The underlying mechanism of somatization is consistent for clients with somatoform disorders of all types.
APPLICATION OF THE NURSINGPROCESS
The underlying mechanism of somatization is consistent for clientswith somatoform disorders of all types. This section discusses application ofthe nursing process for cli-ents with somatization; differences among thedisorders are highlighted in the appropriate places.
Assessment
The nurse must investigate physical health status thoroughly toensure there is no underlying pathology requiring treatment. When a client hasbeen diagnosed with a somatoform disorder, it is important not to dismiss allfuture complaints because at any time the client could develop a physicalcondition that would require medical attention.
History
Clients usually provide a lengthy and detailed account of previousphysical problems, numerous diagnostic tests, and perhaps even a number ofsurgical procedures. It is likely that they have seen multiple health careproviders over several years. Clients may express dismay or anger at themedical community with comments such as “They just can’t find out what’s wrongwith me” or “They’re all incom-petent, and they’re trying to tell me I’mcrazy!” The excep-tion may be clients with conversion disorder, who show littleemotion when describing physical limitations or lack of a medical diagnosis (la belle indifférence).
General Appearance and Motor Behavior
Overall appearance usually is not remarkable. Often, cli-ents walkslowly or with an unusual gait because of the pain or disability caused by thesymptoms. They may exhibit a facial expression of discomfort or physicaldis-tress. In many cases, they brighten and look much better as the assessmentinterview begins because they have the nurse’s undivided attention. Clientswith somatization dis-order usually describe their complaints in colorful,exag-gerated terms but often lack specific information.
Mood and Affect
Mood is often labile, shifting from seeming depressed and sad whendescribing physical problems to looking bright and excited when talking abouthow they had to go to the hospital in the middle of the night by ambulance.Emo-tions are often exaggerated, as are reports of physical symptoms. Clientsdescribing a series of personal crises related to their physical health mayappear pleased rather than distressed about these situations. Clients withcon-version disorder display an unexpected lack of distress.
Thought Process and Content
Clients who somatize do not experience disordered thoughtprocesses. The content of their thinking is pri-marily about often exaggeratedphysical concerns; for example, when they have a simple cold, they may becon-vinced it is pneumonia. They may even talk about dying and what music theywant played at their funeral.
Clients are unlikely to be able to think about or to respond toquestions about emotional feelings. They will answer questions about how theyfeel in terms of physical health or sensations. For example, the nurse may ask,“How did you feel about having to quit your job?” The cli-ent might respond,“Well, I thought I’d feel better with the extra rest, but my back pain was justas bad as ever.”
Clients with hypochondriasis focus on the fear of seri-ous illnessrather than the existence of illness, as seen in clients with other somatoformdisorders. However, they are just as preoccupied with physical concerns asother somatizing clients and are likewise very limited in their abilities toidentify emotional feelings or interpersonal issues. Clients withhypochondriasis are preoccupied with bodily functions, ruminate about illness,are fascinated with medical information, and have unrealistic fears aboutpotential infection and prescription medication.
Sensorium and Intellectual Processes
Clients are alert and oriented. Intellectual functions areunimpaired.
Judgment and Insight
Exaggerated responses to their physical health may affect clients’judgment. They have little or no insight into their behavior. They are firmlyconvinced their problem is entirely physical and often believe that othersdon’t understand.
Self-Concept
Clients focus only on the physical part of themselves. They areunlikely to think about personal characteristics or strengths and areuncomfortable when asked to do so. Cli-ents who somatize have low self-esteemand seem to deal with it by totally focusing on physical concerns. They lackconfidence, have little success in work situations, and have difficultymanaging daily life issues, which they relate solely to their physical status.
Roles and Relationships
Clients are unlikely to be employed, although they may have a pastwork history. They often lose jobs because of excessive absenteeism orinability to perform work; clients may have quit working voluntarily because ofpoor physi-cal health. Consumed with seeking medical care, they have difficultyfulfilling family roles. It is likely that these cli-ents have few friends andspend little time in social activi-ties. They may decline to see friends or togo out socially for fear that they would become desperately ill away from home.Most socialization takes place with members of the health care community.
