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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 patients 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 spouses 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
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