Non-pharmacological Comfort Interventions (Nursing)

00:02 Welcome! My name is Diana Shenefield. And on this lecture, we’re going to talk about non-pharmacological comfort interventions. You know, sometimes as nurses, the easy thing to do is to go get that pain med for our patients. But we have to remember that a lot of times, pain meds don’t always take care of the problem. So, let’s look at some ways that we can help our patient without just giving them a pill. So we’re going to look at what are our options.

00:30 Sometimes as nurses, again, we look at what medically we can do. But we need to remember that we’re holistic, and there's a lot of things we can do to comfort our patients without giving them medications. So, let’s look at those and be thinking about those in your mind. And it’s not necessarily things that you maybe do personally, but maybe you have a resources, or maybe there’s somebody in their family that knows these interventions and can help the patient. There are a lot of things that I don’t know how to do.

00:59 I don’t know how to do acupuncture. But I do understand that acupuncture does help a lot with pain relief for certain illnesses. So, maybe it’s not me that’s doing it, but maybe it’s helping the patient find resources that will work for them. So, what are we going to look at? We’re going to look at assessing our patients, and we’re not only going to look at our patients that we have that are acute, but we’re also going to look at palliative care. We know that people that are in palliative care sometimes have a lot of discomfort, maybe not just pain but restlessness, nausea, all of those other things, itching. So, what can I do to help those symptoms without necessarily giving medications? And then what is the assessing the need for pain? We’ve talked earlier about, sometimes people won’t tell us they’re in pain and we have to pick up on certain clues. But again, sometimes, medication isn’t always the answer. Sometimes, dealing with somebody spiritually or emotionally or helping them deal with their cultural differences, sometimes helps with the pain because it eases the mind. Again, when you have your patient, do a good assessment and make sure that you’re looking at all aspects of what could help that patient feel better.

02:15 So, here’s our practice question. We have a patient who has got chronic back pain, and think about all of the people that you know with chronic back pain, and they ask the nurse about alternative therapies. Sometimes people use their alternative therapies, complimentary therapies. Again, whatever the terminology is, we’re looking at ways to help our patients without giving them medications. And this patient also wants to also keep up with their traditional medicine. Again, a lot of times, people, when they’re asking about alternative medicine, they’re not saying that they don’t want any medical help. They’re just saying, “Is there something else that we can do? Is there something else besides medicine that might help them feel better?” So which of the following forms of alternative therapy could the nurse provide for this patient? A, music therapy or guided imagery; B, acupuncture; C, Kegel exercises; or D, none. Nurses don’t participate in providing alternative treatments.

03:13 Hopefully, you didn’t pick D, because we do. That is a lot of what we do. And if you think about all the times that you’re caring for your patient, when you’re laying hands on your patient or you’re talking to your patient, you are providing alternative therapy.

03:27 So the answer to this question is A, music therapy and guided imagery.

03:32 Again, acupuncture is a good choice, but as a nurse, that’s not what I do. I can help people find, maybe, resources but I don’t do that. And then Kegel exercises, that isn’t going to help somebody with a low backache. So again, looking at what are your options and what are things that you can do, and music therapy definitely. A lot of times, people will ask, “You know, do you have any music? Is there TV stations that have music?” Encourage patients to bring in their iPads or their music so that they can listen to it. It’s very soothing. So, what can you do as a nurse besides just giving medications? So, you want to review heat therapy, and you want to review cold therapy, and when would you suggest to a patient when to use which? We know heat therapy decreases muscle spasms.

04:19 We put heat on people when they’ve had a sprain or something that’s just causing a lot of aching. We also know that ice works well to decrease swelling. And if you can decrease swelling and decrease muscle spasms, you get a better result from your pain therapy with the medication as well. And then don’t forget RICE. You can’t ever forget RICE, your rest, ice, compression, and elevation. Again, none of that involves medication, but those are all things to decrease swelling that will help with pain relief.

04:51 What about massage? Just rubbing somebody’s back or rubbing their legs can make a huge difference in pain relief. So don’t forget about your hands-on care of your patient.

05:03 It’s not just for assessing but it’s also for comfort. TENS units, those are always available. Again, maybe through a pain specialist or a pain nurse, but again, don’t forget that there is electrical stimulation that can help, maybe for your patient that has chronic lower back pain. Spinal cord stimulation. Again, as a nurse, I’m not going to participate in that, but my patients may go to surgery or they may see a pain specialist that will help with that to eliminate some of that pain. And then aromatherapy and essential oils.

05:35 Essential oils are making a big comeback again. So, what is it about aromatherapy that comforts and what smells? Again, in the hospital, we can’t light candles, but maybe there's little oils that the patient can put on their wrist and smell just to help comfort them and to ease them, whether it’s their mood, whether it’s their stress. We all know that that combines with pain. With a patient that’s very stressed and sleep-deprived, their pain is a lot worse. So, maybe just bringing their stress down and helping them relax is going to help with their pain relief too. And then music. Again, many patients enjoy all different kinds of music. And so sometimes just a calming music would help bring their stress down as well, and then subsequently, get rid of their pain or their nausea, itching.

06:24 It just kind of gets their mind off of it. Biofeedback, self-hypnosis, again, all things that pain therapists, pain physicians are trained in, they can help your patient maybe on the long-term, patients with chronic problems. They don’t have to suffer. They don’t have to take lots of our NSAIDs that we know causes gastric bleeding.

06:47 So again, what can we do so that the patient doesn’t have to take as much medication? Laughter. Laughter is huge, just getting patients to laugh. And the old adage that laughter is the best medicine has been proven over and over again, that using humor helps our patients. It gets their minds off of their pain or their discomfort. And then guided imagery. Again, nobody is going to probably say, “You can’t be a nurse because you can’t do guided imagery.” But what they’re looking for on NCLEX is that, “Do you understand that there are other ways to comfort your patient besides giving medications?” So as you’re reading your questions and it’s talking about pain or discomfort, don’t automatically jump to the answer that talks about giving morphine or Dilaudid. Look at your patient and what kind of pain they’re in and what other kind of situations that they’re in. And is there a better answer to your question that maybe would work better than maybe a morphine or a Dilaudid? Palliative care. When we talk about palliative care, we talk about pain. We talk about nausea, vomiting, itching, anxiety, restlessness. Again, when we talk about non-pharmacological comfort, it’s not always just pain. It can be restlessness. You have your Alzheimer’s patient that’s restless, and you know, we don’t want to just tie them to the bed or combine them to a room, but what can we do maybe to lower their anxiety, lower their restlessness in a more natural way so that we’re not sedating them all of the time.

08:18 Lot of your patients with dementia or sundowners, again, we know it’s going to happen.

08:24 So, what can I do proactively? What can I be prepared to do to just lower those symptoms so that my patient can rest, and also eliminate the risk for falls? So in closing again, don’t always jump to medication, but use your critical thinking, use your problem solving skills, and see if there's other ways that you have available to you, or resources that you have available to you, that you can help your patient and comfort them without always going to your medication cabinet. Good luck on NCLEX.