NURSING

PRACTICE
& SKILL

Communication: Communicating with Patients who are Fearful

What is Communicating with Patients who are Fearful?
Communication is the movement of information or feedback (e.g., spoken word) between a sender and a receiver.
Communication is necessary for human interaction. Fear is an emotion that is experienced when a person senses
danger. Fear is often experienced by patients in the healthcare setting in response to their perception of the
potential for physical and emotional harm. Fear can cause patients to become emotionally overwhelmed and
unable to concentrate, leading to impaired communication
What: Communicating with patients who are fearful involves assessing for fearfulness, encouraging patients
to express their fears, acknowledging their fears, providing emotional support, educating about their health
condition and related diagnostic procedures, providing information on prescribed treatment, and assisting with
strategies for coping with being fearful
How: Communicating with patients who are fearful requires listening, acknowledging patients feelings, providing
reliable and realistic information about patients health condition and strategies for coping with being fearful,
and reassuring patients that they are not alone
Where: Communicating with patients who are fearful occurs in all inpatient and outpatient healthcare settings
Who: All healthcare clinicians (e.g., nurses, physicians, physical/occupational therapists, nursing assistants) can
communicate with patients who are fearful

What is the Desired Outcome of Communicating with Patients

who are Fearful?
Communicating with patients who are fearful is performed to
educate about strategies that assist patients in coping with being fearful
share information regarding patients health status and prescribed treatment
allow patients to express their personal thoughts, feelings, and needs

Why is Communicating with Patients who are Fearful

Important?
Communicating with patients who are fearful is
necessary for basic human interaction
important to assist patients with identifying and coping with or overcoming their fear in order to decrease the
physical stress response activated by the body
important to help patients reduce their fear in order to commit to adherence to a prescribed treatment regimen
that improves health outcomes

Author
Jennifer Kornusky, RN, MS
Cinahl Information Systems, Glendale, CA

Reviewers
Darlene Strayer, RN, MBA
Cinahl Information Systems, Glendale, CA
Nursing Practice Council
Glendale Adventist Medical Center,
Glendale, CA

Editor
Diane Pravikoff, RN, PhD, FAAN
Cinahl Information Systems, Glendale, CA

August 2, 2013

Facts and Figures

Experiencing a prolonged state of fear can have adverse effects on physical health (Ross, 2003 Dec.-2004 Feb.)

What You Need to Know Before Communicating with Patients

who are Fearful
Fear is a normal psychological response that occurs as a defense mechanism when a person experiences a
frightening event, object, or environmental stimuli; experiencing fear subsequently stimulates a normal physiologic
response by the sympathetic nervous system to a perceived threat
Patients become more mentally and physically aware of their surroundings when experiencing fear
Fear causes catecholamines to be released into the blood to manage stress
Physical manifestations of fear include
increases in heart rate, respiratory rate, and blood pressure
muscle tension
sweating
Referral to a social worker or a clergyperson for identification of supportive resources and counseling can assist
patients with resolving their fearfulness

Published by Cinahl Information Systems, a division of EBSCO Publishing. Copyright2014, Cinahl Information Systems. All rights reserved. No
part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information
storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information
given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.
Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206

 Asking patients to explain their perception of their health status and the healthcare environment can provide insight into factors causing their fear, and
observing nonverbal responses (e.g., crying; refusing to talk about a topic; body language, such as assuming a closed, protective position) of patients can
provide insight into factors that contribute to their being fearful. Patients experience fear in the healthcare setting due to
perceptions of their health status and/or the healthcare environment
perceiving the potential for discomfort
feeling a loss of control
being separated from family and other support systems
being in an unfamiliar environment
feelings of concern for their future, including the potential for changes in lifestyle
Fear is often a response to facing the unknown
Providing patients with as much information as possible regarding what to expect regarding their diagnosis and treatment regimen can reduce fear and
create optimism
Providing information that is factual and realistic is important; providing false reassurance should be avoided
Reassure patients that the healthcare staff members are knowledgeable and are doing everything possible to provide effective patient care
Allowing patients the opportunity to express additional concerns after receiving educational information is important to the continued reduction in patients
anxiety. Patients can perceive receiving information and reassurance without an opportunity for further discussion as dismissive
Fear can be a barrier to patient agreement and adherence to the prescribed treatment regimen
When patients are fearful, they often exhibit certain behaviors (e.g., withdrawal, denial) as a method of coping; some patients withdraw or use denial because
they are also angry, an emotion patients are often more comfortable with than fear
Patients who are fearful are often comforted by
removal of an object or stimulus that is identified to cause fear
participating in a consistent routine or schedule of patient care activity
speaking with others who have experienced the same health condition or environmental condition
visiting with a clergyperson
discussing the future and hearing stories of survival, which can instill hope
Listening to patients who are fearful is important to identify information that can be useful when communicating with them
Focus on patients level of comfort in sharing information to guide communication
Provide education based on assessment of the level of information patients are willing to discuss or accept
Ask patients for more information on subjects they repeatedly mention and concerns they allude to but do not discuss in detail
- Do not force patients to discuss topics if they appear to be uncomfortable or seem unprepared to discuss the topic (e.g., death)
- Approaching patients with a predetermined agenda can impair communication
Use humor with caution because patients may find the use of humor to be dismissive and insensitive; humor should be avoided unless the patient
demonstrates humor first
It is vital to acknowledge and accept patients fears and support patients who are fearful
Acknowledging fear validates the emotion in fearful patients
Patients may be more comfortable discussing being fearful after their fears are acknowledged
Using shaming and negative statements can impair communication
Reinforcing that fear is a normal reaction to the unknown or to a perceived danger is important to reduce fearfulness
Medication (e.g., antianxiety agents, sedatives) may be ordered for patients who have debilitating levels of fear and/or anxiety; administering prescribed pain
medication can lessen patients fearfulness
Fears of the family members and other caregivers can negatively affect patients; family members and other caregivers should discuss and resolve their fears in
order to avoid making patients more fearful
Preliminary steps that should be performed before communicating with patients who are fearful include the following:
Review the patients medical record for information on
the patients fears
successful coping techniques that have been utilized in the past
the patients diagnosis, health status, and the prescribed treatment regimen
If possible, locate a quiet area free of distractions to use when communicating with patients who are fearful, and coordinate other patient care
responsibilities to provide a period of uninterrupted time
Gather supplies, as appropriate, including
prescribed medications, if appropriate
written information, if available, to reinforce verbal education