Clients may report a lack of family support and under-standing.Family members may tire of the ceaseless com-plaints and the client’s refusalto accept the absence of a medical diagnosis. The illnesses and physicalconditions often interfere with planned family events such going on vacationsor attending family gatherings. Home life is often chaotic and unpredictable.
Physiologic and Self-Care Concerns
In addition to the multitude of physical complaints, these clientsoften have legitimate needs in terms of their health practices. Clients whosomatize often have sleep pattern disturbances, lack basic nutrition, and getno exercise. In addition, they may be taking multiple pre-scriptions for painor other complaints. If a client has been using anxiolytics or medications forpain, the nurse must consider the possibility of withdrawal.
Data Analysis
Nursing diagnoses commonly used when working with clients whosomatize include the following:
·Ineffective Coping
·Ineffective Denial
·Impaired Social Interaction
·Anxiety
·Disturbed Sleep Pattern
·Fatigue
·Pain
Clients with conversion disorder may be at risk for disuse syndromefrom having pseudoneurologic paralysis symptoms. In other words, if clients donot use a limb for a long time, the muscles may weaken or atrophy from lack ofuse.
Outcome Identification
Treatment outcomes for clients with a somatoform disor-der mayinclude the following:
·The client will identify the relationship between stress andphysical symptoms.
·The client will verbally express emotional feelings.
·The client will follow an established daily routine.
·The client will demonstrate alternative ways to deal with stress,anxiety, and other feelings.
The client will demonstrate healthier behaviors regard-ing rest,activity, and nutritional intake.
Intervention
Providing Health Teaching
The nurse must help the client learn how to establish a dailyroutine that includes improved health behaviors. Adequate nutritional intake,improved sleep patterns, and a realistic balance of activity and rest are allareas with which the client may need assistance. The nurse should expectresistance, including protests from the client that she or he does not feelwell enough to do these things. The challenge for the nurse is to validate theclient’s feelings while encouraging her or him to participate in activities.
Nurse: “Let’s take a walk outside for some fresh air.” (encouraging collaboration)
Client: “I wish I could, but I feel so terrible, I just can’t do it.”
Nurse: “I know this is difficult, but some exer-cise is essential. Itwill be a short walk.” (validation; encourag-ing collaboration)
The nurse can use a similar approach to gain client participationin eating more nutritious foods, getting up and dressed at a certain time everymorning, and setting a regular bedtime. The nurse also can explain thatinactivity and poor eating habits perpetuate discomfort and that often it isnecessary to engage in behaviors even when one doesn’t feel like it.
Client: “I just can’t eat anything. I have no appetite.”
Nurse: “I know you don’t feel well, but it is important to begin eating.” (validation;encour-aging collaboration)
Client: “I promise I’ll eat just as soon as I’m hungry.”
Nurse: “Actually, if you begin to eat a few bites, you’ll begin to feel better, and your appetite may improve.” (encouraging collaboration)
The nurse should not strip clients of their somatizing defensesuntil adequate assessment data are collected and other coping mechanisms arelearned. The nurse should not attempt to confront clients about somaticsymptoms or attempt to tell them that these symptoms are not “real.” They arevery real to clients, who actually experience the symptoms and associateddistress.
Assisting the Client to Express Emotions
Teaching about the relationship between stress and physi-calsymptoms is a useful way to help clients begin to see the mind–bodyrelationship. Clients may keep a detailed journal of their physical symptoms.The nurse might ask them to describe the situation at the time such as whetherthey were alone or with others, whether any disagreements were occurring, andso forth. The journal may help clients to see when physical symptoms seemedworse or better and what other factors may have affected that perception.
Limiting the time that clients can focus on physical complaintsalone may be necessary. Encouraging them to focus on emotional feelings isimportant, although this can be difficult for clients. The nurse should provideattention and positive feedback for efforts to identify and discuss feelings.
