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Thursday, September 6, 2012

Comfort Theory and the GLBT Community

Turquoise Running. Image © Alice Merkel.

Comfort Theory for GLBT
By Kathy Kolcaba RN, MSN, PhD, TheComfortLine.com

Pondering the role of Comfort Theory for GLBT teens and adults: a response to the New York Times Editorial, Sept 2nd, 2012 by Frank Bruni, Excluded From Inclusion.

Bruni begins his column by commenting on the politics of exclusion, which he saw in full force at the recent Republican Convention. Being gay himself, he was acutely aware that of all the speakers who were invited to speak, no one was openly gay, nor were policies that would include gays and lesbians mentioned. When Bruni asked a fellow gay Republican about this, the response was “Our messaging within the party has been: if you can’t say anything nice, don’t say anything at all.”

The columnist continues, “But that’s not progress enough. Silence does nothing for gay and lesbian teenagers racked with self-doubt about what the world has in store. “ So I decided I would no longer remain silent about what I think is a very helpful instrument constructed by one of my graduate students nearly 15 years ago.

This student came to me with a passion to focus her dissertation of the plight of the gay, lesbian, bisexual, transgender (GLBT) community. She was a nurse and a counselor, and now was seeking the PhD degree, an important credential for a counseling career. She adapted my General Comfort Questionnaire for the GLBT population, which then could be used for assessment, intervention (when indicated), and evaluation of what works. She then conducted an instrumentation study in which the GLBT Comfort Questionnaire proved to be very strong psychometrically. You can see her brief summary of results by clicking on this link: http://www.thecomfortline.com/resources/cq.html Scroll down to Instruments created by others and look for the one currently titled “Self Comfort With Sexual Identity Questionnaire.” (I will ask my web master to change the title to the GLBT Comfort Questionnaire). When analyzing data, please use total scores (higher scores indicated higher self-comfort).

After her successful defense, I urged my new PhD nurse to publish her story – she had done extensive background research, which demonstrated the need for such a questionnaire for GLBT folks of all ages, especially for those who were having difficulties in “the world.”  

For nurses and counselors, a measure of which interventions worked to increase comfort in the GLBT client should be very helpful.  As a tool to measure the success of  strategies to prevent discrimination or judgment, this questionnaire could be used to compare self-comfort across GLBT populations some of whom were exposed to innovative policy changes.  A psychometrically strong questionnaire could be used across high school or college campuses or even across state lines. In a just society all people with a sense of compassion will need quality data to support the GLBT community, or any community,  in the quest for basic civil rights.

Alas, my new PhD nurse did not follow through with an article or an official publication of her valuable questionnaire. Immediately after graduation, she allowed me to post it on my web site, Comfort Line, and I let it go at that. She stopped answering my communications, and then I felt I had no further recourse…

But now I have a professional blog, on which I can post some of my current thoughts about applications of Comfort Theory. I hope this time around, this wonderful GBLT questionnaire gets a wee bit more traction.

 - Kathy Kolcaba

Find, Friend, Follow, and Share Comfort Is Strength Links!
·      Website http://www.comfortisstrength.net
·      Facebook https://www.facebook.com/ComfortIsStrength
·      Klout http://klout.com/kathykolcaba
·      The Comfort Line http://thecomfortline.com/
·      You Tube

Copyright 2012 Katharine Kolcaba, RN, MSN, PhD. Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works. The Comfort Line, Chagrin Falls, Ohio 44022.  E-mail: kathykolcaba@yahoo.com Phone: 440-655-2098 Web: http://thecomfortline.com/ 

-Betsey Merkel, Comfort Is Strength Communications

Friday, June 29, 2012

Comfort Theory & Peaceful Death

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Ordinary. Image © Alice Merkel.  
Take Me To The Oklahoma City Cars Set on Flickr.

