Nervousness: Comprehensive Nursing Management Guide
A complete guide for nursing students on identification, diagnosis, and management of nervousness in various settings
Introduction to Nervousness
Nervousness is a common human experience characterized by feelings of worry, apprehension, and tension. As a nursing student, understanding nervousness is essential as it affects patients across all healthcare settings. This guide provides comprehensive information on identifying, diagnosing, and managing nervousness in both hospital and home settings.
Throughout a nurse’s career, they will encounter numerous patients experiencing nervousness related to their health conditions, procedures, or hospitalization. Developing competency in addressing nervousness is a critical nursing skill that improves patient outcomes and enhances the quality of care.
Definition & Overview of Nervousness
Nervousness refers to a state of mental or physiological arousal characterized by feelings of anxiety, worry, unease, or apprehension. It typically occurs in response to anticipated events, unfamiliar situations, or perceived threats.
Key Characteristics of Nervousness
- Temporary emotional state (unlike chronic anxiety disorders)
- Typically triggered by specific situations or stimuli
- Manifests through both psychological and physiological symptoms
- Usually subsides when the triggering situation resolves
- Normal adaptive response that can become maladaptive if excessive
Nervousness vs. Anxiety Disorders
| Characteristic | Nervousness | Anxiety Disorders |
|---|---|---|
| Duration | Temporary, situational | Persistent, chronic |
| Intensity | Mild to moderate | Moderate to severe |
| Impact on functioning | Minimal interference | Significant impairment |
| Trigger | Identifiable specific cause | May occur without clear trigger |
| Treatment needs | Often self-manageable | Frequently requires professional intervention |
Identification & Diagnosis of Nervousness
Accurately identifying nervousness requires careful assessment of a patient’s subjective experience alongside objective manifestations. Nurses play a crucial role in recognizing nervousness and distinguishing it from other conditions.
Physical Signs
- Increased heart rate and palpitations
- Elevated blood pressure
- Rapid, shallow breathing
- Trembling or shaking
- Sweating, especially palms and forehead
- Dry mouth
- Muscle tension
- Gastrointestinal disturbances (nausea, “butterflies”)
- Frequent urination
- Dizziness or lightheadedness
Psychological Signs
- Excessive worry or fear
- Difficulty concentrating
- Racing thoughts
- Feeling on edge
- Irritability
- Sleep disturbances
- Restlessness
- Anticipation of worst outcomes
- Heightened vigilance to threats
- Desire to escape the situation
Assessment Tools for Nervousness
While nervousness itself isn’t a clinical diagnosis, several validated tools can help assess its presence and severity:
| Assessment Tool | Description | Application in Nursing |
|---|---|---|
| Visual Analog Scale (VAS) | Simple line scale where patients mark their level of nervousness from 0-10 | Quick assessment; useful for tracking changes over time |
| State-Trait Anxiety Inventory (STAI) | Distinguishes between temporary (state) and long-term (trait) anxiety | Helps differentiate situational nervousness from chronic anxiety |
| Hospital Anxiety and Depression Scale (HADS) | 14-item scale measuring anxiety and depression in medical settings | Useful for inpatient assessment of nervousness and related symptoms |
| Generalized Anxiety Disorder 7 (GAD-7) | 7-item screening tool for anxiety symptoms | Quick screening to detect if nervousness may indicate an anxiety disorder |
Nursing Diagnostic Process for Nervousness
Patient presents with signs of nervousness
Gather subjective data
(Patient’s description)
Collect objective data
(Physical signs)
Review health history
(Previous episodes)
Analyze data and identify patterns
Formulate nursing diagnosis
e.g., “Anxiety related to hospitalization as evidenced by…”
Determine if referral needed
(For severe or persistent symptoms)
Develop and implement care plan
Common Nursing Diagnoses Related to Nervousness
- Anxiety related to threat to health status, hospitalization, or upcoming procedure as evidenced by increased vital signs, restlessness, and verbalization of concerns
- Fear related to unfamiliar environment, diagnostic procedures, or treatment outcomes as evidenced by increased tension, apprehension, and avoidance behaviors
- Ineffective Coping related to situational crisis and personal vulnerability as evidenced by inability to meet basic needs, sleep disturbance, and verbalization of inability to cope
- Disturbed Sleep Pattern related to psychological stress as evidenced by difficulty falling asleep, interrupted sleep, and reports of not feeling well-rested
- Risk for Impaired Decision-Making related to overwhelming anxiety as evidenced by inability to process information and verbalized difficulty with decision-making process
Physiology of Nervousness
Understanding the physiological basis of nervousness helps nurses recognize why patients experience specific symptoms and develop targeted interventions. Nervousness triggers a cascade of biological responses primarily mediated by the autonomic nervous system.