It may help for the nurse to explain to the family about primaryand secondary gains. For example, if the family can provide attention toclients when they are feeling better or fulfilling responsibilities, clientsare more likely to continue doing so. If family members have lavished attentionon clients when they have physical complaints, the nurse can encourage therelatives to stop reinforcing the sick role.
Teaching Coping Strategies
Two categories of coping strategies are important for cli-ents tolearn and to practice: emotion-focusedcoping strategies, which helpclients relax and reduce feelings ofstress, and problem-focused copingstrategies, which help to resolve or change a client’s behavior or situationor manage life stressors. Emotion-focused strategies include progressiverelaxation, deep breathing, guided imagery, and distractions such as music orother activities. Many approaches to stress relief are available for clients totry. The nurse should help clients to learn and practice these techniques,emphasizing that their effectiveness usually improves with routine use. Clientsmust not expect such techniques to eliminate their pain or physical symptoms;rather, the focus is helping them to manage or diminish the intensity of thesymptoms.
Problem-focused coping strategies include learning problem-solvingmethods, applying the process to identi-fied problems, and role-playinginteractions with others. For example, a client may complain that no one comesto visit or that she has no friends. The nurse can help the client to plansocial contact with others, can role-play what to talk about (other than theclient’s complaints), and can improve the client’s confidence in makingrelationships. The nurse also can help clients to identify stressful lifesituations and plan strategies to deal with them. For example, if a clientfinds it difficult to accomplish daily household tasks, the nurse can help himto plan a schedule with difficult tasks followed by something the client mayenjoy.
Evaluation
Somatoform disorders are chronic or recurrent, so changes arelikely to occur slowly. If treatment is effective, the client should make fewervisits to physicians as a result of physical complaints, use less medicationand more positive coping techniques, and increase functional abilities.Improved fam-ily and social relationships are also a positive outcome that mayfollow improvements in the client’s coping abilities.
Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail
Psychiatric Mental Health Nursing : Somatoform Disorders : Application of the Nursing Process - Somatoform Disorders |
FAQs
The nursing interventions for somatoform disorders are: Providing health teaching. The nurse must help the client establish a daily routine that includes improved health behaviors. Assisting the client to express emotions.
What is the application of the nursing process? ›
The nursing process is a systematic problem-solving approach used to identify, prevent and treat actual or potential health problems and promote wellness. It has five steps; Assessment, Diagnosis, planning, implementation and evaluation [5].
What are three therapeutic interventions for clients with somatoform disorders? ›
Psychotherapy
- Examine and adapt your beliefs and expectations about health and physical symptoms.
- Learn how to reduce stress.
- Learn how to cope with physical symptoms.
- Reduce preoccupation with symptoms.
- Reduce avoidance of situations and activities due to uncomfortable physical sensations.
Various forms of psychotherapy have been recommended for somatoform disorder. Evidence supports the role of cognitive behavior therapy (CBT), mindfulness-based interventions, acceptance and commitment therapy, and relaxation therapy in the management of individual subtypes of somatoform disorders [Table 7].
What is the role of the nurse in somatic therapy? ›
The nurse reviews with the patient and family the information they have received and responds to any questions. During this assessment process the nurse also should attempt to identify specific target behaviors the family associates with the patient's illness.
Which interventions are used to care for clients with somatic symptom disorders? ›
Cognitive Behavioral Therapy
Cognitive behavior therapy (CBT) is the primary intervention for all somatic symptom disorders. Cognitive behavioral therapy was designed specifically to address the relationship between irrational thinking and emotional and behavioral distress.
How to apply nursing theory in nursing process? ›
Professionals develop nursing theories to inform nursing practice, advance care strategies, and improve patient outcomes for a better quality of life. Nurses can apply them to all six steps of the nursing process: assessment, diagnosis, outcome, planning, implementation, and evaluation.
How can you apply nursing process in daily life? ›
Here are 12 nursing skills that you tap into and apply to your daily life.
- Patience. Even when our patience runs thin, nurses have more of it than most.
- Compassion. ...
