The effects of preoperative guided imagery interventions on preoperative anxiety and postoperative pain: A meta-analysis

The effect of brochure-assisted education given before septorhinoplasty on surgical fear and anxiety: A randomized controlled trial

This study is a randomized controlled interventional study aimed to determine the effect of preoperative brochure-assisted education on surgical fear and anxiety in patients scheduled for septorhinoplasty surgery. The study was conducted between May 2022 and February 2023 in the Otorhinolaryngology services and clinics of a training and research hospital in the southern region of Turkey. The study included 61 patients, with 29 in the education group and 32 in the control group. All patients received routine nursing care before surgery, with the education group receiving additional education through an informative brochure. The data were collected using the "Personal Information Form", "Surgical Fear Questionnaire", and "Surgical Anxiety Questionnaire". There was no significant difference in the mean scores of surgical fear between the groups on the morning of the surgery (p > 0.05). However, a significant difference was found in the mean scores of surgical anxiety between the groups (p < 0.05). In conclusion, patients in the education group who received preoperative brochure-assisted education had lower anxiety compared with the control group.

Perceived compassionate care and preoperative anxiety in hospitalized patients

BACKGROUND

Quality nursing care and ethical responses to patient pain and suffering are very important in the preoperative period. However, few studies have addressed these variables.

OBJECTIVE

This study aimed to examine the relationship between compassionate care and preoperative anxiety from the perspective of hospitalized patients.

METHODS

The current study was a cross-sectional descriptive one. The participants were selected using convenience sampling. The data were collected using a demographic questionnaire, Burnell Compassionate Care Tool, and Amsterdam Preoperative Anxiety and Information Scale (APAIS). The collected data were analyzed with SPSS software (version 22) through descriptive and inferential statistics at a significance level of 0.05 (p < .05).

PARTICIPANTS AND SETTING

This study was conducted on 704 candidates for surgery in the internal and surgical wards of a large teaching hospital located in the south of Iran from December 2022 to March 2023.

ETHICAL CONSIDERATIONS

The protocol for this study was reviewed and approved by the University Ethics Committee.

FINDINGS

The patients' average age was 36.61 ± 13.07. The average preoperative anxiety and need for information scores were 13.80 ± 2.66 and 7.44 ± 1.47, respectively. The average score of importance was 3.03 ± 0.19, and the average score of the extent of compassionate care provision was 1.22 ± 0.15. There was a significant relationship between preoperative anxiety with importance and the extent of compassionate care provision (r = 0.68, p < .001), r = -0.72, p < .001, respectively). A comparison of the demographic characteristics, need for information, importance, and provision of compassionate care showed that the extent of compassionate care provision had the greatest contribution in explaining preoperative anxiety (β = 0.50; p < .001).

CONCLUSION

Even though patients' preoperative anxiety was high and providing compassionate care in the preoperative period had a great role in relieving their anxiety, many participants appear to have received little compassionate care. To this end, nursing managers should pay attention to the quality of compassionate care in the preoperative stage. Besides, healthcare staff should receive the necessary training in compassionate nursing care.

Effect of Lavender Oil on Preoperative Anxiety: Systematic Review and Meta-analysis

PURPOSE

Surgical interventions are known to induce anxiety in patients due to the associated risks and potential complications. Various methods are employed to alleviate preoperative anxiety. This study aimed to investigate the impact of lavender oil application on the anxiety levels of patients scheduled for surgical procedures.

DESIGN

Systematic review and meta-analysis.

METHODS

Studies were accessed using the keywords "preoperative and lavender oil and stress" in Turkish and English between July 1 and 30, 2022, through PubMed (including MEDLINE), Cochrane, EBSCOhost, Web of Science, YÖK National Thesis Center, and Google Scholar. The standardized mean difference was calculated using random-effects models, and the Cochrane Collaboration tool was used to assess the risk of bias in each study. The study was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist.

