Preoperative Care - Reducing Pre-Surgery Anxiety

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Published: 26 November 2017

Day surgery nurses play an important role in preparing patients for surgery and coordinating the care required for their individual needs.

Preoperative nursing, when performed effectively, can result in satisfaction, patient safety, quality healthcare and cost-effectiveness (Turunen et al. 2017).

Preoperative Patient Anxiety

Preoperative education can decrease the pre-surgery anxiety of patients (Alanazi 2014).

Nurse managers and educators may need to increase guidance for preoperative nurses involved in direct-care, for example by implementing a formal plan for preoperative education requirements. Interventions such as this may help to ‘ease nurses' cognitive workload and enhance patient satisfaction’ (Mitchell 2016).

Studies indicate that ‘play, learning and entertainment’ during preparation for surgery can prevent preoperative anxiety in paediatrics (Messina et al. 2014).

Preoperative Care - Reducing Pre-Surgery Anxiety child patient

Branchs and Lerman (2013) acknowledge that there are other non-pharmacological ways to minimise anxiety.

For children, parental presence during anaesthesia induction is promoted for anxiolysis (Branchs & Lerman 2013). Furthermore, providing toys pre-surgery and educating parents have been found to significantly decrease the anxiety of paediatrics and improve mothers’ satisfaction with treatment (Ghabeli, Moheb & Hosseini Nasab 2014).

It is crucial that person-centred care takes place, as anxiety may be dependent on a range of factors unique to the individual such as:

  • Age
  • Prior admission to hospital
  • Socioeconomic status
  • Ethnicity
  • Temperament.

(Branchs & Lerman 2013)

Preoperative nurses also need to be aware of anxiety causes and triggers.

Preoperative anxiety may be related to:

  • The surgery itself
  • Potential complications
  • Fear of the unknown
  • Anaesthesia
  • The operating room environment
  • Symptoms
  • Recovery
  • The organisation and provision of care.

(King et al. 2017; Gursoy et al. 2016)

Gursoy et al. (2016) note that operating room nurses can reduce the preoperative stress of patients by visiting them prior to surgery.

Day-of-Surgery Cancellations

A different issue that preoperative nurses may face is day-of-surgery cancellation (Ming Teh et al. 2016), which may lead to:

  • Decreased revenue
  • Wasted resources
  • Decreased training opportunities for staff
  • Adverse effects on patients’ psychology, finances and social life.

(Dimitriadis, Iyer & Evgeniou 2013)

According to Ming Teh et al. (2016), ‘a good history obtained by a trained and experienced advanced practice nurse or registered nurse can reduce day-of-surgery cancellations’. Nurses can perform telephone assessments to establish whether patients are at risk of complications and refer those deemed at-risk to relevant health professionals for further evaluation prior to surgery.

This finding aligns with those of Malley et al. (2015), which suggest that preoperative nursing assessment can reveal patients’ risk factors for surgery and the overall ‘perioperative care trajectory’.

Malley et al. (2015) also note that the preoperative nurse’s role is focused on advocating for and detecting patients’ individual needs and potential risks in relation to surgery and the perioperative journey.

Conclusion

It is apparent that preoperative nursing is a speciality that can promote clinical safety, patient satisfaction and cost-efficiency for health organisations. This emphasises the need for adequate staffing, skills mix, competence and continuous development.

It is important that preoperative nurses have an understanding of and are competent in delivering evidence-based health education and other anxiety-relieving interventions relevant to their patients' specific needs. This highlights the need for nurse managers and educators to support direct-care nurses’ continuous professional development, performance evaluations and competency assessments.


References
  • Alanazi, AA 2014, ‘Reducing anxiety in preoperative patients: a systematic review’, British Journal of Nursing, vol. 23, no. 7, pp. 387-393, viewed 20 November 2017, http://web.a.ebscohost.com/abstract?direct…4245
  • Branchs, RJ & Lerman, J 2013, ‘Preoperative Anxiety Management, Emergence Delirium, and Postoperative Behavior’, Anesthesiology clinics, vol. 32, no. 1, pp. 1-23, viewed 20 November 2017, https://www.ncbi.nlm.nih.gov/pubmed/24491647
  • Dimitriadis, PA, Iyer, S & Evgeniou, E 2013, ‘The challenge of cancellations on the day of surgery’, International Journal of Surgery, vol. 11, iss. 10, pp. 1126-30, viewed 20 November 2017, http://www.sciencedirect.com/science/article/pii/S1743919113010509
  • Ghabeli, F, Moheb, N & Hosseini Nasab, SD 2014, ‘Effect of Toys and Preoperative Visit on Reducing Children’s Anxiety and their Parents before Surgery and Satisfaction with the Treatment Process’, Journal of Caring Sciences, vol. 3, no. 1, pp. 21–8, 20 November 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134164/
  • Gürsoy, A, Candaş, B, Güner, S & Yılmaz, S 2016, ‘Preoperative Stress: An Operating Room Nurse Intervention Assessment’, Journal of PeriAnesthesia Nursing, vol. 31, no. 6, pp. 495-503, viewed 20 November 2017, https://www.ncbi.nlm.nih.gov/pubmed/27931701
  • King, A, Bartley, J, Johanson, DL, Broadbent, E 2017, ‘Components of preoperative anxiety: A qualitative study’, Journal of Health Psychology, viewed 20 November 2017, https://www.ncbi.nlm.nih.gov/pubmed/28810456
  • Malley, A, Kenner, C, Kim, T & Blakeney, B 2015, ‘The Role of the Nurse and the Preoperative Assessment in Patient Transitions’, AORN Journal, vol. 102, no. 2, p. 181, viewed 20 November 2017, https://www.ncbi.nlm.nih.gov/pubmed/26227526
  • McLaughlin, SL 2016, ‘Is Therapeutic Play Effective at Reducing Preoperative Anxiety In Children Age 4 Through 12?’, PCOM Physician Assistant Studies Student Scholarship, viewed 20 November 2017, http://digitalcommons.pcom.edu/pa_systematic_reviews/295
  • Messina, M, Molinaro, F, Meucci, D, Angotti, R, Giuntini, L, Cerchia, E, Bulotta, AL & Brandigi, E 2014, ‘Preoperative distraction in children: hand-held videogames vs clown therapy’, La Pediatria Medica e Chirurgica, vol. 36, no, 5-6, http://www.pediatrmedchir.org/index.php/pmc/article/view/98
  • Ming Teh, AH, Turner, BS, Tan, SB & Tham, CS 2016, ‘Effectiveness of an Advanced Practice Nurse–Led Preoperative Telephone Assessment’, Journal of Nursing Care Quality, vol. 31, no. 2, pp. 191–6, viewed 20 November 2017, https://www.ncbi.nlm.nih.gov/pubmed/26352856
  • Mitchell, M 2017, ‘Day surgery nurses’ selection of patient preoperative information’, Journal of Clinical Nursing, vol. 26, iss. 1-2, pp. 225–37, viewed 20 November 2017, http://onlinelibrary.wiley.com/doi/10.1111/jocn.13375/full
  • Turunen, E, Miettinen, M, Setälä, L and Vehviläinen-Julkunen, K 2017, ‘An integrative review of a preoperative nursing care structure’, Journal of Clinical Nursing, vol. 26, no. 7-8, pp. 915-30, viewed 20 November 2017, https://www.ncbi.nlm.nih.gov/pubmed/27325370

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