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Stress is an inherent part of life. Patients may be stressed and anxious about their prognosis due to potentially terminal illnesses such as colon cancer as exampled by the case study. This stress is not limited to the patient but almost always carries over to the friends and family members of the patient who fear for the future wellbeing of their loved one as well as the loved ones current comfort levels.
Nurses strive to relieve patient stress and anxiety through assessment care planning, counselling and direct contact and care with patients and their families. Building a trusting relationship with the family and caregiver is essential for effective treatment and the discharge of the patient. They may describe a patient’s illness, mental or physical state as well as any treatments available. Letting a patient and his family know what to expect and what potential outcomes may reduce patient stress and anxiety. Simple choices of words, depth of information, body language, tone of voice, and facial expressions can greatly affect the quality of communication between the nurse and patient and family.
For the patient (Dave) not only is he in an unfamiliar environment but is also in the process of coming to grips with the fact that he is very ill, which can leave him feeling frightened and confused. A key aspect in minimising stress is the nursing care being provided. Establishing a relationship with the patient that demonstrates empathy and respect is an integral part with respect to this task.
Strategies to help reduce the anxiety for patient in the above case study include:
Active Listening – This conveys support and trust to the patient. It offers the patient reassurance and allows an opportunity for the patient to discuss other issues, which may explain why they are stress and being ill.
Maintaining a calm demeanour while interacting with patient. Patients feel or safe and stable in a calm environment.
Establishing rapport with the patient – Encouraging a person to talk and listening to them express their feelings and grievances is an important role as a nurse. Patients present less anxiety when nurses make an effort to build a rapport with them.
Acknowledge awareness of patient’s anxiety – Acknowledgment of the patient’s anxieties gives assurance to the patients that their concerns are not falling deaf ears.
In Dave’s situation, the mere sight of a loved one is often enough to greatly reduce stress levels by assuring them that they are not alone in the situation. A sense of reassurance and a positive outlook are attributes that family members and loved ones provide to a patient.
However, seeing a loved-one in hospital can also cause a lot of anxiety for the family and simple tasks as eating healthy, getting enough sleep, and addressing work responsibilities and personal commitments often suffer, as time is sacrificed for the good of the patient. To make matters worse, stress is often increased by having to wrestle with concerns about the patient’s care, complex medical information, financial worries, and unforeseen long term issues after the patient’s discharge.
In order to appropriately support family in these situations, a caring, understanding and empathic approach and an ability and willingness to listen is required. Strategies to help reduce the anxiety for family members include:
Encouraging the family to take time to sleep, shower, eat and attend to their own needs and the needs of each other – Reducing the family member’s anxiety levels is also important as it often reflects back onto the patient which may cause their own levels of anxiety to increase.
Suggesting that the family ask another family member, friend or hired aide to be with the patient when they cannot be present.
Informing the family on the patient’s condition and needs. – Clarification and education to the family on the illness may alleviate some anxiety and fears and help the family focus on realistic outcomes.
Answering as many questions posed by the families as possible as well as asking questions of them conveys a sense of real interest in the patients’ wellbeing in the patient by the nurse.
Refer family members to hospital counsellors if they would like to seek emotional support.
2. Nurses also play a direct role in patient education and the delivery of information to family. When delivering complex information to the client and his family it’s critical to assess what the patient and his family already know before providing information. That way confusion and misunderstandings are avoided.
In situations such as these, which involve the delivery of bad news, it is essentially to convey the information in a slow and deliberate manner so it allows time for patient and his family to comprehend the information. A slow delivery with appropriate pauses also gives the listener time to formulate questions. It’s also helpful to be brief and provide short pieces of information as it makes understanding easier. It is wise to avoid the use of jargon whenever possible, particularly with elderly patients like Dave.
Also, we must be honest with our patient and their family. Although the need to be honest remains primary, the therapeutic value of conveying hope in situations that may appear hopeless should not be underestimated. In Dave’s situation, hope can be communicated to the family by assuring them that treatment can be effective in easing pain and discomfort.
