Anxiety is a common psychological response to stress that can become overwhelming and interfere with daily functioning. Identifying and managing anxiety is crucial, as it affects patients’ overall well-being and recovery process.
Definition of Anxiety in Nursing
Anxiety, in a clinical sense, is a subjective feeling of apprehension, uneasiness, or dread resulting from a perceived threat, whether real or imagined. It may be acute, lasting for a short time, or chronic, persisting over a longer period.
Anxiety can manifest in various forms, from generalized anxiety disorder to panic attacks, and it can affect patients of any age, background, or health status.
Etiology of Anxiety
Anxiety in patients can arise from a variety of internal and external factors, including:
- Acute or chronic illness: Patients may experience anxiety due to the uncertainty of a diagnosis, treatment outcomes, or hospitalization.
- Psychosocial stressors: Life events such as financial concerns, family stress, or loss can trigger or exacerbate anxiety.
- Medications and treatments: Certain medications or treatment procedures can contribute to anxiety.
- Substance withdrawal: Patients withdrawing from alcohol, drugs, or nicotine may experience heightened anxiety.
Signs and Symptoms of Anxiety
Anxiety may present in patients in different ways, depending on its severity. Common signs and symptoms include:
- Restlessness or agitation
- Palpitations, increased heart rate, or sweating
- Hyperventilation or shortness of breath
- Trembling or shaking
- Difficulty concentrating or racing thoughts
- Gastrointestinal symptoms like nausea or upset stomach
- Sleep disturbances or fatigue
Nursing Assessment for Anxiety
When assessing anxiety in patients, nurses should focus on the following:
- Subjective data: Explore the patient’s feelings of worry, fear, or uneasiness. Inquire about specific stressors and how anxiety impacts their daily life.
- Objective data: Observe the patient’s physical symptoms such as increased heart rate, trembling, or hyperventilation.
- History: Gather a comprehensive history, including past mental health issues, current medications, and stressors.
- Screening tools: Utilize evidence-based tools like the Hamilton Anxiety Rating Scale (HAM-A) or the Generalized Anxiety Disorder 7-item (GAD-7) scale to assess severity.
Nursing Care Plans for Anxiety
Nursing Diagnosis #1: Anxiety related to hospitalization, as evidenced by increased heart rate, restlessness, and patient verbalizing feelings of fear.
Related Factors/Causes:
- Fear of the unknown
- Hospital environment
- Separation from family
Nursing Interventions and Rationales:
- Establish a therapeutic relationship: Build trust through active listening and empathy. Patients are more likely to express their feelings when they feel supported by their nurse.
- Provide information: Explain procedures, treatments, and expected outcomes to reduce uncertainty and fear of the unknown.
- Encourage relaxation techniques: Teach deep breathing exercises or guided imagery to help the patient reduce physiological symptoms of anxiety.
- Facilitate family involvement: If appropriate, allow the family to be part of the care plan, which can provide emotional support to the patient.
Desired Outcomes:
- Patient will verbalize a decrease in feelings of anxiety.
- Patient will demonstrate relaxation techniques independently.
- Patient will exhibit a stabilized heart rate and decreased physical symptoms of anxiety.
Nursing Diagnosis #2: Anxiety related to fear of treatment, as evidenced by refusal of medical procedures and verbal expressions of dread.
Related Factors/Causes:
- Fear of pain or discomfort
- Lack of understanding of the procedure
- Previous negative experiences
Nursing Interventions and Rationales:
- Educate the patient: Provide detailed, step-by-step information about the procedure to reduce fear of the unknown.
- Involve the patient in decision-making: Empower the patient by offering choices, when possible, to help regain a sense of control.
- Administer anxiolytics as prescribed: If non-pharmacological interventions are insufficient, anxiolytic medications may be used to alleviate extreme anxiety.
- Offer a supportive presence: Stay with the patient during procedures to offer reassurance and emotional support.
Desired Outcomes:
- Patient will express a willingness to participate in treatment.
- Patient’s level of distress will decrease as evidenced by a calmer demeanor.
- Patient will participate in decision-making regarding their care.
Nursing Diagnosis #3: Anxiety related to chronic illness, as evidenced by disturbed sleep patterns, muscle tension, and patient verbalizing concerns about the future.
Related Factors/Causes:
- Uncertainty about disease progression
- Fear of disability or death
- Long-term health management
Nursing Interventions and Rationales:
- Promote open communication: Encourage the patient to discuss fears or concerns about their illness and prognosis.
- Provide education: Offer information about managing the illness and improving quality of life through lifestyle changes and treatments.
- Coordinate with mental health services: Referral to counseling or a support group may provide additional emotional support for chronic illness.
- Teach sleep hygiene: Encourage a regular sleep schedule, relaxation techniques, and avoidance of stimulants like caffeine close to bedtime.
Desired Outcomes:
- Patient will verbalize reduced anxiety regarding their illness.
- Patient will demonstrate improved sleep patterns.
- Patient will engage in disease management activities confidently.
Nursing Diagnosis #4: Anxiety related to fear of death, as evidenced by verbal expressions of worry, crying, and social withdrawal.
Related Factors/Causes:
- Life-threatening diagnosis
- End-of-life issues
- Family distress
Nursing Interventions and Rationales:
- Provide a supportive environment: Offer a quiet and comfortable space for the patient to discuss fears without interruptions.
- Facilitate discussions on end-of-life care: Encourage the patient to express their wishes regarding treatment and palliative care options.
- Engage in spiritual care if desired: Many patients find solace in their spirituality or religious beliefs during times of crisis.
- Monitor for signs of depression: Ensure the patient is assessed for depression, which often coexists with anxiety in patients facing end-of-life decisions.
Desired Outcomes:
- Patient will verbalize a sense of peace or acceptance regarding their prognosis.
- Patient will participate in discussions about end-of-life care.
- Patient will demonstrate reduced social withdrawal and engage with family members or caregivers.
Nursing Diagnosis #5: Anxiety related to social isolation, as evidenced by patient’s withdrawal from social interactions and lack of participation in activities.
Related Factors/Causes:
- Lack of social support
- Long-term hospitalization or immobility
- Fear of embarrassment
Nursing Interventions and Rationales:
- Encourage social interaction: Facilitate opportunities for the patient to interact with others, whether through family visits, group therapy, or recreational activities.
- Promote autonomy: Support the patient’s participation in care planning to boost confidence and independence.
- Use therapeutic communication: Validate the patient’s feelings of isolation and encourage open discussions about their fears and concerns.
- Introduce technology: Teach the patient to use technology to stay connected with loved ones if physical visits are limited.
Desired Outcomes:
- Patient will initiate and participate in social interactions.
- Patient will verbalize reduced feelings of isolation.
- Patient will engage in therapeutic activities designed to improve socialization.
References
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC.
- Beck, A. T., & Emery, G. (2020). Anxiety Disorders and Phobias: A Cognitive Perspective. Basic Books.
- Jarvis, C. (2019). Physical Examination & Health Assessment (8th ed.). Elsevier.
- LeMone, P., Burke, K. M., & Bauldoff, G. (2020). Medical-Surgical Nursing: Critical Thinking in Patient Care (7th ed.). Pearson.
- National Institute of Mental Health. (2020). Anxiety Disorders. Retrieved from [https://www.nimh.nih.gov].