Health choices

“Making health choices and carrying them out can bring benefits… increase self-esteem from the feeling of taking active control are part of life such as being in control of the smoking habit rather than the cigarettes being in control. (Ewles and Simnett 1992 page 19). In the clients case by making his own decisions in a self empowered manner he could then perceive that he was in control of their anxiety not that the anxiety controlled him.

Another example of the client improving his decision-making was when the taxi exposure began. When the taxi arrived for the first time the client was sweating and was very anxious. I deliberately stepped back and allowed the client to cope with it. He took control, he explained to the taxi driver where to go and why we were not going far. This shows that the technique was working as the client began to take control again.

In addition to these techniques another important theory which mental health nurses need to develop all the time in order to work efficiently with clients is interpersonal skills. With anxious clients communication is vital this is because during an anxiety or panic attack the clients’ perceptual field and personality are disturbed to such an extent that the client cannot solve problems of function effectively or discuss how they are feeling. (Wilson and Kneisl 1996). Through communication and body language nursing interventions can reduce the clients’ anxiety to a more manageable level.

An example of this situation occurred with the client frequently during graded exposure so it was important that I knew how to help him. The client would begin to quicken his pace while walking and he would find it difficult to control his mobility. He would trip up and nearly fall to the ground repeatedly he would talk rapidly and make no eye contact. His speech would be incoherent and he will stumble over his words.

Physically he would sweat and has difficulty breathing. It is important to observe a client for anxiety symptoms such as these because nurses can begin to help the client to recognise his anxiety (Peplau 1962). I would ask the client how he was feeling. I would comment you don’t look very comfortable at the moment, how do you feel? Through asking this it would help the client acknowledge his anxiety. Once he acknowledged his symptoms he could begin to learn to control them.

The client would say, “I feel sweaty and I don’t feel like I’m breathing”. I suggested we could stop for a few minutes and sit down in a quieter area. It is important to attempt to move an anxious client away from stimulation if they fare panicking. (Wilson and Kneisl 1996) Once we were sitting on the bench or away from their anxiety-producing situation I would encourage the client to deep breathe, which he had identified as a behaviour, which gave him relief. Adopting relief behaviour is important because it decreases the anxiety and helps the client feel more in control. (Peplau 1962).

I wouldn’t sit too close to the client and I spoke in a calm manner. Anxious clients’ senses are heightened during panic and if I raised my voice or invaded his body space he would probably become more anxious. (Weekes 1995). The client would inhale through his nose and exhale out of his mouth. He would concentrate on his breathing; this helped him refocus his feelings away from the anxiety.

Once he had calmed down we would discuss briefly what he thought triggered the anxiety. The reason we would discuss the situation in brief is because short, simple sentences are more effective with anxious clients because the ability to concentrate is decreased. Lengthy discussion would only have served to make the client more anxious (Wilson and Kneisl 1996). It is important to discuss the trigger for the anxiety because the client can begin to understand when the anxiety occurs. (Peplau 1962 see Appendix 5 for a model of how to deal with anxious clients).

Another issue where using interpersonal skills with anxious clients is vital is because those clients often have very worrying and negative thoughts. They way a person thinks effects the way a person feels which in turn affects their behaviour. Negative thoughts cause negative behaviour and so it is important to be able to work with the client to decrease its negative thoughts. The client believed he was silly and useless he would often say, I wish I could just get out of here and walk but I know I can’t.

For example; Client “I know that I should take but it step by step, and say, OK Paul this is good, but I’m thinking in my mind, Good?” Student “have you considered that maybe you feel this way because you have the experience before the epilepsy began of leading a fully independent life”? Client “Yeah…. But its hard…..” Together a climber explored the reasons why he felt the way he did it and looked at some other positive behaviour he had achieved and how he had improved. When I first began working with the clients’ he could hardly walk to the end of his block of flats and by this stage he was walking around a whole block do and taking taxis in exposure sessions.

The client gradually became aware as time passed that he did have positive thoughts but the negative ones override them; Client “I think it’s like ….I’ve got two sides to my brain thinking…. one side that is thinking you know ……what I should be doing………… and the other side battling against it saying, no you can’t do that” Student “Try to block your negative thoughts with positive ones, but instead of thinking I can’t do that, try…., I can do that if I want to.” I was trying to facilitate the client to encourage and positively. Then he may feel more able to engage in positive behaviour.

Another example would be that the client would often get up in the morning and say, “I’m going to go out”, and then he would think, “but I know I’m not going to”. We identified that these were negative thoughts and I suggested maybe the next time to he woke up and felt like that he should try and go out. This way he would be replacing his negative conditions with positive behaviour. In the long run this may have increased his self-esteem. Positive self talks such as “I can do this” “I will go out” ” I am able to do this” is very constructive and will reinforce positive behaviour. (Wilson and Kneisl 1996)

Finely the client and I also used rationalisation and logic to cope with his fears. For example the client would think I want to go out, but I can’t go out, I feel really unwell and I am scared of having a fit. This fear of having a fit was quite realistic but the client did recognise that his fear did prevent him from going out at all. We discuss rationally how in all that time we had engaged in exposure in the three months I worked with him he had not had a fit outside. However we explored the possibility of him having a fit and how he might cope with it if it happened. If the client had a plan of how he might cope he would hopefully make him feel safer. It is important to help the client explore the options; “You can help clients face the reality of this situation by encouraging them to explore the ways they can change to deal with it more effectively”. (Wilson and Kneisl 1996 page 82)

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