Death anxiety

Domain 9. Coping-stress tolerance
Class 2. Coping responses
Diagnostic Code: 00147
Nanda label: Death anxiety
Diagnostic focus: Death anxiety

Introduction to Nursing Diagnosis Death Anxiety

Death anxiety is a powerful and instinctive emotion experienced by all people, regardless of age, sex, culture, or religion. It is the fear of death, the unknown, and pain that can be so overwhelming that it leads to significant mental health symptoms. By its very nature, death anxiety creates a unique challenge with diagnosis and treatment for medical providers, as understanding and confronting death can cause intense fear in both the patient and clinician.

NANDA Nursing Diagnosis Definition

According to NANDA International, the canonical definition of death anxiety includes fear of death or terminal illness, fear of the unknown of what occurs after death, and fear of the pain and suffering that can accompany death. Associated diagnoses include threat to self-concept, difficulty coping, powerlessness, and grief.

Defining Characteristics

Subjectives

Subjectivity Characteristics of nursing diagnosis for death anxiety can range from verbalization of a fear of death to actual avoidance of end-of-life issues. Other characteristics may include: verbalization of thoughts and images related to death, avoidance of topics related to death and dying, unrealistic expectations about death, expressions of helplessness and hopelessness, anxiety, lack of insight, lack of trust in self, avoidance of activities and places associated with death, changes in sleep and eating habits, depressed mood, and anxiety.

Objectives

Objective Characteristics of nursing diagnosis for death anxiety can range from physical signs like increased pulse and blood pressure, to behavioral changes like increased restlessness or agitation. Other objective data gathered through observation may include: repeated statements indicating fear of pain and suffering in the context of death and dying, physical movements correlating to fear and worry, abnormal phraseology related to death and dying, and posturing as if to flee when end-of-life topics arise.

Related Factors

Death anxiety can be related to a variety of factors, including physiological and cognitive factors. Physiological factors include age, sex, and genetic predispositions to anxious behaviors. In regards to cognitive factors, death anxiety can be influenced by religious beliefs, death phobia, prior traumatic life experiences, and mental health disorders.

At Risk Populations

Certain populations are at greater risk of death anxiety due to their life circumstances or inherent traits. These groups include older adults, individuals with chronic disability or illness, those with a mental health diagnosis, or anyone who has experienced a traumatic life event. People who had particularly stressful childhoods, people who possess a poor coping mechanism, and those who experiment with drugs or alcohol all fall into this high risk category as well.

Associated Conditions

Individuals suffering from death anxiety may also experience various mental health disorder symptoms. These disorders include depression, bipolar disorder, panic disorder, agoraphobia, generalized anxiety disorder, social anxiety disorder, and adjustment disorder. Co-morbid disorders such as substance use disorder and personality disorders can also be associated with death anxiety.

Suggestions for Use

The primary goal of treating death anxiety is to reduce the patient’s fear and guide them toward a healthier and more positive perspective on life and death. To achieve these goals, medical providers should focus on effectively evaluating and diagnosing the patient by asking pertinent questions and listening to their answers. Treatment should include psychotherapy, pharmacologic therapy, and other interventions focusing on psychological symptom reduction and behavior modification. A bereavement program may also help the patient to navigate through their grief and participate in meaningful activities oriented around death and dying.

Suggested Alternative NANDA Nursing Diagnosis

In addition to death anxiety, there are other disorders that provide similar associations. These diagnoses include: spiritual distress, decisional conflict, risk for loneliness, and impaired coping.

Usage Tips

When evaluating for death anxiety, it is important to provide a safe and supportive environment for the patient. Developing an effective therapeutic relationship based on trust is the key to helping them confront difficult issues, allowing them to open up and discuss their fears and anxieties. Providers should also be aware of their own emotional reactions to the patient’s situation, and take steps to create a nonjudgmental atmosphere.

NOC Outcomes

There are many potential outcomes of death anxiety nursing care related to the National Outcome Measures (NOM). In regards to NOM, possible outcomes may include improved coping strategies, self-concept, ability to manage emotions, improved communication patterns, fear control, decreased symptoms, improved social interactions, improved self-care, increased quality of life, and altered lifestyle behaviors.

Evaluation Objectives and Criteria

When evaluating the effectiveness of nurse-led interventions for death anxiety, the following criteria can be utilized: the patient’s ability to meet their goals, improvement in symptoms, overall quality of life, decrease in frequency and intensity of anxiety, improved ability to cope with stressful situations, decreased avoidance of death-related activities/topics, improved cognitive function and mental health, and improved overall psychological functioning.

NIC Interventions

Common nursing interventions for death anxiety include psycho-education, death and dying education, individual counseling, group support, stress reduction techniques, relaxation therapy, guided imagery, cognitive behavioral therapy, and medication evaluation/management. Other interventions may include family support, lifestyle modifications, and alternative therapies such as pet therapy and meditation.

Nursing Activities

Nurses play a pivotal role in helping patients manage their death anxiety by providing attentive care and guidance while they work through the process. This includes offering compassionate listening, providing education and resources, and helping them to develop problem-solving skills. Nurses should also pay attention to the patient’s emotions, encourage self-expression, provide emotional support and empathy, and create a safe and secure environment while they work toward a resolution.

Conclusion

Death anxiety is a powerful and instinctive emotion experienced by all people. It is important for healthcare providers to recognize the signs of death anxiety and provide individualized interventions to help patients cope with their fear. With the proper care and support, individuals can learn to create a healthy relationship with death and make whatever time they have left more meaningful.

5 FAQs

• What is death anxiety?
  Death anxiety is an intense fear of death, the unknown, and any associated pain or suffering. It is a natural emotional response to the idea of mortality, but when severe it can lead to psychological issues.
• What are some signs of death anxiety?
  Death anxiety can manifest itself in many ways, including verbalization of fear, avoidance of activities and places connected with death, posturing as if to flee when end-of-life topics are discussed, changes in eating and sleeping habits, and physical signs like heightened pulse and blood pressure.
• Who is at risk for death anxiety?
  Certain populations are at higher risk of developing death anxiety, such as older adults, individuals with chronic disabilities or illnesses, people with a mental health disorder, and those who have experienced a traumatic life event.
• What treatments are available?
  Treatment for death anxiety should involve a combination of psychotherapy, pharmacologic therapy, behavior modification, and bereavement programs. Additional interventions such as stress reduction techniques, meditation, and cognitive behavior therapy can also be beneficial.
• Who can help with death anxiety?
  Medical providers such as nurses and mental health clinicians possess the knowledge and resources necessary to provide the best care for death anxiety. Additionally, the patient's family members, friends, and loved ones can offer compassionate support and be instrumental in the healing process.

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