The Nervous System Response
Nervousness activates the sympathetic branch of the autonomic nervous system, initiating the “fight-or-flight” response. This evolutionary adaptation prepares the body to respond to perceived threats through several key mechanisms:
| System | Response to Nervousness | Observable Signs |
|---|---|---|
| Cardiovascular | Increased heart rate and cardiac output; blood vessel constriction | Tachycardia, palpitations, increased blood pressure |
| Respiratory | Bronchodilation; increased respiratory rate | Rapid, shallow breathing; shortness of breath |
| Musculoskeletal | Increased muscle tension; blood flow directed to large muscles | Trembling, muscle tightness, restlessness |
| Gastrointestinal | Decreased blood flow; altered gut motility | “Butterflies,” nausea, diarrhea, dry mouth |
| Integumentary | Increased sweat gland activity | Sweating, especially palms, soles, and forehead |
| Neurological | Heightened sensory awareness; increased cortisol release | Hypervigilance, difficulty concentrating |
Neurochemical Pathway of Nervousness
Trigger (e.g., perceived threat, uncertainty)
Amygdala activation (emotional processing center)
Hypothalamus stimulation
Sympathetic nervous system activation
HPA axis activation
Release of epinephrine & norepinephrine
Release of cortisol
Physical & psychological symptoms of nervousness
Nursing Management of Nervousness in Hospital Settings
Hospital environments often intensify feelings of nervousness in patients due to unfamiliar surroundings, loss of control, and concerns about medical procedures or diagnoses. Effective nursing management of nervousness in hospital settings requires a comprehensive and individualized approach.
Assessment in Hospital Settings
Initial Assessment Guidelines
- Establish baseline: Assess vital signs, level of nervousness, and physical manifestations during admission
- Identify triggers: Determine specific hospital-related factors exacerbating nervousness (procedures, pain, uncertainty)
- Review history: Note previous episodes of nervousness, coping strategies, and response to interventions
- Medication review: Check for medications that may cause or worsen nervousness (stimulants, steroids)
- Cultural considerations: Understand cultural factors influencing expression and management of nervousness
Nursing Interventions
Environmental Interventions
- Create a calm, quiet environment by minimizing noise and unnecessary disruptions
- Ensure adequate privacy and maintain patient dignity
- Provide clear orientation to hospital environment and routines
- Organize care to minimize interruptions during rest periods
- Adjust lighting to promote comfort and relaxation
- Allow personal items from home when possible to increase familiarity
Therapeutic Communication
- Use clear, concise language appropriate to patient’s understanding
- Provide information about procedures, treatments, and expected sensations
- Validate patient concerns and normalize feelings of nervousness
- Active listening without interruption or judgment
- Encourage expression of feelings and questions
- Maintain calm, reassuring demeanor even during emergencies
Relaxation Techniques
- Guided imagery: Lead patient through visualization of peaceful scenes
- Progressive muscle relaxation: Instruct on tensing and relaxing muscle groups
- Deep breathing: Teach diaphragmatic breathing (4-7-8 technique)
- Mindfulness: Guide focus on present moment sensations
- Music therapy: Offer calming music through headphones
- Aromatherapy: Use lavender or chamomile when appropriate
Education & Empowerment
- Provide clear explanations about condition, treatment, and prognosis
- Demonstrate use of equipment before procedures
- Teach self-monitoring of nervousness levels
- Involve patient in decision-making when possible
- Establish method for patient to communicate needs
- Prepare for transitions (shift changes, transfers between units)
Pharmacological Interventions
