Download Case Study - The Comfort Line

1
Case Study Module:
How to use this case study: first, identify comfort needs of the intended
recipients such as patients, family members, nurses, ancillary staff (using a
blank TS or care plan to help with the categories). Fill out the TS, similar to
the way I did it on the next page , and/or fill out the care plan. The reason for
adding the care plan is that it helps with planning, evaluating the plan, and
adjusting the plan. The Intervening Variables (IVs) are those factors that
can't be changed by nursing such as income level, social support, diagnosis,
age. Such IVS can be positive or negative, but will have an impact on the
success/failure of the care plan.
Case Study – Comfort Theory
A 45 year old Hispanic male with colon cancer is admitted to surgical intensive
care immediately following sigmoid colon resection. He speaks very poor English and
appears quite anxious. He has many additional comfort needs and examples are
diagramed on the TS. When nurses assess for comfort needs in any of their patients, they
can use the taxonomic structure, or comfort grid, to identify and organize all known
needs. It is easiest to just focus on Physical, Psychospiritual, Sociocultural, and
Environment comfort needs. Just remember, that risk factors for Relief items are
included, and when the comforting interventions are not entirely successful, we never
give up – we help patients transcend their immediate needs so they are able to work
towards a desired outcome.
Also using the comfort grid as a mental guide, nurses can design inter-related
comforting interventions to address identified needs. These interventions can be
implemented in one or two nurse-patient-family interactions. For this case study,
suggestions for individualized comfort interventions are listed on the TS.
To determine through research if the comforting interventions listed on the TS
achieved their goal of enhancing this patient’s holistic comfort, a comfort questionnaire
could be developed, by writing items for each cell in the comfort grid. Complete
directions for doing so are in Kolcaba (2003). A Likert-type scale with responses ranging
from 1-6 would facilitate a total comfort score. Such a questionnaire would be given to
this patient (in Spanish!) before and after the interventions are implemented, and an
increase in comfort would demonstrate increased comfort. For clinical use, the nurse
could ask this patient, through the interpreter, to rate his comfort before and after the
interventions from 0-10, with 10 being highest comfort possible.
See figure and table next page. I have found when submitting articles,
most editors want to see how the TS is utilized and I am asked to show these
tables frequently.
2
Taxonomic Structure of Comfort Needs Applied
PHYSICAL
RELIEF
Pain
Nausea
PSYCHOSPIRITUAL
Anxiety
ENVIRONMENTAL
Noisy PACU;
bright lights;
cold
Absence of
traditions and
culturally
sensitive care
SOCIOCULTURAL
EASE
Comfortable
bed,
homeostasis
Uncertainty
about prognosis
TRANSCENDENCE
Patient thinking “How
can I tolerate pain when I
wake up”
Need for spiritual
support
privacy
desired
Need for calm, familiar,
quiet environmental
elements
Need for support from
family or significant
other; need for
information, consultation
Family
supportive;
language
barriers
Comfort Care Actions / Interventions
Type of Comfort Care Action /
Intervention
TECHNICAL INTERVENTIONS
COACHING
COMFORT FOOD FOR THE SOUL
Example
Vital signs
Lab results
Patient assessment
Medications & treatments
Pain management
Emotional support
Reassurance
Education
Listening
Presence of interpreter
Therapeutic touch
Music Therapy
Spending time
Personal Connections
Ethnic traditions, food
Also, untilize care plan (next page) for planning and evaluation.