The effect of preoperative uncertainty and anxiety on short-term recovery after elective arthroplasty

Meditation for perioperative pain and anxiety: A systematic review

INTRODUCTION

Effective pain and anxiety management during the perioperative phase remains a challenge for patients undergoing surgeries and other invasive procedures. The current standard of care involves prescribing analgesics to treat these conditions; however, there has been recent interest in applying multimodal strategies that limit the use of these medications. One such modality is meditation, which has been shown to be effective in alleviating various physical and psychological symptoms in other settings. This systematic review aims to assess how current meditative practices affect perioperative pain and anxiety.

METHODS

We conducted a systematic review of randomized controlled trials following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted using PubMed MEDLINE, Embase, PsycINFO, APA PsycINFO, EBM Reviews, Scopus, and Web of Science for all available dates. Our primary outcomes of interest were patient-reported pain and anxiety scores using the Visual Analog Scale, the Brief Pain Inventory, the Depression Anxiety Stress Scale, the State-Trait Anxiety Inventory (STAI), and the Hospital Anxiety and Depression Scale (HADS). For the HADS and STAI scales, only the anxiety and anxiety-state subgroups were reported, respectively.

RESULTS

The literature search yielded 1746 articles. A total of 286 full-text articles were screened, and 16 studies were included in this systematic review. A total of eight studies assessed pain scores after invasive procedures; five reported improvements in pain scores, and three reported no change after meditative practices. Ten studies assessed anxiety outcomes after invasive procedures: nine reported a decrease in overall anxiety levels as a result of meditation practices while one study reported no change in anxiety scores.

CONCLUSION

Data from this limited literature suggests that different meditation practices could be effective in alleviating pain and anxiety within the perioperative phase for patients undergoing various types of invasive procedures. Future prospective studies are needed to determine whether routine meditation in the perioperative setting is effective in mitigating perioperative pain and anxiety.

A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study

BACKGROUND

Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth.

OBJECTIVE

This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients.

METHODS

Patients and part-time or per-diem, wound care-certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys.

RESULTS

This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care-specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2).

CONCLUSIONS

This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients' technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care.

Factors related to preoperative uncertainty among patients with breast cancer in Wenzhou, China: A cross-sectional study

Background

One of the most prevalent psychological signs of breast cancer is uncertainty, which is more prevalent in Chinese patients during the preoperative period. Despite the numerous factors contributing to preoperative uncertainty, there is limited relevant research conducted in China.

Objective

This study aimed to describe the current state of preoperative uncertainty and to investigate the relationship between anxiety, illness perception, social support, and preoperative uncertainty in patients with breast cancer in Wenzhou, China.

Methods

This cross-sectional research used a simple random sampling technique to select 122 participants from a university hospital in Wenzhou, China, from July 2022 to December 2022, employing validated instruments. Descriptive statistics and Pearson's correlation coefficient were utilized to analyze the data.

Results

The average preoperative uncertainty scores of the patients fell within a moderate range (M = 61.92, SD = 7.51). Significant correlations were found between anxiety (r = 0.638, p <0.01), illness perception (r = 0.704, p <0.01), social support (r = -0.481, p <0.01), and preoperative uncertainty.

Conclusions

The results can assist healthcare professionals, especially nurses, in recognizing the factors contributing to uncertainty before surgery in patients with breast cancer. This knowledge enables them to promptly address and minimize this issue, leading to improved outcomes.

"This is not negotiable. You need to do this…": A directed content analysis of decision making in rehabilitation after knee arthroplasty

PURPOSE

To understand patients' and physical therapists' perspectives related to decision making during outpatient rehabilitation after total knee arthroplasty (TKA), and to describe potential barriers and opportunities for shared decision making (SDM) in this setting.

METHODS

A qualitative study examined the beliefs, thoughts, and experiences of patients and physical therapists regarding decision making in outpatient rehabilitation after TKA. Semi-structured interviews were conducted and analysed using directed content analysis.

RESULTS

Thirty-five participants were interviewed (20 patients, 15 physical therapists). Three main themes emerged from the data: (1) there is variability among physical therapists in how patients are involved in care decisions, (2) several features of the outpatient care paradigm are not supportive of SDM, and (3) preoperative patient-clinician interactions may facilitate SDM in postoperative rehabilitation, but these interactions are not typically utilized.

CONCLUSION

Physical therapists described using decision-making strategies with varying levels of patient involvement. Both patients and physical therapists described barriers to routine use of SDM in the outpatient setting. Several actionable strategies for overcoming these barriers were identified for providers and organizations seeking to consistently use SDM in outpatient TKA rehabilitation.

Virtual Reality Tour to Reduce Perioperative Anxiety in an Operating Setting Before Anesthesia: Randomized Clinical Trial

BACKGROUND

Perioperative anxiety is a major burden to patients undergoing surgeries with general anesthesia.

OBJECTIVE

This study investigated whether a virtual operating room tour (VORT) before surgery can be used to ameliorate perioperative anxiety.

