295➤ CLINICAL EXAMPLE
Mr. Noe has discussed in detail with the community health nurse how his wife
cannot be expected to walk 2 to 3 miles a day after her triple-bypass operation
because she is afraid to leave the house. He has been taking care of her for the
past 13 years during which time she had rarely left the house and then only
with great distress and only accompanied by him. His wife says she gets so anx-
ious she wants to scream and run back in the door if she tries to walk out of it.
She believes something terrible will happen to her. She knows this is true be-
cause the last time she left the house to go to the doctor she had to have triple-
bypass surgery the next day. Mr. Noe takes care of necessary chores outside the
house, attends parents’ weekend at their children’s colleges, does the grocery
shopping, and so forth.
Mrs. Noe has asked the nurse to “figure out how I can get outside and walk
every day,” but for each suggestion the nurse makes, Mrs. Noe finds some rea-
son it will not work. The nurse is getting frustrated with Mrs. Noe’s constant
rejection of her suggestions and sternly says, “You haven’t the foggiest inten-
tion of walking out that door, so why are we doing this?”
- Rather than giving Mrs. Noe suggestions to get her outside, what might be
a better plan? - How is Mr. Noe’s behavior affecting Mrs. Noe’s agoraphobia? What does
the nurse need to explain and to recommend to Mr. Noe about his response
to her behavior? - What other treatments are available for Mrs. Noe?