Beruflich Dokumente
Kultur Dokumente
doi: 10.1111/scs.12022
Faculty of Para Medicine, Operating Group, Alborz University of Medical Sciences, Karaj, Iran, 2Minimally Invasive Surgery Research
Center, Tehran University of Medical Sciences, Tehran, Iran, 3Student Scientific Research Center, Tehran University of Medical Sciences,
Tehran, Iran and 4Tehran Medical Unit, Islamic Azad University, Tehran, Iran
Introduction
Anxiety is a temporary emotional state of tension,
nervousness, fear and high autonomic nervous system
activity (1). Anxiety-provoking events that can significantly affect recovery include admission to and environment of the hospital, surgery and anaesthesia (2).
Despite progress in surgery and anaesthesia, anxiety is
an important problem for majority of patients who are
Correspondence to:
Abdolreza Pazouki, Minimally Invasive Surgery Research Center,
Rasoul-e-Akram Hospital, Tehran University of Medical Science,
Niayesh Ave, Sattarkhan St, Tehran 1445613131, Iran.
E-mail: apazouki@yahoo.com
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two equal groups (intervention and control) via a computer-based randomization process.
A preoperative nursing visit was conducted for each
patient in the intervention group on the day before surgery, while no such an intervention was offered to the
control group. Preoperative anxiety and postoperative
complications including pain, nausea and vomiting were
then compared between the two groups using a 30-minute survey. Anxiety was evaluated using a Spielberger
StateTrait Anxiety Inventory (10) that was translated
and validated for the Iranian population. Two independent psychologists then reviewed the questionnaire for
the presence of any bias or mistranslation. The questionnaire consisted of 20 items in two 10-question sections
measuring either state or trait anxiety. It was scored
based on an anxiety intensity from 1 (no anxiety) to 4
(highest level of anxiety), giving a sum score between 20
and 80. Pain was measured using a visual analogue scale.
Nausea and vomiting were measured using a Johnson 10
scale criteria.
Data collection included reviewing patient medical
records and then conducting face-to-face interviews.
Patients in the intervention group were interviewed on
the day before surgery. These interviews included asking
the patient about any concerns regarding the scheduled
surgery and postoperative process and then answering
those questions in simple and understandable phrases.
Patients in the intervention group were also educated
about the operating room environment and surgery
team, the anaesthesia process, benefits of laparoscopic
surgery versus open surgery, as well as postoperative care
from the recovery room up to patient discharge (to help
facilitate patient cooperation with nurses). Patients in the
control group were scheduled only for conventional preoperative nursing visits.
To evaluate the efficacy of nursing visits, a Spielberger
StateTrait Anxiety Inventory was completed for patients
in both groups. Nurses conducted a 30-minute survey at
the time of admission to the surgical ward and again just
before transferring the patient to the operating room (OR).
Data regarding surgery, anaesthesia and recovery were
recorded. Pain, nausea and vomiting were also evaluated
by a trained nurse after 24 hours. Surgical and anaesthesia procedures, as well as procedures for pain, nausea
and vomiting control, were the same for all patients.
Written informed consent was obtained from all
patients before randomized allocation to either the intervention or the control group. Our Institutional Review
Board approved the study protocol on human subjects.
Data were analysed using Statistical Package for Social
Sciences (SPSS, Version 16; Chicago, Inc, Chicago, IL,
USA). Values are presented as a mean SD for continuous and as a number (%) for categorical variables. An
independent sample t-test for quantitative variables was
used to compare data between the two groups.
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L. Sadati et al.
Intervention group
Control group
56.98
55.58
40.34
56.1
55
56.7
0.2
0.4
0.0
39.04
55.38
0.0
Time to score 9
consciousnesses (hours)
Nausea/vomiting in
operating room (%)
Intervention group
Control group
18
30
0.0
20
0.04
Results
Data from 100 patients who completed both questionnaires were analysed. All patients were women.
Mean standard deviation (SD) age was 46.8 10.6 years
and mean SD BMI was 27.1 3.1 kg/m2. Both the
intervention and control groups had similar educational
backgrounds. According to the calculated Spielbergers
score, state and trait anxiety at the time of admission to
the surgical ward were 56.98 and 55.58 in the intervention group, compared with 56.1 and 55 in the control
group, respectively, with no significant difference
(p > 0.05) (Table 1) between the groups. However, following the nursing visit and just prior to entering the OR,
both state and trait anxiety dropped to 40.34 and 39.04 in
the intervention group, compared with 56.70 and 55.38 in
the control group, with statistically significant differences
(p < 0.05) in the intervention group after the nursing visit
(Table 1).
Mean time to reach an Aldrete consciousness score of 9
was 18 and 30 minutes in the intervention and control
groups, respectively, with a statistically significant difference (p < 0.05). Moreover, only 6% of the intervention
group developed postoperative nausea and vomiting, significantly less than the 20% of the control group
(p < 0.05) (Table 2). Duration of vital sign stabilization,
postoperative pain, nausea and vomiting, and time to
patients first walk were significantly lesser in the intervention group than in the control group (p < 0.05)
(Table 3).
Discussion
Our study showed that state anxiety decreased in the
intervention group, which received a preoperative nursing visit. Similarly, in a study conducted by ValenzuelaMillan et al. (11) on 135 patients, 76% of them were
anxious before the surgery, and the most important contributing factor was the lack of information. In another
study performed by Kiyohara et al. (8), a preoperative
visit by an anaesthesiologist and sufficient education significantly reduced anxiety in studied patients. In 2007,
Asghari et al. (12) indicated that cortisol levels (as an
Postoperative
characteristics
Intervention
group
Control group
1.49 (hour)
5.1
0%
1.9 (day)
0.9 (day)
16.6 (hour)
2.54 (hour)
5.7
33%
2 (day)
1.2 (day)
18.1 (hour)
0.0
0.001
0.01
0.23
0.002
0.07
References
1 Markland D, Hardy L. Anxiety,
relaxation and anaesthesia for daycase surgery. Br J Clin Psychol 1993;
32: 493504.
2 Smeltzer SC, Bare BG. Brunner &
Suddarths. Text Book of Medical
Surgical Nursing, 10th edn. 2010,
Lippincott Williams & Wilkins,
Philadelphia.
3 Price B, Price P. Surgical Technology
for Surgical Technologist. A Positive
Care Approach. 2007, Delmar/Thomson Learning, Philadelphia.
4 Sukantarat KT, Williamson RC, Brett
SJ. Psychological assessment of ICU
survivors: a comparison between the
hospital anxiety and depression scale
and the depression, anxiety and
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Conclusion
Our study showed that preoperative nursing visits can
decrease rates of anxiety and postoperative complications
and should be integrated into routine care for laparoscopic cholecystectomy patients.
Author contribution
Sadati and Pazouki involved in the study conception/
design. Sadati and Shoar contributed to the data collection/analysis. Shoar and Tamannaie drafted the manuscript. Pazouki, Shoar, Chaichian and Mehdizadeh
involved in critical revisions for important intellectual
content and administrative/technical/material support.
Sadati, Chaichian, Pazouki and Mehdizadeh supervised
the work. Chaichian, Shoar and Tamannaie shared their
statistical expertise.
Ethical approval
This project has been accepted by ethical committee of
Tehran University of Medical Sciences; ethical code: 891/1.
Funding
This study has been funded and supported by Tehran
University of Medical Sciences (TUMS); grant No: 487.
Declaration of interests
There has been no duplicate publication or submission
elsewhere, and no ethical problem or conflict of interest
is declared.
10
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