ANXIETY
By: Chelsey Treglia
Purpose
To create more awareness and a better
understanding of anxiety disorder while
assessing evidence based nursing research in
order to develop a plan of care & high quality
means for advocating to patients with anxiety.
Objective Summary





Communicate the nursing care problem addressed in the
research study
Summarize the study methods and results throughout the study
Design and discuss a care plan for a patient who is
experiencing anxiety disorder
Use the TRUEPIC form to assess a patient with anxiety
disorder
Advocate for those affected by anxiety disorder
What is Anxiety Disorder?

Anxiety vs Anxiety Disorder
http://www.youtube.com/watch?v=ktRRN4mkpEc
Research Study




The research study that was used was, “Student
nurses’ experiences of anxiety in the clinical setting.”
This study examines student nurses' perception of
anxiety in the clinical setting.
The focused population was student nurses from two
baccalaureate nursing programs in the United
States
Nursing Theory: Peplau’s theory of interpersonal
relations
Study Methods





The research study used phenomenology
Sample size of seven student nurses from two
different schools.
Average age was 22.1, all female students - six
white, one Hispanic.
Face- face unstructured interviews were used to
collect data.
Interviews were professionally transcribed.
Results

Several themes emerged which caused anxiety–
 Experiencing inexperience
 Being demeaned
 Being exposed
 Being abandoned
 Competition among peers
 Being uncertain of ability
Study Limitations






Small sample size
All females
Only two different universities used which means
only a few clinical sites were used as well
Not a true picture of student nurses thoughts
Voluntary sample; should have been a randomized
controlled trial design
Use of subjective versus objective measures for
outcomes
Collaboration of Patient Care
Nurses
 Psychiatrists
 Pharmacists
 Family members
 Patient’s friends / support system
 The patient

TRUEPIC Situation


Situation: Nora Hill is a 24 year old patient with no previous medical conditions who states
she is “going mad with anxiety.” Her problem began when she was studying for her NCLEX.
Wanting to be able to pass her NCLEX the first time, she has been unable to cope with the
pressure of having to take it. When she gets to a new study section, she reports not knowing
where to start. She states that if she leaves a lot of questions unanswered, she begins to get
palpitations and shortness of breath. These symptoms have been getting worse over the last
month. Nora also says she has recently been drinking a glass of wine every night to calm her
nerves. She is not currently on any medications and does not want to be due to bad side
effects she has read about. She has been admitted for observation overnight
The nurse is a 25 year old BSN prepared RN and a recent graduate, who has just finished her
orientation for the unit.
TRUEPIC
1.IDENTIFY… The
variables in this
situation

24 yr old
female

No previous
medical history

Refusing
medications

Doesn’t want
any side
effects

Palpitations
and shortness
of breath

Pressure to
study for
NCLEX and
pass first time

Drinks a glass
of wine every
night

Calm nerves
3. UNDERSTAND…the importance
of the propositions, assumptions, and
confounding variables.
2. RELATE…Or put the variables together to form
propositions.
Primary Proposition: “Pt’s pressure to study for NCLEX
exam has increased causing palpitations and shortness of
breath.
Possible Assumptions: “Pt knows that if she does not pass
the NCLEX the first time, she can retake it a second time
Possible Confounding Variables: “Fear of taking any
medications due to possible side effects.”
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 side effects, she may be
reluctant to start any new medications
to help control her anxiety disorder.
Pt may not be able to drink a glass
of wine every night if put on certain
medications.”
TRUEPIC cont.
4. EXPLAIN…the significance of
the situation to those involved
based on their individual KSVME
Proposition: In a way that the
patient can understand, explain
what an anxiety attack is, signs and
symptoms, how to prevent or stop
one from happening and possible
complications from unresolved
attacks.
Assumptions: Explain 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. Explain that you are there
to support her.
5. PREDICT…what will happen in this situation if
one or more variables are not changed.
Proposition: If the pt’s anxiety foes not get
controlled, her symptoms may worsen and she
may begin to have thoughts of self harm which
then could lead to longer recovery
Assumptions: If the 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 for her
lifestyle.
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 means of
coping.
Confounding Variables: Make sure the pt
understands the psychiatrist is there for her
when she needs some medical help
regarding her anxiety and anti-anxiety pills.
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 cannot drink alcohol while in the hospital
Nursing Advocacy

Build a relationship
 Family
life
 Stressors

All patients are different, so it is important to treat
each patient individually
 Individualized
care plans
References


Current Nursing. (2011). Application of
interpersonal theory in nursing practice. Retrieved
from http://currentnursing.com/nursing_theory/a
pplication_Peplau's_interpersonal_theory.html
Melincavage, S.M. (2011). Student nurses’
experiences of anxiety in the clinical setting. Nurse
Education Today, 31, 785-789.
doi:10.1016/j.nedt.2011.05.007