Impaired comfort is a multidimensional diagnosis used to describe the physical, emotional, social, cultural, and spiritual challenges a patient encounters. Comfort levels vary between patients and age groups and are dynamic. It is recommended the nurse assess for a specific cause of impaired comfort as much as possible in order to best intervene.
Pain and symptom control aren’t the only ways to improve comfort. Patients need to feel comfortable in their environment, connected spiritually, have family present, receive timely assistance, be involved in their treatment plan, and feel engaged with committed staff members. Evidence shows that patient comfort is directly related to the overall patient experience.
It may not be possible to eliminate all aspects of discomfort, but the nurse has a unique opportunity to create a safe environment that allows for peace and a sense of control.
In this article:
- Causes (Related to)
- Signs and Symptoms (As evidenced by)
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Causes (Related to)
The following are common causes of impaired comfort:
- Pain
- Anxiety
- Inadequate sleep
- Worry and overwhelm
- Stress
- Nausea and vomiting
- Unfamiliar surroundings (hospitalization)
- Imbalanced thermoregulation
- Loss of support systems
- Conflicts with cultural or spiritual beliefs
Signs and Symptoms (As evidenced by)
The following are common signs and symptoms of impaired comfort. They are categorized into subjective and objective data based on patient reports and assessment by the nurse.
Subjective: (Patient reports)
- Verbalizes pain, exhaustion, or general unwellness
- Expresses feeling stressed or worried
- Expresses concern about their health or a procedure
- Verbalizes a sense of unease
Objective: (Nurse assesses)
- Signs of pain: grimacing, guarding, moaning, diaphoresis
- Flat affect
- Irritability or restlessness
- State of panic or anxiety
- Rapid breathing
- Increased heart rate
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for impaired comfort:
- Patient will appear calm and relaxed with vital signs within normal limits.
- Patient will report a pain score of 3 or less out of 10.
- Patient will state two methods to control their stress and worry.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to impaired comfort.
1. Assess physical causes of discomfort.
Pain, nausea, fatigue, and medical equipment such as IV lines and catheters can cause impaired comfort.
2. Assess pain level.
Monitor the pain level closely using a pain scale (verbal or nonverbal).
3. Assess for mental or emotional feelings of discomfort.
The nurse may observe outward signs of discomfort such as restlessness or tearfulness, but the patient may be struggling with an emotional challenge.
4. Ask the patient about their comfort goals.
There are some instances that the nurse may not be able to control, or the patient may not have a realistic understanding of the situation.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you’ll learn more about possible nursing interventions for a patient with impaired comfort.
1. Be kind.
The easiest and foremost action the nurse can take with patients is to be kind. Smile, use a warm tone of voice, and emit a sense of competent caring. Patients need to feel safe in order to feel comfortable.
2. Administer medications to ease discomfort.
Pain medications, antiemetics, and antianxiety medications are necessary to increase comfort and improve rest and healing.
3. Consider nonpharmacologic interventions.
Warm blankets can increase comfort. Cool rags can ease nausea or feeling overheated. Pillows and repositioning prevent physical discomfort. Encourage the patient to engage in deep breathing exercises or guided imagery if appropriate.
4. Explain procedures and care before implementing.
Patients often feel a sense of lack of control and can feel vulnerable when sick and hospitalized. The nurse should always explain everything they do before they do it. Explain the steps of starting an IV, obtaining vital signs, or how a medication might make them feel. This drastically decreases fear and discomfort when a patient knows what to expect.
5. Offer relaxation and calming techniques.
A patient feeling overwhelmed or anxious may need a calming voice to remind them they are safe. Teach breathing and meditation exercises.
6. Keep the environment stress-free.
After asking permission, help the patient clear their environment. Scattered papers, old food, and cluttered tables can feel overwhelming. Reduce stimuli by decreasing outside noise, dimming the lights, and ensuring privacy by keeping the door closed.
7. Offer hygiene care or items to clean themselves.
Feeling unclean has a huge impact on comfort. If the patient cannot clean themselves, offer a bed bath with skincare and oral care. If the patient is independent, provide supplies such as a toothbrush, comb, and deodorant.
8. Offer chaplain services for spiritual distress.
The patient may require a visit from the chaplain if their discomfort is related to a spiritual issue.
9. Encourage family visitation.
Encourage the patient to have their family and friends visit to improve their mood (unless this is the cause of their discomfort). If they do not feel well enough for visitors, recommend a phone call.
10. Recommend distractions.
A patient who is worried or anxious may need to be distracted. Drawing or reading a book can be helpful.
11. Respect cultural values.
Being hospitalized can feel lonely, and the patient may feel out of their comfort zone. Respect their privacy, ask before touching them, and do not push topics they are uncomfortable discussing.
12. Acknowledge their thoughts.
The nurse should patiently listen and reassure the patient that their thoughts and feelings are valid. The nurse does not always have to offer a solution as sometimes the patient only needs to voice their concerns.
13. Be proactive with long-term needs.
The patient may be worried about finances or how they will handle their illness once they return home. The nurse can involve a case manager or social worker and begin the discussion of support at home before the patient discharges to ease their uncertainty.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for impaired comfort.
Care Plan #1
Diagnostic statement:
Impaired comfort secondary to gastroenteritis as evidenced by vomiting and reports of nausea.
