by Valarie Juntunen

Created on: August 31, 2009   Last Updated: September 03, 2009

Fear is a primal response that cannot be controlled by strength of will alone. This emotion is beneficial in many situations because it sparks physiological responses that can preserve life and help avert danger. Yet, in the medical setting, these physiological responses are at best useless and at worst damaging to overall wellbeing. Therefore we must do more than just deal with a fearful patient; we must act to stabilize their emotional health.

There is little doubt that uncontrolled fear or anxiety, experienced over long periods of time, can negatively impact health. What is not commonly known is that acute fear can cause medical complications and in rare cases, death. Fear produces adrenalin and other biochemicals that increase metabolic rates, constrict blood vessels, and increase cardiac and respiratory workloads. Once turned on, these internal events can cascade unless the fear is alleviated or the internal pressures are relieved.

According to an analysis entitled Somatic and Psychologic Predictors of Long-term Unfavorable Outcomes After Surgical Intervention (published by Lippincott), "Fear of the long-term consequences of the operation was associated with more pain, poor global recovery, and worse quality of life 6 months later, whereas optimism was associated with better recovery and higher quality of life."1 This analysis only verified a surgical theory that is taught in most nursing schools around the world - fear can lead to negative surgical outcomes.

Perhaps the most extreme example of the medical danger associated with unrelieved fear occurred in 1970 when a four year old girl named Denise O'Connor died from cardiovascular collapse caused by the fright she experienced during a dental procedure.2 Other similar cases have been documented during war and natural disaster conditions.

Nursing must recognize and treat underlying fear before it negatively impacts the patient's health. Often, it is too easy for us to be consumed with treating the medical conditions of our patients. After all, as nurses we give the medications, monitor health status, and are often the first to respond to rapid deteriorations or emergency situations. However, there is a whole medical team that focuses on physical health. Nurses are often the only and most qualified providers of emotional support.

The first step in dealing with a fearful patient is to recognize the symptoms of fear. Often fear is seen as a weak trait in our culture, so your patient may attempt to hide this

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