Hospice - Focusing on the word, "Comfort" vs. "Pain"

pmabraham, BSN, RN · Mar 28, 2020

According to the National Institute on Aging, “Comfort care is an essential part of medical care at the end of life” (National Institute on Aging [NIA], 2017, para. 1). When we talk about comfort, are you aware a person can be uncomfortable without having pain or comfortable while tolerating pain?

As a hospice nurse, I want to challenge your practice of asking patients if they are comfortable before you ask if they are having pain as well as for your observational assessment of the patient for comfort/discomfort as well as pain. Why the distinction?

If you practice in an area where the patient’s loved ones have concerns about opioids, you may hear such things as “they don’t need morphine, they are not in pain” while the patient is clearly uncomfortable. I was recently in a situation where two other nurses have been seeing a patient who was going through hyper-terminal restlessness where the patient was in severe discomfort, but the family was refusing to use liquid morphine because they associated morphine with pain control vs. comfort control.

When the discussion language changed to using the words, “your loved one looks very uncomfortable,” and “being so restless is very discomforting” tied to re-educating the family that opioids at end of life help keep the patient comfortable, the family became eager to provide comfort to their loved ones by learning how to administer liquid morphine.

So, when you visit your next patient, do a visual assessment on them: Do they appear comfortable or uncomfortable? What’s their complexion (especially if you have seen them recently for a comparison)? What do their eyes/pupils look like (to help with neurological symptoms)? Are their respirations in a normal rhythm? And then ask them are they comfortable before you ask about their pain. You may then find less resistance when it comes time to discuss opioids for comfort at end of life.

References

National Institute on Aging. (2017, May 17). Providing Care and Comfort at the End of Life. Retrieved March 28, 2020, from https://www.nia.nih.gov/health/providing-comfort-end-life