Cues

Nursing Diagnosis

Analysis

Goal & Objectives GOAL:

Nursing Intervention INDEPENDENT:

Rationale

Evaluation

SUBJECTIVE: - Pangatlong beses ko na kasi dito, kaya ayoko na talaga bumalik. Gusto ko na umuwi

Anxiety related

EFFECTIVENESS 1. Was the

patient calmed and relaxed ?

to

Changes in environmen t and routines

OBJECTIVE: >Anger and Irritability > Dark circles under eyes >Flushed >Dry mouth >v/s taken and recorded as follows: BP: 130/80 mmHg PR: 89bpm RR: 14cpm Temp: 36.1 degrees Celsius

Anxiety is a vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with the threat.

After 2 hours of nursing interventions,

Patient will appear calmed and relaxed

OBJECTIVES:
Acknowledge but do not reinforce use of denial. Avoid confrontation s as much as possible.

__Yes __No Why?_____________ EFFICIENCY

Denial can be beneficial in reducing anxiety but can delay dealing with the truth or reality of the current situation. Confronta tion can promote anger and boost use of denial which eventually reduces

Patient will exhibit behaviors of acceptance

2. Were the interventions done within the timeframe? __Yes __No Why?_____________ APPROPRIATENESS Were the interventions realistic to the norms? __Yes __No Why?_____________ ACCEPTABILITY Was the patient cooperative and willing to the interventions

Patient will be able to demonstrat e relaxation techniques ( deep breathing, positive visualizatio n) Patient will be able to recall

positive behaviors to reduce stress

Acknowledge patients awareness anxiety.

cooperatio n and recovery may be delayed. Acknowledgment of the patients feelings confirms the feelings and corresponds acceptance of those feelings.

done? __Yes __No Why?_____________

of

Answer all questions truthfully. Provide information that is consistent; repeat as necessary.

Acknowledgment of the patients feelings confirms the feelings and corresponds acceptance of those feelings.

As patients level of anxiety subsides, encourage exploration of specific events prior to both the beginning and reduction of the anxious feelings.

Recognition and exploration of causative factors leading to or reducing anxious feelings are essential steps in developing alternative reactions.

Assist the patient in developing anxiety-reducing

Using anxietyreduction

skills (e.g., relaxation, deep breathing, positive visualization, and reassuring selfstatements).

strategies enhances patients sense of personal mastery and confidence.

Assist the patient to identify or recall positive coping behaviors used in the past. Be empathic and nonjudgmental while working with patient and family.

Successful behaviors in the past can be reinforced in dealing with current problems/stress, enhancing patients sense of self-control. Showing empathy and nonjudgmental attitude enhances cooperation of the patient and family.

Given this symptom profile, it is quite possible that Teddy is suffering from Dissociative Identity Disorder. However, some symptoms do not directly match those which are set out in the DSM. According to the DSM, a person may be officially diagnosed with Dissociative Identity Disorder if the following criteria are met; "A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self). B. At least two of these identities or personality states recurrently take control of the person's behaviour. C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. D. The disturbance is not due to the direct physiological effects of a substance."

Based on these criteria, it is quite evident that Teddy is in-fact suffering with Dissociative Identity Disorder. Teddy's other symptoms can also be accounted for. It is known that persons suffering with this illness may be vulnerable to auditory and visual hallucinations, in Teddy's case these are mostly visual. "An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions)". (DSM-IV-TR, 2000). Also, Teddy's recurrent migraines can also be seen as a common feature of Dissociative Identity Disorder. "Individuals with this type of disorder may have migraine and other types of headaches, irritable bowel syndrome and asthma". (DSM-IV-TR, 2000). "Behavioural theorists generally consider dissociation as an avoidance response that protects the person from stressful events and memories of these events. Because the person does not consciously confront these painful memories, the fear they elicit has no opportunity to extinguish". (Davison et al, 2004). It seems apparent then, that the case of Teddy Daniels fits mostly with the behavioural model. There is no evidence in the film that suggests that Teddy was physically or sexually abused as a child. It may simply be that Teddy is avoiding the stressful and traumatic memories of his wife and children's murder by creating this personality in which he believes his wife died in a fire. Teddy may simply be avoiding the stress of recognising that he in fact murdered his wife. It can be said then that the etiology of Teddy's mental illness is an accurate portrayal of real life understanding.

There are three major models proposed which attempt to account for the etiology of Dissociative Identity Disorder. The sociocognitive model describes Dissociative Identity Disorder as a result of a therapists influence during therapy. Spanos (1994) developed the idea that Dissociative Identity Disorder is merely a role-play. This doesn't necessarily mean that the patient is faking the illness but that they are responding to cues that are given during the course of therapy. Simply, if the therapist suggests to a patient that they may have multiple personalities, the patient can easily take this idea on board and begin to show more evidence as a result. "According to this view, some therapists may provide their patients with information and suggestions about multiple personality, subtly and unconsciously encouraging them to behave in ways that are consistent with these expectations, and rewarding them with extra attention and care when they adopt the role". (Oltmanns et al, 1999).