Nursing in Practice Autumn 2021 (issue 121) - Page 32


I think my patient has anxiety , what can I do ?

The pandemic has worsened the UK ’ s already high levels of anxiety . Simone Garland advises on how the condition presents and how to broach the subject with patients

Anxiety is a common mental health condition . In 2013 , it was estimated to affect more than eight million people in the UK 1 and since then that figure is likely to have risen . A 2020 study looking at the impact of the Covid-19 pandemic suggests the condition is becoming more common , with more than half of participants reporting symptoms of anxiety and almost two-thirds describing symptoms of depression . 2

In its simplest form , anxiety is completely normal . It is triggered by a natural stress response ; identify a potential danger or threat and prime the body for fight or flight . The difficulty for nurses and other health practitioners is judging when anxiety has gone beyond this point .
Anxiety becomes problematic for a person when it is disproportionate to their situation , persists over time or affects their ability to live their life .
Common types of anxiety : Generalised anxiety disorder ( GAD ) 3 Panic disorder Phobias Social anxiety 4 Post-traumatic stress disorder ( PTSD ) 5 As well as these common types , there are also other specific conditions where anxiety can play a part but is not the primary diagnosis . An example of this is irritable bowel syndrome .
What to look out for Anxiety presents itself in many different forms and can be hard to spot . At times people may not recognise what they are feeling as anxiety . The condition can trigger intense physical reactions including palpitations , dizziness , chest pains and breathlessness . It ’ s common for someone experiencing their first anxiety attack ( or panic attack ) to feel like they ’ re having a heart attack .
Non-verbal signals
Non-verbal cues and body language – does the patient appear open and comfortable with you or do they seem to be withdrawn or distant ?
A shaking hand and sweaty palm might be a normal sign of nerves , but is it more than you would expect ?
Hyperventilation and overbreathing can be a sign of anxiety . The patient may be deep-breathing to counteract the feeling of anxiety .
Does the patient seem on high alert to their surroundings , appearing jumpy or on edge ?
Have regular appointments changed with a patient ? Have they started not attending ?
Questions to ask Broaching the subject of anxiety should be done delicately , especially if the patient hasn ’ t brought it up themselves .
Reflecting what you ’ re seeing or hearing back to them can be a way of starting a conversation about what they might be experiencing .
Questions that can be helpful in this respect include : ‘ I can see that you seem very tense today , is there anything you ’ re worried about ?’, or ‘ You seem to be finding it hard to slow down your breathing , how are you feeling ?’
If the patient seems receptive to the conversation , you could explore further : Are they experiencing any physical symptoms ? 3 Is there anything in particular worrying them at the moment , related to their reason for attending today , or in general ? Again , be mindful of any non-verbal signals .
Are they experiencing any additional stressors such as work demands or family responsibilities ?
Have they been drinking more alcohol than usual or using illicit substances ?
Do they have a support network ? Are they at risk or experiencing isolation or loneliness ?
New normal While the recent rise in psychiatric conditions , including anxiety , can be linked to the Covid-19 pandemic , it is predicted to continue well past the easing of restrictions . 7
Many studies have monitored changes to the prevalence of mental health conditions over the past 18 months . 8
Despite a clear correlation emerging between the increase of these issues and the ‘ new normal ’ post pandemic , we should all be mindful not to normalise mental illness . If you feel a patient is experiencing anxiety , first and foremost offer them reassurance . Provide any self-help leaflets you have available and signpost them to charities or other organisations that can provide help and guidance ( see Resources ). Some localities have self-referral routes to psychological therapies or mental health services .
Arrange appropriate follow-up appointments to monitor presentation , provide your patient with reassurance and encourage them to pursue further support .
More serious concerns There may be situations where you have a concern for the severity of your patient ’ s anxiety . NICE guidance describes a moderate mental health problem as making a patient ’ s daily life much more difficult than usual , with severe conditions making daily life extremely difficult . 9 You might need to take action on behalf of your patient , such as liaising with their GP or making a referral to mental health services .
Resources Anxiety UK . anxietyuk . org . uk ; 03444 775 774 ( 9.30am - 5.30pm weekdays )
No Panic . nopanic . org . uk ; 0300 772 9844 ( 10am -10pm every day )
Social Anxiety UK . social-anxiety . org . uk
Mind peer support group directory . bit . ly / 3BRZryM
Simone Garland is a registered mental health nurse working in the health and social care sector . She is also a wellbeing coach at mental health service The Wandering Mind
Go to bit . ly / 3BUujyq for the article with references
nursinginpractice . com Autumn 2021