How to Decrease Veterans' Anxiety

Picot Question 

How does veterans’ anxiety decrease from the beginning to the end of the study after a good nurse-patient relationship has been established compared when there is no relationship with the nurse? 

Systematic Review of the Question 

The clinical question assesses the patient’s problem, chosen intervention, comparison and outcomes in a clinical setting as shown by the question above. It is important to note that anxiety patients face a lot of challenges in seeking treatment that make it hard for them to cope effectively. The systematic review is influenced by the way veterans often face unique mental health challenges that affect how they interact with other people in and outside clinical environments (Ross, 2014). Crucially, an effective systematic review done from a patient’s perspective allows scholars to determine various issues that affect relationships between patients and nurses and their effects on outcomes. Such awareness is vital in uncovering important healthcare issues that impact on the wellbeing of anxiety patients in a clinical setting. On the other hand, the paper explores nurses’ perceptions regarding the way they handle patients’ anxiety and specific measures they can take to improve their wellbeing. 

In many clinical environments, anxiety disorders are part of mental healthcare services that are meant to create better outcomes for people who are affected. Using evidence based research allows a practitioner to understand some of the challenges patients face and necessary actions that need to be taken to improve their relationship with nurses. Consequently, assessing the effectiveness of building relationships between nurses and their patients makes it easy for all parties involved to register positive outcomes (Ross, 2014). A patient centered approach enables nurses to collect data from patients and analyze different issues they are facing to ensure they get quality care at a particular period. It is worth noting that veterans need to feel confident before they share the problems they are experiencing with nurses at a particular period as they seek treatment in a clinical facility. Therefore, anxiety affecting them might lead to mistrust making it hard for them to get the mental healthcare services they require to overcome their difficulties. 

The study focused on a group of 20 male veterans who took part in various activities within a 16 week period. The data obtained from their assessments measured blood pressure, heart rate and other healthcare factors that were likely to contribute to anxiety. The study also focused on their interactions with nurses and other health practitioners to establish their level of comfort after their visits to the facility (Tabler, et al. 2014). Evidence-based research was an important aspect that allowed researchers to investigate different behavioral as well as physical situations they faced due to their anxiety. It is worth noting the randomized trial focused on routine activities performed by nurses which were intended to offer more comfort to the patients. In hindsight, the research study reviews healthcare perceptions and how they affect the delivery of quality services to patients who need them in diverse locations. 

Evidence Based Research 

Evidence-based research in nursing is vital in uncovering various situations that determine the service model adopted in a particular healthcare environment. Developing templates allows healthcare professionals to establish the types of interventions needed and the nature of outcomes they expect within specified periods. Different scores allow professionals to uncover any imbalances that might affect relationships patients have with their caregivers at a particular period (Tabler, et al. 2014). Positive relationships are the cornerstone of patient centered care because they enable caregivers to engage with patients to determine therapies that are likely to be effective in giving them positive outcomes. On the other hand, past studies enable healthcare professionals to be sensitive to patients and determine unmet needs so that they experience better results in a particular healthcare setting. As a result, it is necessary for healthcare professionals to focus on creating an ideal environment that inspires trust and cordial relationships with their patients. 

A study focusing on benefits associated with collaborative care in treating depression investigated the way nurses can contribute to assisting patients with depression and diabetes. In effect, the True Blue model was used to determine how practicing nurses are likely to form strong working relationships with patients with anxiety, diabetes or heart disease. The main reason for choosing the model is it allows nurses to adhere to best practice guidelines while conducting different recommended observations on their patients (Morgan, 2013). Crucially, the collaborative model makes it easy for all those involved to communicate openly about their expectations and come up with effective ways of addressing them. The design chosen for the model helps all health professionals to get important insights on clinical care standards needed so that those affected are satisfied with services they are offered. Therefore, important considerations regarding the long-term effects of the model affected the randomized trial and how it was carried out in the healthcare facility where it was implemented. 

The study also estimated the costs associated with the patient-centered care approaches to establish if they served enabled patients seeking treatment to recover effectively from various challenges they faced. Using a nine-item depression questionnaire assessing patient health, nurses and other healthcare professionals focused on individual issues and formulated appropriate actions to be taken. Thus, the True Blue model allowed healthcare professionals to find out if patients were able to get assistance from nurses quickly and how they felt the way they were treated by various professionals (Morgan, 2013). Notably, the study’s design made researchers investigate whether depression when it affects patients with diabetes and heart complications brings about risk factors in patients. Consequently, the investigation also sought to establish how procedures used to identify depression serve their intended purpose and how they can be improved in the long-term. Therefore, the study revealed that there are specific guidelines that have been incorporated in diagnoses used by various healthcare professionals seeking to establish the presence of depression in patients. 

