Psychiatric Mental Health Nursing by Videbeck

19 SOMATOFORMDISORDERS 471

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The nursing assessment provides a baseline from

which to begin planning care.

Genuine physical problems must be noted and

treated.

It is unsafe to assume that all physical complaints

are hypochondriacal—the client could really be ill

or injured. The client may attempt to establish the

legitimacy of complaints by being genuinely in-

jured or ill.

If physical complaints are unsuccessful in gaining

attention, they should decrease in frequency over

time.

It is important to make clear to the client that at-

tention is withdrawn from physical complaints,

not from the client as a person.

Because physical complaints have been the

client’s primary coping strategy, it is less threat-

ening to the client if you limit this behavior ini-

tially rather than forbid it. The client’s hypochon-

driacal behavior may exacerbate if he or she is

denied this coping mechanism abruptly before

new skills can be developed.

Arguing with the client still constitutes attention,

even though it is negative. The client is able to

avoid discussing feelings.

IMPLEMENTATION

Nursing Interventions *denotes collaborative interventions Rationale

The initial nursing assessment should include a
complete physical assessment, a history of
previous complaints and treatment, and a
consideration of each current complaint.

*The nursing staff should note the medical staff’s
assessment of each complaint on the client’s
admission.

*Each time the client voices a new complaint (or
claims injury), the client should be referred to the
medical staff for assessment (and treatment if
appropriate).

*Minimize the amount of time and attention given
to complaints. When the client makes a complaint,
refer him or her to the medical staff (if it is a new
complaint) or follow the team treatment plan; then
tell the client you will discuss something else but
not bodily complaints. Tell the client that you are
interested in the client as a person, not just in his
or her physical complaints. If the complaint is not
acute, ask the client to save the complaint until a
regular appointment with the medical staff.

Withdraw your attention if the client insists on
making complaints the sole topic of conversation.
Tell the client your reason for withdrawal and
that you desire to discuss other topics or will
interact at a later time.

Allow the client a specific time limit (like 5 min-
utes per hour) to discuss physical complaints with
one person. The remaining staff will discuss only
other issues with the client.

Do not argue with the client about the somatic
complaints. Acknowledge the complaint as the
client’s feeling or perception and then follow the
previous approaches.

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