METHODS

We employed a randomized parallel-group design with 2 study arms to compare VORT to the standard operation preparation procedure. The study included 84 patients. A validated inventory (state-trait operation anxiety-state) was used to assess perioperative state anxiety before (T1) and after (T2) surgery. In addition, trait operation anxiety was evaluated with an additional validated inventory (state-trait operation anxiety-trait). Moreover, user ratings on the usefulness of VORT were assessed with an evaluation questionnaire. Study arms were compared for perioperative state anxiety with two-tailed independent samples t tests. Subjective ratings were correlated with STOA-Trait values to investigate possible associations between perioperative anxiety with perceived usefulness.

RESULTS

There were no significant differences in perioperative state anxiety between VORT and standard operation preparation procedures before and after the surgery. Nonetheless, patients' ratings of VORT overall were positive. The tour was perceived as useful and, therefore, showed acceptance for VR use. These ratings were unrelated to the degree of perioperative anxiety.

CONCLUSIONS

The subjective benefit of VORT could not be explained by a reduction of perioperative anxiety. Instead, VORT appears to serve the need for information and reduce uncertainty. In addition, VORT is perceived as beneficial regardless of the age of the patients. Considering this effect and the manageable organizational and financial effort toward implementation, the general use of VORT can be recommended.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04579354; https://clinicaltrials.gov/ct2/show/NCT04579354.

Symptoms of anxiety and depression in surgical patients at the hospital, 6 weeks and 6 months postsurgery: A questionnaire study

Aims

To describe prevalence of symptoms of anxiety and depression in surgical patients at three time points: at hospital postsurgery (T1), 6 weeks (T2) and 6 months (T3) postdischarge from hospital; and detect situations and experiences that predict symptoms of anxiety and depression at T2 and T3.

Design

Prospective, explorative two-site follow-up study.

Methods

Patients having selected surgeries from January-July 2016 were invited to participate. Final participation was 390 patients. Participation involved answering questionnaires, including the Hospital Anxiety and Depression Scale (HADS). A stepwise multiple linear regression model was employed to calculate predictors of anxiety and depression.

Results

The proportion of patients presenting with moderate-to-severe anxiety or depression ranged from 5.4%-20.2% at different times. Major predictors of anxiety at both times were not feeling rested upon awakening and higher scores on HADS-Anxiety at T1 and T2 and at T2 also experiencing more distressing postoperative symptoms. For depression, the major predictors were at both times higher scores on HADS-Depression at T2 and T3 and also at T2 not feeling rested upon awakening and at T3 reporting delayed or very delayed recovery.The four models explained from 43.9%-55.6% of the variance in symptoms of anxiety and depression. Our findings show that patients presenting with psychological distress at the hospital are in a vulnerable position. Also, that benefits of good sleep during the recovery should be emphasized during hospital stay.

Investigating the True Effect of Psychological Variables Measured Prior to Arthroplastic Surgery on Postsurgical Outcomes: A P-Curve Analysis

Patients' presurgical psychological profiles have been posited to predict pain and function following arthroplastic surgery of the hip and knee. Nevertheless, findings are conflicting, and this may be rooted in biased reporting that makes the determination of evidential value difficult. This ambiguity may have negative consequences for researchers and governmental agencies, as these rely on findings to accurately reflect reality. P-Curve analyses were used to establish the presence of evidential value and selective reporting in a sample of studies examining the effect of presurgical psychological predictors on outcomes following knee and hip arthroplastic surgery. A systematic search of the literature revealed 26 relevant studies. The examined sets of studies indicate that there is evidential value for the effect of depression on pain intensity and function, anxiety on pain intensity and function, pain catastrophizing on pain intensity, as well as the combined effects of all psychological predictors on pain intensity and function. The presence of evidential value was inconclusive for the effect of optimism on pain intensity. There were no signs that any results were influenced by biased reporting. The results highlight the importance of patients' psychological profiles in predicting surgical outcomes, which represent a promising avenue for future treatment approaches. PERSPECTIVE: The effects of P-hacking are difficult to detect and might be at the root of conflicting findings pertaining to the predictive properties of presurgical psychological variables on postsurgical outcomes. P-Curve analysis allows the determination of evidential value underlying these relationships and detection of P-hacking to ensure that findings are not the result of selective reporting.

The impact of early information concerning the surgical operations on anxiety in patients with burns

AIMS

Stress has been linked to poor coping with health-related issues, poor adaptation, a decrease of quality of life, poor recovery and poor wound healing. Therefore, it is important to address patients' uncertainty and feelings of anxiety. The aim of this study was to examine the effect of providing early treatment information based on an LDI-scan to patients with burns on their feelings of anxiety.

DESIGN

An observational prospective pre-test post-test study.

METHODS

Patients with intermediate burns (n = 59) admitted to our burn centre in 2016 were evaluated for anxiety using a visual analogue scale (VAS-A) before and after an LDI-scan was made. Two groups were compared: a group that heard whether surgery would or would not be recommended for wound closure (certain group) versus a group that heard to wait and see whether an operation was determined to be helpful (uncertain group).

RESULTS

Before the LDI-scan was made, both groups showed clinically high levels of anxiety (median VAS scores above 5). After the information gathered with the LDI was discussed with the patient, anxiety dropped significantly (median VAS below 3; p = .001). No significant differences between the groups were observed (p > .05).

CONCLUSION

In contrast to other studies, anxiety was significantly reduced in all our study groups after information was shared. Early communication of knowledge by health care professionals is important regardless whether it includes treatment uncertainty.

