Anxiety and Panic Attacks: How Nurses Can Help Patients (and Recognise When It’s Something Else)

WHO estimates that anxiety disorders are the most common mental disorders worldwide, affecting hundreds of millions of people. In hospital, anxiety is almost universal: fear of diagnosis, pain, procedures, cost, or being away from family. Panic attacks can look frightening, and nurses are often the ones at the bedside. Responding calmly and correctly makes a real difference.

What a panic attack looks like

• Sudden intense fear, peaking within minutes.
• Racing heart, palpitations, chest tightness.
• Shortness of breath, feeling of choking, fast breathing.
• Tingling in fingers and around the mouth (from over-breathing), dizziness.
• Sweating, trembling, nausea.
• Feeling of unreality, or fear of dying or “going crazy”.

Don’t assume it’s “just anxiety”

Many serious conditions cause similar symptoms: heart attack, arrhythmias, pulmonary embolism, asthma, hypoglycaemia, thyroid problems, sepsis, drug withdrawal and anaphylaxis. Always assess properly: A–E, full observations, SpO₂, blood glucose and an ECG where indicated. A patient with low oxygen saturation is not having “just” a panic attack. Be especially careful with patients who have known anxiety; they can still have heart attacks.

Helping someone through a panic attack

1. Stay with them and stay calm. Speak slowly and simply.
2. Reassure: “You’re having a panic attack. It’s frightening, but it will pass. I’m here.” (Once serious causes have been considered.)
3. Slow breathing: breathe in through the nose for 4, out slowly through the mouth for 6. Breathe with them.
4. Grounding: ask them to name 5 things they can see, 4 they can touch, 3 they can hear.
5. Reduce stimulation: a quieter space, fewer people.
6. Don’t use a paper bag for rebreathing. It can lower oxygen levels dangerously and isn’t recommended.

Reducing anxiety in hospital

• Explain what is happening and what to expect, before procedures.
• Answer questions honestly; involve the patient in decisions.
• Manage pain well. See our pain assessment guide.
• Allow family or a companion where possible.
• Support sleep and routine.
• Respect faith practices that bring comfort.

Anxiety disorders

When anxiety is persistent and interferes with daily life (generalised anxiety disorder, panic disorder, social anxiety, phobias, PTSD), effective treatments include psychological therapies such as cognitive behavioural therapy (CBT) and, where needed, medicines such as SSRIs. WHO’s mhGAP guide supports non-specialist health workers, including nurses, to identify and manage common mental health conditions. Benzodiazepines are generally for short-term use only because of dependence risks.

Ask about safety

Severe anxiety often coexists with depression. If you’re concerned, ask directly about thoughts of self-harm. See our suicide risk guide.

Nurses experience anxiety too. If it’s affecting you, you deserve the same care you give others. See support after a traumatic shift.

Based on WHO mental disorder fact sheets, the WHO mhGAP Intervention Guide and NICE CG113 (Generalised anxiety disorder and panic disorder in adults). Educational content.