FINDINGS

Twenty studies were included in the analysis. The anxiety level of the experimental group to which lavender oil was applied before the surgical intervention was significantly lower than that of the control group (standardized mean difference:-5.40; 95% CI: -8.76 to -2.04).

CONCLUSION

Preoperative lavender oil application was found to be an effective method for relieving patients' anxiety. Lavender oil is thought to be a potential standalone treatment for preoperative anxiety.

The Effect of Preoperative Pain, Fear, and Anxiety on Postoperative Pain in Urological Surgery Patients: A Descriptive and Correlational Study

PURPOSE

The study was conducted to determine the effect of preoperative pain, fear, and anxiety on postoperative pain and analgesia use in urology patients.

DESIGN

A descriptive and correlational design was used.

METHODS

The population of the study consisted of patients who were hospitalized in the Urology clinic of a university hospital and were planning surgery. The sample consisted of 106 patients who met the inclusion criteria and agreed to participate in the study. The study's data was collected using the Personal Information Form, Analgesia Follow-up Form, Surgical Fear Questionnaire, Surgical Anxiety Questionnaire, and Visual Analog Scale prepared in line with the literature. Descriptive statistics, Pearson correlation coefficient, and linear regression analysis were used to evaluate the data.

FINDINGS

A positive linear relationship was found between postoperative pain and surgical anxiety, surgical fear, and preoperative pain (P < .05). Regression analysis revealed that preoperative pain (P = .006) affected the level of postoperative pain. In addition, fear of surgery (P = .035) and postoperative pain (P = .000) were found to affect the use of postoperative 24-hour analgesia.

CONCLUSIONS

The study revealed a relationship between the postoperative pain experienced by the patients and preoperative pain, fear, and anxiety.

Effect of Guided Imagery on Patient Comfort, Vital Signs, Pain, Anxiety, and Satisfaction in Cancer Patients Undergoing Port Catheterization With Local Anesthesia: A Prospective Randomized Controlled Study

BACKGROUND

Port catheter placement is usually an operation performed under local anesthesia. Being conscious during the interventions performed with local anesthesia can lead to anxiety and stress.

OBJECTIVE

The aim of this study was to determine the effect of guided imagery performed before and during the procedure on vital signs and comfort, pain, anxiety, and satisfaction levels in patients with cancer undergoing port catheterization with local anesthesia.

METHODS

A total of 80 patients were included in the study. Patients in the intervention group received standard treatment and nursing care, as well as a guided imagery intervention once before and once during the procedure. Patients in the control group received only standard treatment and nursing care.

RESULTS

Patients in the guided imagery group reported lower pain and anxiety scores, higher patient satisfaction, and increased comfort compared with patients in the control group. Patients in the guided imagery group showed significantly lower respiratory rate and heart rate than the control group by the end of the procedure. There was no significant difference in blood pressure.

CONCLUSION

Practicing guided imagery before and during a procedure performed under local anesthesia reduced cancer patients' pain, increased patient satisfaction and comfort, and had a positive effect on their respiratory and heart rates.

IMPLICATIONS FOR PRACTICE

We recommend guided imagery as a practical, low-cost complementary therapy for patients receiving local anesthesia.

Effects of non-pharmacological interventions on pain in wound patients during dressing change: A systematic review

BACKGROUND

Changes to the wound dressing frequently cause pain. Some adverse side effects of pharmacologic pain management may cause problems or even impede wound healing. There is no systematic study of non-pharmacologic therapies for pain during wound dressing changes, despite the gradual promotion of non-pharmacologic pain reduction methods.

OBJECTIVES

To give clinical wound pain management a new direction, locating and assessing non-pharmacological interventions regarding pain brought on by wound dressing changes are necessary.

METHOD

The researchers conducted a comprehensive literature review on non-pharmacological interventions for pain during wound dressing changes across five databases: PubMed, Web of Science, Medline, Embase, and the Cochrane Library spanning the period from January 2010 to September 2022. The evaluation of literature and data extraction was carried out independently by two researchers, and in cases of disagreement, a third researcher participated in the deliberation. To assess the risk of bias in the literature, the researchers utilised the Cochrane Handbook for Reviews of Interventions, version 5.1.0.

