Background
Clinicians often underestimate the fear that children have with frequent needlesticks required in the care of many endocrine disorders (Bracha, 2004). While fear lessened, 28% of young children with Type 1 diabetes mellitus continued to report needle fear 6 months after diagnosis (Howe et al., 2011).
Aims
A concept analysis of fear with a focus on childhood fear was undertaken to define the antecedents, criteria, and consequences of fear to develop a theoretical definition of fear that informs nursing interventions to help children cope with fear.
Methods
A literature review was conducted on fear theories, neurophysiology of fear, and childhood fear. A brief review of animal fear was also included because it offers an interesting perspective. The methods of Walker and Avant (2005) were used to describe the criteria, antecedents, and consequences of fear.
Results
Two leading theories include fear as a conditioned response or fear as an evolutionarily adaptive response to imminent threat. There are two key criteria for fear: 1) a neurophysiologic response that triggers an autonomic physiologic response; 2) a behavioral response: freeze, flight, fight, fright, and faint (Bracha, 2004). The antecedent to fear is the presence of a real or perceived threat (Forsner et al., 2009). While the range of threats seem infinite, the subjective experience of what is feared and the fear itself are influenced by developmental age, vulnerability, past experiences, and genetic factors. The consequences of fear include conditioning and avoidance.
Conclusion
Fear is a conditioned or evolutionary adaptive, neurophysiologic and behavioral response that is part of the normal developmental experience in childhood to real or perceived threat. A model and contrary case will be presented.
Clinical Implications
Needle fear begins as an evolutionary adaptive response but with negative experiences, the child's fear response escalates. Desensitizing interventions with incremental exposure to needles help children cope. A nurse can turn a negative moment for a child fearful of needles into a powerful, empowering experience.
Article info
Identification
Copyright
© 2012 Published by Elsevier Inc.
