Insomnia Nursing Diagnosis
Concept Analysis Of Anxiety
- I. Abstract
The paper is an examination of anxiety as a concept. This report began with a definition of the concept and some statistics surrounding the prevalence of anxiety among patients. Thereafter, the paper looked at observational traits of the disease. Thereafter, it was necessary to look at its occurrence in three different case studies; i.e. a typical case study with no other medical conditions, a contrary case study with other medical conditions and borderline case study where an individual registered two types of anxiety disorders. This paper will be useful in nursing education because it will contribute towards concept analysis, it will be insightful in research and management because it will provide new information about how to handle different conditions of the disorder.
A Definition and background
Anxiety is a condition in which an individual is in a constant state of worry or is always nervous regardless of normal actions. This state of anxiety eventually leads to anxiety disorders which are then regarded as emotional or psychological health conditions.
Anxiety and anxiety related disorders are one of the most common mental reasons for seeing medical professionals today. This is why recent statistics indicate that about a quarter of the country’s population have exhibited symptoms of anxiety disorders. It is a worrying trend for nursing practitioners specifically and for the medical profession in general because it signifies serious mental health problems. (Hayes & Strosahl, 2004)
One of the major reasons for these excessive occurrences is that society’s demands have changed. Today’s working environment is more demanding than ever before. Relationships are becoming increasingly difficult to maintain thus serving as fertile ground for propagating anxiety. Anxiety may occur in various forms. Sometimes, it may be exhibited as a mild case, in other scenarios, it can progress to become severe and can impede one’s day to day life. Anxiety usually manifests itself in the form of a series of disorders most of which include; phobias, generalized anxiety disorder, post traumatic stress disorder, obsessive compulsive disorder and separation anxiety disorder. Some of the latter mentioned forms exhibit more or less the same symptoms. Consequently, one can deal with them as distinct groups.
B Purpose of the analysis
The purpose of the analysis is to demystify anxiety as a clinical disease. The research will give some insights into various features of the concept. It will also examine the consequences of anxiety on patients. These will all be analyzed though the use of typical cases, non-typical cases and cases that lie in between. Additionally, the empirical referents relating to this concept (anxiety) will be examined in greater detail.
- III. Literature review
Fox (2001) asserts that the major characteristics in almost all persons who suffer from anxiety is the existence of fear. All individuals are faced with fear at one point or another in their lives. However, those who are controlled by it are said to be suffering from anxiety or anxiety disorders. (Craske and Barlow, 2003) This fear is so intense that it hampers the person from performing their daily obligations or roles.
In certain scenarios, anxiety may be manifested in the form of tension or anticipation about a certain issue. The latter form is mild. In other instances, anxiety may be exhibited by acute panic attacks. Bourne (2000) explains that the following physical symptoms are prevalent in a number of patients diagnosed with anxiety
- Loss of appetite
- Stomach upsets
- Lack of sleep
- Muscle aches
Besides these symptoms, acute cases of fear among patients with anxiety disorders may be depicted. For instance, certain individuals get panic attacks. When this occurs they may begin having a dry mouth, experience numbness in their bodies, difficulty breathing, chest discomfort, racing hearts, disorientation, low concentration spans, dizziness and unsteadiness. (Hoffman & Barlow, 1999)
Many writers also assert that the largest percentage of cases of anxiety are characterized by cognitive traits where cognitive refers to matters concerning the mind. When anxiety strikes, certain ideas or images are usually present in one’s mind. Usually, anxious individuals think that some danger may befall them or the person they care about. (Chorpita & Barlow, 1998) This is usually depicted as a phobia where an individual believes that something dangerous may happen to them even when the chances of its occurrence are quite slim. In order words, one of the major cognitive characteristics is possession of irrational thoughts. Such person usually distort actual facts and lack control over their thoughts. (Bourne, 2000)
It should be noted that these cognitive traits are not beyond the sufferer of the anxiety disorder. In fact, these patients are well aware of the excessiveness of their thoughts. However, they lack the ability to limit these excesses and usually continue thinking about the issue regardless of its irrationality.
Kearney et al (1997) claim that social phobias may occur when individuals fear circumstances surrounding social situations. For instance, one may assume that they can get embarrassed by interacting with others. Also, there may be a scenario in which one fears failure or garnering approval from one’s peers.
In panic attacks, Craske et al (1991) explain that when individuals get panic attacks, they are likely to imagine that they are on the verge of death, loosing control or going crazy. The latter authors have also highlighted the issue agoraphobic thoughts. Here, the individual under attack will usually operate under the fear of another panic attack and may require the presence of another individual in order to stop them. Also, such individuals usually assume that these are things that present constant danger in their lives.