RESULTS

In total, 951 people were involved in 11 investigations covering seven non-pharmacological therapies. For pain triggered by dressing changes, virtual reality (VR) distraction, auditory and visual distractions, foot reflexology, religious and spiritual care, and guided imaging demonstrated partially positive effects, with hypnosis therapy and jaw relaxation perhaps having a weak effect.

CONCLUSION

The key to managing wounds is pain management. According to our review, there is some indication that non-pharmacologic interventions can help patients feel less discomfort when having their wound dressings changed. However, the evidence supporting this view is weak. It needs to be corroborated by future research studies with multicentre and large samples. To promote and use various non-pharmacologic interventions in the future, it is also necessary to build standardised and homogenised paths for their implementation.

The effect of guided imagery applied on geriatric orthopaedic patients on preoperative anxiety and comfort

BACKGROUND

This study was designed to examine the effect of guided imagery applied to geriatric orthopaedic patients on preoperative anxiety and comfort.

METHODS

This study was conducted as a randomized controlled trial. The population of the study consisted of geriatric patients treated in the orthopaedics and traumatology clinic of a university hospital. The sample consisted of 80 patients, including the experimental group (n = 40) and the control group (n = 40). Personal Descriptive Form, The State-Trait Anxiety Inventory (STAI) and General Comfort Scale were used as data collection tools.

RESULTS

After the guided imagery application, it was determined that the anxiety of the experimental group decreased statistically significantly, and their comfort improved (P < 0.05).

CONCLUSION

After the imagery, it was determined that the patients in the experimental group had a decrease in their anxiety level and an improvement in their comfort. Since it is a low-cost and easily accessible method, applying imagery in the preoperative period is recommended.

The relationship between uncertainty and acute procedure anxiety among surgical patients in Chinese mainland: the mediating role of resilience

BACKGROUND

Surgery, as one of the main diagnostic and treatment methods, is a routine work in medical settings. Patients undergoing surgery often experience acute procedure anxiety due to uncertainty. There is ample evidence showing that uncertainty is a risk factor for the acute procedure anxiety in surgical patients. However, little is known about the psychological processes mediating this relationship. Therefore, this study aims to evaluate resilience as a mediator of the association between uncertainty and anxiety.

METHODS

A population-based cross-sectional survey with a convenience sampling method was conducted, involving 243 surgical patients in Jiaxing, Zhejiang province of China was carried out. Relevant data were collected by self-reporting questionnaires, including demographic characteristics questionnaire, Amsterdam Preoperative Anxiety and Information Scale (APAIS-C), Mishel's Illness Uncertainty Scale (MUIS), Connor-Davidson Resilience Scale (CD-RISC). Pearson correlation analysis was employed to examine correlations between various variables. A path model was used to assess the mediation effect of resilience with respect to uncertainty and acute procedure anxiety.

RESULTS

In the path model, uncertainty have an indirect effect on acute procedure anxiety through resilience. The results suggest that resilience has a mediating role in uncertainty and acute procedure anxiety among surgical patients.

CONCLUSIONS

These findings call for the development of interventions targeting the role of resilience in effectively predicting and preventing acute procedure anxiety and uncertainty among surgical patients.

Effectiveness of virtual reality in reducing preoperative anxiety in adults: A systematic review and meta-analysis

AIM

To evaluate the impact of a virtual reality (VR) intervention on adult patients' preoperative anxiety, heart rate, respiration rate and blood pressure.

DESIGN

A systematic review and meta-analysis of randomized controlled trials (RCTs).

DATA SOURCES

A librarian-designed search of the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI and Wanfang databases was conducted to identify research studies in English or Chinese on RCTs from their inception to 31 May 2022. Detailed search strategies and the checklist are provieded in Supplementary files S1 and S2.

