468 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
explain that inactivity and poor eating habits perpet-
uate discomfort and that often it is necessary to en-
gage in behaviors even when one doesn’t feel like it.
Client: “I just can’t eat anything. I have no
appetite.”
Nurse: “I know you don’t feel well, but it is im-
portant to begin eating.”(validation, encouraging
collaboration)
Client: “I promise I’ll eat just as soon as I’m
hungry.”
Nurse: “Actually, if you begin to eat a few bites,
you’ll begin to feel better, and your appetite may im-
prove.”(encouraging collaboration)
The nurse should not strip clients of their soma-
tizing defenses until he or she has collected adequate
assessment data and clients have learned other cop-
ing mechanisms. The nurse should not attempt to
confront clients about somatic symptoms or attempt
to tell them that these symptoms are not “real.” They
are very real to clients, who actually experience the
symptoms and associated distress.
ASSISTING THE CLIENT TO
EXPRESS EMOTIONS
Teaching about the relationship between stress and
physical symptoms is a useful way to help clients
begin to see the mind–body relationship. Clients may
keep a detailed journal of their physical symptoms.
The nurse might ask them to describe the situation
at the time such as whether they were alone or with
others, whether or not any disagreements were occur-
ring, and so forth. The journal may help clients to see
when physical symptoms seemed worse or better and
what other factors may have affected that perception.
Limiting the time that clients can focus on phys-
ical complaints alone may be necessary. Encouraging
them to focus on emotional feelings is important, al-
though this can be difficult for clients. The nurse
should provide attention and positive feedback for
efforts to identify and discuss feelings.
It may help for the nurse to explain to the family
about primary and secondary gains. For example, if
the family can provide attention to clients when they
are feeling better or fulfilling responsibilities, clients
are more likely to continue doing so. If family mem-
bers have lavished attention on clients when they
have physical complaints, the nurse can encourage
the relatives to stop reinforcing the sick role.TEACHING COPING STRATEGIES
Two categories of coping strategies are important for
clients to learn and to practice: emotion-focused
coping strategies,which help clients relax and re-
duce feelings of stress; and problem-focused cop-
ing strategies,which help to resolve or change a
client’s behavior or situation or manage life stressors.
Emotion-focused strategies include progressive re-
laxation, deep breathing, guided imagery, and dis-
tractions such as music or other activities. Many ap-
proaches to stress relief are available for clients to try.
The nurse should help clients to learn and practice
these techniques, emphasizing that their effective-
ness usually improves with routine use. Clients must
not expect such techniques to eliminate their pain or
physical symptoms; rather, the focus is helping them
to manage or diminish the intensity of the symptoms.
Problem-focused coping strategies include learn-
ing problem-solving methods, applying the process
to identified problems, and role-playing interactions
with others. For example, a client may complain that
no one comes to visit or that she has no friends. The◗ CLIENT ANDFAMILYTEACHING
- Establish daily health routine including adequate
rest, exercise, and nutrition. - Teach about relationship of stress and physical
symptoms and mind/body relationship. - Educate about proper nutrition, rest, and exercise.
- Educate client in relaxation techniques: progres-
sive relaxation, deep breathing, guided imagery,
and distraction such as music or other activities. - Educate client by role-playing social situations
and interactions. - Encourage family to provide attention and
encouragement when client has fewer
complaints. - Encourage family to decrease special attention
when client is in “sick” role.
◗ INTERVENTIONS FOR
SOMATOFORMDISORDERS- Health teaching
Establish a daily routine.
Promote adequate nutrition and sleep. - Expression of emotional feelings
Recognize relationship between stress/coping
and physical symptoms.
Keep a journal.
Limit time spent on physical complaints.
Limit primary and secondary gains. - Coping strategies
Emotion-focused coping strategies such as
relaxation techniques, deep breathing, guided
imagery, and distraction
Problem-focused coping strategies such as
problem-solving strategies and role-playing