Barlow and Lehman (1996) claim that obsessive compulsive thoughts are also another unique cognitive trait. Here, one cannot seem to stop the continuous thoughts about a certain issue which they are obsessed about. For instance, one may be constantly thinking of getting violent with another person or with oneself. Also, such persons may be obsessed about their daily responsibilities, religion, appearance, death, illness, germs, contamination and many other examples.
Campbell and Barlow (2000) explain that such persons with post traumatic stress disorder may be fixated with flashbacks on a traumatic event. Consequently, such person may have difficulties sleeping and may even report cases of night mares. Furthermore, it is possible to find that these people may blame themselves for the traumatic event.
Generalized anxiety disorders are usually manifested amongst people who have worries about general issues in their lives. For instance, such persons may worry about their financial situations, their health etc. (Bourne, 2000)
It should be noted that the latter forms of anxiety disorder are reflected differently depending on a number of demographic traits. For instance, age is an important factor because children’s forms of anxiety disorders are manifested in unique forms; some of them may be afraid of monsters in the closet or eyes watching them at night. Children may also express these anxieties in totally different manners from their adult counterparts. Gender is another important demographic trait. Women are more concerned with certain obsessions or thoughts in comparison to their male counterparts. Also, cultural influenced have a large part to play. Carske et al (1991) explain that what may be deemed as a critical issue in one society may be completely unimportant in another. Consequently, care must be taken to ensure that each and every case it treated uniquely.
Certain behavioral traits are synonymous with individuals as explained by Andrews et al (2003) The latter authors assert that some people may choose not to go to a certain place if there is likelihood that that place may have things which they are afraid of. Additionally, these authors explain that others may simply leave a certain place if they feel that they have been overwhelmed by those fears. In other words, this behavioral trait is known as avoidance. Most of the cases may be direct, however, avoidance can sometimes be quite complicated. In certain scenarios, it is possible to find that an individual repeats their actions from time to time. For instance, if someone is afraid of burglars, they may keep checking their door locks continually.
Elfert & Forsyth (2005) explains that avoidance as a behavioral characteristic can be a severe problem because it has a tendency to worsen the anxiety. Usually, this is one of the traits that make coping with anxiety disorders extremely difficult.
CPA (2004) asserts that almost fifty nine percent of anxiety cases may catapult into clinical depression if left untreated. This usually occurs when certain individuals let the problem progress for long periods of time. Usually, these people may feel powerless over their anxiety disorders. Consequently, they may develop feelings of hopelessness and frustration. Additionally, the ADAC (2003) add that it is common to find such persons developing a dependence on drugs or alcohol. Sometimes, such person may be looking for ways in which they can calm themselves down and this is usually achieved by the drugs. The latter association calls this self medication.
- IV. Observation
Sometimes, anxiety may be brought about by genetic factors. For instance, if one’s parent had anxiety disorders, then one’s chances of depicting anxiety disorders are also heightened. Genetic factors can explain the reason why identical twins posses this trait both at the same time. In fact, identical twins account for some of the highest cases of family related anxiety disorders. (Maisel, 2003)
Anxiety disorders are manifested by a series of cognitive behaviors, consequently, this implies that the brain could be an important antecedent to the condition. If normal brain functions have been hampered, then chances are that one might depict anxiety disorders and their symptoms. Also, is essential to remember that anxiety disorders can respond to medical treatment. Usually, these treatments target brain functions and it therefore denotes the fact that anxiety disorders are brought about by brain malfunctions.
One of the major antecedents to this problem is psychological. One’s personality has a large role to play in determining whether an individual will suffer from anxiety disorders or not. When an individual has poor social skills, then it is likely that they may be treated negatively in a number of situations and this may then people them into developing anxiety disorders. (Kaplan and Saddocks, 2003)
Additionally, some people may just have a low self esteem. If left unchecked, this can lead to anxiety because it causes them to have irrational fears about circumstances that do not solicit such fears in the first place. Usually, these people do no believe that they have the ability to carry out normal day to day function such as fending for their families. Consequently, such individuals develop anxiety disorders.
