舒適之概念分析

Comfort: A Concept Analysis

「 舒適」是護理的重要概念與基本的核心價值，也在護理過程及文獻中一再地被使用與肯定，但對於此概念的定義性屬性、先決條件、產生的後果、及測量舒適的護理研究仍有待分析與探討。本文運用Walker及Avant（2005）所描述的概念分析步驟，統整相關文獻後重新賦予舒適概念更明確的定義。歸納其定義性屬性包括：（1）有效溝通，（2）具家庭與有意義的關係，（3）功能的維持，（4）自我特性的展現，（5）生理症狀的緩解、狀態與措施，（6）心理和靈性活動與狀態，及（7）安全感與保障感。舒適的先決條件包含不舒適、痛苦或受苦的情境，處置後的後果則包含：（1）需求獲得滿足，（2）控制感增加，（3）內在平和的感受，（4）有一種愉快的經驗，（5）有被關懷的感覺，（6）症狀緩解，（7）受苦程度減低，（8）不平衡感減少，及（9）沒有不舒適。接著運用不同案例說明與分析舒適概念，最後提供整理所得的常見實證性參考指標與測量工具。藉由本文的概念分析，更加確認舒適為多面向且需被重視的臨床議題，且有助於增進護理人員對舒適概念的瞭解，並能依據實證性工具評估舒適的程度及追蹤其變化，發展舒適措施或舒適護理方案，以確保病患獲得優質照護。

Comfort is an important concept and core value of nursing. The defining attributes, antecedents and consequences of comfort need further analysis and exploration, even though the concept of comfort has been addressed previously in nursing literature. We employed the strategies of concept analysis as described by Walker & Avant (2005) to analyze the concept of comfort. The defining attributes of comfort include: 1) effective communication; 2) family and meaningful relationships; 3) maintaining functionality; 4) self-characteristics; 5) physical symptom relief, states, and interventions; 6) psychological, spiritual activities and states; and 7) a sense of safety and security. Antecedents consist of discomfort, distress and suffering. Consequences consist of (1) met/satisfied needs; (2) increased sense of control; (3) sense of inner peace; (4) a pleasant experience; (5) feeling cared for; (6) relief of symptoms; (7) reduced suffering; (8) decreased disequilibrium; and (9) absence of discomfort. We also outline the construction of cases, empirical references and comfort measurement tools. Analysis found comfort to have multiple dimensions and confirmed it as a clinical issue that should receive greater emphasis and valuation. Findings are hoped to increase nurse understanding of the concept of comfort and enable nurses to evaluate level of comfort and follow up on variations in such using empirical tools. Concept analysis can guide further comfort related interventions and research to benefit patients.