Indian Journal of Psychiatric Nursing

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 16  |  Issue : 1  |  Page : 19--23

Evaluative study to assess the level of anxiety among the patients undergoing endoscopy at All India Institute of Medical Sciences, Hospital Bhubaneswar


Nanda Kumar Paniyadi1, Asha P Shetty2, Yashswi Untwale3, Deepika Prajapati3, Oshin Kharayat3, Ratna Kumbhkar3, Shashi Bala3, Upasana4,  
1 Assistant Professor, College of Nursing, AIIMS, Bhubaneswar, Odisha, India
2 Professor-Cum Principal, College of Nursing, AIIMS, Bhubaneswar, Odisha, India
3 B.Sc. (H) Nursing Student, College of Nursing, AIIMS, Bhubaneswar, Odisha, India
4 Statistician, College of Nursing, AIIMS, Bhubaneswar, Odisha, India

Correspondence Address:
Mr. Nanda Kumar Paniyadi
Assistant Professor, Department of Psychiatric Nursing, College of Nursing, AIIMS, Bhubaneswar, Odisha
India

Abstract

Background: Anxiety is a very common phenomenon which takes place in the patients before undergoing any medical / surgical procedure. Endoscopy procedures are usually done for the purpose of diagnosis and usually create anxiety in patients. Aims and Objectives: Study intended to find the level of anxiety in patients undergoing upper GI endoscopy and their association with demographic variables (Age, Marital Status, Gender, Education, Occupation, Residence and Family Income). Materials and Methods: Evaluative research approach and the quantitative descriptive research design used in the study. Total 56 Patients who were undergoing Upper Gastro Intestinal Endoscopy in Gastro OPD and Surgery OPD at AIIMS, Bhubaneswar were selected by a Non-probability purposive sampling technique. The tool used to obtain data were Demographic proforma and Beck's Anxiety Inventory. The tool was converted into Odia and the reliability established (α = 0.8) pilot study was conducted to see the feasibility of the study. Results: Total 49 (87.5%) of subjects experienced mild anxiety, whereas only 7 subjects (12.5%) experienced moderate anxiety and none of the subjects experienced no anxiety and severe anxiety. The data revealed that every individual experienced anxiety. There is no significance association was established between the demographic variables and the level of anxiety experienced by the individuals. Conclusion: All patients undergoing endoscopy, experienced mild to moderate level of anxiety. Nurses can adapt anxiety reduction guidelines prior to endoscopy to reduce level of anxiety to these patients.



How to cite this article:
Paniyadi NK, Shetty AP, Untwale Y, Prajapati D, Kharayat O, Kumbhkar R, Bala S, Upasana. Evaluative study to assess the level of anxiety among the patients undergoing endoscopy at All India Institute of Medical Sciences, Hospital Bhubaneswar.Indian J Psy Nsg 2019;16:19-23


How to cite this URL:
Paniyadi NK, Shetty AP, Untwale Y, Prajapati D, Kharayat O, Kumbhkar R, Bala S, Upasana. Evaluative study to assess the level of anxiety among the patients undergoing endoscopy at All India Institute of Medical Sciences, Hospital Bhubaneswar. Indian J Psy Nsg [serial online] 2019 [cited 2022 Aug 19 ];16:19-23
Available from: https://www.ijpn.in/text.asp?2019/16/1/19/269162


Full Text



 Introduction



Anxiety is a very common phenomenon which takes place in the patients before undergoing any medical/surgical procedure. Endoscopy procedures are usually done for the purpose of diagnosis and usually create anxiety in patients.[1] Anxiety in patient results due to lack of awareness about the procedure and fear of discomfort or pain in procedure throughout and is totally a subjective feeling, presenting out various signs and symptoms, by which one can predict that an individual is facing anxiety.[2] Anxiety levels in all the individuals are always variable, varying under various circumstances and factors. Prevention of anxiety during the examination is very much important, because of discomfort feeling, and due to which anxiety may increase the time of the procedure and cause more side effects in patients. Anxiety in patient before endoscopy procedure may have more adverse consequences and can increase the need for sedation and analgesics.[3]

