400218 Mental Health Nursing Practice 1
Question:
Clinical Scenario
Answer:
Active Listening
Active listening involves the nurse’s hearing, processing and objectively understanding the words of the patient, in addition to processing the client’s sentiments according to the context of the patient. This also involves the nonverbal communication that is given as a feedback by the patient when verbally responding to the nurse (McNaughton, Hamlin, McCarthy, Head-Reeves, & Schreiner, 2008). Active listening is a non-intrusive technique of showing concern for the feelings and thoughts of the patient (Floyd, 2014). Active listening is significant in the case of Stefan because through this technique, the patient will feel valued and be convinced that the nurse is interested in his welfare and thus win the confidence of the patient which will lead him to provide more information necessary for surgery preparation. Active listening will also enable the nurse to put together more persuasive feedbacks that will meet the needs of the client.
Focusing
Focusing is a therapeutic communication skill that is often applied by healthcare providers to help the patient to pay attention to present issues. The technique of focusing is premised on the understanding that there is an intimate connection between mind and body, and that keen listening to the body enables one to understand himself or herself (Elliott, 2013; Young & Young, 2014). Focusing, therefore, enables an individual to effectively converse with themselves and develop an in depth understanding of their current feelings. Focusing allows an anxious patient or one under pain to empathically link with his body and to comprehend the psychological meaning of the body discomfort and sensations, and at the end overcoming these sensations. This approach minimizes stress and anxiety (Chiesa & Serretti, 2009). The nurse tries to direct the attention of the patient to the issue at hand and eliminate all distractions. Focusing technique is most appropriate in the case of Stefan who through body languages like walking about the room, staring at different objects, uncombed hair, clenching and unclenching of hands etc. is evidence of one whose is being overwhelmed with body sensations and therefore becoming more stressful.
Using Open Ended Questions
The use of open ended questions elicit additional and detailed information and is applicable in cases where the nurse is in need of in depth information about the client. This technique is also applicable when the client is required to freely express his or her own feelings and beliefs (Beauchemin, Hutchins, & Patterson, 2008). This skill is appropriate in the case of Stefan who is to undergo surgery and therefore his attitude and feelings should be right in order to regulate activities like blood pressure.
You have formed a clinical opinion that Stefan is presenting with signs and symptoms of anxiety. Briefly explain the presenting features in the scenario that support your opinion
Inability to stay calm and still
Stephan is not able to stay calm and still in the waiting room. He is often seen walking about the room and looking at every object in his sight but doesn’t appear to be concentrating on whatever he sets his eyes upon. Stefan at one moment walks out of the interview room and continues to walk about the room. Additionally, the patient is observed clenching and unclenching his hands while walking. According to De Moor, Boomsma, Stubbe, Willemsen, and de Geus (2008), an anxious patient will exhibit symptoms such as having difficulty controlling worry, lack of concentration.
Panic fear and uneasiness
Stefan also appears uneasy and with panic fear of the impending surgery. He confesses that he is fearful of the awaiting surgery since he has never had a similar experience before in his lifetime. The client is seen to be uneasy in the manner in which he gets up and walks about the room observing all objects on sight but without a particular focus on any. Panic attack is a type of anxiety disorder that is associated with recurring panic attacks. This disorder leads to irresistible sensation of fear that can turn out to be devastating (Ströhle, 2009). Shin and Liberzon (2010) observes that patients that are diagnosed with panic attack disorder develop an intense fear of death or loss of control. According to Smoller, Gardner?Schuster, and Covino (2008) panic attacks take place when someone is in an anxious state and are very worried about making drastic changes in their lifestyle.
Sleepless, restless
Stefan confesses during the interview that he has lacked sleep and has been restless from the time he became aware of the surgery. A study done by Wetherell et al. (2009) found out that patients developed sleepless nights when they had information on the impending treatment compared to when they were ignorant of the same. Studies on both human and animals have shown that acute and chronic stress leads to sleep deprivation and are regulated through the stimulation of the HPA axis and the sympathetic system (Hirotsu, Tufik, & Andersen, 2015). Stefan experiences sleeplessness and is restless due to the constant fear of the thought that he is to undergo surgery. The entertainment of such thoughts develops fear which disrupts sleep and the sensations overwhelm the body and mind.
