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PREOPERATIVE TEACHING CLINICPREOPERATIVE TEACHING CLINICEFFECTS ONEFFECTS ON
SURGICAL ANXIETY REDUCTION:SURGICAL ANXIETY REDUCTION:
TO ASSESS THE EFFICACY OF A TO ASSESS THE EFFICACY OF A SURGICAL ORIENTATION SURGICAL ORIENTATION
VIDEO IN DECREASING VIDEO IN DECREASING PREOPERATIVE ANXIETYPREOPERATIVE ANXIETY
Richard D. Kuylen, RN, BSNRichard D. Kuylen, RN, BSNLallie Kemp Medical CenterLallie Kemp Medical Center
Independence, LouisianaIndependence, Louisiana
PREOPERATIVE ANXIETYPREOPERATIVE ANXIETY Anxiety and pain – subjective elements of the patient
experience
Can result in an increase in the levels of patients’ experience of pain, which usually requires management through analgesia
Can adversely influence anesthetic induction and patient recovery
Decrease patient satisfaction with the perioperative experience
OPPORTUNITY STATEMENTOPPORTUNITY STATEMENT
Participation in a Preoperative Participation in a Preoperative Teaching Clinic, on a day prior to Teaching Clinic, on a day prior to
scheduled surgery, will significantly scheduled surgery, will significantly decrease preoperative anxiety and decrease preoperative anxiety and
facilitate a smooth transition facilitate a smooth transition through the surgical process for through the surgical process for
patients, family members and patients, family members and operating room staff.operating room staff.
EXCESSIVE EXCESSIVE PREOPERATIVE PREOPERATIVE
ANXIETYANXIETY Can lead to pathopysiological responses:
* tachycardia * hypertension * arrhythmia * higher levels of pain that may persist into the postoperative period
PREOPERATIVE PREOPERATIVE EDUCATIONEDUCATION
The process of informing clients about their condition, surgery and postoperative care
Prepare patients for surgery and help them to manage their care postoperatively
Key to decreased complications and readmission; thus, improving cost effectiveness
GOALS OF GOALS OF PREOPERATIVE PREOPERATIVE
EDUCATIONEDUCATION Provide the means for patients to participate in
treatment decisions with full understanding of factors relevant to their proposed care
Decrease potential complications through patient education and family involvement
Improve postoperative recovery Reduce surgical anxiety Mold attitudes regarding surgery, staff and the facility
Clear up misconceptions and inaccurate information Address questions and concerns Provide emotional support Provide thorough and accurate information to patient
and family Facilitate smooth flow of surgery schedule
METHODS/FORMAT OF METHODS/FORMAT OF PREOPERATIVE EDUCATIONPREOPERATIVE EDUCATION
One to one instruction
Demonstrations
Printed materials
Videotapes
STANDARD PREOPERATIVE STANDARD PREOPERATIVE EDUCATIONEDUCATION
Involves the use of verbal instructions by physicians and nurses
Often delivered during a brief session prior to the day of surgery
Patient memory of instructions often inadequate due to anxiety and feelings of uncertainty
PREOPERATIVE PREOPERATIVE VIDEOTAPED VIDEOTAPED INSTRUCTIONINSTRUCTION
Enhances learning in patients with low literacy skills
Beneficial for elderly patients who have difficulty reading small printed documents
LITERATURE REVIEWLITERATURE REVIEW
Patients scheduled for surgery have increased anxiety and fear of the unknown
Preoperative period is the time when most patients experience significant fear regarding surgery, complications and level of recovery
The more informed and better prepared patients are about what to expect during the surgical experience, the less anxious they tend to be
Efficient organization and utilization of resources available in a preoperative clinic results in cost savings via reduction in operating room delays
LITERATURE REVIEWLITERATURE REVIEW(Cont’d)(Cont’d)
Preoperative teaching clinics improve efficiency in admission and screening of patients
Preoperative teaching programs foster : decreased length of stay * less demand for postoperative analgesic * quicker recovery from surgery * decreased infection rate * decreased anxiety
THEORY-PRACTICE GAPTHEORY-PRACTICE GAP
A Theory-Practice gap identified Preoperative education benefits along with
cost effectiveness to institutions and patients are well documented through years of research
Many facilities have no formal policy or program for providing structured education
Thus, many patients arrive the morning of surgery very anxious and poorly informed
Organizational FrameworkOrganizational Framework
Patient presents to Medicine Clinic or Emergency Room with a complaint/symptom
Patient referred to Surgery Clinic for surgical evaluation if clinically indicated
Surgery scheduled with OR staff based on surgeon’s evaluation/recommendation
Patient provided appointment to Preoperative Teaching Clinic on a day prior to scheduled surgery
Family and friends involved in postoperative care encouraged to attend preoperative education
Aim/Purpose of ProjectAim/Purpose of Project Aim of project: * Promote
awareness of benefits and effectiveness of a Preoperative Teaching Clinic * Encourage development of a Surgical Orientation Video in other LSU Hospitals
Purpose of study: * To evaluate the effectiveness of a preoperative surgical orientation video in decreasing anxiety in patients scheduled for surgery with general anesthesia
Surgical Orientation Video, developed at Lallie Kemp Medical Center, walks a patient through the surgical process from admit through discharge.
