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To some observers, comforting patients, as in this fictional example, may seem secondary to treating their injuries. But Dr. Janice Morse believes it can be vitally important to their survival. "Trauma care terrifies patients," she says. "The importance of studying comfort provided by nurses cannot be overemphasized, since success in providing comfort means that care can be provided quickly and safely, resulting in less stress and risk to the patient."
The U of A Heritage Senior Scholar and qualitative health researcher has set out to detail what she calls an essential relationship between nurses and their patients. She has amassed hours of videotaped scenes like the one above as part of a study to explore the strategies nurses use to provide comfort, their experience of providing comfort, and the patients' experience of seeking comfort. Data is being collected by videotaping nurses at work in emergency rooms, and by interviewing patients, their relatives, and nurses involved in the comforting process. So far, 175 cases of trauma at three sites, two in the U.S. and one in Canada, have been recorded. Dr. Morse and her team will analyze these tapes frame by frame, then compare them with trauma situations in which patients do not have a nurse to comfort them.
When their research began, Dr. Morse and her colleagues were quick to realize that it wasn't comfort they needed to study. Rather, it was states of discomfort, relieving discomfort, and comforting that needed to be examined. "Florence Nightingale said, 'When the patient is comfortable you have no need of a nurse.' So in a sense, it was ridiculous for us to study comfort. Comfort is our goal." she explains. Dr. Morse initiated her research on comfort in Edmonton in 1989. She has continued her efforts at Pennsylvania State University over the past six years. Now, thanks in part to AHFMR support, the New Zealand native has returned to Alberta to complete the work she started almost nine years ago.
Nurses gear their comforting methods to a particular situation or patient state. For example, Dr. Morse has discovered that patients and even their loved ones go through two states in a traumatic situation enduring and suffering. In an enduring state, people will steel themselves, often by holding back emotion, to deal with pain or bad news. In contrast, people in a suffering state will be very emotional and outwardly distressed. It's critical for nurses to adjust their comforting methods to respond to each of these states. Using the wrong method at the wrong time may have dire consequences.
Dr. Morse tells the story of a trauma nurse who used a suffering approach on a man who was in an enduring state. To illustrate her point, "A man was pacing outside of a trauma room in which his daughter was being treated for injuries she suffered when she fell out of a tree. It was very noisy inside the room. His daughter was crying and shouting, and her father couldn't stand being in the room. The nurse approached him and said, 'Hugs are free here,' meaning, 'If you want sympathetic support, it's okay. I'm here for you.' He promptly fainted. This quite big man just crumpled to the floor. He was trying to hold himself together, and her approach just did him in. So this is what comforting is all about, identifying the needs of the person you are trying to help."
Dr. Morse has also identified and developed a new concept called "compathy" that accounts for a nurse's ability to share the pain experience. This insight helps nurses to assess the patients' pain without their having to verbally report on it. "It is critical to the comforting process. It is what motivates nurses to alleviate their patients' discomfort." An example of compathy is couvade, where a husband experiences his wife's labor pains.
Compathy can, however, be a two-edged sword. In some instances, nurses may be overwhelmed becoming nauseous or faint when their senses are assaulted with the odour or sight of horrific injuries. When this happens they may not be able to provide comforting. "Nurses who work in burn units, for example, may have to block out the compathetic response so that they can do their work, but they may also lose that part of care which makes them treat the patient as human. This may be harmful to patients. When the compathetic response is blocked, the caregiver sees the patient as an object and not as a person," Dr. Morse explains. With experience, nurses learn how to use or block the compathetic response as necessary.
Seasoned nurses use a range of comforting strategies to aid patients. These are usually learned informally by trial and error as they gain experience. Comforting may involve touch, eye contact, and comfort talk a form of speech that is loud, high-pitched, and usually in a sing-song tone that's used to help the patient maintain control. It may be used to convey caring comments, or to distract, inform, or reassure patients.
Dr. Morse hopes to construct a model of providing comfort that can be used in nursing education. "The notion of comforting is becoming very complex. It's not pillow fluffing. Comforting is the very heart of nursing." She is quick to add that providing comfort is not a role limited to nurses. "We recognize that the concept is a relevant one for all health disciplines which are involved in providing direct care to patients, and that the resulting theory will have application in multidisciplinary settings."
Dr. Morse is a leading qualitative health researcher in North America. She was recently awarded the highest honor in nursing research, the 1997 Baxter Foundation Episteme Award. Dr. Morse is currently working on a book entitled Comfort and Comforting, which she hopes will be used to teach comforting to nursing students.
Dr. Morse is a Heritage Senior Scholar and Director of the new International Institute for Qualitative Methodology, Professor in the Faculty of Nursing, U of A, and Adjunct Professor, School of Nursing at the Pennsylvania State University. In addition to AHFMR support, Dr. Morse receives funding for her work from the National Institute of Nursing Research, NIH, and the Medical Research Council of Canada.
To find out more about comforting, please check the following website:
http://www.www.ualberta.ca/~iiqm/
| CUTTING EDGE RESEARCH |
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| It would have been difficult to suppress
Dr. Janice Morse's wide grin at the recent opening of the International Institute for Qualitative Methodology. Like an expectant parent, she had spent several months anticipating and preparing for the birth
of the first institute of its kind in North America.
The highly sought-after qualitative health researcher had been successfully recruited back to the University of Alberta from Penn State last fall to set up the IIQM, of which she is director. It officially opened its doors in Edmonton in late February thanks, in part to a $400,000 AHFMR grant. Located in the University's Extension Center, the Institute has been intentionally designed to mimic the open atmosphere of a library. It is hoped this layout will help to promote interaction between researchers from varied disciplines using such diverse qualitative methods as ethnography, narrative inquiry and phenomenology. Many are predicting the IIQM's high-calibre personnel will quickly earn it an international reputation. Dr. Martha Ann Carey, the Institute's first fellow, hails from the Public Health Service, Washington, D.C. She seized on the chance to spend time working at the IIQM and says that many of her American colleagues are eager to do the same. "There is a tremendous amount of potential for the type of work the Institute supports." Along with providing support for ongoing research projects, the IIQM will offer research training and mentoring in the form of seminars, university lecture series, internships, workshops, and yearly conferences. It will also be home to the Qual Institute Press, which publishes outstanding dissertations as well as Qualitative Health Research, an international, multidisciplinary journal for the health sciences. A simultaneous virtual opening over the Internet broadcast internationally, including the IIQM's five international sites Newcastle, NSW; Australia, Sao Paulo-SP, Brazil; Seoul, Korea; Utrecht, The Netherlands; and Johannesburg, South Africa highlighted the Institute's advanced information technology capabilities. It is intended that students from these sites will be taught online. Although less than three months old, the Institute has already attracted a great deal of interest. "There is a tremendous demand for qualitative research, but at present there are not enough resources available to meet that demand, " says Dr. Morse. She hopes in the days to come the Institute will correct the shortfall. To find out more about programs at the IIQM, please check the following website: http://www.www.ualberta.ca/~iiqm/ |
Quick Reference of Contents:
Best Cartoon | A Study in Nerves | Genetics in Sight
Genetics at Work in Sight Test | Links for Sight | Getting to the Heart of Nursing
The Waiting Game | AHFMR in the Community | SEARCH Profiles