Loss of body weight
The loss of employment and the fear of undergoing surgery must have caused Stefan to develop anxiety disorder which had a negative impact on his body weight. Studies have associated anxiety disorder with loss of body weight (Lavie, Milani, Artham, Patel, & Ventura, 2009).
You decide to provide relaxation techniques to help reduce Stefan’s anxiety. Briefly describe how you would apply this intervention to help Stefan.
Slow Diaphragmatic Breathing
This a relaxation technique used to get through a difficult situation without causing any negative consequence (Larson, El Ramahi, Conn, Estes, & Ghibellini, 2010). This approach will be much relevant to Stefan’s case. The patient will be requested to sit comfortably in a chair with his feet flat on the floor, and his hands folded on his belly. Stefan will then be required to breathe in slowly and calmly in order to fill up the belly with a normal breathe. The breathing should not be too heavy, and the hands should move up as he breathes in. The shoulders should also not be lifted up during inhalation, but instead he should breathe into the stomach.
During exhalation the patient should slowly breathe out to the count of five. The rate of exhalation should be slowed down. The patient should then hold for like three seconds after exhalation and before inhaling again. This can be practiced for like ten minutes.
Visualization
Visualization is a relaxation technique in which an individual uses his or her imagination to form mental pictures that are more calming in order to relax the body and soothe thoughts (Hofmann, Sawyer, Witt, & Oh, 2010). This technique is most appropriate for Stefan who is suffering symptoms of anxiety such as lack of concentration of intense fear. The patient begins by sitting quietly on a comfortable chair with the feet on the floor. Then followed by a slow, diaphragmatic breathing. The patient is then to focus his mind on his breath as it exhales and inhales. In the second step, Stefan is to note the inclination of the mind to stray to other things such as worry, memory or the anticipation of the surgery. Irrespective of the thoughts, the patient is to endeavour to gently bring back the mind to concentrate on the breath. However, the client is to allow the mind to wander as it will often be the case, but try to bring it back by focusing on the breath. The patient should not try to force the mind to focus on something, but instead to simply allow it to stray and bring it back gently. The client should also note the tendency of his experience to fluctuate. The patient can divert the mind by thinking on positive things or just thinking of the sky soon to change shape. This procedure is to be practiced for about 10 minutes.
You have a medication order available to you for diazepam 5 to 10mg oral PRN once-only for anxiety symptoms. You make a decision to offer this medication to Stefan. Briefly describe the relevant information you need to provide to help him decide.
In order for me to administer diazepam 5 to 10mg oral PRN to Stefan as a treatment of anxiety symptoms, I will have to provide detailed information to help him decide. These information include the benefits of the drug in treating anxiety, warnings, and side effects.
Diazepam is one of the best drugs for treatment of anxiety symptoms. Diazepam is effective in treating anxiety, panic disorders among others. The drug aids in calming an anxious mind by having an impact on the brain through the binding with receptor cells that cause feelings of tranquillity. When diazepam is taken under instructions it is multipurpose, effective, and with minimal side effects. Diazepam is also important in sedation. It is used to put a patient into sleep in readiness for surgery. It is best administered prior to a major surgery in order to prepare the patient and to make him or her relaxed (Bandelow et al., 2008). These advantages make diazepam the most appropriate for Stefan. I will try to convince Stefan that this drug will work to counter all the current anxiety symptoms that he is undergoing. Additionally, the drug will put him at ease in readiness for the medical procedure. This will ensure that he doesn’t feel much pain.
Perhaps the most serious part of the black box warning that comes with it. According to the Food and Drug Administration, the black box warning is the most serious of all. This warning is important because of the presence of evidence of nicotine stains on his fingers. Diazepam should not be used with opioid drugs because this can lead to dangerous effects such as slow breath, extreme drowsiness, coma and even death (McCance?Katz, Sullivan, & Nallani, 2010). I will warn Stefan not to take alcohol while taking Diazepam. The side effects of diazepam includes fatigue, muscle weakness, tremor, nausea, dry mouth and dizziness. Information on the benefits of the drug, warnings and side effects will help Stefan to make an informed decision regarding the medical procedure awaiting him. Additionally, these information will help him reduce anxiety and make him at ease in readiness for the surgery.
Reference
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