Factors Influencing Postoperative Recovery and Time Off Work of Patients with Benign Indications for Surgery - Results of a Prospective Study

Objectives The study aimed to answer a number of questions: Which medical, psychological and sociodemographic factors affect the recovery of women after gynecological surgery for benign indications? Does patients' health-related quality of life improve after surgical intervention? How long are patients signed off work postoperatively? How do patients assess their own capacity to work? Method Study population: All women between the ages of 18 and 67 years who underwent gynecological surgery for benign indications at the Charité Campus Virchow Clinic over a 7-month period were consecutively enrolled in the study. Four standardized patient surveys (the first survey [T0] was carried out in hospital, T1 at 1 week, T2 at 6 weeks and T3 at 7 - 8 months after discharge by telephone interview) were carried out using evaluated questionnaires to record patients' recovery (Recovery Index), quality of life (RAND-36), satisfaction, complications, sociodemographic information and time off work with a medical sick note. Relevant medical and demographic data were also collected. Statistical analysis was carried out using univariate statistical tests for descriptive analysis and complex multifactorial statistical procedures to record observations over time. Results A total of 182 patients were included in this study (participation rate: 70%). Relevant prior operations (p = 0.01), in-hospital (p = 0.004) and postoperative complications (p < 0.001), preoperative psychological wellbeing (p = 0.01), physical functioning (p = 0.005) and postoperative anxiety (p = 0,006) had a significant impact on recovery (Recovery Index) and changed significantly over time (p < 0.001). The invasiveness of the surgery or sociodemographic parameters (including migration background) had no significant effect. Health-related quality of life (measured with the RAND-36 questionnaire) also improved postoperatively. More invasive surgical interventions were associated with longer sick leave times and, to a certain extent, with a poorer evaluation of patients' capacity to work. Conclusion Recovery after gynecological surgery is a multifactorial process. This survey of a patient population identified psychological and physical factors which influence recovery but did not find significant sociodemographic parameters affecting recovery. Irrespective of these findings, gynecological surgery for benign indications resulted in an improvement in health-related quality of life. Prospective studies need to investigate whether psychological interventions could reduce preoperative fear and thereby improve postoperative recovery.

[The effects of preoperative anxiety on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy]

BACKGROUND AND OBJECTIVES

It is suggested that 38-45% of patients experience preoperative anxiety. We observe that patients undergoing living donor nephrectomy suffer from anxiety. Preoperative anxiety may complicate a patient's recovery from anesthesia and postoperative pain control. This study investigates the preoperative anxiety rate and its effect on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy.

METHODS

Forty-eight individuals undergoing living-related renal donor nephrectomy were included in this analytic prospective observational cohort study. Their preoperative anxiety was measured with the STAI-I and STAI-II inventories. The relationships between anxiety scores with data regarding demographics, recovery from anesthesia, and postoperative pain scores were investigated.

RESULTS

The findings were remarkable in that the anxiety scores of living renal donors were significantly correlated with their recovery variables, which are spontaneous respiration time, sufficient respiration time, extubation time, and PACU discharge time (p<0.01). Anxiety scores were significantly positively correlated with the pain scores of the 30th minute, 1st, 2nd, 4th, 8th, 12th, 24th hours, and the total amounts of analgesic administered in 24hours (p<0.05). A significantly negative correlation was also determined between anxiety scores and patients' satisfaction.

CONCLUSION

Our study showed that patients undergoing living-related donor nephrectomy with high anxiety levels had late recovery times and high postoperative pain scores. Thus, determining those patients with high preoperative anxiety level is crucial to providing patients with satisfactory emerging from anesthesia and the control of their postoperative pain during donor nephrectomy.

Associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among Swedish orthopaedic patients

BACKGROUND

The evaluation of one's physical health and psychological wellbeing may be subjective. Aspects of functional capacity, including the patients' own estimation of physical health and wellbeing, have been shown to be strong predictors of postoperative outcomes and should be the focus of further research.

AIM

This study aimed to explore the associations between ASA classification, self-estimated physical health, psychological wellbeing and anxiety among orthopaedic patients.

METHODS

This was a longitudinal study using a quantitative approach.

SETTINGS

A central county hospital in northern Sweden.

RESULTS

A high ASA classification rated by anaesthetists was not associated with physical health and psychological wellbeing self-estimated as less than good. A high ASA classification was significantly associated with self-estimated anxiety prior to surgery. Three days and one month post-surgery, the situation was reversed, and the ASA I/II group, to a significantly higher extent, rated that they felt anxiety.

CONCLUSION

Preoperative screening systems for orthopaedic patients should not only focus on the medical and objective physical issues but also include the patients' own estimation of their physical health and psychological wellbeing. It is essential that orthopaedic patients receive relevant information that provides a realistic outlook, as well as an honest and optimistic future view.

The effects of preoperative anxiety on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy

Background and objectives

It is suggested that 38-45% of patients experience preoperative anxiety. We observe that patients undergoing living donor nephrectomy suffer from anxiety. Preoperative anxiety may complicate a patient’s recovery from anesthesia and postoperative pain control. This study investigates the preoperative anxiety rate and its effect on anesthetic recovery and postoperative pain in patients undergoing donor nephrectomy.

