5 Psychosocial support
Nursing diagnosis:
Fatigue
related to disease process, treatment, medications, depression, or stress
| ASSESSMENT/INTERVENTIONS | RATIONALES |
|---|---|
| Assess patient’s patterns of fatigue and times of maximum energy. (Use of a visual analog scale may be helpful in monitoring the fatigue level.) | This information helps identify areas for teaching energy conservation, relaxation, and diversional activities to reduce fatigue. |
| Assess how fatigue affects patient’s emotional status and ability to perform activities of daily living (ADLs). Suggest activity schedules to maximize energy expenditures (e.g., “After you eat lunch, take a 15-minute rest before you go to x-ray”). | Developing an activity plan (e.g., rescheduling activities, allowing rest periods, asking for assistance, exercise) will help conserve energy, reduce fatigue, and maintain ADLs. |
| Assess patient for signs and symptoms of anemia. | Anemia can result from cancer or its treatments. Fatigue can occur because of decreased oxygen-carrying capacity of blood. Pharmacologic agents or transfusions may be needed to increase red blood cells. |
| Assess patterns of sleep. | Disturbance in sleep pattern may influence level of fatigue. |
| Help patient maintain a regular sleep pattern by allowing for uninterrupted periods of sleep. Encourage patient to rest when fatigued rather than attempting to continue activity. Encourage naps during the day. | Lack of effective sleep can lead to psychosocial distress (e.g., inability to concentrate, anxiety, uncertainty, and depression). |
| Reduce environmental stimulation overload (e.g., noise level, visitors for long periods of time, lack of personal quiet time). | This action helps promote uninterrupted sleep patterns. |
| Discuss with patient how to delegate chores to family and friends who are offering to assist. | This action helps conserve energy and enables family and friends to feel a part of patient’s care. |
| Encourage patient to maintain a regular schedule once discharged, recognizing that attempting to continue previous activity levels may not be realistic. | This information helps patient engage in a realistic activity schedule to minimize fatigue and avoid frustration if his or her physical functioning does not return to baseline levels. |
| Encourage mild exercise such as short walks and stretching, which may begin in the hospital if not contraindicated. | Such exercise will promote flexibility, muscle strength, and cardiac output and reduce stress. |
Nursing diagnosis:
Disturbed sleep pattern
| ASSESSMENT/INTERVENTIONS | RATIONALES |
|---|---|
| Assess patient’s usual (before and after diagnosis) sleeping patterns (e.g., bedtime routine, hours of sleep per night, sleeping position, use of pillows and blankets, napping during the day, nocturia). | Some or all of patient’s usual sleep pattern may be incorporated into the plan of care. A routine as similar to patient’s normal routine as possible will help promote sleep. |
| Assess causative factors and activities that contribute to patient’s insomnia, awaken patient, or adversely affect sleep patterns. | Factors such as pain, anxiety, hypoxia, therapies, depression, hallucinations, medications, underlying illness, sleep apnea, respiratory disorder, caffeine, and fear may contribute to sleep pattern disturbance. Some may be ameliorated, and others may be modified. |
| Explore relaxation techniques that promote patient’s rest/sleep. | Imagining relaxing scenes, listening to soothing music or taped stories, and using muscle relaxation exercises are relaxation techniques that are known to promote rest/sleep. |
| Administer sleep medicines at a time appropriate to induce sleep, taking into consideration time to onset and half-life. | Simulating patient’s usual sleep/wake pattern aids in uninterrupted sleep. |
| As indicated, administer pain medications before sleep. | This intervention decreases the likelihood that pain will interfere with patient’s sleep. |
| Promote physical comfort via such measures as massage, back rubs, bathing, and fresh linens before sleep. | These measures help relieve stress and promote relaxation. |
| Organize procedures and activities to allow for 90-min periods of uninterrupted rest/sleep. Limit visiting during these periods. | Ninety minutes of sleep allows complete progression through the normal phases of sleep. |
| Whenever possible, maintain a quiet environment. | Excessive noise and light can cause sleep deprivation. Providing earplugs, reducing alarm volume, and using white noise (i.e., low-pitched, monotonous sounds: electric fan, soft music) may facilitate sleep. Dimming the lights for a period of time, drawing the drapes, and providing blindfolds are other ways of promoting sleep. |
| If appropriate, limit patient’s daytime sleeping. Attempt to establish regularly scheduled daytime activity (e.g., ambulation, sitting in chair, active range of motion), which may promote nighttime sleep. | Napping less during the day will promote a more normal nighttime pattern. Physical activity causes fatigue and may facilitate nighttime sleeping. |
