THESIS ABSTRACT

Title: “ESTABLISHING EFFECTIVE APPROACHES TOWARDS CARE

ENHANCEMENT IN POST-PARTUM PATIENTS USING KOLCABA’S THEORY OF

COMFORT.”

Researchers: Hall, Arianne Caress B.

Llanes, Florence Mae C.

Loberiano, Aivyn M.

Portuguez, Emily E.

Juan, Jay Ryan T.

Number of Pages: 65

Adviser: Mrs. Pearl Ed G. Cuevas

School: Centro Escolar University

Year: 2010-2011

Subject Area: Post-Partum Patients

Statement of the Problem

The Study aims to establish effective approaches towards care enhancement in post-

partum patients using Kolcaba’s theory of comfort. Specifically, it seeks to answer the following

questions:

1. What are the care needs of Post-partum patients?

2. How does Kolcaba’s theory of comfort address the care needs of Post-partum patients?

3. How do the Post-partum patients rate the effectiveness of care given at Dr. Jose Fabella

Memorial Hospital using Kolcaba’s Theory of Comfort?

Methods and Procedure

This study made use of the Descriptive research design is a scientific method which

involves observing and describing the behavior of a subject without influencing it in any way.

These types of experiments are often used to observe natural behaviors without affecting them in

any way. The researchers gathered from 30 respondents composed of post-caesarean patients in

Jose Fabella Memorial Medical Hospital. The researchers used this method to measure the

quality of care using the Theory of Comfort and to establish effective approaches towards care

enhancement on post-partum patients.

Procedure of Data Gathering

Phase I. The researchers were able to come up with the theory to be used. Research

focuses on Theory -based testing with the theory of Comfort by Kolcaba. Title was formulated

focusing on postpartum mothers relating to the holistic care provided by nurses and the recovery

of the women. Letter of Approval for the title was passed and signed by the dean. Members of

the research team went to libraries to gather information and articles. Chapter 1 and Chapter 2

were also passed and checked by the research adviser as well as the Chapter 3. Dr. Jose Fabella.

Hospital was chosen as the site of the study.

Phase II. Institutional Letter for the survey to be conducted was made addressing to the head of

the hospital on October 26, 2010. Institutional Defense was conducted prior to

research to be done. Researchers were asked for follow-up prior to pilot study. The

researcher will be using questionnaire in gathering data from respondents. It is divided into

three parts. Part I consists of the basic and general information of the respondents. This aims to

obtain the profile regarding age, gravida and date of interview. Part II was the adoptation

of Kolcaba's General Comfort Questionnaire. Part III. Consists of questions pertaining

to the care the institution is rendering.

Phase III. The pilot study was conducted on Jose Fabella hospital November 7, 2010. Copy of

the questionnaire, stated in Filipino, shall be distributed to ten(10) postpartum women

( post- Cesarean). Respondents’ age will be 15y/o-35y/o during the pilot testing. Researchers

will be the one asking the questions in the questionnaire.

Phase IV. Gathering of the data was made November 24,2010 at Jose Fabella Hospital.

Consent was taken from the respondents. Information regarding the purpose of research and

the necessary data to be obtained was clearly discussed to the population needed. Revisions were

done.

Phase V. The data were analyzed, interpreted and presented in tabular form. Narration of the

information will be placed under each table. This serves as the discussion and

analyzing of result. Conclusion was also given at the end as well as recommendation for the

other researchers.
Sampling Technique

The researcher chooses probability sampling (simple random sampling) where in the

researcher randomly selected a caesarian Jose Fabella Memorial Hospital. It is the basic

sampling technique where you select a group of subjects, a sample, for study from a larger

group, a population. Each individual is chosen entirely by chance an each member of the

population has an equal chance of being included in the sample. Every possible sample of a

given size has the same chance of selection. As a result, each member of the population is

equally likely to be chosen at any stage in the sampling process.

Summary of Findings

I. Demographic Profile

1.1 Age

Interpretation and Analysis

The table above shows how many patients falls under each age bracket. There were 8

patients under 15-19, 7 patients under 20-25 , 9 patients under 26-30, and 6 patients under 31-35.

The data shows that among the 9 women who had been asked to answer the given

questionnaire were mostly at the age of 26-30y/o. The result showed that the mothers at the ward

having the age with the highest among the given age brackets were adult and at the years of high

sexual activity (Kozier).

