Introduction
Anxiety disorder has become one of the most common health conditions not only in the United States but also in many other countries around the world. According to Remes, Brayne, Linde, and Lafortune (2016), “Anxiety disorders, defined by excess worry, hyper-arousal, and fear that is counterproductive and debilitating, are some of the most common psychiatric conditions in the Western world,” (p. 1). It is normal for one to be anxious over an issue, especially when faced with a new challenge. However, the condition is considered a disorder when it becomes chronic. Under normal circumstances, a person should no longer be anxious when the trigger is eliminated. For those who suffer from various forms of anxiety disorder, the fear or worry becomes chronic and sometimes paralyzing, making it impossible for them to undertake normal tasks. They become dysfunctional, which only exacerbates their condition (Hantsoo & Epperson, 2017). The most common types of anxiety disorders include generalized anxiety disorder, social anxiety disorder, specific phobia, panic disorders, post-traumatic stress disorder, and obsessive-compulsive disorder (Hellwig & Domschke, 2019). Each of these conditions manifests themselves in different ways.
Early diagnosis and management of these conditions may help an individual to overcome these mental health problems before they can degenerate into more serious problems. Scott (2020) explains that the biggest challenge is that most of these conditions are rarely diagnosed at the right time. In most cases, patients with these conditions do not even realize that they have a medical problem that may need the attention of a specialist. They feel that it is normal to worry over specific issues in life. As such, they rarely seek medication until such a time when they become paralyzed with fear. According to a report by Yasgur (2018), women are more likely to suffer from anxiety disorders than men. The trend is attributed to socio-cultural and economic factors that tend to disfavor women and biological factors such as regular menstrual pains, fatigue associated with pregnancy, and labor pain. They need support and proper management of these conditions to help them overcome the pain. A family nurse practitioner has a major role to plan in the management of anxiety among adult women. This paper focuses on the management of anxiety in adult women and the role of the family nurse practitioner.
Operational Definitions
It is necessary to provide operational definitions of the teams and phrases used in this report. Anxiety refers to excessive worry or fear of something in a way that impedes the ability of a person to function normally. People with anxiety disorder tend to overreact when exposed to the slightest trigger factor (Lim, Kangas, & Bergman, 2018). Such individuals tend to be hypersensitive and may also suffer from emotional imbalance. In this paper, adult women refer to females who are over 22 years. Although the age of the majority is 18 years in the United States and many other countries in the world, Ackerman (2020) explains that most Americans under 22 years still depend on their parents because of the long time taken in school. The study was focused on independent women who are either in marriage or living independently. A family nurse practitioner, as defined by Tredway (2020), refers to “graduate-educated, nationally certified, and state-licensed advanced practice registered nurses (APRNs) who care for medically stable patients across age groups, including infants, adolescents, adults, and seniors.” In this study, the focus was to explain the role that these nurses play in the management of anxiety among adult women. Anxiety management refers to the deliberate process of addressing excessive fear or worry that a person has towards something to enable them to lead a normal life.
Health assessments conducted by different scholars show that there is an upsurge of anxiety among women in the United States. The increasing cost of living, divorce, challenges in marriage, work-related stress, and medical problems are some of the leading causes of anxiety among women in the United States. The current COVID-19 pandemic is likely to worsen the already bad situation as the country is expected to go through economic turmoil, with many people losing their jobs. A Master of Science in Nursing (MSN) has a major role to play in addressing the problem. It provides a platform for family nurse practitioners furthering their education to conduct further research on anxiety among adult women and how the medical condition can be managed. It empowers nurses to offer a wide range of services to patients suffering from this condition. The researcher has a personal and professional interest in this issue. As an MSN student, it is expected that the researcher will encounter cases where care has to be offered to an adult woman suffering from an anxiety disorder. Knowledge gained through this research will be crucial in the future of a researcher as a family nurse practitioner.
Background and Significance
Anxiety disorder is currently one of the major medical concerns in the United States. One can suffer from different types of anxiety disorder depending on the primary cause. Some of the most prevalent anxiety disorders include social anxiety disorder, specific phobias, generalized anxiety disorder, post-traumatic stress disorder, and obsessive-compulsive disorder (Cardany, 2018). Studies have suggested that the problem is becoming more prevalent in the country. Lipschitz et al. (2018) reports that “anxiety is the most prevalent form of mental illness in the United States, and that approximately 25% of people will develop an anxiety disorder at some point,” (p. 215). The problem could be worse than what is currently reported because a significant number of those who are affected suffer in silence. The current outbreak of the COVID-19 pandemic is already associated with massive stress among most Americans.
Most of those who suffered from various forms of anxiety often had support from friends and family (Milev et al., 2016). However, the statewide lockdown has eliminated social interactions, which is most likely going to lead to further emotional pain among many people in the country. It is not clear how the problem is likely to affect the country when a solution is developed, but it is apparent that many people may lose their jobs, their homes, and the dream they had of a better future. As such, it is possible that anxiety may become more common in the country than it has ever been. As has always been the case, women are more likely to be the worst affected group. According to a report by Sarris (2018), the majority of single-parented families in the United States are headed by women, and about a third of these families live in poverty. Some have to rely on food stamps and other government-sponsored relief programs to have access to basic needs. As such, women are the most vulnerable to anxiety disorder but they play the biggest parenting role in the country.
It is important to understand the significance of the problem and the reasons why it is important to address it. According to Ravindran et al. (2016), a major medical problem can only be addressed if there is adequate knowledge about it. A family nurse practitioner can only help adult women to manage their anxiety if they understand the nature of the problem, its primary causes, and ways in which it can be managed. Blaskovits, Tyerman, and Luctkar-Flude (2017) note, “Chronic illness is a substantial global burden, with the World Health Organization (WHO) reporting that 38 million of 56 million deaths worldwide in 2012 were due to non-communicable, or chronic illness” (p. 1765). The problem with anxiety disorders is that it burdens the country in two major ways. First, the government has to spend resources to ensure that those who are suffering from the condition are given proper medical care. As the number of Americans who suffer from anxiety continues to increase, the demand for nurses and other medical practitioners increases, which translates to increased government expenditure in the healthcare sector. This mental condition also renders the affected individuals less capable of undertaking normal duties. They become unproductive at a time when they are expected to provide for their families. Such patients will either rely on their families or the government for basic support.
Review of Literature
Method
The review of literature focused on understanding anxiety management in adult women and the role of the family nurse practitioner through the lens of other scholars who have conducted investigations in this field. The methodology that the researcher used in the literature review involved collecting journal articles and books from various databases such as PubMed, CINAHL, Medline, and NCBI. Other important databases included Anxiety and Depression Association of America (ADAA), American Family Physician, Frontiers in psychology, EMBASE, Cochrane Library, EBSCO, and PsycINFO. Some of the keywords and phrases used in identifying the materials in these online databases include anxiety, fear management, phobia, mental health problems, anxiety in women, managing anxiety, and the role of the nurse in managing anxiety, psychotherapy, primary care, education, and recovery program. The search yielded over 1,314 articles and books published from 2015 to 2020. They were further screened and narrowed on the basis of the relevance of their topic and the design used. The screening process identified about 120 sources relevant to the study. Using parameters such as the targeted population, measurability of the outcome, and sample size, the researcher narrowed down the number of sources further to 45. These articles were considered effective in addressing issues relevant to this study.
