What Is the Meaning of Comfort Care? FAQ and Best Practices

In spite of the growing demand for in-home hospice services, nearly 60% of all deaths still occur in hospitals. Comfort care measures are used in in-patient settings to direct care for patients in the time immediately surrounding death. These guidelines ensure that each patient experiences a dignified end-of-life journey, reflecting the true meaning of comfort care.

So, what do comfort measures look like for patients and staff and how are they put into practice? We’ll define comfort care, discussing its forms and how it relates to palliative and hospice care services. Then, we’ll cover five best practices your facility can use to guide and support staff in providing the highest quality care possible during these challenging episodes of care.

Frequently Asked Questions About Comfort Care

Before we discuss best practices, it’s important to get a baseline understanding of what comfort care is, why it’s used, and when it’s incorporated into a patient’s plan of care. Below we’ll provide answers to some common questions about comfort measures.

What is comfort care in the hospital?

Comfort care in hospital-based settings is also referred to as end-of-life (EOL) care. It describes the interventions that reduce suffering, alleviate pain, and provide relief for patients who are actively dying. It doesn’t have to be provided by a hospice provider (and often isn’t). For example, registered nurses may oversee physician-directed comfort care in the hospital setting — with or without a hospice or palliative care consultation.

What is comfort care vs. hospice vs. palliative care?

So, how is comfort care distinct from hospice and palliative care? Both comfort care and hospice are available to patients nearing the end of their life who want to prioritize quality of life, stopping treatments that don’t align with that goal. The difference between comfort care and hospice is a set of subtle parameters, including the expected duration before death and types of allowable care providers.

• Comfort care is available to those expected to die within the next 7 days and may be provided by any qualified care team member.
• Hospice services may be provisioned only by hospice-trained staff, usually for patients who have a prognosis of 6 months or less.

Palliative care also addresses a patient’s need for symptom management, but unlike comfort/hospice care, it can be used at any point during the course of a serious illness, including during active, curative treatment.

Can comfort care be done at home?

Although we classically consider comfort care for patients dying in the hospital, it is available to anyone in their last days of life. For example, patients with a home health nurse or caregiver whom they’re comfortable with may transition to comfort measures at home under their care. Friends and family often participate, though the comfort care plan itself must be overseen by a physician.

How long does comfort care last?

Unlike hospice, there is no set time limit on comfort care — meaning that a patient who lives past their seven-day life expectancy is still entitled to comfort measures. However, when patients live longer than expected in acute settings, providers may consult families about discharging the comfort care patient home (or to another setting) that might enhance their end-of-life experience.

A large majority of U.S. citizens report feeling unhappy or distrusting of healthcare. To help them avoid these uncomfortable settings during a phase of life where comfort is the top priority reinforces the true meaning of comfort care.

Can someone recover from comfort care?

The truth about comfort care is that it is reserved for patients with a life expectancy of mere days. Patients may see some improvements while on comfort care (for elderly patients with advanced dementia, this may appear as terminal lucidity). Yet this is likely due to the focus on enhancing their overall quality of life. A small, often temporary improvement doesn’t (usually) indicate real recovery.

On some occasions, a patient’s prognosis could unexpectedly change and they may live longer than expected. In these instances, patients and their doctors will discuss their care options and make plans for how to respond to a relapse in their condition.

Best Practices for Embodying the Full Meaning of Comfort Care

Now that you know how to answer the question, What does comfort care mean? it’s important to learn how to best navigate these emotionally-charged care measures. Here are five best practices that give your team the tools to provide exceptional comfort care and support their patients’ physical, mental, emotional, and spiritual needs.

1. Create an Order Set for Symptom-Based Care

Order sets help standardize care between providers and are effective for ensuring that every aspect of care and physical comfort has been specifically addressed. Many facilities base their order sets on symptom management categories.

Adequate pain control upholds the true meaning of comfort care and is one of the most important symptoms to manage. About 40% of patients experience moderate-to-severe pain during the last three days of life.

Other important categories of information outside of symptom management include code status (confirmed DNR/DNI), withdrawal from mechanical ventilation, and removal of invasive monitoring devices. Hydration, artificial nutrition, and oxygen administration can be controversial with varied opinions on their use.

2. Develop a Nursing Order Set for Comfort Care

A nursing order set is an essential companion to the standards for symptom management. It should help clarify the fundamental comfort care measures in practice, detailing and addressing all aspects of nursing-related care.

Many facilities support nursing orders by including them in a comprehensive EOL policy and protocol. It’s important to make sure that both order sets and related policies are all in alignment and that updates are made as needed.

3. Develop a Comfort Care Education Plan

Your team must have a solid understanding of EOL care practices, including training that highlights the meaning of comfort care while clarifying any order sets, policies, or procedures that specifically guide care. Education efforts should be ongoing and are often incorporated into annual competencies.

• The End-of-Life Nursing Education Consortium (ELNEC) offers courses and resources for nurses who practice in critical care, geriatric, and pediatric care settings.
• Specific training courses can help improve communication between clinicians and patients during EOL care.
• The Hospice and Palliative Care Nurses Association also offers a host of other educational materials.

Above all, remember to engage the patient and their support systems in your education plan. You should ask yourself, What does comfort care mean to your patients? To them, does comfort care mean death in a manner synonymous with giving up? These types of associations reveal why it’s critical to assess educational needs around EOL care, helping to set expectations and initiate those difficult — but essential — conversations about how the patient defines a “good death.”

4. Enlist a Multidisciplinary Team

The entire interdisciplinary team — the physician, nursing, respiratory therapy, and social work for example — should all contribute their expertise to lend the best possible decisions when transitioning care. The patient and their loved ones are the focus of all discussions and should be involved (as much as possible) every step of the way.

Once EOL care is initiated, it’s important to clearly communicate this to everyone working in the facility, including dietary services, environmental services, and phlebotomy. The patient and their family should be given as much privacy and respect as possible. In addition to placing an order in the electronic health record (EHR), many facilities use signage on the door of the room to alert staff and prevent unwanted visitors. Disruptions should be avoided in order to maintain a peaceful, quiet environment for the dying patient.

5. Support and Care for Your Team

It’s important to recognize that caring for the dying can be emotionally difficult for healthcare staff members. These assignments often carry the additional burden of caring for loved ones in addition to the patient — risking burnout and compassion fatigue in an already stressful profession. Consider rotating staff assignments for patients who are receiving comfort care nursing so your team has time to recharge and focus on their own well-being.

• Establish support systems to help staff process the intensity of working with dying patients and grieving loved ones.
• Conduct structured debriefs after a patient’s death to encourage staff to share their experiences and evaluate what worked well and what didn’t.
• Provide resources like mindfulness and wellness strategies, or employee assistance programs (EAPs) that offer free counseling sessions.

Many facilities make social workers and chaplaincy services available to staff to help with emotional and spiritual needs for not just the patient and family, but affected staff, too. Caring for your team shows you value them as individuals and acknowledge that they’re affected, spiritually and mentally, by witnessing death and grief.

Looking for More Ways to Support Your Staff?

The meaning of comfort care is reflected by organizations that value people — not just through the demonstration of person-centered care, but also staff morale. Strengthen and uplift your nursing teams with IntelyCare’s wide range of facility resources and healthcare management tips.

IntelyCare writer Kerry Larkey, MSN, RN, contributed to the writing and research for this article.