Anxiety/Fear — AIDS

Nursing Diagnosis: Anxiety/Fear

May be related to

• Threat to self-concept, threat of death, change in health/socioeconomic status, role functioning
• Interpersonal transmission and contagion
• Separation from support system
• Fear of transmission of the disease to family/loved ones

Possibly evidenced by

• Increased tension, apprehension, feelings of helplessness/hopelessness
• Expressed concern regarding changes in life
• Fear of unspecific consequences
• Somatic complaints, insomnia; sympathetic stimulation, restlessness

Desired Outcomes

• Verbalize awareness of feelings and healthy ways to deal with them.
• Display appropriate range of feelings and lessened fear/anxiety.
• Demonstrate problem-solving skills.
• Use resources effectively.

Nursing Interventions	Rationale
Assure patient of confidentiality within limits of situation.	Provides reassurance and opportunity for patient to problem-solve solutions to anticipated situations.
Maintain frequent contact with patient. Talk with and touch patient. Limit use of isolation clothing and masks.	Provides assurance that patient is not alone or rejected; conveys respect for and acceptance of the person, fostering trust.
Provide accurate, consistent information regarding prognosis. Avoid arguing about patient’s perceptions of the situation.	Can reduce anxiety and enable patient to make decisions/choices based on realities.
Be alert to signs of denial/depression (e.g., withdrawal; angry, inappropriate remarks). Determine presence of suicidal ideation and assess potential on a scale of 1–10.	Patient may use defense mechanism of denial and continue to hope that diagnosis is inaccurate. Feelings of guilt and spiritual distress may cause patient to become withdrawn and believe that suicide is a viable alternative. Although patient may be too “sick” to have enough energy to implement thoughts, ideation must be taken seriously and appropriate intervention initiated.
Provide open environment in which patient feels safe to discuss feelings or to refrain from talking.	Helps patient feel accepted in present condition without feeling judged, and promotes sense of dignity and control.
Permit expressions of anger, fear, despair without confrontation. Give information that feelings are normal and are to be appropriately expressed.	Acceptance of feelings allows patient to begin to deal with situation.
Recognize and support the stage patient/family is at in the grieving process.	Choice of interventions as dictated by stage of grief, coping behaviors
Explain procedures, providing opportunity for questions and honest answers. Arrange for someone to stay with patient during anxiety-producing procedures and consultations.	Accurate information allows patient to deal more effectively with the reality of the situation, thereby reducing anxiety and fear of the known.
Identify and encourage patient interaction with support systems. Encourage verbalization/interaction with family/SO.	Reduces feelings of isolation. If family support systems are not available, outside sources may be needed immediately
Provide reliable and consistent information and support for SO.	Allows for better interpersonal interaction and reduction of anxiety and fear.
Include SO as indicated when major decisions are to be made.	Ensures a support system for patient, and allows SO the chance to participate in patient’s life. Note: If patient, family, and SO are in conflict, separate care consultations and visiting times may be needed.
Discuss Advance Directives, end-of-life desires/needs. Review specific wishes and explain various options clearly.	May assist patient/SO to plan realistically for terminal stages and death. Note: Many individuals do not understand medical terminology/options,
Refer to psychiatric counseling (e.g., psychiatric clinical nurse specialist, psychiatrist, social worker).  Provide contact with other resources as indicated, e.g.: Spiritual advisor; Hospice staff.	May require further assistance in dealing with diagnosis/prognosis, especially when suicidal thoughts are present.  Provides opportunity for addressing spiritual concerns. May help relieve anxiety regarding end-of-life care and support for patient/SO.