When non-pharmacological approaches are insufficient, medication may be considered as part of the treatment plan, always in consultation with the primary provider:
| Medication Class | Examples | Nursing Considerations |
|---|---|---|
| Benzodiazepines | Lorazepam (Ativan), Diazepam (Valium) | Monitor for respiratory depression, sedation, fall risk; avoid long-term use |
| Beta-blockers | Propranolol | Monitor heart rate and blood pressure; contraindicated in asthma |
| Antihistamines | Hydroxyzine (Vistaril) | Monitor for sedation, dry mouth; may cause confusion in elderly |
| SSRIs/SNRIs | Sertraline (Zoloft), Venlafaxine (Effexor) | For chronic anxiety; require 2-4 weeks for full effect; monitor for serotonin syndrome |
Mnemonic: CALM PATIENT
For managing nervousness in hospital settings:
C – Create calm environment
A – Assess triggers and symptoms
L – Listen actively to concerns
M – Manage symptoms with interventions
P – Provide information
A – Address physical comfort
T – Teach relaxation techniques
I – Involve in care decisions
E – Encourage expression of feelings
N – Note response to interventions
T – Time management of medications
Documentation and Evaluation
Proper documentation is essential for tracking the effectiveness of interventions and ensuring continuity of care:
- Document baseline assessment of nervousness using standardized tools when possible
- Record specific triggers identified and patient’s unique manifestations
- Detail interventions implemented and patient’s response
- Note effectiveness of PRN medications when administered
- Update care plan based on evaluation of interventions
- Include patient’s self-reported nervousness levels before and after interventions
- Document education provided and patient’s demonstrated understanding
Nursing Management of Nervousness in Home Settings
Managing nervousness in home settings presents unique challenges and opportunities. Nurses in home health, community settings, or providing discharge education play a vital role in helping patients develop sustainable strategies for managing nervousness in their daily lives.
Assessment in Home Settings
Home assessment provides valuable insights into environmental factors and daily routines that may contribute to or alleviate nervousness:
- Evaluate home environment for stressors (noise, crowding, safety concerns)
- Assess family dynamics and support systems
- Identify daily activities that trigger nervousness
- Review self-management strategies currently employed
- Determine impact of nervousness on activities of daily living
- Assess sleep environment and habits
- Review medication regimen for adherence and effectiveness
Home-Based Interventions
Environmental Modifications
- Create a dedicated relaxation space in the home
- Recommend noise reduction strategies (white noise machines, earplugs)
- Suggest organization of living space to reduce visual clutter
- Implement lighting adjustments to promote calm
- Establish technology boundaries (screen-free times, spaces)
- Incorporate calming elements (plants, nature sounds, soothing colors)
Lifestyle Interventions
- Develop consistent daily routines to reduce uncertainty
- Create a balanced schedule with adequate rest periods
- Incorporate regular physical activity (30 minutes daily)
- Teach nutrition principles to avoid anxiety-triggering substances (caffeine, alcohol)
- Establish healthy sleep hygiene practices
- Encourage participation in enjoyable activities and hobbies
Daily Routine Planning for Nervousness Management
| Time | Activity | Nervousness Management Strategy |
|---|---|---|
| Morning | Wake-up routine | 5-minute breathing exercise before getting out of bed |
| Breakfast | Mindful eating; avoid caffeine or limit to one cup | |
| Morning activities | Prioritize tasks; break large tasks into smaller steps | |
| Midday | Lunch | Take full lunch break away from work area; eat balanced meal |
