Expert Nursing Tips: How to Deal With a Fearful Patient

Understanding and dealing with patient's fears

Patients can become fearful, at any time, for many different reasons. Dealing with a frightened patient takes compassion, care and concern on the part of registered nurses, as well as other medical personnel and family members. Sometimes fear is not easy to deal with.

A frightened patient's situation can suddenly become very volatile, intense and complex, as well as unpredictable in nature. The patient's fear may be justified, if grounded in something real or legitimate. It may be rooted in that which imagined or associated with a panic attack.

How you respond to your frightened patient, as a registered nurse is important. What you say or do as a professional health care giver may help to resolve a potentially serious, critical situation.

Here are some tips with regard to dealing with a fearful patient. Consider this example.

Sam, a teenage patient, is screaming, as you walk down the hallway. Upon entering his room, you see him cringe and suddenly, dive under the covers. Within seconds, he jumps out of his bed, pulls everything on the bedside table onto the floor and crawls under the bed.

What should you, as a registered, nurse do?

Recognize the reality that your patient is frightened. Do not panic, as this may increase his fear. Call someone to assist you, as help may be needed to resolve this crisis or you may need to notify his doctor, immediately.

Meanwhile, quickly assess the situation with regard to what is happening. Depending on what you see, it may not be advisable to try to approach him. If you decide to approach him, do so cautiously and quietly, unless it appears to be an emergency situation, in which the patient is likely to harm himself or someone else.

You may need to intervene very quickly. Be aware that your patient and others may be in danger, particularly if it involves a fire. (If there is a fire, pull the fire alarm, immediately.)

Try not to frighten your patient by anything that you say or do. Speak to him in a quiet, calm and re-assuring manner, using his name. "Sam, everything is going to be all right."

Acknowledge your awareness of his fear, by stating, "I see that you are frightened. Trust me. You can come out from under the bed now." He may or may not move, depending upon how frightened he is or what he is afraid of. Assure him that he will be safe.

Attempt to pinpoint exactly what has frightened your patient. If possible, remove whatever it is from the room. (That may not always be possible.)

Offer your assistance to the frightened patient by suggesting to him, "Let me help to get you back into your bed, Sam."

Smile at your patient. Many times, a smile can allay unnecessary fears, particularly when it involves children or troubled teenagers.

"Can you tell me what it is that you are afraid of, Sam?" 

Your patient may not know what he is afraid of or may be too frightened to tell you. Discuss your patient's fear with him in a kindly manner. Is his fear rational or legitimate? Can it be resolved immediately and effectively? Is there more than one thing that is frightening your patient? If you are able to pinpoint the patient's fear, explain to him that there are things that a patient does not need to be afraid of and may be able to explain away some of his fear.

If the situation is escalating, do not put yourself in danger. If you are injured, you cannot assist your patient or other patients. Ring the patient's call bell for additional help, if someone has not already come to assist you or use the phone in the patient's room to call for further assistance, if needed.

Try to ascertain if there is someone else who is able to help your frightened patient more than you can, at that time. There may be a parent or a family member in the immediate vicinity, who recognizes this pattern of behavior and knows how to deal with the patient's specific fear or phobia. He may have been having repeated panic attacks like this, for a long time.

"Your mom is in the lunch room, Sam. Shall I ask someone to go and get her for you?"

Stay beside your patient's bed or sit quietly with your patient, until this person comes or the patient's fear is allayed. You may be able to hold your patient's hand or put an arm over his shoulder. Be careful, as you may wind up getting bitten or hit by the patient. He may throw something at you.

Document everything as it happens, if possible, because this may be a regular pattern of behavior for him. 

Identify possible triggers for his fear and record his reactions and responses to what you say or do. Note what appears to allay his fear.

Assign someone to stay with him at all times. Check on him regularly, to make certain that he is all right and reassure him that he is safe. 

Take appropriate security precautions to make certain that others in the room are safe too, particularly if he appears to be disoriented or confused.

Re-assess the situation, as restraints may be indicated, if your patient becomes violent or is abusive towards you or others. Obtain additional assistance from an orderly or security personnel, as necessary.

Make certain that your patient's doctor is contacted as soon as possible, to obtain appropriate sedation or medication. Be aware that his fear may be triggered by a drug reaction of some kind. It may also be alcohol or drug related, induced or triggered by withdrawal from something he has become dependent upon.

There are numerous things that frighten patients when they go to see a doctor or when they are ill and must be hospitalized. Always record anything that a patient is normally afraid of, on his nursing care plan. 

Document specific phobias that he has, like fear of the dark. Other fears may include fear of the unknown, something in the hospital environment, blood, pain, death, x-ray machines, medical personnel wearing gowns, gloves and masks, medication, surgery, procedures or lab tests, intravenous therapy, needles or injections.

What happens to a patient when he or she is afraid of something or someone?

Fear causes a sudden rush of adrenalin, which can result in the patient having the feeling of paralysis or being unable to move. He may not be able to act upon or voice any of his fears. This often occurs in conjunction with schizophrenia. Hallucinations may be involved. Fear also causes patients to become aggressive, fight with others, including doctors and nurses, other medical personnel and family members. Fear leads to the expression of frustration and anger, which may cause him to hit out, bite or argue with everyone attempting to care for him. The patient may become destructive with respect to his environment. He may pull out feeding tubes or intravenous lines. Fear causes a flight response, as the patient instinctively wants to flee or may try to hide somewhere. He may attempt to leave or disappear.

As a professional registered nurse, you understand patient's fears to some extent and yet, there is always the unexpected to deal with.

Be prepared to be challenged by any fearful patient. Know that your patients will learn to trust you, when you assist them to deal with their real or imaginary fears or phobias, in a way that demonstrates sincere concern, care and compassion in a professional manner.