Anxiety, Anger And Depression in Nursing

I FEEL DEJECTED, The patient spoke out morosely. Nurse looked over at his miserable condition, and felt to deal with his anger, anxiety and depression. It is very interesting to conform with such cases, dealing with difficult emotions is a challenge for nurses in clinical setup. Emotion includes a widespread range of apparent behaviors and expressed feelings. According to West and turner (2009) emotion is the critical inner organization that orients us to and involves us with what matters in our lives: our feelings about ourselves and others.

As nurses are in the business of caring and health-giving. They have the ability to see the requirements of patients and help. But there are some patients in clinical setting that nurses find hard to deal with them. Nurses need to maintain a generous, attentive manner for every patient, But when the patient’s behavior is unsociable, For example feeling frustrated, anger, anxiety and depressive which makes them difficult to connect with people. These complications can come from the patient’s side as well as from the nurse’s side. If there is a patient who has some boundary issues, anger issues or anxiety and depression, on any day a patient can become difficult for nurses. So, Nurses must find a way around these kinds of issues to provide the finest care as a nurse.

According to Locsin and Purnell (2009) when the patient meet good nurses, patients relational comfort is elevated, negative emotions and discomforts are dismissed, and patients are enabled to deal with life positively. The patient will often try to share with the nurse that what he or she is feeling or how he or she is living the difficult life. Patient may be short of interest in health, feel ignored and neglected, Because of which he’s depressed and having aggression and anxiety. So, Nurses should identify the real parameters of the situation before the problem can worsen.

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Feeling of fear in an exam, going into hospital, beginning of a new job or entering into a new environment, feeling uncomfortable, In turn, these conditions can affect your sleep and ability to think and focus. Anxiety is a normal reaction to worrying or stressful situations. It affects a person’s whole being, how a person feel, how he or she behave. According to Stein et al. (2009) Anxiety is: “characterized by an un pleasant affective experience marked by a significant degree of apprehensiveness about potential appearance of further aversive or harmful events” (p.104). Anxiety can also be described as an unpleasant state of tension from dissatisfaction in personal relations (Columbus, 2008.). Anxiety may be caused by a physical and mental condition, the effects of drug or substance abuse or combination of these. In Fatemi and Clayton (2008) for some people, the depersonalization marijuana often provokes anxiety.

It has been observed at the clinical settings in hospitals that when a patient enters in the hospital environment for the routine checkup and suddenly doctor recommend him/her to get admitted in the hospital, at that time patient become anxious about his/her health. When patient got to know that he/she will be going for any surgical procedure and nurse is giving the pre-operating teaching, the anxiety level will be at its peak. In the light of an article, Allen et al. (2002) “Hospitalization for surgery is associated with increased anxiety” (p. 7). Raised anxiety levels also have clinical significance; they unfavorably impact on intra and post operative outcomes such as pain. In addition, it indicates that surgical anxiety and post-operative pain can be challenging for the patients.

Nurses do their best to ease patient stress and anxiety through a correct assessment, diagnosis and through care with patients. Nursing process includes a systematic assessment which is the initial step. First, nurses set up the anxious client’s opinion about the situation. This is accomplished by asking questions recently and listening carefully to the response. Anxiety is an experience which is subjective and cannot be directly observed. There are a lot of goals and outcomes appropriate for the patients for example: Identify situations when stress and anxiety increase. White (2005) emphasizes that nurses should meet the basic needs of the patients such as patients who are in pain, cold or hungry have higher anxiety levels. The nurse should in fact progress the potential for recovery by reducing patients anxiety. There are other methods also like: Minimizing the environmental stimuli. He also emphasizes on using the stress management techniques by nurses which includes exercise, done on the regular basis encouraged by the nurse. Furthermore, relaxation techniques can help patients to feel fine and relax; it includes guided imaginary activity and meditation. These techniques are useful in helping patients to relieve anxiety. Another way of reducing anxiety is “cognitive behavioral therapy”, It is defined in Norton (2012) the goal of CBT for anxiety is to help the patients with anxiety to re-orient his or her perceptions of dangerousness. Psycho education is a trans-diagnostic anxiety treatment described in his book, helps to correct the misconceptions about why he/she is experiencing the problems with anxiety.