1.2 Gravida

Interpretation and Analysis

The table above shows the gravida of the respondents. 20 of the respondents has a gravida of 1-2

and 10 of the respondents have a gravida of 3-4.

There were mostly mothers who gave birth for the first and second time. Preference of

the mothers are to have Cesarean section rather than the Normal spontaneous delivery. This was

clearly showed in the table above. The caesarean section is performed because vaginal delivery

would put the baby's or mother's life or health at risk, although others has been performed upon

request of the mother.

Comfort is achieved faster in multigravida rather than primigravida because the patients

who are first time to give birth usually anxious about what could happen after delivery which can

cause discomfort.

II. General Comfort Questionnaire

FOUR CONTEXT OF EXPERIENCE

2.1 Physical

Interpretation and Analysis

According to the table above, it shows that among the respondents most of them agree of

the negative feelings based from the sentence given. It means that most of the in the physical
aspects are experiencing uneasiness and are uncomfortable primarily due to the incisional pain

and effects of labor and anesthesia. There were 4 sentences interpreted as ‘agree’ while only 2

answered ‘disagree’. An interactional and developmental process occuring over time in which

the mother becomes attached to her infant, acquires competence in the care-taking tasks involved

in the role and expresses pleasure and gratification. Women who deliver by cesarean birth have

additional care concern in the immediate postpartal periods.

Digestion and absorption begin to be active again soon after birth. Almost immediately,

woman feels hungry from the glucose used during labor and thirsty from the long period of

restricted fluids plus the beginning of diaphoresis. Bowel movements are active.

A woman’s general appearance in the postpartal period reveals a great deal about her

energy level, her self esteem, and whether she is moving into taking-hold phase of recovery. As

soon as birth is completed, the woman experiences total exhaustion. Near the end of pregnancy,

she was unable to find comfortable position in bed because of the fetus’ activity or the presence

of back pain or leg pain. All during labor, ahe has eaten little if anything, and has worked very

hard with little or no time for sleep. Now she has hunger, which may make it difficult for her to

cope with new experiences and stressful situations. ( Perla, 2002). It is common for the

respondents to ‘agree’ with the statement of being tired especially days after giving birth.

Pain can be a hindrance in movement of the mothers. The intensity may intensify after the

surgery and can be enhance by the effects of labor and anesthesia giving the answer of some

mother the disagreement with the statement. But, for some it was not a hindrance. According to

Newman’s Model of Health, movement is the means whereby one person receives reality and,

therefore, is a means of becoming aware of self. She maintained that movement brings change,

without which there is no manifest reality. After all, early ambulation prevents bleeding and
thrombophlebitis which are complications of any surgery. Early ambulation also prevents atony

and provide faster healing due to vasodilation increasing the blood supply in the wound area.

Lack of knowledge regarding this matter can be also a factor in not doing this advise. The

respondents are agreeing of the importance of exercise in their condition. Kolcaba has persisted

in the development of her theory from its conception analysis that provided taxonomic structure

of comfort, to the development of ways to measure the concept and currently in its use for

practice, education, and research.

2.2 Psycho-spiritual

Interpretation and Analysis

The table above shows that most of the respondents agree with the following statements

that correspond to their perceptions when it comes to their psycho-spiritual needs. There are

three are those who answered strongly agree in 3 of the statements. That may indicate that the

respondents have a high self-concept because of their support system. Comfort is subjective in

nature but the above table indicates that it will also vary from one person to another. Thus,

psycho-spiritual comfort has a great significance in the patient’s recovery.

Psychospiritual comfort needs, include the need for confidence, motivation, and trust in

order for the family to “rise above” or move peacefully through the discomforts of painful

procedures or trauma that cannot be immediately relieved. These needs are often met by comfort

food for the soul targeted to transcendence, such as massage, mouth care, special visitors, caring

touch, facilitation of self-comforting strategies, of special words of continued encouragement.

These “extra special” interventions, for which nurses often have trouble finding time, are

unexpected but endearing to children and family members they facilitate transcendence.
 Hamilton stressed that psycho-spiritual comfort combined mental, emotional, and

spiritual components of self. The definition that has evolved is whatever gives life meaning for

an individual and entails self-esteem, self-concept, sexuality, and one’s relationship to a higher

order or being.

