Nursing HOMEWORK

CASE STUDYA 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.TABLE 33.1Taxonomic Structure of Comfort Needs for Case StudyContext of ComfortReliefEaseTranscendencePhysicalAching backEarly strong contractionsRestlessness and anxietyPatient thinking, “What will happen to my family and to my babies?”PsychospiritualAnxiety and tensionUncertainty about prognosisNeed for emotional and spiritual supportEnvironmentalRoommate is a primigravidaRoom is small, clean, and pleasantLack of privacyTelephone in roomFeeling of confinement with bed restNeed for calm, familiar environmental elements and accessibility of distractionSocioculturalAbsence of family and culturally sensitive careFamily not presentLanguage barriersNeed for support from family or significant otherNeed for information and consultationTABLE 33.2Comfort Care Actions and InterventionsType of Comfort Care Action or InterventionExampleStandard comfort interventionsVital signsLaboratory test resultsPatient assessmentMedications and treatmentsSocial workerCoachingEmotional supportReassuranceEducationListeningClergyComfort food for the soulEnergy therapy such as healing touch if it is culturally acceptableMusic therapy or guided imagery (patient’s choice of music)Spending timePersonal connectionsReduction of environmental stimuliFor 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.