Betwixt and between: a critical ethnography of comfort in New Zealand residential aged care

AIMS AND OBJECTIVES: This research sought to explore the nature of comfort within the context of three New Zealand nursing homes and examine how nursing and other actions contribute to residents' comfort. BACKGROUND: Comfort has been acknowledged as a key nursing goal since the days of Florence Nightingale, but the nature of comfort and how nurses can contribute to and enhance patient/resident comfort is unclear. Comfort is often considered to be merely the absence of discomfort. DESIGN: A critical ethnographic approach was used to facilitate understanding of nursing home residents' comfort. Fieldwork included 90 days of participant observation, interviews with 27 residents and 28 staff and extensive document examination. RESULTS: Comfort was multidimensional, idiosyncratic, dynamic and context dependent, rather than merely the absence of discomfort. This multidimensional nature meant residents could be 'betwixt and between' comfort and discomfort simultaneously. The constraints of one-size-fits-all care delivery practices and the tensions inherent in communal living compounded residents' discomfort. CONCLUSIONS: Individualized care, based on comprehensive and accurate nursing assessment, is fundamental to the comfort of residents. RELEVANCE TO CLINICAL PRACTICE: Staff working in nursing homes must re-examine their care delivery practices to ensure these do not disempower residents. Ensuring the comfort of each resident is a nursing priority and the key component of individualized care.