Despite our collective obsession with medical shows such as Scrubs and Grey’s Anatomy, being admitted to the hospital can be a scary and jarring experience for anyone.
One minute you’re going about a normal routine, the next you’re lying on a stretcher beneath fluorescent lights, being poked and prodded by face masks and medical scrubs. And none of them have a magical solution to our problems like they do on television.
It’s perfectly normal, even expected, for patients to feel moderate to extreme anxiety when entering a hospital or clinic for an unexpected visit, and this can cause problems for both of you. Communication may be more difficult, as the person in the hospital bed may display their anxiety through extreme emotion or physical symptoms.
As a nurse, it is essential for you to know how to provide effective intervention for anxiety in any situation, to help mitigate any fears and bring comfort to your patients.
Step 1: Assessing the Patient
Do some sleuthing. Ask the patient questions about their life outside of the hospital; this may provide you with some vital clues to the situation. Maybe they missed a scheduled medication which is the underlying cause of their episode, or perhaps they’re hypoglycemic and their blood sugar boosted.
Whatever the cause, it is important to listen carefully and empathetically to your patient. Sometimes they just need to know someone sees what they’re going through; and talking to them empathetically will also assure the patient that you are interested in them as a person, not just as an admittee.
Be sure to ask specific questions about their anxious episode, to determine whether it’s simply situational, or something they experience on a regular basis: “Have you experienced anxiety before? What has helped you with anxiety in the past?” Ask simple but probing questions to help you understand how you can be most effective for your patient in this moment.
Step 2: Communicating
Part of the reason patients experience stress in-hospital is because they are in a strange environment where they feel virtually helpless; especially new or infrequent patients. Make sure that you are prepared to answer any and all questions before you enter their room.
Even if they don’t ask questions, explain what you’re doing and why you’re doing it in terms they can understand. But do try to avoid a patronizing tone; this will let your patient know that you respect them, and help them feel that they have some power over the situation.
Step 3: Intervention
The least invasive form of intervention is always the first one to try, and often the most effective, if more serious measures are not required.
If the patient is physically able and wants to move around, allow them time to wander the halls, or go outside for a breath of fresh air (provided this is permissible by the operating standards in your unit). Too much time spent in a hospital room will make anyone claustrophobic, and it can help a patient immensely to change their view from time to time. In addition, physical activity is extremely effective at mitigating stress and situational anxiety. Encourage the patient’s family and pets (if your hospital allows) to visit often. Visits with loved ones can be invigorating.
If a patient is exaggeratedly fearful: of death, treatment, needles etc. be sure to receive their fears compassionately and with attention. Don’t dismiss them, don’t tell them there’s nothing to worry about or simply to relax. Ask them what they need from you when they are experiencing this fear, and meet them halfway. Guide them through activities to help keep them calm: breathing and mindfulness exercises are easy and effective coping techniques you can teach them. Do, however, take some vitals if a patient is anxious to make sure there is not a medical cause.
If the patient enjoys arts, you may turn on soothing music for them, or offer them a coloring book to distract them and take their mind of things. Little interventions can be extremely effective in this way to create a pleasant environment during their admittance.
Creating a Nursing Care Plan
Care plans are a common method used by nurses to organize treatment based on both subjective and objective information in a given medical scenario involving a patient. Having a care plan will help you to identify goals, strategize interventions and provide rationale, and create a nursing diagnosis.
According to NANDA, the medical definition of anxiety is as follows:
“A state in which an individual or group experiences feelings of uneasiness or apprehension and activation of the autonomic nervous system in response to a vague, nonspecific threat.”
Using this definition and the tools illustrated below, you should be able to create a care plan for effective anxiety intervention.
- Nursing DiagnosisThe first step is to identify that the patient is experiencing anxiety, and to describe based on medical examination and interview the probable causes of your patient’s anxiety. This will help you begin to formulate a plan of action for their treatment.
- Subjective DataHere you will record your patient’s account of their experience of anxiety.
What are their symptoms as they describe them? Have they attempted treatment before today? Have they experienced any stressful or life-changing events recently? How does the patient purport to be affected by their anxiety?
All of this information will aid you in understanding the patient’s experience of their ailment, and how best to help them.
- Objective DataThis is where you record your observations of the patient in relation to your nursing diagnosis, and data collected from vitals. Behavioural observations, physiological observations, blood pressure, temperature, etc. all go in this column.
- Nursing OutcomesHere you will identify goals for the patient.
Related to anxiety, this may be decreasing a sense of fear for your patient; your patient exploring and using coping mechanisms effectively; or the patient volunteering to see a psychiatrist for long-term treatment of their anxiety. Organizing hopeful outcomes in this way will help you strategize and administer care.
- Nursing InterventionsThis is where you lay out your “plan of attack.” What specific methods and interventions will you use in order to help the patient meet your goals for them?
This section should have points which all relate specifically to the outcomes which you outline above. After this final step, you will be fully prepared to provide excellent and effective intervention for your anxious patients.
Hospitals can be stressful places to visit as patients and, by following the steps we’ve outlined, you can help your patients to overcome their acute anxiety. Hospitals can also be stressful places for nurses to work, where they are placed under a mountain of demands and run ragged on a punishing schedule.
Medley is a platform that helps nurses set their own schedules and work on their own terms by delivering per-diem opportunities right to your phone. If you want a schedule that’s easier on your nerves, you can sign up here for free.