REVIEW METHODS

Two researchers independently screened eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias in the included studies. A fixed- or random-effects meta-analysis model was used to determine the pooled mean difference based on the results of the heterogeneity test.

RESULTS

This study included 11 articles with a total of 892 participants. VR distraction comprised five studies, and VR exposure consisted of six studies. The results indicated that VR could reduce preoperative anxiety in adult patients and VR exposure seems to be more effective. The results also indicated that VR intervention can effectively reduce patients' heart rate and blood pressure compared to traditional intervention methods, but had no significant effect on respiration rate.

CONCLUSION

VR technology could relieve preoperative anxiety in adult patients through distraction or exposure. More well-designed RCTs containing a wider range of surgical types are needed to verify our findings before we can make strong recommendations.

IMPACT

Our systematic review and meta-analysis show a positive effect of VR distraction and exposure interventions in reducing preoperative anxiety in adult patients. We suggest incorporating VR into preoperative procedures as an auxiliary way to reduce negative emotions in eligible patients.

NO PATIENT OR PUBLIC CONTRIBUTION

Our paper is a systematic review and meta-analysis and such details do not apply to our work.

Efficacy of nonpharmacologic interventions in preoperative anxiety: A systematic review of systematic reviews

AIMS AND OBJECTIVES

Evidence suggests that preparing patients for surgery using nonpharmacological strategies reduces their anxiety. However, there is no consensus on what the best practices are. This study aims to answer the question: Are interventions using nonpharmacological therapies effective in reducing preoperative anxiety?

BACKGROUND

Preoperative anxiety causes physiological and psychological adverse effects, with a negative effect on postoperative recovery.

INTRODUCTION

According to the World Health Organization, between 266 and 360 million surgical procedures are performed annually worldwide, and it is estimated that more than 50% of patients will experience some degree of preoperative anxiety.

DESIGN

Systematic review of systematic reviews with results of interventions aimed at mitigating preoperative anxiety.

METHODS

A search was conducted for systematic reviews with meta-analyses published between 2012 and 2021 in Medline, Scopus, Web of Science and Cochrane Library. Quality was assessed using the AMSTAR-2 scale. The protocol was registered in PROSPERO.

RESULTS

A total of 1016 studies were examined, of which 17 systematic reviews were selected, yielding 188 controlled trials with 16,884 participants. In adults, the most common intervention included music, followed by massage, in children virtual reality and clowns. Almost all controlled trials reported a reduction in preoperative anxiety after the intervention, of which almost half had statistically significant results.

CONCLUSION

Interventions that include music, massage and virtual reality reduce preoperative anxiety and have shown that they are cost-effective, minimally invasive and with a low risk of adverse effects. Preoperative anxiety can be reduced through a short-term intervention involving nursing professionals as an alternative or complement to drugs.

RELEVANCE TO CLINICAL PRACTICE

This review suggests that nursing professionals, in collaboration with other health professionals, should continue to conduct research on the reduction in preoperative anxiety. Further research in this area is needed, to reduce heterogeneity and consolidate the results.

NO PATIENT OR PUBLIC CONTRIBUTION

Not applied to our study, as it is a systematic review of systematic reviews.

[Perioperative anxiety and fear of death]

An important field of anesthesiology but also of psychiatry and psychotherapy, is perioperative anxiety and especially the fear of death. In this review article the most important types of anxiety in the individual phases before, during and after surgery are presented and diagnostic aspects as well as risk factors are discussed. Benzodiazepines can classically be used therapeutically here, but in recent years the preoperative anxiety-reducing effects of e.g., supporting talks, acupuncture, aroma therapy, and relaxation methods have come more into focus, because benzodiazepines promote postoperative delirium, which significantly increases morbidity and mortality. Perioperative fear of death should, however, be given greater clinical and scientific attention in order not only to have a better understanding and preoperative care of patients, but also to reduce adverse consequences during surgery and afterwards.

