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ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 2  |  Page : 1-3

Effect of preoperative teaching on anxiety level of patients with neurosurgery


Nursing Tutor, NIMHANS, Bengaluru, India

Date of Web Publication9-Jul-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-1505.262432

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  Abstract 


Neurosurgical procedures are carried out to treat various disorders affecting the nervous system. It is common to feel nervous and anxious when one is scheduled to undergo a neuro surgical procedure. Aim: to know the effect of preoperative teaching in reduction of anxiety just before the neurosurgery. Methods: The study was conducted using nonequivalent control group pre-test and post-test design on patients who were admitted in surgical ward for first fifteen days 26 patients as interventional group. After fifteen days interval, again selected all the patients who met the inclusive criteria who were admitted in surgical ward for another fifteen days 28 patients for as control group. Anxiety was evaluated using a validated Spielberger State-Trait anxiety inventory. Findings: The study includes and. Comparison between interventional and control group in relation to sex, education, domicile and income found statistically similar. At admission, State and trait anxiety score mean value of interventional group were 45.31 and control group were 45.11. Interventional group anxiety score reduced to Mean value of 40.31, just before surgery, which is statistically significant (p>0.05) whereas no change of anxiety score in control groups, Mean value to 47.75 just before surgery, which is not statistically significant. Conclusion: The study findings suggest that preoperative teaching could decrease the level of preoperative anxiety in this patient population.

Keywords: Anxiety, Neurosurgery Patient, Preoperative Teaching


How to cite this article:
Esther Lilly A C, Dakshayani B. Effect of preoperative teaching on anxiety level of patients with neurosurgery. Indian J Psy Nsg 2018;15:1-3

How to cite this URL:
Esther Lilly A C, Dakshayani B. Effect of preoperative teaching on anxiety level of patients with neurosurgery. Indian J Psy Nsg [serial online] 2018 [cited 2019 Aug 20];15:1-3. Available from: http://www.ijpn.in/text.asp?2018/15/2/1/262432


  Introduction Top


Neurosurgical procedures are carried out to treat various disorders affecting the nervous system. Neurosurgical patients have high levels of anxiety, with a higher incidence in females. There was a moderately high need for information, particularly in patients with a high level of preoperative anxiety.[1]Anxiety is a temporary emotional state of tension, nervousness, fear and high autonomic nervous system activity.[2]

Anxiety is a usual reaction to a stressful situation and found in patients awaiting for major surgery. Most of the patient enter the operative room with fear and anxiety. The evaluation of preoperative anxiety levels before surgery is important. It is also important to address the anxiety before the surgery in order to deliver appropriate intervention and to prevent undesirable post-operative complication.[3]

It is common to feel nervous and anxious when one is scheduled to undergo a neurosurgical procedure. Carl R, Wajer IH et.al, concluded that significant anxiety occurs in one fourth of patients undergoing neurosurgery. Furthermore states that it is important to ask patients about their specific anxieties.[4]

There is evidence in the literature that the practice of giving preoperative information can reduce patient anxiety.[5] It is also evident anxiety affect the recovery of the patient. Preoperative teaching also serves as a way to offer appropriate reassurances to the patient via therapeutic communication.[6]

Masood Jawaid, et.al, evaluated preoperative anxiety on 193 patients, 108 (56%) patients thought that their anxiety would be less if they were provided with detailed information regarding the operation and anesthesia.[7] Pre-operative teaching regarding the surgical procedure, importance of various investigation, relaxation techniques and information related postoperative discomforts and its management are vital. These may not be included in routine preoperative preparation.

Hypothesis

Anxiety. Of Patient will significantly reduce Just Before Neurosurgery After Receiving pre-admission Preoperative Teaching.


  Material and Methods Top


The study subjects were chosen by convenient sampling. Study was conducted using nonequivalent control group pretest and post-test design. Study started by obtaining permission from institute authority.Candidate for inclusion were adults, who were familiar with Kannada and English language and without any sensory or auditory deficits. The study was conducted using nonequivalent control group pretest and post-test design on patients who were admitted in surgical ward for first fifteen days 26 patients as interventional group. After fifteen days interval, again selected all the patients who met the inclusive criteria who were admitted in surgical ward for another fifteen days 28 patients for as control group. Anxiety was evaluated using a validated Spielberger State-Trait anxiety inventory. STAI measures two types of anxiety - state anxiety, or anxiety about an event, and trait anxiety, or anxiety level as a personal characteristic. Anxiety of study subjects was evaluated on admission to both interventional and control group. Preoperative teaching was conducted for each patient of interventional group after assessment of anxiety. Again Anxiety was evaluated using a validated STAI -state anxiety to both interventional and control group just before shifting to the surgery.


  Result Top


Sample characteristic

Out of 26 patients from Interventional group, in that 61.5% were male and 38.5% female. Whereas control group comprised of 28 patients, 71.4% male and 28.6% female.Comparison of sex, education, domicile and income between interventional and control group was done using chi-square test. It was found both the interventional and control groups had similar background. As given in [Table 1].
Table 1: Comparison of two groups according to variables

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Comparison of anxiety score on admission

Comparison of anxiety score on admission done to both the interventional and control groups. Mean value of interventional and control groups were 45.31 and 45.11 respectively. Equality of Mean were calculated using t-test. Anxiety score t - test value was .070. P-value was .945, nonsignificant. Interventional and control group anxiety score was similar on admission.[Table 2]
Table 2: Comparison of anxiety score on admission of two groups

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Comparison of anxiety score between groups

There was drop of anxiety score Mean value on admission and just before surgery from 45.31 to 40.31 among interventional group and it was statistically significant [Figure 1]. However no change of anxiety score Mean value was found among control group[Table 3]
Figure 1: Anxiety score of interventional group before and after the intervention

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Table 3: Comparison of anxiety score on admission and just before surgery between interventional and control group.