| Promote nonpharmacologic comfort measures that are known to promote patient’s sleep. | Nonpharmacologic comfort measures such as earplugs, anxiety reduction, and use of patient’s own bed clothing and pillows may promote sleep. |
| Also see this nursing diagnosis in “Perioperative Care,” p. 54. |
Nursing diagnosis:
Anxiety
| ASSESSMENT/INTERVENTIONS | RATIONALES |
|---|---|
| Assess patient’s level of anxiety. Be alert to verbal and nonverbal cues. | Being cognizant of patient’s level of anxiety enables nurse to provide appropriate interventions, as well as modify the plan of care accordingly. Levels of anxiety include: – Moderate: Inattentiveness, expressions of concern, narrowed perceptions, insomnia, increased heart rate (HR). – Severe: Expressions of feelings of doom, rapid speech, tremors, poor eye contact. Patient may be preoccupied with the past; may be unable to understand the present; and may have tachycardia, nausea, and hyperventilation. |
| Introduce self and other health care team members; explain each individual’s role as it relates to patient’s care. | Familiarity with staff and their individual roles may increase patient’s comfort level and decrease anxiety. |
| Engage in honest communication with patient, providing empathetic understanding. Listen closely. | These actions help establish an atmosphere that allows free expression. |
| For patients with severe anxiety or panic state, refer to psychiatric clinical nurse specialist, case manager, or other health care team members as appropriate. | Patients in severe anxiety or panic state may require more sophisticated interventions or pharmacologic management. |
| Approach patient with a calm, reassuring demeanor. Show concern and focused attention while listening to patient’s concerns. Provide a safe environment and stay with patient during periods of intense anxiety. | These actions reassure patient that you are concerned and will assist in meeting his or her needs. |
| Restrict patient’s intake of caffeine, nicotine, and alcohol. | Caffeine is a stimulant that may increase anxiety in persons who are sensitive to it. Cessation of caffeine, nicotine, and alcohol can lead to physiologic withdrawal symptoms including anxiety. |
| Avoid abrupt discontinuation of anxiolytics. | Abrupt withdrawal can cause headaches, tiredness, and irritability. |
| If patient is hyperventilating, have him or her concentrate on a focal point and mimic your deliberately slow and deep breathing pattern. | Modeling provides patient with a focal point for learning effective breathing technique. |
| Validate assessment of anxiety with patient. | Validating patient’s anxiety level provides confirmation of nursing assessment, as well as openly acknowledges patient’s emotional state. In so doing, patient is given permission to share feelings. For example, “You seem distressed. Are you feeling uncomfortable now?” |
| After an episode of anxiety, review and discuss with patient the thoughts and feelings that led to the episode. | This action validates with patient the cause of the anxiety and explores interventions that may avert another episode. |
| Identify patient’s current coping behaviors. Review coping behaviors patient has used in the past. Assist patient with using adaptive coping to manage anxiety. | Identifying maladaptive coping behaviors (e.g., denial, anger, repression, withdrawal, daydreaming, or dependence on narcotics, sedatives, or tranquilizers) helps establish a proactive plan of care to promote healthy coping skills. For example, “I understand that your wife reads to you to help you relax. Would you like to spend a part of each day alone with her?” |
| Encourage patient to express fears, concerns, and questions. | Encouraging questions gives patient an avenue in which to share concerns. For example, “I know this room looks like a maze of wires and tubes; please let me know when you have any questions.” |
| Provide an organized, quiet environment (see Disturbed Sensory Perception, p. 79). | Such an environment reduces sensory overload that may contribute to anxiety. |
| Encourage social support network to be in attendance whenever possible. | Many people benefit from support of others and find that it reduces their stress level. |
| Teach patient relaxation and imagery techniques. | Teaching relaxation and imagery skills empowers patient to manage anxiety-provoking episodes more skillfully and fosters a sense of control. |
Nursing diagnosis:
Fear
| ASSESSMENT/INTERVENTIONS | RATIONALES |
|---|---|
| Assess patient’s fears and concerns and provide opportunities for patient to express them. | These actions help determine factors contributing to patient’s feelings of fear. For example, “You seem very concerned about receiving more blood today.” |
| Listen closely to patient. | Reactions such as anger, denial, occasional withdrawal, and demanding behaviors may be coping responses. |
