2. Z EN M EDITATION FOR G ENERAL A NXIETY D ISORDER By: Audra Brooks

3. I NTRODUCTION The purpose of this presentation is to provide nurses with an alternative way to plan care and advocate for patients with general anxiety disorders using evidenced-based research

4. E VIDENCE OF C ARE Nursing care problem Nursing theory used in the study (Taylor,C.R., Lillis, C., LeMone, P., & Lynn, P., 2011, p.75 )

5. E VALUATION OF E VIDENCE Study Methods Study Results

6. Credibility of the study Author Journal Rigor/Reliable Limitations of the study Participants Qualitative study

7. PATIENT CARE DESIGN Collaboration Nurses Pharmacist Psychiatrist Family Members/ Support System Patient

8. TRUPIC Situation: Mrs. Miller is a 26 year old married new college student comes into ER complaining of insomnia, nausea, headaches and periodic upper right stomach quadrant pain. Due to upper right stomach quadrant pain diagnostic testing is required to rule out appendicitis. She has history of general anxiety disorder (GAD) but is not being treated at this time, has not had any surgeries. No reports of pain at this time. The nurse is a 23 year old BSN prepared RN and a recent graduate, who has minimal exposure to the mental health patient populations. 1. IDENTIFY… The variables in this situation College student Insomnia Nausea UR quad stomach pain Headaches 2. RELATE…Or put the variables together to form propositions. Primary Proposition: Patient is experiencing symptoms of GAD Patient is having appendicitis attack Possible Assumptions: Is a mental issue not a physical health issues It is a physical health issue Possible Confounding Variables: symptoms of appendicitis Cause could be symptoms of stomach flu 3. UNDERSTAND…the importance of the propositions, assumptions, and confounding variables. Proposition: Deterioration of health GAD symptoms needs to managed with diet exercise, sleep, medication administration Significance of Assumptions: Could be a medical health issue. If appendicitis could burst GAD could progressively get worse. Possible Confounding Variables: Pain and infection. Coping mechanism like Zen meditation and relaxation is not helpful patient need inpatient treatment

9. TRUPIC CONTINUED 4. EXPLAIN… the significance of the situation to those involved based on their individual KSVME Proposition: Explain to patient what appendicitis is and to determine if surgery is necessary. Explain and educate about the importance of managing anxiety Assumptions: Confounding Explain benefits of diagnostic test to rule out appendicitis Explain benefits of medication administration for GAD Variables: Explain role that symptoms of GAD could be similar to appendicitis 5. PREDICT… what will happen in this situation if one or more variables are not changed. Proposition: If symptoms persist diagnostic test are necessary. Could require inpatient management for GAD Assumptions: Patient will have diagnostic test done. Confounding Variables: Medication may be necessary for stomach pain and anxiety. 6. INFLUENCE… someone to change one or more variables in order to achieve a desired outcome or prevent an undesirable one. Proposition: Patient understands the difference between GAD and appendicitis. Assumptions: Patient’s diagnostics test come back within normal limits. Confounding Variables: Medications will help with the GAD symptoms 7. CONTROL… one or more variables in order to achieve a desired outcome or prevent an undesirable one. To control isn’t an issue of wanting to dominate or do what is unreasonable or unwanted, but simply a matter of changing one or more variables in order to bring about a desired outcome when influence is not possible, realistic, or advisable. Patient not experiencing appendicitis symptoms related to GAD. Nursing Diagnosis; anxiety related to inability to controls surrounds. Medications and stress relief will help alleviate some health concerns. Education of coping mechanisms; for example health diet, exercise program, consistent schedule, and Zen meditation.

10. ADVOCATE ROLE Physician/Psychiatrist Family members/Support Members Community

11. P ATIENT Ways to support the patient Routine Diet/Exercise Sleep Coping techniques

12. S ELF A WARENESS Culture Biases

13. R EFERENCES Lu, C., Smith, L. N., & Gau, C. (2012). Exploring the zen meditation experiences of patients with general anxiety disorder: a focus-group approach. Journal of Nursing Research, 20, 43-51. http://dx.doi.org/10.1097/JNR.0b013e3182466e83 Nieswiadomy, R. M. (2012). Foundations of nursing research (6th ed.). 259-276. Upper Saddle, NJ: Pearson. Retrieved from: http://www.nimh.nih.gov/health/topics/generalized-anxiety- disorder-gad/index.shtml Retrieved from: http://www.ebmpyramid.org/samples/complicated Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamental’s of nursing: the art and science of nursing care (7th ed.). 19. Videbeck, S. L. (2014). Psychiatric-Mental health nursing (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.