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.
Taxonomic Structure of Comfort Needs for Case Study
Context of Comfort
Early strong contractions
Restlessness and anxiety
Patient thinking, “What will happen to my family and to my babies?”
Anxiety and tension
Uncertainty about prognosis
Need for emotional and spiritual support
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
Absence of family and culturally sensitive care
Family not present
Need for support from family or significant other
Need for information and consultation
Comfort Care Actions and Interventions
Type of Comfort Care Action or Intervention
Standard comfort interventions
Laboratory test results
Medications and treatments
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)
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.
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