Methods

Forty-eight individuals undergoing living-related renal donor nephrectomy were included in this analytic prospective observational cohort study. Their preoperative anxiety was measured with the STAI-I and STAI-II inventories. The relationships between anxiety scores with data regarding demographics, recovery from anesthesia, and postoperative pain scores were investigated.

Results

The findings were remarkable in that the anxiety scores of living renal donors were significantly correlated with their recovery variables, which are spontaneous respiration time, sufficient respiration time, extubation time, and PACU discharge time (p < 0.01). Anxiety scores were significantly positively correlated with the pain scores of the 30th minute, 1st, 2nd, 4th, 8th, 12th, 24th hours, and the total amounts of analgesic administered in 24 hours (p < 0.05). A significantly negative correlation was also determined between anxiety scores and patients’ satisfaction.

Conclusion

Our study showed that patients undergoing living-related donor nephrectomy with high anxiety levels had late recovery times and high postoperative pain scores. Thus, determining those patients with high preoperative anxiety level is crucial to providing patients with satisfactory emerging from anesthesia and the control of their postoperative pain during donor nephrectomy.

Perioperative anxiety and length of hospital stay after caesarean section - A cohort study

OBJECTIVE

The caesarean section is one of the most frequently performed surgeries. Due to growing economic challenges, hospitals are encouraged to improve their cost-efficiency. One factor that influences hospital costs of caesarean sections is a prolonged hospital stay.

STUDY DESIGN

The aim of the current prospective study was to investigate psychosocial factors, with an emphasis on anxiety, and sociodemographic factors that are associated with longer hospital stay after caesarean sections with no medical complications. Data of 195 women who gave birth by caesarean section was analyzed. As possible predictors anxiety levels measured pre-, peri- and postoperative as well as age, parity (primiparous/multiparous), repeated caesarean (yes/no), BMI (<30/ ≥30), STAI-Trait scores, duration of surgery, PH arterial and Apgar 5 min. were entered into a backward linear regression with duration of hospital stay as the dependent factor.

RESULTS

The analysis revealed that higher age, primiparity as well as higher anxiety scores during the postoperative phase are significant factors associated with prolonged hospital stay. The significant model explains 22.1 % of the variance.

CONCLUSION

The results should sensitize the medical team to these risk factors in order to improve patients' recovery and shorten hospital stays.

Preoperative Anxiety in Patients Undergoing Outpatient Cancer Surgery

OBJECTIVE

Our primary research aim was to determine the prevalence of preoperative anxiety in patients undergoing outpatient cancer surgery. Our secondary aim was to examine the association between preoperative anxiety and negative intraoperative and postoperative outcomes in patients undergoing outpatient cancer surgery, including increased anesthesia requirements, postoperative nausea and vomiting (PONV), extended overnight stay, total length of stay (LOS), transfer to hospital, surgical complications, and postoperative visits to urgent care centers (UCC).

METHODS

We conducted a retrospective cohort study to investigate the prevalence of preoperative anxiety and its association with postoperative outcomes in patients undergoing outpatient cancer surgery. Our retrospective cohort included 10,048 outpatient procedures performed on 8683 patients at a large comprehensive cancer center between January 1, 2016, and April 30, 2018.

RESULTS

The analysis included 8665 patients undergoing procedures at an outpatient facility over 16 months; 16.7% had preoperative anxiety. In patients with preoperative anxiety, higher rates of adverse outcomes were seen, including PONV (adjusted difference 1.8%, 95% confidence interval [CI] 0.12%, 3.4%, P = 0.029), unplanned overnight admission (adjusted difference 1.1%, 95% CI 0.07%, 2.0%, P = 0.021), and urgent care visits within 30 days (adjusted difference 1.5%, 95% CI 0.44%, 2.6%, P = 0.002).

CONCLUSIONS

Even assuming a causal relationship between preoperative anxiety and postoperative outcomes, preventing one instance of PONV would require treating at least 30 patients for anxiety, and preventing longer-term outcomes such as urgent care visits or readmissions within 30 days would require treating even larger numbers of patients. Future studies should attempt to elucidate the causal pathway between preoperative anxiety and postoperative adverse events in outpatients undergoing outpatient cancer surgery.

Preoperative education in hip and knee arthroplasty patients in Bloemfontein

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are frequently performed surgeries worldwide. Preoperative education enhances patient physiotherapy management and satisfaction and should be tailored to patients’ educational needs. Limited research is available regarding the preoperative educational needs for these patients.Objectives: To determine the extent of preoperative education received and the preoperative educational needs of patients undergoing THA and TKA.Method: A structured interview utilising a self-developed questionnaire was used and included questions exploring preoperative education, educational needs, method of education and health care professional providing education. A total of 14 THA and 36 TKA patients, 2–4 days post-operatively at private hospitals in Bloemfontein, were conveniently sampled.Results: All participants had arthroplasties because of osteoarthritis. All participants with THA and 35 (98%) participants with TKA received preoperative education from orthopaedic surgeons, and 8 (57%) participants with THA and 9 (25%) participants with TKA received preoperative education from physiotherapists. Education was mostly given as pamphlets months before the surgery. Participants received the least amount of information regarding exercises, especially preoperative exercise, pain relief and activities of daily living.Conclusion: This study highlights the need for improvement in patient engagement and education, together with enhanced health care practitioner communication and collaboration. Patient centeredness and individualised THA and TKA preoperative education programmes are recognised as a necessary attribute of quality health care and can lead to improved THA and TKA outcomes. The importance of exercise as part of preoperative interprofessional education in the management of THA and TKA should be emphasised as exercise is the cornerstone for rehabilitation of THA and TKA.Clinical implications: This study aimed to emphasise the importance of tailored preoperative education for THA and TKA patients to improve patient outcomes.