It is also important to continually show empathy and respect towards the patient. Patient satisfaction is likely to be enhanced by nurses who acknowledge their patients’ expressed emotions and treat the patients’ with dignity and respect.
Dave, 66 years old, male
Admitted for small bowel obstruction
Diagnosis: Colon cancer
Recently had an explanatory operation
Previously had a colostomy
Patient anxiety is high, suffering from pain, vomiting and is having trouble eating. Receiving Iv fluids.
Bowl movements need to be checked. Pain relief medication is not working, needs review. Family member are anxious, concerned about the patients comfort and have been referred to patients doctor and counsellors.
If the patient and or family members would like to seek further information, they can be referred to the head nurse, the patients’ doctors, dieticians and counsellors.
3. Handover Notes
Article number one:
The focus of this article is on meditation as a mode of alternative pain relief. Meditation, relaxation and visualization can be useful for some people to control pain. When you meditate your body releases endorphins and boost serotonin levels, Visualization is also useful tool for managing pain for some patient. The article also asserts that meditation will also be effective in reducing the anxiety in patients who are suffering from pain.
Article number two:
This article focuses on the natural alternative pain relief methods of Herbs and Supplements, Meditation and Acupuncture, Acupressure and Exercise. It outlines the effectiveness of natural resources like coffee and poppies in tea to help ease pain, as well as effective ways to stimulate natural hormones to block pain through things such as exercise and acupuncture.
A. Meeting Procedure
The first step to holding a meeting is plan ahead and set the date, time and location of the meeting. When selecting a location, make sure it is in a place where there is there is minimal noise to ensure optimum communication. You will also need to develop an agenda. The agenda should outline clear objectives, and topics for discussion which, in this case is the standard of food that is being provided to the patients.
Meeting information needs to be circulated to everyone involved prior to the meeting. This way, participants have background information of the meeting and give them time to prepare for discussions during the meeting.
Start the meeting on time. By adhering to the schedule you are demonstrating the seriousness of the meeting. This also shows respect to those who showed up on time. As the meeting begins, provide an introduction and the overall objective of the meeting. You might also want to establish some ground rules to keep the meeting running smoothly., for example, setting time limits for each speaker. That way everyone has a chance to speak and no one talks over each other.
As the Director of Nursing, it is your responsibility to keep the meeting moving, and on track. This involves keeping track of the time and ensuring that the agenda is met within the scheduled time frame. You will also help to ensure that everyone who is interested in speaking gets a fair and equal opportunity.
Always end meetings on time and attempt to end on a positive note. At the end of the meeting, the leader should review the outcomes of the discussion. Once the meeting objective has been achieved, take a few moments to exchange feedback and discuss the pros and cons of the meeting and areas that need improving.
B. To successfully communicate to staff and residents during the event of a fire alarm, you have to remain calm and collective. Miscommunication heightens during a crisis therefore when speaking you need to be clear and concise. Use simple and clear words and avoid ambiguous words and jargons.
Non-verbal communication such as body language is also an effective technique of communication in this situation. Through non-verbal communication we can support words or verbal communication.
C. Conflict in meetings can be very disruptive and hold up a decision or resolution. When dealing with different personalities such as passive and aggressive, it helps to reflect on the motivating factors that drive the actions of these individuals.
To address the problem of an unspoken personality, you need to focus on staying calm. Challenging with the other person will only cause more problems whilst someone who is calm is seen as being in control, cantered and more respectable.
If someone is outspoken in a meeting, they need to be told. The best way to communicate in this situation is by being assertive. Being assertive requires you to express your case and needs without violating the rights of others and without being aggressive. Be straightforward, simple, and to the point, yet empathetic, which strengthens and deepens the relationship and rapport.
It’s particularly important to make sure that when you are being assertive that you don’t come off as being aggressive. Use a calm tone and make sure you present yourself with an understanding attitude. A good method to use is the ‘sandwich effect’. This involves showing your appreciation to what the person is doing right, followed by structural criticism, and ending it off with a positive comment. We also need to we need to actively listen to what the person has to say as well as stating our case. By listening it shows that you value their contribution.
Remember, the goal is to find a win-win situation where all members involved are satisfied with the outcome.
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