Findings
Studies have shown that it is normal for an individual to be anxious from time to time, especially when faced with something new. It may be a problem at work, handling a new assignment, meeting a new group of people, or even when one has just been promoted to a more demanding assignment. However, such anxieties are often resolved within a short time and one can continue with normal life activities. Anxiety disorder comes when such fears paralyzed the ability of a person to undertake normal duties (Parikh et al., 2016). In some cases, one may suffer a nervous breakdown at a time when one is expected to undertake a major responsibility. Mental illness makes it almost impossible for an individual to lead a normal life. They face constant and overwhelming fear of the unknown, and often need medical management to overcome the problem. It is necessary to look at the different types of anxiety disorders before focusing on how they affect women and the ways in which they can be managed.
Types of Anxiety Disorders. Anxiety disorder is a medical problem that defines different conditions. Panic disorder is one of the most common anxiety disorders. Lam et al. (2016) explain that those who suffer from this condition feel terror, which strikes randomly. During such a time, a person may end up sweating, having chest pain, and sometimes a strong irregular heartbeat (Cohen, Cukor, & Kimmel, 2016). The person may feel that they are choking or even experiencing a heart attack. These symptoms exacerbate the fear as one feels that one is dying. If not properly managed at the right time, the condition may lead to other more serious health problems.
Social anxiety disorder, sometimes referred to as phobia, is another condition in this class. In this case, the affected person tends to feel overwhelmingly worried and is often self-conscious about social situations (Ghandour et al., 2019). They are fixated on the idea that other people will judge or ridicule them, as a result, they fear embarrassment. Such problems are often associated with the social upbringing of a person. These individuals find it difficult to address large gatherings because of the fear of embarrassing themselves. Although the condition may not lead to a major health problem in itself, the problem affects the ability of a person to socialize with others and take leadership positions.
MacIntyre (2019) explains that some individuals suffer from specific phobias. It may be the fear of heights, flying, animals, or relating with specific individuals. Such unexplained fears towards specific things or individuals may affect the normal activities of a person. For instance, a woman who was sexually abused by a man from a given race associated with violence may find it difficult to relate with such men in the future. Whenever she comes into contact with such men, they are reminded of their ordeal and a paralyzing fear grips them, which makes it impossible for them to work normally.
Generalized anxiety disorder (GAD) is another condition that affects a significant number of people. The condition is often characterized by exaggerated tension or worry and chronic anxiety without proper justification (Chisholm et al., 2016). Such an individual can be depressed by simply remembering something in the past that may not be of significance today. They also tend to worry a lot when they are faced with minor challenges in life. They feel that they may fail to deliver the expected outcome even before starting the assignment. The strong fear limits their capacity to perform specific tasks as would have been expected of them.
Obsessive-compulsive disorder (OCD) is another form of anxiety disorder characterized by recurring obsessions (unwanted thoughts) or negative behavior. An individual may be obsessed with cleanliness. Such a person may wash their hands many times as doing so offers them a temporary reprieve from the anxiety. However, failing to do these rituals significantly increases their anxiety. The problem with OCD is that it may subject an individual to engaging in a behavior that may be harmful to their health. Hanson (2016) explains that some women become obsessed with the desire to have sexual fulfillment. In so doing, they may subject themselves to various sexually transmitted infections and emotional problems.
Post-traumatic stress disorder (PTSD) also falls in the same class of anxiety disorders. This condition arises specifically from exposure to a terrifying ordeal, which resulted in major physical injury or mental distress (Andrews et al., 2018). Soldiers who witness gruesome murders and manage to live often develop such conditions. Individuals who have been victims of rape or torture may also develop such disorders. They end up reliving the ordeal whenever they encounter the slightest of things that remind them of the events. The trauma can be so bad that one cannot lead a normal life without proper therapy. Appendix 2 shows the prevalence of different types of anxiety disorders.
Diagnosing Anxiety Disorders. Early diagnosis of anxiety disorder makes it easy for the condition to be managed before it can worsen. According to Ezegbe et al. (2019), the problem that many people face is a late diagnosis of anxiety disorder. The majority of adults often consider anxiety as something that is normal in life. They feel it is normal to be shy, to have fear towards certain things, or to be compulsive. Even those who have gone through major ordeals such as rape tend to avoid signs of PTSD, believing that they can deal with the condition. As such, most of the early symptoms are ignored. When left unmanaged, most of the anxiety disorders worsen and limit the ability of an individual to behave normally. When such a patient visits a hospital, the medical practitioner has the responsibility of conducting an accurate diagnosis of the condition to understand specifically what the patient is suffering from (Takebayashi, Tanaka, Sugiura, & Sugiura, 2018). The mental health provider is expected to use two approaches to diagnosing the condition.
The first approach is to give the patient a psychological evaluation (Byrnes, 2018). The practitioner is expected to discuss the patient’s feelings, behavior, and thoughts to help check related complications. The psychological evaluation is meant to help the mental health provider to understand the plausible cause of the condition and how it can be classified in the long list of anxiety disorders. The evaluation will also enable the practitioner to understand whether the condition is worsened by factors such as substance abuse and depression. The practitioner is then expected to conduct a comparison of the symptoms of the patients to the criteria provided in the DSM-5 manual for mental disorders (Jalnapurkar, Allen, & Pigott, 2018). This step is meant to ensure that there is an accurate diagnosis of the condition to help determine the appropriate medication that the patient needs. The table in appendix 1 provides a description of these anxiety disorders, which helps in their diagnosis.
Management and Treatment of Anxiety Disorders. Once the anxiety disorder is correctly diagnosed, the next step is to provide appropriate medication for the condition. A patient may require psychotherapy, the use of medication, or a combination of both depending on the state. Bandelow, Michaelis, and Wedekind (2017) observe that sometimes the process may involve trial and error before an appropriate medication is discovered. Psychotherapy, also referred to as psychological counseling or talk therapy, is one of the most effective ways of managing various forms of anxiety. It involves helping the patient to face the problem by first appreciating its existence and acknowledging the fact that they have the power to overcome it (Abbing, Baars, Haastrecht, & Ponstein, 2019). Cognitive-behavioral therapy (CBT) has often been considered the most effective psychotherapy that can help in managing anxiety disorders. This approach focuses on teaching the patient-specific skills that they can use to gradually overcome various symptoms in a way that can help them return to their normal behavior. It aims at building confidence by reminding the patient that many other people have gone through their experiences and come out stronger. As such, they are no exception.
Behavioral therapy has also proven to be effective in managing these conditions. In this approach, the practitioner is expected to help the patient in deliberately confronting the fear (Abbing, Sonneville, Baars, Bourne, Swaab, 2019). Regular and deliberate exposure to the source of fear desensitizes oneself and trains the patient to have a realistic understanding of the danger. Training a patient to be assertive helps patients suffering from social phobia. They learn how to express themselves articulately without harshly judging themselves. Locke, Kirst, and Shultz (2015) believe that most of these people tend to be their own worst critics. They want to be perfect but they feel they have various inadequacies. They struggle with their own personality, making them unable to address large audiences. Training them on having structured problem-solving skills eliminate most of their worries, making it possible to overcome their condition. Sometimes it may be necessary for them to join support groups where they meet individuals with similar problems. With the help of a behavioral therapist, these patients will work as a unit and learn how to deal with their fears and other psychological problems.
The diagnosis may reveal a severe mental problem that may need more than a simple medication. In such cases, the medical practitioner may prescribe drugs for short-term use depending on the nature of the problem. The patient may be given antidepressants to help in managing their depression. Buspirone is another popular anti-anxiety drug that may help an individual to overcome their problem. Benzodiazepines or beta-blockers may also be used depending on the nature of the problem that the patient faces. In some extreme cases, sedatives may be used to numb the mental pain and to provide relief for the patient. As Abbing, Baars, Sonneville, Ponstein, and Swaab (2019) observe, these medications are meant for short-term use to avoid addiction. It is recommended that they should be used alongside psychotherapy measures.
