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Informational/Educational Report
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Predicting panic: pausing for prevention Kristell Michael, BSN, RN, ET, CWS, CHRN, United Regional HCS, Wichita Falls, TX Hyperbaric oxygen (HBO) is an adjunctive treatment that is prescribed when routine interventions have failed for the patient with a non-healing wound, as with diabetes or refractory osteomyelitis. Some patients, due to an initial claustrophobic reaction in the chamber, are unable to receive the benefit of this therapy and may face amputation. The failure to adequately anticipate such an event places staff in a position to treat panic, while the patient fails to complete a necessary procedure. This results in wasted resources and less than therapeutic care and may cause the patient to refuse further attempts at hyperbaric treatment. A review of the literature is presented for the purpose of providing an educational report. The research question is posed: ÒCan a claustrophobic reaction be reliably predicted?Ó The medical interventions included for literature review, magnetic resonance imaging and hyperbaric oxygen therapy, were selected to provide a more integrative review of the literature. A patient experiences similarities in confinement in both the Magnetic Resonance Imaging (MRI) machine and the monoplace hyperbaric chamber. This link allows conclusions to be drawn and clinical assessment applications to be carried from the MRI to the HBO patient. The research reviewed demonstrates that a panic reaction during MRI can be reliably predicted; however, there is a lack of agreement among researchers regarding the assessment tool which best correlates with a panic reaction. Studies regarding hyperbaric oxygen, though not predictive, focused on the magnitude of anxiety and levels of anxiety before and after hyperbaric treatment. Recommendations are made delineating specific nursing strategies prior to HBO that can impact the magnitude of anxiety during an initial treatment. Abraini J, Ansseau M, Bisson T, de Mendoza J, Therme, P. Personality patterns of anxiety during occupational deep dives with long-term confinement in hyperbaric chamber [Electronic version]. J Clin Psychol. 1998;54(6):825Ð830 Clark C, Rock D, Tackett K. Assessment of the magnitude of anxiety in adults undergoing first oxygen treatment in a hyperbaric chamber [Electronic version]. Milit Med. 1994;159(5).:412Ð415 Harris L. Predictors of panic symptoms during magnetic resonance imaging scans [Electronic version]. Int J Behavior Med. 2001;8(1):80Ð87 Katz R, Wilson L, Frazer N. Anxiety and its determinants in patients undergoing magnetic resonance imaging [Electronic version]. J Behavior Ther Exp Psych. 1994;25(2):131Ð134 Parker M. (2001). Nursing theories and nursing practice. Philadelphia, Pa: FA Davis Company, 2001:317Ð320 Roy C. Introduction to nursing: an adaptation model. Englewood Cliffs, NJ: Prentice-Hall, 1976:23Ð37, 210Ð224. . |
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