Expected outcomes:
- Patient will report an increased appetite and ability to eat bland foods.
- Patient will not experience nausea and vomiting.
Assessment:
1. Note dietary, travel, and medical history.
A comprehensive medical history, including travel and diet, may help identify the etiology of gastroenteritis.
2. Monitor hydration status.
Nausea and vomiting alter the patient’s hydration due to fluid loss. Note mucous membranes, skin turgor, daily weight, BP, intake and output. Signs of dehydration are signs to look out for since severe cases may warrant hospitalization and more complex treatment.
3. Assess for the presence of abdominal pain.
Patients with gastroenteritis may also experience abdominal pain and tenderness upon palpation. Abdominal pain adds to the impaired comfort that needs to be addressed.
Interventions:
1. Administer medications as ordered.
- Antiemetics (i.e., antihistamines, anticholinergics, dopamine antagonists, serotonin (5-HT3) receptor antagonists, and benzodiazepines): Most antiemetics raise the threshold of the chemoreceptor trigger zone of stimulation, creating a reduction in the feeling of needing to vomit.
- Antibiotics: Antibiotics should target the etiologic agent causing bacterial gastroenteritis. Addressing the root cause will relieve the discomfort of symptoms.
2. Administer IV fluids.
Supportive management through rehydration is crucial to prevent excessive fluid loss. Rehydration via the oral route is preferable in mild cases. But since the patient experiences nausea and vomiting, the patient may not tolerate drinking. Hence, hydration through the IV route may be needed.
3. Offer frequent small amounts of foods that appeal to the patient, such as dry foods (i.e., toast or crackers), bland simple foods (i.e., broth, banana, rice, jell-O), and avoid oily or fried foods.
Patients experiencing nausea may tolerate these foods and need to eat more when nausea is absent. Oily and fatty foods are hard to digest. Hence, it may exacerbate nausea.
4. Remove noxious sights and odors. Provide good oral hygiene after vomiting.
Noxious triggers can stimulate the vomiting center.
5. Encourage nonpharmacologic measures to control nausea and vomiting (i.e., guided imagery, music therapy, deep breathing exercises).
These measures are adjuncts to other treatments for nausea and must be used before nausea occurs or exacerbates.
6. Educate the family about the importance of handwashing after toileting and before preparing food.
Gastroenteritis is acquired through consuming contaminated food. Proper handwashing will prevent gastroenteritis and the spread of infection to others.
Care Plan #2
Diagnostic statement:
Impaired comfort related to muscle spasms secondary to fibromyalgia as evidenced by disturbed sleeping patterns and irritability.
Expected outcomes:
- Patient will report improved sleep quality and pattern.
- Patient will verbalize two strategies to improve comfort and quality of life.
Assessment:
1. Assess for pain and note the precipitating and alleviating factors, location, severity, quality and timing.
Patients with fibromyalgia usually complain of generalized musculoskeletal pain as the chief discomfort is felt. Understanding what factors precipitate or alleviate pain and understanding the pain pattern is the first step in creating a plan to reduce pain.
2. Assess the sleeping pattern.
Due to fatigue, a cardinal symptom of fibromyalgia, patients have disturbed sleeping patterns. They sleep lightly and wake up frequently at dusk due to muscle stiffness. Even though they complete an 8- to 10-hour sleep, they still feel unrefreshed upon waking up every morning.
Interventions:
1. When the patient feels discomfort, teach or assist with relaxation techniques such as progressive relaxation training, guided imagery, hand massage, or music therapy.
Relaxation techniques can effectively decrease the perception of uncomfortable sensations, including pain.
2. Teach good sleeping hygiene to maximise rest.
Good sleep hygiene is vital in the management of fibromyalgia. Muscle stiffness, pain, and fatigue are common signs experienced by patients with fibromyalgia, contributing to poor sleep quality. Teach the patient about the importance of creating a cool, dark and quiet sleeping environment and creating a wind-down routine before bed.
3. Administer analgesics as ordered.
Some patients may not seek adequate relief from nonpharmacologic measures alone. Anticonvulsants and antidepressants like tricyclic medications, selective serotonin reuptake inhibitors (SSRIs) and norepinephrine reuptake inhibitors (SNRIs) are effective pain relievers for fibromyalgia.
4. Encourage or assist with exercise training.
The cardiovascular exercise comprised of doing aerobic exercises 30 minutes a day three times a week within a target heart rate improves sleep and decreases pain in patients with fibromyalgia.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- Bhargava, J.& Hurley, J.A. (2022). Fibromyalgia. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK540974/
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Clark, M. (2020, July 11). 11 Fast and Easy Ways for Hospitals to Boost Patient Comfort. Etactics. https://etactics.com/blog/patient-comfort
- Cynthia Wensley, Mari Botti, Ann McKillop, Alan F. Merry, A framework of comfort for practice: An integrative review identifying the multiple influences on patients’ experience of comfort in healthcare settings, International Journal for Quality in Health Care, Volume 29, Issue 2, April 2017, Pages 151–162, https://academic.oup.com/intqhc/article/29/2/151/2910767
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Sattar, S.B.A.& Singh, S. (2022). Bacterial gastroenteritis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK513295/