Thematic Discussion of Literature
Anxiety disorder is becoming an increasingly common medical problem in the United States and other parts f the world. The current lifestyle and various factors that people encounter are believed to be the primary cause of anxiety among women. In this section of the paper, the focus is to conduct a thematic discussion of literature. The section focuses on three main themes: common causes of anxiety among adult women, the prevalence of the problem, and how often the affected group seeks medical support when suffering from the condition.
Common Causes of Anxiety in Adult Women
A study by Stein and Sareen (2015) indicates that the primary cause of anxiety is stress. Over 90% of those who suffer from various forms of anxiety trace the root cause of their problem to stress. Stress may come in different forms and may have a varying degree of impact. Financial stress is one of the most common emotional challenges that women in the United States face (Theophilos, Green, & Cashin, 2016). Many women find themselves single parenting, having to meet all the economic needs of the family without the support of their partner. Work-related stress has been identified as another area of concern. Some women have highly demanding supervisors who frustrate them in various ways. They are given unrealistic demands and they have to meet the set standards in case they want to keep their job. Some women observe that they have stress from school.
Such problems often affect adult students who have to go to work during the daytime and attend classes in the evening (Balestra, 2019). They report massive exhaustion as one of the main concerns they have to deal with most of the time. Relationships such as marriage are also becoming stressful not only in the United States and other parts of the world. Issues such as infidelity, lack of care, unmet promises, and over-expectations are known to cause cracks in relationships. Some women trace their primary source of stress as being emotional trauma that may result from events such as the loss of a loved one (Posmontier, 2012). Various other factors may lead to stress and if it is unchecked, stress can easily lead to anxiety.
Anxiety may also be caused by other factors such as the side effects of medication. Some forms of medication, such as cancer management drugs, may cause anxiety. Studies have suggested that substance abuse, such as the use of cocaine or heroin may also cause anxiety among women (Kearney, 2017). The problem may also be a symptom of a major health condition such as heat stroke, heart attack, and hypoglycemia. In some cases, one may develop anxiety because of lack of sufficient oxygen because of a medical condition or when climbing a mountain. When anxiety is caused by any of the medical conditions discussed above, it can easily be resolved when the patient has access to the right medication for the condition (Chandler, Robins, & Kinser, 2019). However, anxiety caused by stress tends to be more elusive and can lead to more serious consequences in case it is not managed within the right time. Understanding these causes of anxiety makes it easy to develop proper management mechanisms.
Prevalence of Anxiety in Adult Women
Anxiety is a mental condition that every normal person goes through at every stage of life. However, it becomes a medical problem when it turns out to be chronic, as Ara, Yaqoob, Raja, Bukhari, and Mudasir (2020) observe. When the mental tension remains even when the perceived stressor no longer exists, then it is an indication that the individual suffers from a medical condition that may need some form of treatment. The problem is very common but often less reported. According to a study by Posmontier (2012), women tend to affect more women than it does men. The condition is twice as common in women (5.2%) as it is in men (2.8%) (Bazian, 2016). This is caused by constant worry about the infidelity of the partner, the need to provide support for the entire family, and the desire to maintain a positive image of the family.
As shown in appendix 3, the level of anxiety starts to rise sharply in the late teens and early twenties when women are in a romantic relationship. It intensifies in their thirties and forties when they have to meet both the financial and emotional needs of the family, sometimes in the absence of their partners. At this age, they are 44% more likely to suffer from GAD than the younger population and 70% more likely to suffer from the same condition than the older population (Chalabi, 2019). The level of stress starts to decline consistently past the age of 55 years. At this stage, these women have struggled with their children through their education process and most of them are working and have their own families. They are retired or approaching the retirement age and have little to worry about (Balestra, 2019). As they age, they become less anxious.
How Often Women Seek Medical Support When Suffering from Anxiety Disorder
Anxiety can be managed easily when it is diagnosed in time and addressed effectively by targeting its primary cause. However, the problem is that it is one of the least reported medical conditions in the United States (Balestra, 2019). Most of those who are suffering from anxiety do not consider it a medical problem. They feel it is normal for them to be anxious. They blame it on their work or a challenge they are going through, believing that it is not necessary for them to have access to any form of medication. Women tend to persevere, believing that they can overcome the anxiety. Studies show that about 5.2% of women in the United States suffer from the condition, but most of these cases are only reported when they become worse to the level of paralyzing the patient (Stein & Sareen, 2015). The majority of anxiety cases are unreported and these women rarely seek medication in time.
Synthesis and Summary of Literature Review
The review of the literature shows that anxiety is a common problem among women but it is rarely reported. Social anxiety disorder, specific phobia, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder are some of the most common anxiety problems that women face. It is evident that stress is the primary cause of anxiety. However, medical conditions may also cause anxiety among women. The problem is that most of those who suffer from this condition rarely report it until it is too late when it is affecting their health. It is important to promote awareness about the problem so that women can know when they are suffering from anxiety and how they can deal effectively with the problem at the right time.
Anxiety among adult women is a widely researched topic because of its significance in society. However, the literature review reveals that there is a knowledge gap about some of the intervention strategies for managing this mental condition. Chandler at al. (2019) observes that the effect of the workplace environment in managing anxiety among working women is yet to get proper academic attention. Future research should place emphasis on how companies can eliminate stressors in the workplace. It is necessary to outline the role of managers in protecting women from unnecessary stress.
Related Socio-Economic, Political, Cultural, and Health Literacy Issues of Anxiety Management in Adult Women
Managing anxiety among adult women is of interest in the United States. Studies have shown that adult women play the most important parenting role in society, especially at a time when cases of divorce are at a record high (MacIntyre, 2019). Their ability to offer proper care to their children is directly affected by their mental health. It is a worrying trend that those who play the crucial parenting role in the country are the worst affected group by the problem of anxiety. According to Lim et al., (2018), children who are subjected to trauma at a tender age often have so many mental problems when they become adults. Some of them become serial killers, prostitutes, robbers, or drug peddlers and users. They embrace these socially unacceptable behaviors because of their inappropriate upbringing. As such, American society has to focus on and address the problem of anxiety among adult women as a way of improving parenting in society.
Managing anxiety among this population does not only benefit American women but also children. Most of the cases of domestic violence, some of which end up in deaths, are caused by these anxiety disorders. Managing the medical problem may help reduce cases of family violence. It can also help in reducing cases of divorce in the country, allowing children to grow up getting care and attention from both parents. When managing anxiety among women, it may be appropriate to look at it from various angles to help find an effective and lasting solution (Cardany, 2018). The multifaceted approach to the investigation helps in understanding all the possible causes of the problem and ways in which it can be addressed.
Main Socio-Economic and Political Issues
The socio-economic environment has a major influence on anxiety management in the country. According to Lipschitz et al. (2018), an overwhelming majority of those who suffer from various forms of anxiety cite social and economic challenges as the main cause of their problem. From a social angle, anxiety in adult women is caused by various factors. Family problem is one of the most common causes of anxiety. A good number of adult women are always living in constant fear about the stability of their marriages (Milev et al., 2016). Infidelity is the single most common concern of these women that causes them anxiety. Going through their spouse’s phones or trying to trace their moves causes a lot of tension in the family. When they finally realize that their husbands are unfaithful, it becomes devastating experience. Such social problems end up in divorce. Studies about the psychological consequences of divorce may be limited, but Ravindran et al. (2016) argue that the experience is often traumatizing. The majority of women rarely seek counseling after divorce even when they are emotionally drained. They suffer in silence, hoping that with time the pain would go away. For some, they sink into depression, especially when the reality of single parenting dawns on them.