| Afternoon activities | Schedule brief relaxation breaks every 90 minutes | |
| Evening | Dinner | Eat 2-3 hours before bedtime; limit sugar and heavy foods |
| Evening wind-down | Dim lights; limit screen time; relaxing activity (reading, bath) | |
| Bedtime | Sleep preparation | Progressive muscle relaxation; consistent bedtime routine |
Family and Caregiver Education
Key Education Points for Support Persons
- Recognition: Teach family members to recognize signs of nervousness
- Supportive communication: Provide techniques for calm, validating responses
- Avoidance of reinforcement: Explain how excessive reassurance can sometimes reinforce anxiety
- Balance of support: Guide on providing support without enabling avoidance behaviors
- Self-care: Emphasize importance of caregiver’s own mental health maintenance
- Crisis management: Develop plan for handling severe episodes of nervousness
- Resource navigation: Familiarize with community resources and when to seek professional help
Self-Management Tools and Resources
Self-Monitoring Tools
- Nervousness journal: Template for tracking triggers, symptoms, and effective interventions
- Symptom rating scales: Simple 0-10 scales for daily monitoring
- Mobile applications: Recommend evidence-based apps for anxiety management
- Thought records: Templates for identifying and challenging anxious thoughts
- Body scan checklist: Guide for recognizing physical symptoms of nervousness
Community Resources
- Support groups (in-person or online)
- Mental health hotlines and crisis services
- Community wellness programs
- Stress management classes
- Meditation and yoga centers
- Public library resources on anxiety management
- Local mental health professionals specializing in anxiety
Mnemonic: HOME CARE
For managing nervousness in home settings:
H – Healthy routine establishment
O – Organize environment for calm
M – Mindfulness practice daily
E – Exercise regularly
C – Connect with support systems
A – Avoid anxiety triggers when possible
R – Relaxation techniques practice
E – Educate self and family about nervousness
Follow-Up and Continuity of Care
- Establish clear follow-up schedule based on nervousness severity
- Provide contact information for questions between visits
- Coordinate care with other healthcare providers (primary care, mental health)
- Create actionable plan for escalation if symptoms worsen
- Schedule periodic reassessment of management strategies
- Develop transition plan as nervousness improves
- Document progress and update home care plan accordingly
Control of Nervousness
Effective control of nervousness involves a combination of preventive strategies, immediate interventions during acute episodes, and long-term management approaches. Nurses play a crucial role in empowering patients with tools to recognize and manage their nervousness independently.
Prevention Strategies
Physical Approaches
- Regular aerobic exercise (30 min, 5x weekly)
- Adequate sleep (7-9 hours)
- Balanced nutrition with regular meals
- Limit caffeine, alcohol, and sugar
- Stay hydrated
- Practice deep breathing daily
- Progressive muscle relaxation training
Cognitive Approaches
- Mindfulness meditation practice
- Cognitive restructuring of anxious thoughts
- Positive self-talk development
- Worry scheduling (designated worry time)
- Problem-solving skill building
- Acceptance practices
- Realistic goal setting
Social/Behavioral Approaches
- Building strong support network
- Regular social connection
- Time management techniques
- Setting healthy boundaries
- Engaging in enjoyable activities
- Volunteer work or helping others
- Expressive activities (art, music, writing)
Acute Management Techniques
The 5-4-3-2-1 Grounding Technique
A powerful method for managing acute nervousness by engaging the senses:
- Identify 5 things you can see – Look around and name 5 objects in your environment
- Acknowledge 4 things you can touch/feel – Notice the texture of your clothing, the surface you’re sitting on, etc.
