatments had higher comfort levels than those with fewer than 4.

Correlations among measures of bladder function and comfort.

There is a need for standard functional and psychosocial measurements of compromised urinary bladder syndrome (CUBS). Utilizing Kolcaba’s Comfort Theory, the purpose of this study was to assess the psychometric properties and relationships among 8 measures of comfort, status of urinary frequency and incontinence, and quality of life. A convenience sample of 47 persons (45 women, 2 men) ages 25 to 92, who had UI for more than 6 months, was recruited. Data were collected twice with a 2-week interval. We examined (a) 1 measure of the immediate outcome of comfort related to CUBS, (b) 5 measures of UI status, and (c) 2 measures of quality of life. Reliabilities were adequate for all measures. Relationships among variables are presented and discussed. Recommendations are made for measures that detect improvement over time related to first line interventions.

FEMA nurses face "Mission Impossible": remembering Katrina.

Dowd, a faculty member, is a strong proponent for nurses sharing their stories. Millers story about her volunteer experience was so compelling that Dowd challenged her to share it with the nursing community. This story is a demonstration of how a nurse can bring leadership, sensitive interpersonal skills, and a sense of humor to help forge a cohesive and outward looking temporary community. Nurses naturally interact from a paradigm of care and comfort. Miller makes this interaction explicit. The outcome of the journey was a memorable lived experience that brought caring, healing, and comfort to a situation of devastation. It is hoped this nursing story will inspire the reader to try a similar new role or to tell their story.

A cognitive therapy approach to promote continence.

Both urinary and fecal incontinence are frequently occurring problems with costly consequences—physically, emotionally, and economically. General self-management strategies to promote continence, as well as behavioral and medical interventions, are often advocated. In this article, strategies based on a cognitive model are directed toward 2 overall goals: managing cognitions that are largely outside the individuals control while altering those within the individuals control, and improving management of continence with cognitive techniques. This approach expands and supports the behavioral and medical approaches to continence care. Nurses can use this comprehensive approach to increase the likelihood of positive continence outcomes.

The Addition of Coaching to Cognitive Strategies

Urinary incontinence (UI) defined as the involuntary loss of urine sufficient to be a problem (UI Guideline Panel (UGIP, 1992), causes major physical, emotional, and social discomforts that are not often discussed with health professionals. Depression, physical unease, embarrassment, fear of discovery, and social isolation are common discomforts experienced by many persons (Dowd, 1991).