Address the behavioral and psycho-social
factors with primary focus on psycho-social interventions, including any identified
protective factors which could reduce presenting concerns.
Describe step by step nursing interventions to address behavioral, psychological and
emotional responses seen in the patient and their family and links them to research
evidence. Acknowledge the benefit of and incorporates pre-existing protective factors.
PRESENTING CONCERNS
Ellen’s neighbour phoned for an ambulance after noticing her slumped in a chair on her veranda. She was pale
and short of breath. She had protested to the neighbour that she was just tired and did not want a fuss. The
paramedics checked her vital signs on arrival and commenced cardiac monitoring. She was in tachycardia and
was hyperventilating. Her cardiac monitor indicated some arrhythmias were present and other abnormalities.
Ellen insisted to the paramedics that she would be fine in a while and did not need to go to hospital. She declared
she did not have any chest pain. The paramedics explain that she should go to hospital to rule out any risk of
any heart damage and Ellen reluctantly agreed. They enquired about her past medical history and current
medications during transport to hospital.
RELEVANT MEDICAL HISTORY
Ellen has a history of hypertension which was diagnosed when she was in her 50s. Two years ago she had some
episodes of angina. She is currently under the care of a cardiologist who has been advising her to lose weight.
She was recently commenced on antidepressant medication by her general practitioner.
During transport to hospital Ellen became visibly upset as she responded to questions about her next of kin. Her
husband had died suddenly and she still misses him.
SOCIAL HISTORY
Ellen lives alone in a small unit which she bought 12 months ago after selling the home that her husband and
family had lived in for twenty five years. Previously an active and outgoing person, she now has limited contact
with her ex-work colleagues and the friends that she and her husband socialised with. She has made little effort
to mix with the other residents in her apartment block, despite their attempts to welcome her.
FAMILY HISTORY
Ellen’s husband died of an acute myocardial infarction 18 months ago, at the age of 70. Ellen had phoned for an
ambulance when he complained of a sharp stabbing pain in his chest. He had no previous cardiac history and
had enjoyed an active lifestyle. Their adult children are both married, with children of their own. Neither of them
lives nearby. Ellen’s son Maurice, lives in another state and rings each Sunday. Candice lives in a regional town
and encourages her mother to stay with her, however Ellen claims it is too much effort.
Interventions
Ellen Simpson is a former shop attendant that lives her alone since her husband passed away, and
her children live away from her residence. There are several psycho-social, behavioral, and
physical parameters that should be considered and utilized in ensuring that Ellen gets better in
both the short and long-term interventions used for her case.
Cognitive behavior therapy could be one of the successful interventions that could be used in
Ellen’s psychological case to positively contribute to her cardiac health. The nurse would discuss
with the patient why she was experiencing depression, and the importance of interacting with her
relatives and members of her community as a means of sharing any issues that she could be
facing (Alun et al., 2015: Montilla, Roberto & Hector, 2016).
A formal psychosocial convention should be put in place to manage Ellen’s psychosocial
state so that she feels that she is part of the community. Psycho-educational mechanisms should
be utilized in Ellen’s case so that she can understand how she can improve her health status. An
intervention team including a physician and nurse could meet with her to discuss the issues that
INTERVENTIONS 2
stress her, and how they can be handled. Ellen’s children or a loved one that can be therefore for
her on a consistent and constant basis can be asked to be present at the intervention so that a
discussion is made on how the challenges can be handled (not just by Ellen alone). Ellen should
feel that she has a support system that would ensure she stayed encouraged throughout.
As a behavioral intervention, a cardiac case patient could enroll in an exercise program where her
peers attend, so that she could feel like part of a community, and also get to interact with people
outside the confines of her home (Hall, Murphy & Scanlon, 2016).
References
Alun, J., LeGrande, M., Higgins, R., Rogerson, M. & Murphy, B. (2015). Psychosocial
Assessment Practice within Cardiac Rehabilitation: A Survey of cardiac Rehabilitation
Coordinators in Australia. Heart, Lung and Circulation. 1-8. Australia: Elsevier.
Hall, C., Murphy, M. & Scanlon, A. (2016). Cardiac rehabilitation in the Acute care setting:
Integrative review. Australian Critical Care. 327:1-9. Australia: Elsevier.
Montilla, P.I., Roberto, M. & Hector, B. (2016). Management of Acute Coronary Syndromes in
Geriatric Patients. Heart, Lung and Circulation. 1-7.