CDU Nursing: Assessment 2 - Communication with Patients in Day Surgery

This report, written by a nursing student, analyzes a clinical scenario involving a patient named Stefan who is experiencing anxiety before day surgery. The report begins by outlining the communication skills required for nurses, emphasizing active listening and empathy to address patient concerns. It identifies signs and symptoms of anxiety, such as excessive worrying, restlessness, and difficulty concentrating, and diagnoses Stefan with generalized anxiety disorder (GAD). The report then details various relaxation techniques, including deep breathing exercises, visualization, and progressive muscle relaxation, to help manage the patient's stress. Additionally, it discusses the use of Diazepam (Valium), explaining its mechanism of action, potential side effects, and the importance of informed consent. The report underscores the importance of patient-centered care, providing a comprehensive overview of communication strategies, anxiety management, and pharmacological interventions in a nursing context. The report is well-researched, with references provided. The report is submitted to Desklib, a platform providing AI-based study tools for students.

Running head: COMMUNICATION WITH PATIENTS
COMMUNICATION WITH PATIENTS
Name of the student:
Name of the university:
Author note:

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Communication skills required:
The nursing professional can realize that the patient is highly nervous about the surgery
and therefore, she needs to be careful while interacting with him ensuring that none of her
conversations with the patient adds to his anxiety. The first important thing that the patient
should be maintaining while communicating with the patient is the active listening skill (Wood et
al., 2015). It is very important for the person to feel that the professionals are listening to them.
This helps them to feel that the professionals are concerned about them and are respectful about
what they want to say. Therefore, the nurse attending Stefan would first listen to him entirely
without interrupting him. In many of the situations, it is seen that patients get anxious as the
hospital environment is unknown to them and they do not know what to expect (Hoge et al.,
2015). Therefore, the nurse should first help Stefan to become comfortable and discuss in details
about his situation and what needs to be done with him. Clear description of the procedure with
the positive and negative aspects associated with surgeries or other treatments help in developing
a clear scenario in the mind of the patient and this would help in reducing anxiety and
nervousness in the patient. Many researchers are of the opinion that nurses should not constantly
tell anxious patients to relax (El alaqui et al., 2015). Instead, the nursing professionals should tell
the patient about the techniques that they can undertake to relax as that would help them to
overcome nervousness. The nurse should also show Stefan some relaxation techniques to help
him overcome nervousness. Often using of humor is seen to be effective helping patients to
relieve their stress. Therefore while communicating, the nurse should make efforts to lighten the
mood of Stefan and try to bee personable. She can also engage in different types of informal
conversations to keep his mind away from his source of concern. The professionals also need to
be empathetic when the patients are nervous. This would make Stefan feel that the nurse has

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understood his condition and is not judging him and rather feeling exactly what Stefan is feeling.
This helps in developing therapeutic relation with patients and helps in managing their
nervousness. The nursing professionals need to ensure that they are patient enough to handle
such situation and do not impose their biased thinking on the comments of the patients. The
nurse who is attending the patient might feel that Stefan’s worry is baseless but she should never
express them and maintain the uniqueness of each patient providing him person centered care,
she should never be biased and judgmental on the condition of the patient and sure
communication with him in a respectful manner.
Signs and symptoms:
A number of signs and symptoms have been identified after close analysis of the patient
named Stefan that help to know that he is highly nervous and has developed anxiety. The first
symptom that helps to understand is Stefan’s excessive worrying about the surgery. Restlessness
is yet another symptom for restlessness (Miloff et al., 2015). Stefan is found to be excessively
restless and he was not able to sit peacefully and comfortably at any position. This high level of
restlessness and worrying give a clear indication that he was suffering from anxiety. One of the
most important sign that was also noticed is the difficulty in concentrating. Different evidence
based studies have already shown that people suffering from anxiety cannot concentrate on any
particular activities. While the nurse was taking the medical history of the patient along with his
partner, Stefan was seen to be replying with short answers and suddenly stood up and started
working in the room. This showed that he was not putting concentration in the medical history
recording with the nurse. Another sign and symptom of anxiety is the trouble of the patient
falling or staying asleep (Storch et al., 2015). From the outer appearance of the patient, it was
seen that he had bags under his eyes, which implied that he might have not slept for many days,