- Listen for 3 things you can hear – Pay attention to sounds around you: traffic, birds, voices
- Note 2 things you can smell – Identify scents in the air or recall familiar comforting smells
- Recognize 1 thing you can taste – Notice the current taste in your mouth or take a small sip of water
Quick Calming Techniques
- Box breathing: Inhale (4 counts), hold (4), exhale (4), hold (4)
- Cold stimulus: Hold ice cube or splash cold water on face
- Body scan: Systematically relax each body part
- Anchoring statement: Repeat calming phrase (“This will pass”)
- Physical grounding: Push feet firmly into floor
- Bilateral stimulation: Tap alternating legs or shoulders
Cognitive Interruption Strategies
- Thought stopping: Mentally yell “STOP” when anxious thoughts begin
- Reality testing: Examine evidence for and against anxious thoughts
- Worst-case/best-case analysis: Identify actual likely outcome
- Distraction: Count backwards from 100 by 7s
- Perspective shift: “How will I view this in one year?”
- Cognitive defusion: Observe thoughts without attachment
Long-Term Management Approaches
Comprehensive Nervousness Management Plan
| Domain | Daily Practices | Weekly Practices | As-Needed Interventions |
|---|---|---|---|
| Physical | 10-minute morning stretching; balanced meals; 8-hour sleep schedule | 3-4 exercise sessions (30+ min); meal planning | Deep breathing; progressive muscle relaxation |
| Psychological | 10-minute mindfulness practice; positive affirmations | Cognitive journal entry; skill development practice | Grounding techniques; thought records |
| Social | Brief connection with loved one; gratitude practice | Meaningful social interaction; setting boundaries | Reach out to support person; temporary withdrawal from overstimulating environments |
| Environmental | Maintain organized space; limit news exposure | Nature exposure; technology detox period | Create quiet space; use comforting sensory items |
Tracking Progress and Effectiveness
Helping patients monitor their nervousness over time provides valuable data for refining management strategies:
- Baseline assessment: Establish starting point for symptoms and frequency
- Regular self-ratings: Daily nervousness levels (0-10 scale)
- Intervention effectiveness: Rate helpfulness of specific techniques
- Trigger identification: Document patterns of nervousness occurrence
- Progress review: Weekly reflection on changes and improvements
- Strategy refinement: Adjust approach based on collected data
- Celebration of successes: Acknowledge and reinforce progress
Mnemonic: CONTROL
For long-term management of nervousness:
C – Challenge negative thoughts
O – Observe body sensations without judgment
N – Nourish body with proper nutrition and exercise
T – Take time for relaxation each day
R – Recognize early warning signs
O – Obtain support when needed
L – Limit exposure to known triggers
Special Considerations for High-Risk Populations
Children and Adolescents
- Use age-appropriate language and explanations
- Incorporate play therapy and art expression
- Involve parents/caregivers in management strategies
- Address school-related nervousness specifically
- Watch for somatic complaints (stomach aches, headaches)
- Teach simple self-regulation techniques
- Monitor for impact on developmental milestones
Older Adults
- Consider medication interactions and sensitivities
- Address sensory deficits that may increase nervousness
- Modify physical interventions for mobility limitations
- Screen for cognitive impairment affecting coping
- Assess for loneliness and isolation factors
- Provide written instructions with larger font
- Consider life transitions (retirement, loss) as triggers
Case Studies: Nervousness Management
Case Study 1: Pre-Operative Nervousness
Patient Profile: Maria, 45-year-old female scheduled for cholecystectomy. No psychiatric history but reports increasing nervousness about upcoming surgery.
