Transcript File

 Awareness
 Review
Evidence
Based Research
 Enhance
Care
Nursing
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Describe the nursing care problem
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Summarize individual parts of the research
study
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TRUEPIC care plan
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Explain how nurses collaborate, provide
care, and advocate for this patient
population
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Normal natural
physiological
response to
perceived fear
Uneasy,
uncomfortable
feeling, unexplained
tension, anticipation
or suspense, also
known as stressors
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Covers a range of
conditions which
stem from a
generalized state
of anxiety.
Intensity
Duration
Whether it leads to
normal life being
disrupted
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“Biofeedback Intervention for Stress and
Anxiety among Nursing Students: A
Randomized Controlled Trial.”
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Investigate the impact of biofeedback
intervention program on nursing students'
levels of stress and anxiety during their
first clinical training.
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Nursing Theory: Peplau’s Theory of
Interpersonal Relations
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Randomized controlled study
60 volunteer second-year baccalaureate nursing
students at a public nursing college in Thailand.
All of the participants were female, within the age
range between 18 and 21 years old, and the GPA
range between 2.98 and 3.90
The 30 participants in the biofeedback group
received training on how to use the
biofeedback device while the 30 in the control
group did not receive any training.
Pre-intervention survey and post-intervention survey
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Biofeedback training
intervention not only kept the
nursing students' stress levels
from increasing, but also
significantly reduced their levels
of anxiety.
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Nursing students in the Control
Group had a significant increase
in their stress and anxiety level
over the same period.
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Importance of the role as a
Nurse Educator
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Improved outcomes for student
nurse and patient care
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This study was
conducted only at
one nursing college
in one country
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All females
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Follow-up study
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A randomized
control trail
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Credible Nursing
Authors
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ISRN Nursing Journal
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Nurses
Psychiatrists
Pharmacists
Family members
Patient’s friends /
support system
The patient
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Savannah Johnson is a 28 year old patient with no previous medical
conditions who states she “Can’t stand this feeling of stress and anxiety any
longer.” The intensity of her problem began during a stressful day of her
nursing program when she was studying for her final exam before
completing her final semester in nursing school. She has been struggling with
balancing her life stressors such as the stress within her family, work, and
school, causing her to grades in all of her classes to drop and barely making
to the cut off grade of a 75%. She has been unable to cope with the
pressure of having to retake the semester and not graduating. When
another assignment is assigned, she reports not knowing where to start. She
states that if she doesn’t pass her classes, it will cause even more issues in her
life to intensify, making her mind races and causing her to get palpitations
and shortness of breath. These symptoms have been getting worse over the
last month. Savannah also says she has recently been taking sleeping pills
every night help her sleep because she states her, “Mind keeps her up at
night”. She is not on any other medications and does not want to be
because she does not have enough money to pay for them. She has been
admitted to the hospital for and overnight observation.
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The nurse is a 32 year old BSN prepared RN and has been working on the
floor for 5 years.
3. UNDERSTAND…the
importance of the
propositions, assumptions,
and confounding variables.
1.IDENTIFY… The
variables in
this situation
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28 yr old
female
No previous
medical
history
Refusing
medications
Doesn’t have
the money to
afford it
Palpitations
and shortness
of breath
Pressure to
pass nursing
school
Taking
sleeping pills
Helps her
sleep
2. RELATE…Or put the variables together to
form propositions.
Primary Proposition: “Pt’s pressure to pass her
classes to graduate nursing school is causing
her to have palpitations and shortness of
breath.
Possible Assumptions: “Pt knows that if she does
not pass her classes, then her stressors in life are
going to intensify
Possible Confounding Variables: “Fear of taking
any medications because she cannot afford to
continue the medication.”
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 the costs, she may be
reluctant to start any new
medications to help control
her anxiety disorder. Pt may
not be able to continue to
take sleeping pills if put on
certain medications.”
4. EXPLAIN…the
significance of the
situation to those
involved based on their
individual KSVME
Proposition: Explain to
the pt what an anxiety
attack is, signs and
symptoms, how to
prevent or stop one
from happening and
possible complications
from unresolved
attacks.
Assumptions: Explain to
the pt 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. Talk to the pt
and explain that you
are there to support her
and to answer any
questions
5. PREDICT…what will happen in this situation if
one or more variables are not changed.
Proposition: If pt’s anxiety is not controlled, her
symptoms may worsen and she may begin to
have thoughts of self-harm which then could lead
to longer recovery and hospitalization time
Assumptions: If 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 best for her
and her lifestyle.
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 take her own sleeping pills during her stay at
the hospital
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 coping
mechanisms
Confounding Variables: Make
sure the pt understands the
psychiatrist is there for her
when she needs medical help
regarding her anxiety and antianxiety pills.
Nursing Diagnosis
Mild Anxiety related to multiple
co-existing stressors AEB
palpitations and shortness of
breath and pt statements, “I
can’t stand this feeling of stress
and anxiety any longer.”

Build a relationship
› Family life
› Stressors
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All patients are different, so it is important
to treat each patient individually
› Individualized care plans
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Ratanasiripong, P., Ratanasiripong, N., &
Kathalae, D. (2012). Biofeedback
Intervention for Stress and Anxiety
among Nursing Students: A Randomized
Controlled Trial. ISRN Nursing, 2012, 1-5.
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Videbeck, S. (2011). Psychiatric-mental
health nursing (5th ed.). Philadelphia:
Wolters Kluwer Health/Lippincott Williams
& Wilkins.