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 nursepatientfamily 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 (patients 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.
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