Response to a perceived threat that is consciously recognized as a
• Behaviors involving aggression, avoidance, impulsivness, increased
alertness, and narrowed focus of the source of fear
• Cognitive effects such as decreased self-assurance, productivity, and
ability to problem solve
• Feelings of alarm, apprehension, increased tension, panic, and terror
• Physiological changes including increased heart rate, respiration
rate, perspiration, and/or blood pressure; anorexia, nausea, vomit-
ing, diarrhea, muscle tightness, fatigue, and shortness of breath
• Language barrier
• Separation from support
• Learned response
• Phobic stimulus
• Unfamiliarity with
• Sensory impairment
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Risk management
• Physical regulation
The patient will
• Identify source of fear.
• Communicate feelings about separation from support systems.
• Communicate feelings of comfort or satisfaction.
• Use situational supports to reduce fear.
• Integrate into daily behavior at least one fear-reducing coping
mechanism, such as asking questions about treatment progress or
making decisions about care.
SUGGESTED NOC OUTCOMES
Anxiety Control; Comfort Level; Coping; Fear Control; Pain Level
INTERVENTIONS AND RATIONALES
Determine: Ask patient to identify source of fear; assess patient’s
understanding of situation. Perceptions may be erroneously based.
Perform: Help patient maintain daily contact with family: Arrange
for telephone calls; help write letters; promptly convey messages to
patient from family and vice versa; encourage patient to have
pictures of loved ones; provide privacy for visits; take patient to day
room or other quiet area. These measures help patient reestablish
and maintain social relationships.
Involve patient in planning care and setting goals to renew conﬁ-
dence and give a sense of control in a crisis situation. If patient has
no visitors, spend an extra 15 min each shift in casual conversation;
encourage other staff members to stop for brief visits. These meas-
ures help patient cope with separation.
Administer antianxiety medications, as ordered, and monitor effec-
tiveness. Drug therapy may be needed to manage high anxiety levels
or panic disorders.
Inform: Instruct patient in relaxation techniques such as imagery and
progressive muscle relaxation to reduce symptoms of sympathetic
Answer questions and help patient understand care to reduce anx-
iety and correct misconceptions.
Attend: When feasible and where policies permit, relax visiting
restrictions to reduce patient’s sense of isolation.
Allow a close family member or friend to participate in care to
provide an additional source of support.
Support family and friends in their efforts to understand patient’s
fear and to respond accordingly to help them understand that
patient’s emotions are appropriate in context of situation.
Manage: Refer patient to community or professional mental health
resources to provide assistance.
SUGGESTED NIC INTERVENTIONS
Active Listening; Anxiety Reduction; Cognitive Restructuring; Coun-
seling; Coping Enhancement; Decision-Making Support; Security
Enhancement; Presence; Support Group
Cookman, C. (2005, June). Attachment in older adulthood: Concept clariﬁca-
tion. Journal of Advanced Nursing, 50(5), 528–535.