One of the most prevalent and common antecedents to anxiety disorders are related to life experiences. The following is summary of some of the situations that could trigger an anxiety disorder
- Susceptibility to illness
- Etc (Hayes, 2005)
It should be noted that the highest cases of anxiety disorder antecedents fall in the latter category. When a person has been subjected to sexual or violent abuse by a member of their family, then chances are that that person may live in constant fear of their attacker or the nature of their attack. Family abuse is one of the major causes of general anxiety disorders. Additionally, when a person has been a victim of violence .i.e. if they were attacked by an armed robber, then chances are that that person may develop an excessive fear of another attack. Consequently, this heightens the chances of developing an anxiety disorder. In addition to the latter it is also possible to find that those persons who have grown up in poverty are likely to manifest excessive fear of poverty related conditions.
B Attributes / characteristics/features
There are certain characteristics that depict mild forms of anxiety. In other words, they show that the disorder is still at its early stages. For instance, when a person is in the early stages of panic attacks, then they are likely to depict mild signs as sweating, chills or hot flashes.
If a person has a case of anxiety disorder manifested a phobia, then early stages of the condition may be depicted in a number of ways. When a person is in a situation that triggers the phobia, the person puts up with the situation but after undergoing a lot of stress. Also, early signs of phobias may be depicted when a person stays for a much shorter time than they should in a certain scenario. (Twamas and Bangi, 2003)
In cases where patients are suffering from agoraphobia, then early stages of anxiety can be depicted when that person finds it extremely difficult to interact with others or to conduct their daily obligations as a result of the fear of panic attacks. It should be noted that in the early stages it is usually possible to go about daily activities but with great difficulty.
For those suffering from obsessive compulsive disorder, then early stages of the disease can be manifested in cases where those respective individuals start thinking about certain issues. Usually, these thoughts may precede actions to cope with the anxiety. For instance, a person constantly thinks about the level of their cleanliness or the safety of their house.
In the middle stages of anxiety disorders, more severe symptoms start being exhibited. For those individuals with panic attacks, then the symptoms begin to be more dominant in this scenario, one might feel dizzy or nauseous. In certain circumstances, it is common to find that the person who suffers from such anxieties may begin feeling pain in the chest or register abdominal pains. These kinds of symptoms are indications that the disease is progressing at a fast pace. (CPA, 2004)
In the middle stages of a phobia, it is likely that the affected individual may avoid cases that case the phobia in certain instances and then endure those phobias in certain cases. For instance, if one has a social phobia, then they stop going to social gatherings but may still be able to do basic tasks such as going for shopping or gathering with family members. Also, if a person is suffering from the fear of other panic attacks, then that persons may only attend selected gatherings while skipping most of them.
If a patient has obsessive compulsive disorder, then the middle stages are usually depicted by certain rituals. In this case, the person now progresses from just thinking about the obsession to actually doing something about it. For instance, one may frequently check on the kitchen oven to find out if they had switched it off. Or they may keep washing their hands from time to time.
If a person has post traumatic stress disorder as a form of anxiety, then the middle stages of the conditions are usually characterized by a lack of sleep. In certain scenarios, that person may constantly be jittery or on guard because of fear of the event. For example, if a person was a victim of a burglary, then they may always be keeping vigil or having nightmares about the incident.
For those with general anxiety disorder, the middle stages are depicted by substance abuse such alcohol dependence, severe headaches, trembling, muscle tension and an overall avoidance of situations that can cause the issue as explained by Andrews et al (2003)
Late stages of anxiety disorders also differ depending on the type of anxiety which one suffers from. For those individuals with panic disorders then late stages are usually characterized by behavioral and cognitive traits. At this stage, patients may fear death or may think that they are going crazy. Also, these people may feel out of touch with the rest of the world and may retreat to their own ‘cocoons’. Some physical manifestations at such a point include shortness of breath, a chocking sensation, extreme beating of the heart or symptoms that resemble heart attacks.
Those who have phobias also depict certain peculiar characteristics at the late stage. For instance, one may stop doing any activity at all. Those with social phobias may never leave the house again. Also, those with agoraphobia may then spiral into depression thus being unable to do anything else or go on with their personal responsibilities as asserted by Craske and Barlow (2003).
In cases where an individual registers certain cases of obsessive compulsive disorder, then chances are that at the last stages, that person may increase the number of times which they perform their rituals. For instance, if one was obsessed about personal hygiene, then they may take three hours to prepare for work every day. Also, if someone was obsessed about safety, then they may increase the excessiveness of their security measures. Also in the late stages of the conditions, it is likely that a person will increase their dependence on drugs or substance abuse as a way of relieving their anxiety. (Elfet & Forsyth, 2003)
If a person had been diagnosed with post traumatic stress disorder, then it is likely that that person may exhibit cases of numbness or may seem detached from his or her surroundings. Consequently, such individuals may not be able to perform their day to day functions and may therefore have spiraled out of control. The late stages of this anxiety disorders can also be characterized by depression where the person feels that they have lost control of their lives.
