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What is Comfort care?


Comfort care

Comfort care is a type of care given to people who are near the end of life and have ceased medical treatment to cure or control their disease, according to the National Cancer Institute (NCI). The NCI, under the National Institutes of Health, is the U.S. government’s primary agency for cancer research. The NCI states that comfort care is aimed at controlling the pain and symptoms of the patient’s disease. By controlling the pain and symptoms, patients can be more comfortable as possible as they near the end of life. End of life care is another term for comfort care that may include palliative care, supportive care, and hospice care.

A study published in the New England Journal of Medicine defines comfort care as a set of palliative care interventions. This set of palliative care interventions aims to provide an immediate relieve of symptoms in a patient who is approaching the end of life. Dr. Craig Blinderman and Dr. Andrew Billings add that these measures are used so that the patient will experience comfort at a faster rate. Other palliative measures like diagnostic or therapeutic maneuvers in the earlier stages of the disease are not considered as part of comfort care.

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What is included in Comfort care?

Comfort care includes physical or personal care, emotional or compassionate care, social, and spiritual care, and bereavement care not only for patients but also for their families including family caregivers, according to the National Cancer Institute (NCI). The NCI states that comfort care may also include palliative care, supportive care, and hospice care.

Palliative care is specialized care to provide medical care for symptoms or along with treatment or therapy to cure a medical illness. Supportive care is aimed at improving the quality of life of patients by preventing or treating the symptoms of the disease and the side effects of the disease treatments. Hospice care is more focused on the care, comfort, and quality of life for patients near the end of life.

What is Comfort care in the hospital?

Comfort care in the hospital is providing care that aims to improve the quality of life of patients who are near the end of life. End of life care skills are needed in hospital practice, according to Dr. Craig Blinder of Columbia University. Dr. Blinder, director of the Adult Palliative Medicine Service, identifies the necessity of basic comfort measures for all clinicians caring for patients with life-threatening diseases.

Comfort care in the hospital is continued to fall in the hands of generalists and specialists, according to Dr. Blinder in his article for the New England Journal of Medicine. He mentions the scarcity of palliative care specialists, accompanied by a workforce shortage projection in the future, presents an added responsibility for generalists and specialists to provide end of life care to dying patients.

What is Comfort care nursing?

Comfort care nursing is defined by the American Nurses Association (ANA) in their revised position statement. The ANA position statement mentions the roles, responsibilities, and opportunities for nurses to provide comfort care for patients at the end of life.

Nurses have several responsibilities, as outlined in the ANA position statement. The first responsibility is to recognize the patients’ symptoms. The patient symptoms and pains must be managed by nurses. Nurses must have the knowledge and skills to do address the distressing conditions brought by the life-limiting illness.

The next responsibility is to take measures within their scope of practice to administer medications. Medications and treatments should benefit the patient in terms of comfort and quality of life.

Another responsibility of nurses in comfort care is to provide other measures for symptom alleviation and pain relief. Symptom alleviation and management must be collaborated by nurses with other members of the health team, including social workers, therapists and counselors. Symptoms may include pain, dyspnea, nausea, constipation, and others.

One more responsibility of nurses is to collaborate with other professionals to optimize the comfort of patients and the understanding and adaptation of their families. Families, especially the primary caregiver should have current and accurate information about the patient’s probability of impending death. Patients must also receive optimal symptom management from the collaboration of nurses with other healthcare medical team members.

The ANA position statement provides recommendations for improvements in practice, education, research, and administration. For practice, nurses must have basic skills in recognizing and managing symptoms, must be comfortable with having discussions about death, must encourage patient and family participation in healthcare decision-making, and must have basic knowledge of palliative nursing.

For education, nurses who practice in secondary or tertiary palliative care must have specialist education and certification. Schools and other medical, and educational institutions must include primary palliative care in their curriculum. Also, basic and specialist End of Life Nursing Education Consortium (ELNEC) must be available. Lastly, advocate for additional education in academic programs that are related to palliative care, including management of symptoms, supported decision-making, and end of life care must be centered on patients and families.

