Do Nursing Interventions Play a Role in OCD Treatments?

Obsessive-compulsive disorder (OCD) is a mental health condition that involves a cycle of obsessions and compulsions. Intrusive, upsetting, and unwanted thoughts, urges, fears, worries, visions, beliefs, emotions, and desires make up obsessions, while repetitive behaviors (rituals and routines) make up compulsions. The purpose of compulsions (specific actions) is to ease the stress and anxiety causing the obsessions.

While people who do not have OCD engage in compulsions (rituals and routines) to ease upsetting or intrusive thoughts, fears, worries, emotions, etc., most people are able to eventually get past them and go on with their lives. People with OCD struggle with this. For people with OCD, the thoughts (obsessions) and behaviors (compulsions) are uncontrollable, often taking up 60+ minutes of their day. Thus, OCD is life-altering, disrupting a person’s life, relationships, finances, and even health.

Most OCD therapists use a multi-treatment approach to address OCD symptoms. This treatment approach usually involves psychotherapy (i.e., exposure-response and prevention(ERP) therapy), medications (i.e., SSRI antidepressants), natural remedies, and/or self-help tools. These treatments are typically conducted on an outpatient basis, however, in some cases, when the OCD symptoms are severe or unrelenting, an inpatient rehab treatment program may be warranted. In these cases, nursing interventions may be needed to break the OCD cycle and help them get on the path to OCD recovery.

What is OCD?

Obsessive-compulsive disorder (OCD) is an anxiety condition with neurological components. Persistent, upsetting, and unwanted obsessions and/or compulsions comprise this condition. When a person has OCD, they are unable to shake the intrusive thoughts or feelings (obsession) until they perform a certain action or behavior (compulsion) designed to stop the distress and provide relief. These actions or behavior (compulsion) must be performed in a certain way to be effective. 

If the compulsion is disrupted or performed incorrectly, the action or behavior is re-started until it is “just right” or “perfect.” While most OCD sufferers struggle with both obsessions and compulsions, an OCD sufferer may only have one or the other (obsessions or compulsions). And, contrary to popular belief, OCD is not a monolith. Rather, there are many different “types” of OCD and each version of it is unique to the individual. 

It is also important to understand that people with OCD are aware that their thought processes, emotions, and/or behaviors are irrational, however, they are powerless to stop them – without OCD help. While this help often takes the form of outpatient therapy, medications, and self-help tools, like Impulse Therapy, an online OCD recovery treatment program. It can also come in the form of inpatient treatment at a rehabilitation center. In either case, nursing interventions are employed to help patients get a grip on their severe anxiety and unrelenting OCD symptoms.

What is a Nursing Intervention?

If you have ever seen a medical drama, like “Grey’s Anatomy,” “New Amsterdam,” or “The Good Doctor,” nursing may seem like a fairly exciting field of work, however, nursing interventions are not nearly as exciting (or dramatic) as what you see on sitcoms on in movies. And, contrary to what most people think, nursing interventions are not just for people struggling with addiction or a traumatic injury or illness, and they do not always involve dramatic confrontations, most times, the goal of nursing interventions involve helping patients manage their symptoms and get back on track.

Simply put, a nursing intervention is any act that a nurse implements from a nursing care plan. Most nursing interventions are considered “routine” actions in a treatment plan. For example, an OCD nursing intervention may involve administering antidepressants to a patient to help them control their anxiety, depression, or OCD symptoms and assessing how a patient is filling on a particular day. Nursing interventions can be employed on an outpatient or inpatient basis, however, nursing interventions typically occur in inpatient treatment facilities.

Nurses operate alongside a care team consisting of physicians and other specialists with the goal of working together to determine which interventions a particular patient will need to get and feel better.

Nursing interventions fall into three main categories – independent, dependent, and interdependent.

