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.