Nursing Care Plan: Conversion Disorder PDF

11/16/23, 11:05 AM Realizeit for Student Nursing Care Plan: Conversion Disorder Nursing Diagnosis Ineffective Denial: Unsuccessful attempt to ignore or minimize reality of events or situations that are unpleasant to confront Assessment Data Presence of physical limitation or disability with indif...

11/16/23, 11:05 AM Realizeit for Student Nursing Care Plan: Conversion Disorder Nursing Diagnosis Ineffective Denial: Unsuccessful attempt to ignore or minimize reality of events or situations that are unpleasant to confront Assessment Data Presence of physical limitation or disability with indifference to or lack of concern about the severity of the symptom Refusal to seek health care for the physical symptom Lack of insight into stress, conflict, or problematic relationships Difficulty with feelings of anger, hostility, or conflict Decreased ability to express needs and feelings Secondary gain related to the physical symptom or disability Expected Outcomes Immediate The client will: Identify the conflict underlying the physical symptoms within 4 to 5 days. Identify feelings of fear, anger, guilt, anxiety, or inadequacy within 4 to 5 days. Verbalize steps of the problem-solving process within 4 to 5 days. Stabilization The client will: Verbalize feelings of fear, anger, guilt, or inadequacy. Verbalize knowledge of illness, including the concept of secondary gain. Demonstrate use of the problem-solving process. Community The client will: Negotiate resolution of conflicts with family, friends, and significant others. Implementation Nursing Interventions Rationale Involve the client in the usual activities, self-care, eating in the Your expectation will enhance the client’s participation and will dining room, and so on, as you would other clients. diminish secondary gain. After medical evaluation of the symptom, withdraw attention from the client’s physical status except for necessary care. Avoid discussing the physical symptom; withdraw your attention from the client if necessary. Lack of attention to expression of physical complaints will help minimize secondary gain and decrease the client’s focus from the symptom. Expect the client to participate in activities as fully as possible. Granting special privileges and excusing the client from Make your expectations clear and do not give the client special responsibilities are forms of secondary gain. The client may need to privileges or excuse him or her from all expectations due to become more uncomfortable to risk relinquishing the physical physical limitations. conversion as a coping strategy. Do not argue with the client. Withdraw your attention if necessary. Arguing with the client undermines limits. Withdrawing attention may be effective in diminishing secondary gain. Focus interactions on the client’s feelings, home or work Increased attention to emotional issues will help the client shift situations, and relationships. attention to these feelings. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 1/9 11/16/23, 11:05 AM Realizeit for Student Nursing Interventions Rationale Explore with the client his or her personal relationships and related feelings. Conversion reaction symptoms are often related to interpersonal conflicts or situations. Talking about these things may help the client develop insight and additional coping mechanisms. Teach the client and the family or significant others about The client and the family or significant others may have little or no conversion reaction, stress management, interpersonal dynamics, knowledge of these areas. Increasing their knowledge can promote coping, and conflict resolution strategies.* understanding, motivation for change, and support for the client. The client may have used coping strategies in the past that did not Talk with the client about coping strategies he or she has used in result in physical symptoms, perhaps for issues or conflicts that the past that did not include physical symptoms. were less stressful for the client. The client may be able to build on these strategies in the future. Teach the client about stress management skills, such as The client may have limited or no knowledge of or may not have increasing physical exercise, expressing feelings verbally or in a used stress management techniques in the past. If the client begins journal, or meditation techniques. Encourage the client to practice to build skills in the treatment setting, he or she can experience this type of technique while in the hospital. success and receive positive feedback. Teach the client the problem-solving process: identify the problem, The client may not know the steps of a logical, orderly process to examine alternatives, weigh the pros and cons of each alternative, solve problems. Such a process can be helpful to the client in select and implement an approach, and evaluate its success. dealing with stressful situations in the future. Praise the client when he or she is able to discuss the physical symptom as a method used to cope with conflict. Positive feedback can reinforce the client’s insight and help the client recognize physical symptoms as related to emotional issues in the future. Give the client positive feedback for expressing feelings and trying Positive feedback can increase desired behavior and help the client conflict resolution strategies. build confidence in preparation for discharge. *Collaborative interventions. Application of the Nursing Process The underlying mechanism of somatization is consistent for