For research, the integration of evidence-based care across end of life care dimensions must be increased. Also, the best practices for quality care for end of life care, including physical, psychological, spiritual, and interpersonal, must be developed. The use of evidence-based and ethical care, and support-decision making for care at the end of life must be supported. The best practices for measuring the quality and effectiveness of counseling and interdisciplinary care of patients and families for end of life decision-making and treatments must be developed. Lastly, research that tackles the relationship between patient and family satisfaction and utilization of healthcare resources must be supported.

For administration, work environments with standards that extends through the patient’s death and into post-death care for families must be promoted. Nursing facilities and institutions that support clinical competence and professional development to help nurses provide excellent, dignified, and compassionate end of life care must be encouraged. A standard of palliative care available to patients and families from the time of diagnosis must be established. Lastly, the development and integration of palliative care services for all in and outpatients and their families must be supported.

How long can a person live on Comfort care?

A person can live in comfort care as long as possible, which is different from hospice care. Hospice care benefits require a certification by the patient’s doctor. The certification must state that the patient will live within the next 6 months or less in order to qualify for the hospice benefit by Medicare. Medicare is a federal health insurance program for people who are 65 years old and older.

The National Institute on Aging (NIA) states that older people with one or more chronic illnesses live for days, weeks, and months. These people with life-limiting illnesses require significant care or comfort care to manage their pain and symptoms. Their pain management and symptoms management needs can come from four areas, such as physical comfort, mental and emotional needs, spiritual needs, and practical tasks.

The physical comfort area includes discomfort issues that are due to pain, breathing problems like shortness of breath and noisy breathing, skin irritation, digestive problems, temperature sensitivity, and fatigue. Mental and emotional needs include the management of mental and emotional distress for patients and their families. Spiritual needs include finding meaning in one’s life, ending disagreements with others, or making peace with life circumstances. Lastly, practical tasks support can be performed to relieve both the patient and their families.

How is comfort care different from palliative care?

Comfort care is different from palliative care through several things. The first thing is that comfort care does not include curative treatment or therapeutic care like palliative care. Palliative care is similar to comfort care in alleviating pain and discomfort, reducing stress, and helping patients achieve the highest quality of life possible.

The second thing is that comfort care is applied from the diagnosis until the end of life. While palliative care is applied at any stage of terminal illness and not just at the end of life, it is also applied to non-life-threatening illnesses.

Another difference of comfort care from palliative care is the intensity of medical care. Medical care in comfort care may be less intensive because the burden outweighs the benefits. Also, patients under comfort care may spend the majority of the end of life with their families and friends rather than their medical doctors or palliative care team.

Does Comfort care include feeding?

Yes, comfort care includes feeding. Feeding alleviates the symptoms of hunger of terminally ill patients, according to a study published by Dr. Robert McCann and others in the Journal of American Medical Association. The study mentions that some patients who are terminally ill needed small amounts of food for alleviation. For thirst and dry mouth symptoms, mouth care and liquid sips were administered to prevent dehydration. However, food and fluid administration beyond the specific requests of patients play a minimal role in providing comfort to patients with terminal illnesses.

On the other hand, feeding using feeding tubes or the use of IV fluids can also be uncomfortable for patients who are at the end of life. Patients who are at the end of life may naturally limit their food and fluid intake because the condition decline and less energy requirements.

Is Comfort care end of life?

Yes, comfort care is end of life care. End of life care is similar to comfort care in providing comfort, quality of life, and dignity. Comfort care helps or soothes the patient who is at the end of life. The goal of comfort care is to relieve suffering and improve the quality of life while respecting the wishes of the dying patient.

End of life care depends on the patient’s preferences, needs, or choices, according to the National Institute on Aging (NIA). The NIA states that patients may want to be at home when they die or at a hospital, nursing home, or medical facility until the very end. Comfort care ensures that both patients and their families’ needs are addressed until the final days of life.

Contact the hospice support team at Specialized Home Care today to learn more about Comfort care.
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