• Independent Nursing Interventions: Nurses carry out independent interventions alone, without input or assistance from others. For instance, an independent intervention may involve educating a patient on the importance of a particular medication (i.e., an antidepressant or antipsychotic), so they can administer it to them, as prescribed by their doctor.
• Dependent Nursing Interventions: Dependent nursing interventions require an order from a physician. For instance, if a patient was in physical, emotional, or psychological distress, and needed medication (not already provided on the patient’s approved medicine list) to provide relief to them, a nurse would need to contact a doctor for a new prescription. The nurse cannot do anything without getting prior approval from the doctor.
• Interdependent Nursing Interventions: Interdependent interventions require nurses to work alongside various members of a care team so that certain interventions can be enacted. For instance, a nurse will work with a doctor and physical therapist to provide care to a person who is recovering from a foot injury. In this scenario, the doctor may prescribe painkillers for the patient, the nurse will administer the pain medication to the patient, and a physical therapist will help them become more mobile by providing them with targeted stretches and exercises.

  Likewise, in the case of OCD, a psychiatrist may prescribe an antidepressant, antipsychotic, etc., to curb the OCD sufferer’s distress (i.e., intrusive thoughts, fears, urges, visions, emotions, and/or compulsions or repetitive rituals or routines, a nurse will administer the medication(s) to the patient, and a psychologist (i.e., CBT, ERP therapy, etc.) will provide counseling to them. In this case, all of the roles are intertwined.

Are There Different Types of Nursing Interventions?

Yes, there are.

Nursing interventions vary because health conditions and medical needs are unique to the patient. Fortunately, they do not have the task of choosing the right medical intervention for their patients – alone. Nurses have a system in place to help them determine what intervention(s) to use. This system is called the “Nursing Interventions Classification” or NIC. NIC provides and defines 550+ nursing interventions that nurses can use to provide quality care to their patients.

These nursing interventions are divided into seven different types of interventions, such as:

• Behavior-Based Nursing Interventions: These interventions include actions, behaviors, or habits that can help a patient change their behavior, such as seeking therapy (i.e., CBT, ERP therapy, etc.), or practicing stress-management techniques (i.e., deep breathing exercises and mindfulness meditation, exercising, etc.).
• Community-Based Nursing Interventions: These interventions focus on public health initiatives, like supporting OCD awareness or developing and implementing an OCD education program.
• Family-Based Nursing Interventions: These interventions influence or impact a patient’s family, such as offering support to loved ones who love someone with OCD, teaching family members how to talk to or help a loved one with OCD, finding OCD support groups that the whole family can attend, etc.
• Health System-Based Nursing Interventions: With these interventions, nurses work with a healthcare team to provide a safe, inpatient rehabilitation treatment center or medical facility for patients. This may include following procedures to reduce the risk of self-harm while patients (i.e., OCD sufferers) are in the hospital, treatment center, or facility.
• Physiological-Based Nursing Interventions: These interventions come in two categories, and involve a patient’s physical health. The two nursing interventions are basic and complex. An example of a physiological nursing intervention would be providing antidepressants to a patient diagnosed with severe OCD to stop the intrusive thoughts, fears, urges, visions, and/or behaviors, and prevent them from engaging in self-harm.
• Safety Nursing Interventions – These interventions occur when a nurse must maintain a patient’s safety and prevent injuries. These include educating the patient on how to call for assistance if they start to experience violent intrusive thoughts that are prompting urges to engage in dangerous or harmful activities or behaviors.

Understand that nursing interventions are not just about “fixing” a patient. Rather, the goal of nurses is to provide quality care to all of their patients – in almost every way, such as physically, mentally, emotionally, and socially. Thus, the overall aim of nurses, who perform daily interventions is to help patients experience long-lasting, positive effects in their lives.

What Are the Priorities of Nurses When Caring For People With OCD?

Listed below are some nursing priorities when caring for people with OCD:

• To help patients or clients identify the onset of their OCD symptoms 
• To educate patients or clients on the meaning and purpose of their compulsions (i.e., rituals or routines)
• To help patients or clients reduce their ritualistic behaviors
• To teach patients or clients alternative responses to stress and anxiety
• To encourage family members to participate in OCD therapy programs with an OCD loved one

Can a Nurse Tell When a Particular OCD Nursing Intervention Has Been Successful?