The importance of collaborative healthcare approaches in treating anxiety has been enhanced by training approaches seeking to address a wide range of depression issues in patients. In this regard, healthcare practitioners are able to use self-report systems such as the patient health questionnaire to assess the presence of mental health complications. Such approaches allow healthcare practitioners to establish if biophysical characteristics are responsible for different phases of mental illness in patients surveyed (Morgan, 2013). Additionally, identifying risk factors in a community in the early phases of a diagnosis allows healthcare practitioners to understand the backgrounds of patients they treat. Such insights allow healthcare practitioners to know limits that define their work so that they are sensitive to the peculiar needs of each patient that seeks treatment. Therefore, it enhances the study showed that patients need a lot of support to help them overcome various challenges they face at any given period to strengthen their trust in a particular process. 

Study Approach, Sample Size, and Population Studied 

Study Approach 

The study was undertaken in 2009 in two stages where the first phase was in form of a cluster randomized trial. On the other hand, the second stage was done after six months to establish if the collaborative care model had the desired effects in the populations that took part in the study. It is worth noting in the first phase, the study investigated whether collaborative care approaches designed by caregivers affected the way data was gathered from different participants after six months. In essence, the main objectives of the first stage was to deduce whether patients with moderate to serious cases of depression were likely to experience better results than those in the control group. In the second phase, the study analyzed whether the collaborative model chosen affected results after a further six month period. Therefore, a five point decrease was used as the ideal measurement to establish if desired changes had taken place in patients with depression. 

Sample Size 

Significantly, the study also relied on depression metrics from earlier research with an average of 5.5 and a standard deviation of 6.1 based on unique attributes of patients who took part. A correlation assessment of 0.04 that was realized sought to limit the number of participants who were recruited to 50 from each clinic to allow them to streamline their schedules more effectively. Thus, each nurse was expected to spend time with four patients weekly within a 3-month period of care but the study also had an allowance of a 50% dropout rate after recruitment. In this regard, the study needed 450 participants drawn from nine facilities in the intervention and control groups who were expected to share their insights on the quality of treatment they received from nurses. Thus, the sample size calculation had projected that 18 clinics in total would provide the required information on the study to enable researchers get the data they needed. 

Population Studied 

The population studied comprises of patients with different types of depression, heart disease and diabetes who needed extra attention from caregivers and health practitioners. The patient healthcare questionnaire served as the main self-report assessment to determine depression in the patients. Patients surveyed were required to not be living in a residential care facility and they had to be aged 18 and above. The care template allowed healthcare professionals involved to establish if the care plan conformed to patients’ wellbeing in clinics where they received care. Nurses involved in the study were required to go for further training to make them more aware of goals they needed to set and problem solving approaches they could use to improve the wellbeing of patients. In the same vein, a care-plan outline allowed them to determine body mass, weight, blood pressure and other attributes to determine the physical condition of patients faced before they were treated. 

Application of Evidence 

The randomized control trial shows that it is necessary for collaborative frameworks to be used in a mental healthcare setting to improve outcomes. High standards of care planning where the personal goals of patients are accounted for in the care model chosen are likely to yield better outcomes for patients at a particular period. Such situations enable all those involved to make the required sacrifices that lead to improvements in the quality of care provided to patients with anxiety (Kornhaber, Walsh, Duff, & Walker, 2016). The uncertainty faced by the 20 male veterans who were involved in a preliminary study in the clinic can be further addressed if viewpoints obtained from the randomized trial are incorporated in the care model. Such an approach will allow all healthcare practitioners to understand the types of sacrifices they need to make to build better relationships with patients to improve the quality of outcomes realized. 

The evidence based approaches used also indicate that building meaningful relationships with patients improves the therapeutic value of the service model chosen. Creating an environment that encouraged open communication, high levels of satisfaction, and attention to detail led to positive results in the long-term. When patients had a lot of confidence in their caregivers, they were likely to be satisfied by services they received leading to attainment of the set goals in a healthcare environment (Kornhaber, Walsh, Duff, & Walker, 2016). Alternatively, the evidence based approaches also showed that it is vital for caregivers to address different forms of distress that were likely to make patients feel uneasy thereby hampering their cooperation. By involving family members in therapies chosen in a healthcare setting, patients were likely to experience emotional calmness leading to their recovery in the long-term. Therefore, the study showed that it is necessary for clinicians to rely on constructive approaches in healthcare settings that enhance the trust of patients at a particular period. 

