Nursing Care For Managing Patient Anxiety: Clinical Scenario

Communication skills required

The nursing professional can realize that the patient is highly nervous about the surgery and therefore, she needs to be careful while interacting with him ensuring that none of her conversations with the patient adds to his anxiety. The first important thing that the patient should be maintaining while communicating with the patient is the active listening skill (Wood et al., 2015). It is very important for the person to feel that the professionals are listening to them. This helps them to feel that the professionals are concerned about them and are respectful about what they want to say. Therefore, the nurse attending Stefan would first listen to him entirely without interrupting him.  In many of the situations, it is seen that patients get anxious as the hospital environment is unknown to them and they do not know what to expect (Hoge et al., 2015). Therefore, the nurse should first help Stefan to become comfortable and discuss in details about his situation and what needs to be done with him. Clear description of the procedure with the positive and negative aspects associated with surgeries or other treatments help in developing a clear scenario in the mind of the patient and this would help in reducing anxiety and nervousness in the patient. Many researchers are of the opinion that nurses should not constantly tell anxious patients to relax (El alaqui et al., 2015). Instead, the nursing professionals should tell the patient about the techniques that they can undertake to relax as that would help them to overcome nervousness. The nurse should also show Stefan some relaxation techniques to help him overcome nervousness. Often using of humor is seen to be effective helping patients to relieve their stress. Therefore while communicating, the nurse should make efforts to lighten the mood of Stefan and try to bee personable. She can also engage in different types of informal conversations to keep his mind away from his source of concern. The professionals also need to be empathetic when the patients are nervous. This would make Stefan feel that the nurse has understood his condition and is not judging him and rather feeling exactly what Stefan is feeling. This helps in developing therapeutic relation with patients and helps in managing their nervousness. The nursing professionals need to ensure that they are patient enough to handle such situation and do not impose their biased thinking on the comments of the patients. The nurse who is attending the patient might feel that Stefan’s worry is baseless but she should never express them and maintain the uniqueness of each patient providing him person centered care, she should never be biased and judgmental on the condition of the patient and sure communication with him in a respectful manner.

A number of signs and symptoms have been identified after close analysis of the patient named Stefan that help to know that he is highly nervous and has developed anxiety. The first symptom that helps to understand is Stefan’s excessive worrying about the surgery. Restlessness is yet another symptom for restlessness (Miloff et al., 2015). Stefan is found to be excessively restless and he was not able to sit peacefully and comfortably at any position. This high level of restlessness and worrying give a clear indication that he was suffering from anxiety. One of the most important sign that was also noticed is the difficulty in concentrating. Different evidence based studies have already shown that people suffering from anxiety cannot concentrate on any particular activities. While the nurse was taking the medical history of the patient along with his partner, Stefan was seen to be replying with short answers and suddenly stood up  and started working in the room. This showed that he was not putting concentration in the medical history recording with the nurse. Another sign and symptom of anxiety is the trouble of the patient falling or staying asleep (Storch et al., 2015). From the outer appearance of the patient, it was seen that he had bags under his eyes, which implied that he might have not slept for many days, and this can be because of the result of nervousness of the surgery or might be tensions due to his financial situations after loss of employment. Both might have resulted in anxiety in the patient. Researchers are also of the opinion that panic attacks are yet another symptom that shows that patients are nervous. Panic attacks have also been noticed among the patient. The patient was having extreme fear about the consequences of the surgery and this was clearly seen from the way he was communicating as well as from the statement that her partner used “silly idiot thinks he’s going to die”. This fear was giving the patient panic attacks and his clenching and unclenching of his hands and others are proofs of this. The different signs helped me to realize that the patient named Stefan was actually suffering from generalized anxiety disorder (GAD). In this type of disorder, people are seen to experience constant anxiety as well as worry about different activities as well as event that are ordinary and even routine (Baumiester et al., 2014). Stefan was highly anxious about the consequences of the day-surgery and was therefore anxious about the outcomes of the surgery largely.

Signs and symptoms

The nurse needs to provide relaxation techniques to the patient named Stefan in order to help him release the stress, overcome the panic attacks and be relaxed and comfortable in the healthcare area. Relaxation techniques can be explained as the strategies that help in the reduction of the stress as well as the anxiety helping to manage the symptoms of the panic attacks, restlessness and worrying. It helps in management of the flight or fight responses or the stress actions that are triggered among the people suffering from anxiety issues (Oerback et al., 2014). One of the most important techniques that should be adopted is the deep breathing exercises. Researchers are of the opinion that this is one of the easiest and the relaxation technique and is also the most fruitful one helping in making patients relaxed. The nurse would be teaching the patient about how to breathe slowly as well as deeply which will allow him to feel more relaxed. Researchers are of the opinion that such relaxation techniques have a cleansing effect that make patients feel energized as well as refreshed. It also helps in the focusing as well as providing attention to the different breathing procedures helping in clearing of the patient and helping in the controlling of the rhythm of the breath. Another important relaxation technique that also needs to be addressed is the visualization technique (Barkowski et al., 2016). This is one of the most powerful way of letting stress and anxiety go off from the mind of the patient. This technique mainly helps the patient in imagining a picture to the calming as well as the serene environment such as a beach or that that of the flower-bed meadow. This technique would help the patient in relaxing his body and thereby soothing his thoughts. When the nurse can successfully help the patient to follow the technique, the patient would feel more rejuvenated as it allows the body and the mind to feel free from any tensions.  The nurse can also make the patient try out progressive muscle relaxation technique, as this would help in the patient to overcome anxiety symptoms. The first step would be making the patient feel comfortable with the second step being able to breathe deeply through the nose, feel the abdomen rise when filled with air and then exhaling from the mouth with the drawing of the naval towards the spine. After repeating, it for three to four times, muscles of the feet will be advised to be tightened and released with the clenching of the toes and thereby pressing the heels towards the ground. They should be squeezed for the tightly for a few minutes and then they should be released. The feet would be then flexed with the pointing of the toes up towards the head and then should be held for few seconds. This should be advised to carry on with the tightening and the releasing technique in the order of legs, glutes, abdomen, back, arms, shoulders, neck. Face. These should be need with taking a few breaths noting more calmness in the body (DeCastella et al., 2015).

