Psychiatric Mental Health Nursing by Videbeck

19 SOMATOFORMDISORDERS 473

continued from page 472

Continued, regular interest in the client facili-

tates the relationship. It also can desensitize the

client regarding discussion of feelings and emo-

tional issues.

The client may have difficulty identifying and

expressing feelings directly. Your encouragement

and support may help him or her to develop these

skills.

The client and his or her family or significant

others may have little or no knowledge of stress,

interpersonal dynamics, hypochondriacal behav-

ior, and so on. Knowledge of the treatment plan

will promote long-term behavior change.

Maintaining limits to reduce secondary gain

requires everyone’s participation to be successful.

The client’s family and significant others must be

aware of the client’s needs if they want to be effec-

tive in helping to meet those needs.

Positive feedback and support for healthier be-

havior tends to make that behavior recur more

frequently. The client’s family and significant

others also must use positive reinforcement.

If physical problems do not get the client what he

or she wants, the client is less likely to cope in

that manner.

A team effort helps to discourage the client’s

manipulation of some staff members to obtain

additional medication. See Care Plan 42: Passive-

Aggressive Personality Disorder.

If the client can obtain stress relief in a nonchem-

ical, nonmedical way, he or she is less likely to

use the medication or treatment.

Talk with the client at least once per shift, focus-
ing on the identification and expression of the
client’s feelings.

Encourage the client to ventilate feelings by talk-
ing or crying, through physical activities, and so
forth.

*Teach the client and his or her family or
significant others about the dynamics of
hypochondriacal behavior and the treatment
plan including plans after discharge.

*Talk with the client and significant others about
the concept of secondary gains and together de-
velop a plan to reduce those gains. Identify the
needs the client is attempting to meet with sec-
ondary gains (such as attention or escape from
perceived responsibilities or from stress).

Help the client plan to meet his or her needs in
more direct ways. (Show the client that attention
and support are available when he or she is not
exhibiting symptoms or complaints and when he
or she deals with responsibilities directly or
asserts himself or herself in the face of stress or
discomfort.)

Reduce the benefits of illness as much as possible.
Do not allow the client to avoid responsibilities by
voicing somatic discomfort; do not excuse the
client from activities or allow special privileges
such as staying in bed or dressing in night clothes.

• Work with the medical staff to limit the number,
  variety, strength, and frequency of medications,
  enemas, and so forth that are made available to
  the client.

When the client requests a medication or treat-
ment for a complaint, encourage the client to
identify what precipitated the complaint and to
deal with the discomfort in other ways.

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