How lack of physiotherapist out-of-hours led to nurses developing their role: A UK case study

The aim of this article is to share the experience of how a multi-disciplinary team worked together to develop the nursing role to incorporate the practitioners supporting mobilisation of a patient. The role developed nurses' competence, ensuring that the information and instruction patients received were consistent between therapists and nursing staff, but also supported the Enhanced Recovery Programme (2010). There were issues with the level of therapy support, especially out of hours. The team agreed a vision together, with a solution to the problem on how the mobilisation of patients post-surgery could be achieved. This would ensure postoperative complications were reduced and that there was continuity in education for the patients. This experience is an example of how staff can be empowered to provide patients with a positive experience through challenging practices and behaviours and resulting in innovative practice and role development.

Preoperative Stress: An Operating Room Nurse Intervention Assessment

PURPOSE

The purpose of this research study was to determine the effect of preoperative visits by the operating room (OR) nurse on patient stress levels before undergoing surgery.

DESIGN

This research was a quasi-experimental study.

METHODS

The research sample included patients (N = 179) who were hospitalized for surgery during 6 months in the general surgery department of a public hospital in the Eastern Black Sea Region. The OR nurse, part of the medical staff for surgery, visited patients in the experimental group 1 day before surgery. The OR nurse collected information that was consistent with the requirements of the patients. Patients in the control group were provided with preoperative care that was consistent with hospital procedure. Research data were collected using question forms, patient satisfaction scores, and Burford Distress Thermometer scale. Statistical evaluations included t tests and receiver operating characteristic analysis for independent groups.

FINDING

Most patients stated that they felt stressed because of the impending surgery. Patients made the following most common statements of the factors that caused stress; fear of unknown, anesthesia phobia, and fear of OR environment and complications that may occur during surgery. Patients in both groups experienced a significant decrease in postoperative stress levels. The perceived distress in the experimental group was significantly lower than the control group during the postoperative period. Patients in the experimental group reported that the OR nurse's visit effectively minimized their stress levels.

CONCLUSIONS

OR nurse visits to patients before surgery contributed to decreased preoperative stress levels.

The Effectiveness of Psychosocial Interventions as Adjuncts to Orthopaedic Surgery: A Systematic Review Protocol

AIMS

Pain and anxiety are commonly reported among those undergoing orthopaedic surgery. Improvement in anxiety and pain control might be achieved by supplementing standard care with psychological interventions. However, the effectiveness of adjunctive psychosocial interventions in anxiety and pain control have not been addressed sufficiently by previous systematic reviews in orthopaedic surgeries. The present study aimed to assess the effectiveness of adjunctive psychosocial techniques to improve perioperative clinical care in orthopaedic surgery, to identify the most effective intervention types and to evaluate potential moderators.

METHODS

We will perform a systematic review and meta-analysis to address the study aims. PubMed, PsycINFO, CINAHL and ProQuest Dissertations & Theses will be searched between 1980 and 2015. Prospective controlled clinical trials completed in adults, contrasting standard care and standard care supplemented with psychosocial methods, will be eligible for inclusion. Effectiveness will be assessed through the outcomes of postoperative pain intensity, analgesic requirement, perioperative anxiety, quality of life and postoperative recovery. The results of a random-effect meta-analysis will be reported. To aid implementation of best practice, moderating effects of the type and timing of psychosocial intervention, type of surgical intervention and type of anaesthesia will be evaluated through meta-regression. Sensitivity analyses and subgroup contrasts will follow as necessary.

DISCUSSION

Recommendations will be made to improve medical care in orthopaedic procedures. The quality of evidence will be rated using GRADE criteria. Copyright © 2016 John Wiley & Sons, Ltd.

Vulnerability in perioperative patients: a qualitative study

The study aimed to explore perioperative practitioners' knowledge, awareness and experiences of perioperative vulnerability in clinical practice. A qualitative descriptive design was used; data was obtained by conducting semi-structured interviews with ten perioperative practitioners over a two week period in July 2014. The study found that perioperative practitioners were aware of the concept of perioperative vulnerability and had varied experience of it in practice. Data analysis identified three main themes in relation to vulnerability: labels, recognition and management. We conclude that the concept of perioperative vulnerability exists in practice and that perioperative practitioners manage the concept effectively using strategies that promote positive outcomes.

Effect of Structured Information on Immediate Preoperative Anxiety and Uncertainty for Women Undergoing Laparoscopic Hysterectomy

PURPOSE

Purpose of this study was to identify the effect of structured information on immediate preoperative anxiety and uncertainty for women undergoing total laparoscopic hysterectomy.

METHODS

Sixty women who were admitted for total laparoscopic hysterectomy were recruited at a university hospital in Gyeonggi-do from June to October 2014. Thirty women were assigned to either the experimental or the control group. Women in the experimental group were provided structured information, which consisted of visual and auditory materials about surgical preparation and process, practical experience on devices such as IV-PCA pump and Inspiro-meter and actual experience on route to go to the operating room. State-anxiety, uncertainty, and blood pressure and pulse rate as biological indicators were measured before and after the intervention to examine the effect.