Adult women who are going through various challenges in life need social support. Byrnes (2018) explains that religious institutions are always effective in offering the needed social support. Hope that they receive about rewards of perseverance offers them the mental power to overcome their challenges. The support from friends and family members is also crucial in protecting adult women who are going through various challenges in their families. Blaskovits et al. (2017) believe that solitude can be dangerous for those who are under immense stress or fear. Their condition can worsen very fast, leading them to act in ways that are harmful to their health or the wellbeing of their loved ones.
The economic challenge is another major cause of concern for adult women in the United States. According to MacIntyre (2019), the population of homeless women in the United States has been rising consistently because of the tough economic conditions. Men earn slightly more than women in almost every sector of the economy. When that woman is a single mother, she has to ensure that the little amount of money she earns is used appropriately to meet all the economic needs of the family. Some of them are forced to take two or three jobs a day just to make ends meet. They become emotionally strained as they move from one workplace to another. One of the best ways of addressing anxiety in adult women is to address their financial problems (Andrews et al., 2018). It may require the political class to redefine some of the economic policies in the country.
The political environment in the country may also have some influence on the management of anxiety in adult women. According to Takebayashi et al. (2018), men tend to be more involved in politics than women, but policies that are made by the political class affect everyone in the country. For a long time, women were denied the opportunity to vote, but it took the goodwill of the political class to address the problem. Currently, there is a concern about the pay gap between men and women in the country. It will require the goodwill of the political class to address the problem. Women have as many responsibilities as men, and as such, it is not justified to pay them lesser salaries when they deliver the same services as men. Equal pay for the equal job done is based on the principle of fairness. Byrnes (2018) also reports about cases of abuse of women in the workplace, which causes anxiety. Sexual and verbal abuses are the most common problems that women report in their workplace. Political leaders have a major responsibility of enacting laws that protect women in the workplace. There should be effective mechanisms for investigating such claims and punishing the perpetrators accordingly.
Cultural and Linguistic Concerns
Cultural practices may exacerbate or help in the fight against anxiety in adult women. The United States is one of the most culturally diverse countries in the world, caused by decades of immigration. Among many African societies, women are not expected to share their family challenges with any non-family member (Jalnapurkar et al., 2018). They are expected to persevere and religion is the only solace that is offered to them. They are expected to withstand both physical and emotional abuse from their husbands. The United States has robust laws meant to protect women from any form of abuse. However, some of the immigrants are unaware of these laws. As such, they stick to their cultural practices of suffering in silence (Bandelow et al., 2017). Others are aware of the laws but they fear the possible consequences of reporting such abuses to relevant authorities.
Fear may be caused by the economic reliance of the victim. They feel that when they report the abuse, they may lose the only source of livelihood in the country. Others fear deportation because they are living in the country illegally. It is estimated that there are over 11 million illegal immigrants in the United States. A significant population of them is women. Such women are willing to withstand various forms of abuse because they fear deportation in case, they present themselves to the authorities. A language barrier may also be a problem in reporting cases of abuse or discussing emotional problems with relevant people. Some of those who immigrate to the country from Latin America only speak Spanish. When they live in a population where most people can only communicate in English, they find it difficult to share with their neighbors the challenges that they go through.
The government needs to have a mechanism for dealing with such problems in the country. In some countries, one of the most important requirements that one has to meet is the ability to speak local languages. Such laws are meant to ensure that the immigrant is able to communicate effectively with the locals. It is necessary to find ways of introducing such laws that have to be met before one can be admitted into the country. Abbing, Baars, Haastrecht, and Ponstein (2019) also believe it is necessary for the government, through various state organs and non-governmental institutions, to find ways of fighting retrogressive cultures that promote abuse of women. Practices such as wife battering have no place in society. However, the government can only fight them if there are effective mechanisms of enforcement.
Health Belief Issues
Health beliefs may also have an impact on the management of anxiety in adult women. According to Balestra (2019), buying drugs over the counter is a common practice in the United States and many other parts of the world. When one is suffering from acute anxiety, one is quick to come to a conclusion and go for non-prescription drugs as a cure for the problem. In the current digital age, many people are keen on using the internet to diagnose their problem instead of visiting a medical practitioner (Jalnapurkar et al., 2018). They use the wrong keywords to describe the conditions they feel, which makes it likely that their problem will be misdiagnosed in these online platforms. They also search for appropriate drugs that can be used in managing their condition.
The outcome is that these individuals will end up taking the wrong medications that can only worsen their condition. Bandelow et al. (2017) warn that it is easy for one to have a misdiagnosis in these online platforms when suffering from acute anxiety. Some of the conditions associated with this condition include lightheadedness, chest pain, and rapid heartbeat (Ghandour et al., 2019). These are the primary symptoms of someone having a heart attack. If one fails to have access to a professional medical checkup, it is possible to start taking measures to manage the heart attack. One may end up taking medicine that will only worsen their condition. As MacIntyre (2019) observes, a heart attack is one of the most feared health conditions because it is common for the patient to fail to recover. It means that when a person misdiagnoses acute anxiety as a heart attack, the panic will intensify, and one may actually develop a heart attack, which is more lethal.
It is necessary to promote a new culture in the country where people can easily contact health experts and explain their conditions before rushing to purchase drugs. The internet has vast information, which can help in various ways. However, there should be a change of approach to using it, especially when one feels that they are unwell. Balestra (2019) advises that before searching for information on various websites, it is advisable for one to start by visiting a doctor. Society must also rethink its approach to the use of non-prescription drugs. They may offer temporary reprieve to the pain that one is going through, but they may also have negative long-term effects. The government, through various agencies, should create awareness among its people about the dangers of some of the health beliefs and practices in the management of anxiety disorders.
Educational and Health Literacy Issues
Family nurse practitioners, psychiatrists, and other mental health experts have a major role to play in the management of anxiety among adult women. However, some of the measures may not need a physical interaction between the patient and the medical practitioner. According to Bandelow et al. (2017), one of the biggest steps in managing anxiety is to ensure that the patient understands their medical condition. One should know that they are suffering from post-traumatic stress disorder, specific phobia, or generalized anxiety disorder. Accepting their condition makes it easy for them to be willing to follow the right approach of managing them. They should then understand the possible causes of their condition. In case one is suffering from GAD, they should know specific triggers that make their condition worse. If it is PTSD, they should understand specific events or event that affected them, causing the problem, and some of the current triggers that reminds them of the trauma. After understanding the cause of their medical condition, they need to understand the steps that they need to take to manage it. They need to know what they should avoid and practices they need to embrace to improve their mental health (Jalnapurkar et al., 2018). These patients will be empowered if they have access to the right information about their condition.
