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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.
Taxonomic Structure of Comfort Needs Applied
PHYSICAL / Pain
Nausea / Comfortable bed, homeostasis / Patient thinking “How can I tolerate pain when I wake up”
PSYCHOSPIRITUAL / Anxiety / Uncertainty about prognosis / Need for spiritual support
ENVIRONMENTAL / Noisy PACU;
bright lights;
cold / privacy
desired / Need for calm, familiar, quiet environmental elements
SOCIOCULTURAL / Absence of traditions and culturally sensitive care / Family supportive; language barriers / Need for support from family or significant other; need for information, consultation
Comfort Care Actions / Interventions
Type of Comfort Care Action / Intervention / ExampleTECHNICAL INTERVENTIONS / Vital signs
Lab results
Patient assessment
Medications & treatments
Pain management
COACHING / Emotional support
Reassurance
Education
Listening
Presence of interpreter
COMFORT FOOD FOR THE SOUL / Therapeutic touch
Music Therapy
Spending time
Personal Connections
Ethnic traditions, food