RESULTS

Significant group differences were found on state anxiety, uncertainty, including ambiguity, inconsistency, and unpredictability at the holding area. There was a significant difference on pulse rate in the operating room between the two groups.

CONCLUSION

Findings demonstrated that the structured information provided for women undergoing laparoscopic hysterectomy preoperatively was effective on immediate preoperative anxiety and uncertainty. Nurses may contribute to decreasing patients' anxiety and uncertainty by utilizing this structured information preoperatively.

Total knee replacement pre-operative education in a Singapore tertiary hospital: A best practice implementation project

OBJECTIVES

To increase the competency of specialist outpatient clinic nurses in the provision of pre-operative total knee replacement (TKR) education, and ensure that all patients scheduled for elective TKR received the pre-operative education package.

METHODS

The project was implemented in three phases. Phase 1 entailed a baseline audit that analysed 30 randomized TKR patients who received pre-operative education. In Phase 2, the gaps and barriers in the project were discussed. Using best practice recommendations from the Joanna Briggs Institute, the project team leader collated and standardized the pre-operative education tools, which consisted of a pictorial booklet, a video and home care advice. A teaching plan guided the nurses to increase their understanding and improve practice using the education tools. The usefulness of education strategies and tools was discussed and these were improved over the proposed timeline. Phase 3 entailed a post-implementation audit to evaluate the provision of pre-operative education.

RESULTS

Post implementation, nurses' competency in the provision of pre-operative TKR education increased from 18% to 91%. The number of patients who received the structured pre-operative education package increased from 27% to 50%.

CONCLUSION

Overall, there was improvement in the provision of pre-operative TKR education to patients by clinic nurses using evidence-based best practice and a standardized education package.

Improving Information Provision for Neurosurgical Patients: A Qualitative Study

Background:

Patients confronted with the daunting prospect of a potentially life-altering procedure with uncertain outcome demonstrate high levels of anxiety and need for information. Regardless, many patients are left unsatisfied by the amount of information received from physicians. This study sought to examine the information-seeking patterns of patients and suggest ways to optimize the communication of medical information, specifically within the context of neurosurgery.

Methods:

Semi-structured interviews were conducted with 31 neurosurgical patients operated on for benign or malignant brain tumors. Interviews were transcribed and subjected to thematic analysis in NVivo10.

Results:

Three major themes relating to information-seeking by neurosurgical patients were identified: 1) almost all patients searched for information on the Internet; 2) in addition to characterizing the tumor as benign or malignant, patients sought additional information such as the location of the tumor in the brain; and 3) patients with malignant tumors were less likely to seek information online and more likely to consider alternative therapies. To improve the provision of information to neurosurgical patients, physicians can 1) offer to review imaging results with patients; 2) promote an environment open to questions; 3) provide information in a forthright manner, avoiding the use of medical jargon; and 4) consider guiding patients to reliable Internet sites and facilitating written records of consultations.

Conclusions:

There are many ways that physicians can improve the provision of information to patients, including providing written information and physician recommended online resources, and being mindful of patient perceived time constraints and barriers to effective communication.

Vulnerability in the perioperative patient: a concept analysis

This study aims to report the analysis of the concept of perioperative vulnerability. Literature searches were conducted in databases CINAHL, Medline, PsychINFO, OVID, InterNurse, as well as a manual library search from article reference lists. Search terms were restricted to 'concept analysis', 'vulnerability', 'perioperative', 'patient' and 'perioperative patient'. Retrieved literature was analysed using the Walker & Advant (2005) concept analysis framework. Based on the concept analysis, vulnerability can be seen as having both physical and psychological elements and can be influenced by personal traits. Vulnerability is affected by previous experiences, perceptions of life, disease and ultimately the level of control an individual has over a given situation. The study concludes that inclusion of the concept of vulnerability within both pre- and post-registration training programmes would facilitate awareness of the issues surrounding perioperative vulnerability and the need to plan individualised care accordingly. It is hoped that this analysis will inspire further research and theoretical underpinning of perioperative practice, facilitating the development of new ways to manage vulnerability that will benefit individual patients, develop practice and promote positive patient outcomes.

The effects of preoperative, video-assisted anesthesia education in Spanish on Spanish-speaking patients' anxiety, knowledge, and satisfaction: a pilot study

We studied the effect of an instructional video in Spanish on self-reported anxiety, knowledge about general anesthesia procedures, and satisfaction with the preoperative anesthesia process in patients requiring a Spanish interpreter. This prospective, randomized, nonblinded pilot study took place at Massachusetts General Hospital (MGH), a university-affiliated tertiary-care hospital. Twenty adult, ASA physical status 1, 2, and 3 patients, scheduled for elective surgery (gynecological, orthopedic, and intrabdominal surgery) during general anesthesia were studied. Anxiety, knowledge, and patient satisfaction were assessed using a visual analog scale (VAS). There was a significant reduction in anxiety score in patients who viewed the video compared with those who did not (median reduction 2 vs 0; P = 0.020). There was an increase in satisfaction score in the video group (median increase 2 vs 0; P = 0.046). There was no difference in reported knowledge-improvement scores between the two groups (3.5 vs 4; P = 0.908). In Spanish-speaking patients, the addition of an instructional video in Spanish to a preanesthesia interview decreased anxiety and increased patient satisfaction.

