Anxiety management: a distinct nursing role in day surgery

Desenhos de Crianças Submetidas a Cirurgias Eletivas

Resumo O presente artigo tem por objetivo investigar as memórias que as crianças têm sobre a cirurgia a qual foram submetidas. Participaram desta pesquisa 80 crianças com idade entre 6 e 12 anos, internadas num hospital infantil para a realização de cirurgia eletiva de pequeno porte, divididas em quatro grupos de intervenção. Foram utilizados desenhos como forma de instrumento de coleta de dados. A pesquisa ocorreu em duas etapas: na primeira, cada grupo recebeu a sua preparação no hospital, e na segunda, cerca de quinze dias após a cirurgia. Pôde-se constatar, após uma análise dos desenhos, que todos os grupos retrataram a condição de hospitalização e cirurgia, e trouxeram detalhes sobre os aspectos relacionados a esta temática.

The Changing Face of Surgery Using Systematic Reviews

Three systematic reviews relating to pre-admission procedures, admission procedures and staffing policies were undertaken to establish evidence to develop best practice guidelines for day surgery units. Results revealed that a pre-admission intervention can improve patient and surgery outcomes, although the most effective type of intervention should be further investigated. It was also found that distraction can reduce patient preoperative anxiety, and there is no high quality evidence relating skill mix, staffing levels and desired health outcomes in day surgery units. Recommendations for areas of future research are presented.

Preparação psicológica de pacientes submetidos a procedimentos cirúrgicos

Este trabalho tem por objetivo identificar, entre artigos publicados em periódicos indexados pelo PubMed/MedLine, informações sobre as principais modalidades e efeitos de intervenção psicossocial em procedimentos pré e pós-operatórios com pacientes adultos, bem como, apontar algumas lacunas na produção científica acerca do tema. Foram selecionados 32 artigos, sendo oito teórico-conceituais e 24 empíricos, dos quais um era estudo de caso, nove se referiam à avaliação específica de efeitos de preparação psicológica e 14 tratavam de temas associados ao contexto de preparação psicológica e cuidados cirúrgicos. As intervenções psicológicas foram divididas em oito categorias, baseadas em características funcionais das respectivas intervenções. Verificou-se uma deficiência de estudos na área de atuação específica da Psicologia, sendo os profissionais de enfermagem e medicina os que mais produziram estudos sobre o tema. Constatou-se, também, a ausência de protocolos sistematizados de intervenção psicológica relacionados a procedimentos cirúrgicos.

Developing New Ways to Address Learning Needs of Adult Abdominal Organ Transplant Recipients

Context

The degree to which patients are knowledgeable about posttransplant care can affect outcomes and patients' satisfaction. Transplant team members must identify knowledge gaps, contributory factors, and innovative methods to address learning needs.

Objective

To identify patients' perceptions of their knowledge gaps and identify ways to improve current approaches to patient education.

Design

Nonexperimental.

Setting

Midwestern teaching hospital.

Patients

726 adult abdominal organ transplant recipients.

Intervention(s)

A patient education survey was mailed out to solid-organ transplant recipients who met study criteria. A modified version of the Patient Learning Needs Scale (PLNS) was used to identify the recipients' learning needs. Additional questions on the survey addressed factors that we hypothesized would influence responses to the PLNS and asked patients which methods would help them learn during various phases of the transplant process.

Main Outcome Measure(s)

Statistical analysis was conducted on survey responses.

Results

Overall, PLNS scores were satisfactory in all 4 categories. Analysis of PLNS subscales revealed significantly lower scores in the quality of life/psychosocial subscale compared with the other 3 subscales. Significantly lower scores in the medications and follow-up categories of the PLNS items were found among the group whose length of stay was between 15 to 30 days compared with patients with shorter and longer stays. A variety of different methods are desired by patients in order to get information, especially before transplant.

Patient anxiety and conscious surgery

The amount of surgery undertaken on the conscious patient is increasing. However, many patients are anxious and resistant to such surgery. Patients (n = 214) were surveyed to determine their related apprehensions. Being awake, feeling or seeing the body cut open and experiencing pain all increased anxiety. The potential for insufficient information provision was also a source of concern. Formal management of intraoperative apprehension may help limit anxiety and expel apparent misapprehensions.