Dealing with an angry patient is an uncomfortable condition for many health care practitioners. Austin and Boyd (2010) states that the “Anger is a strong, uncomfortable emotional response to a provocation that is unwanted and incongruent with one’s values, beliefs or rights.” (p. 884). Anger can be beneficial for patients. It gives a way to express false feelings or motivate you to find solutions. But extreme anger can cause complications. Increased blood pressure and other physical changes are connected with anger, which can harm your physical and mental health.

In reference to, Suls et al. (2010) anger is associated with greater psychosocial vulnerability for example increased interpersonal conflict, lack of social support and more stressful events. As it is discussed above in a clinical scenario that patient is going for a surgical procedure and that could be stressful event for the patient. Besides this, the post-operative pain can become a reason for the patient’s anger. Fishman (2009) states that: “Anger has been widely observed in people with chronic pain” (p. 753). It is also noted that, rejection of patients by nurses in the clinical setup is also a leading cause of patient’s anger and aggression. There are also cultural and religious beliefs from which this rejection is taking place, it should be avoided by nurses because it can create a barrier between a nurse and a patient, the patient care should not be compromised. The nurse should know about the cultural norms of patient to provide cultural competent care. According to Videbeck (2010) the rejection can lead to anger and aggression and it can be a threat to self-esteem of the patient.

Patient’s anger can be able to control by pharmacotherapy. It includes medications such as haloperidol and lorazepam, these drugs are commonly used for reducing the anger and psychotic symptoms. There are other many strategies which a nurse can adopt for anger management of patients. It is mentioned in Damon et al. (2012) One-to-one contact is an effective a strategy, nurse will assess the patients understanding about anger and patient’s perceptions about angry behavior. Patients who demonstrate no suffering from angry behavior may not ready to change or manage it. On the other hand, some patients will express and say that they want to cope with it and they want to learn coping skills. Patients who discuss their feelings, thoughts and triggers with nurse are more likely to be able to learn anger management techniques. Another strategy is to provide education about the emotion of anger, Nurse will identify the patient’s teaching needs and explain the purpose of anger, physiological sign or symptom that the patient may experience when angry and the importance of identifying the patient’s unique triggers and reactions to anger. By these strategies a nurse can help a patient to cope with anger and facilitate the patient in the continuity of healthy life.

Another challenging emotion is depression, which is linked to anxiety and anger. It is mentioned in an article Busch (2009) that research studies have shown the link between depression and anger have indicated either increase outwardly directed anger or increased degree of suppressed anger in patients with depression. Depression can be described as feeling sad, dejected or miserable. Steptoe (2006) defined Depression as “Condition that primarily entails a disturbance of mood; this affective disturbance is often characterized by a mood that s sad, hopeless, discouraged or simply depressed” (p. 299). A complex mixture of causes can lead to depression. The death of loved one, any financial issues or the stress of work can lead to depression. Disturbed sleep, interruption of body chemistry and illness can complex the problem. In psychoanalytic theories, according to Freud (1917) depression results from a fantasized or actual loss of an individual to whom the patient experienced ambivalent feelings.

In the management of depression, the ultimate goal is straight forward – To return from depression to a state of full health. Planning interventions for a client with depression can be done with optimism. Patients with depression can be stabilized by medications and different therapies that enable the patient to achieve a healthier life. Appropriate nursing interventions for patients with depression should be taken, such as assistance in meeting basic needs of the patient. It is stated in (Shives, 2008, p. 341) “The severity of the client’s symptoms directly influences the degree of importance of physical care”. Nurse’s assistance in hygiene, grooming and selection of appropriate attire is necessary and also evaluate the patient’s rest and activity. Likewise, medication management and observing for adverse effects is a challenging intervention for nurses. Patients who are new to anti-depressants are at greater risk of discontinuing their medication from which the depression can become more compound.

In conclusion, the stability of emotions is essential in daily life for every human being. Even though, these emotions help in the survival. People can express their feelings to others by the help of emotions but on the other hand, it can create a huge change in life. In today’s world, emotional instability is common among people around the world which lead them to some severe psychiatric illness. As we are in nursing profession and we work for the well-being of people, we should be aware about some provoking factors. We should approach the patient holistically and should not feel reluctant to assess the emotional status of patients under our care. A nurse’s duty is to be competent enough to provide the finest care. There are numerous effective strategies for the patients which should be in-cooperate, some of them are discussed in the paper above. Hence, it is must to deliver a patient centered holistic approach in every clinical setting to facilitate the continuity of a healthy life.

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