Anxiety

1. Anxiety Jade Gamber Ferris State University

2. Purpose • Awareness • Review Evidence Based Research • Enhance Nursing Care

3. Summary of Presentation • Describe the nursing care problem • Summarize individual parts of the research study • TRUEPIC care plan • Explain how nurses collaborate, provide care, and advocate for this patient population

4. What is Anxiety? Anxiety Anxiety Disorder • Normal natural physiological response to perceived fear • Uneasy, uncomfortable feeling, unexplained tension, anticipation or suspense, also known as stressors • Covers a range of conditions which stem from a generalized state of anxiety. • Intensity • Duration • Whether it leads to normal life being disrupted

5. Research Study • “Biofeedback Intervention for Stress and Anxiety among Nursing Students: A Randomized Controlled Trial.” • Investigate the impact of biofeedback intervention program on nursing students' levels of stress and anxiety during their first clinical training. • Nursing Theory: Peplau’s Theory of Interpersonal Relations

6. Research Methods • Randomized controlled study • 60 volunteer second-year baccalaureate nursing students at a public nursing college in Thailand. • All of the participants were female, within the age range between 18 and 21 years old, and the GPA range between 2.98 and 3.90 • The 30 participants in the biofeedback group received training on how to use the biofeedback device while the 30 in the control group did not receive any training.  • Pre-intervention survey and post-intervention survey

7. Results • Biofeedback training intervention not only kept the nursing students' stress levels from increasing, but also significantly reduced their levels of anxiety. • Nursing students in the Control Group had a significant increase in their stress and anxiety level over the same period. • Importance of the role as a Nurse Educator • Improved outcomes for student nurse and patient care

8. Limitations Article Critique • This study was conducted only at one nursing college in one country • All females • Follow-up study • A randomized control trail • Credible Nursing Authors • ISRN Nursing Journal

9. Collaboration of Patient Care • Nurses • Psychiatrists • Pharmacists • Family members • Patient’s friends / support system • The patient

10. TRUEPIC Situation • Savannah Johnson is a 28 year old patient with no previous medical conditions who states she “Can’t stand this feeling of stress and anxiety any longer.” The intensity of her problem began during a stressful day of her nursing program when she was studying for her final exam before completing her final semester in nursing school. She has been struggling with balancing her life stressors such as the stress within her family, work, and school, causing her to grades in all of her classes to drop and barely making to the cut off grade of a 75%. She has been unable to cope with the pressure of having to retake the semester and not graduating. When another assignment is assigned, she reports not knowing where to start. She states that if she doesn’t pass her classes, it will cause even more issues in her life to intensify, making her mind races and causing her to get palpitations and shortness of breath. These symptoms have been getting worse over the last month. Savannah also says she has recently been taking sleeping pills every night help her sleep because she states her, “Mind keeps her up at night”. She is not on any other medications and does not want to be because she does not have enough money to pay for them. She has been admitted to the hospital for and overnight observation. • The nurse is a 32 year old BSN prepared RN and has been working on the floor for 5 years.

11. TRUEPIC 3. UNDERSTAND…the importance of the propositions, assumptions, and confounding variables. Proposition:“If anxiety does not get under control, patient will have increased number of anxiety attacks. Significance of Assumptions: “If pt is not aware of the need to lower anxiety levels to decrease attacks, she may unintentionally be contributing to the worsening of her condition.” Possible Confounding Variables: “If the pt has a fear of medications because of the costs, she may be reluctant to start any new medications to help control her anxiety disorder. Pt may not be able to continue to take sleeping pills if put on certain medications.” 2. RELATE…Or put the variables together to form propositions. Primary Proposition: “Pt’s pressure to pass her classes to graduate nursing school is causing her to have palpitations and shortness of breath. Possible Assumptions: “Pt knows that if she does not pass her classes, then her stressors in life are going to intensify Possible Confounding Variables: “Fear of taking any medications because she cannot afford to continue the medication.” 1.IDENTIFY… The variables in this situation • 28 yr old female • No previous medical history • Refusing medications • Doesn’t have the money to afford it • Palpitations and shortness of breath • Pressure to pass nursing school • Taking sleeping pills • Helps her sleep

12. 6. INFLUENCE…someone to change one or more variables in order to achieve a desired outcome or prevent an undesirable one. Proposition: Make sure the pt understand what an anxiety attack is. Refer her to a psychiatrist to further evaluate her concerns and manage her medications. Assumptions: Make sure pt understands how to help herself if she feels an anxiety attack coming on. Discuss triggers and coping mechanisms Confounding Variables: Make sure the pt understands the psychiatrist is there for her when she needs medical help regarding her anxiety and anti-anxiety pills. TRUEPIC cont. 5. PREDICT…what will happen in this situation if one or more variables are not changed. Proposition: If pt’s anxiety is not controlled, her symptoms may worsen and she may begin to have thoughts of self-harm which then could lead to longer recovery and hospitalization time Assumptions: If pt cooperates and begins taking the prescribed medication and other helpful nonpharmacological methods, her anxiety levels will lessen dramatically and relatively fast. Confounding Variables: If the pt has other alternative methods to help with anxiety, it will give her a sense of control and she will be able to decide for herself what method works best for her and her lifestyle. 7. CONTROL…one or more variables in order to achieve a desired outcome or prevent an undesirable one. To control isn’t an issue of wanting to dominate or do what is unreasonable or unwanted, but simply a matter of changing one or more variables in order to bring about a desired outcome when influence is not possible, realistic, or advisable. Pt take her own sleeping pills during her stay at the hospital Nursing Diagnosis Mild Anxiety related to multiple co-existing stressors AEB palpitations and shortness of breath and pt statements, “I can’t stand this feeling of stress and anxiety any longer.” 4. EXPLAIN…the significance of the situation to those involved based on their individual KSVME Proposition: Explain to the pt what an anxiety attack is, signs and symptoms, how to prevent or stop one from happening and possible complications from unresolved attacks. Assumptions: Explain to the pt the benefits of the anti-anxiety medications and how it can benefit the patient’s overall quality of life. Confounding Variables: Explain alternative options to help control anxiety. Talk to the pt and explain that you are there to support her and to answer any questions

13. Nursing Advocacy • Build a relationship • Family life • Stressors • All patients are different, so it is important to treat each patient individually • Individualized care plans

14. References • Ratanasiripong, P., Ratanasiripong, N., & Kathalae, D. (2012). Biofeedback Intervention for Stress and Anxiety among Nursing Students: A Randomized Controlled Trial. ISRN Nursing, 2012, 1-5. • Videbeck, S. (2011). Psychiatric-mental health nursing (5th ed.). Philadelphia: WoltersKluwer Health/Lippincott Williams & Wilkins.