{
  "resourceType": "StructureDefinition",
  "id": "zib-ComfortScale",
  "meta": {
    "versionId": "1",
    "lastUpdated": "2025-08-25T10:00:06.8511787+00:00"
  },
  "url": "http://nictiz.nl/fhir/StructureDefinition/zib-ComfortScale",
  "version": "1.0.2",
  "name": "Zib ComfortScale",
  "title": "HCIM ComfortScale",
  "status": "active",
  "date": "2019-09-09T08:07:01.2428268Z",
  "publisher": "Nictiz",
  "contact": [
    {
      "name": "Nictiz",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.nictiz.nl",
          "use": "work"
        }
      ]
    }
  ],
  "description": "The Comfort Behaviour scale /Comfortneo scale is an assessment tool, that is used to assess the pain behaviour of neonates (new born).\r\nThe Comfort Behaviour scale has 7 observation points that that need to be addressed. For each on observation is value is assigned from a 5-point scale, the final score indicates whether the observed child suffers pain and 'how much'. The score is combined with an NRS score that is completed by the nurses on basis of clinical experience.",
  "purpose": "A pain observation instrument is a tool in determining the intensity of pain and can be useful in order to determine the effectiveness of pain treatment interventions (pharmacological or non-pharmacological). For new born it is nevertheless difficult to differentiate between pain or distress/anxiety. This is relevant in determining the treatment. The score on a pain measurement instrument remains a snapshot in time.",
  "copyright": "CC0",
  "fhirVersion": "3.0.2",
  "mapping": [
    {
      "identity": "hcim-comfortscale-v1.0-2017EN",
      "uri": "https://zibs.nl/wiki/ComfortScale-v1.0(2017EN)",
      "name": "HCIM ComfortScale-v1.0(2017EN)"
    }
  ],
  "kind": "resource",
  "abstract": false,
  "type": "Observation",
  "baseDefinition": "http://fhir.nl/fhir/StructureDefinition/nl-core-observation",
  "derivation": "constraint",
  "differential": {
    "element": [
      {
        "id": "Observation",
        "path": "Observation",
        "short": "ComfortScale",
        "alias": [
          "ComfortScore"
        ],
        "mapping": [
          {
            "identity": "hcim-comfortscale-v1.0-2017EN",
            "map": "NL-CM:12.12.1",
            "comment": "ComfortScale"
          }
        ]
      },
      {
        "id": "Observation.code.coding",
        "path": "Observation.code.coding",
        "slicing": {
          "discriminator": [
            {
              "type": "value",
              "path": "code"
            }
          ],
          "rules": "open"
        },
        "min": 1
      },
      {
        "id": "Observation.code.coding:comfortScaleCoding",
        "path": "Observation.code.coding",
        "sliceName": "comfortScaleCoding",
        "min": 1,
        "max": "1"
      },
      {
        "id": "Observation.code.coding:comfortScaleCoding.system",
        "path": "Observation.code.coding.system",
        "min": 1,
        "fixedUri": "http://snomed.info/sct"
      },
      {
        "id": "Observation.code.coding:comfortScaleCoding.code",
        "path": "Observation.code.coding.code",
        "min": 1,
        "fixedCode": "108301000146109"
      },
      {
        "id": "Observation.code.coding:comfortScaleCoding.display",
        "path": "Observation.code.coding.display",
        "defaultValueString": "COMFORT scale (assessment scale)"
      },
      {
        "id": "Observation.effective[x]",
        "path": "Observation.effective[x]",
        "short": "ScoreDateTime",
        "definition": "The date and time at which the Comfort Behaviour scale/ComfortNeo scale was determined.",
        "alias": [
          "ScoreDatumTijd"
        ],
        "min": 1,
        "type": [
          {
            "code": "dateTime"
          }
        ],
        "mapping": [
          {
            "identity": "hcim-comfortscale-v1.0-2017EN",
            "map": "NL-CM:12.12.11",
            "comment": "ScoreDateTime"
          }
        ]
      },
      {
        "id": "Observation.value[x]",
        "path": "Observation.value[x]",
        "short": "TotalScore",
        "definition": "The total score is the sum of all the individual scores. The total score has a range from 0 - 35.",
        "alias": [
          "TotaalScore"
        ],
        "type": [
          {
            "code": "Quantity"
          }
        ],
        "minValueQuantity": {
          "value": 0
        },
        "maxValueQuantity": {
          "value": 35
        },
        "mapping": [
          {
            "identity": "hcim-comfortscale-v1.0-2017EN",
            "map": "NL-CM:12.12.2",
            "comment": "TotalScore"
          }
        ]
      },
      {
        "id": "Observation.value[x].value",
        "path": "Observation.value[x].value",
        "minValueDecimal": 0,
        "maxValueDecimal": 35
      },
      {
        "id": "Observation.comment",
