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Mind Over Matter

February 3, 2012

I’ve been hearing the phrase, “mind over matter” since I was just a kid. Up until now I was a firm believer in that school of thought and believed in its powers.  Now, after a recent experience with a patient, I’m not fully convinced of its efficacy which has really made me contemplate the way I view medicine and nursing care.

Generally when I’m caring for patients in a lot of pain, feeling anxious and scared I pull the “mind over matter” bit out of my bag of tricks and coach my patients through guided imagery to think of places that make them feel relaxed and happy. Often I find myself asking, “Has anyone shown you the relaxation tv channel here yet?” Sometimes we talk about favorite music and TV shows and whatever distracts my patients from their ailments and it often works very well. In nursing school we learned that the use of guided imagery during acute distress may not be applicable, but I’d never seen it not work–until now.

The other day I cared for a patient suffering with what I would call severe anxiety. The patient was recovering from cardiac surgery and the anxiety was a secondary problem exacerbated by the hospital stay. My patient would hyperventilate and get so worked up that their oxygenation status would decline drastically, they’d be covered in sweat, and were barely able to articulate their needs. I like to think I am able to “talk down” patients suffering from anxiety attacks as I’ve been successful many times before. With this patient, I was unable to get them to respond to my “mind over matter” techniques. I tried providing massages, replacing cool cloths for the patient to wipe the sweat away,  turning on the relaxation station, repositioning, offering pain medications, administering ativan, coaching them through guided imagery and more. The patient didn’t really know why they felt anxious.

In the hospital, depending on the patient’s history and diagnosis, we like their oxygen levels to be at least 92%. For reference, a “healthy” adult without respiratory distress should be at about 96-100%. During my shift this patient’s oxygen levels would range from 85% to 90% even with oxygen therapy. My patient denied shortness of breath, difficulty breathing, headaches, and chest pain. It was difficult to determine if the decreased oxygen status was a result of pathological/physical findings (which was a possibility) or because the patient was so anxious, at times voluntarily holding their breath. I found myself sitting on the edge of my patient’s bed throughout my shift trying to get the oxygen levels to increase by titrating the liters of oxygen and providing relaxation techniques. Of course the MD was notified and respiratory therapy was on their way to evaluate my patient, but I felt defeated. After everything I tried, I could not get my patient’s oxygen level to the level it needed to be. My patient could not mentally focus on guided imagery during this time of acute anxiety and the anti-anxiety agents were the only thing that could help them during this time.

Prior to this situation, as mentioned above I really believed “mind over matter” and other relaxation techniques would work during these times, and I was skeptical of anti-anxiety agents and still am to some degree, but for this patient it was the right thing. At the end of my shift, the patient’s oxygen levels did increase to about 92% after working with the respiratory tech. I’ve learned that guided imagery/mind over matter, while extremely helpful in many situations is not always going to work during times of acute anxiety.

4 Comments leave one →
  1. Elyn permalink
    February 3, 2012 7:46 pm

    Very informative, Lili. You are a sensitive and brilliant nurse. I hope you can take care of me when I am in the hospital. Or should I say “if”.

  2. Ann Kays permalink
    February 3, 2012 9:38 pm

    Lili.. I have seen many people who benefit from medication for anxiety.. and although mind over matter would be the first line of attack would never hesitate if medication would help..
    Anxiety can be so crippling.

    • February 4, 2012 5:48 pm

      I agree. Anxiety is a terrible thing to live with. In the hospital it’s difficult to determine if the patient has suffered from anxiety throughout their life, or if it is a new onset related to the hospital. This experience really taught me to have faith in medications. Thanks for reading!

  3. LeShea permalink
    February 4, 2012 1:48 am

    Try not to rule out any technique( or type of drug)…………your experiences will make you eat your words every time!! LOL!

    It’s good to see you posting- I like keeping up with your progress! 🙂

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