Assessment Findings:
- Vital signs: HR 98, BP 138/88, RR 22
- Reports difficulty sleeping for past three nights
- Expresses fear of surgical complications and pain
- Demonstrated trembling hands during pre-op teaching
Nursing Interventions:
- Provided detailed explanation of surgical procedure and post-op care
- Taught diaphragmatic breathing technique and practiced together
- Arranged pre-op visit with anesthesiologist to address pain control
- Guided 10-minute progressive muscle relaxation before pre-medication
- Maintained calm, reassuring presence during pre-op preparation
Outcomes:
- Pre-medication HR decreased to 82, patient reported feeling “more in control”
- Successfully used breathing techniques during IV insertion
- Post-operative report indicated stable vital signs during induction
- Patient reported intervention effectiveness: 8/10
Case Study 2: Chronic Nervousness in Home Setting
Patient Profile: James, 67-year-old male with COPD, recently discharged after exacerbation. Reports increasing nervousness about managing condition at home.
Assessment Findings:
- Home environment: Lives alone in apartment, organized but isolated
- Support system: Daughter visits weekly, minimal other social contacts
- Primary nervousness triggers: Shortness of breath, fear of not being able to reach help
- Current coping: Limits activity to avoid breathlessness, increasing isolation
Nursing Interventions:
- Created “breathlessness action plan” with clear steps for different scenarios
- Taught pursed-lip breathing technique to manage respiratory symptoms
- Set up medical alert system with demonstration and practice calls
- Developed activity pacing schedule to balance rest and movement
- Connected patient with weekly COPD support group (virtual option)
- Established weekly home nursing visits for first month post-discharge
Outcomes:
- After 4 weeks, self-reported nervousness decreased from 8/10 to 4/10
- Successfully used action plan during one episode of increased symptoms
- Began short daily walks with gradual distance increase
- Reported improved sleep quality and reduced morning anxiety
Mnemonics for Nervousness Management
NURSE Response to Nervousness
N – Name the emotion (“I notice you seem nervous about the procedure”)
U – Understand the patient’s perspective (“It’s understandable to feel this way”)
R – Respect the patient’s coping efforts (“You’re doing well with deep breathing”)
S – Support through presence and assistance (“I’ll stay with you during this”)
E – Explore strategies to address concerns (“Let’s discuss what might help”)
RELAX Technique for Acute Nervousness
R – Recognize early signs of nervousness
E – Exhale slowly and completely
L – Loosen muscles progressively from head to toe
A – Attend to the present moment
X – X-amine thoughts for distortions
AWARE Strategy for Nervousness
A – Accept the anxiety (don’t fight it)
W – Watch the anxiety (observe without judgment)
A – Act normally despite feeling anxious
R – Repeat these steps as needed
E – Expect the best outcome
STOP Approach for Assessment
S – Symptoms identification (physical and psychological)
T – Triggers identification (situational factors)
O – Outcome effects (impact on functioning)
P – Patient’s coping resources
Comprehensive Mnemonic: NERVOUSNESS
A complete approach to assessment and management:
N – Note physical manifestations
E – Evaluate psychological impact
R – Recognize environmental triggers
V – Validate patient’s feelings
O – Offer appropriate support
U – Understand patient’s perspective
S – Start relaxation techniques
N – Normalize the experience
E – Educate about nervousness management
S – Support coping strategy development
S – Strengthen self-efficacy
Additional Resources
For Patients
- Anxiety and Depression Association of America (ADAA)
- National Alliance on Mental Illness (NAMI)
- Mental Health America
- Calm and Headspace meditation apps
- Breathing Zone app for controlled breathing
- “The Anxiety and Phobia Workbook” by Edmund Bourne
For Nurses
- American Psychiatric Nurses Association
- Anxiety Disorders: A Pocket Guide for Primary Care
- NANDA Nursing Diagnoses related to anxiety
- Cognitive Behavioral Therapy basics for nurses
- Relaxation technique demonstration videos
- Motivational interviewing resources
Assessment Tools
- Hamilton Anxiety Rating Scale (HAM-A)
- Generalized Anxiety Disorder 7-item (GAD-7) scale
- Hospital Anxiety and Depression Scale (HADS)
- State-Trait Anxiety Inventory (STAI)
- Beck Anxiety Inventory (BAI)
- Visual Analog Scale for Anxiety (VAS-A)