        "path": "Observation.comment",
        "short": "Comment",
        "definition": "A comment on the circumstances during the measurement.",
        "alias": [
          "Toelichting"
        ],
        "mapping": [
          {
            "identity": "hcim-comfortscale-v1.0-2017EN",
            "map": "NL-CM:12.12.12",
            "comment": "Comment"
          }
        ]
      },
      {
        "id": "Observation.component",
        "path": "Observation.component",
        "slicing": {
          "discriminator": [
            {
              "type": "pattern",
              "path": "code"
            }
          ],
          "rules": "open"
        }
      },
      {
        "id": "Observation.component:Alertness",
        "path": "Observation.component",
        "sliceName": "Alertness",
        "max": "1"
      },
      {
        "id": "Observation.component:Alertness.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
              "code": "12.12.3"
            }
          ]
        }
      },
      {
        "id": "Observation.component:Alertness.code.coding.display",
        "path": "Observation.component.code.coding.display",
        "defaultValueString": "Alertness"
      },
      {
        "id": "Observation.component:Alertness.value[x]",
        "path": "Observation.component.value[x]",
        "short": "Alertness",
        "definition": "Observation of:  Alertness",
        "alias": [
          "Alertheid"
        ],
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "extensible",
          "description": "AlertheidCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.12.1--20171231000000",
            "display": "AlertheidCodelijst"
          }
        },
        "mapping": [
          {
            "identity": "hcim-comfortscale-v1.0-2017EN",
            "map": "NL-CM:12.12.3",
            "comment": "Alertness"
          }
        ]
      },
      {
        "id": "Observation.component:CalmnessAgitation",
        "path": "Observation.component",
        "sliceName": "CalmnessAgitation",
        "max": "1"
      },
      {
        "id": "Observation.component:CalmnessAgitation.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
              "code": "12.12.4"
            }
          ]
        }
      },
      {
        "id": "Observation.component:CalmnessAgitation.value[x]",
        "path": "Observation.component.value[x]",
        "short": "Calmness_Agitation",
        "definition": "Observation: Calmness/ agitation",
        "alias": [
          "Kalmte_Agitatie"
        ],
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "extensible",
          "description": "Kalmte_AgitatieCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.12.2--20171231000000",
            "display": "Kalmte AgitatieCodelijst"
          }
        },
        "mapping": [
          {
            "identity": "hcim-comfortscale-v1.0-2017EN",
            "map": "NL-CM:12.12.4",
            "comment": "Calmness_Agitation"
          }
        ]
      },
      {
        "id": "Observation.component:RespiratoryResponse",
        "path": "Observation.component",
        "sliceName": "RespiratoryResponse",
        "max": "1"
      },
      {
        "id": "Observation.component:RespiratoryResponse.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
              "code": "12.12.5"
            }
          ]
        }
      },
      {
        "id": "Observation.component:RespiratoryResponse.code.coding.display",
        "path": "Observation.component.code.coding.display",
        "defaultValueString": "Respiratory Response"
      },
      {
        "id": "Observation.component:RespiratoryResponse.value[x]",
        "path": "Observation.component.value[x]",
        "short": "RespiratoryResponse",
        "definition": "Observation: Respiratory response (only in mechanically ventilated children)",
        "alias": [
          "Ademhalingsreactie"
        ],
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "extensible",
          "description": "AdemhalingsreactieCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.12.3--20171231000000",
            "display": "AdemhalingsreactieCodelijst"
          }
        },
        "mapping": [
          {
            "identity": "hcim-comfortscale-v1.0-2017EN",
            "map": "NL-CM:12.12.5",
            "comment": "RespiratoryResponse"
          }
        ]
      },
      {
        "id": "Observation.component:Crying",
        "path": "Observation.component",
        "sliceName": "Crying",
        "max": "1"
      },
      {
        "id": "Observation.component:Crying.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
              "code": "12.12.6"
            }
          ]
        }
      },
      {
        "id": "Observation.component:Crying.code.coding.display",
        "path": "Observation.component.code.coding.display",