clients with somatoform disorders of all types. This section discusses application of the nursing process for clients with somatization; differences among the disorders are highlighted in the appropriate places. Assessment The nurse must investigate physical health status thoroughly to ensure there is no underlying pathology requiring treatment. Box 21.1 contains a useful screening test for somatic symptom severity. When a client has been diagnosed with a somatic symptom illness, it is important not to dismiss all future complaints because, at any time, the client could develop a physical condition that would require medical attention. BOX 21.1 Assessment for Somatic Symptom Severity For the past 4 weeks, each of the following symptoms is rated as the following: - Not bothered at all - Bothered a little https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 2/9 11/16/23, 11:05 AM Realizeit for Student - Bothered a lot 1. Stomach pain 2. Back pain 3. Pain in arms, legs, and joints 4. Menstrual cramps or other problems with periods (females only) 5. Headaches 6. Chest pain 7. Dizziness 8. Fainting spells 9. Feeling your heart race or pound 10. Shortness of breath 11. Pain or problems during sexual intercourse 12. Constipation, loose stools, or diarrhea 13. Nausea, gas, or indigestion 14. Feeling tired or having low energy 15. Trouble sleeping Score by: Not bothered at all = 0 Bothered a little = 1 Bothered a lot = 2 History Clients usually provide a lengthy and detailed account of previous physical problems, numerous diagnostic tests, and perhaps even a number of surgical procedures. It is likely that they have seen multiple health care providers over several years. Clients may express dismay or anger at the medical community with comments such as “They just can’t find out what’s wrong with me” or “They’re all incompetent, and they’re trying to tell me I’m crazy!” The exception may be clients with conversion disorder, who show little emotion when describing physical limitations or lack of a medical diagnosis (la belle indifférence). General Appearance and Motor Behavior Overall appearance is usually not remarkable. Often, clients walk slowly or with an unusual gait because of the pain or disability caused by the symptoms. They may exhibit a facial expression of discomfort or physical distress. In many cases, they brighten and look much better as the assessment interview begins because they have the nurse’s undivided attention. Clients with somatization disorder usually describe their complaints in colorful, exaggerated terms, but often lack specific information. Mood and Affect Mood is often labile, shifting from seeming depressed and sad when describing physical problems to looking bright and excited when talking about how they had to go to the hospital in the middle of the night by ambulance. Emotions are often exaggerated, as are reports of physical symptoms. Clients describing a series of personal crises related to their physical health may appear pleased rather than distressed about these situations. Clients with conversion disorder display an unexpected lack of distress. Thought Process and Content Clients who somatize do not experience disordered thought processes. The content of their thinking is primarily about often exaggerated physical concerns; for example, when they have a simple cold, they may be convinced it is pneumonia. They may even talk about dying and what music they want played at their funeral. Clients are unlikely to be able to think about or respond to questions about emotional feelings. They will answer questions about how they feel in terms of physical health or sensations. For example, the nurse may ask, “How did you feel about having to quit your job?” The client might respond, “Well, I thought I’d feel better with the extra rest, but my back pain was just as bad as ever.” Clients with illness anxiety disorder focus on the fear of serious illness rather than the existence of illness, as seen in clients with other somatoform disorders. However, they are just as preoccupied with physical concerns as other somatizing clients and are likewise limited in their abilities to identify emotional feelings or interpersonal issues. Clients with hypochondriasis are preoccupied with bodily functions, ruminate about illness, are fascinated with medical information, and have unrealistic fears about potential infection and prescription medication. Sensorium and Intellectual Processes Clients are alert and oriented. Intellectual functions are unimpaired. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 3/9 11/16/23, 11:05 AM Realizeit for Student Self-Concept Clients focus only on the physical part of themselves. They are unlikely to think about personal characteristics or strengths and are uncomfortable when asked to do so. Clients who somatize have low self-esteem and seem to deal with it by totally focusing on physical concerns. They lack confidence, have little success in work situations, and have difficulty managing daily life issues, which they relate solely to their physical status. Nursing Care Plan: Hypochondriasis/Illness Anxiety Disorder Nursing Diagnosis Ineffective Coping: Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources Assessment Date Denial of emotional problems Difficulty identifying and expressing feelings Lack of insight Self-preoccupation, especially with physical functioning Fears of or rumination on disease Numerous somatic complaints (may involve many different organs or systems) Sensory complaints (pain, loss