A relaxation protocol to reduce patient anxiety

A qualitative study of the experiences of patients following transfer from intensive care

In nursing literature much attention has been paid to patients' experiences while in intensive care. Extensive literature exists examining the longer-term effects of critical care [Jones C, Humphris GM, Griffiths RD. Psychological morbidity following critical illness - the rationale for care after intensive care. Clinical Intensive Care 1998;9:199-205; Griffiths RD, Jones C. ABC of intensive care. Recovery from intensive care. Br Med J 1999;319:417-429]. There is an apparent scarcity of data examining patients' experiences immediately following discharge to wards. A Husserlian phenomenological approach was utilised to gain some understanding of the experience of patients following transfer from intensive care. Ten patients selected purposively comprised the sample. Interviews were performed on the wards 3-5 days following transfer from intensive care. Data was analysed utilising () [Colaizzi PF. Psychological Research as the phenomenologist views it. In: Valle R, King M, editors. Alternatives for psychology. New York: Oxford University Press; 1978. p. 48-71] procedural approach to phenomenological interpretation and analysis. Three major themes emerged: physical response, psychological response and provision of care. These provide a possible framework for patient assessment. Implications for future practice and study are discussed.

The effects of guided imagery relaxation in people with COPD

The aim of this study was to explore the effects of guided imagery relaxation in people with chronic obstructive pulmonary disease (COPD) using a randomized controlled design. Half of 26 participants were allocated to the treatment group in which six practice sessions on guided imagery were conducted, while the control group was instructed to take rest quietly during the six sessions. At the seventh session, physiological changes: partial percentage of oxygen saturation; heart rate; upper thoracic surface electromyography; skin conductance; and peripheral skin temperature were recorded during a 30-minute session with a sampling frequency of one minute. Repeated measures analysis of variance was used to explore the changes of the parameters between the groups. Mann-Whitney U test was used to compare the change of perceived dyspnoea between the groups. Results showed there was a statistically significant (p < 0.05) increase in partial percentage of oxygen saturation in the treatment group, but no significant effects on the other physiological parameters. Further study exploring the psychological effects of guided imagery is suggested.

The effect of music on preprocedure anxiety in Hong Kong Chinese day patients

AIMS AND OBJECTIVES

To identify the effect of music on preprocedure anxiety levels of Hong Kong Chinese patients undergoing day procedures in a local community based hospital.

DESIGN

Pre and post-test quasi experimental design with non-random assignment.

METHOD

A total of 113 participants were assigned to the control group or intervention group depending on the day of their procedure. Participants' anxiety levels were measured objectively by comparing their vital signs and subjectively by the Spielberger State Trait Anxiety Scale. Participants' physiological parameters (blood pressure, pulse and respiration) and State Trait Anxiety Scale were measured at two time periods. The control group undertook the usual relaxing activities provided in the waiting room compared with the intervention group who listened to music of their own choice in reclining chairs while waiting for the procedure.

RESULTS

The physiological parameters for both the control and intervention groups dropped significantly during the waiting period, however, only the intervention group had a significant reduction in reported anxiety levels.

CONCLUSIONS

These results suggest that providing self-selected music to day procedure patients in the preprocedure period assists in the reduction of physiological parameters and anxiety, yet, a relaxing environment can assist in the reduction of physiological parameters.

RELEVANCE TO CLINICAL PRACTICE

The administration of self-selected music to day procedure patients in the preprocedure period can be effective in the reduction of physiological parameters and anxiety.

Dungan model of dynamic integration

TOPIC

The Dungan Model of Dynamic Integration (DMDI), which views humans as having three synergistic dimensions of body, mind, and spirit.

PURPOSE

To present a new nursing model for practice and education.

SOURCE

This is the author's model and it is composed of concepts and constructs that are well-documented in nursing literature.

CONCLUSIONS

Dynamic Integration is a broad conceptual model that allows for testing a number of mid-range theories to add to the science and discipline of nursing.

Managing spiritual distress in patients with advanced cancer pain

Cancer threatens our very existence; when pain is also present, suffering is compounded and leads to spiritual distress. This article presents a nursing strategy to deal with the responses of clients and families in such complex situations. Four case studies were analyzed to describe the methodology and applicability of an approach based upon the Dungan model of dynamic integration. The goal of the first appointment was to teach clients how to effectively deal with the advanced cancer pain that brought them to the center. Presence, caring, genuine concern, and active listening facilitated the therapeutic relationship and were the hallmarks of nursing modalities. Daily appointments with the nurse continued for 6-10 days while clients were also being treated by medical staff. Trust was established by reaching the mutual goal of giving the client control over pain. Spiritual assessment confirmed the diagnosis. Grief was a characteristic of spiritual distress experienced by all clients. Therefore, grief counseling was instituted early and reinforced daily. Spiritual counseling, cognitive reframing, crisis intervention, and reminiscence were used selectively. Because of the complexity of problems faced by families, multi-disciplinary referrals were required by all clients. Outcomes were evaluated positively by participants. All clients increased hope, participated in the grief process, and integrated the possibility of death in such a way as to promote personally defined "quality of life" through their waning days.