Educational health and literacy are therefore essential in managing anxiety disorder. MacIntyre (2019) observes that the government has made little effort in providing regular and reliable information about mental health. Although the management of the problem is often captured in the budget of the Department of Health and Human Services, there has been no effort to promote health literacy in the country regarding anxiety. It explains why the majority of Americans do not think that anxiety or stress is a medical condition. Those who consider visiting healthcare facilities do so late when they feel overwhelmed. Balestra (2019) explains that in most of the poor neighborhoods in the United States, those who suffer from chronic stress caused by specific occurrences in their lives consider visiting their priests instead of going to the hospitals. The majority of these priests do not have medical backgrounds, making it impossible for them to correctly diagnose the problem and prescribe appropriate medication. Such a patient may have a temporary reprieve, but they are more likely to redevelop these conditions. The government should use both mass and social media platforms to create awareness about this condition and the best approach to diagnosing and managing it.
Research Gaps
Mental health problems have attracted the attention of many scholars over the years. According to Bandelow et al. (2017), this subject is widely researched because of its significance in the field of medicine. However, proper attention is yet to be given to the role of the political environment in the management of anxiety among women. Studies have shown that financial constraint is one of the most common causes of anxiety among women in modern society, especially as the cases of single parenting continue to arise. These women struggle to find ways of providing for their families in a country where the cost of living continues to rise. It means that if the American society is keen on addressing this problem, then there should be a focus on how to lessen the financial burden that these parents face. The solution would require policy development both at the federal and state levels (Jalnapurkar et al., 2018). It would require the involvement of the political class in finding a lasting solution to the problem. However, most of the current studies have not adequately addressed the role that the political class should play in addressing the problem
Related Spiritual, Ethical, Family, and Community Issues
When managing anxiety among adult women, it is important to review related spiritual, ethical, family, and community issues related to the problem and proposed intervention plans. The identified problem is affecting millions of Americans, and as such, it is of interest to the entire society. Women who suffer from these conditions are still expected to offer parental care to their children, be responsible wives to their husbands, and responsible children to their fathers.
Ethical Issues Embedded in the Main Problem
Managing anxiety in adult women may be complicated by some ethical issues. As explained above, one of the most common causes of anxiety is stress that may be associated with various factors. Sometimes the primary source of the problem may be a husband, another close family member, or a friend. The best way of fighting anxiety is to eliminate the stressor. It may not be easy for a nurse to advise a wife to separate or even divorce the husband even if it is obvious that it is the best solution. The ethical dilemma is that the intervention may break the marriage, which may have unforeseen consequences to the patient and other people related to them. Balestra (2019) advises that when faced with such a dilemma, it is advisable to start by offering to counsel to both the patient and the person believed to be the source of the problem. If the person fails to change, the nurse should discuss with the patient the possibility of staying away from the person for some time or even permanently. The primary interest of the nurse, in this case, will be the wellbeing of the patient, even if it means separating from the partner.
Spiritual Issues
Spiritual issues may emerge when managing anxiety among women. Religion is often considered a good source of support for people suffering from anxiety disorders. Deeply held values and beliefs may offer a sense of hope even when one is feeling hopeless (Ghandour et al., 2019). As such, a family nurse practitioner should find a way of incorporating religion when managing the problem. However, care should be taken to ensure that the patient values these religious beliefs and practices. They should not be forced into embracing a practice they do not value.
Implications for Family and the Community
It is always in the interest of the family and the community, in general, to ensure that anxiety among adult women is addressed. As caring mothers, wives, daughters, sisters, and members of society, it is crucial for women to be in the right mental state to undertake their duties. When they suffer from various forms of anxiety that impair their judgment and capacity to behave and work normally, their families and the entire community will be affected. As such, managing this problem will be of major benefit to friends, family members, and the entire community.
Theoretical Framework
It is important to review the perspective through which anxiety among adult women can be explored for a better understanding. According to Connolly and Britton (2017), one can use a theoretical framework, conceptual framework, or both to explain a given phenomenon. In this case, the focus was on managing anxiety in adult women. The investigation had revealed that a significant number of women in the United States suffer from a wide range of anxiety disorders caused by various factors. Family nurse practitioners have a major role to play in providing them with relevant care. They need to embrace various theories that can help in guiding their approach to managing patients with anxiety disorders.
Dorothea Orem’s self-care theory is one of the grand nursing theories that can be used when managing adult women suffering from anxiety disorders. This theory has principles and assumptions that should guide a medical practitioner who seeks to apply it. One of its main principles is the concept that people need to be responsible and self-reliant for their own care (Pal & Sayegh, 2017). The patient must understand their primary role in managing their health. They have to be committed to maintaining a positive lifestyle, avoid practices that may put them on the path towards harm, and ensure that they maintain a pool of friends who can be of positive impact in their lives. The principle is closely related to its second major assumption, which holds that the knowledge a person has towards a given medical condition defines their ability to practice self-care. They need accurate information about the cause of the health problem, its manifestation, and ways of mitigating it. The theory also holds that nursing is a form of action that involves the interaction of two or more people (Srivatsa, 2016). As such, the nurse should always remain committed to engaging their patients in finding a solution to their health problems.
Humanistic nursing theory is another major model that can be used in managing anxiety among adult women. Developed by Josephine Paterson and Loretta Zderad, this theory’s primary principle is the element of a close nurse-patient relationship (Stewart & Dennert, 2017). According to the two theorists, the ability of a patient to recover from a given medical condition depends on the support they receive from the caregivers. As such, it is logical for nurses to maintain a close professional relationship with their patients. They need to listen to their concerns as a way of enabling the patients to feel calm and comfortable. The humanistic model considers every patient a unique individual with unique needs that should be met to ensure that they are comfortable in their environment. As a nurse using this model to offer care, it is advisable to create time and understand issues that the patient feels may worsen their condition.
Theoretical Framework Applied
It is necessary to apply the two theories in solving the problem of anxiety among adult women. The self-care theory is one of the most relevant models that family nurse practitioners can use to manage the condition. Assumptions and principles of the theory make it an effective model that can be used effectively to help patients overcome the mental disorder. One of its primary principles holds that people should be responsible and self-reliant for their own care (Pal & Sayegh, 2017). The assumption is one of the most important principles that should guide nurses when handling patients suffering from anxiety. They need to advise these patients that the solution to their problem depends on their personal effort. These patients have the biggest role to play in enhancing their condition.
There is a direct relationship between the concept of self-care and the need for the patient to take a leading role in managing their condition. The theory informs the approach that a nurse practitioner should use in caring for adult women suffering from anxiety disorder (Gonzalo, 2019). In this case, the nurse should help the patient to understand the primary cause of their anxiety and environmental factors that may worsen the condition. They need to know what they should do to lead a positive lifestyle with limited levels of stress. Appendix four shows the relationship between the efforts that a nurse should make and those expected of the patient. As shown in the diagram, the role of the researcher will be to guide the patient so that they can face their mental health problem with positivity and commitment.
The humanistic model is another theoretical framework that was considered effective in helping adult women to overcome their anxiety disorder. The primary principle of this theory is the need for nurses to maintain a close relationship with their patients (Beidel, Bowers, & Marks, 2020). There is a close relationship between this principle and the element of constant care that some of the patients suffering from anxiety disorder require. Conditions such as specific phobia, obsessive-compulsive disorder, or even post-traumatic stress disorder may not require medication when managing them. Instead, the medical practitioner needs to offer the patient constant assurance that they can overcome their condition by embracing specific practices. As shown in appendix 5 below, a family nurse practitioner must maintain a close relationship with that patient to enable them to overcome their condition. The nurse is expected to maintain a dialogue with the patient (Shallik, 2018). They need to understand their primary concerns, how they developed the mental condition, approaches they are using to manage the problem, and the nature of the relationship they have with their family and friends. Such a dialogue will allow the family nurse practitioner to know the factors that might have led to the condition of the patient.
