The concept of anxiety is very important to nursing. Individuals suffering from disease or medical problems often experience anxiety. Anxiety is both psychological and physiological in nature and is characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create an unpleasant and sometime detrimental effect. Generally, anxiety is associated with upcoming negative events. Anxiety is considered to be a normal reaction to stress. It may help a person deal with a difficult situation, such as an upcoming test or a meeting, by prompting one to cope with it.
However, when anxiety is severe, it may have extremely detrimental effects on the body that may ultimately result in physical impairment or death (Murphy & Leighton, 2009; Tefera & Tomao, 2010). For this reason, nurses must consider anxiety regularly when working with patients. Words related to anxiety include alarm, angst, anguish, apprehension, concern, depression, discomfort, distress, doubt, dread, fear, foreboding, fretfulness, frustration, hysteria, impatience, mania, misery, mistrust, nervousness, panic, pessimism, pressure, strain, stress, suffering, tension, uncertainty, and worry.
The concept of anxiety was discussed with several nurses. When asked to define anxiety, one advanced practice nurse stated that anxiety is a negative feeling that is often experienced by many patients in a hospital. The negative feelings are usually associated with unfamiliar events and treatments that cause uncertainty on the part of the patient (S. Barnett, personal communication October 20, 2010). Another advanced practice nurse described anxiety as the fear that a patient feels about the treatment or medical interventions they are receiving.
Left unaddressed anxiety can have extremely detrimental effects on an individual’s health and well being including psychological problems (i.
e. clinical anxiety) and physical problems (i. e. high blood pressure) (M. Gill-Shut, personal communication, October 20, 2010). According to the Webster’s Third New International Dictionary of the English Language, Unabridged (Grove, 2002) anxiety is defined as a state of being anxious or of experiencing a strong or dominating blend of uncertainty, agitation, or dread, and brooding fear about some contingency.
Anxiety is a strong concern about some imminent development or a strong desire, mixed with doubt and fear, for some event or issue. An abnormal and overwhelming sense of apprehension and fear often marked by such physical symptoms as tension, tremor, sweating, palpitation, and increased pulse rate are also characteristics of anxiety. Furthermore, anxiety is associated by an unpleasant feeling of helplessness and isolation sometimes accompanied by physiological manifestations of fear, consciously accounted for by the anticipation of pain, death, or some unknown catastrophe but without sufficient objective justification.
Finally, anxiety is a state of mind that is deeply troubled or distressed (Grove, 2002). Synonyms of anxiety include concern, disquiet, hysteria, uneasiness, worry, nervousness, apprehension, fretfulness, fear, angst, trepidation, panic, fright, alarm, dread, tenseness, and misgiving. Antonyms of anxiety may be security, confidence, certainty, calmness, trust, faith, reassurance, comfort, hope, peace, tranquility, unruffled, relaxed, and belief. Generally, anxiety is a strong concern resulting in negative feelings and emotions about some imminent development (Grove, 2002).
This may negatively impact a person’s happiness and/or ability to function on a day-to-day basis. Anxiety is a fact of life (Peeke, 2003). A little anxiety can heighten one’s senses and concentration allowing a person to function well in a stressful environment, for example, during a speech or when taking a test. However, too much of a good thing can be counterproductive. Anxiety is meant to be a short-lived experience. If left unchecked, anxiety can have lasting physical and psychological effects (Peeke, 2003). In particular, anxiety affects an individual’s ability to think realistically and use good judgment (Brody, 2003).
Murphy and Leighton (2009) described anxiety as “fearful apprehension that is mainly out of proportion to external circumstances. ” Furthermore, anxiety is often accompanied by autonomic hyperactivity symptoms such as heart palpitations, sweating and other sympathetic nervous system responses (Murphy & Leighton, 2009; Tefera & Tomao, 2010). Anxiety is a normal emotion that is a key part of the fight-or-flight stress response (Peeke, 2003). Debilitating emotions can result if anxiety is allowed to persist (Tefera & Tomao, 2010). The concept of anxiety can be further broken down into two distinct aspects: trait and state.
Trait anxiety, which is a personality characteristic, refers to a person’s predisposition toward anxiety. State, also known as situational anxiety, is a person’s transient reaction to an event, and is the result of a person’s appraisal of the situation (Bossert, 1990). These two aspects are inter-related and not mutually exclusive because trait anxiety influences the level of threat perceived in a given situation. An increase in perceived threat results in the associated anxiety of the individual negatively impacting coping and thereby increasing anxiety even more (Bossert, 1990).