Participants stated that being mentally fit, having a positive outlook for the self along

with confidence and not insecurities, and strong beliefs to the doctrines of the church were

central to their comfort. The importance of this comfort was prominent in ergonomics and was

associated with increased function and productivity.

2.3 Environmental

Interpretation and Analysis:

The data shows above that most of the respondents answered “agree” among statement above

under environmental. It means that most of the post partum patient didn’t achieve their comfort

through the hospital setting. The right environment for healing and health promotion was

considered an important source of comfort by nurses interested in holistic care.

Myra Levine proposed a model of holism based on the basic interaction of individuals with their

environments (shades of Florence Nightingale) .Watson stated in her theory of caring that

patients environment was a critical for their mental and physical well-being. Therefore when

possible, nurses provided comfort through environmental interventions. Watson identified

comfort measures that nurses used in that regard.

2.4 Sociocultural

Analysis and Interpretation

 Table 7 shows the sociocultural aspect. The criteria “I need to be better informed about my

health” has the highest mean of 3.5 that is interpreted as strongly agree. It is followed by “There

are those I can depend on when I need help” with mean of 3.4, “My friends remember me with

their cards and phone calls” with mean of 3.2, “My personal belongings are not here” with mean

of 3.2 which are all interpreted as agree, and last is “I feel out of place here” with mean of 1.8

and is interpreted as disagree.

It shows that most of the postpartum patients achieved their comfort through the help of

their support system like their family and friends. Support system is important in the recovery of

a postpartum mother because it lessens the risk of developing postpartum depression, minimizes

fatigue, wellness and improves the relationship between family members and significant others.

A personal belonging also contributes to achieved comfort as well as information about their

health because it lessens their anxiety. Support system greatly affects the health of a postpartum

mother to maintain comfort.

According to Kolcaba, Sociocultural comfort needs are the needs for culturally sensitive

reassurance, support, positive body language, and caring. These needs are met through coaching,

which includes a can-do attitude, messages of wellness and encouragement, assurances of

"you're doing great," companionship of the nurse during the tasks ahead, developmentally

appropriate information about every aspect that relates to a procedure, waking up, discharge, and

rehabilitation. Social needs also include the needs of the family for financial assistance, paper

work assistance, honoring cultural traditions, and sometimes for friendship during the

hospitalization if the family unit has a limited social network. Discharge planning also helps

meet social needs for a smooth transition home, as does discussion of funeral plans and help with

bereavement in those special circumstances.

Interpretation

The table above shows that patients are satisfied to the care rendered by the nurses to

achieve comfort.

Conclusion

In light of the above findings, the following conclusions are drawn:

1. The effectiveness of individualized, compassionate care among postpartum patients has a

great relationship on the promotion of their well-being and comfort then third, holistic

approaches toward quality care has a greater effectiveness if trained nurses are guided by well-

developed theories and lastly, caring for patients begins and ends with comfort.

2. Enhanced comfort strengthens postpartum patients to engage in Health Seeking

Behaviors of their choice (Kolcaba 2005).

3. Comfort Theory provides a framework for clinical practice guidelines, which state that

the provision of holistic care oriented to comfort, must be explicit and well- documented.

4. The desirable outcome of comfort is related to engagement in HSBs (important to

patients, families, and the health care team) and to better institutional outcomes (important to

administrators).

5. The framework also suggests to administrators that a culture of comfort in the Post-

partum setting cannot be achieved without necessary institutional commitment and support.
6. Clinical practice guidelines specify comfort as an outcome; they can describe staffing

levels and patterns of interdisciplinary care delivery that are necessary to reach specific comfort

goals.

7. Enhancing comfort of families in clinical settings is altruistic, practical, and satisfying to

recipients and nurses. Measuring the strength of relationships between comfort, health seeking

behaviors, and institutional outcomes will provide rationale for strong staffing, committed to

outcomes of comfort.

Recommendations

After determining the patient’s needs for comfort in Jose Fabella Memorial Hospital, the

researches would like to make the following recommendations:

To academe: they should emphasize the Nursing Theorist course in the curriculum to

uplift the nursing practice in the nursing profession and in our country.

To the nurses in Jose Fabella Memorial Hospital: the nurses should render holistic care to each

patient to achieve their comfort.

To the post-partum patients: they should be aware of the comfort that they need and adapt easily

to physiologic and psychologic transition they experienced.