The development and validation of the Pre-operative Intrusive Thoughts Inventory (PITI)

Pre-operative anxiety is common and influences postoperative pain, hospital stay and patient satisfaction. We set out to explore anxiety content and develop a tool to evaluate patient anxiety at the pre-operative assessment clinic. We recruited 128 day surgery patients. Pre-operative anxiety content was explored and six factors (themes) were identified: 'preoccupation', 'outcome concerns', 'being unconscious', 'loss of control', 'dependence on others' and 'pain/discomfort'. The Pre-operative Intrusive Thoughts Inventory (PITI) was constructed and evaluated using exploratory and confirmatory factor analysis. The PITI demonstrated internal consistency for the full scale (Cronbach's alpha = 0.91) and for the subscales (Cronbach's alpha 0.74-0.85) as well as sensitivity (0.88) and specificity (0.60) to clinically significant anxiety assessed using the Hospital Anxiety and Depression Scale. The properties of the PITI suggest that it has potential as an additional tool for the evaluation of pre-operative anxiety.

Day surgery: patients' perceptions of a nurse-led preadmission clinic

BACKGROUND

Previous research studies have demonstrated that nursing intervention is often lacking in the provision of adequate information and psychological support, and fails to meet the holistic needs of patients in the preassessment for day surgery.

AIM

The aim of this study was to elicit patients' perceptions of the preassessment preparation they received prior to day surgery.

METHOD

A hermeneutic phenomenological research approach was utilized to elucidate the participants' experiences of the preassessment process and to collect data. Qualitative data were collected using face-to-face interviews and analysed thematically following procedures expounded by Colaizzi and van Manen.

SAMPLE

The sample included 30 patients undergoing day surgery in a large teaching hospital in the north of England. The day unit built for this purpose consisted of a preassessment unit, a seated preoperative area, three theatres, a six space first stage recovery area, a 24 space second stage recovery area and a separate seated recovery area. The patient groups focused on individuals scheduled for general surgery, gynaecology and urology procedures.

RESULTS

Findings suggest that the nurse-led clinic appeared to function effectively; most patients felt they were adequately assessed and prepared for day surgery. The majority reported receiving comprehensive information about procedures, appreciated health education interventions and had opportunity to ask questions. A few patients pointed to deficits in information giving, indicating that their individual needs were not met, leaving them feeling anxious. Others alluded to problems associated with unexpected cancellation of procedures, which threw them into states of disequilibrium.

RELEVANCE FOR CLINICAL PRACTICE

The findings indicate that information giving, psychological support and person-centred care could be strengthened in the preassessment preparation of patients undergoing day surgery.

Patient anxiety and modern elective surgery: a literature review

Medical advances have led to a considerable rise in the level of elective surgery undertaken as day-case surgery and with minimal hospital stay. However, amid such advances, preoperative psychological care has remained relatively static. A considerable number of patients are very anxious prior to elective surgery and little formal care is undertaken to address this major issue. A review of the literature from 1990 to 2002 was therefore undertaken in order to assess the present level of knowledge and interventions concerning patient anxiety when undergoing modern, intermediate surgical intervention. Thirty-four studies embracing data from 3754 patients undergoing both inpatient and day-case procedures were reviewed. Three main themes emerged - causes of anxiety, clinical concerns and measurement, and anxiety management. Each theme is discussed alongside details extracted from the relevant studies. Finally, the main issues arising are summarized and future research challenges identified.

Pre-registration student nurses' perceptions of the day surgery unit

An increasing number of complex surgical interventions are now taking place on a day case basis with some surgical specialities able to perform 80% of their elective surgery as day surgery. It is important that student nurses are exposed to clinical practice within the day surgery unit. Some students, for a variety of reasons, exhibit a reluctance to experience a day-surgery placement. The writer describes a programme of study which takes place before the students take up their placements to demonstrate that day surgery offers many opportunities for the delivery of highly skilled, specialised nursing care. Day Surgery Nursing is emerging as a speciality in its own right. The clinical skills of the nurse are required alongside the interpersonal, informational and psychological care-giving skills to ensure safety and comfort for the patient whilst in the unit and transfer home where responsibility for care, normally performed by nurses, now lies with the patients and their carers.