Anxiety. It is such a broad term and defined very differently by different people. Anxiety in homecare is often missed as a core reason outcomes are not realized. Anxiety can prevent the patient from moving successfully towards healthier living and adversely control the outcome. Let’s take a look at anxiety and what it means for your patient.
Anxiety Disorder vs. Anxiety:
The Mayo Clinic describes anxiety disorders involving repeated episodes of intense anxiety that peak within minutes in the form of panic attacks. After decades of reading homecare documentation, it is easy to see that anxiety controls outcomes much more than we currently realize. In the article, the Mayo Clinic speaks directly to those with anxiety disorders. The question is whether or not we in homecare address anxiety as a key factor in how we move forward with care planning. Someone doesn’t have to have a diagnosed panic disorder to suffer anxiety. As nurses and therapists, we can’t diagnose, but we can cue in to sensing signs and symptoms. It also means we need to think a little more about how we approach the patient when we talk about anxiety. It can be very tough for a patient to distinguish it based upon how it manifests itself.
The Scary Part of Anxiety:
- Feeling nervous, restless or tense
- Having a sense of impending danger, panic or doom
- Having an increased heart rate
- Breathing rapidly (hyperventilation)
- Feeling weak or tired
- Trouble concentrating or thinking about anything other than the present worry
- Having trouble sleeping
- Experiencing gastrointestinal (GI) problems
- Having difficulty controlling worry
- Having the urge to avoid things that trigger anxiety
The scary part here is the fact that all these symptoms can be associated with some other issue. Sometimes recognizing a physical symptom as a manifestation of anxiety is tough. Someone may have a rapid heart rate and feel afraid, but not be able to say why. Or, a patient may experience a panic attack but state they don’t feel “nervous” about anything. This is what makes anxiety so tricky. As clinicians, we often speak of anxiety as if all patients understand what anxiety really is. Also, if the clinician has never experienced episodes of true anxiety, it may be difficult to recognize. The important thing is to recognize that a rapidly beating heart or hyperventilation may have absolutely nothing to do with the heart.
Let’s Talk About Blood Pressure:
I am going to speak directly about an elderly patient who was plagued with ongoing blood pressure fluctuations. All kinds of different med combinations and nothing really worked very well over a period of years prior to homecare. In spending more time with the patient, he spoke of the men in his family and how his father and uncle both died young. One is his early 60’s and one in his early 70’s. Now, as this patient was approaching the age his father was when he passed, the nurse began to see some of his physical blood pressure issues centered around anxiety. This led to coordination with the patient’s physician and a decision to try very low dose valium. The patient was not happy about the medication as he considered only that it was a blood pressure issue. After much consultation, he did begin to use the valium once in the morning and once at night. Then, as things settled, he was able to drop to only one time per day and eventually it is only used as needed. The difference today is that he has more insight as to his anxiety and how to get on top of it before it is out of control. At that point, his blood was maintained without any significant medication changes.
Ok, So What Next?
At Kenyon Homecare Consulting, we know that trying to address everything in the complexity of patient care is tough. Clinicians are dealing with OASIS, Outcomes, documentation, patient care, coordination of care, and productivity requirements. We work with agencies to put the financial and clinical care together in a way that maximizes outcomes for patients and helps agencies remain financially viable. Call us at 206-721-5091 or contact us online to see how we can help with education, processes, or direct patient services.