The best way possible! A fieldwork study outlining expectations and needs for nursing of patients in endoscopy facilities for short-term stay

This paper is a descriptive study of nursing in facilities for short-term stay, aiming to outline the expectations and needs for nursing of patients undergoing gastroscopy in outpatient endoscopy clinics. Existing research finds it important to meet patients' expectations and needs for help to get through a procedure in the best and safest way possible. Despite recent years' focus on patient expectations, little attention has been paid to understanding the patients' distinct expectations and needs for nursing in the context of facilities for short-term stay. A fieldwork study influenced by practical ethnographic principles was performed in high-technology endoscopy outpatient clinics during 2008 - 2010. Data were collected using triangulation of participant observation for 12 weeks including participant reports and semi-structured interviews with eight patients and four nurses. The expectations and needs for nursing of patients undergoing gastroscopy were related to two main areas, summarized by the categories: 'Nervousness and anxiety' and 'Maintaining control'. The former concerned how patients managed their nervousness and anxiety and was described differently in terms of 'Getting it over with', 'The meaning of words' and 'Taking precautions'. The latter 'Maintaining control' concerned how patients in different ways managed to maintain control over their situation and was described in terms of 'Being informed', 'Others are in the same "boat"' and 'Being proactive'. The study concludes that nervousness and anxiety are expressed differently in patients undergoing gastroscopy and that patients have individual ways of claiming their right to elements of control over the situation and the course of gastroscopy. In order for nursing in endoscopy settings to be tailored to the individual patient, it must be adapted to the individual patient's ways of managing nervousness and anxiety as well as ways of claiming control.

The lived spiritual experiences of patients transitioning through major outpatient surgery

Dramatic changes in outpatient surgery have occurred in recent years, but the basic care needs of surgical patients remain constant. Most outpatients face the same spiritual and coping issues that inpatients do, but outpatient surgery requires that patients cope with the surgery at an accelerated pace. This phenomenological study describes the meanings of the lived spiritual experiences of patients transitioning through major outpatient surgery. Analysis of interviews with participants resulted in four distinct themes: a point in time, holy other, vulnerability in the OR, and appraisals of uncertainty. Ways that health care providers can provide holistic case include developing an understanding of the patient's overall experience, understanding the patient's goals, and supporting the patient's own coping mechanisms and resources. Additional research should be conducted to explore interventions related to patients' spiritual well-being in outpatient settings.

Postoperative psychological distress in patients having total hip or knee replacements: an exploratory panel study

PURPOSE

The purpose of this study was to describe postoperative anxiety and depression in patients undergoing total hip or knee replacement, describe and identify preexisting factors known during hospitalization and postdischarge, and detect associations with symptoms of anxiety and depression at home at least 4 weeks posthospital discharge.

METHODS

Patients from 2 sites in Iceland answered self-administered questionnaires at the hospital and at home. The questionnaires included questions about anxiety, depression, pain, family and social situations, and hospital and illness experience.

FINDINGS

Patients exhibited few symptoms of anxiety and depression. Significant associations between symptoms of anxiety and depression at the hospital with anxiety and depression at home, as well as between general postoperative symptoms and quality of sleep, were found. Postoperative anxiety was predicted by depression at the time of admission to the hospital. Postoperative depression was predicted by depression at the hospital and presence of pain at home. Most patients found that the operation was as successful as expected; 29.6% stated that they had recovered very well and 33.6% wanted more information about the time it takes to recover.

The Effect of Stress on Cognitive Structuring

In this article, we outline a model of the factors involved in the relationship between stress and cognitive structuring. More specifically, we propose that the desire for certainty, the need for cognitive structure, and perceived efficacy at satisfying one’s epistemic needs intervene in the effect exerted by stress on cognitive structuring. We further suggest expanding the model to account for aspects of general information processing and to encompass the effect of various trait-like characteristics on the cognitive response to stress. We also offer an account of the possible effects of extreme stress on the model’s components.

The effect of social support on functional recovery and wellbeing in older adults following joint arthroplasty

Projections by the U.S. Census Bureau indicate a continual rise in the population of older adults. Along with increased dependency among older adults, chronic illness and aging may have attendant social and personal concerns in the areas of health care, community health services, and quality of life. Direct and indirect costs of osteoarthritis are $120 billion per year in medical treatment and lost wages. Every year more than 300,000 knee replacements and 120,000 hip replacements are performed in the United States (Sapountzi-Krepia et al., 2007). A large percentage of joint replacement patients have now assumed responsibility for their recovery process. This exploratory study assessed and measured social support and evaluated its impact on functional recovery and well-being in older adults after joint arthroplasty. Although social support, associated with the covariates of "living arrangements" and "age," demonstrated a positive relationship with perceived wellbeing, no relationship was demonstrated with high or low levels of social support and functional recovery.

Distress in the radiology waiting room

PURPOSE

To assess the level of distress in women awaiting radiologic procedures.

