Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Comfort Plan Mental Health and Addictions Program Example

I developed this plan with my nurse  
or other provider  

I like to be called:  

ID Tag

(Please do not label individual's personal copy).

My Distress Signs & Signals: My warning signals, or things that others might see when I am upset or losing control are:

  •  Sweating
  •  Crying
  •   Breathing hard
  •  Yelling
  •  Hurting others
  •  Throwing objects
  •  Pacing
  •  Injuring self by
  •  Clenching teeth
  •  Not taking care of myself
  •  Running
  •  Clenching fist
  •  Swearing
  •  Not eating
  •  Over eating / binging
  •  Being rude
  •  Other

Comfort & Calming Measures: These 5 activities that have helped me feel better when having a hard time.

  •  Listening to music
  •  Reading a book
  •  Wrapping myself in cozy blanket
  •  Writing in a journal
  •  Watching TV
  •  Talking with staff
  •  Talking with peers on the unit
  •  Calling a friend or family member
  •  Take a shower or bath
  •   Exercise
  •  Pacing in the halls
  •  Going for a walk
  •  Drinking a beverage
  •  Eating certain food(s)
  •   Working on a craft, artwork
  •  Medication
  •  Reading religious/spiritual material
  •  Writing a letter
  •  Hugging a stuffed animal

My Triggers or Irritants: Some things that make me angry, very upset or cause me to go into crisis?

  •  Being touched
  •  Security in uniform
  •  Yelling
  •  Loud noises
  •  Being hungry
  •  Being tired
  •  Staff telling me to come back later
  •  Being called names, made fun of
  •  Being forced to do something
  •  Physical force
  •  Being isolated
  •  Being threatened
  •  Being anxious
  •  Being lonely
  •  Personal space violated
  •  Contact with person who upsets me
  •  Someone else lying about me
  •  Other

Seclusion & Restraints: In extreme emergencies seclusion and/or restraint may be used as a last resort. In emergencies, I would find the following helpful in trying to prevent these from being used?

  •  Comfort or quite room
  •  Exercise room
  •   Medications by mouth  
  •  Emergency Injection 
  •  Other

Medications:
If I need or want medications to help calm me, these would be my preference:
 
 
 

Comments:
 

Physical Contact: I find it helpful to be touched appropriately when I am upset:

  •  Yes
  •  No

Comments:
 

I am aware that staff may prefer not to touch me.

Gender Concerns:

I am aware that gender of staff is out of my control, but in an emergency I would prefer to speak with:

  •  male staff
  •  female staff

If at all possible.

Reprinted with permission from St. Joseph’s Health Care Hamilton, Ontario.