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Journal of Pediatric Psychology 17(1) pp. 95-109, 1992
© 1992 Society of Pediatric Psychology

research-article

Assessing Distress in Pediatric Intensive Care Environments: The COMFORT Scale1

Bruce Ambuel2, Kim W. Hamlett, Celeste M. Marx3 and Jeffrey L. Blumer

Medical College of Wisconsin, University of Virginia, Case Western Reserve University, Case Western Reserve University

2A11 correspondence should be sent to Bruce Ambuel, Department of Family Medicine, Medical College of Wisconsin, Waukesha Family Practice Center, 210 N.W. Barstow Street, Waukesha, Wisconsin 53188

3Requests for copies of the COMFORT Scale and manual should be addressed to Celeste Marx, Department of Pediatrics, Rainbow Babies and Childrens Hospital, 2101 Adelbert Road, Cleveland, Ohio 44106

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.

Key words: distress; pain; critical care; pediatric intensive care; developmental.


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