Comfort Theory & Peaceful Death
By Kathy Kolcaba RN, MSN, PhD, TheComfortLine.com

Response to the New York Magazine article, A Life Worth Ending

      "I have very strong feelings about a peaceful death - and before I get as bad as this poor mom in the article you linked me to, I have decided to just stop eating and drinking ANYTHING once I receive a terminal prognosis and feel my capacities deteriorate at a rapid pace. I will gather my family about me, and try to make them understand that I highly value escaping a long, no-exit, agonizing death.  I want to spare them watching me helplessly and wasting scads of money. I have experienced, through relatives of mine and my friends, this kind of death.

     I want loved ones to remember me as a vital force, not as a helpless and dependent shadow of myself. There is a solution. It occurs when one decides to stop eating and drinking.  It takes two weeks to die this way, no one has to assist, and hospice will help (if there is a terminal disease with advancing symptoms). This is my exit strategy, my legacy, - to die as I lived, making my own decisions with love and peace while I still am able.

      My mother is 91 and I am her "care manager." I worked professionally in this capacity for about 10 years, and we always strove for some kind of peaceful death in our clients (most of whom were in their 90's). Thus, I pray my mother dies "suddenly," in her home, in her easy chair, or while sleeping. 

     She, however, does not seem at all ready to do this - as she investigates every new sensation in her body with a doctor visit (she arranges her own transportation with her vast repertoire of helpers). She is extremely frail physically, extremely sharp mentally (occasionally sharp-tongued too). She can barely walk, although she manages pretty well in her own home with minimal assistance in the mornings. She is quite hard of hearing, and nearly blind. 

     And yet, she now states that her advance directives, which I had her fill out about 15 years ago, are only if she is "terminal." So there you are.

     Perhaps my generation will wise up a bit to how we really want to die and to prepare our families to honor and respect our wishes. It helps that I am a nurse. It helps that I am a former care manager. 

     Most of all, it helps that I have been thinking about the comfort of my family and myself for a long time. And for me, comfort is planning for my own peaceful death one way or another."

- Kathy Kolcaba, Comfort Theory

Find, Friend, Follow, and Share Comfort Is Strength Links!
·      Website http://www.comfortisstrength.net
·      Klout http://klout.com/kathykolcaba
·      The Comfort Line http://thecomfortline.com/
·      You Tube

Copyright 2012 Katharine Kolcaba, RN, MSN, PhD. Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works. The Comfort Line, Chagrin Falls, Ohio 44022.  E-mail: kathykolcaba@yahoo.com Phone: 440-655-2098 Web: http://thecomfortline.com/ 

-Betsey Merkel, Comfort Is Strength Communications

Wednesday, June 27, 2012

Sharing Best Practices in Comfort Theory For Certified Registered Nurse Anesthetists (CRNA)

 
Color of Sharpness. Image © Alice Merkel
Social Media Conversations Accelerate Knowledge Sharing 

Erin Carline RN BSN CCRN hosted Sharing Best Practices in Comfort Theory For Certified Registered Nurse Anesthetists (CRNA) on Monday June 25, 2012.

Following Erin's presentation of The Comfort Theory for Certified Registered Nurse Anesthetists (CRNA) at the Goldfarb School of Nursing at Barnes-Jewish College in St. Louis, Missouri to 25 nurse anesthesia and nurse practitioner classmates, everyone enjoyed a quick Twitter conversation with Katharine Kolcaba, RN, MSN, PhD, author of Comfort Theory and Practice: A Vision For Holistic Health Care And Research. 

We've posted the conversation thread below:
Sharing Best Practices in Comfort Theory For Certified Registered Nurse Anesthetists (CRNA)


How do you apply Comfort Theory to your patient centered care? Post your comments below this article - we'd like to hear from you! 

Find, Friend, Follow, and Share Comfort Is Strength Links!

Copyright 2012 Katharine Kolcaba, RN, MSN, PhD. Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works. The Comfort Line, Chagrin Falls, Ohio 44022.  E-mail: kathykolcaba@yahoo.com Phone: 440-655-2098 Web: http://thecomfortline.com/ 

- Betsey Merkel, Comfort Is Strength Communications

Sunday, June 24, 2012

June 25, 2012: Comfort Theory Conversations With Dr. K!