What causes anxiety? Anxiety can also be the result of a physiological condition. Comorbid diseases have been known to cause intrinsic anxiety as with cardiac disease (Perpina-Galvan & Richart-Martinez, 2010). Additionally, many abused drugs raise anxiety level. Individuals who use drugs and alcohol may develop an anxiety disorder as a result of substance use (Rodriguez, 2009; Tefera & Tomao, 2010). Finally, many pathological anxiety disorders have a familial pattern (Tefera & Tomao, 2010). There are also non-physiological causes for anxiety.
Although the degree of perceived threat appears to be related to trait anxiety, there seems to be a common thread in the events that result in anxiety. Bailey (2010) described anxiety as “a human reaction to any unknown situation. ” Lack of adequate information about a situation often results is an increase in anxiety (Lopez, Siaga, Kelly-Rutter, & Nicholson, 1997). This is particularly evident for individuals hospitalized in an intensive care unit (Perpina-Galvan & Richart-Martinez, 2010), as well as for individuals undergoing surgery (Bailey, 2010).
These individuals are responding negatively to an unknown situation in which loss of control will be a factor (Bailey, 2010). Loss is another cause of anxiety. This is particularly evident in older individuals who experience many different types of loss including physical, psychological, and social loss. The older individual my experience loss of physical wellness, loss of cognitive ability including memory, and loss of loved ones (Juratovac, 2005). Anxiety can be characterized by the following criteria. A strong negative must be emotion present.
For example, the person must be experiencing uncertainty, apprehension, fear or agitation about some contingency. Physical symptoms must also accompany these negative emotions. These physical symptoms should be observable or measurable and may include increased muscle tension, intensified awareness, elevated blood pressure, dilated pupils, sweating, palpitation, increased heart rate, increased respiratory rate, reduced gastric motility secondary to shunting of blood away from the digestive tract, and reduced urine output (Sorensen, n. d. ).
Anxiety is usually preceded by an event that gives rise to negative emotions. Events such as an upcoming speech or test, an upcoming activity such as a class reunion, impending surgery, learning of a new medical condition, or any kind of loss may result in anxiety. Loss may not just describe loss of a loved one but also loss of possessions or finances, loss of a job, loss of independence, loss of cognitive function or loss of physical skill or functioning (Tefera & Tomao, 2010). Physiological anxiety does not require an antecedent event.
However, the presence of a medical condition such as acute coronary syndrome, mitral valve prolapse, alcohol or substance abuse, congestive heart failure, depression, suicide, thyroid conditions, hypoglycemia, and neuropathy or an antecedent event is required (Tefera & Tomao, 2010). Consequences of anxiety can have extremely detrimental effects on the body (Tefera & Tomao, 2010). Elevated blood pressure, a dysfunctional immune response, and overall burnout are some examples. These conditions increase the risk of other health problems including heart disease and gastric ulcers (Peeke, 2003).
Psychosocially, anxiety can also have major implications for an individual to establish and maintain healthy interpersonal relationships (Juratovac, 2005). Anxiety can also negatively impact sleep patterns and energy levels resulting in irritability (Juratovac, 2005). The following is a working definition of anxiety. Anxiety is the state of feeling a strong sense of uncertainty, agitation, fear, or uneasiness about an impending or unfamiliar event or loss. Model Case of Anxiety Mary, a thirty-five year old woman of children, was healthy and without previous medical problems.
She stayed at home and took care of her children. Although her job as a homemaker took up most of her time, she occasionally found time for herself to exercise, rest, or do some other activity that allowed her to focus on herself. During a routine self-breast exam Mary found a lump in her right breast. She immediately made an appointment with her doctor who recommended that she have a mammogram. The mammogram revealed a mass measuring 20 mm in diameter in Mary’s right breast. Mary’s physician recommended that she have the mass biopsied. Mary did as she was asked.
The mass was found to be benign, however, Mary’s physician recommended that she have the mass surgically removed. Mary was scheduled for surgery. In the days prior to surgery, Mary began thinking about the surgery constantly. She was uncertain about what to expect because she had never had surgery before. She became more and more agitated as the day of surgery drew near. She was unable to focus on her daily tasks. She felt tired and ill, was unable to eat, unable to sleep and was forgetful. Mary even forgot to pick her children up from school one day. Mary was debilitated by the fear and uneasiness she felt about her upcoming surgery.