Evaluating Outcomes 

As shown in the True Blue model, patients had close relationships with nurses and other healthcare professionals. In hindsight, different risk factors that were likely to expose them to depression and other forms of mental disorders were assessed to determine if they contributed to the situations being experienced. The validity of the study is attributed to statistical analyses conducted to establish whether baseline values were adhered to in depression scores obtained from different clinics (Bolster & Manias, 2010). There was not a large variance in the scores obtained from different clinics which shows the True Blue model is effective in determining collaborative approaches in clinical approaches used to deal with depression. The study also assessed changes in the two groups over a 12 month period to establish if approaches used had any visible effects on patients who participated. 

Various items were compared to find out if there were similarities or peculiar differences that were likely to affect how the results were interpreted. A key aspect focused on how the clinics that participated reacted to patients’ who were emotionally unstable at different times. By determining the level of empathy and compassion showed by caregivers to patients, the study assessed the way various forms of communication affected patient reactions in different clinics (Bolster & Manias, 2010). More importantly, the study examined the way encounters patients had with their families, peers and caregivers shaped their perceptions and attitudes during the time they participated in the study. In this regard, the assessment was reliable because it linked various actions by healthcare professionals to emotional responses patients had, which were likely to affect their overall wellbeing. Therefore, the study managed to illustrate how close interactions between patients and clinicians affected the emotional state of participants and actions that could be taken to deal with the situation. 

Bias in the Study 

There was some bias in the study because sampling mostly focused on patients who were not housed in residential care facilities. However, the researchers involved were driven by the expectation of consistency because patients housed in residences were unlikely to attend all sessions as required. Both intervention and control groups required patients to be consistent over a six month period and caregivers involved also had to adhere to a predictable pattern of care to ensure adequate data was obtained. Moreover, comparing outcomes between the two groups faced challenges because some patients chose to pursue other commitments during the six months period (Webster, S., 2012). However, most of the nurses involved were satisfied with the overall design of the studies and there were improvements that were registered in both groups after the 12 months period had elapsed. A few nurses did not adhere to some guidelines they considered less important which did not significantly impact on the results obtained. Notably, outcomes obtained from the study showed that patients’ awareness had significantly improved and they were able to understand the benefits of the program they were involved in. Moreover, researchers were also encouraged to share other positive details with patients regarding some of the difficulties they had experienced in the 12 months when the process was undertaken. 

Level of Evidence in the Review 

The level of evidence in the review illustrates that patient-centered approaches that encourage positive engagements between caregivers and patients are likely to yield good results. Patient response assessments showed that some participants were at first apprehensive towards models used to assess them but they later became more receptive to approaches chosen. On the other hand, various research activities performed in clinics that were part of the study showed that it is vital for both physical and emotional traits to be assessed to determine their significance on patients’ wellbeing (Kennedy, et al. 2014). In this regard, the study relied on different data to show the correlations between different approaches that affected the wellbeing of patients who were involved in the study. On the other hand, the study also considered issues relating to representativeness of the sample used to determine if it was adequate to cope with requirements that had been formulated. Another consideration is the adherence to standards that had been set from the beginning by both patients and caregivers in various clinics. Some caregivers used physiological estimates to assess the levels of blood pressure, weight, which indicated the states of mind of various patients that took part. Therefore, such approaches gave a comprehensive description of various challenges patients experienced and how they could be resolved by the interventions proposed. 

Conclusion 

In conclusion, the study has revealed that good nurse-patient relationship is crucial when administering therapies that target anxiety patients in a particular healthcare environment. More importantly, the study has also revealed that appropriate communication approaches are crucial in dealing with various challenges facing patients with anxiety to ensure they attain positive outcomes in healthcare models used. A notable limitation in the study was the inability by some patients to adhere to standards that had been stipulated, which affected the final research design and data obtained from various processes. 

References 

Bolster, D., & Manias, E. (2010). Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: Qualitative observation and interview study. International Journal of Nursing Studies , 47 (2), 154–165. 

Kennedy, M. et al. (2014). Improving the patient experience through provider communication skills building. Patient Experience Journal, 1 (1), 56–60. 

Kornhaber, R., Walsh, K., Duff, J. & Walker, K. (2016). Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review. Journal of Multidisciplinary Healthcare, 9 , 537–546. 

Morgan, M.A.J. et al. (2013).The True Blue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: A randomised trial BMJ , 3, 1-11. 

Ross, L. (2014). Facilitating rapport through real patient encounters in health care professional education. Australian Journal of Paramedicine, 10 (4), 1-11. 

Tabler, M., et al. (2014). Patient care experiences and perceptions of the patient-provider relationship: a mixed method study. Patient Experience Journal , 1 (1), 75–87. 

Webster, S., et al. (2012). The perceptions of nurses in their management of patients experiencing anxiety. Journal of Nursing Education and Practice , 2 (3), 38-45.