ISSUES AND INNOVATIONS IN NURSING PRACTICE Comfort on a ward for older people Elizabeth Tutton BSc MSc PhD RGN PGCEA Research Fellow, RCN Institute, Oxford, UK Kate Seers BSc PhD RGN Head of Research, RCN Institute, Oxford, UK Submitted for publication 14 May 2003 Accepted for publication 25 November 2003 Correspondence: Elizabeth Tutton, RCN Institute, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, UK. E-mail: liz.tutton@rcn.org.uk TUTTON E. & SEERS K. (2004) TUTTON E. & SEERS K. (2004) Journal of Advanced Nursing 46(4), 380–389 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 col- lected 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. Keywords: comfort, qualitative interviews, participant observation, ethnography, older people, nursing Background There is a general expectation that when we need health care our comfort will be considered. Nurses have the potential to help fulfil this expectation. Nurse theorists identify comfort as playing a fundamental role in patient care (Orlando 1961, Paterson & Zderad 1988, Kolcaba 1991, Morse 1992), however, over the years it has been relegated to a more minor role (McIlveen & Morse 1995, Ersser 1997). This paper identifies the importance of bringing comfort to the fore in order to explore and examine its contribution to current nursing practice. Comfort appears to be an essential issue in nursing. Many authors refer to it in passing and others identify it as the overall goal of nursing. However, attempting to understand it more closely in light of the complexity of nursing practice is 380 Ó 2004 Blackwell Publishing Ltd