Care plans are a way to strategically approach and streamline the nursing process. This guide includes two examples of nursing care plans for anxiety disorders that you can use. One will cover a nursing care plan for generalized anxiety disorder and the other is one nursing care plan for ineffective coping
Example 1 Nursing Care Plan for Anxiety Disorder
Nursing diagnosis: Anxiety related to the situational crisis, a threat to or change in health status, socioeconomic status, role functioning, a recurrent disorder with continuing pain, inadequate relaxation, little or no exercise, inadequate coping methods
Possibly evidenced by
Apprehension, uncertainty, helplessness
Expressed concerns regarding changes in life events
Verbalization of inability to cope
Muscular tension, general irritability, restlessness; insomnia, fatigue
Inability to meet role expectations
Desired Outcomes/Evaluation Criteria—Client Will
Anxiety Self-Control
Appear relaxed and report anxiety is reduced to a manageable level.
Identify ineffective coping behaviors and consequences.
Assess the current situation accurately.
Demonstrate effective problem-solving skills.
Develop plan for necessary lifestyle changes.
Nursing intervention with rationale
1. Assess level of anxiety. Determine previous coping strategies. Help client identify strategies to address current perceived or actual problems.
Rationale: Aids in identifying strengths and skills that may help client deal with current situation and enable others to provide appropriate assistance.
2. Provide accurate information and honest answers.
Rationale: Honest answers and accurate information facilitate development of rapport. These enable the client to use own experiences and knowledge to make decisions.
3. Provide opportunity for expression of concerns, such as possible permanent nerve damage, paralysis, effect on sexual ability, changes in employment, finances, and altered role responsibilities.
Rationale: Open communication promotes client realization of short- and long-term implications of current condition and can promote coping with situation.
4. Assess presence of secondary gains that may impede recovery.
Rationale: Client may unconsciously experience positive reinforcement, such as attention, control of others, and relief from responsibilities. These need to be recognized and addressed positively to promote recovery.
5. Note behaviors of SO that promote “sick role” for client.
Rationale: By relieving the client from roles and responsibilities or not allowing the client to perform optimal level of function, the SO may unconsciously enable client to remain dependent.
6. Refer to appropriate support groups, social services, financial or vocational counseling, and marital therapy or psychotherapy, as appropriate.
Rationale: These services provide support for promoting coping and adaptation to life changes.
One will cover a nursing care plan for generalized anxiety disorder and the other is one nursing care plan for ineffective coping
Example 2: Nursing Care Plan Anxiety – Ineffective coping
3. Nursing Diagnosis ( Nursing Care Plan Anxiety )
Ineffective coping ( Nursing Care Plan Anxiety )
related to
- Underdeveloped ego; punitive superego
- Fear of failure
- Situational crises
- Maturational crises
- Personal vulnerability
- Inadequate support systems
- Unmet dependency needs
evidenced by
- Ritualistic behavior
- Obsessive thoughts
- Inability to meet basic needs
- Inability to meet role expectations
- Inadequate problem solving
- Alteration in societal participation
Goals
Short term Goal
Within 1 week, the client will decrease participation in ritualistic behavior by half
Long term Goal
By the time of discharge from treatment, the client will demonstrate an ability to cope effectively without resorting to obsessive-compulsive behaviors or increased dependency.
| Interventions | Rationales |
| Assess client’s level of anxiety. Try to determine the types of situations that increase anxiety and result in ritualistic behaviors. | Recognition of precipitating factors is the first step in teaching the client to interrupt the escalating anxiety. |
| Initially meet client’s dependency needs as required. Encourage independence and give positive reinforcement for independent behaviors. | Sudden and complete elimination of all avenues for dependency would create intense anxiety on the part of the client. Positive reinforcement enhances self-esteem and encourages the repetition of desired behaviors. |
| At the beginning of treatment allow plenty of time for rituals. Do not be judgmental or verbalize disapproval of the behavior. | To deny the client this activity may precipitate a panic level of anxiety. |
| Support client’s efforts to explore the meaning and purpose of the behavior | The client may be unaware of the relationship between emotional problems and compulsive behaviors. Recognition is important before change can occur. |
| Provide a structured schedule of activities for the client, including adequate time for completion of rituals. | The structure provides a feeling of security for the anxious client. |
| Gradually begin to limit the amount of time allotted for ritualistic behavior as the client becomes more involved in unit activities. | Anxiety is minimized when the client is able to replace ritualistic behaviors with more adaptive ones. |
| Give positive reinforcement for nonritualistic behaviors. | Positive reinforcement enhances self-esteem and encourages repetition of desired behaviors (Nursing Care Plan for anxiety disorder) |
| Encourage recognition of situations that provoke obsessive thoughts or ritualistic behaviors. Explain ways of interrupting these thoughts and patterns of behavior (e.g., thought-stopping techniques, relaxation techniques, physical exercise, or other constructive activity with which the client feels comfortable). |
