Discussion Theory #10

CASE STUDY

A 32-year-old African American mother of three toddlers who is 28 weeks pregnant is admitted to the high-risk pregnancy unit with regular contractions. She is concerned because the plans for her family are not finalized. She has many comfort needs, diagrammed in  Table 33.1 . When nurses assess for comfort needs in patients, they use the taxonomic structure, or comfort grid, to identify and organize all known needs. Using the comfort grid (see  Fig. 33.1 ) as a mental guide, nurses design interrelated comforting interventions that can be implemented in one or two nurse–patient–family interactions. For this case, some suggestions to individualize the types of comfort interventions that might be considered are presented in  Table 33.2 .

TABLE 33.1

Taxonomic Structure of Comfort Needs for Case Study

Context of Comfort	Relief	Ease	Transcendence
Physical	Aching back Early strong contractions	Restlessness and anxiety	Patient thinking, “What will happen to my family and to my babies?”
Psychospiritual	Anxiety and tension	Uncertainty about prognosis	Need for emotional and spiritual support
Environmental	Roommate is a primigravida Room is small, clean, and pleasant	Lack of privacy Telephone in room Feeling of confinement with bed rest	Need for calm, familiar environmental elements and accessibility of distraction
Sociocultural	Absence of family and culturally sensitive care	Family not present Language barriers	Need for support from family or significant other Need for information and consultation

TABLE 33.2

Comfort Care Actions and Interventions

Type of Comfort Care Action or Intervention	Example
Standard comfort interventions	Vital signs Laboratory test results Patient assessment Medications and treatments Social worker
Coaching	Emotional support Reassurance Education Listening Clergy
Comfort food for the soul	Energy therapy such as healing touch if it is culturally acceptable Music therapy or guided imagery (patient’s choice of music) Spending time Personal connections Reduction of environmental stimuli

For clinical use, the nurse might ask the patient to rate her comfort before and after receiving the interventions on a scale from 0 to 10, with 10 being the highest level. To determine whether a specific comforting intervention enhanced the comfort of the patient, a comfort questionnaire is administered, assessing each cell in the comfort grid (see  Fig. 33.1 ). A Likert-type scale with responses ranging from 1 to 6 facilitate a total comfort score. A questionnaire, given to the patient before and after the intervention, demonstrates the level of effectiveness of intervention.

Compare the suggestions for the comfort of this mother of three presented in  Table 33.2  with comfort measures you considered as you read the case study of this woman. Are there nursing comfort measures you might add? Explain your addition using  Table 33.1 .