Nursing care of patients with anxiety disorders is often a challenging and rewarding task. Patients with anxiety do not only present with psychological symptoms; they also sometimes suffer from physical symptoms. While it may be true that anxiety is more of an emotional response to the presence of stressful stimuli, it cannot be discounted that it has many physiologic symptoms as well.
Anxiety comes at different levels of intensity to an individual, and how one patient responds to it versus how another would react to it may be different. The nurse should remember that each patient may manifest and experience anxiety differently from others, and some patients may be able to draw back on their previous coping mechanisms, while others would experience difficulty doing so. These differences in dealing with anxiety also place others more prone to developing panic attacks, some forms of phobias, obsessive-compulsive disorders, and other health problems.
Because of the many manifestations of anxiety and the intensity at which they are experienced, the problem has been categorized into four distinct levels. These four levels are:
- Mild anxiety- considered a good or acceptable level of anxiety, this level of anxiety can help enhance an individual’s attention span and focus. This is usually seen among individuals feeling anxious about the results of an examination, a job interview, or driving for the first time.
- Moderate anxiety is considered the second level of anxiety; this stage is often manifested when an individual display narrowed perception of his environment. This causes him to have problems in judgment, or understanding of the situation. Moreover, symptoms such as increased blood pressure, heart rate, and respiratory rates can be seen in individuals who are experiencing moderate levels of anxiety.
- Severe anxiety- this stage is associated with increased emotional responses and experience of physical symptoms. In this stage, individuals also experience further narrowing of their perceptions, making them unable to arrive at sound decisions for the perceived problems at hand. Also, when an individual is at the panic level of anxiety, the activation of the fight-or-flight response happens, sometimes leading the person to make irrational decisions.
- Panic Anxiety- considered to be the stage where severe anxiety gets worse, panic anxiety causes the individual to suffer from severe physical manifestations such as elevated blood pressure, increased pulse rates, gastrointestinal problems, and difficulty of breathing. Individuals who also suffer from panic levels of anxiety may suffer from disorganization of personality and may display other mental health symptoms.
While the four anxiety levels are widely known and used in diagnosing patients, other forms of anxiety are seen in some patients. These include but are not limited to phobias, obsessive-compulsive disorder, and post-traumatic stress disorder.
- Phobias- defined as an irrational and extreme fear of certain objects, situations, or activities, phobias occur at mild to severe levels in individuals suffering from it. Individuals with the problem may appear to be normal, but any stimuli related to the feared object or situation can cause them to stop rational thinking, exhibit erratic behaviors, and suffer severe levels of anxiety.
- Obsessive-Compulsive Disorders- commonly known as OCD, this form of anxiety is defined by the presence of obsessions and compulsions. Obsessions are thoughts that cause individual anxiety, while compulsions are actions that the person feels compelled to do to relieve himself of anxiety. These actions are unavoidable, and the individual needs behavior modification to recognize what triggers the anxiety and what behavior modifications can be done to address it.
- Post Traumatic Stress Disorder (PTSD)- a severe form of anxiety that occurs among individuals who have suffered from traumatic experiences such as rape, being sent to war zones, or life-threatening conditions such as landslides, earthquakes, and other disasters.
Management of Anxiety Disorders
Anxiety Disorders are managed using a variety of interventions relevant to the symptoms being manifested and the triggers that have caused the attacks of anxiety. Interventions such as meditation, deep breathing exercises, behavior modification therapies, and in some cases, administration of anti-anxiety and other psychotropic medications when needed.
Anxiety Nursing Care Plan
The nurse caring for patients with anxiety disorders needs to conduct a thorough assessment of the presenting symptoms and determine what causes these symptoms to plan interventions well. The Nursing Care Plan below can be used to provide care for patients with anxiety to help them deal with their mental health concerns and prevent it from progressing.
Anxiety (specify level, if possible)
Anxiety (include level) related to actual or perceived threat to biologic integrity (specify the treat) as evidenced by (include assessment findings specific to which particular type of deficit the patient is manifesting such as:
- Limited attention span
- Restlessness and irritability
- Impaired thinking and judgement
- Changes in the vital signs (increased blood pressure, heart and respiration rates)
After nursing interventions, the patient is expected to:
- Identify situations and circumstances that trigger attacks of anxiety
- Determine which stress management techniques to use to deal with anxiety
- Reduce current levels of anxiety experienced
|Approach the patient in a calm and non-threatening manner, with an open stance and palms facing up.
