Assessing Distress in Pediatric Intensive Care Environments: The COMFORT Scale

TLDR

Managing psychological distress is a central treatment goal in PICUs, yet no objective measure exists to assess the efficacy of pharmacologic and psychological interventions. The study develops the COMFORT scale, a nonintrusive measure for assessing distress in PICU patients, and proposes an ecological‑developmental model for further research on children’s distress and coping. The scale comprises eight dimensions chosen through a literature review and survey of PICU nurses. The COMFORT scale shows high interrater agreement, internal consistency, and criterion validity, and factor analysis identifies two correlated behavioral and physiological factors explaining 84 % of the variance.

Abstract

Managing psychological distress is a central treatment goal in Pediatric Intensive Care Units (PICUs), with medical and psychological implications. However, there is no objective measure for assessing efficacy of pharmacologic and psychological interventions used to reduce distress. Development of the COMFORT scale is described, a nonintrusive measure for assessing distress in PICU patients. Eight dimensions were selected based upon a literature review and survey of PICU nurses. Interrater agreement and internal consistency were high. Criterion validity, assessed by comparison with concurrent global ratings of PICU nurses, was also high. Principal components analysis revealed 2 correlated factors, behavioral and physiologic, accounting for 84% of variance. An ecological-developmental model is presented for further study of children's distress and coping in the PICU.