Kathy Kolcaba visits Miami Children's Hospital May 2012 to bring Comfort Theory to the very tiniest of patients! Take Me To The Flickr SlideShow
Best Practices In Comfort Theory For Strength

The Comfort Theory for Certified Registered Nurse Anesthetists (CRNA) by Erin Carline RN BSN CCRN will be presented at the Goldfarb School of Nursing at Barnes-Jewish College in St. Louis, Missouri on Monday June 25, 2012.

Following Erin's presentation to her class of 25 nurse anesthesia and nurse practitioners, she will lead an interactive Twitter conversation with Katharine Kolcaba, RN, MSN, PhD The Comfort Line on Comfort Theory for improved CRNA practice. (More details below.)
  • LIVE CHAT: Mon June 25, 2012 at 5:15pmCST/6:15pmEDT to 5:45pmCST/6:45pmEDT
  • THROUGH THE WEEK: Dedicated conversation with Dr. K
Scroll For Your Twitter Instructions Below 
 
We look forward to sharing and learning more about your insights and innovations in health care through the lens of Comfort Theory!

Check back next week for the Comfort Is Strength summary and follow-up article! 

Find, Friend, And Follow Comfort Theory Community Links Below!

Copyright 2012 Katharine Kolcaba, RN, MSN, PhD. Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works. The Comfort Line, Chagrin Falls, Ohio 44022.  E-mail: kathykolcaba@yahoo.com Phone: 440-655-2098 Web: http://thecomfortline.com/ 

- Betsey Merkel, Comfort Is Strength Communications 


Monday, April 16, 2012

Women Are Watching: Guarantee Access To Women's Healthcare

Design Reflection. Image © Alice Merkel Photography 
From The Savannah Set on Flickr.
Guarantee Access To Women's Healthcare

How can uninsured and underinsured women in this country possibly be comfortable when they are refused affordable health care services such as family planning, contraception, hormonal therapies, counseling, cancer screening, vaccinations, physical exams, etc?  

How can women be comfortable when forced to carry a pregnancy that resulted from date rape, family rape, incest or that is likely to cause death or serious damage to the mom or fetus?

When and how did these services become the business of politicians, most of whom KNOW that pregnancy prevention and knowledge are the best alternatives to abortion?

Planned Parenthood Services Essential To Women’s Comfort And Strength

I recently attended a local informational meeting to hear Tara Broderick, CEO of Planned Parenthood of NE Ohio (PPNEO) and Ashley Thornton, local organizer who helped dispel myths and explore issues that have been extremely public and controversial this past year. 

They wanted us to know that:
  1. PPNEO started in Cleveland in 1928 as a maternal health center and that remains its primary focus today. 
  2. Nationally, only 4% of its budget (all from private donations) is used for terminating early and unwanted pregnancies. (Their preventive services have radically decreased the need for abortion which is what we ALL want.) 
  3. The rest of Planned Parenthood’s budget (96%) is used for women's health. This part of their mandate is funded by insurance companies, private pay for services based on a sliding scale, and supplemented by limited Federal and state funding most of which will be lost if radical Republicans gain control in their legislative branches. 
  4. For every dollar spent in preventive services to women, a national budgetary savings of $4.00 (per dollar spent) is realized. 
  5. In addition to working to defeat anti-choice legislation at the state level and in DC, Planned Parenthood is working proactively to advance legislation regarding prevention of unplanned pregnancies (SB190/HB281) and promotion of sexual health education in public schools (SB232/HB338).
Planned Parenthood is the Number One provider of health care services to women. Those of us in healthcare MUST advocate for women as we all enter into the political campaign season in earnest. Letters, phone calls, and e-mails to potential voters have the collective power to CHANGE OUTCOMES.  

Empower Our Conversations Around The World

Learning about candidates who support preventive and health services for women is critical, and spreading the word on social media such as Facebook and Twitter will help dispel falsehoods and elect pro-women candidates . 

Follow the "Women are Watching" campaign and/or check out the informative national Planned Parenthood (PPAO) web site. America Votes is another very informative web site.  

As a nurse, it is my ethical obligation to support women in this fight. Can you help me by passing my message along to everyone you know?….

Thank you very much!    
 Dr. K

Find, Friend, Follow and Share Comfort Is Strength Links!