| Encourage patient to ask questions and gather information about the unknown. Provide information about equipment, therapies, and routines according to patient’s ability to understand. | Increasing knowledge level about therapies and procedures reduces/eliminates fear of the unknown and affords a sense of control. |
| Acknowledge fears in an empathetic manner. | Acknowledging feelings encourages communication and hence reduces fear. For example, “I understand this equipment frightens you, but it is necessary to help you breathe.” An empathic response promotes expression of fears and provides reassurance that concerns are acknowledged. |
| Encourage patient to participate in and plan care whenever possible. | Participation promotes an increased sense of control, which helps decrease fears. |
| Provide continuity of care by establishing a routine and arranging for consistent caregivers whenever possible. Appoint a case manager or primary nurse. | Consistency in care providers promotes familiarity and trust. |
| Discuss with health care team members the appropriateness of medication therapy for patients with disabling fear or anxiety. | Pharmacologic interventions are sometimes necessary in assisting patients to cope with fears/anxieties about treatment, diagnosis, and prognosis. |
| Explore patient’s desire for spiritual or psychologic counseling. | Exploring spiritual/psychologic dimension of the current experience may assist patient to cope with fear and stress. |
| Explore patient’s desire to participate in support groups or meet with others with similar diagnoses. | Many people benefit from outside sources of support in decreasing fears. Interaction with another person who has had a similar experience provides hope and encouragement. |
Nursing diagnosis:
Ineffective coping
related to health crisis, sense of vulnerability, or inadequate support systems
| ASSESSMENT/INTERVENTIONS | RATIONALES |
|---|---|
| Assess patient’s perceptions and ability to understand current health status. Discuss meaning of disease and current treatment with patient, actively listening with a nonjudgmental attitude. | Evaluation of patient’s comprehension enables development of an individualized care plan. |
| Establish honest, empathetic communication with the patient. | This promotes effective therapeutic communication. For example, “Please tell me what I can do to help you.” |
| Support positive coping behaviors and explore effective coping behaviors used in the past. | These actions identify, reinforce, and facilitate positive coping behaviors, for example, “I see that reading that book seems to help you relax.” |
| Identify factors that inhibit patient’s ability to cope. | This enables patient to identify areas such as unsatisfactory support system, deficient knowledge, grief, and fear that may contribute to anxiety and ineffective coping and to consider modification of these factors. |
| Help patient identify previous methods of coping with life problems. | How patient has handled problems in the past may be a reliable predictor of how he or she will cope with current problems. |
| Recognize maladaptive coping behaviors. If appropriate, discuss these behaviors with patient. | Examples of maladaptive behaviors include severe depression; dependence on narcotics, sedatives, or tranquilizers; hostility; violence; and suicidal ideation. Patient may have used substances and other maladaptive behaviors in controlling anxiety. This pattern can interfere with ability to cope with current situation. If appropriate, nurses should discuss these behaviors with patient. For example, “You seem to be requiring more pain medication. Are you having more physical pain, or does it help you cope with your situation?” |
| Refer patient to psychiatric liaison, clinical nurse specialist, case manager, or clergy, or recommend support groups or other programs as appropriate. | Professional intervention may assist with altering maladaptive behaviors. |
| Help patient identify or develop a support system. | Many people benefit from outside support systems in helping them cope. |
| As patient’s condition allows, assist with reducing anxiety. See Anxiety, p. 71. | Anxiety makes effective coping more difficult to achieve. |
| Maintain an organized, quiet environment. See Disturbed Sensory Perception, p. 79. | Such an environment helps reduce patient’s sensory overload to aid with coping. |
| Encourage frequent visits by family and caregiver if visits appear to be supportive to patient. | Visitors may help minimize patient’s emotional and social isolation, thereby promoting coping behaviors. |
| As appropriate, explain to caregiver that increased dependency, anger, and denial may be adaptive coping behaviors used by patient in early stages of crisis until effective coping behaviors are learned. | Lack of understanding about patient’s maladaptive coping can lead to unhealthy interaction patterns and contribute to anxiety within the family. |
| Arrange community referrals for discharge planning, as appropriate. | Support in the home environment promotes healthier adaptations and may avert crises. |
Only gold members can continue reading. Log In or Register to continue
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