Thus, assessing the variable levels of anxiety may help in identifying the group which experiences more anxiety under a particular circumstance. Marking the vulnerable groups will help the nurses to take the appropriate interventions for that group in future. To ensure the quality and safety of the procedure in upper gastrointestinal (GS) system endoscopy, it is important to know the patient anxiety level and the effective factors. The nurse must be skilled and knowledgeable enough to use and apply various anxiety scales and handle patients with more anxiety.[4] Therefore, this study will provide information about the focus groups that suffer anxiety and the various demographic factors associated to them.

 Materials and Methods



In this study, evaluative research design is adapted. Research setting was Gastroenterology outpatient department (OPD) and General Surgery OPD at All India Institute of Medical Science, Bhubaneswar. A nonprobability purposive sampling technique was used to select the individuals who were patients undergoing upper GI endoscopy in AIIMS Bhubaneswar. Nonprobability convenient sampling technique was adapted (estimated sample size was 56). The data were obtained using demographic pro forma and Beck Anxiety Inventory (BAI).

Tools and technique

A demographic pro forma was used that consists of demographic pro forma which includes demographic details of sample such as age, marital status, gender, education, occupation, residence, and family income in Odia language.

The tool used for anxiety was BAI, created by Aaron T. Beck MD and his colleagues. It has 21-item multiple choice self-report inventory that measures the severity of an anxiety in adults and adolescents. The BAI is a standardized tool with internal consistency (Cronbach's alpha) ranging from 0.92 to 0.94 for adults and test–retest (1 week interval) reliability is 0.75. Tool was translated in Odia language by experts, and language reliability of tool was calculated (α =0.8) and found to be reliable. Each of the items on the BAI is a simple description of a symptom of anxiety in one of its four expressed aspects: (1) subjective (e.g., unable to relax), (2) neurophysiologic (e.g., numbness or tingling), (3) autonomic (e.g., feeling hot), and (4) panic related (e.g., fear of losing control). The BAI requires only a basic reading level, can be used with individuals who have intellectual disabilities, and can be completed in 5–10 min using the preprinted paper form and a pencil. Because of the relative simplicity of the inventory, it can also be administered orally for sight-impaired individuals. Respondents were asked to report the extent to which they have been bothered by each of the 21 symptoms. Each symptom item has four possible answer choices: Not at All, Mild, Moderate, and Severe. The researcher assigns the following values to each response: Not at All = 0, Mild = 1, Moderately = 2, and Severely = 3. The values for each item are summed yielding an overall or total score for all 21 symptoms that can range between 0 and 63 points. A total score will be in interpreted as follows: 0–21 as Mild, 22–42 as Moderate, and 43–63 as Severe Anxiety.

Sample characteristics

As given in [Table 1], out of 56 individuals, 48 (85.7%) of the individuals were married and 8 (14.3%) were unmarried. 30 (53.6%) of individuals were males and 26 (46.4%) were females. 35 (62.5%) people belonged to the rural area, and the rest 21 (37.5%) had their homes in urban areas.{Table 1}

There were 20 (35.7%) individuals who had family income < Rs. 5000 per month, 13 (23.2%) had family income ranging from Rs. 5001 to 10,000 per month, 7 (12.5%) had family income ranging from Rs. 10,001–15,000 per month, 9 (16.1%) had a family income ranging from Rs. 15,001 to 20,000 per month, and 7 (12.5%) had a salary above Rs. 20,000 per month.

