Nursing diagnosis – FEAR

FEAR

DEFINITION

Response to a perceived threat that is consciously recognized as a

danger

DEFINING CHARACTERISTICS

• 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
and pallor

RELATED FACTORS

• Language barrier

• Separation from support

• Learned response

system

• Phobic stimulus

• Unfamiliarity with

• Sensory impairment

environmental experience

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Risk management

• Coping

• Sleep/rest

• Physical regulation

EXPECTED OUTCOMES

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.

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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

stimulation.

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

Reference

Cookman, C. (2005, June). Attachment in older adulthood: Concept clarifica-

tion. Journal of Advanced Nursing, 50(5), 528–535.

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