Anxiety - Weebly
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By: Chelsey Treglia
Purpose To create more awareness and a better understanding of anxiety disorder while assessing evidence based nursing research in order to develop a plan of care & high quality means for advocating to patients with anxiety.
Communicate the nursing care problem addressed in the research study Summarize the study methods and results throughout the study Design and discuss a care plan for a patient who is experiencing anxiety disorder Use the TRUEPIC form to assess a patient with anxiety disorder Advocate for those affected by anxiety disorder
What is Anxiety Disorder?
Anxiety vs Anxiety Disorder
The research study that was used was, “Student nurses’ experiences of anxiety in the clinical setting.” This study examines student nurses' perception of anxiety in the clinical setting. The focused population was student nurses from two baccalaureate nursing programs in the United States Nursing Theory: Peplau’s theory of interpersonal relations
The research study used phenomenology Sample size of seven student nurses from two different schools. Average age was 22.1, all female students - six white, one Hispanic. Face- face unstructured interviews were used to collect data. Interviews were professionally transcribed.
Several themes emerged which caused anxiety– Experiencing inexperience Being demeaned Being exposed Being abandoned Competition among peers Being uncertain of ability
Small sample size All females Only two different universities used which means only a few clinical sites were used as well Not a true picture of student nurses thoughts Voluntary sample; should have been a randomized controlled trial design Use of subjective versus objective measures for outcomes
Collaboration of Patient Care Nurses Psychiatrists Pharmacists Family members Patient’s friends / support system The patient
Situation: Nora Hill is a 24 year old patient with no previous medical conditions who states she is “going mad with anxiety.” Her problem began when she was studying for her NCLEX. Wanting to be able to pass her NCLEX the first time, she has been unable to cope with the pressure of having to take it. When she gets to a new study section, she reports not knowing where to start. She states that if she leaves a lot of questions unanswered, she begins to get palpitations and shortness of breath. These symptoms have been getting worse over the last month. Nora also says she has recently been drinking a glass of wine every night to calm her nerves. She is not currently on any medications and does not want to be due to bad side effects she has read about. She has been admitted for observation overnight The nurse is a 25 year old BSN prepared RN and a recent graduate, who has just finished her orientation for the unit.
TRUEPIC 1.IDENTIFY… The variables in this situation 24 yr old female No previous medical history Refusing medications Doesn’t want any side effects Palpitations and shortness of breath Pressure to study for NCLEX and pass first time Drinks a glass of wine every night Calm nerves
3. UNDERSTAND…the importance of the propositions, assumptions, and confounding variables.
2. RELATE…Or put the variables together to form propositions. Primary Proposition: “Pt’s pressure to study for NCLEX exam has increased causing palpitations and shortness of breath. Possible Assumptions: “Pt knows that if she does not pass the NCLEX the first time, she can retake it a second time Possible Confounding Variables: “Fear of taking any medications due to possible side effects.”
Proposition: “If anxiety does not get under control, patient will have increased number of anxiety attacks. Significance of Assumptions: “If pt is not aware of the need to lower anxiety levels to decrease attacks, she may unintentionally be contributing to the worsening of her condition.” Possible Confounding Variables: “If the pt has a fear of medications because of side effects, she may be reluctant to start any new medications to help control her anxiety disorder. Pt may not be able to drink a glass of wine every night if put on certain medications.”
TRUEPIC cont. 4. EXPLAIN…the significance of the situation to those involved based on their individual KSVME Proposition: In a way that the patient can understand, explain what an anxiety attack is, signs and symptoms, how to prevent or stop one from happening and possible complications from unresolved attacks. Assumptions: Explain the benefits of the anti-anxiety medications and how it can benefit the patient’s overall quality of life. Confounding Variables: Explain alternative options to help control anxiety. Explain that you are there to support her.
5. PREDICT…what will happen in this situation if one or more variables are not changed. Proposition: If the pt’s anxiety foes not get controlled, her symptoms may worsen and she may begin to have thoughts of self harm which then could lead to longer recovery Assumptions: If the pt cooperates and begins taking the prescribed medication and other helpful nonpharmacological methods, her anxiety levels will lessen dramatically and relatively fast. Confounding Variables: If the pt has other alternative methods to help with anxiety, it will give her a sense of control and she will be able to decide for herself what method works for her lifestyle.
6. INFLUENCE…someone to change one or more variables in order to achieve a desired outcome or prevent an undesirable one. Proposition: Make sure the pt understand what an anxiety attack is. Refer her to a psychiatrist to further evaluate her concerns and manage her medications. Assumptions: Make sure pt understands how to help herself if she feels an anxiety attack coming on. Discuss triggers and means of coping. Confounding Variables: Make sure the pt understands the psychiatrist is there for her when she needs some medical help regarding her anxiety and anti-anxiety pills.
7. CONTROL…one or more variables in order to achieve a desired outcome or prevent an undesirable one. To control isn’t an issue of wanting to dominate or do what is unreasonable or unwanted, but simply a matter of changing one or more variables in order to bring about a desired outcome when influence is not possible, realistic, or advisable. Pt cannot drink alcohol while in the hospital
Build a relationship Family
All patients are different, so it is important to treat each patient individually Individualized
Current Nursing. (2011). Application of interpersonal theory in nursing practice. Retrieved from http://currentnursing.com/nursing_theory/a pplication_Peplau's_interpersonal_theory.html Melincavage, S.M. (2011). Student nurses’ experiences of anxiety in the clinical setting. Nurse Education Today, 31, 785-789. doi:10.1016/j.nedt.2011.05.007