|Approaching the patient calmly helps alleviate anxiety, thereby allowing the nurse to establish rapport with the patient. The increased sense of security that the patient feels will enable him to verbalize his thoughts and feelings to the nurse, facilitating better assessment.|
|Establish trust and rapport with the patient through the therapeutic use of the self.||Trust should be established to allow for effective provision of care. The nurse should provide truthful answers to the questions of the patient while maintaining professional decorum and respecting boundaries.|
|Encourage the patient to talk about his feelings.||This allows the nurse to gather more assessment data about how he feels and what he perceives to be a threat to his safety and security.|
|Assess for the current level of anxiety felt by the patient, checking for both verbal and non-verbal cues and noting for physiologic and psychosocial responses to anxiety.||Assessing the current levels of anxiety allows the nurse to plan for more effective care, focusing on the priority problems being encountered by the patient.|
|Remove the patient away from the anxiety-causing situation if possible.||Taking the patient away from places and situations that cause anxiety can help calm the patient and make him more open to interventions.|
|Stay with the patient, especially when he is having severe panic anxiety attacks.||Staying with the patient allows the nurse to ensure that the patient is safe and free from harm.|
|Ask the patient about coping mechanisms used in the past that were effective in dealing with anxiety.||Using coping mechanisms that the patient has used in the past helps deal with the current problem and helps ease anxiety because of familiarization with the interventions.|
|Place the patient in a comfortable position, in a place with less environmental stimuli.||Positioning the patient comfortably and placing him in an environment with fewer stimuli helps reduce stress and anxiety, provides safety, and allows the nurse to focus on other interventions.|
|Involve the family in the care plan, letting them know the level of guidance and assistance the patient needs on a daily basis, ensuring that independence and optimal levels of functioning are maintained.||Having the family know the care protocols for the patient, its rationale, and how it affects overall patient wellbeing.|
|Support the initiatives of the patient to try to reduce his levels of anxiety while providing cues on interventions that would be helpful.||This intervention promotes independence in addressing anxiety and helps the patient develop effective coping mechanisms to deal with anxiety.|
|For Patients in Panic Attack:
During the attack, stay with the patient, providing him with short and simple instructions to deal with a perceived or actual threat.
|Patients in panic attacks lack the mental clarity to deal with their current situations. Priority of nursing care in this stage involves ensuring patient safety and allowing him to have reduced levels of anxiety to participate in his care.|
|Provide patient and family teachings about the different signs and symptoms that indicate escalating levels of anxiety and simple interventions to deal with these.||These measures help both the patient and family identify when anxiety levels increase and what to do to ensure that these do not escalate further. It also helps the patient to have more control over his anxiety, thereby increasing his confidence in his ability to deal with the problem.|
|Administer medications as prescribed.
These medications may include:
-other forms of psychotropic medications
|Patients with moderate to severe or panic anxiety may require medications to help manage their symptoms. It is important the nurse knows what medications the patient may be taking, instructions for administration, and provide the patient and his family teachings about medication safety.|
|Coordinate care of the patient with a collaborative team.||Specific problems that the patient may be experiencing may require management from other health care providers such as psychologists, psychiatrists, occupational and physical therapists. Referral to these professionals may help in better managing the care of the patient.|
Other Intervention for Patients with Anxiety
Patients with anxiety may also be recommended to receive cognitive behavioral therapy when needed. This therapy may help the patient deal with his anxiety on a long-term basis, ensuring that the patient will be equipped with the tools that can help him deal with his problem as it happens. Examples such as systematic desensitization may be used to help patients with phobia deal with their problem, decatastrophizing for patients experiencing post-traumatic stress disorders, or assertiveness training for individuals who experience anxiety and feel that they are unable to take control of their life situations. Examples of these are listed below:
- Assertiveness Training- a strategy that aims to help patients feel they have more control over situations that cause anxiety. This type of intervention also helps the patient to be able to work through potentially stressful interpersonal interactions and increase confidence.
- Decatastrophizing- generally used for individuals who have PTSD, this intervention uses a therapist guiding the patient to take another perspective on things that have happened from a more realistic and objective point of view. This helps to reduce or eliminate the “what if” thinking on the part of the patient, helping to resolve through feelings of guilt or regret.
- Positive Affirmations and Reframing- providing patient, positive feedbacks on things that he was able to do well and allowing him to look at the positive side of the situation rather than focusing on the negative ones.
- Behavior Modification- this therapy helps the nurse guide the patient on adopting more acceptable and positive behaviors while eliminating ones that increase stress and anxiety.
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.
- Carpenito, L. (2016). Handbook of Nursing Diagnosis (15th ed.).
- Herdman, T., & Kamitsuru, S. (2018). NANDA International, Inc. nursing diagnoses (11th ed.).
- Videbeck, S. L., & Miller, C. J. (2017). Psychiatric-mental health nursing.