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Psychological Care 135

TABLE 7.2 Anxiety self-report scales TABLE 7.3 Non-pharmacological measures to
reduce anxiety
Scale Number of Items Comments
Nurse-initiated treatments Environmental factors
Hospital 14 (including 7 Easy and fast to complete
Anxiety and anxiety items) Extensively used and Patient massage 26 Provision of natural light 27,28
Depression therefore international
Scale comparisons are Aromatherapy 24,29 Calming wall colours such as
(HADS) 14 available blue, green and violet 27,28
Demonstrated validity 15 Music therapy 2,30-32 Noise reduction with
Depression 21 (including 7 Items measured on scale consideration of alarms,
Anxiety and anxiety items) of 0 (did not apply to paging systems, talking, etc.
Stress Scale me at all) to 3 (applied
21 (DASS to me very much or
21) 16 most of the time)
Demonstrated validity in consent. Beneficial effects that have been reported include
clinical populations 17
lowered blood pressure, heart rate and respiratory rate,
Spielberger 20 items Items measured on a improved sleep and reduced stress, anxiety and pain,
State scale of 1 (not at all) to although as with any therapy, each non-pharmacological
Anxiety 4 (very much so)
Inventory Validity demonstrated in treatment may have different effects on individual
23-25
(SAI) 1 various populations 1 patients, consequently ongoing assessment is essential.
Too long for routine In addition, the safety of these therapies within the criti-
clinical use, but may cal care environment has not been well demonstrated,
be useful in associated necessitating a high level of monitoring through
research
administration.
Visual 1 item 10 cm/100 mm line from
Analogue ‘not at all anxious’ to
Scale ‘very anxious’
– Anxiety Demonstrated validity 18
(VAS–A) Practice tip
Faces Anxiety 1 item 5 possible responses or
Scale 19 ‘faces’ to reflect anxiety Ask your patient or his/her family if he/she likes music to help
Fast and easy to use relax. Have the family bring in a music player with some favou-
Validity has been rite music and headphones. Prepare the patient for a rest
demonstrated in a period. Ensure that pain relief is sufficient, all interventions are
small number of ICU complete, and the patient is comfortable. Assess the anxiety or
cohorts 20,21
level of sedation beforehand and then commence at least 30
minutes of uninterrupted music. Reassess after the session, and
record and report results.

Practice tip
FIGURE 7.1 Faces anxiety scale. Prioritise the assessment and treatment of discomfort, pain
19
and anxiety. This will greatly reduce sedative medication
requirements.

such as anxiolytic and pain-relieving medication are well-
recognised and often-used ways to reduce anxiety,
non-pharmacological treatments are also useful, and can Other strategies to reduce anxiety include interpersonal
be divided into environmental and nurse-initiated interventions such as communication and information
interventions. sharing by the healthcare team and inclusion of family
22
members in care processes. The presence of a family
Non-pharmacological Treatments member can provide additional reassurance and can
An advantage of the non-pharmacological treatments is facilitate communication between the health team and
that they can be nurse-initiated or implemented when patients.
units are designed or refurbished (see Table 7.3). Although
the benefits of non-pharmacological treatments may be Pharmacological Treatment for Anxiety
widely accepted in the community, incorporation of com- Treatment for pain and other reversible physiological
plementary therapies is dependent on their acceptance causes of anxiety and agitation should be a priority.
within the clinical context and appropriate patient Should anxiety and agitation continue despite the