The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [152]
Related theory
There are a number of theories about anxiety, its causes and therefore how to manage it (Powell and Enright 1990). To be effective in supporting and communicating with a patient with anxiety, it is necessary to know that there are three aspects of feeling anxious.
Bodily sensations.
Behaviour: how the individual behaves when faced with the fear, especially if the behaviour involves avoiding it.
Thinking: this is the ideas, beliefs and mental pictures about what might happen in the situation feared (Powell 2009).
Anxiety is a normal response to threatening events but can become a problem when it is frequent, exaggerated, experienced out of context or interfering with an individual’s life (Blake and Ledger 2007). As levels of anxiety increase, awareness and interaction with the environment decrease, and recall and general function are also impaired (Kennedy Sheldon 2009). At the extreme, anxiety may become a panic attack.
Evidence-based approaches
Research has recently demonstrated that the most effective way of helping an individual with the more acute levels of anxiety is through a cognitive behavioural approach (Donohoe and Ricketts 2006, NICE 2007). Some of these principles are applicable to communicating with a patient with general anxiety associated with their illness and treatment. One of the key interventions is educating the patient, normalizing their response to their situation but also giving information about the situations and circumstances that may be triggering the anxiety (Donohoe and Ricketts 2006). Referring the patient for relaxation therapy can also help them physiologically, as they will learn how to release the muscular tension that may lead to headaches, backaches and other aches and pains (Blake and Leger 2007, Powell 2009).
Principles table 5.4 Supporting an anxious individual
Principle Rationale
Be alert to the signs and symptoms of anxiety. Early recognition and intervention may help to prevent worsening of symptoms. E
Encourage the patient to talk about the source of their anxiety if they can. Patients may find some benefit from expressing their concerns and being heard. E
Listen and only when the patient has expressed all their fears offer information or gently challenge misinformation about treatment, processes or outcomes if this is the source of the anxiety. Information about a procedure, particularly an operation, can reduce anxiety and improve outcomes (Scott 2004, R3a; Nordahl et al. 2003, R2b).
If the patient doesn’t know why they are feeling anxious, encourage them to describe what is happening in their body, when it started, what makes it worse, what makes it better. Patient feels listened to and less alone, which may increase their sense of security and therefore reduce anxiety. E
Ask the patient if they have had the feelings before. What has helped previously (coping mechanisms) and what do they think may help this time? The patient is encouraged to take control and apply their own coping mechanisms. E
Panic attacks (acute anxiety)
Related theory
A panic attack is a discrete period of intense fear or discomfort that is accompanied by a range of somatic or cognitive symptoms (Donohoe and Ricketts 2006) (Box 5.6).
Box 5.6 Criteria for a panic attack
A discrete period of intense fear or discomfort in which four (or more) of the following symptoms develop abruptly and reach a peak within 10 minutes.
Palpitations, pounding heart or accelerated heart rate.
Sweating.
Trembling or shaking.
Sensations of shortness of breath or smothering.
Feeling of choking.
Chest pain or discomfort.
Nausea