A nurse knows that her intervention was successful when the following things occur:

• The patient’s or client’s stress, anxiety, and OCD symptoms declined to a manageable level.
• There has been a decline in the patient’s or client’s compulsions (ritualistic behaviors) and/or their compulsions are more manageable.
• There has been a decline in the patient’s or client’s environmental and/or interpersonal stress.
• The patient or client, and their family are attending an OCD support group.
• There is an aftercare plan in place to meet the patient’s or client’s needs once discharged from the program or treatment facility.

Can a Nurse Preliminarily Diagnose OCD?

Yes, a nurse can preliminarily diagnose OCD.

The following experiences can help a nurse preliminarily diagnose OCD – earlier life conflicts linked to repetitive thoughts and behaviors.

These thoughts and behaviors must be evidenced by:

• Repetitive actions or behaviors (i.e., checking, ordering, hand-washing, etc.)
• Intrusive, unwanted, and recurring thoughts, fears, urges, worries, visions, etc. (i.e., dirt and germs (contamination), harm, mistakes, etc.)
• A decline in social and personal functioning

What Are Some Common Nursing Interventions OCD Goals?

Although the goal(s) of nursing interventions depend on the individual – i.e., needs, symptomatology, severity of the OCD symptoms, OCD triggers, health, and goals, there are some common goals that apply to every case.

Universal common nursing intervention OCD goals include:

• To understand the connection between a patient’s or client’s thoughts, feelings, and ritualistic behaviors, and help them understand how stress and anxiety play into their obsessions
• To teach patients and clients how to effectively cope with stressful situations – without resorting to obsessive thoughts and/or compulsive behaviors

What is An Example of an OCD Nursing Intervention?

Listed below is an example of an OCD nursing intervention:

Intervention

• Develop a relationship with the patient or client using empathy, warmth, and respect. Demonstrate a genuine interest in your patients or clients and show this interest through your gestures and behaviors.
• Acknowledge your patient’s and client’s behavior without paying too much attention to it. Verbalize your compassion towards your client’s or patient’s experience, rather than expressing disapproval or being critical of them. For example, you should say, “I see you washing your hands multiple times in a row every morning. That must be extremely exhausting.” Instead of, “Try to wash your hands only one time each morning.”
• Try to exhibit a relaxed demeanor with your patient or client and try to keep your patient or client calm as well.
• Assist the client to learn stress management, (e.g., thought-stopping, relaxation exercises, imagery).
• Identify what your patient or client views as “relaxing” (i.e., a warm bath or shower, soothing music, a sound machine, the beach, spending time with friends, reading, etc.). Encourage your patient or client to engage in healthy and productive activities (i.e., quiet concentration games, arts and crafts, sewing, woodworking, cooking, ceramics-making, painting, etc.).
• Encourage your patient or client to get daily exercise (i.e., jogging, swimming, exercising at a gym, participating in sports, etc.).
• Provide your patient or client with positive reinforcement when they refrain from engaging in compulsive behaviors (rituals or routines). Do not reinforce compulsive behaviors like compulsive cleaning, ordering, checking, etc. Teach your patient’s or client’s partner the value of ignoring ritualistic behaviors.
• Teach your patient or client how to set limits on their own behaviors. At the same time, give your patient or client adequate time to perform daily tasks and routines.
• Limit the amount of time your patient or client gets to perform rituals or routines. Also, encourage them to gradually decrease this time.
• Encourage your patient or client to explore the meaning and purpose of their behaviors, describe the feelings that occur during these behaviors, determine if your feelings and behaviors are interrelated, and lastly, to examine the precipitating factors that often lead to your intrusive thoughts, feelings, and ritualistic behaviors.
• Discuss the home situation with your patient or client and their partner and family when appropriate. Add partner and family involvement into your patient’s or client’s discharge plan.
• Administer medications to your client or patient, as prescribed by the doctor. Common OCD medications include fluvoxamine (Luvox), clomipramine (Anafranil), or fluoxetine (Prozac).
• Administer medications to your client or patient, as prescribed by the doctor. Common OCD medications include buspirone (BuSpar), lithium (Eskalith), sertraline (Zoloft), or venlafaxine (Effexor).