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and this can be because of the result of nervousness of the surgery or might be tensions due to his
financial situations after loss of employment. Both might have resulted in anxiety in the patient.
Researchers are also of the opinion that panic attacks are yet another symptom that shows that
patients are nervous. Panic attacks have also been noticed among the patient. The patient was
having extreme fear about the consequences of the surgery and this was clearly seen from the
way he was communicating as well as from the statement that her partner used “silly idiot thinks
he’s going to die”. This fear was giving the patient panic attacks and his clenching and
unclenching of his hands and others are proofs of this. The different signs helped me to realize
that the patient named Stefan was actually suffering from generalized anxiety disorder (GAD). In
this type of disorder, people are seen to experience constant anxiety as well as worry about
different activities as well as event that are ordinary and even routine (Baumiester et al., 2014).
Stefan was highly anxious about the consequences of the day-surgery and was therefore anxious
about the outcomes of the surgery largely.
Relaxation techniques:
The nurse needs to provide relaxation techniques to the patient named Stefan in order to
help him release the stress, overcome the panic attacks and be relaxed and comfortable in the
healthcare area. Relaxation techniques can be explained as the strategies that help in the
reduction of the stress as well as the anxiety helping to manage the symptoms of the panic
attacks, restlessness and worrying. It helps in management of the flight or fight responses or the
stress actions that are triggered among the people suffering from anxiety issues (Oerback et al.,
2014). One of the most important techniques that should be adopted is the deep breathing
exercises. Researchers are of the opinion that this is one of the easiest and the relaxation
technique and is also the most fruitful one helping in making patients relaxed. The nurse would

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be teaching the patient about how to breathe slowly as well as deeply which will allow him to
feel more relaxed. Researchers are of the opinion that such relaxation techniques have a
cleansing effect that make patients feel energized as well as refreshed. It also helps in the
focusing as well as providing attention to the different breathing procedures helping in clearing
of the patient and helping in the controlling of the rhythm of the breath. Another important
relaxation technique that also needs to be addressed is the visualization technique (Barkowski et
al., 2016). This is one of the most powerful way of letting stress and anxiety go off from the
mind of the patient. This technique mainly helps the patient in imagining a picture to the calming
as well as the serene environment such as a beach or that that of the flower-bed meadow. This
technique would help the patient in relaxing his body and thereby soothing his thoughts. When
the nurse can successfully help the patient to follow the technique, the patient would feel more
rejuvenated as it allows the body and the mind to feel free from any tensions. The nurse can also
make the patient try out progressive muscle relaxation technique, as this would help in the
patient to overcome anxiety symptoms. The first step would be making the patient feel
comfortable with the second step being able to breathe deeply through the nose, feel the
abdomen rise when filled with air and then exhaling from the mouth with the drawing of the
naval towards the spine. After repeating, it for three to four times, muscles of the feet will be
advised to be tightened and released with the clenching of the toes and thereby pressing the heels
towards the ground. They should be squeezed for the tightly for a few minutes and then they
should be released. The feet would be then flexed with the pointing of the toes up towards the
head and then should be held for few seconds. This should be advised to carry on with the
tightening and the releasing technique in the order of legs, glutes, abdomen, back, arms,

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shoulders, neck. Face. These should be need with taking a few breaths noting more calmness in
the body (DeCastella et al., 2015).
Diazepam:
This tablet is mainly known by the name of valium and can be taken as oral solution as
well as rectal get. This is mainly used n the treatment of anxiety as well as for alcohol
withdrawal, muscle spasms and certain types of specific seizures. The nurse should first describe
the patient about the way by which diazepam will work. The chemical called gamma
aminobutyric acid (GABA) if present in less amount in the body might make the body stay in the
excited state and this may result in the creation of anxiety, muscle spasms or might result in
seizures (Aggarwal et al., 2016). Therefore, diazepam will increase the quantity of the chemical
helping the body to overcome the said signals. However, she also needs to explain the various
negative ways the medication can also affect the body. The common side effects would be
drowsiness, muscle weakness, headache, dizziness, nausea, tiredness or fatigue, inability to
control muscle movements (ataxia), tremor, dry mouth or excessive saliva, as well as
constipation. Some of the serious side effects that also associates with the taking of the disorder
like worsening of the seizures resulting in severity and frequency but since, seizures are not
occurring in the patient, this might be omitted. Changes in the brain might occur like depression,
confusion, slowing or the slurring of the speech, thoughts of suicide, memory loss feeling of
vertigo (Newby et al., 2015). Unexpected reactions are also common like that of the
hallucinations, extreme excitement, agitation and many others. Liver and bladder problems might
also rise along with different sex drive issues (Iverach & Rapee, 2014). Withdrawal symptoms
like muscle cramps, convulsions, sweating as well as tremor might also occur. Therefore, the

