Comfort Contract

I, [patient’s name], or my surrogate, [surrogate’s name], agree to the following terms:

• I expect to be as comfortable as possible during my post-surgical recovery.
• I will communicate my pain and discomfort to my nurse or other healthcare provider so that they can be addressed promptly.
• I will follow the instructions of my nurse or other healthcare provider regarding pain management and other interventions to promote comfort.
• I will inform my nurse or other healthcare provider of any chronic discomforts that I have and the interventions that I use at home to relieve them.
• I understand that there may be times when my comfort needs cannot be met perfectly, but I will work with my nurse or other healthcare provider to find solutions that work for me.

Chronic Discomforts and Interventions

I have the following chronic discomforts:

• [List of chronic discomforts]

I use the following interventions to relieve my chronic discomforts:

• [List of interventions]

I understand that these interventions may not be effective in relieving my discomfort during my post-surgical recovery, but I am willing to try them.

Signatures

[Patient’s signature] [Surrogate’s signature]

Date

[Date]

This comfort contract is a way for patients to communicate their expectations about post-surgical comfort to their nurses and other healthcare providers. By discussing these expectations in advance, patients can help to ensure that their comfort needs are met as well as possible.

The comfort contract also allows patients to specify any chronic discomforts that they have and the interventions that they use at home to relieve them. This information can be helpful to nurses and other healthcare providers in developing a plan for post-surgical comfort.

It is important to note that the comfort contract is not a guarantee of perfect comfort. There may be times when a patient’s comfort needs cannot be met perfectly, but the comfort contract can help to ensure that the patient’s needs are communicated and addressed as best as possible.