Because of Mary’s recent behavioral changes, Mary’s mother came to take care of her and the children. Mary arrived at the hospital to have surgery at her scheduled time. She was taken in to pre-op still very upset about the event. The surgery went without complication. The mass was removed. Mary emerged from surgery with severe post-operative pain. She required medication to calm her down as well as multiple doses of pain medication to make her comfortable. Because she received so much medication, Mary was kept overnight at the hospital for monitoring. Antecedents
The antecedents of anxiety include an anticipated event or loss. In this model case of Mary was told she would need surgery to remove a mass in her breast. Although the mass was benign, the impending event of surgery was unfamiliar enough to cause anxiety in Mary. Consequences The consequences of anxiety include impairment of functioning, changes in behavior or attitude, increased or decreased physiological responses (heart rate, breathing, malaise, insomnia, etc. ) In this model case Mary became so anxious about her impending surgery that she was unable to function normally.
Physiological changes arose in her body such as her general malaise, lack of appetite, insomnia, and forgetfulness. Following her surgery she was so upset she required medication to calm. Additionally, she complained of a great deal of pain requiring multiple doses of pain medication. Finally, because of the extra medication she was required, Mary had to stay overnight at the hospital, resulting in additional cost to her personally. Discussion of Model Case Mary’s case shows how anxiety can impact the outcome of a surgery. In Mary’s case she was a healthy individual who had never needed surgery.
Mary’s surgery was the impending event as described in the working definition of anxiety. She was unfamiliar with what surgery entailed. Uncertainty, is the next aspect of the definition of anxiety that is seen in Mary’s case. Mary was unfamiliar and therefore uncertain of what surgery entailed. Mary’s uncertainty gave rise to agitation and finally fear. Once Mary began to feel fear, response from her sympathetic nervous system can be seen in her inability to eat and sleep (Kunert, 2009). Mary was able to go through with her surgery despite her anxiety. However, there were consequences.
She was still very upset after surgery, required more pain medication and was kept overnight in the hospital. Contrary Case of Anxiety Now consider the case of Jane. Jane a thirty-five year old mother of three children was also healthy and without prior medical problems. She was a homemaker with a primary job responsibility of taking care of her children. During routine breast self-examination Jane found a lump in her right breast and immediately scheduled an appointment with her doctor. Jane’s doctor recommended further diagnostic testing including a mammogram and a biopsy of the mass. The mass was found to be benign.
However, Jane’s doctor recommended that she undergo surgery to remove the mass. While waiting for the impending surgery Jane went on about her daily activities. She did not give having the surgery any thought. On the day of surgery she went to she hospital as scheduled and was taken into pre-op. The surgery went without complication. Jane emerged from surgery with very little post-operative pain. She required only one dose of pain medication and was sent home the same day. Discussion of Contrary Case Jane’s case depicts all of the same events coming up to the recommendation of surgery including the fact that surgery was unfamiliar to Jane.
However, Jane did not respond to this uncertain event with a feeling of agitation and fear. She also did not demonstrate any of physiological indicators of stress. As a result, she did not experience anxiety about her surgery. Because she did not have anxiety, her outcome in surgery was better and she was able to go home the same day. Borderline Case of Anxiety Next consider the case of Lynn. Lynn, a thirty-five year old, mother of three children was healthy and without any previous medical history. She was a homemaker who took care of three children.
Upon routine breast self-examination, Lynn noticed a lump in her right breast. She promptly made an appointment with her physician. Lynn’s doctor recommended that she undergo further diagnostic testing including a mammogram and a breast biopsy. The results of the tests showed that Lynn had a benign mass in her right breast. Lynn’s physician recommended that she have the mass removed. In the days before surgery Lynn voiced very little nervousness regarding her impending procedure. She was unfamiliar with having surgery and was getting agitated. Lynn decided to call her doctor’s office about her feelings.
She spoke with a nurse and was given information about what to expect pre-operatively and post-operatively including information about the pain she may experience. The conversation and information helped Lynn significantly. She was able to go home and function normally in her life while she waited for her surgery. Lynn arrived at the hospital on the day of surgery and was taken into pre-op. Lynn’s surgery took place without incident. She emerged from surgery with very little pain. Lynn required only one does of post-operative pain mediation and was sent home the same day without complication.