Comfort on a ward for older people.

BACKGROUND: Comfort is often considered to be a central part of nursing, although the value placed on it may have diminished over time. Many views of comfort are expressed in the literature but it still remains a diffuse concept that requires further clarification. Research evidence about older people and comfort is limited, and further work is needed to find out how staff and patients view comfort and how it is achieved in practice. AIMS: This paper reports a study to investigate what comfort means both to older people in hospital and their health care workers. RESEARCH METHODS: Ethnography was the methodology chosen, and data were collected using in-depth interviews with 19 older people and 27 staff members, and 130 hours of participant observation, complemented by additional weekly visits to the study ward. FINDINGS: Three themes were identified: the nature of comfort/discomfort; key determinants of comfort/discomfort; and the underlying factors that influence the achievement of comfort/discomfort. DISCUSSION: In this hospital setting, the focus of nursing on relief of discomfort suggested a tendency to react to problems, rather than proactively to create an environment that facilitated comfort. Staff were aware of ideals of practice but found these difficult to achieve in reality. In this study comfort was not consistently provided, and some ways of working actively promoted discomfort. As comfort is central to nursing and nursing is central to the care of hospitalized older people, it is crucial that practitioners are enabled to fulfil their potential in this area.