Anxiety is one of the most frequently encountered psychological nursing diagnoses in both hospital and community settings. Patients experiencing anxiety exhibit emotional distress, worry, or fear that may or may not be related to a real threat. In clinical nursing practice, anxiety greatly influences patient behavior, decision-making, and physiological responses, thereby affecting the success of treatment, cooperation with medical procedures, and overall patient outcomes.
Understanding how to assess, diagnose, and manage anxiety is crucial for nurses. This article provides a complete explanation of the NANDA nursing diagnosis for anxiety, including its definition, levels, characteristics, related factors, nursing interventions, outcomes, and examples of nursing care plans.
What Is Anxiety in Nursing?
According to NANDA International, anxiety is defined as:
"A vague, uneasy feeling of discomfort or dread accompanied by an autonomic response (the source often non-specific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting signal that warns of impending danger and enables the individual to take measures to deal with the threat."
Anxiety is a universal human experience. It can be adaptive—motivating individuals to seek solutions or protect themselves from harm. However, excessive or persistent anxiety may impede functioning and lead to pathological conditions that require intervention.
Understanding Anxiety in Nursing Practice
In healthcare settings, anxiety may arise from illness, hospitalization, unfamiliar environments, loss of control, or fear of diagnosis and procedures. Nurses must identify signs of anxiety early, provide emotional support, and implement strategies that promote coping and psychological comfort.
Every patient's response to anxiety is unique. While some individuals channel anxiety into improved performance, others become overwhelmed and unable to cope. Therefore, personalized nursing interventions are essential.
Levels of Anxiety
Anxiety is categorized into four distinct levels. Understanding these levels helps nurses determine the severity of the patient's condition and select appropriate interventions.
1. Mild Anxiety
- Enhances perception and alertness
- May improve motivation and performance
- Symptoms include slight restlessness or irritability
2. Moderate Anxiety
- Narrowed perceptual field
- Difficulty concentrating
- Increased heart rate and respiratory rate
3. Severe Anxiety
- Greatly reduced perceptual field
- Inability to focus or problem-solve
- Physical symptoms: trembling, nausea, hyperventilation
4. Panic Level Anxiety
- Loss of rational thought
- Disorganized behavior or immobility
- A medical emergency requiring immediate intervention
Nursing Diagnosis for Anxiety
Official NANDA Diagnosis: Anxiety
Definition: A state of uneasiness and apprehension related to an actual or perceived threat.
Domain: Coping/Stress Tolerance
Class: Coping Responses
Defining Characteristics of Anxiety
These signs and symptoms help confirm the diagnosis:
Physiological Characteristics
- Increased blood pressure, pulse, and respirations
- Dizziness or light-headedness
- Perspiration
- Frequent urination
- Flushing and palpitations
- Dyspnea or shortness of breath
- Dry mouth
- Headaches, nausea, or diarrhea
- Tremors or restlessness
- Pupil dilation
- Insomnia or nightmares
- Feelings of helplessness and discomfort
Behavioral Characteristics
- Crying or expression of fear
- Difficulty concentrating
- Preoccupation or rumination
- Inability to problem-solve
- Social withdrawal
- Verbalization of inadequacy or helplessness
Related Factors of Anxiety
Anxiety may stem from internal or external stressors, including:
- Threats to emotional or physical well-being
- Intrusive diagnostic procedures (e.g., MRI, biopsy)
- Changes in role or identity (retirement, disability)
- Hospitalization or unfamiliar environments
- Interpersonal conflicts
- Financial difficulties or job loss
- Chronic illness or fear of death
- Maturational crises (puberty, menopause, aging)
NOC Outcomes (Nursing Outcomes Classification)
Suggested goals for patients diagnosed with anxiety:
- Anxiety Control – Patient demonstrates reduced anxiety signs and symptoms
- Coping – Patient uses appropriate coping strategies in stressful situations
NIC Interventions (Nursing Interventions Classification)
Recommended nursing interventions include:
- Anxiety Reduction: Teach relaxation and deep breathing techniques
- Presence: Stay physically close to the patient to decrease feelings of isolation
- Calming Techniques: Guide patient through mindfulness, meditation, or controlled breathing
- Emotional Support: Encourage verbalization of feelings and validate patient concerns
Nursing Interventions for Anxiety
Therapeutic Interventions
- Maintain a calm, reassuring presence
- Use clear, simple language
- Encourage expression of fears and concerns
- Limit external stimuli in severe anxiety
- Teach relaxation, guided imagery, and progressive muscle relaxation
- Encourage problem-solving and decision-making
Pharmacological Interventions
- Benzodiazepines for short-term relief
- SSRIs for chronic anxiety disorders
- Monitor for side effects and dependence
Family and Social Support Interventions
- Include family members in the care plan
- Provide education about anxiety triggers
- Encourage social connectedness
Example Nursing Care Plan for Anxiety
- Nursing Diagnosis: Anxiety related to unfamiliar hospital environment, evidenced by restlessness and frequent questioning.
- Goal/Outcome: Patient will verbalize reduced anxiety and demonstrate use of coping strategies within 48 hours.
- Interventions: Provide emotional support, educate patient about procedures, teach breathing exercises.
- Evaluation: Patient reports feeling calmer and shows willingness to engage in treatment.
Expected Patient Outcomes
- Patient recognizes early signs of anxiety
- Patient describes reduction in anxiety levels
- Patient demonstrates positive coping mechanisms
- Patient engages effectively in treatment decisions
Conclusion
Anxiety is a common and significant nursing concern that affects patients’ physiological, emotional, and behavioral functioning. Early identification and intervention are key to preventing escalation to severe or panic-level anxiety, which can compromise treatment adherence and recovery. By applying evidence-based nursing interventions, providing reassurance, and promoting effective coping strategies, nurses play a fundamental role in reducing anxiety and enhancing patient well-being.
A deep understanding of anxiety not only improves patient outcomes but also strengthens nurse-patient relationships, fosters trust, and supports holistic patient care.
References
- NANDA International. Nursing Diagnoses: Definitions and Classification
- Potter & Perry. Fundamentals of Nursing
- American Psychiatric Association (APA). Anxiety Disorders
- Elsevier Clinical Skills Database
- World Health Organization (WHO) – Mental Health Guidelines
