When I set out to write the column, my plan was to discuss "Skin Hunger," a syndrome I heard about listening to a therapist being interviewed about the current social isolation associated with quarantining at home. According to the therapist, we are not receiving the physical stimulation that we receive from touching and hugging needed by the autonomic nervous system. Very intrigued, I scoured the literature and found nothing. I did find that there are 2135 articles on COVID-19 pandemic and 2154 articles on coronavirus and COVID-19. There is information on meat-processing plants and infections that were only in the news a couple of weeks ago. Friends and family are more tired of constantly having coronavirus and the pandemic in their faces everywhere you turn! It would be easier to shelter in place if there was some good news and diversions. I can understand why Netflix had a large increase in subscriptions!

Thoughts about concerns family and friends are voicing led me to think of ways that I could provide comfort for them. I am certainly not an expert on the virus, but as a nurse, I know how to assess and evaluate someone and then develop a plan to provide comfort to enhance his or her well-being. Those of you practicing clinically in the maternal and newborn areas provide comfort, usually without thinking, as a matter of care delivery. Comfort Theory, a middle-range theory, was developed by Kolcaba in 1990.1,2 She defined comfort as, "helping the needs of an individual, providing tranquility and an expected result within physical, psychosocial, social and environmental integrity towards overcoming the problems." The 3 levels of the theory are relief, ease, and transcendence.3,4 Relief is what the person feels when the uncomfortable condition/situation is eliminated and is necessary for the person to be able to return to his or her previous functional state.1,2 Many are feeling relief now that the restrictions have been lifted somewhat, while others are still feeling discomfort because of uncertainty in the safeness of returning toward their old life. Ease is achieved when feelings of calm or being comfortable are attained and is expressed as satisfaction.1,2 It must be very difficult to be surrounded by loved ones who are not at ease and are afraid of losing social distancing and of people who do not wear face masks. Transcendence is defined by the person overcoming the problem and regaining his or her strength.4 I view the transcendence level as having the courage to leave the home and venture forward to the clinic to provide care and find satisfaction in comforting others. If comfort is not achieved on the 3 levels, the person is left with a feeling of deficiency.

There are 4 dimensions of the Comfort Theory in which the requirements for comfort are housed. Physical comfort includes factors such as working out, nutrition, and overall health that affect the person's physical condition.1 Pain is one of the most common factors that affect comfort, but given that the unemployment rate is high and people are waiting in line at food banks, perhaps nutrition is more the priority. I think of the empty shelves at the grocery stores 7 and 8 weeks ago, and the "run" on toilet tissue that I never quite understood (although I've been told that hoarding decreases anxiety). Psychospiritual comfort has mental, spiritual, and moral components and consists of elements, such as self-concept, that give meaning to a person's life.2 Not being able to go to church to worship with others and seek guidance/comfort has been difficult for those who have religion as an integral sense of self. Environmental comfort includes the impact of external factors, such as environment, noise, safe environment, and landscape.1 Being quarantined with 5 or 6 others, or only you and your significant other, can be difficult because there is little to no "alone" time. There are people who lock themselves in the bathroom to get some space, because it's the only door in the house that has a lock. Currently, the definition of what a "safe environment" is, is unclear. The sociocultural comfort has been significantly disrupted, perhaps the most distressing dimension, as it contains the interpersonal, family, social, and financial support systems.4 The pandemic has created unprecedented unemployment and loss of businesses, some of which will never recover. There was a 30-day grace period where tenants could not be evicted from the homes for not paying the rent. As soon as the grace period ended, more than 800 eviction notices were filed in my area. Weddings and graduations have been canceled or postponed indefinitely, major life milestones that are important to every family. Domestic abuse has increased dramatically because of the constant inseparability, and shelters have had to turn away women and children because they are full.

All humans have a desperate need to be comfortable and work to reach the basic comfort requirements. Developing and maintaining friendships, pursuing spiritual and social interactions, and having a calm, restful home environment to restrengthen our minds and spirits are as critical as basic nutrition. As nurses, we can assess those important to us to determine what their comfort level is and develop an individualized plan to help them successfully achieve the basic levels and dimensions of comfort. It doesn't have to be big-you could deliver a meal to a family, order out from the local small restaurant, and offer to clean the house so that the nurse on the front line doesn't come home to disarray. I've heard that the 19:00 clap hour in New York City has lifted the spirits and got communities back together again. At 19:00, people open their windows or step onto balconies and clap or bag pots and pans. It is wonderful to see blocks of people smiling again!

-M. Terese Verklan, PhD, CCNS, RNC, FAAN

Professor and Neonatal Clinical Nurse Specialist

University of Texas Medical Branch

School of Nursing

Graduate School of Biological Sciences

Galveston, Texas

References