5.5 Spotlight Application

This spotlight application demonstrates how a nurse provides mental health care to a client admitted to a medical-surgical unit.

Situation/Background

A nurse is caring for a 55-year-old client admitted to the medical-surgical unit for complications related to uncontrolled diabetes. The client reports feelings of extreme stress, insomnia, and inability to focus. The nurse plans to apply principles of stress management and provide health teaching about positive coping strategies while caring for this client.

Critical Thinking Questions

1. What assessment data should the nurse collect?

Blood glucose levels, vital signs, fatigue, changes in appetite, and sleep patterns. Anxiety, mood, affect, and cognitive function; recent stressors (e.g., hospitalization, financial concerns, family dynamics); use of adaptive or maladaptive coping techniques (e.g., relaxation techniques, substance use, or avoidance behaviors); availability and engagement with family, friends, or community resources; and understanding of diabetes management and ability to follow a treatment plan.

2. Based on the assessment data, what NANDA nursing diagnosis applies to this client?

Ineffective Coping

3. What is an appropriate SMART outcome criterion for this client?

The client will demonstrate at least two adaptive coping strategies to manage stress by discharge from the facility.

4. What nursing interventions can the nurse plan to implement?

Nursing Actions

• Assist the client in identifying current stressors and emotional triggers.
• Teach the client deep-breathing exercises and progressive muscle relaxation.
• Encourage journaling or other expressive activities to identify stress patterns.
• Collaborate with the interdisciplinary team to address unmet psychosocial needs.
• Refer the client to a diabetes educator for stress management related to illness.
• Provide a quiet, comfortable environment to promote relaxation and sleep.

Teaching Topics

• Teach stress management techniques, such as mindfulness and meditation.
• Educate the client about the effects of stress on blood glucose control.
• Reinforce the importance of adhering to a diabetes care plan (e.g., meal planning, medications, exercise).
• Teach the client how to recognize early signs of stress overload and when to seek help.

5. Give an example of how the nurse can evaluate if the outcome criterion was met and if the interventions were effective.

The identified outcome criterion was, “The client will demonstrate at least two adaptive coping strategies to manage stress by discharge from the facility.” The nurse assesses the client’s progress towards meeting the established outcome criterion:

• The client states they are using deep breathing exercises when feeling stressed.
• The client keeps a journal to document stress triggers and coping strategies.
• The client expresses feeling more in control of their stress and reports improved focus.
• The client sleeps 6–7 hours per night with reduced interruptions.
• The client actively participates in mindfulness sessions led by the nurse.
• The client identifies family support as a resource and plans to talk with a family member daily.
• The client uses journaling consistently but struggles with time management for relaxation techniques.

The nurse evaluates the outcome criterion as “partially met” and plans to continue the current interventions and add additional interventions of setting specific times for implementing relaxation techniques to improve adherence and emphasizing time management techniques and prioritizing self-care in the next nursing session.