Rationale

• If your patient or client feels anxious, their ritualistic behaviors (compulsions) will increase. Establishing a trusting relationship with the patient or client not only provides them with support but also communicates to them you accept them, as a person, who has a right to determine their course of treatment.
• Ignoring ritualistic behaviors can reduce them. As a patient’s or client’s anxiety is reduced, the need to engage in compulsive behaviors is also reduced. Considering your patient’s or client’s feelings can reduce the severity of their ritualistic behaviors.
• Attempting to reduce your patient’s or client’s stress can help them feel less anxious, which, in turn, may reduce the severity of their ritualistic behaviors.
• Using stress-management techniques, instead of compulsive behaviors, can break habitual patterns.
• Engaging in productive activities (i.e., quiet concentration games, arts and crafts, sewing, woodworking, ceramic-making, painting, etc.) can keep your client or patient busy so they do not have time to engage in compulsive behaviors.
• Exercising can help relieve your patient’s or client’s stress and anxiety. Keep in mind that the exercise does not have to be aerobic or intensive, in nature, to achieve the desired results.
• Encouraging, not pushing, your patient or client to take small steps toward OCD recovery is the best way to motivate them.
• Encouraging your patient or client to find ways to limit their behaviors. Also, help them understand that some behaviors or actions cannot be stopped – and that is okay. If the time required for performing a ritual is not part of your patient’s or client’s treatment plan, they will likely feel “rushed” and “anxious,” while performing these behaviors.

  If your patient or client feels “rushed,” they are likely to make a mistake, causing them to restart the ritual. This, in turn, will increase their stress, thereby worsening your patient’s or client’s anxiety — possibly to an unmanageable level.

• Temporarily taking control of your patient’s or client’s maladaptive behaviors can provide them with time to enforce their own limits, and replace maladaptive behaviors with ones that are more adaptive to stress.
• Encouraging your patient or client to explore their thoughts, feelings, triggers, and behaviors can provide them with opportunities to understand themselves and stop their OCD cycle. When compulsive behaviors are not present, your patient or client may be convinced that something bad will happen. Recognizing precipitating factors can interrupt or stop your patient’s or client’s escalating anxiety.
• Returning to an “unchanged” home environment can increase your patient’s or client’s risk of returning to their compulsive behaviors.
• Certain medications can help balance your patient’s or client’s serotonin levels, decrease their anxiety, reduce their need to engage in ritualistic behaviors, and teach them other ways to reduce their stress and anxiety.
• Patients and clients, who are resistant to antidepressants may be required to combine therapy with other medications (i.e., buspirone, fluoxetine, lithium, and/or clomipramine).

Final Thoughts

When most people think of nursing or nursing interventions they imagine a compassionate and helpful person, whose sole job is to take care of them. Although this is true, nursing goes beyond just taking care of someone who is ill or injured. Nurses wear a number of hats and are involved in many aspects of the treatment process. In fact, in many cases, it is the nurses who first detect problems and the first people to alert doctors that further evaluation may be needed. While doctors are usually the ones who are recognized when it comes to medical intervention, nurses play a big role in treatments as well. Nurse interventions can provide aid and resources to OCD sufferers who need assistance or who are waiting for doctor recommendations. And, in some cases, these interventions save lives.

So, do nursing interventions play a significant role in OCD treatments? Absolutely!

References

• Iowa College of Nursing. (n.d.). Center for Nursing Classification and Clinical Effectiveness (CNC). Retrieved from https://nursing.uiowa.edu/center-for-nursing-classification-and-clinical-effectivenessss
• Brooks, A. (2019). What Is a nursing intervention? A beginner’s guide. Rasmussen University. Retrieved from https://www.rasmussen.edu/degrees/nursing/blog/nursing-intervention-beginners-guide
• RNSpeaks. (2018). Obsessive-compulsive disorder nursing care plan – Severe anxiety. Retrieved from https://rnspeak.com/obsessive-compulsive-disorder-nursing-care-plan-severe-anxiety/