The Differentiation Between Pain and Discomfort: A Concept Analysis of Discomfort.

BACKGROUND: Discomfort is a concept found in the literature, usually related to pain. Some sources do not distinguish between pain and discomfort. Others refer to different sources of discomfort, thereby leading to a lack of conceptual clarity. AIMS: The objective of this paper was to present a concept analysis of discomfort. Full-text articles published between 1970 and 2016 in English were used to inform the concept analysis. DESIGN: Articles were taken from CINAHL, Medline and PsycNET databases. METHODS: A total of 7,406 articles and 120 abstracts were identified for evaluation. After initial review, 42 articles were further analyzed. Two reviewers independently evaluated the selected publications using the Walker and Avant approach to concept analysis. RESULTS: Discomfort can be physical or psychological and is characterized by an unpleasant feeling resulting in a natural response of avoidance or reduction of the source of the discomfort. Pain is one of the causes for discomfort, but not every discomfort can be attributed to pain. It is identified by self-report or observation. Discomfort in noncommunicative patients is assessed and measured via behavioral expression, also used to describe pain and agitation, leading to discomfort being interpreted as pain in some conditions. CONCLUSIONS: A clarification of the concept of discomfort leads to a more accurate theoretical and operational definition. This clarification can help nurses to make more accurate nursing diagnoses and develop methods to measure discomfort in order to provide optimal quality of nursing care.

Comfort level classification during patients transport.

BACKGROUND: Passenger comfort is affected by many factors. Patient comfort is even more specific due to its mental and physical health condition. OBJECTIVE: Developing a system for monitoring patient transport conditions with the comfort level classification, which is affected by the patient parameters. METHODS: Smartphone with the developed Android application was installed in an EMS to monitor patient transport between medical institutions. As a result, 10 calculated parameters are generated in addition to the GPS data and the subjective comfort level. Three classifiers are used to classify the transportation. At the end, the adjustment of classified comfort levels is performed based on the patient's medical condition, age and gender. RESULTS: Modified SVM classifier provided the best overall classification results with the precision of 90.8%. Furthermore, a model that represents patient sensitivity to transport vibration, based on the patient's medical condition, is proposed and the final classification results are presented. CONCLUSIONS: The Android application is mobile, simple to install and use. According to the obtained results, SVM and Naive Bayes classifier gave satisfying results while KNN should be avoided. The developed model takes transport comfort and the patient's medical condition into consideration, so it is suitable for the patient transport comfort classification.

Increasing Information Dissemination in Cancer Communication: Effects of Using "Palliative," "Supportive," or "Hospice" Care Terminology.

BACKGROUND: When attempting to share information about comfort-oriented care, many use "palliative," "supportive," and "hospice" care terminology interchangeably, but we lack evidence about the effects of using these different terms. OBJECTIVES: This study was designed to test whether the use of "palliative," "supportive," or "hospice" terminology can improve the dissemination of information among breast cancer patients-a large and growing oncology population. Design, Setting, and Measurement: This experimental study was conducted at a major U.S. hospital serving a diverse population. Patients visiting a cancer clinic encountered opportunities to learn more about cancer care. They were offered health materials that were described as reporting on "palliative," "supportive," or "hospice" care and the primary outcome was whether a patient decided to select or reject each. As a secondary outcome, the study measured the patient's level of interest in receiving each. RESULTS: Compared with alternatives, materials labeled as "supportive" care were most likely to be selected and considered valuable (p value <0.01). CONCLUSIONS: In this study, the terminology used had a large effect and, compared with alternatives, the information labeled as being about "supportive" care was significantly more likely to be selected. If these effects are supported by additional research, there may be low-cost, highly feasible changes in language choice that increase the dissemination of relevant health information.

Development of the Contact Lens User Experience: CLUE Scales.

PURPOSE: The field of optometry has become increasingly interested in patient-reported outcomes, reflecting a common trend occurring across the spectrum of healthcare. This article reviews the development of the Contact Lens User Experience: CLUE system designed to assess patient evaluations of contact lenses. CLUE was built using modern psychometric methods such as factor analysis and item response theory. METHODS: The qualitative process through which relevant domains were identified is outlined as well as the process of creating initial item banks. Psychometric analyses were conducted on the initial item banks and refinements were made to the domains and items. Following this data-driven refinement phase, a second round of data was collected to further refine the items and obtain final item response theory item parameters estimates. RESULTS: Extensive qualitative work identified three key areas patients consider important when describing their experience with contact lenses. Based on item content and psychometric dimensionality assessments, the developing CLUE instruments were ultimately focused around four domains: comfort, vision, handling, and packaging. Item response theory parameters were estimated for the CLUE item banks (377 items), and the resulting scales were found to provide precise and reliable assignment of scores detailing users' subjective experiences with contact lenses. CONCLUSIONS: The CLUE family of instruments, as it currently exists, exhibits excellent psychometric properties.

Influence of Vision on Ocular Comfort Ratings.

PURPOSE: To evaluate the influence of blur on ocular comfort while systematically manipulating vision using habitual refractive correction, induced spatial blur, dioptric defocus, and under the absence of visual structure. METHODS: Twenty emmetropic subjects rated vision, ocular comfort, and other sensations (burning, itching, and warmth) under clear viewing condition, spatial blur, and dioptric defocus, each lasting for 5 min. During each condition, subjects viewed digital targets projected from a distance of 3 m, and vision and ocular sensations were rated using magnitude estimation. Dioptric defocus was induced using +6.00DS contact lens, and equivalent spatial blur was produced by spatially filtering the targets. In a separate study, 15 participants rated vision and comfort while viewing a ganzfeld and behind an occluding patch (each of which provided an absence of visual structure) in addition to the above experimental conditions. Repeated-measures analysis of variance was used to compare the ratings of vision and comfort under the different experimental conditions. RESULTS: Vision under blurred conditions (both spatial blur and dioptric defocus) was rated significantly different (p < 0.001) from clear viewing condition. Vision was significantly different when targets were dioptrically defocused than when they were spatially blurred (p < 0.001). Ratings of comfort showed significant differences between clear and blurred conditions (p < 0.001). However, there was no significant difference in comfort ratings between dioptric defocus and spatial blur (p value at least 0.28). There were also no differences in comfort (p value at least 0.99) between clear vision, ganzfeld viewing, and occlusion despite the lack of visual structure in the latter two conditions. CONCLUSIONS: There does seem to be an association between clarity of vision and ocular comfort. Although the pathways for ocular surface pain and vision are perhaps exclusive, complex psychological influences such as nocebo or Hawthorne effects can subtly influence the participants to anticipate a change in comfort when vision is blurred.