The effect of guided imagery on postoperative pain and comfort of geriatric orthopaedic patients: a randomized controlled trial

BACKGROUND

The purpose of this study is to investigate the effects of guided imagery on postoperative pain and comfort in geriatric orthopedics patients.

METHODS

This study was carried out with a randomized-controlled true experimental design. The population of the study included geriatric patients receiving treatment at the orthopedics and traumatology inpatient clinic of a university hospital. Based on random selection, the sample consisted of total of 102 patients, including 40 patients in the experimental group and 40 in the control group. The data were collected using a Personal Information Form, the Visual Analog Scale, and the General Comfort Questionnaire.

RESULTS

After the guided imagery intervention, the pain levels of the experimental group significantly decreased compared to their baseline pain levels (t = 4.002, P = 0.00). Their perceived comfort was also significantly improved (t = -5.428, P = 0.00). Although the perceived comfort of the control group decreased, this decrease was not statistically significant (t = 0.698, P = 0.489).

CONCLUSION

It is recommended that guided imagery, which is an inexpensive and accessible method, be integrated into the nursing care process to reduce the pain and increase the comfort of geriatric orthopedics patients.

The Effect of Guided Imagery on Postoperative Pain Management in Patients Undergoing Lower Extremity Surgical Operations: A Randomized Controlled Trial

Guided imagery distracts patients from disturbing feelings and thoughts, positively affects emotional well-being, and reduces pain by producing pleasing mental images. This study aimed to determine the effects of guided imagery on postoperative pain management in patients undergoing lower extremity surgery. This randomized controlled study was conducted between April 2018 and May 2019. This study included 60 patients who underwent lower extremity surgery. After using guided imagery, the posttest mean Visual Analog Scale score of patients in the intervention group was found to be 2.56 (1.00 ± 6.00), whereas the posttest mean score of patients in the control group was 4.10 (3.00 ± 6.00), and the difference between the groups was statistically significant (p <.001). Guided imagery reduces short-term postoperative pain after lower extremity surgery.

The Impact of Scripted Self-Hypnotic Relaxation on the Periprocedural Experience and Anesthesiologist Sedation Use in the Pediatric Cardiac Catheterization Suite: A Prospective Randomized Controlled Trial

Purpose

To assess the impact on children of self-hypnotic relaxation scripts read by trained staff prior to the induction of anesthesia and/or extubation on the periprocedural experience.

Patients and Methods

A total of 160 children aged 7–18 years undergoing a cardiac catheterization intervention under general anesthesia were randomized into 4 groups: (1) a pre-procedure (PP-script) read prior to entering the procedural room, (2) a script read prior to extubation (PX-Script), (3) both PP- and PX-Scripts read and (4) no script read. Anxiety and pain were rated on self-reported 0–10 scales. The modified Yale Preoperative Anxiety Scale was used for preoperative anxiety. The effect of script reading was associated with outcomes by linear regression for continuous variables, and logistic regression for binary variables in two-sided tests at a significance level of 0.05. Results are given in odds ratios (OR) and 95% confidence intervals (CI).

Results

Data were available for 158 patients. Reading the PP-Script prior to anesthesia was associated with a significant reduction in the use of intraoperative sedatives from 30% to 14% (OR 0.40; CI 0.18–0.88; p = 0.02) by the anesthesiologists, who were blinded to group attribution until extubation. This was despite the children not self-reporting significantly lower levels of anxiety or pain. The PX-Script did not change outcomes. Among groups, there was no significant difference in room time, postoperative recovery time and pain.

Conclusion

Reading a PP-Script for guidance in self-hypnotic relaxation can result in less need for intravenous sedation in the judgment of the anesthesiologist, independent of the children’s self-reported anxiety and pain. This raises interesting questions about subconscious patient–physician interactions affecting pain management.

Clinicaltrials.gov Identifier

NCT02347748.

Effect of comprehensive nursing intervention for congenital heart disease in children: A meta-analysis

OBJECTIVES

This meta-analysis aimed to assess the impact of nursing interventions (e.g., educational and empathic interviewing, motor exercise, therapeutic play interventions) on the perioperative outcome of children with congenital heart disease (CHD).