After gathering adequate information about the condition of the patient and possible trigger factors in their immediate environment, the nurse is expected to offer advice and words of comfort. As shown in the framework in appendix 5, nurses are required to nurture patients back to well-being. Boyle (2019) believes that the process can only be a success if there is trust between the patient and the primary caregiver. The fact that these patients suffer from mental disorders may complicate the whole process of building trust. The family nurse practitioner may need to offer assurance to the patient and proper care to win their trust. They should not feel threatened in any way when they are under the care of the nurse. Garbarino (2019) emphasizes the need for the practitioner to be patient with these patients, especially when one is suffering from acute stress.
MSN Scope and Role in Assessment of the Problem
Family nurse practitioners have a major role to play in managing anxiety among adult women. According to MacIntyre (2019), patients interact with nurses more than they do with doctors. As such, these nurses have a better capacity to help these patients to overcome their mental health problems. It is important to understand MSN scope to understand its significance in the management of anxiety among adult women. According to Bandelow et al. (2017), MSN broadens the scope of a nurse beyond a primary care giver. It propels a nurse to the management level where they can make policies and guide their implementation in a healthcare facility. One of the roles that one can take after graduating with MSN is community services manager. In this position, a nurse is responsible for planning, supervising, and coordinating social work programs within the community. The position offers them a perfect platform to interact with some of the adult women suffering from various anxiety disorders. They can visit their workplaces or homes to have a better understanding of triggers or primary causes of their anxiety. They can also understand how they can deal with the condition based on the realities that they face.
MSN enables one to become a nursing director. In this position, the nurse is responsible for managing and directing other nurses within a healthcare facility. They can develop and implement policies meant to guide the activities of other nurses (Jalnapurkar et al., 2018). With a proper understanding of anxiety in adult women, these nurses have the capacity to create a perfect environment for the management of the condition. They can work closely with other departments to ensure that these patients are offered the support they need to manage their condition. As a patient safety director, a nurse can play a major role in protecting patients who are admitted to the facility who are suffering from mental problems. Some of those who suffer from acute anxiety may require inpatient rehabilitation (Balestra, 2019). During that period, these patients need support and understanding from all the healthcare practitioners who are handling their cases. As the safety director, the nurse can ensure that the unique needs of these patients are met. Master of Science in Nursing can also enable one to become a healthcare executive or healthcare administrator, a position that gives a nurse a significant amount of influence when it comes to policy development within a healthcare facility. They can use the position to provide support to adult women suffering from anxiety.
A family nurse practitioner who holds MSN has a better capacity to offer help to patients suffering from various ailments as discussed above. This level of education provides the needed skills that can be used to address anxiety in women. In managing anxiety among adult women, the whole process starts with making the right diagnosis (Lim et al., 2018). A position such as community service manager enables a nurse to assess the problem within the community. Such a nurse can easily conduct a survey within a city such as New York to identify some of the most common types of anxiety disorders. They can also collect data to understand the primary causes of these conditions and the population worst affected. The assessment will help in mapping the problem within a specified region. The information that they gather can effectively be used to conduct diagnoses even by the most junior nurses working within the community. This approach will help identify cases of anxiety within the community at the earliest stage possible when it is easy to manage the condition.
The knowledge gained from MSN will have major implications on the overall health of the patient. The nurse will have a better capacity to offer quality care to women suffering from different types of anxiety. Such a nurse will also have the capacity to coordinate easily with other nurses in improving the environment for patients receiving medical attention because of mental problems. The targeted population, in this case, is adult women suffering from a wide range of anxiety disorders (Ghandour et al., 2019). Some of them may require outpatient services while others may require admission depending on the magnitude of their condition.
Proposed Interventions to Problem
Anxiety in adult women is a major problem in the United States and it is necessary to find effective ways of addressing it. Family nurse practitioners have a major role to play in assisting these patients to overcome their condition. According to Balestra (2019), managing anxiety starts with the patient understanding and appreciating their condition. They need to know that they have a mental health problem that requires the attention of a medical practitioner. In this section, the report focuses on the effective intervention plans that a family nurse practitioner should use when managing a patient with the condition.
Proposed Intervention
The researcher proposes three approaches to managing anxiety among adult women. The three are patient-led, practitioner-led, and family/friends-led intervention plans. In each case, there are important elements needed for an effective solution to the problem. Each of the three plans may also require instruments and protocols that have to be followed to achieve the best outcome.
Patient-Led Intervention Plan. The first plan is a patient-led intervention plan needed for the management of anxiety among adult women. The most important element needed in this plan is for the patient to understand and appreciate the fact that they have a mental condition. Bandelow et al. (2017) explain that one of the biggest challenges when fighting a mental health problem is denial. When a person fails to appreciate that they have a medical condition, then it is possible for them to take the right measures to address their problem. Adult women suffering from any form of anxiety should know about their condition. A family nurse practitioner or a psychiatrist may help them to classify their condition so that they can specifically understand the type of anxiety disorder and how it can be managed.
In this plan, the first step that the patient should take is to identify the source of their problem. Most anxiety disorders are often caused by stress or traumatic event (Jalnapurkar et al., 2018). They need to trace the specific source of the trauma. After understanding the genesis of the problem, they need to appreciate the fact that they cannot change the past but they have the capacity to define a better future. As such, they need to learn not to live in the past. MacIntyre (2019) advises that these patients may need to learn about relaxation techniques. Yoga is one of the ways in which they can use to release excess pressure and calm their mind. They need to know when it is appropriate to use effective breathing techniques, especially when they start developing fear when exposed to the trigger. Balestra (2019) emphasizes the need for these individuals to learn to be assertive and to boost their self-esteem. Developing a structured approach to solving their problems can also make it easy for them to solve their problems. A healthy lifestyle that includes regular exercise and dietary changes should also be embraced in this plan. The patient must understand that they play the biggest role in facilitating their recovery from the problem.
Practitioner-Led Intervention Plan. The second approach is for the family nurse practitioner to take a leading role in managing the anxiety of the patient. The practitioner-led plan is necessary when the patient’s condition is worse and they no longer trust in their own abilities to overcome their anxiety. Under this plan, the nurse has to start by making an accurate diagnosis of the condition. They should classify the anxiety in its appropriate class. They should then investigate the cause, its manifestation, and the current triggers. With that knowledge, the practitioner can offer counseling services to the patient on how they can manage their condition. Counseling is often considered one of the most effective ways of managing anxiety (Bandelow et al., 2017). It helps the patient to understand their condition and how they can manage it.
Art therapy is another approach that a practitioner can use to manage the condition of a patient. Abbing, Baars, Sonneville, Ponstein and Swaab (2019) define art therapy as “a non-verbal, experience-oriented therapy that uses the visual arts (such as painting, drawing, sculpting, clay modeling) and is provided as a standalone therapy or in multidisciplinary treatment programs for anxiety,” (p. 2). This form of therapy may be necessary when handling a patient with acute anxiety that paralyzes them, making it impossible for them to reason normally. Using visual art, the practitioner will focus on calming the patient. It requires plenty of skills, as Balestra (2019) warns, because some of these patients may be hostile. Both cognitive and behavioral therapies will be essential in managing the condition of these patients.
Transcranial direct current stimulation (tDCS) may be another strategy that a family nurse practitioner can use to manage anxiety among adult women. Milev et al. (2016) define tDCS as “a form of brain stimulation that delivers a continuous low-amplitude electrical current to a specified cortical region using scalp electrodes,” (p. 562). The procedure may need to be done by a general physician and psychiatrist, alongside a family nurse practitioner. The procedure is necessary when the patient fails to respond to other forms of medication and there is fear that their condition may worsen or cause other major medical problems.