of taste sensation, olfactory complaints) Reluctance or refusal to participate in psychiatric treatment program or activities Reliance on medications or physical treatments (such as laxative dependence) Extensive use of over-the-counter medications, home remedies, enemas, and so forth Ritualistic behaviors (such as exaggerated bowel routines) Tremors Limited gratification from interpersonal relationships Lack of emotional support system Anxiety Secondary gains received for physical problems History of repeated visits to physicians or hospital admissions History of repeated medical evaluations with no findings of abnormalities Expected Outcomes Immediate The client will: Participate in the treatment program; for example, talk with staff for 15 minutes or participate in a group activity at least twice a day within 24 to 48 hours. Demonstrate decreased physical complaints within 2 to 3 days. Demonstrate compliance with medical therapy and medications within 2 to 3 days. Demonstrate adequate energy, food, and fluid intake; for example, eat at least 50% of each meal within 3 to 4 days. Identify life stresses and anxieties within 2 to 3 days. Identify the relationship between stress and physical symptoms within 4 to 5 days. Express feelings verbally within 3 to 4 days. Identify alternative ways to deal with stress, anxiety, or other feelings, for example, talking with others, physical activity, keeping a journal, and so forth within 4 to 5 days. Stabilization The client will: Demonstrate decreased ritualistic behaviors. Demonstrate decreased physical attention-seeking complaints. Verbalize increased insight into the dynamics of hypochondriacal behavior, including secondary gains. Verbalize an understanding of therapeutic regimens and medications, if any. Community The client will: Eliminate overuse of medications or physical treatments. Demonstrate alternative ways to deal with stress, anxiety, or other feelings. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 4/9 11/16/23, 11:05 AM Realizeit for Student Implementation Nursing Interventions The initial nursing assessment should include a complete physical assessment, a history of previous complaints and treatment, and a consideration of each current complaint. Rationale The nursing assessment provides a baseline from which to begin planning care. The nursing staff should note the medical staff’s assessment of each complaint Genuine physical problems must be noted and on the client’s admission.* treated. Each time the client voices a new complaint, the client should be referred to the medical staff for assessment (and treatment if appropriate).* It is unsafe to assume that all physical complaints are hypochondriacal; the client could really be ill or injured. The client may attempt to establish the legitimacy of complaints by being genuinely injured or ill. Work with the medical staff to limit the number, variety, strength, and frequency of medications, enemas, and so forth that are made available to the client.* A team effort helps prevent the client’s manipulation of staff members to obtain additional medication. When the client requests a medication or treatment, encourage the client to identify what precipitated his or her complaint and deal with it in other ways. If the client can obtain stress relief in a nonchemical, nonmedical way, he or she is less likely to use the medication or treatment. Observe and record the circumstances related to complaints; talk about your observations with the client. Alerting the client to situations surrounding the complaint helps him or her see the relatedness of stress and physical symptoms. Help the client identify and use nonchemical methods of pain relief, such as relaxation. Using nonchemical pain relief shifts the focus of coping away from medications and increases the client’s sense of control. Minimize the amount of time and attention given to complaints. When the client makes a complaint, refer him or her to the medical staff (if it is a new complaint) or follow the team treatment plan. Then tell the client you will discuss something else, but not bodily complaints. Tell the client you are interested in the client as a person, not just in his or her physical complaints. If the complaint is not acute, ask the client to discuss the complaint during a regular appointment with the medical staff.* If physical complaints are unsuccessful in gaining attention, they should decrease in frequency over time. Withdraw your attention if the client insists on making complaints the sole topic of conversation. Tell the client your reason for withdrawal and that you will return later to discuss other topics. It is important to make clear to the client that attention is withdrawn from physical complaints, not from the client as a person. Allow the client a specific time limit (like 5 minutes/hour) to discuss physical complaints with one person. The remaining staff will discuss only other issues with the client. Because physical complaints have been the client’s primary coping strategy, it is less threatening to the client if you limit this behavior initially rather than forbid it. If the client is denied this coping mechanism before new skills can be developed, hypochondriacal behavior may increase. Acknowledge the complaint as the client’s perception and then follow the previous approaches; do not argue about the somatic complaints. Arguing gives the client’s complaints attention, albeit negative, and the client is able to avoid discussing feelings. Use minimal objective