METHODS

We searched PubMed, Embase, Web of Science, Scopus, Cochrane, EBSCO, The Chinese National Knowledge Infrastructure, Wan Fang Data and the VIP Chinese Journal Service platform from the date of database creation to August 2021. Our study adhered to the recommendations of the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RevMan 5.4 and Stata 16.0 were used to complete the meta-analysis.

RESULTS

This meta-analysis showed that comprehensive nursing intervention reduced both the length of hospital stay (weighted mean difference [WMD] = -1.982, 95%CI [-2.329, -1.634], P < .001) and the related risk of post-operative complications [OR = 0.345, 95%CI (0.225, 0.528), P < .001]. In addition, nursing intervention increased parental satisfaction with the care provided [OR = 0.308, 95%CI (1.923, 6.863), P < .001]. Nursing interventions have also had a positive impact in reducing preoperative anxiety [WMD = -6.721, 95% CI (-7.194, -6.249), P < .001] and postoperative pain [WMD = -7.103, 95% CI (-7.103, -7.663), P < .001] in children.

CONCLUSIONS

This meta-analysis confirms the beneficial effects of comprehensive nursing interventions in terms of reduced complication rates and shorter hospital stays. The effectiveness of comprehensive nursing in reducing anxiety and pain levels was also demonstrated. The findings support the implementation of comprehensive care interventions in the perioperative period for children with CHD to improve clinical outcomes.

Race, ethnicity, and the use of regional anesthesia in cancer patients undergoing open abdominal surgery: A single-center retrospective cohort study

Background

Where applicable, regional anesthesia has been shown to be superior to opioid or non-opioid analgesic modalities alone. However, some studies have shown ethnic-based disparities in the use of regional anesthesia in patients undergoing surgical procedures. In this study of patients who had undergone major oncologic surgery, our main objective was to compare the use of regional anesthesia between patients of different ethnicities.

Methods

A retrospective review of adults who had undergone major open abdominal surgical procedures between 2016 and 2021 was performed. Logistic regression models were used to assess the association between baseline patient characteristics and the use of regional anesthesia.

Results

A total of 4,791 patients were included in the analysis. The median age was 60.5 years [interquartile range, 49, 69], the majority were female (65%), and of American Society of Anesthesiologists Physical Status Class (ASA) 3 (94.7%). Regional anesthesia was used in 2,652 patients (55.4%) and was not associated with race or ethnicity (p = 0.287). Compared to White patients, the odds of regional anesthesia use in other racial/ethnic groups were: Asian {odds ratio (OR) 0.851 [95% confidence interval (CI), 0.660–1.097]; p = 0.2125}, Black/African American [OR 0.807 (95% CI, 0.651–1.001); p = 0.0508], Hispanic/Latino [OR 0.957 (95% CI, 0.824–1.154); p = 0.7676], Other race [OR 0.957 (95% CI, 0.627–1.461); p = 0.8376]. In the multivariable analysis, age [OR 0.995 (95% CI, 0.991–1.000); p = 0.0309] and female gender [OR 1.231 (95% CI, 1.090–1.390); p = 0.0008] were associated with the use of regional anesthesia.

Conclusion

In this single-institution retrospective study of adults who had undergone major open abdominal surgery, the use of regional anesthesia was not associated with race or ethnicity. In the multivariable analysis, age and female gender were associated with the use of regional anesthesia.

