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Nursing Process for Client With Anxiety. NurseMarty 09/12/2009

Filed under: Uncategorized — soulmarti @ 11:02


Anxiety is a normal, alerting response that occurs universally in human beings. It may manifest as excitement, or as disconcerting feelings of uneasiness, insecurity, tension, and apprehension. Clients commonly refer to it as being “nervous.” In todays society many people think they should never be anxious, and often to “fix” themselves when they experience even mild anxiety, when reality is that anxiety is hardwired into our human systems and is normal. Some anxiety is necessary for functioning. For example, normal anxiety activates people to respond to the clock alarm and get out of bed in the morning, or pick up a crying child, or leave an obviously dangerous situation.

Responses to anxiety:

1.  Adaptive Responses

Although anxiety is initially discomforting, it may also be a strong, positive motivator for the individual who experiences it. To respond adaptively, anxiety symptoms must be consciously recognized, identified, and then managed constructively. A normal reaction is to avoid anxiety. Instead of merely reacting to anxiety, the person who learns to become aware of their symptoms can respond intentionally, using learned techniques to control anxiety and adapt favorably to the situation and environment.

2.  Maladaptive Responses

While adaptive responses to anxiety in th form of learned techniques and strategies my assist a person to manage and cope in socially acceptable and positive ways, the opposite is true about maladaptive responses. When a clientis unable to manage anxiety, maladaptive responses often occur and may e harmful or detrimental to the individual, the family, or others. When these responses are repeated frequently, a pattern becomes establishedand may lead to subsequent disorders that are treatment resistant. Maladaptive responses thet defend against anxiety take several conscious or unconscious forms.

Nursing process


Since all persons experience anxiety in everyday living and all persons seeking health care express at least some anxiety related to their need for care, it is essential that the nurse have the ability to make an assessment of anxiety and determine if the anxiety being expressed is healthy or not. One author states, “Recognizing anxiety and assessing its cause are as assential (to nursing care)as monitoring vital signs (Spear,1996,p.41.) Another author cautions that nurses in home care settings will see clients with anxiety and the nurses must be in a position to make careful assessment of that anxiety (Busch, 1996). In such an assessment, the nurse must be able to determinine if te client’s anxiety is a symptom of one of the anxiety disorders presented in this chapter or if the anxiety is a temporary response to a current stressor.

In making the assessment, the nurse should begin with the observable, physical signs of anxiety-increased pulse, blood pressure, and respiratory rate, a heightened startle response; and “gut symptoms” such as urinary frequency or abdominal distress. Then, the nurse should inquire about the client’s cognitive responses – sense of disorientation, difficulty concentrating, and/or fear of losing control. When anxiety levels rises, the client may not be able to cope.

The nurse may find that both the client and his family members can provide information on how he usually copes and what degree of stress he has been experiencing. Knowledge of the client’s support system will also assistin determining to what degree the client’s environment is able to support his own ability to cope. The accompanying display provides an axcellent tool for use in screening for anxiety disorders. By asking these 13 questions, the nurse has a measure to assess if an anxiety disorder may exist.

Once data are collected and screening is completed, the nurse may assess that the client has anxiety to the level that psychiatric care need be initiated.

Nursing diagnosis

Several nursing diagnoses are relevant to any of the anxiety disorders, and some are likely to be relevant to one of the specific disorders. The accompanying display lists diagnoses and related factors commonly assigned to clients with anxiety disorders. These diagnoses address not the anxiety disorder itself, but the human response to the disorder

Nursing diagnoses and related factors common in clients with anxiety disorders:

Anxiety related to a subjective sense of uneasiness and tension

Fear related to a specific object, for example, a phobic fear of heights

Disturbed sleep pattern related to anxiety of being alone, fear of the dark, or flashback associated with      post-traumatic stress

Interrupted family processes related to adjustments family members must make to accommodate compulsive and/or phobic behaviors of one of their members

Powerlessness related to feeling out of control of one’s own thoughts and behaviors

Post-trauma syndrome related to anxiety felt follow-ing  a significant, life-threatening event

Disfuctional grieving related to inability to cope with grief following significant losses associated with a significant, life-threatening event.