If a person was suffering from generalized anxiety disorder and has reached their last stages, then that person is likely to spiral into depression. In certain circumstances, that person may begin recording other mental difficulties even when those difficulties had been non –existent before. Also, such a person my appear tired all the time, they may begin depending on drugs to cope with their anxiety and some of them may centre their lives around that thing that they worry about. For instance, if the anxiety is about finances, then everything their family does will be linked to finances and their need to conserve it.
The consequences of anxiety disorder vary from individual to individual and also depend upon what an individual did to cope with the anxiety. If an anxiety disorder is detected during earlier stages, then chances are that the person can deal with it either through pharmacology or psychological and thus curb the problem. However, if the person allows the situation to spiral out of control i.e. to reach its last stages, then anxieties can bring with it other mental health and social problems. For instance, it would cause drug abuse and hence dependence. Also, if a person is in their last stages, then they are likely to register depression.
It should be noted that one form of anxiety disorder can create other forms. For instance, panic attacks can eventually lead to phobias related to the attacks and failure to seek treatment may eventually lead to depression. Consequently, anxiety disorders are not mutually exclusive; they bring in other diseases that can cause tremendous harm to the individual under consideration. (Maisel, 2003)
Additionally, some of the symptoms associated with anxiety can lead to extreme cases, for instance, when one exhibits shortness of breath, then they may put themselves in greater danger by loosing control of their actions. This can lead to injury from secondary sources. Perhaps the worst consequence of anxiety disorders is that they can cause some brain malfunctions that eventually lead to mental breakdowns. In other scenarios, some persons may choose to commit suicide. However, the latter may usually occur when one chooses not to do anything about their earlier circumstances.
D Empirical referents
The first thing that needs to be done when tackling cases of anxiety disorder is accurate assessment and diagnosis. Here, there is a need to look at the symptoms that a certain patient may be suffering from. In other words, one analyzes the psychotic symptoms depicted by the patient. Additionally, it is necessary to look into the level of complexity of the symptoms. This also means that the level to which the anxiety disorder has impaired one’s functions should be assessed.
It is also necessary to look at the resources available to assist in the treatment process. This means that the family of the affected individual should be mobilized. Also, there should be an assessment of the financial resources required to provide the patients with adequate treatment.
In close relation to this, is the need to asses a patient’s risk of suicide. Because anxiety disorders can proceed to extreme levels i.e. when they have reached the last stages, then one ought to examine the likelihood of this occurrence. By doing this, then nursing practitioners will be ensuring that they have dealt with the most dangerous scenarios in subsequent order.
It is absolutely necessary for medical practitioners to ensure that there are no other mental health problems that exist aside from anxiety disorders. This is mostly as a result of the fact that most anxiety patients rarely have one single mental disorder. Likely cases include depression and alcohol abuse. (Maisel, 2003)
It is also essential for one to look for ways in which they can prevent possible occurrences of the same in the future. This means that nursing practitioners ought to monitor a patient’s response to treatment. If the treatment does not seem to be working i.e. the patient has relapsed, then it would be advisable for one to look for other avenues that can be used to treat the disease in the future. (Kaplan and Saddocks, 2003)
E Model case
The ideal example of an anxiety disorder can be depicted by the case of a thirty three year old man; George. George works in a car dealership businesses as a sales man. He has been doing relatively well in his job and is one of the most valuable workers in his company. However, George has been registering cases of insomnia where he may not sleep for three days on end. At other times, George may extreme a lot of tension in his muscles which subsequently leads to pain. He has also been exhibiting a lot of headaches over a long period of time.
Additionally, George has also explained that he worries a lot to the point that his friends call him the worrywart. He feels that he may not be able to secure a future for his family if he looses his jobs or if he passes away. Additionally, George worries about the security of his job. Being a sales man means that he constantly has to meet deadlines. Those deadlines will determine the amount of commission he gets and the reviews that he receives from his manager. George feels that in case he looses his job, he may not be able to secure another one that offers him generous financial rewards as the one he is currently holding.
Besides these symptoms, George has begun registering high blood pressure. He has been unable to cope with the pressure at work because he can no longer complete the work that he used to complete in the past. This means that he has not been able to meet his deadlines adequately. Additionally, George has recorded some heart palpitations that occur from time to time.
