Discomfort as a Potential Nursing Diagnosis: A Concept Analysis and Literature Review

Field: Nursing (Health Sciences)

PURPOSE To explore the concept of discomfort and clearly identify this phenomenon; to compare and contrast this concept with the accepted concepts of acute pain and chronic pain; and to develop a diagnostically useful definition, including defining characteristics and related factors. METHODS A wide range of published literature was reviewed as were definitions for pain, discomfort, and comfort from both English and medical dictionaries. Texts on nursing classification language were scanned for intervention and outcome labels or definitions that suggest the concept of discomfort. Audiotaped interviews with expert clinicians were conducted to explore the presentation of pain and discomfort in the clinical realm using a semistructured format. Finally, Morse's modified approach to concept analysis using qualitative methodology was used to perform an analysis of the diagnosis, using the literature review, interviews, and case studies as data. FINDINGS The literature fell into four categories: (a) common definitions and related terms, (b) works suggestive of the concept of discomfort, (c) studies differentiating pain and discomfort, and (d) studies equating pain and discomfort or ambiguity in the use of terms. A lack of conceptual clarity was identified. The definitions offered were not congruent, referring to the selected terms in varying manners, including as states, actions, or absences of the opposite term. Many works appeared to interchange the terms pain and discomfort for editorial reasons only, to avoid frequent repetition of a single term. Other works treated the terms as distinct without providing a definition for either. Clinicians expressed support for the concept of discomfort as a diagnostic concept separate from pain, and provided insight into the complex interrelation of pain/discomfort in the physical sense, and emotional discomforts such as fear. Additionally, support appeared for the concept of environmental discomfort, a class in the taxonomy that currently has no accepted diagnostic concepts. However, clinicians were not able to articulate clearly the concept of either discomfort or pain, generally discussing them in terms of assessment findings. The concept analysis for the proposed diagnosis discomfort initially focused on concept delineation, but moved into a format of concept clarification because of the lack of consensus on the clinical manifestations of discomfort. DISCUSSION The goal of establishing discomfort as a nursing diagnosis is to facilitate clinicians' ability to identify an anecdotally common phenomenon that requires nursing interventions and outcome evaluation. The preliminary data on this diagnostic concept is insufficient to demonstrate defining characteristics or related factors. Additional study is required. CONCLUSIONS Data suggest that discomfort may be a phenomenon distinct from either acute pain or chronic pain; there is no clear consensus, however, among clinicians. The label discomfort may not, in fact, be the most clinically useful, and a new term may need to be developed. Perhaps the diagnostic concept should be labeled physical discomfort for clarity, and a new term be developed or explored as the diagnostic label that communicates the concept of generalized physical discomfort. Further research must be done to validate the nursing diagnosis discomfort, regardless of the final label. The acceptance of a nursing diagnosis addressing discomfort would be beneficial to clinicians, providing guidance for interventions and supporting the choice of outcome measures. It may be possible to develop a research tool to obtain data regarding patient experiences of discomfort based on the findings of this study, which in turn could lead to an objective assessment tool.