Can perioperative psychological interventions decrease the risk of postsurgical pain and disability? A systematic review and meta-analysis of randomized controlled trials

ABSTRACT

Many patients experience pain after surgery. Psychological factors such as emotion and cognition are shown to be associated with the development of acute and chronic postsurgical pain (CPSP). Therefore, the question arises whether targeting these psychological factors can reduce negative postsurgical outcomes. The aim of the current review was to investigate the efficacy of perioperative psychological interventions in reducing (sub)acute postsurgical pain and CPSP and disability in adults. Randomized controlled trials were identified through 4 databases (Web of Science, PsychINFO, PubMed, and Cumulative Index to Nursing and Allied Health Literature [CINAHL]). The outcomes of interest were (sub)acute (ie, within 3 months after surgery) and chronic (>3 months after surgery) pain and disability. After screening, 21 studies were included in the final analyses. It was found that psychological interventions significantly reduced (sub)acute pain (d = -0.26, 95% confidence interval [CI] [-0.48 to -0.04]) and disability (d = -0.43, 95% CI [-0.84 to -0.03]) as well as CPSP (d = -0.33, 95% CI [-0.61 to -0.06]) and disability (d = -0.43, 95% CI [-0.68 to -0.18]). In addition, interventions delivered after surgery and interventions delivered by a psychologist tended to be more effective than interventions delivered before surgery and interventions delivered by another healthcare provider. Furthermore, the current review points to the need for more research to determine which specific type of intervention may be most beneficial for surgical patients. Finally, the current review identified that research in this domain has concerns regarding bias in missing outcome data due to withdrawal and drop out.

Aromatherapy massage seems effective in critically ill children: an observational before-after study

Children treated in a pediatric intensive care unit (PICU) are at risk of distress and pain. This study investigated if aromatherapy massage can reduce children's distress and improve comfort. This observational before-after study was performed in a 22-bed PICU in Cape Town, South Africa. The aromatherapy massage consisted of soft massaging using the "M-technique" and a 1% blend of essential oils of Lavender (Lavandula angustifolia), German Chamomile (Matricatia recutita) and Neroli (Citrus aurantium) mixed with a grapeseed carrier oil. All present children were eligible, except those who had recently returned, were asleep or deemed unstable. The primary outcome was distress measured with the COMFORT-Behavior scale (COMFORT-B). Secondary outcomes were heart rate, oxygen saturation (SatO2), the Numeric Rating Scale (NRS)-Anxiety and pain assessed by the NRS-Pain scale. Outcomes variables were evaluated with Wilcoxon signed-rank test and multiple regression analysis. The intervention was applied to 111 children, fifty-one of whom (45.9%) were younger than three years old. The group median COMFORT-B score before intervention was 15 (IQR 12-19), versus 10 (IQR 6-14) after intervention. Heart rate and NRS-Anxiety were significantly lower after the intervention (P < 0.001). Multiple regression analysis showed that interrupted massages were less effective than the uninterrupted massages. Parental presence did not influence the outcome variables. We did not find a significant change on the NRS-Pain scale or for SatO2. Aromatherapy massage appears beneficial in reducing distress, as measured by the COMFORT-B scale, heart rate and the NRS-Anxiety scale, in critically ill children. Thus, the potential of aromatherapy in clinical practice deserves further consideration.

Role of information and preparation for improvement of pediatric perioperative care

The perioperative period is a significant and stressful experience that may cause negative consequences in children, both in a short-term and long-term perspective. Despite a wide base of evidence stating the importance of adequate preparation to reduce anxiety, improve coping, cooperation and enhance recovery, many children continue to report that they feel unprepared for their perioperative experience. To secure children's right to request and need for preparation, the content, format, and availability of existing programs need to be scrutinized. Preparation programs in perioperative care must change from simply providing information to embracing the importance of children's need to process the information provided in order to learn and understand. Interactive web-based technology can function as a significant resource for preparation of children for perioperative procedures. By changing perspective from children's need for information to their need for learning and by developing preparation programs including adequate educational principles, web-based technology can be used to its fullest advantage as a healthcare learning and preparation resource.

Effectiveness of nursing interventions for preoperative anxiety in adults: A systematic review with meta-analysis

AIMS

The aim of this review and meta-analysis is to analyse the effectiveness of nursing interventions for the management of preoperative anxiety in adults.

BACKGROUND

The perioperative process is a stressful situation for many people who are going to be operated and it can generate feelings of anxiety. Also, preoperative anxiety can appear in the perioperative period. Nursing management of preoperative anxiety through individualized interventions can be effective for reducing anxiety.