Family/Friends-Led Intervention Plan. The third approach is the intervention plan that is led by friends and family members. According to Bandelow et al. (2017), people suffering from anxiety disorders require an effective support system. They need people they can trust offering them emotional and spiritual support at a time when they feel weak and helpless. Some of these close family members and friends will need to be trained so that they can understand what is expected of them in managing the condition of the patient. A family nurse practitioner should train them on the importance of being mindful of the delicate condition of the patient. They should understand the fact that even things that others consider trivial may affect them significantly (Jalnapurkar et al., 2018). As such, they have to be sensitive in their words and actions. They can also help in policing the behavior of these patients. They should help them maintain a healthy lifestyle and to avoid actions that may exacerbate their condition.
Outcomes, Timelines, and Evaluation
A family nurse practitioner who commits to helping a patient suffering from anxiety disorder should have specific goals that must be realized within a given period. The outcome of the process should be assessed based on the ability of the nurse to achieve these goals. The proposed intervention to this problem takes different forms as discussed in the section above. Having a collaborative interdisciplinary approach that also involves community partnerships is essential in managing anxiety in adult women. Managing this condition is a continuous process and the care giver needs to work closely with all stakeholders who can directly or indirectly influence the mental stability of the patient. In this section, the focus is to discuss the expected outcome, timeline of different activities, and the evaluation strategies that should be employed to assess the outcome of the program.
Outcomes and Elements of Evaluation
It is necessary to assess the outcome of each of the three intervention plans suggested in the section above. It is expected that each of them will have varying impacts on the patient within a specific period. Cooper and Quick (2017) explain that the approach that is used to manage stress in a patient depends on the current condition of the patient. In each case, there will be an appropriate element of evaluation. A patient-led intervention plan should ensure that the patient understands her condition, causes of the problem, and ways through which she can manage it. The outcome of the program will be an empowered patient who can avoid stressors and lead a healthy and positive lifestyle. A family/friends-led intervention plan focuses on creating awareness among family and friends of the patients so that they can help the patient manage their condition. The expected outcome of the program is to have a mindful and caring support group for the patient. The practitioner-led intervention plan is applied in case the other two fails and it may involve the use of drugs. The outcome is to help improve the condition of the patient to the level that they can rely on themselves or their support groups to manage their condition.
Intervention Timeline
The three intervention plans will be conducted at different stages. It will only be necessary to move to the next stage if the current one fails to deliver the expected outcome. That means that the first step will be to empower the patient so that they can take a leading role in managing their condition. The patient-led program will be a continuous process because the patient is expected to be responsible for managing their condition. If that fails to yield the desired outcome, close family members and friends will be invited so that they can also help in providing enabling environment for the patient. Their support and care for the patient should also be a continuous process. The third stage will involve practitioner-led intervention that may involve using drugs if counseling fails to yield the desired outcome. Table 1 below shows the proposed timeline of the intervention plans.
Table 1: Timeline of the Proposed Intervention Plans
Conclusion & Recommendations/Implications for Clinical Practice
Anxiety among adult women is currently one of the most common mental health problems in the United States. Studies have shown that almost one-quarter of women suffer from some form of anxiety. The main challenge in managing this condition is that the majority of the patients rarely consider it necessary to seek medical attention when they are affected by various forms of anxiety. They choose to suffer in silence, hoping that the stress will be gone when certain things change in life. The severity of anxiety disorder may vary depending on its cause and the approach that is used to manage it. Early intervention is essential to ensure that the condition is effectively managed. A family nurse practitioner can use three main approaches to manage the condition of these patients. They can use patient-led, family-led, or practitioner-led approaches to managing anxiety among adult women in the country. When the patient is suffering from acute anxiety, family nurse practitioners are expected to take the primary role of managing the condition of the patient.
Recommendations and Implications
The study focused on the management of anxiety in adult women and the role of family nurse practitioners. The findings have major implications for future research and current clinical projects. It is clear that nurses have a major role to play in the management of the conditions of patients suffering from anxiety disorders. The following recommendations should be considered by family nurse practitioners and future scholars in this field:
- Family nurse practitioners should emphasize patient-led intervention programs as the best approach to managing anxiety among adult women.
- Patient-led programs should involve effective awareness creation among patients so that they understand their condition and how to manage it.
- It is crucial to ensure that elements of stress are eliminated at home and in the workplace to enhance the quick recovery of the patient.
- Future scholars should focus on how family nurse practitioners can work closely with the family and friends of these patients to help manage their condition.
References
Abbing, A. C., Baars, E. W., Haastrecht, O., & Ponstein, A. S. (2019). Acceptance of anxiety through art therapy: A case report exploring how anthroposophic art therapy addresses emotion regulation and executive functioning. Case Reports in Psychiatry, 19(1), 1-11.
Abbing, A., Baars, E. W., Sonneville, L., Ponstein, A. S., & Swaab, H. (2019). The effectiveness of art therapy for anxiety in adult women: A randomized controlled trial. Frontiers in Psychology, 10(1), 1-12. doi: 10.3389/fpsyg.2019.01203.
Abbing, A., Sonneville, L., Baars, E., Bourne, D., Swaab, H. (2019). Anxiety reduction through art therapy in women. Exploring stress regulation and executive functioning as underlying neurocognitive mechanisms. PLoS One, 14(12), 1-23.
Ackerman, C. E. (2020). 83 benefits of journaling for depression, anxiety, and stress. Positive Psychology.
Andrews, G., Bell1, C., Boyce, P., Gale, C., Lampe, L., Marwat, O., … Wilkins, G. (2018). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Australian and New Zealand Journal of Psychiatry, 52(12), 1109-1172.
Ara, I., Yaqoob. S., Raja. Y., Bukhari, B., & Mudasir, M. (2020). Managing anxiety disorders: A short communication. World Journal of Pharmacy and Pharmaceutical Sciences, 9(3), 1919-1925.
Balestra, M. L. (2019). Family nurse practitioner scope of practice issues when treating patients with mental health issues. The Journal for Nurse Practitioners, 15(1) 479-482.
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19(2), 93-104.
Bazian, A. (2016). Women are more likely to suffer from anxiety than men. The National Health Service. R
Beidel, D. C., Bowers, C. A., & Marks, M. R. (2020). Mental health intervention and treatment of first responders and emergency workers. Hershey, PA: Medical Information Science Reference.
Bhatt, N. V. (2019). Anxiety disorders. MedScape.
Blaskovits, F., Tyerman, J., & Luctkar-Flude, M. (2017). Effectiveness of neurofeedback therapy for anxiety and stress in adults living with a chronic illness: A systematic review protocol. JBI Database System Review Implement, 15(7), 1765-1769. doi:10.11124/JBISRIR-2016-003118
Boyle, S. (2019). Emotional detox for anxiety: 7 steps to release anxiety and energize joy. Avon, MA: Simon and Schuster.
Byrnes, L. (2018). Perinatal mood and anxiety disorders. The Journal for Nurse Practitioners, 14(7), 507-512.
Cardany, A. B. (2018). Mitigating death anxiety: Identifying music’s role in terror management. Psychology of Music, 46(1) 3-17. doi.org/10.1177/0305735617690600
Centre of Perinatal Excellence. (2020). Perinatal anxiety. COPE.
Chalabi, M. (2019). Is anxiety more common in our 30s and 40s? The Guardian.