- Multi-tasking. ...
- Assessment. ...
- Prioritizing. ...
- Time Management. ...
- Basic First Aid. ...
- Critical thinking.
Diagnosis. This phase in the nursing process is one of the most important. We must consider all external factors of the patient (environmental, socioeconomic, and physiological etc.) when developing a diagnosis, which can be challenging at times.
What is the most effective treatment for somatization disorder? ›
Numerous studies have found that cognitive behavioral therapy (CBT) is highly effective at treating somatization. CBT focuses on helping people identify automatic negative thoughts. It then teaches people how to combat these thoughts with less self-defeating messages.
This may include mindfulness or meditation practices, family sculpting, or the use of safe touch between therapist and client or within a Page 10 4 family system. For the purposes of this study, somatic interventions may also include practices such as EMDR, yoga therapy, or expressive movement therapy.
What are patients with somatoform disorder? ›
Recognising a patient with somatoform disorder
- Persistent abdominal pain, headaches, joins pains, etc.
- Poor concentration, dizziness and moodiness.
- Continual worry over decreasing physical health.
- Onset of an acute flu-like illness or glandular fever.
- Complete loss of bodily sensation or movements.
Measurement Instruments
The PHQ-15 is a somatic symptom severity scale for the purpose of diagnosing somatoform disorders.
What is the conclusion of somatoform disorders? ›
Conclusion. Somatoform disorders and MUS are common in later life, although the available data suggest that prevalence rates decline after the age of 65 years. More systematic research with special focus on the older population is needed to understand this age-related decline in prevalence rates.
Which approach is the most promising treatment for somatic symptom disorders? ›
The biopsychosocial model of treatment is one of the most effective for somatic disorders as it considers the various biological, psychological, and social factors that influence the illness and presenting symptoms and includes a multidisciplinary approach.
What are four frequently used somatic therapies? ›
This article will explore five kinds of somatic therapy approaches: Somatic Experiencing (SE), Accelerated Experiential Dynamic Psychotherapy (AEDP), Sensorimotor Psychotherapy, Eye movement desensitization and reprocessing (EMDR), and Gestalt. There are some key similarities and differences between these approaches.
What is the nurses role in providing psychological support? ›
Dealing with the Illness
Nurses should help them deal with their symptoms by providing emotional support to them. By meeting their patients' physiological and emotional needs, they also improve the healing process and help patients feel safe and more empowered with managing their own recovery.
What are the 4 somatic practices? ›
They include:
- rolfing.
- Body-Mind Centering.
- Alexander technique.
- Feldenkrais method.
- Laban movement analysis.
Cognitive behavior therapy and mindfulness-based therapy are effective for the treatment of somatic symptom disorder. Amitriptyline, selective serotonin reuptake inhibitors, and St. John's wort are effective pharmacologic treatments for somatic symptom disorder.
How do you think most patients with somatic disorders usually present? ›
Pain is the most common symptom, but whatever your symptoms, you have excessive thoughts, feelings or behaviors related to those symptoms, which cause significant problems, make it difficult to function and sometimes can be disabling.
Somatic Intervention is a technique which allows you to sense and interrupt habitual patterns (like anxiety, anger, stress or fear), discharge the bodily tension and associated memories, and move forward in a calmer and more centered way.
What is an example of applying nursing theory to practice? ›
An example is the belief that it is not good to have blood transfusion among specific religious groups and because of this transcultural theory, nurses are able to understand the belief of this group and therefore advocate for the client's preferences.
What is an example of application of nursing theory? ›
An example of a nursing theory in use is seen in the care of a Jehovah's Witnesses patient that does not believe in blood transfusions.
What are the theories that can be applied in the nursing process? ›
Four major concepts are frequently interrelated and fundamental to nursing theory: person, environment, health, and nursing. These four are collectively referred to as metaparadigm for nursing. Person, Nursing, Environment, and Health – the four main concepts that make up the nursing metaparadigm.
