Measuring comfort with the Comfort Questionnaire (CQ)-ICU in critically ill patients during intensive care unit stay: A cross-sectional study

Abstract

Background: Stress factors have been studied in critically ill patients; however, there is a paucity of research examining the holistic aspects of comfort in this population.

Objective: The aim of this study was to identify the factors influencing the perceived comfort of critically ill patients in the intensive care unit (ICU) and their association with sociodemographic and clinical variables.

Methods: An analytical cross-sectional study was conducted with 580 patients admitted to two 1000-bed hospitals in Spain. Participants were interviewed during their ICU stay between 2015 and March 2020. Comfort was measured using the Spanish version of the Comfort Questionnaire (CQ)-ICU with seven factors: Psychological Context, Need for Information, Physical Context, Sociocultural Context, Emotional Support, Spirituality, and Environmental Context. Sociodemographic and clinical variables also collected.

Results: The comfort level was 3.18 (0.42). The mean (standard deviation [SD]) CQ-ICU score was 88.96 (11.87). The highest values (SD) were obtained in Sociocultural Context (20.21 (3.03)) and Emotional Support (10.62 (1.91)); scores (SD) were moderate in Psychological Context (16.61 (2.98)) and Spirituality (6.66 (1.93)), whereas the lowest scores (SD) were found in Need for Information (5.44 (2.23)) and Physical Context (17.33 (4.26)) and Environmental Context (12.07 (2.65)). In the logistic regression model with explained variance (62.80%), predictive variables were odds ratio [95% confidence interval]: Religion (p = 0.041) 1.54 [1.018-2.333], Numerical Rating Scale Oral (NRS-O) (p < 0.001) 2.51 [1.662-3.784], Acute Physiology and Chronic Health Evaluation II (APACHE II) (p = 0.041) 1.57 [1.019-2.433], and the number of vascular access catheters (p = 0.003), 1.79 [1.219-2.638].

Conclusion: The comfort level was high. Patients with religious beliefs or those cared for with a nurse-to-patient ratio of 1:1 were associated with higher comfort values. Sociocultural support, professionals, and spirituality were factors increasing comfort levels, whereas moderate or severe pain, lack of information, or noise requires bundles to improve comfort. The results show the importance of evaluating individual needs during ICU stay via a holistic approach using a validated instrument that also allows the measurement of the impact of interventions that prevent delirium and post-ICU syndrome. Nonetheless, studies in specific critical care units are recommended to provide further evidence.

Keywords: Comfort; Critical care; Critically ill patient; Healthcare quality indicators; Intensive care units; Patient-centred care.