Chandler, S. K., Robins, L., & Kinser, P. A. (2019). Nonpharmacologic interventions for the self-management of anxiety in Parkinson’s disease: A comprehensive review. Behavioural Neurology, 2019(1), 1-9.
Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., … Saxena, S. (2016). Scaling-up treatment of depression and anxiety: A global return on investment analysis. Lancet Psychiatry, 6(3), 415-24.
Cohen, S. D., Cukor, D., & Kimmel, P. L. (2016). Anxiety in patients treated with hemodialysis. Clinical Journal of the American Society of Nephrology, 11(1), 2250-2255. doi:10.2215/CJN.02590316
Connolly, A., & Britton, A. (Eds.). (2017). Women’s health in primary care. Cambridge, UK: Cambridge University Press.
Cooper, C., & Quick, J. C. (Eds.). (2017). The handbook of stress and health: A guide to research and practice. Hoboken, NJ: John Wiley & Sons.
Ezegbe, B. N., Eseadi, C., Ede, M. O., Igbo, J. N., Anyanwu, J., Ede, K. R., … Ozoemena L. C. (2019). Impacts of cognitive-behavioral intervention on anxiety and depression among social science education students: A randomized controlled trial. Medicine, 98(15), 1-9.
Garbarino, J. (2019). Children and families in the social environment (2nd ed.). New York, NY: Transaction Publishers.
Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M., Lynch, S. E., Bitsko, R. H., … Blumberg, S. J. (2019). Prevalence and treatment of depression, anxiety, and conduct problems in US children. The Journal of Pediatrics, 206(1), 256-67.
Gonzalo, A. (2019). Dorothea Orem: Self-care deficit theory. Nurses Lab.
Hanson, R. (2016). Yoga for depression and anxiety: A systematic review. Social Work Commons.
Hantsoo, L., & Epperson, C. N. (2017). Anxiety disorders among women: A female lifespan approach. American Psychiatric Association Publishing, 15(2), 162-172. doi: 10.1176/appi.focus.20160042
Hellwig, S., & Domschke, K. (2019). Anxiety in late life: An update on pathomechanisms. Gerontology, 65(5), 465-472.
Jalnapurkar, I., Allen, M., & Pigott, T. (2018). Sex differences in anxiety disorders: A review. Journal of Psychiatry Depression and Anxiety, 4(12), 1-9. doi:10.24966/PDA-0150/100012
Kearney, K. D. (2017). Education program using non-pharmacologic support during benzodiazepine reduction in patients with anxiety disorders. Journal of Nursing & Interprofessional Leadership in Quality & Safety, 1(2), 1-12.
Lam, R. W., McIntosh, D., Wang, J., Enns, M. W., Kolivakis, T., Michalak, E., … Sareen, J. (2016). Canadian network for mood and anxiety treatments 2016 clinical guidelines for the management of adults with major depressive disorder: Section 1 disease burden and principles of care. The Canadian Journal of Psychiatry, 61(9) 510-523. doi: 10.1177/0706743716659416
Lim, C. H., Kangas, B., & Bergman, J. (2018). The utility of psilocybin in managing anxiety and depression in cancer patients. Journal of Young Investigators, 35(2), 45-48.
Lipschitz, J. M., Paiva, A. L., Redding, C. A., Levesque, D., Rossi, J. S., Weisberg, R. B., … Prochaska, J. O. (2018). Development and preliminary psychometric evaluation of decisional balance and self-efficacy measures for managing anxiety in a national sample of clinically anxious adults. American Journal of Health Promotion, 32(1), 215-223. doi:10.1177/0890117116669493
Locke, A. B., Kirst, N., & Shultz, C. G. (2015). Diagnosis and management of generalized: Anxiety disorder and panic disorder in adults. American Family Physician, 91(9), 617-623.
MacIntyre, P. D. (2019). Anxiety/uncertainty management and communication accommodation in women’s brief dyadic conversations with a stranger: An idiodynamic approach. SAGE Open, 3(1), 1-18.
Milev, R. V., Giacobbe, P., Kennedy, S. H., Blumberger, D. M., Daskalakis, Z. J., Downar, J., … Modirrousta, M. (2016). Canadian network for mood and anxiety treatments 2016 clinical guidelines for the management of adults with major depressive disorder: Section 4 neurostimulation treatments. The Canadian Journal of Psychiatry, 61(9), 561-575. doi:10.1177/0706743716660033
Pal, L., & Sayegh, R. A. (Eds.). (2017). Essentials of menopause management: A case-based approach. Cham, Switzerland: Springer.
Parikh, S. V., Quilty, L. C., Ravitz, P., Rosenbluth, M., Pavlova, B., Grigoriadis, S., … Velyvis, V. (2016). Canadian network for mood and anxiety treatments 2016 clinical guidelines for the management of adults with major depressive disorder: Section 2 psychological treatments. The Canadian Journal of Psychiatry, 61(9) 524-539.doi: 10.1177/0706743716659418
Posmontier, B. (2012). Managing generalized anxiety disorder in primary care. The Journal for Nurse Practitioners, 8(4), 268-274.
Psychiatric-Mental Health Nurse Practitioner. (2020). Josephine Paterson & Loretta Zderad humanistic nursing theory. PMHNP.
Ravindran, A. V., Balneaves, L. G., Faulkner, G., Ortiz, A., McIntosh, D., Morehouse, R. L.,… Ravindran, L. (2016).Canadian network for mood and anxiety treatments 2016 clinical guidelines for the management of adults with major depressive disorder: Section 5 complementary and alternative medicine treatments. The Canadian Journal of Psychiatry, 61(9) 576-587. doi: 10.1177/0706743716660290
Remes, O., Brayne, C., Linde, R., & Lafortune, L. (2016). A systematic review of reviews on the prevalence of anxiety disorders in adult populations. Brain and Behavior, 6(7), 1-33. doi: 10.1002/brb3.497
Sarris, M. (2018). What anxiety treatments work for people with autism? Interactive Autism Network.
Scott, E. (2020). Journaling is a great tool for coping with anxiety. Stress Management.
Shallik, N. A. (Ed.). (2018). Pain management in special circumstances. London, UK: IntechOpen.
Srivatsa, D. M. (2016). Maya: Bring tears of happiness. Bloomington, IN: Authorhouse.
Stein, M. B., & Sareen, J. (2015). Generalized anxiety disorder. The New England Journal of Medicine, 373(21), 2058-2068.
Stewart, J. G., & Dennert, N. L. (Eds.). (2017). Family nurse practitioner certification review. Burlington, MA: Jones & Bartlett Learning
Takebayashi, Y., Tanaka, K., Sugiura, Y., & Sugiura, T. (2018). Well-being and generalized anxiety in japanese undergraduates: A prospective cohort study. Journal of Happiness Studies, 19(1), 917-937.
Theophilos, T., Green, R., & Cashin, A. (2016). Nurse practitioner mental health care in the primary context: A Californian case study. Healthcare, 3(1), 162-171. doi:10.3390/healthcare3010162
Tredway, K. (2020). Role & scope of practice of a family nurse practitioner. Nurse Journal. Web.
Yasgur, B. S. (2018). Agoraphobia: An evolving understanding of definitions and treatment. Psychiatry Advisor.
Appendices
Appendix 1: Description of Anxiety Disorders
Appendix 2: Prevalence of Different Types of Anxiety
Appendix 3: Prevalence of Anxiety by Age and Gender
Appendix 4: Self-Care Theory
Appendix 5: Humanistic Nursing Model