        "defaultValueString": "Crying"
      },
      {
        "id": "Observation.component:Crying.value[x]",
        "path": "Observation.component.value[x]",
        "short": "RespiratoryResponse",
        "definition": "Observation: Respiratory response (only in mechanically ventilated children)",
        "alias": [
          "Ademhalingsreactie"
        ],
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "extensible",
          "description": "HuilenCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.13.4--20171231000000",
            "display": "HuilenCodelijst"
          }
        },
        "mapping": [
          {
            "identity": "hcim-comfortscale-v1.0-2017EN",
            "map": "NL-CM:12.12.6",
            "comment": "Crying"
          }
        ]
      },
      {
        "id": "Observation.component:BodyMovement",
        "path": "Observation.component",
        "sliceName": "BodyMovement",
        "max": "1"
      },
      {
        "id": "Observation.component:BodyMovement.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
              "code": "12.12.8"
            }
          ]
        }
      },
      {
        "id": "Observation.component:BodyMovement.code.coding.display",
        "path": "Observation.component.code.coding.display",
        "defaultValueString": "Body movement"
      },
      {
        "id": "Observation.component:BodyMovement.value[x]",
        "path": "Observation.component.value[x]",
        "short": "BodyMovement",
        "definition": "Observation: Physical movement",
        "alias": [
          "Lichaamsbeweging"
        ],
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "extensible",
          "description": "LichaamsbewegingCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.12.5--20171231000000",
            "display": "LichaamsbewegingCodelijst"
          }
        },
        "mapping": [
          {
            "identity": "hcim-comfortscale-v1.0-2017EN",
            "map": "NL-CM:12.12.8",
            "comment": "BodyMovement"
          }
        ]
      },
      {
        "id": "Observation.component:FacialTone",
        "path": "Observation.component",
        "sliceName": "FacialTone",
        "max": "1"
      },
      {
        "id": "Observation.component:FacialTone.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
              "code": "12.12.9"
            }
          ]
        }
      },
      {
        "id": "Observation.component:FacialTone.code.coding.display",
        "path": "Observation.component.code.coding.display",
        "defaultValueString": "Facial Tone"
      },
      {
        "id": "Observation.component:FacialTone.value[x]",
        "path": "Observation.component.value[x]",
        "short": "FacialTone",
        "definition": "Observation: Facial tension",
        "alias": [
          "Gezichtsspanning"
        ],
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "extensible",
          "description": "GezichtsspanningCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.12.6--20171231000000",
            "display": "GezichtsspanningCodelijst"
          }
        },
        "mapping": [
          {
            "identity": "hcim-comfortscale-v1.0-2017EN",
            "map": "NL-CM:12.12.9",
            "comment": "FacialTone"
          }
        ]
      },
      {
        "id": "Observation.component:BodyMuscleTone",
        "path": "Observation.component",
        "sliceName": "BodyMuscleTone",
        "max": "1"
      },
      {
        "id": "Observation.component:BodyMuscleTone.code",
        "path": "Observation.component.code",
        "patternCodeableConcept": {
          "coding": [
            {
              "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.0",
              "code": "12.12.10"
            }
          ]
        }
      },
      {
        "id": "Observation.component:BodyMuscleTone.code.coding.display",
        "path": "Observation.component.code.coding.display",
        "defaultValueString": "Body Muscle Tone"
      },
      {
        "id": "Observation.component:BodyMuscleTone.value[x]",
        "path": "Observation.component.value[x]",
        "short": "BodyMuscleTone",
        "definition": "Observation: Muscle tone",
        "alias": [
          "Spierspanning"
        ],
        "type": [
          {
            "code": "CodeableConcept"
          }
        ],
        "binding": {
          "strength": "extensible",
          "description": "SpierspanningCodelijst",
          "valueSetReference": {
            "reference": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.40.2.12.12.7--20171231000000",
            "display": "SpierspanningCodelijst"
          }
        },
        "mapping": [
          {
            "identity": "hcim-comfortscale-v1.0-2017EN",
            "map": "NL-CM:12.12.10",
            "comment": "BodyMuscleTone"
          }
        ]
      }
    ]
  }
}