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  Discussion Top


The findings of this study suggest that patients who had received preoperative teaching had lower state-anxiety levels .Similarly, in a study conducted by Leila Sadaiah et.al found drop of Spielberger’s state anxiety to 40.34 from 56.98 among interventional group8. AzraParveen et.al, found decreasing of anxiety after preoperative education among cataract surgery.9 Interventional group and control group sample characteristics were similar and Mean value of both groups were found statistically non-significant. It is so evident that preoperative teaching lower the anxiety level in patients scheduled for neurosurgery. As stated by Kruzik, developing a preoperative teaching program that improves patients understanding and provides more information about the surgical patient process could alleviate much of the patient’s anxiety10. In Our studythe individual teaching was like interactive session and it was possible to resolve their doubts regarding surgery in addition to programed teaching. It would benefitted in alleviating anxiety.

Most of the patient expressed fear regarding operative procedure, indefinite about their prognosis and many more queries during preoperative teaching session. At the end of teaching session they satisfied, as their doubts were clarified regarding the surgery. Preoperative routines of the hospital and also post-operative care and recovery were explained and deep breathing exercise were demonstrated. Some patients gave positive feedback on breathing exercises that made them to feel at ease and was helpful in overcoming anxiety. Similarly Mulugeta et. al, reported common factors for preoperative anxiety in patients undergoing a surgical operation were fear of complication, concern about family, fear of post-operative pain and fear of death.11

Further Kiyoshara12 study also demonstrated that patients who had information regarding surgical procedure had lower Stat anxiety level. Pager CK, demonstrated that a simple, inexpensive videotape showing patients what to expect from cataract resulted in significant increase in patient understanding and satisfaction, as well as reduction in reported anxiety.13 Similarly in our study, explanation of neuro surgical procedure was done by using flip chart in simple language. It helped in alleviating anxiety just before surgery.[14]


  Conclusion Top


Patients who are undergoing surgery definitely will have anxiety, it was evident that Preoperative teaching was effective in alleviating anxiety among patient scheduled for neurosurgery. The nurse play a major role in providing preoperative education to the patient who are admitted for neurosurgery in order to reduce the anxiety of the patient.



 
  References Top

1.
Perks, Anna, Chakravarti, Sucharita, Mannien, and Pirjo. Pr-operative Anxiety in neurosurgical patients. Journal of neuroanesthesiology.2009:21(2); 127-130  Back to cited text no. 1
    
2.
Mark land D, Hardly L. Anxiety relaxation and anesthesia for day care surgery. British journal of clinical psychology. 1993:32(1); 493-504.  Back to cited text no. 2
    
3.
Ramesh C, Nayak SB, Pai VB et, al. Preoperative anxiety in patients undergoing coronary artery bypass graft surgery-A cross sectional study. International journal of Africa nursing science.2017; 7(6):31-36  Back to cited text no. 3
    
4.
Carl R, Wajer HI, et, al. Anxiety in the pre-operative phase of awake brain tumor surgery. Clinical neurology and neurosurgery.2017; 157(3):7-10  Back to cited text no. 4
    
5.
Bondy LR, Sims N, Schroeder DR et al. The effect of anesthetic patient education on preoperative patient anxiety. RegAnest Pain Med .1999; 24: 158-164  Back to cited text no. 5
    
6.
Bernier MJ, Sanares DC, Owens SV, Newhouse PL. Preoperative teaching received and valued in a day surgery setting. AORN J. 2003; 77(3):563-582  Back to cited text no. 6
    
7.
Masood Jawaid, AsimMushtaq, SabihMukhar and Zeeshan Khan, Preoperative anxiety before surgery. J Neuroscience. 2007; 12(2):145-148.  Back to cited text no. 7
    
8.
Leila Sadaiah, and AbdolrezaPazouki, et.al, Effect of preoperative nursing visit on preoperative anxiety and postoperative complications in candidates for laparoscopic cholecystectomy: a randomized clinical trial. Scand J Caring science: 2013; 27:994998.  Back to cited text no. 8
    
9.
Azra P, Rehana E, Saima S, Muhammad T, and Tahira K. Effect of Preoperative Education on Level of Anxiety in Patients Undergoing Cataract Surgery. JIMDC. 2016; 5(4):192-194.  Back to cited text no. 9
    
10.
Nancy Kruzik. Benefits of Preoperative Education for Adult Elective Surgery Patients. AORN. 2009; 90(3):381-387.  Back to cited text no. 10
    
11.
Mulugeta H, Ayana, Sintayelu M, et, al. Preoperative anxiety and associated factors among adult surgical patients in DebreMarko’s and FelegeHiwot referral hospitals,NorthwestEthiopia.BMC a n es t h e o l og y. 2 0 1 8 ; 1 5 5 ( 1 8 ) .Retrieved from https://doi.ord/10.1186/s12871-018-0619-0  Back to cited text no. 11
    
12.
http://dx.doi.org/101590/3004/87812004000200001  Back to cited text no. 12
    
13.
Pager C K, Randomised controlled trial of preoperative information to improve satisfaction with cataract surgery. British journal of ophthalmology, 2005; 89(1); 10-13  Back to cited text no. 13
    
14.
Spielberger CD, (1983), Manual for the state-trait anxiety inventory consulting psychologists Palo alta. Retrieved from http; //scholar, google.nl/scholar?q=Spielberger.  Back to cited text no. 14
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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