How to Communicate with Patients who are Fearful

Perform hand hygiene to prevent the transmission of microorganisms among patients

Identify the patient according to facility protocol
Establish privacy by closing the door to the patients room and/or drawing the curtain surrounding the patients bed
Introduce yourself to the patient and family member(s), if present, and assess the patient and the environment for potential barriers to communication (e.g.,
patient confusion or sensory impairment [e.g., vision loss, hearing loss]; environmental noise, lack of privacy, or distracting lighting)
Determine if the patient/family requires special considerations regarding communication (e.g., due to illiteracy, language barriers, or deafness); make
arrangements to meet these needs if they are present
Use professional certified medical interpreters, either in person or via phone, when language barriers exist
Remove or reduce barriers to communication (e.g., provide pain medication, turn the television off, provide the patient with hearing aid or glasses, close the
door to the patients room)

 Ask the patient if he/she is comfortable and if he/she needs anything to promote comfort
Sit close to the patient and at eye level (e.g., sit in a chair at the side of the bed)
Explain the importance of communication and the physiologic reaction to fear
Ask the patient to explain his/her perception of his/her health status and the healthcare environment
Assess nonverbal behaviors while the patient speaks
Verbally interpret body language and other nonverbal communication to the patient phrased as a question to prevent misunderstandings
Listen for topics or themes in the patients responses that are not directly mentioned by the patient
Use open-ended questions to gather additional information on topics that the patient mentions but does not clarify or elaborate on
Allow the patient to speak, set the pace of the conversation, and express himself/herself without interrupting
Tell the patient that his/her concerns and fears are appropriate
Perform the following while communicating your support to the patient:
Call the patient by name
Speak clearly and loudly and avoid lowering your voice at the end of a sentence
Maintain eye contact
Use simple, nonmedical terminology
Have the patient repeat your words, as appropriate, to verify that he/she interprets your comments correctly
Repeat in your own words what you hear the patient say to verify your understanding and demonstrate that you are listening to him/her
Provide the patient with positive feedback regarding his/her participation in the conversation
Provide the patient with an opportunity to ask questions about tests, procedures, equipment, and prescribed treatment
Answer the patients questions using simple terminology that he/she is able to easily understand
Provide information on the prescribed treatment regimen, including the plan of care for managing pain, if appropriate
Share stories of other patients who have experienced the same health condition and treatment, and describe what coping strategies they used
Educate about what to expect in the future regarding health status and treatment using positive terminology
Provide the patient with a sense of control by allowing him/her to participate in planning care and initiating coping strategies to reduce fearfulness
Collaborate with the patient to establish a daily routine/schedule to decrease uncertainty
Provide consistent caregivers or assign a primary care nurse to decrease variation in administration of nursing care
Provide a schedule of religious/spiritual gatherings and suggest that the patient participate, or suggest referral to the facility chaplain or a clergyperson
Offer referral to a social worker for identification of local resources for support groups and information on the patients health condition
End the communication session by reviewing all information that was discussed, stating what the next steps will be, and scheduling a time to continue the
conversation, if appropriate
Place the nurse call button within the patients reach
Update the patients plan of care, if appropriate, and document the patient interaction and education in the patients medical record, including the following
information:
Date and time of the patient interaction
Patient assessment findings, such as
fears identified
Patients response and level of participation in the interaction
All topics discussed, education and referrals provided, next steps/follow-up plan
Outcome of the interaction, including the patients feedback on the communication
Any unexpected patient events or outcomes, interventions performed, and whether or not the treating clinician was notified

Other Interventions That May be Necessary Before, During, or After Communicating

with Patients who are Fearful
If it is possible to talk with the patient in an area other than the patients room, identify a quiet area that is free of distractions; find a comfortable place for the
patient to sit and a place for you to sit that is at eye level for the patient
One or more additional interactions may be necessary to continue the discussion about the patients fears and possible coping strategies
The patient may require reinforcement of the identified coping strategies

What to Expect After Communicating with Patients who are Fearful

Patients will report a feeling of psychological comfort
Patients may report that fearfulness is eliminated
Patients will be able to focus when communicating

Red Flags
Remaining in a state of fear for a prolonged period can lead to physical complications (e.g., decreased cardiac output, development of an ulcer)

What Do I Need to Tell the Patient/Patients Family?

Reinforce that fear is a normal response to the unknown or to a perceived threat

Educate the patient/family on the importance of acknowledging fear as a first step to identify the cause and eliminate or cope with the fear
Explain to the patient/family that patients often report increased physical and mental comfort after fears have been discussed
Remind family members that it is not effective to discuss the patients fears unless the patient is comfortable doing so

Note
Recent review of the literature has found no updated research evidence on this topic since previous publication on April 20, 2012

References
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