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nursing professional need to say all the negative effects and the positive effects and accordingly
informed consent should be taken from him whether he is ready to use it or not.

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References:
Aggarwal, N. K., Pieh, M. C., Dixon, L., Guarnaccia, P., Alegría, M., & Lewis-Fernández, R.
(2016). Clinician descriptions of communication strategies to improve treatment
engagement by racial/ethnic minorities in mental health services: a systematic
review. Patient education and counseling, 99(2), 198-209.
Barkowski, S., Schwartze, D., Strauss, B., Burlingame, G. M., Barth, J., & Rosendahl, J. (2016).
Efficacy of group psychotherapy for social anxiety disorder: A meta-analysis of
randomized-controlled trials. Journal of anxiety disorders, 39, 44-64.
Baumeister, H., Reichler, L., Munzinger, M., & Lin, J. (2014). The impact of guidance on
Internet-based mental health interventions—A systematic review. Internet
Interventions, 1(4), 205-215.
De Castella, K., Goldin, P., Jazaieri, H., Heimberg, R. G., Dweck, C. S., & Gross, J. J. (2015).
Emotion beliefs and cognitive behavioural therapy for social anxiety disorder. Cognitive
behaviour therapy, 44(2), 128-141.
El Alaoui, S., Hedman, E., Kaldo, V., Hesser, H., Kraepelien, M., Andersson, E., ... & Lindefors,
N. (2015). Effectiveness of Internet-based cognitive–behavior therapy for social anxiety
disorder in clinical psychiatry. Journal of consulting and clinical psychology, 83(5), 902.
Hoge, E. A., Bui, E., Goetter, E., Robinaugh, D. J., Ojserkis, R. A., Fresco, D. M., & Simon, N.
M. (2015). Change in decentering mediates improvement in anxiety in mindfulness-based
stress reduction for generalized anxiety disorder. Cognitive Therapy and Research, 39(2),
228-235.

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Iverach, L., & Rapee, R. M. (2014). Social anxiety disorder and stuttering: Current status and
future directions. Journal of fluency disorders, 40, 69-82.
Miloff, A., Marklund, A., & Carlbring, P. (2015). The challenger app for social anxiety disorder:
New advances in mobile psychological treatment. Internet Interventions, 2(4), 382-391.
Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic
review and meta-analysis of transdiagnostic psychological treatments for anxiety and
depressive disorders in adulthood. Clinical psychology review, 40, 91-110.
Oerbeck, B., Stein, M. B., Wentzel‐Larsen, T., Langsrud, Ø., & Kristensen, H. (2014). A
randomized controlled trial of a home and school‐based intervention for selective
mutism–defocused communication and behavioural techniques. Child and Adolescent
Mental Health, 19(3), 192-198.
Storch, E. A., Lewin, A. B., Collier, A. B., Arnold, E., De Nadai, A. S., Dane, B. F., ... &
Murphy, T. K. (2015). A randomized controlled trial of cognitive‐behavioral therapy
versus treatment as usual for adolescents with autism spectrum disorders and comorbid
anxiety. Depression and anxiety, 32(3), 174-181.
Wood, J. J., Ehrenreich-May, J., Alessandri, M., Fujii, C., Renno, P., Laugeson, E., ... &
Murphy, T. K. (2015). Cognitive behavioral therapy for early adolescents with autism
spectrum disorders and clinical anxiety: A randomized, controlled trial. Behavior
Therapy, 46(1), 7-19.

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