Comfort Plan: Collaborative Creation Guidelines
Introduction to client:
- A comfort plan is a way of identifying strategies you can use to cope with intense emotions. This is a plan made by you to help you feel comfortable and safe.
- By filling out a comfort plan, both you and the staff here will have better awareness of:
- The main challenges you experience
- What strong emotions look like and feel like when you experience them
- How you can deal with those challenges and intense emotions; and
- How staff can help
Fill out the comfort plan:
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Encourage the client to contribute as many ideas as possible and to do the writing, if they are able, to better gain a sense that the comfort plan is their own
- Ideas from families and private providers are welcome at client’s consent
For “when a challenge happens…what it looks like/feels like” discuss how emotions are on a spectrum. A crisis/trauma happens when emotions are so strong that the emotion goes outside the window of tolerance and may feel unmanageable
For “when a challenge happens…what to do/how others can help” make use of the Comfort Plan Guide (Fig. 2) for ideas
- Discuss how the more we learn what “level” our emotions are at, the more control we gain in making them more manageable
- Discuss how there are things we can do and others can help with to manage emotions and how these strategies may be different depending on how intense the emotions are
- Strategies may change over time and the comfort plan can be revised
Discuss use of the comfort plan:
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Client can hang the Comfort Plan on their wall or keep it in an accessible place to remind them of all the things they can do when a challenge arises
- Staff will:
- Discuss with the patient how their plan will be used by staff
- Review/update it with client after a crisis or code white as part of the debrief
Wrap up:
Thank you for filling out your comfort plan. Remember this is for you to help you feel more comfortable and safe. If it isn’t working, just let us know so that we can find strategies that do work
Example procedure for an acute inpatient psychiatric setting:
The Two-Step Comfort Toolkit is part of the primary nurse admission checklist, to be initiated during orientation to the unit if the client is settled. If the client is not able to participate at admission (e.g., admitted into seclusion, or sedated from medications), initiation of the Two-Step Comfort Toolkit is postponed until next earliest opportunity. Although primary nursing initiates the Comfort Toolkit, all disciplines are encouraged to contribute, including Psychology, Social Work, Occupational Therapy, and Psychiatry. Throughout a client’s stay, the Comfort Plan is updated, and the Comfort Kit is reviewed and utilized. Sample Comfort Kits are kept on each unit, and clients may use them with a clinician or on their own (after instruction has been provided). Following discharge, the Community Team takes over in maintaining the Comfort Plan and encouraging the client to create his/her own individualized Comfort Kit.
Technology Plan
- Technology can be used to accentuate the Comfort Toolkit, but is not a requirement.
- The Comfort Plan can be completed digitally, and tracking features enabled to document how many times a given symptom was noticed, how many times a coping strategy was used, how effective the strategy was, etc. This can be used to refine the list of symptoms and coping techniques.
- Technology-enabled anxiety rating scales that would be triggered before and after Comfort Kit use can give valuable data about the effectiveness of the intervention.
- Many modern smart watches have heart rate tracking features. Heart rate is a good way for patients to track symptoms of anxiety, build awareness about emotional states, and prompt use of the Comfort Kit when necessary.
- Technology can be good grounding tools, and may be helpful in a grounding kit. For example, MP3 players pre-loaded with soothing music, handheld video games, technology guided meditation.
Patient & Family Engagement
The inclusion of a patient’s family and/or support persons (friends, religious leaders, private mental health clinician etc.) in a patient’s care planning while in hospital is vital to providing complete care for the patient. We have identified the involvement of family and other supports as a key factor in promoting optimal patient outcomes, and propose to:
- Create a conceptual model of family and support engagement in acute psychiatric settings
- Create tools to help clinicians better assess and map out a patient’s family and support system e.g. genograms
- Provide identified family and supports with psychoeducation about ways to best support a patient during an acute psychiatric crisis
- Develop metrics for quantifying the impact of family and support on patient outcomes, to contribute to the existing body of research.