reassurance in conjunction with questions to explore the client’s feelings. (“Your tests have shown that you have no lesions. Do you still feel that you do? What are your feelings about this?”) This approach helps the client make the transition to discussing feelings. Initially, carefully assess the client’s self-image, social patterns, and ways of dealing with anger, stress, and so forth. This assessment provides a knowledge base regarding hypochondriacal behaviors. Talk with the client about sources of satisfaction and dissatisfaction, relationships, employment, and so forth. Open-ended discussion is usually nonthreatening and helps the client begin self-assessment. After some discussion of the above and developing a trust relationship, talk more directly with the client and encourage him or her to identify specific stresses, recent and ongoing. The client’s perception of stressors forms the basis of his or her behavior and is usually more significant than others’ perception of those stressors. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 5/9 11/16/23, 11:05 AM If the client is using denial as a defense mechanism, point out apparent or possible stresses (in a nonthreatening way) and ask the client for feedback. Realizeit for Student If the client is in denial, more direct approaches may produce anger or hostility and threaten the trust relationship. Gradually, help the client identify possible connections between anxiety The client can begin to see the relatedness of stress and and the occurrence of physical symptoms. What makes the client more physical problems at his or her own pace. Self-realization will or less comfortable? What is the client doing, or what is going on be more acceptable to the client than the nurse telling the around the client when he or she experiences symptoms? client the problem. Encourage the client to discuss his or her feelings about the fears rather than the fears themselves. Explore the client’s feelings of lack of control over stress and life events. Encourage the client to keep a diary of situations, stresses, and occurrence of symptoms and use it to identify relationships between stresses and symptoms. Talk with the client at least once per shift, focusing on the client identifying and expressing feelings. The focus is on feelings of fear, not fear of physical problems. The client may have helpless feelings but may not recognize this independently. Reflecting on written items may be more accurate and less threatening to the client. Demonstrating consistent interest in the client facilitates the relationship and can desensitize the discussion of emotional issues. Encourage the client to ventilate feelings by talking or crying, through The client may have difficulty expressing feelings directly. Your physical activities, and so forth. support may help him or her develop these skills. Encourage the client to express feelings directly, especially feelings with Direct expression of feelings will minimize the need to use which the client is uncomfortable (such as anger or resentment). physical symptoms to express them. Notice the client’s interactions with others and give positive feedback for self-assertion and expressing feelings, especially anger, resentment, and other so-called negative emotions. The client needs to know that appropriate expressions of anger or other negative emotions are acceptable and that he or she can feel better physically as a result of these expressions. Teach the client and his or her family or significant others about the The client and his or her family or significant others may have dynamics of hypochondriacal behavior and the treatment plan, little or no knowledge of these areas. Knowledge of the including plans after discharge.* treatment plan will promote long-term behavior change. Talk with the client and significant others about secondary gains, and Maintaining limits to reduce secondary gain requires together develop a plan to reduce those gains. Identify the needs the everyone’s participation to be successful. The client’s family client is attempting to meet with secondary gains (such as attention or and significant others must be aware of the client’s needs if escape from responsibilities).* they want to be effective in helping to meet those needs. Help the client plan to meet his or her needs in more direct ways. Show the client he or she can gain attention when he or she does not exhibit symptoms, deals with responsibilities directly, or asserts him or herself in the face of stress. Positive feedback and support for healthier behavior tend to make that behavior recur more frequently. The client’s family and significant others must also use positive reinforcement. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 6/9 11/16/23, 11:05 AM Realizeit for Student Reduce the benefits of illness as much as possible. Do not allow the client to avoid responsibilities or allow special privileges, such as staying in bed by voicing somatic discomfort. Teach the client more healthful daily living habits, including diet, stress management techniques, daily exercise, rest, possible connection between caffeine and anxiety symptoms, and so forth. If physical problems do not get the client what he or she wants, the client is less likely to cope in that manner. Optimal physical wellness is especially important with clients using physical symptoms as a coping strategy. *Collaborative interventions. Adapted from Schultz, J. M., & Videbeck, S. L. (2013). Lippincott’s manual of psychiatric nursing care plans (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Roles and Relationships Clients are unlikely to be employed, though they may have a past work history. They often lose jobs because of excessive absenteeism or inability to perform work; clients may have quit working voluntarily because of poor physical health. Consumed with seeking medical care, they have difficulty fulfilling family roles. It is likely that these clients have few friends and spend little time in social activities. They may decline to see friends or go out socially for fear that they would become desperately ill away from home. Most socialization takes place with members of the health care community. Clients may report a lack of family support and understanding. Family members may tire of the ceaseless complaints and the client’s refusal to accept the absence of a medical diagnosis. The illnesses and physical conditions often interfere with planned family events, such as going on vacations or attending family gatherings. Homelife is often chaotic and unpredictable. Physiological and Self-Care Concerns In addition to the multitude of physical complaints, these clients often have legitimate needs in terms of their health practices (Box 21.2 ). Clients who somatize often have sleep pattern disturbances, lack basic nutrition, and get no exercise. In addition, they may be taking multiple prescriptions for pain or other complaints. If a client has been using anxiolytics or medications for pain, the nurse must consider the possibility of withdrawal. BOX 21.2 Clinical Nurse Alert Just because a client has been diagnosed with a somatic symptom illness, do not automatically dismiss all future complaints. He or she should be could at any time develop a physical condition requiring medical attention. Data Analysis Nursing diagnoses commonly used when working with clients who somatize include: Ineffective coping Ineffective denial Impaired social interaction Anxiety Disturbed sleep pattern Fatigue Pain Clients with conversion disorder may be at risk for disuse syndrome from having pseudoneurologic paralysis symptoms. In other words, if clients do not use a limb for a long time, the muscles may weaken or undergo atrophy from lack of use. Outcome Identification Treatment outcomes for clients with a somatic symptom illness may include: The client will identify the relationship between stress and physical symptoms. The client will verbally express emotional feelings. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 7/9 11/16/23, 11:05 AM Realizeit for Student The client will follow an established daily routine. The client will demonstrate alternative ways to deal with stress, anxiety, and other feelings. The client will demonstrate healthier behaviors regarding rest, activity, and nutritional intake. Intervention Providing Health Teaching The nurse must help the client learn how to establish a daily routine that includes improved health behaviors. Adequate nutritional intake, improved sleep patterns, and a realistic balance of activity and rest are all areas where the client may need assistance. The nurse should expect resistance, including protests from the client that he or she does not feel well enough to do these things. The challenge for the nurse is to validate the client’s feelings while encouraging him or her to participate in activities. Nurse: “Let’s take a walk outside for some fresh air.” (encouraging collaboration) Client: “I wish I could, but I feel so terrible, I just can’t do it.” Nurse: “I know this is difficult, but some exercise is essential. It will be a short walk.” (validation; encouraging collaboration) The nurse can use a similar approach to gain client participation in eating more nutritious foods, getting up and dressed at a certain time every morning, and setting a regular bedtime. The nurse can also explain that inactivity and poor eating habits perpetuate discomfort and that it is often necessary to engage in behaviors even when one doesn’t feel like it. Client: “I just can’t eat anything. I have no appetite.” Nurse: “I know you don’t feel well, but it is important to begin eating.” (validation; encouraging collaboration) Client: “I promise I’ll eat just as soon as I’m hungry.” Nurse: “Actually, if you begin to eat a few bites, you’ll begin to feel better, and your appetite may improve.” (encouraging collaboration) The nurse should not strip clients of their somatizing defenses until adequate assessment data are collected and other coping mechanisms are learned. The nurse should not attempt to confront clients about somatic symptoms or attempt to tell them that these symptoms are not “real.” They are real to clients, who actually experience the symptoms and associated distress. Assisting the Client in Expressing Emotions Teaching about the relationship between stress and physical symptoms is a useful way to help clients begin to see the mind–body relationship. Clients may keep a detailed journal of their physical symptoms. The nurse might ask them to describe the situation at the time, such as whether they were alone or with others, whether any disagreements were occurring, and so forth. The journal may help clients see when physical symptoms seemed worse or better and what other factors may have affected that perception. Limiting the time that clients can focus on physical complaints alone may be necessary. Encouraging them to focus on emotional feelings is important, though this can be difficult for clients. The nurse should provide attention and positive feedback for