These are also symptoms of General anxiety disorder. (Kaplan and Saddocks, 2003)
However, in order to asses George critically for treatment, it is necessary to use a cognitive behavioral model shown below
No support from spouse
Meeting family responsibilities
Was abandoned by parent at early age and thus does not feel good enough
These issue will cause loss of family
These fears will case failure to family
The fears will cause an inability to take care of self
Symptoms: Racing mind, Exhaustion
Relies on medicine heavily
Gets constant reassurance from wife and work colleagues
Absent; temporary relief from avoidance
This case was handled by two-week treatment programs in which the misperceptions of danger were corrected, exposure response was adopted, the patient was taught skills to cope with anxiety symptoms, and he received supportive psychotherapy for dealing with the issues that impeded his success. After the plan, George began relying less on the medications, he also reduced the cases of sleep disorders and reported overall success in dealing with the symptoms of anxiety. (Elfet & Forsyth, 2003)
F Contrary case
Christine is a twenty eight year old lady who works as restaurant chef in a busy location. She is single mother who is raising a five year old son. She had been diagnosed with fragile syndrome X ever since her childhood. In other words, Christine is a rather shy person but is also very friendly. In certain instances when she has to meet a new person, Christine, cannot stare at a stranger’s eyes and usually greets people while looking at the floor or sideways.
Christine has always known that she is different from the rest. This is because she is extremely sensitive to people’s comments and they create anxiety within her. She constantly worries about her competence, acceptability and performance. This also implies that she is a highly sensitive person and would react very aggressively to comments made about her. Lately, her anxiousness has been increasing; she has been registering symptoms of panic attacks. ( Elfet & Forsyth, 2003)
Because Christine had a history of another disease, it was necessary to provide her with pharmacological treatment tailored for persons with fragile syndrome X. She started taking serotonin inhibitors and this assisted her in dealing with the anxiety symptoms.
G Borderline case
Timothy is a fist born among a family of three sons. His family has had a history of anxiety disorders. He began experiencing panic attacks five years ago. Two years after the panic attacks, he witnessed his father’s dead body at the scene of their real estate business. And this triggered a fear of blood, ill people or dead bodies. Hi symptoms were therefore manifestations of both post traumatic stress disorder and panic attacks hence a border line case.
Treatment involved a medical approach in which Timothy was given parlzolam. This was fact acting and assisted in eliminating the panic attacks. In order to deal with post traumatic stress disorder, he was exposed to violent movies at gradual paces. He saw horror films that gradually minimized the fear of dead bodies.
- V. Application to Nursing
The latter findings will be very insightful in nursing practice because they will pave the way for dealing with anxiety disorders in different forms. This research has merged nursing psychology with other aspects of the nursing course. Consequently, it will offer alternatives to conventional treatment. Additionally, the research will also be very helpful in demystifying treatment of anxiety disorders.
In nursing education, the paper will be useful in understanding how concept analysis can be conducted. Through the use of anxiety as a concept, this paper will serve as an example of how empirical referents, symptom analysis and other aspects of the paper can be applied to specific medical cases. (Maisel, 2003)
The paper will assist in nursing management because it will go long way in streamlining some of the courses of action that need to be taken when coping with mental patients. It will assist in improving the efficiency of nursing practice and also the speed of response. On top of the latter the paper will also go a long in applying systematic analysis to cases.
The paper has contributed to nursing research because it has provided new insights into anxiety and anxiety disorders as a disease. This work has contributed to nursing research because it has compared three scenarios of anxiety i.e. borderline, typical and peculiar cases and has thus brought out different ways of handling it.
The paper is a report of a concept analysis of anxiety. Anxiety is depicted through a series of symptoms that range from physical, cognitive to behavioral. Each stage of anxiety disorders is characterized by its own symptoms that usually progress with time. Consequently, when the condition is detected early enough, the patient has a better chance of recovering from it.
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Maisel, E. (2003): The Creative Person’s Path Through Depression; Rodale
Hayes, S. and Strosahl, K. (2004): A Practical Guide to Acceptance and Commitment Therapy; Springer
Hayes, S. (2005): Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy; New Harbinger Publications
Bourne, E. (2000): The Anxiety & Phobia Workbook; Harbinger Publications
Eifert, G. and Forsyth, J. (2005): Acceptance & Commitment Therapy for Anxiety Disorders; New Harbinger Publications.
Kaplan, T. and Saddocks, P. (2003): Synopsis of Psychiatry: Behavioural Sciences/ClinicalPsychiatry; Lippincott Williams and Wilkins
Iwamasa, G. & Bangi, A. (2003): Women’s Mental Health Research; Routledge
Andrews, G., Hunt, C., Crino, R., Creamer, M., Page, A. & Lampe, L., (2003): The treatment of anxiety disorders; Cambridge University Press
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