All About Nursing · Hospice & Palliative Care

Anxiety, Depression, Caregiver Burnout, Grief, Anger, Frustration in End of Life Care


  • According to the DSM-5, anxiety disorders are those that share features of excessive anxiety and fear with related behavioral disturbances.
  • These disorders differ from normal fear and anxiety in their being excessive and persisting beyond developmentally appropriate periods, typically lasting 6 months or more
  • Types of anxiety:
    1. Separation anxiety – anxiety or fear about separation from an attachment figure
    2. Selective mutism- consistent failure to speak in social situations
    3. Social anxiety – fear or anxiety about social interactions or situations
    4. Panic disorder -recurrent panic attacks
    5. Phobias- fear of a specific object or situation
    6. Generalized anxiety disorder- persistent or excessive anxiety and worry about various domains.
  • Treatment:
    • Nonpharmacological interventions
      1. Establish a trusting relationship
      2. Be aware of any anxiety that you as a nurse may have that may be picked up on
      3. Do not leave a person experiencing an anxiety disorder exacerbation alone
      4. Maintain a calm, nonthreatening, manner-of-fact approach
      5. Keep stimuli minimized
      6. Use simple words and brief messages that are calmly and clearly explained
      7. Discuss the reality of the situation
      8. Include person on decision-making to feel more in control
      9. Encourage exploration of underlying feelings that contribute to irrational fears
      10. Teach and reinforce stress management /relaxation techniques
    • Pharmacological interventions
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​Generalized Anxiety Disorder (GAD)

Prevalence of GAD

​Generalized Anxiety Disorder (GAD) is one of the most common mental illness in the United States encountered by primary care physicians (ER, 2015). Anxiety may be normal in day to day life because people may worry about things like health, family, money, work, and other things. However, individuals with GAD may feel worried excessively or feel nervous about certain things even if there is no reason to (ER, 2015). People with GAD often find it difficult to control their anxiety and stay focused on daily tasks. Despite all these, GAD can still be treated.

​The 12-month prevalence for GAD is 3.1% of US adult population according to the National Institute of Mental Health (NIH, 2018). Again 3.5% of these cases are classified as severe, however, no data is reported on gender distribution of the condition. 12-month Healthcare Use is 43.2% of the patients with the disorder, and 43.7% of those receiving treatment receives less adequate treatment, and this represents 18.9% of those with the disorder (NIH, 2018).

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Anxiety / Reading and Sharing

Anxiety can be normal from time to time, but excessive ongoing anxiety and worry that someone might have difficulty in controlling and interfere with day-to-day activities may be a sign of generalized anxiety disorder (Mayo Clinic Staff, 2018, p. 1). This disease is a chronic condition with exacerbations and suicide risk is higher than in the general population.


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