What is nursing process this question is an example of? ›
The nursing process is defined as a systematic, rational method of planning that guides all nursing actions in delivering holistic and patient-focused care. The nursing process is a form of scientific reasoning and requires the nurse's critical thinking to provide the best care possible to the client.
What action should the nurse perform during the implementation step of the nursing process? ›
During the implementation phase of the nursing process, the nurse prioritizes planned interventions, assesses patient safety while implementing interventions, delegates interventions as appropriate, and documents interventions performed.
What is the most important nursing priority? ›
Prioritizing Patient Care
The ability of nurses to prioritize patient care is paramount because it largely determines success or failure in delivering quality health care.
What is the most important four ways of knowing in nursing? ›
The four ways of knowing are empirics—the science of nursing, esthetics—the art of nursing, the component of personal knowledge in nursing, and ethics—the component of moral knowledge in nursing.
What is the most difficult component of the nursing process? ›
The second step of the nursing process, is the most difficult component. Requires that data be validated and clustered and that their significance be determined. Requires a strong foundation in scientific principles related to nursing theory, social sciences, and physical sciences.
Why are somatoform disorders difficult to treat? ›
What is the treatment for somatoform disorders? Treatment is often difficult, as people with somatisation disorders commonly do not accept that their symptoms are due to mental (psychological) factors. They may become angry with their doctors who cannot find the cause for their symptoms.
Keeping true with the behavioral approach to psychological disorders, behaviorists propose that somatic disorders are developed and maintained by reinforcers. More specifically, individuals experiencing significant somatic symptoms are often rewarded by gaining attention from other people (Witthoft & Hiller, 2010).
What are somatic examples? ›
Other examples of somatic nervous system functions include voluntary movements like walking, lifting weights, swallowing, blinking, etc., which are mediated through motor fibers. Feeling sensations like touch, vibration, muscle tension, etc., are examples of somatic sensory neuron function.
What is the difference between somatic and behavioral intervention? ›
Somatic intervention: manipulating the body may affect behavior. Behavioral intervention: experience affects the brain.
What are some examples of functions controlled by the somatic nervous system? ›
The somatic nervous system connects the central nervous system with the body's muscles and skin. Its primary function is to control voluntary movements and reflex arcs, while also helping us process the senses of touch, sound, taste, and smell.
What is a somatoform disorder summary? ›
In somatoform disorders, physical symptoms suggest a physical disorder, but there are no demonstrable organic findings and there is strong evidence for link to psychological factors or conflicts. The term is from Greek, “soma” for body.
What do people with somatoform disorders mostly complain about? ›
They complain, for example, of pain, digestive problems (e.g. diarrhoea), and heart and circulatory problems (e.g. racing heart). Usually, these complaints have already persisted for several years.
What do people with somatoform disorders complain about? ›
It focuses on cognitive distortions, unrealistic beliefs, worry, and behaviors that promulgate health anxiety and somatic symptoms.
What is a somatic symptom disorder in nursing? ›
Somatic symptom disorder is characterized by a combination of distressing symptoms and an excessive or maladaptive response or associated health concerns without significant physical findings and medical diagnosis. Patients' suffering is authentic, and they typically experience a high level of functional impairment.
What is the treatment plan for somatoform disorder? ›
Natural treatment for somatoform disorder can include stress management and relaxation techniques, regular physical activity, socialization opportunities and avoiding substance use. Other common alternative therapies for somatoform disorders include hypnotherapy, relaxation techniques and somatic experiencing.
Can you recover from somatoform disorder? ›
Although there is no known cure for somatoform disorders, they can be managed. Treatment focuses on helping the person who has the disorder to live as much of a normal life as possible. Even with treatment, they may still have some pain or other symptoms.
Treatment options include medications, particularly tricyclic antidepressants and SSRIs,21,22 and psychotherapy. 23 Nonpharmacologic treatment strategies (e.g., massage, acupuncture) may also be beneficial.
Are there any treatments that are not effective in treating somatic disorders? ›
Electroconvulsive therapy is not effective for somatic symptom disorders, but it may successfully treat somatic symptoms related to an underlying mood disorder.
