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

RELIEF EASE TRANSCENDENCE

PHYSICAL Pain Comfortable Patient thinking “How
Nausea bed, can I tolerate pain when I
homeostasis wake up”
PSYCHOSPIRITUAL Anxiety Uncertainty Need for spiritual
about prognosis support

ENVIRONMENTAL Noisy PACU; privacy Need for calm, familiar,

bright lights; desired quiet environmental
cold elements
SOCIOCULTURAL Absence of Family Need for support from
traditions and supportive; family or significant
culturally language other; need for
sensitive care barriers information, consultation

Comfort Care Actions / Interventions

Type of Comfort Care Action / Example

Intervention
TECHNICAL INTERVENTIONS Vital signs
Lab results
Patient assessment
Medications & treatments
Pain management
Emotional support
COACHING Reassurance
Education
Listening
Presence of interpreter
Therapeutic touch
COMFORT FOOD FOR THE SOUL Music Therapy
Spending time
Personal Connections
Ethnic traditions, food

Also, untilize care plan (next page) for planning and evaluation.