Patient Fear: 3 Strategies to Help

The sights and sounds of a busy perioperative suite can be overwhelming for a patient waiting for surgery. Judith Clayton, MSN, RN, CNOR, believes perioperative nurses can do more to acknowledge and reduce a patient’s fear before surgery to help improve their recovery after surgery.

“We know our patients are anxious before surgery, but the fears many patients feel as they wait for surgery go much deeper than we sometimes acknowledge or address,” she says. For example, she hears patients share fears about the surgery not working and about the loss of control while under anesthesia. She also hears increasing concerns regarding pain management because patients are afraid they will be exposed to opioid medication and become addicted.

“Nurses may think a warm touch and acknowledging a patient is enough to allay patient fears before surgery, but I don’t think it is enough,” Clayton stresses.

How Nurses Can Do more

In her 45 years in perioperative nursing, Clayton has seen a wide range of patient responses to surgical fear, including patients who try to get up and walk off the table because they are so scared. As surgical services manager at St. Mary's Hospital in Athens, Ga., Clayton has been pursuing research in patient fear to find more effective ways to help.

Here are several nurse-led interventions she has found make a difference for patients:

Listen (with 100% of your attention)—The preoperative interview, over the phone or in person, is a great time to ask a patient about all of the fears they are feeling leading up to surgery. The patient’s perception of fear is important for a nurse to make note of and for day of surgery providers to be aware of.

“Sometimes just the act of being able to voice a fear or ask a question that has been worrying a patient can make a difference,” Clayton suggests.

She says this is a conversation that requires a nurse’s full attention and intuition to catch any underlying concerns with the patient’s fear that the team needs to understand.

Make the environment less scary—Bright lights, providers talking loudly, and the sound of moving equipment can all increase a patient’s fears. Try these environmental modifications:

• Dim the lights.
• Make sure the patient is warm.
• Limit traffic and conversation near the patient.
• Ask the patient if they prefer specific music they find calming.

Talk about what the patient will experience—It’s difficult to overcome fear but giving a patient knowledge to understand more about what will happen to them before, during and after surgery can help. Preoperative education is an important time when the nurse, surgeon and anesthesiologist talk to the patient about medications and postoperative pain management. Checking in with the patient to make sure they feel comfortable with their plan can help them get answers they were afraid to ask or need to hear again.

Clayton hopes more perioperative nurses will tap into research on patient fear and also engage in new research to uncover more about surgical patient fear and how nurses can help patients reduce fear and improve their postoperative outcomes.  For example, research suggests that alleviating patient fear and anxiety can play a role in reducing the amount of pain medication required to relieve pain. 

“We want emotionally, spiritually and physically able patients with the best outcomes possible,” Clayton says. “Addressing fear is just one of the many ways that nurses can help patients achieve these goals.”

Additional Resources

Learn more from Clayton about the range of patient fears and strategies to help at AORN Global Surgical Conference & Expo in her session on Understanding and Dealing with Fear of Surgery.

Find more strategies to alleviate patient anxiety in AORN’s Guideline for Complementary Care Interventions.

Free Resources for Members

Perioperative Patient Engagement Tool Kit: Get strategies and resources to incorporate patient engagement activities into your practice.