Psychiatric Mental Health Nursing by Videbeck

472 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS

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This approach helps the client to make the transi-

tion to discussing feelings.

The focus is on feelings of fear, not fear of physi-

cal problems.

The client may have helpless feelings but may not

recognize this independently.

This assessment provides a knowledge base re-

garding hypochondriacal behaviors.

Open-ended discussion usually is nonthreatening

and helps the client to begin self-assessment.

The client’s perception of stressors usually is

more significant than others’ perception of those

stressors. The client will operate on the basis of

what he or she believes.

If the client is in denial, more direct approaches

may produce anger or hostility and threaten the

trust relationship.

The client can begin to see the relatedness of

stress and physical problems at his or her own

pace. Self-realization will be more acceptable to

the client as opposed to the nurse telling the

client the problem.

Reflecting on written items may be more accurate

and less threatening to the client.

Use the interventions suggested previously as

well as minimal objective reassurance in conjunc-

tion with questions (or other techniques) to

explore the client’s feelings. (“Your tests have

shown that you have no lesions. Do you still feel

that you do? What are your feelings about this?”)

Encourage the client to discuss his or her feelings

about the fears rather than the fears themselves.

Explore the client’s feelings of lack of control over

stress and life events.

Initially, carefully assess the client’s self-image,

social patterns, and ways of dealing with anger,

stress, and so forth.

Talk with the client about sources of satisfaction

and dissatisfaction in his or her daily life, family

and other significant relationships, employment,

and so forth.

After some discussion of the above and the contin-

ued strengthening of your trust relationship, talk

more directly with the client and encourage the

client to talk more openly about specific stresses,

recent and ongoing. What does the client perceive

as stressful?

If the client is using denial as a defense mecha-

nism, the discussion of stresses may need to be

less direct. Point out apparent, probable, or possi-

ble stresses to the client (in a nonthreatening way)

and ask the client for feedback.

Gradually help the client to identify possible

connections between stress and anxiety and the

occurrence or exacerbation of physical symptoms.

Points you might help the client to assess are:

What makes the client more or less comfortable?

What is the client doing or what is going on

around the client when he or she feels more or

less comfortable or is experiencing symptoms?

Encourage the client to keep a diary of events or

situations, stresses, and occurrence of symptoms.

This diary can then be used to identify relation-

ships between stresses and symptoms.

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