By viewing video, patient sees many nurses and anesthesia personnel that will provide care morning of surgery, along with some monitoring equipment used
PREOPERATIVE PREOPERATIVE TEACHING CLINIC VISITTEACHING CLINIC VISIT
Intervention group (n=13) – views a preoperative surgical orientation video and receives surgery-specific preoperative education
Control group (n=17)– receives standard preoperative education without viewing the orientation video
Surgery and anesthesia-related anxiety evaluated by using a quantitative scale of preoperative anxiety before and after implementing preoperative education and viewing the preoperative video
RESEARCH DESIGNRESEARCH DESIGN Two - group, pretest / posttest research
design Determine significant difference in anxiety
levels between: * group that received standard preoperative education (control group) * group that received standard preoperative education, along with viewing the surgical orientation video (intervention group)
Sample size : 30 patients (n=30) * randomly assigned to either * intervention or control group
HYPOTHESISHYPOTHESIS The intervention group that also views the video
will have less preoperative anxiety than the control group that does not view the video
The intervention group will have decreased anxiety after preoperative teaching is implemented
The control group will also have decreased anxiety after preoperative teaching is implemented
There will be no difference in anxiety between the two groups prior to preoperative teaching
METHODOLOGYMETHODOLOGY
Principal Investigator (PI) obtained approval to conduct study from the following authorities: * Institution Compliance liaison and privacy officer * LSU HCSD Office of Research and Development * Institution Medical Executive Committee
Institutional Review Board of Southeastern Louisiana University (SLU) also granted permission
Population consisted of patients seen in the surgery clinic at a LSU HSC Lallie Kemp Medical Center
METHODOLOGYMETHODOLOGY(Cont’d)(Cont’d)
Patients evaluated in the surgery clinic and scheduled for surgery
Patients scheduled for preoperative teaching clinic visit for surgery and anesthesia education, on a day prior to surgery
Family members involved in postoperative care encouraged to attend preoperative education
CRITERIA FOR CRITERIA FOR INCLUSION IN STUDYINCLUSION IN STUDY
English - speaking patientEnglish - speaking patientBetween the ages of 21 and 65Between the ages of 21 and 65
Basic Literacy (able to read and understand)Basic Literacy (able to read and understand)
First 30 that met criteria were randomly First 30 that met criteria were randomly assigned to:assigned to:
** intervention group -13 **** intervention group -13 ** ** control group - 17 ** ** control group - 17 **
SETTINGSETTING
Preoperative Teaching Clinic at Lallie Kemp Medical Center in Independence, Louisiana
Patients provided scheduled appointment to see the preoperative teaching nurse when discharged from the surgery clinic
Focus on anxiety reduction through surgery - specific preoperative education
Preoperative Surgical Orientation Video viewed after preoperative education implemented
Krames color illustrated surgical literature used to facilitate preoperative education
INSTRUMENTATIONINSTRUMENTATION
Amsterdam Preoperative Anxiety and Information Scale (APAIS)
Anxiety Scale * consists of 4 questions (1, 2, 4, 5) * each question scores from 1 to 5 * score is the sum of the four questions, ranging from 4 to 20
Subscales * anesthesia-related anxiety (Sum A=1+2) * surgery-related anxiety (Sum S=4+5) * combined anxiety component Sum C=Sum A +Sum S=1+2+4+5
Scale also includes an information desire component (3+6)
AMSTERDAM PREOPERATIVE ANXIETY AMSTERDAM PREOPERATIVE ANXIETY & INFORMATION SCALE& INFORMATION SCALE
CRONBACH’S CALCULATED ALPHA CRONBACH’S CALCULATED ALPHA ESTIMATES FOR ANXIETY COMPONENTSESTIMATES FOR ANXIETY COMPONENTS
For Anesthesia - Related Anxiety (Alpha.779) For Surgery - Related Anxiety (Alpha .848) For Combined -Anesthesia Component (Alpha .810) For Information - Desire Component (Alpha .730)
* Findings confirm the internal consistency and reliability of the measurements
* Results also confirm the scales validity for use in preoperative anxiety assessment
DATA ANALYSIS & DATA ANALYSIS & CALCULATIONSCALCULATIONSSPSS PROGRAMSPSS PROGRAM
Demographic data * Gender * Age * Educational level * Frequencies and percentages of responses
T- test for differences between control and intervention groups on anxiety * Independent t-test - compares across group means * Paired t-test – compares pre- and posttest scores across each group
RESULTRESULTEXPERIMENTAL 2-GROUP EXPERIMENTAL 2-GROUP