Relaxation techniques

This tablet is mainly known by the name of valium and can be taken as oral solution as well as rectal get. This is mainly used n the treatment of anxiety as well as for alcohol withdrawal, muscle spasms and certain types of specific seizures. The nurse should first describe the patient about the way by which diazepam will work. The chemical called gamma aminobutyric acid (GABA) if present in less amount in the body might make the body stay in the excited state and this may result in the creation of anxiety, muscle spasms or might result in seizures (Aggarwal et al., 2016). Therefore, diazepam will increase the quantity of the chemical helping the body to overcome the said signals. However, she also needs to explain the various negative ways the medication can also affect the body. The common side effects would be drowsiness, muscle weakness, headache, dizziness, nausea, tiredness or fatigue, inability to control muscle movements (ataxia), tremor, dry mouth or excessive saliva, as well as constipation. Some of the serious side effects that also associates with the taking of the disorder like worsening of the seizures resulting in severity and frequency but since, seizures are not occurring in the patient, this might be omitted. Changes in the brain might occur like depression, confusion, slowing or the slurring of the speech, thoughts of suicide, memory loss feeling of vertigo (Newby et al., 2015). Unexpected reactions are also common like that of the hallucinations, extreme excitement, agitation and many others. Liver and bladder problems might also rise along with different sex drive issues (Iverach & Rapee, 2014). Withdrawal symptoms like muscle cramps, convulsions, sweating as well as tremor might also occur. Therefore, the nursing professional need to say all the negative effects and the positive effects and accordingly informed consent should be taken from him whether he is ready to use it or not.

References:

Aggarwal, N. K., Pieh, M. C., Dixon, L., Guarnaccia, P., Alegría, M., & Lewis-Fernández, R. (2016). Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: a systematic review. Patient education and counseling, 99(2), 198-209.

Barkowski, S., Schwartze, D., Strauss, B., Burlingame, G. M., Barth, J., & Rosendahl, J. (2016). Efficacy of group psychotherapy for social anxiety disorder: A meta-analysis of randomized-controlled trials. Journal of anxiety disorders, 39, 44-64.

Baumeister, H., Reichler, L., Munzinger, M., & Lin, J. (2014). The impact of guidance on Internet-based mental health interventions—A systematic review. Internet Interventions, 1(4), 205-215.

De Castella, K., Goldin, P., Jazaieri, H., Heimberg, R. G., Dweck, C. S., & Gross, J. J. (2015). Emotion beliefs and cognitive behavioural therapy for social anxiety disorder. Cognitive behaviour therapy, 44(2), 128-141.

El Alaoui, S., Hedman, E., Kaldo, V., Hesser, H., Kraepelien, M., Andersson, E., … & Lindefors, N. (2015). Effectiveness of Internet-based cognitive–behavior therapy for social anxiety disorder in clinical psychiatry. Journal of consulting and clinical psychology, 83(5), 902.

Hoge, E. A., Bui, E., Goetter, E., Robinaugh, D. J., Ojserkis, R. A., Fresco, D. M., & Simon, N. M. (2015). Change in decentering mediates improvement in anxiety in mindfulness-based stress reduction for generalized anxiety disorder. Cognitive Therapy and Research, 39(2), 228-235.

Iverach, L., & Rapee, R. M. (2014). Social anxiety disorder and stuttering: Current status and future directions. Journal of fluency disorders, 40, 69-82.

Miloff, A., Marklund, A., & Carlbring, P. (2015). The challenger app for social anxiety disorder: New advances in mobile psychological treatment. Internet Interventions, 2(4), 382-391.

Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical psychology review, 40, 91-110.

Oerbeck, B., Stein, M. B., Wentzel?Larsen, T., Langsrud, Ø., & Kristensen, H. (2014). A randomized controlled trial of a home and school?based intervention for selective mutism–defocused communication and behavioural techniques. Child and Adolescent Mental Health, 19(3), 192-198.

Storch, E. A., Lewin, A. B., Collier, A. B., Arnold, E., De Nadai, A. S., Dane, B. F., … & Murphy, T. K. (2015). A randomized controlled trial of cognitive?behavioral therapy versus treatment as usual for adolescents with autism spectrum disorders and comorbid anxiety. Depression and anxiety, 32(3), 174-181.

Wood, J. J., Ehrenreich-May, J., Alessandri, M., Fujii, C., Renno, P., Laugeson, E., … & Murphy, T. K. (2015). Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: A randomized, controlled trial. Behavior Therapy, 46(1), 7-19.