4.

allying anxiety in a patient and use preoperative cheklists

A pre -oprative visit refers to communicationbetween a surgical patient and a theatre nurse inthe
period before the patient is taken to theatre.Hayward (1975), in his classic research
publicationInformation: A Prescription Against Pain, statedthat it is an unfortunate truth that most
patientsenter hospitals and operating rooms with unnec-essary fears and anxieties. A great part of
the appre-hension stems from a lack of knowledge concerningtheir illness and the operative
procedure that is tobe performed on them. He also highlights that thepersistence of these anxieties
often interferes greatlywith smooth post-operative results.

Kalideen (1991) concluded that Hayward’s studyindicated that good psychological preparation pre-
operatively contributed greatly to reduced analge-sia requirements in the post-operative period.
Egbertet al (1963) showed that the pre-operative visit byan anaesthetist reduced anxiety and related
signsand symptoms, for example, fear of pain, fear ofthe anaesthetic and fear of perhaps not
wakingup. The patient’s ability to understand and retaininformation depends greatly on the
communica-tion skills and experience of the medical attendant(Egbert et al 1963).

Weschler-Evans (1990) sug-gested that by having made contact with a mem-ber of the theatre staff,
patients were often anxiousto retain the relationship as emotional support.The combination of
essential physical aspects ofcare, lack of time, the increasing complexity of surgery,shorter hospital
stays and an increased turnover haslargely prohibited the introduction of formalised careplans to
address the more marginal issues, such aseffective anxiety management (Cahill 1999).

Numerous research studies have suggested waysin which the management of anxiety can be
improved(De Groot et al 1997, Linden and Engberg 1996,Mitchell 2000).Martin (1996) in a quasi-
experimental design study,evaluated the effect of pre-operative visits by the-atre nurses on pre- and
post-operative levels of anx-iety in two groups of general surgical patients, tosee if the outcome was
reflected in the level of post-operative pain, nausea, mobility or length of hos-pitalisation. A
combination of qualitative andquantitative research was used. Rees (1997) states:‘Qualitative
research believes that if we are to under-stand a topic, we need to look at it through theeyes of
those who experience it, and try to under-stand it from their point of view.’ Quantitative

research is defined as a formal, objective, system-atic process in which numerical data are used
toobtain information about the world (Burns and Grove1995). The outcome of any research project
is depen-dent on the reliability of the method used and thetype and quality of the sample on whom
the resultsare based (Rees 1997). The sample consisted of 40elective general surgical patients of
both sexes in alocal general hospital. The criteria to be met werethat the patients were over the age
of 16, willingto take part in the study, able to comprehend ver-bal instruction and expected to stay in
hospital forat least 24 hours. One group received pre-operativevisits, but the other group did
not.Three of the most common ways of collectingquantitative data are to observe behaviour using
astandardised checklist, to survey a sample of thepopulation using a standardised questionnaire,
orto measure performance following some experi-mental manipulation (Tarling and Crofts
1998).Questionnaires must produce data that are reliableand valid for the information to be of use
to nursesand healthcare professionals (Jack and Clark 1998).

Polit and Hungler (1997) state that the reliability ofa questionnaire refers to the consistency with
whichrespondents understand and respond to all thequestions. Validity is the extent to which a
ques-tionnaire measures what it is supposed to measure(Polit and Hungler 1997).

The results of Martin’s (1996) study demonstrateda significant decrease in anxiety 24 to 72 hours
post-operatively for the visited group. A positive rela-tionship was also found between pre-
operativeanxiety levels and the level of pain, nausea and lackof independence experienced by both
groups. Lengthof hospitalisation was unaffected in either group.The study concluded that patients
who are proneto feelings of anxiety might demonstrate increasedpre-operative anxiety, and that all
surgical patientsshould receive a visit from the theatre nurse to informthem about the forthcoming
surgical experience

Feature N%
Male gender 131 (29.5)
Age in median years (range) 50 (18–91)
Level of education
Less than middle school 63 (14.2)
SMA 126 (28.4)
Colleges 197 (44,4)
University 58 (13.1)
Number of previous surgical operations
 0 52 (11.7)
 1 64 (14.4)
 2 71 (16.0)
 3 58 (13.1)
 4 32 (7.2)
 5 36 (8.1)
 6 31 (7.0)
 7 21 (4.7)
 8 14 (3.2)
 9 5 (1.1)
 10 8 (1.8)
>10 52 (11.7)
Previous error in treatment: Yes 161 (36.3)
Active as a clinician (doctor or nurse) 58 (13.1).