Physicians of the Zane Cohen Centre

Powerlessness

Powerlessness experienced post-operatively can be related to lack of knowledge, previous inadequate coping patterns, and insufficient decision-making opportunities.

The nurse can help the patient post-operatively by:

  • Increasing regular, frequent communication between patient and health care provider.

  • Explaining all procedures, rules, plans and options to patient.

  • Allowing time to answer questions.

  • Keeping patient informed about schedule, condition, treatments, and results.

  • Anticipating questions, interest, and offering information.

  • Pointing out positive changes in patient’s condition.

  • Allowing patient to verbalize concerns and feelings.

  • Providing consistent staffing within framework of primary nursing.

  • Discussing daily plan of activities and allowing patient to make as many decisions as possible.

  • Keeping promises.

  • Providing daily recognition of progress, praise gains and achievements .

  • Assessing patient’s usual responses to problems and stressors.

  • Identify short-term realistic goals and give positive reinforcement when achieved


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Ineffective Individual Coping

Ineffective coping experienced post-operatively can be due to negative self-concept, disapproval by others, inadequate problem-solving, loss-related grief, sudden change in life pattern, recent change in health, inadequate support systems, unanticipated stressful events, occurrence of several major events in a short period of time, unrealistic goals.

The nurse can help the patient post-operatively by:

  • Assessing the patient’s present coping status. Identify coping strategies.

  • Demonstrate to the patient that you believe her/his desire to help — avoid challenging, minimizing patient’s feelings, arguing or trying to reason with her/him.

  • Offering support as the patient talks — reassure that their feelings must be difficult. Provide a more helpful, realistic perspective if the patient is pessimistic. Document your strategies.

  • Assisting the patient to problem solve in a constructive manner (What is the problem? Who or what is reasonable for the problem? What are the options? (make a list) What are the advantages and disadvantages of each option?

  • Discussing possible alternatives (talking over problem with those involved, trying to change the situation, or doing nothing and accepting the consequence).

  • Helping the patient to identify problems that she/he cannot control directly and help her/him to produce stress-reducing activities for control.

  • Teaching patient relaxation techniques.

  • Having patient describe previous encounters with conflict and how she/he managed to resolve them.

  • Giving options — but leaving decision-making to the patient. Give many choices.

  • Coordinating possible multidisciplinary activities to serve patient’s best interests. Consult with Enterostomal Therapy, Clinical Nurse Specialist, Social Work, Psychiatry as needed.

  • Encouraging patient to deal directly with individuals with whom there are conflicts (do not put self in middle).


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Depression

Depression experienced post-operatively can be due to stress, hopelessness, helplessness, lack of support systems, chronic illness, chronic pain, palliative care diagnosis, extensive surgery,inadequate coping skills, separation from family, role changes or identity crisis.

To help alleviate depression seen in patients, the nurse can:

  • Assess for feelings of hopelessness, isolation, anger, hostility, helplessness, and guilt/shame.

  • Determine how the patient has previously coped with depression.

  • Work with positive goals to affect change in attitude.

  • Be non-judgmental and empathetic.

  • Encourage interactions with others.

  • Encourage appropriate expression of anger and hostility.

  • Facilitate examination of stresses, present/past coping mechanisms — assist in planning alternatives.

  • Involve patient in planning treatment goals and evaluating progress.

  • Provide teaching that will prepare patient to deal with life stresses (relaxation, problem-solving skills, how to express feelings constructively).

  • Recognize increase in risk (i.e. change in behaviour, verbal, nonverbal communication, withdrawal, signs of depression, decrease in sleep or appetite, hopelessness, helplessness, increase self-destructive thoughts of behaviours.

  • Consult with Psychiatry, Social Work, CNS, Enterostomal Therapy nurses for additional support.

  • If anti-depressant medication is prescribed, reassure patient it may take three to six weeks before differences in mood are noted.


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Manipulative Behaviour

Manipulative behaviour is a coping mechanism sometimes used by patients when facing stress. It can be very destructive and can greatly interfere in the nurse/patient relationship.

To help a patient with manipulative behaviour, the nurse can:

  • Assess a patient’s needs or anxieties, which he/she is addressing through manipulative behaviour.

  • Assist patient in recognizing his/her pattern of behaviour.

  • Teach patient direct ways to communicate needs.

  • Ensure patient does not“split” (i.e. tell you something about someone else). Encourage patient to communicate directly with involved party.

  • Give consistent, clear messages.

  • Establish a written contract with the patient as necessary.

  • Involve the Enterostomal Therapy Nurse, Clinical Nurse Specialist, Social Worker, Psychiatry as necessary.


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Altered Family Process

Altered family processes can be related to the impact that an ill family member can have on the family system. An illness, hospitalization, surgery, previous diagnoses, coping styles, culture can all place tremendous stress on a family and greatly interfere with keeping a family strong and united.

To help family members deal with illness, the nurse can:

  • Assess causative and contributing factors — assist patient to define them.

  • Acknowledge your feelings about the family and their situation.

  • Approach family with warmth, respect and support.

  • Avoid vague and confusing advice and cliches. Be clear and concise.

  • Reflect family emotions to clarify these feelings (i.e. "this is very painful for you” or “you must find this very frightening”).

  • Identify family strengths to them.

  • Identify and involve family members in care of ill person if possible.

  • Involve family members in patient care conferences where appropriate.

  • Promote self-esteem of individual family members.

  • Facilitate communication; encourage verbalization of guilt, anger, blame and hostility and subsequent recognition of own feelings in family members.

  • Enlist help of other professionals when problems exceed realm of nursing – Enterostomal Nurse, Psychiatry, Social Work, Clinical Nurse Specialist.

  • Discuss stresses of hospitalization and assist patient to identify them.

  • Describe implications of the “sick role” and how it will return to the “well role”.

  • Facilitate family involvement with social supports. Identify social supports.

  • Assist family to re-organize roles at home and set priorities to maintain family integrity and reduce stress.


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