Copyright 2012 Kathy Kolcaba, PhD., RN. Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works. The Comfort Line, Cleveland, Ohio USA. Phone: 440-655-2098 Web: http://thecomfortline.com/

-Betsey Merkel, Comfort Is Strength Communications

Thursday, April 5, 2012

Comfort Applied At Miami Children’s Hospital

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Magnet Redesignation March 21, 2012 
Shown: Miami Children's Hospital Chief Nursing Officer, Jackie Gonzales
and Dr. Kathy Kolcaba during the MAGNET redesignation consultation March 21, 2012. 
Take Me To The Miami Children's Hospital Photo Set On Flickr
Preparing For Magnet Redesignation At Miami Children's Hospital 

Last week I was worked with nurses at Miami Children's Hospital, where dedication to  patients and families was awesome and inspiring. Indeed, I find that working towards Magnet (for more information see American Nurses Credentialing Center (ANCC) Magnet Recognition Program) whether for the first or third award, brings health care workers together and helps them focus on and remember all of the wonderful things they do every day. Blog continues below photos.
 

Recognize and Celebrate Comfort Theory

When they choose Comfort Theory for their journey, they also see that the comforting strategies they employ intuitively, and which mean so much to their “clients, ” are legally
invisible!


The invisibility of comforting strategies was brought home during this visit when I discovered that one of the nurse leaders at Miami Children's Hospital had gotten her MSN (Master of Science in Nursing) and was now close to finishing her Law degree.

Invest  In Comfort Theory For Competitive Advantage 

After discussing with the larger audience of nurses some of their comforting strategies (which were so inspiring), I asked the nurse/lawyer if, legally, any of these strategies were being done. The answer was, of course, “NO,” because there was no place in the patient record to document this type of important nursing work.

This absolutely must change…..and is my goal for every health care institution that utilizes Comfort Theory as its framework for practice.  I always offer lots of suggestions for meeting this challenge, and hopefully, change will begin happening in this arena.

- Dr. K 

Find, Friend, Follow and Share Comfort Is Strength Links!


Copyright 2012 Kathy Kolcaba, PhD., RN. Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works. The Comfort Line, Cleveland, Ohio USA. Phone: 440-655-2098 Web: http://thecomfortline.com/

-Betsey Merkel, Comfort Is Strength Communications

Patient Comfort: Engaging the Full Nursing Arsenal

Response to the NYT Op-Ed Contribution, March 15, 2112, by Theresa Brown, Oncology Nurse. The article is entitled, “Hospitals Aren’t Hotels.” 

Article link: http://www.nytimes.com/2012/0/15/opinion/hospitals-must-first-hurt-to-heal.html 

In this article, Nurse Brown made the observation that questions about “Patient Satisfaction”  fail to reflect the true nature of hospital care, which tends to be (by its nature) “invasive, painful and even dehumanizing.” She goes on to say that “sometimes we cannot give them the kind of help they need” and ends with, “In order to heal, we must first hurt.” 

From my patient comfort perspective, nurses may participate in painful procedures, but the WAY IN WHICH THE PRIOR EXPLANATIONS AND THAT PROCEDURE ARE DONE can make all the difference in the world.  In other words, the expert nurse does both: he or she may deliver a painful chemotherapy, but while doing so holds the patient’s hand, explains what is happening, sometimes distracts,  and always offers comfort and soothing words in order to give the patient a life line. The patient’s needs are acute and pervasive during such procedures, and the best nurses address all of them, including physical pain, immobility, anxiety, terror, depression, dread, hopelessness, or loneliness.  I would hope that NO nurse would become hardened to a patient’s distress, but rather engages the full arsenal of comforting nursing strategies to help patients transcend pain and suffering. For it is these important nursing functions that are the only things that can give our patients hope and courage in the face of extreme stress.

Copyright 2012 Kathy Kolcaba, PhD., RN. Creative Commons 3.0 Attribution-Noncommercial-No Derivative Works. The Comfort Line, Cleveland, Ohio USA. Phone: 440-655-2098 Web: http://thecomfortline.com/

-Betsey Merkel, Comfort Is Strength Communications