Interventions for Anxiety
Anxiety (Moderate) Interventions
Priority Diagnosis: Anxiety (moderate) related to a situational event or psychological stress, as evidenced by increased vital signs, moderate discomfort, narrowing of perceptual field, and selective inattention.
Intervention: Help the patient identify anxiety.
Rationale: Validate observations, name the anxiety, and start working with the patient to lower anxiety. Ask, "Are you comfortable right now?"
Example: A patient appears restless and is tapping their foot. You say, "I notice you seem a bit uneasy. Are you feeling anxious about something?"
Intervention: Anticipate anxiety-provoking situations.
Rationale: Prevents escalation of anxiety to a more disorganizing level.
Example: If a patient becomes anxious during blood draws, prepare them by explaining the procedure step-by-step and ensuring a calm environment.
Intervention: Use nonverbal language to demonstrate interest.
Rationale: Verbal and nonverbal messages should be consistent. The presence of an interested person provides a stabilizing focus. Examples: lean forward, maintain eye contact, nod your head.
Example: While the patient is speaking, maintain eye contact, nod occasionally, and lean slightly forward to show you are engaged.
Intervention: Encourage the patient to talk about feelings and concerns.
Rationale: When concerns are stated aloud, problems can be discussed, and feelings of isolation decrease. Avoid closing off avenues of communication.
Example: Ask, "What's been on your mind lately?" or "Is there anything you'd like to talk about?"
Intervention: Focus on the patient's concerns.
Rationale: Avoiding the topic or offering advice can isolate the person.
Example: Instead of saying, "Don't worry, it'll be fine," respond with, "It sounds like you're really worried about this."
Intervention: Ask questions to clarify what is being said.
Rationale: Increased anxiety results in the scattering of thoughts. Clarification helps patients to identify their thoughts and feelings. Example: "I'm not sure what you mean. Give me an example."
Example: If a patient says, "Everything is a mess," ask, "Can you tell me more about what feels like a mess?"
Intervention: Help the patient identify thoughts or feelings before the onset of anxiety.
Rationale: Helps the patient to identify triggers, facilitating problem-solving. Ask, "What were you thinking right before you started to feel anxious?"
Example: Ask, "Before you felt anxious about the meeting, what thoughts were going through your mind?"
Intervention: Encourage problem-solving with the patient.
Rationale: Increases their sense of control and decreases anxiety. Patients experiencing mild to moderate anxiety levels can solve problems.
Example: Guide the patient by asking, "What are some steps you can take to address this issue?"
Intervention: Help the patient develop alternative solutions through role-play or modeling behaviors.
Rationale: Encourages trying out alternative behaviors and solutions.
Example: Practice a stressful conversation with the patient, taking turns playing different roles to explore various responses.
Intervention: Explore behaviors that have worked to relieve the patient's anxiety in the past.
Rationale: Encourages mobilizing successful coping mechanisms and strengths.
Example: Ask, "What have you done in the past that has helped you feel less anxious?"
Intervention: Provide outlets for working off excess energy.
Rationale: Physical activity can relieve built-up tension, increase muscle tone, and increase endorphin levels. Examples: walking, playing ping-pong, dancing, exercising.
Example: Suggest a walk around the garden or offer a game of ping-pong in the recreation room.
Anxiety (Severe, Panic) Interventions
Priority Diagnosis: Anxiety (severe, panic) related to perception of a severe threat as evidenced by verbal or physical acting out, extreme immobility, sense of impending doom, and inability to solve problems.
Intervention: Maintain a calm manner.
Rationale: Anxiety is communicated interpersonally. The nurse's calm can calm the patient.
Example: Speak in a gentle, reassuring tone.
Intervention: Always remain with the person experiencing acute, severe, or panic-level anxiety.
Rationale: Alone with immense anxiety, a person feels abandoned. A caring face may be the patient's only contact with reality when confusion becomes overwhelming.
Example: Stay physically present with the patient, ensuring they know they are not alone.
Intervention: Minimize environmental stimuli.
Rationale: Helps to minimize further escalation of the patient's anxiety. Move to a quieter setting, and stay with the patient.
Example: Move the patient to a quiet room, dim the lights, and reduce noise.
Intervention: Use clear and simple statements and repetition.
Rationale: A person experiencing a severe to panic level of anxiety has difficulty concentrating and processing information.
Example: Say, "You are safe. I am here to help you. Breathe in, breathe out."
Intervention: Use a low-pitched voice; speak slowly.
Rationale: A high-pitched voice can convey anxiety. Low pitch can decrease anxiety.
Example: Use a calm, even tone, speaking slowly and deliberately.
Intervention: Reinforce reality if distortions occur.
Rationale: Anxiety can be reduced by focusing on and validating what is going on in the environment. Examples: seeing objects that are not there or hearing voices when no one is present.
Example: If the patient says, "The walls are closing in," respond with, "You are in a safe room, and the walls are not moving."
Intervention: Listen for themes in communication.
Rationale: In severe to panic levels of anxiety, verbal communication themes may be the only indication of the patient's thoughts or feelings.
Example: If the patient repeatedly mentions feeling trapped, explore feelings related to control and freedom.
Intervention: Attend to physical and safety needs when necessary.
Rationale: High levels of anxiety may obscure the patient's awareness of physical needs. Examples: need for warmth, fluids, elimination, pain relief, family contact.
Example: Offer a blanket, water, or assist with going to the bathroom.
Intervention: Set physical limits if safety is a concern.
Rationale: A person who is out of control is often terrorized. Staff must offer the patient and others protection from destructive and self-destructive impulses. Speak in a firm, authoritative voice: "You may not hit anyone here. If you can't control yourself, we will help you."
Example: If a patient becomes aggressive, state firmly, "You need to stop. You are safe, but you cannot hurt yourself or others."
Intervention: Provide opportunities for exercise.
Rationale: Physical activity helps channel and dissipate tension and may temporarily lower anxiety. Examples: walk with nurse, punching bag, ping-pong game.
Example: Offer a walk down the hallway or supervised use of a punching bag.
Intervention: Offer high-calorie fluids when a person is constantly moving or pacing.
Rationale: Dehydration and exhaustion must be prevented.
Example: Offer juice or a protein shake to maintain energy levels.
Intervention: Assess need for medication or seclusion.
Rationale: Exhaustion and physical harm to self and others must be prevented. Implement after other interventions have been tried and have been unsuccessful.
Example: If the patient remains a danger to themselves or others after other interventions, consider administering a sedative or using seclusion following facility protocol.