MATERIALS AND METHODS

In this institutional review board-approved and HIPAA-compliant study, 214 women between 18 and 86 (mean, 47.9) years of age completed the State Trait Anxiety Inventory (STAI), Impact of Events Scale (IES), Center for Epidemiologic Studies Depression Scale (CES-D), and Perceived Stress Scale (PSS) immediately prior to their procedures. One hundred twelve women awaited breast biopsy; 42, hepatic chemoembolization for cancer; and 60, uterine fibroid embolization. Data were analyzed with multivariate analysis of variance and post hoc Tukey tests. Results are reported as means and 95% confidence intervals (CIs).

RESULTS

All three patient groups experienced abnormally high mean PSS, IES, and CES-D scores, but only the breast biopsy group had highly abnormal anxiety levels. Breast biopsy patients had a significantly higher mean STAI score of 48 (95% CI: 45, 50) than did women awaiting hepatic chemoembolization (mean score, 26; 95% CI: 22, 29; P < .001) and fibroid embolization (mean score, 24; 95% CI: 21, 27; P < .001). IES ratings did not differ significantly among the groups, with a mean score of 26 (95% CI: 23, 29) for breast biopsy patients, 23 (95% CI: 18, 28) for hepatic chemoembolization patients, and 23 (95% CI: 18, 27) for fibroid embolization patients. The CES-D score did not differ significantly among breast biopsy (mean score, 15; 95% CI: 13, 17), hepatic chemoembolization (mean score, 14; 95% CI: 11, 18), and fibroid embolization (mean score, 12; 95% CI: 9, 15) patients. PSS ratings of breast biopsy patients were significantly higher (mean score, 18; 95% CI: 16, 19) than those of hepatic chemoembolization patients (mean, 15; 95% CI: 13, 17; P < .01), but they were not significantly different from those of women awaiting fibroid embolization (mean, 16; 95% CI: 14, 18; P = .23).

CONCLUSION

Uncertainty of diagnosis can be associated with greater stress than is awaiting more invasive and potentially risky treatment.

Strategies for decreasing patient anxiety in the perioperative setting

Perioperative patient anxiety is a pervasive problem that can have far-reaching effects. Among these effects are increased postoperative pain, increased risk for infection, and longer healing times. Many factors affect perioperative patient anxiety, including the need for surgery, perceived loss of control, fear of postoperative pain, and alteration of body image. This systematic review of current literature was undertaken to identify evidence-based interventions for decreasing patient anxiety in perioperative practice. According to the current research literature, perioperative education and music therapy can be used to successfully reduce surgical patients' anxiety.

General anaesthesia and day-case patient anxiety

AIM

This paper is a report of a study carried out to uncover the most anxiety-provoking aspects of general anaesthesia and determine what interventions may help to alleviate such anxiety.

BACKGROUND

General anaesthesia has proved to be highly anxiety-provoking. With the rise in elective day surgery, this aspect of patients' experience has become a prominent issue. Indeed, with brief hospital stays, limited contact with healthcare professionals, restricted formal anxiety management and the acute psychological impact of day surgery, such anxiety may be increasing.

METHOD

As part of a larger study, a questionnaire was given on the day of surgery to 1250 adult patients undergoing surgery with general anaesthesia over a two year period from 2005-2007. The issue examined was anxiety in relation to the environment, hospital personnel and general anaesthesia. Participants were requested to return the questionnaire by mail 24-48 hours following surgery, and 460 completed questionnaires were returned.

FINDINGS

A total of 85% of respondents experienced some anxiety on the day of surgery. Immediate preoperative experiences and concerns about unconsciousness were highly anxiety-provoking. Using factor analysis Preoperative Anaesthetic Information, Anaesthetic Catastrophising, Final Support, Personal Support, Imminence of Surgery, Possible Adverse Events and Final Preoperative Experiences were identified as central features. Multiple regression demonstrated Preoperative Anaesthetic Information, Anaesthetic Catastrophising and Imminence of Surgery were statistically significantly associated with an overall increased level of anxiety.

CONCLUSIONS

Focusing on the timely, formal delivery of information about anaesthesia management, emphasizing the notion of 'controlled unconsciousness' and dispelling misconceptions associated with general anaesthesia may help to limit patient anxiety.

Factors influencing early rehabilitation after THA: a systematic review

A wide variation exists in rehabilitation after total hip arthroplasty (THA) in part due to a paucity of evidence-based literature. We asked whether a minimally invasive surgical approach, a multimodal approach to pain control with revised anesthesia protocols, hip restrictions, or preoperative physiotherapy achieved a faster rehabilitation and improved immediate short-term outcome. We conducted a systematic review of 16 level I and II studies after a strategy-based search of English literature on OVID Medline, PubMed, CINAHL, Cochrane, and EMBASE databases. We defined the endpoint of assessment as independent ambulation and ability to perform activities of daily living. Literature supports the use of a multimodal pain control to improve patient compliance in accelerated rehabilitation. Multimodal pain control with revised anesthesia protocols and accelerated rehabilitation speeds recovery after minimally invasive THA compared to the standard approach THA, but a smaller incision length or minimally invasive approach does not demonstrably improve the short-term outcome. Available studies justify no hip restrictions following an anterolateral approach but none have examined the question for a posterior approach. Preoperative physiotherapy may facilitate faster postoperative functional recovery but multicenter and well-designed prospective randomized studies with outcome measures are necessary to confirm its efficacy.

LEVEL OF EVIDENCE

Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.