title: Betwixt and between: a critical ethnography of comfort in New Zealand residential aged care.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Nursing, UCOL, Palmerston North, New Zealand. m.bland@ucol.ac.nz
authors.forename: Marian
authors.initials: M
authors.lastname: Bland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000884:Anthropology, Cultural; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D009520:New Zealand; D009723:Nurse-Patient Relations; D009732:Nursing Care / Q000592:standards; D009735:Nursing Homes / Q000592:standards*; D015279:Organizational Culture; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D011787:Quality of Health Care