DESIGN

A systematic review with meta-analysis was performed.

DATA SOURCES

CINAHL, CUIDEN, Pubmed, ProQuest and Scopus databases were consulted without restriction per year of publication. The search was conducted in February 2020.

REVIEW METHODS

Experimental studies on nursing management in preoperative anxiety with adults sample (>18 years) published in English and/or Spanish were included. All types of surgery were included in the review. A random effects meta-analysis was performed to estimate the effect size for preoperative anxiety measured with STAI.

RESULTS

After the selection process n = 9 quantitative studies with nursing interventions for preoperative anxiety were included. A preoperative educational and informative interview was used in six studies, one study used empathic interview, one used motivational interview and one used hand massage. The meta-analysis, including four studies using nursing interviews, had a sample of n = 419 in the intervention group and n = 445 in the control group. The mean difference in preoperative state anxiety measured with the STAI was in favour of the nursing intervention.

CONCLUSION

Nursing interventions for patients who are going to be operated seems to have a positive impact in their preoperative anxiety. However, due to the low number of studies and the heterogeneity of the sample, more research is needed about the topic.

Effects of Educational Video on Pre-operative Anxiety in Children - A Randomized Controlled Trial

Objective: Audio-visual interventions have been used to provide relevant patient information to reduce pre-operative anxiety in children. The aim of the study was to investigate whether self-reported state anxiety in children could be reduced by presenting a child-friendly educational video on the day of surgery. Methods: A prospective, single-blinded, two-armed, randomized controlled study was designed with three measurement time points including 90 children (6-17 years) and their parents. In the intervention group (IG), the children and their parents were shown a child-friendly video explaining the perioperative procedures that would be applied during the hospital stay, in addition to receiving standard information. In the control group (CG), children and parents received standard information provided by the nursing staff. The primary outcome was any change in the children's pre-operative state anxiety levels, as measured by the State-Trait Operation Anxiety Inventory (STOA). A secondary outcome was patient satisfaction regarding the received information. Results: Anxiety was significantly reduced in both groups after receiving either the intervention plus standard information or the standard information only. No significant difference in anxiety reduction was observed between the IG and the CG. However, the children and parents in the IG reported fewer worries than those in the CG. Conclusion: A child-friendly, educational video can be an additional tool for providing patient information and reducing pre-operative anxiety in children and their parents. Further studies should focus on the timing of the intervention and on age- and developmentally appropriate information formats and contents to address children's pre-operative anxiety. Clinical Trial Registration: Patient Anxiety Reduction in Children by Using Simple Explanation Videos, ID: NCT0441377; www.clinicaltrials.gov, Data Sharing Statement: Deidentified individual participant data will not be made available.

Smart Sensor Based on Biofeedback to Measure Child Relaxation in Out-of-Home Care

Children from out-of-home care are a vulnerable population that faces high stress and anxiety levels due to stressful experiences, such as being abused, being raped, and violence. This problem could have negative effects on their bio-psycho-social well-being if they are not provided with comprehensive psychological treatment. Numerous methods have been developed to help them relax, but there are no current approaches for assessing the relaxation level they reach. Based on this, a novel smart sensor that can evaluate the level of relaxation a child experiences is developed in this paper. It evaluates changes in thermal biomarkers (forehead, right and left cheek, chin, and maxillary) and heart rate (HR). Then, through a k-nearest neighbors (K-NN) intelligent classifier, four possible levels of relaxation can be obtained: no-relax, low-relax, relax, and very-relax. Additionally, an application (called i-CARE) for anxiety management, which is based on biofeedback diaphragmatic breathing, guided imagery, and video games, is evaluated. After testing the developed smart sensor, an 89.7% accuracy is obtained. The smart sensor used provides a reliable measurement of relaxation levels and the i-CARE application is effective for anxiety management, both of which are focused on children exposed to out-of-home care conditions.