What is the nursing responsibility of anxiety disorder? ›
The nursing interventions for anxiety disorders are: Stay calm and be nonthreatening. Maintain a calm, nonthreatening manner while working with client; anxiety is contagious and may be transferred from staff to client or vice versa. Assure client of safety.
What is the nursing role in mental disorder? ›
The role of a Mental Health Nurse is to build effective relationships with patients who use mental health services and also their relatives or carers, whether that's helping them to take their medication correctly, or advising about relevant therapies or social activities.
What is the nursing responsibility for diagnosis? ›
13 essential responsibilities for nurses
- Recording medical history and symptoms. ...
- Administering medications and treatments. ...
- Collaborating with teams for patient care. ...
- Performing diagnostic tests. ...
- Conducting physical examinations. ...
- Monitoring patients' health. ...
- Providing support and advice to patients. ...
- Operating medical equipment.
Nurses in psychiatric-mental health:
Conduct intake screening, evaluation, and triage. Provide Case management. Teach self-care activities. Administer and monitor psychobiological treatment regimens.
What is the most appropriate nursing action for a patient with anxiety? ›
The following are the nursing priorities for patients with anxiety disorders: Assess anxiety levels and triggers. Establish therapeutic rapport. Administer prescribed anti-anxiety medication.
What are the nursing interventions for anxiety patients? ›
Encourage relaxation techniques such as deep breathing. Educate the client on the importance of sleep hygiene and reducing environmental stressors. Assist the client with identifying and challenging irrational thoughts. Goals and outcomes should include a plan for coping with anxious situations.
Which nursing responsibility is the most effective in relieving the patient's anxiety? ›
The best nurses listen to what patients say, taking their concerns and questions seriously. Active listening skills provide a great deal of anxiety relief for patients. This includes asking open-ended questions, asking about their feelings, and taking interest in what they are saying.
What is the most important role of a nurse caring for a client with a mental health disorder? ›
A mental health nurse plays a key role in evaluating the mental health needs of the patients. A mental health nurse also encourages the patient to express feelings and help them in handling their anger and frustration. The nurse also helps in developing the nursing care plan for mental health patients.
Caring for someone having a mental health crisis
- introduce yourself calmly and clearly.
- explain why you are there.
- be polite and non-threatening but also be honest and direct.
- listen to what they are saying in a non-judgmental way.
- avoid confrontation.
- ask them what they see as the main problem.
Plans and provides nursing care for patients. Makes nursing diagnosis of the medical and emotional status of patients and recommends treatment options. Consults with psychiatrists and other behavioral health staff in designing appropriate treatment plans for clients.
What are examples of responsibility in nursing? ›
Key Responsibilities
- Perform physical exams and health histories before making critical decisions.
- Provide health promotion, counseling and education.
- Administer medications and other personalized interventions.
- Coordinate care, in collaboration with a wide array of health care professionals.
- The common thread uniting different types of nurses who work in varied areas is the nursing process—the essential core of practice for the registered nurse to deliver holistic, patient-focused care. Assessment. ...
- Diagnosis. ...
- Outcomes / Planning. ...
- Implementation. ...
- Evaluation.
An example of a written nursing diagnosis using all three components is as follows: “Ineffective airway clearance (problem statement) related to bronchial airway inflammation (etiology/related factor) as evidenced by coarse rhonchi to bilateral apices heard on auscultation (defining characteristics).” Risk factors can ...
What is the goal of a nurse working in psychiatric rehabilitation? ›
The goal of rehabilitation nursing is to assist individuals with a disability and/or chronic illness to attain and maintain maximum function. The rehabilitation staff nurse assists clients in adapting to an altered lifestyle, while providing a therapeutic environment for client's and their family's development.
Why is assessment of mental health important in nursing? ›
An assessment is important because the PMHNP needs to understand what is causing a patient's distress. A patient may have a medical condition that is affecting their mental health rather than a neurological illness. Or a patient may have both a physical and mental illness.
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