Outcome Identification

Nursing care for any of the anxiety disorders must be based on achieving realistic outcomes of care. The nurse will set outcome goals in collaboration with the client and will recognize that it may take weeks for the client to feel a sense of control of his life or months to achieve a day-to-day perception of decreased anxiety. Realistic outcomes might be that the client’s anxiety is decreased so that he may drive a car on the freeway without fear of panic attack or that he may leave the house in the morning at least 2 days without excessive anxiety regarding being out in public.


The nurse’s independent role in treating anxiety disorders is to plan interventions aimed at assisting the client to cope with subjective, human responses to the anxiety experienced. The nurse’s collaborative role is to work with a psychiatric team to carry out a multidisciplinary treatment plan. Thus, the interventions discussed in what follows will include both the nurse’s independent and collaborative roles.


Severe and Panic Levels of Anxiety

1. Estabilishing a Trusting Relationship.

Patient may be hospitalized, to reduce this patient’s level of anxiety, most nursing action are supportive and protective. Nurses need to establish an open, trusting relationship. Nurse should actively listen to patients and encourage them to discuss their feelings of anxiety, hostility, guilt and frustration.

2. Self Awarness.

Nurse should strive to accept their patients anxiety without reciprocal anxiety by continually clarifying their own feelings and role

3. Protecting the Patient.

Nurse allowing the patient to determine the amount of stress that can be handled at the time. Nurse should also not attack their coping mechanism or try to strip them of these. Nurse should not attempt to argue with patients about it or reason them out of it.

4. Modifying the Environtment.

If the patient is hospitalized, the nurse can consult with other members of the health team to identify anxiety producing situations for the patient and attempt to reduce them. Nurse can set limits by assuming a quiet, calm manner and decreasing environmental stimulation.

5. Encouraging Activity.

Nurse should encourage the patient’s interest in activities. This limits the time available for destructive coping mechanisms and increase participation in and enjoyment of other aspects of life. Similar interventions can be implemented with the severely anxious patient who is not hospitalized. The nurse and patient can plan a daily schedule of activities that can be carried out in the community.

6. Medication.

Moderate Level of Anxiety

The specific nursing interventions for a moderate level of anxiety were originally describe by Peplau and Burd and reflect the problem solving process.

1. Recognition of Anxiety

After analyzing the patient’s behavior and determining the level of anxiety, the nurse helps the patient to recognize anxiety by helping the patient explore underlying feelings with such questions as “Are you feeling anxious now?” or “Are you uncomfortable?” it is also helpful for the nurse to identify the patient’s behavior and link it to the feeling of anxiety. Nurse should use open questions that move from nonthreatening topics to central issues of conflict.

2. Insight into the Anxiety.

The nurse then helps the patient see which values are being threatened by linking the threat with underlying causes, analyzing how the conflict developed and relating the patient’s present experiences to past ones. It is also important to explore how the patients reduced anxiety in the past and what kinds of actions produced relief.

3. Coping with the threat.

The nurse can help the patient in problem solving efforts in various cognitive and behavioral ways.

4. Promote the Relaxation Response.

Give relaxation in small groups, or even in larger group setting.


Nursing care should be evaluated in terms of whether or not the expected outcomes were achieved. In anxiety disorders, one cannot expect the client to experience a complete”cure” or remission of the disorder. However, the therapeutic goal should be that the client achieve a level of control over his anxieties and be able to experience life in a personally satisfying manner. There is obviously a need for the nurse and client t discuss realistic expectations and to determine the client’s needs and wants in relation to his own illness.

The following three case studies illustrate the application of the nursing process to clients having different anxiety disorders.


  • D. barry Patricia,1997. Mental health & mental illness, philadelphia newyork : Lippincott
  • Fontainate, Karen Lee.1999. Mental health nursing. 4 thred. Menlo park, California : Addison WesleyFontainate, Karen Lee.1999. Mental Health Nursing. 4 thred. Menlo Park, California : Addison Wesley
  • Frinch Noreen Cavan & Lowrence E Frisch. 2006. Psychiatric Mental Health Nursing. Third edition, Colorado Springs, Colorado : Thomson Delmar Learning
  • Wiscorz Stuart & Shandra J Sundeen. 1995, Principles and practice of Psychiatric nursing. Fifth edition. United states of america. Mosby. Year book. Inc