efforts to identify and discuss feelings. It may help for the nurse to explain to the family about primary and secondary gains. For example, if the family can provide attention to clients when they are feeling better or fulfilling responsibilities, the clients are more likely to continue doing so. If family members have lavished attention on clients when they have physical complaints, the nurse can encourage the relatives to stop reinforcing the sick role. Teaching Coping Strategies Two categories of coping strategies are important for clients to learn and to practice: emotion-focused coping strategies, which help clients relax and reduce feelings of stress, and problem-focused coping strategies, which help resolve or change a client’s behavior or situation or manage life stressors. Emotion-focused strategies include progressive relaxation, deep breathing, guided imagery, and distractions such as music or other activities. Many approaches to stress relief are available for clients to try. The nurse should help clients learn and practice these techniques, emphasizing that their effectiveness usually improves with routine use. Clients must not expect such techniques to eliminate their pain or physical symptoms; rather, the focus is helping them manage or diminish the intensity of the symptoms. CLIENT AND FAMILY EDUCATION For Somatic Symptom Illnesses: https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 8/9 11/16/23, 11:05 AM Realizeit for Student Establish daily health routine, including adequate rest, exercise, and nutrition. Teach about relationship of stress and physical symptoms and mind–body relationship. Educate about proper nutrition, rest, and exercise. Educate client in relaxation techniques: progressive relaxation, deep breathing, guided imagery, and distraction such as music or other activities. Educate client by role-playing social situations and interactions. Encourage family to provide attention and encouragement when client has fewer complaints. Encourage family to decrease special attention when client is in “sick” role. Problem-focused coping strategies include learning problem-solving methods, applying the process to identified problems, and role-playing interactions with others. For example, a client may complain that no one comes to visit or that she has no friends. The nurse can help the client plan social contact with others, can role-play what to talk about (other than the client’s complaints), and can improve the client’s confidence in making relationships. The nurse can also help clients identify stressful life situations and plan strategies to deal with them. For example, if a client finds it difficult to accomplish daily household tasks, the nurse can help him to plan a schedule with difficult tasks followed by something the client may enjoy. Community-Based Care Health care professionals often encounter clients with somatic symptom illnesses in clinics, physicians’ offices, or settings other than those related to mental health. Building a trusting relationship with the client, providing empathy and support, and being sensitive to rather than dismissive of complaints are skills that the nurse can use in any setting where clients are seeking assistance. Making appropriate referrals such as to a pain clinic for clients with pain disorder or providing information about support groups in the community may be helpful. Encouraging clients to find pleasurable activities or hobbies may help meet their needs for attention and security, thus diminishing the psychological needs for somatic symptoms. NURSING INTERVENTIONS For Somatic Symptom Illnesses: Health teaching Establish a daily routine. Promote adequate nutrition and sleep. Expression of emotional feelings Recognize relationship between stress/coping and physical symptoms. Keep a journal. Limit time spent on physical complaints. Limit primary and secondary gains. Coping strategies Emotion-focused coping strategies such as relaxation techniques, deep breathing, guided imagery, and distraction Problem-focused coping strategies such as problem-solving strategies and role-playing Mental Health Promotion A common theme in somatic symptom illnesses is their occurrence in people who do not express conflicts, stress, and emotions verbally. They express themselves through physical symptoms; the resulting attention and focus on their physical ailments somewhat meet their needs. As these clients are better able to express their emotions and needs directly, physical symptoms subside. Thus, assisting them in dealing with emotional issues directly is a strategy for mental health promotion. Somatic symptom illnesses have declined over the past few decades, in part due to increased knowledge of the public, increasing selfawareness or self-knowledge, and scientific evidence of mind–body interaction. Some would credit the internet with putting unlimited resources at people’s fingertips, and knowledge often precedes understanding and behavior change. Interestingly, there are others who credit the internet accessibility with feeding some peoples’ fears about their health—called cyberchondria. Cyberchondria refers to excessive or repeated online searches for health-related information that is distressing or anxiety-provoking for the person (McMullan, Berle, Arnaez, & Starcevic, 2018). The person’s anxiety about his or her own health increases as more time is spent online seeking health information. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IfXgL26npJPT22aAWsq08u6Npe56xgiyh8MpUasnCQGXnd… 9/9