PRETEST-/POSTTEST DESIGNPRETEST-/POSTTEST DESIGN
PURPOSE – to determine if significant anxiety exists between the control and intervention groups
SAMPLE – 30 patients (n=30) scheduled for elective surgery with general anesthesia > Randomly assigned to either : * control group (n=17) * intervention group (n=13) > Gender Frequency * Males (n=11) 36.7% * Females (n=19) 63.3% * Age range: 21 – 62 years (m=44.4years) > Educational level * Less than high school – 23 % (n=7) * High school graduate - 70 % (n=21) * Post high school - 7 % (n=2)
HYPOTHESIS IHYPOTHESIS I Intervention group will have less preoperative anxiety than
the control group after preoperative teaching is implemented * Independent sample t- test – conducted to evaluate hypothesis * Post t- test – all p- values greater than .05
Not enough evidence to say that the means are different at the 95% confidence level
However, pre-test means in the Intervention group were higher in all categories than pre-test means in Control group
Hypothesis I is not supported
HYPOTHESIS IIHYPOTHESIS II Intervention group will have decreased anxiety after
preoperative teaching is implemented
Paired t- test analysis results (p-value) * anesthesia related anxiety - 0.006 * surgery related anxiety - 0.002 * information desire component - 0.001 * combined anxiety component - 0.003
P- values less than 0.05 – There is enough evidence to say that the means are different at 95% confidence
Hypothesis II is supported
HYPOTHESIS IIIHYPOTHESIS III The control group will have decreased anxiety after
implementation of preoperative teaching
Control group t- test results (p- value) * anesthesia related anxiety - 0.227 ( > .05) * surgery related anxiety - 0.039 ( < .05) * information desire component - 0.005 ( < .05) * combined anxiety component - 0.037 ( < .05)
Not enough evidence to say that means are different at 95% confidence for anesthesia related anxiety
With 95% confidence, there is not enough evidence to say that the means are equal in all other anxiety components
Hypothesis III is partially supported
HYPOTHESIS IVHYPOTHESIS IV There will be no difference in anxiety between the two groups prior to preoperative
teaching
Independent sample t-test results (p-value) * anesthesia-related anxiety - 0.014 ( < .05 ) *
combined anxiety component - 0.024 ( < .05 ) * surgery-related anxiety - 0.320 ( > .05)
T-test at pre-measure significantly higher in one out of three measures
Pre-test means higher in all components in the intervention group than in the control group
Hypothesis IV is not supported
DISCUSSION/CONCLUSIONDISCUSSION/CONCLUSION
Participation in a Preoperative Teaching Clinic prior to surgery can significantly decrease preoperative anxiety as evident in this small pilot study
Intervention group: significant decrease in mean anxiety between pre and post test analysis for : * anesthesia-related anxiety (p= 0.006) * surgery-related anxiety (p= 0.002) * information desire component (p= 0.001) * combined anxiety component (p= 0.003)
DISCUSSIONDISCUSSION(Cont’d)(Cont’d)
Control group: significant decrease with preoperative education for :
* surgery-related anxiety (p= 0.039) * information desire component (p= 0.005) * combined anxiety component (p= 0.037)
No significant reduction in mean anesthesia-related anxiety (p=0.227) shown in the control group compared to intervention group (p=0.006) with preoperative education. Video includes section where Anesthesiologist speaks with patient prior to surgery
Perhaps this decreased anxiety in this group! Pilot study showed no significant difference in
preoperative education with addition of surgical orientation video as evidenced by independent samples t-test for post test between groups (Table 2).
Systems ImpactedSystems Impacted
The LSU HCSD system could benefit from results of this pilot study by improving preoperative education or developing preoperative teaching clinics
Preoperative Surgical Orientation Videos specific to each hospital could also facilitate preoperative education
Since this was a small pilot Since this was a small pilot study conducted in a rural study conducted in a rural
hospital that caters to a mostly hospital that caters to a mostly indigent population, future indigent population, future
research is indicated to assess research is indicated to assess the Preoperative Surgical the Preoperative Surgical
Orientation Video’s effects on Orientation Video’s effects on anxiety reduction. Larger anxiety reduction. Larger
studies in multiple, non-profit studies in multiple, non-profit and private hospitals would and private hospitals would increase the validity of the increase the validity of the
findings.findings.