Basic, intense emotional response aroused by the detection of imminent threat, involving an immediate alarm reaction (American Psychological Association)

Physiological

Anorexia

Diaphoresis

Diarrhea

Dyspnea

Increased blood pressure

Increased heart rate

Increased respiratory rate

Increased sweating

Increased urinary frequency

Muscle tension

Nausea

Pallor

Pupil dilation

Vomiting

Xerostomia

Behavioral/Emotional

Apprehensiveness

Concentration on the source of fear

Decreased self-assurance

Expresses alarm

Expresses fear

Expresses intense dread

Expresses tension

Impulsive behaviors

Increased alertness

Ineffective Impulse Control

Nervousness

Psychomotor agitation

Fear can be a response to various health problems, situations, or conflicts. Some common sources are indicated in the following.

Pathophysiologic

Related to perceived immediate and long-term effects of:

Cognitive impairment

Disabling illness

Long-term disability

Loss of body function or part

Sensory impairment

Terminal disease

Treatment Related

Related to loss of control and unpredictable outcome secondary to:

Hospitalization

Invasive procedures

Surgery and its outcome

Radiation

Anesthesia

Situational (Personal, Environmental)

NANDA-I approved*

Related to:

Communication barriers*

Learned response to threat*

Response to phobic stimulus*

Unfamiliar situation*

Related to loss of control and unpredictable outcome secondary to:

Change or loss of significant other

Pain

New environment

New people

Success

Divorce

Lack of knowledge

Failure

Related to potential loss of income

Maturational

Preschool (2 to 5 years)

Related to:

Age-related fears

Animals

Being alone

Bodily harm

The dark, strangers, ghosts

Not being liked

Separation from parents, peers

Strangers

School-Age (6 to 12 years)

Related to:

Being lost

Being in trouble

Thunder, lightning

Bad dreams

Weapons

Adolescent (13 to 18 years)

Related to uncertainty of:

Appearance

Scholastic success

Peer support

Adult

Related to uncertainty of:

Marriage

Job security

Pregnancy

Effects of aging

Parenthood

Older Adult

Related to anticipated dependence:

Prolonged suffering

Financial insecurity

Vulnerability to crime

Abandonment

Children

Individuals exposed to traumatic situation

Individuals living in areas with increased violence

Individuals receiving terminal care

Individuals separated from social support

Individuals undergoing surgical procedure

Individuals with family history of post-traumatic shock

Individuals with history of falls

Older adults

Pregnant women

Women

Women experiencing childbirth

Sensation disorders

AUTHOR'S NOTE

Refer to Anxiety.

Level I Fundamental Focused Assessment (all settings)

How can I help you feel more comfortable?

The adult will relate increased psychological and physiologic comfort as evidenced by the following indicators:

• Shows decreased visceral response (pulse, respirations).
• Differentiates real from imagined situations.
• Describes effective and ineffective coping patterns.
• Identifies own coping responses.

The child will exhibit or relate increased psychological and physiologic comfort as evidenced by the following indicators:

• Discusses fears.
• Exhibits less crying.

Level 1 Fundamental Focused Interventions (all settings)

Nursing interventions for Fear represent interventions for any individual with fear regardless of the etiologic or contributing factors.

Assess Possible Contributing Factors

Refer to Related Factors.

Reduce or Eliminate Contributing Factors

Unfamiliar environment

• Use their name in interactions, use light touch if comforting.
• Orient to environment using simple explanations.
• Explain all procedures.
• Speak slowly and calmly.
• Avoid surprises and painful stimuli.
• Plan one-day-at-a-time; follow a familiar routine.
• Establish frequent and consistent contacts; use family members and significant others to stay with the individual if desired.

Attempt to assign the same nursing personnel

R:Explanations and consistency can reduce fears (Halter, 2018). A quiet, calm professional can communicate calm to the individual (*Varcarolis, 2014).

Intrusion on Personal Space

• Allow personal space.
• Remain with the individual until fear subsides (listen, use silence).

R:Minimizing environmental stimuli can help reduce escalation of fear (*Varcarolis, 2011).

Level 2 Extended Focused Interventions (any setting)

• Explore that fear is just an emotion. It may be overwhelming but is just a feeling.
• Confirm that everyone has fears.
• What is important is how one chooses to live with fear.
• Acknowledge that if one controls one's fears then there may be more opportunities for success and enjoyment (employment, hobbies, adventures).

R:"Fear doesn't have to rule one's life. One can control fear and when one does their lives are more exciting, and fulfilling. We feel more empowered, supported, guided and present. Enjoy your life more by allowing fear to be your fellow traveler instead of the boss" (Sutreiasa, 2015).

Address specific fears and/or fearful situations.

• Encourage expression of fearful feelings (helplessness, anger).
• Have individual breathe with you. Slowly breathe in through nose and out through mouth. Ask how it helped.
• Refocus interaction on areas of capability rather than dysfunction.
• Give feedback of the effect their behavior has on others.

R:Strategies to reduce fear response can then lead to constructive problem solving and can instill hope.

When Intensity of Feelings Has Decreased, Assist with Insight and Controlling Response

• Ask the individual to write their fears in narrative form

R:Writing down one's fears can give insight and control (*Crossley, 2003).

Teach how to approach problem-solving.

• What is the problem?
• Who or what is responsible?
• What are the options?
• What are the advantages and disadvantages of each option?

R:Open, honest dialogue may help initiate constructive problem-solving and can instill hope.

Initiate Health Teaching and Referrals as Indicated

• Progressive relaxation technique
• Reading, music, breathing exercises
• Desensitization, self-coaching
• Thought stopping, guided fantasy
• Yoga, hypnosis, assertiveness training
• Contact information for counseling services.

R:These methods can increase control and increase comfort or relaxation.