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Adult Nursing PracticeUsing evidence in care$
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Ian Bullock, Jill Macleod Clark, and Joanne Rycroft-Malone

Print publication date: 2012

Print ISBN-13: 9780199697410

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199697410.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2022. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use.date: 28 May 2022

Managing Anxiety

Managing Anxiety

(p.225) 14 Managing Anxiety
Adult Nursing Practice

Sarah Kendal

John Baker

Oxford University Press

This chapter explores anxiety, providing a clinical description of its impact on patients with guidance for evidence-based assessment and management. Anxiety has a defined physiological mechanism and merits a planned management approach. Every nurse should possess the knowledge and skills to identify patients with and/or at risk of anxiety, to select and implement evidence-based strategies to manage anxiety, and to review the effectiveness of these to inform any necessary changes in care. It can be useful to think of most mental and emotional phenomena as being a combination of four systems: autonomic, behavioural, cognitive, and environmental (Box 14.1). Emotions that we experience, such as happiness, sadness, anxiety, and anger, depend on how the systems interact with each other. These four systems combine to form a common model in mental health, known as the ABC-E model of emotion (Briddon et al., 2008) (also see Chapter 8), which will be used as a framework for the chapter. An ABC-E-based assessment helps to clarify nursing interventions in each one of these four areas. An intervention in one of these systems can often help to alleviate distressing emotions. A commonly used classification system for mental disorders is the International Classification of Diseases version 10 (ICD-10) (World Health Organization (WHO), 2010). An alternative classification system is the Diagnostic and Statistical Manual of Mental Disorders (DSM) (American Psychiatric Association, 1994). The main types of anxiety are listed in Box 14.2. Many features of anxiety disorder also present in the patient who is agitated. Agitation is a form of anxiety that can raise particular concerns about safety. As illustrated in Table 14.1, the main difference is in the cognitive and behavioural domains, i.e. what the person is thinking and doing. The descriptions in Table 14.1 apply to anxiety as a clinical problem, as in the case of David, whose story is described in Case study 14.1. The difference between non-clinical and clinical anxiety is explained in the ‘Making a clinical assessment’ section. There are other approaches to defining anxiety.

Keywords:   acute stress reaction, biopsychosocial approach, childhood adversity, emotion models, paroxetine, therapeutic relationship, venlafaxine, wellness–illness continuum

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