As given in [Figure 1] the age distribution of the 56 individuals, 9 (16.1%) individuals belonged to the age group of 18–27 years, 10 (17.9%) belonged to 28–37 years, 12 (21.4%) belonged to 38–47 years, 10 (17.9%) belonged to 48–57 years, and 15 (26.8%) belongs to 58–67 years of age group.{Figure 1}

As given in [Figure 2], 5 (8.9%) of the individuals had a job, 6 (10.7%) had a business, 14 (25%) of the individuals were farmers, 10 (17.9%) were laborers, and 21 (37.5%) people practiced some other profession or were homemakers.{Figure 2}

As shown in [Figure 3], a pyramid graph shows that 10 (17.9%) of the population was illiterate, 18 (32.1%) had studied up to primary school, 16 (28.6%) had studied up to secondary school, 6 (10.7%) had completed their plus two, 3 (5.4%) had a bachelor degree, and 3 (5.4%) had a postgraduate degree. Thus, it shows that majority of the individuals had only completed their primary education; thus, they might also lack the knowledge about the procedure of endoscopy. Since 10.8% population done their graduation/post-graduation, majority people not have knowledge about the procedure of endoscopy.{Figure 3}

Description of level of anxiety in terms of frequency and percentage

Data related to anxiety were obtained by administering the tools to the selected individuals. Their level of anxiety is given in [Table 2].{Table 2}

As given in [Table 2], majority of individuals, i.e., 87.5% (49) experienced mild anxiety, whereas only 12.5%[5] individuals experienced moderate anxiety. The data also show that every individual suffered some amount of anxiety either in mild or moderate form, and none of the individuals reported absence of anxiety. Furthermore, none of the individuals reported severe anxiety.

Anxiety scores among individuals

[Table 3] shows the mean (13.88), median (12.5), and standard deviation (7.712) of the anxiety level of patients undergoing endoscopy.{Table 3}

Association of anxiety with selected demographic variables

As given in [Table 4], none of the demographic variables (age, marital status, gender, occupation, educational status, residence, and family income) have significant association with the level of anxiety. Based on the above result, null hypothesis is accepted and research hypothesis is rejected. None of the demographic variables influenced the level of anxiety. Level of anxiety in study individuals is independent from age, marital status, gender, occupation, educational status, residence, and family income.{Table 4}

 Discussion



Recent studies stress the importance of discussing patients' anxiety and concerns before the procedure to avoid adverse outcomes; their findings suggest that provision of information is effective in reducing patients' anxiety and improving procedure tolerance. Based on these findings, patients should be informed in simple language about the type of procedure being performed so that they can decide whether or not to undergo the proposed procedure. Following this information, patients should have the opportunity to express their feelings and concerns about the procedure and all its possible risks. One suggestion would be to show an educational video a week before the endoscopy as it has been found that watching a video is associated with improvements in short-term knowledge.[4],[5],[6],[7]

Several nonpharmacological interventions, such as relaxation music, educational material including videotapes, relaxation, and coping techniques, have been shown to effectively reduce anxiety levels and to prevent the emergence of panic attacks during endoscopy.[8] Music played during endoscopic procedures may alleviate anxiety and improve patient acceptance of the procedure. Medical and nursing staff should be aware of the positive effects of nondrug interventions and incorporate into pain management plans.

Further investigation incorporating cutoff points is recommended to identify the patients who are likely to experience panic attack and cannot tolerate elective gastrointestinal endoscopy without sedation. Study finding suggest, endoscopy nurse will develop the skill of anxiety assessment among endoscopy patients and prevent panic attack.

 Conclusion



In conclusion, endoscopy is an interventional procedure that can be stressful for some patients and may induce panic attacks. Patients who experience panic attacks during endoscopic procedures appear to have significantly higher anxiety levels before the procedure. Administering the anxiety questionnaire before the endoscopy seems to be a useful screening method for the selection of vulnerable patients who may be in particular need for conscious sedation during elective GI endoscopy. Limitations of the study were the relatively small sample size.

Clinical implication

Nurses who are working endoscopy room able to take care of endoscopic patients as well as equipment's used in endoscopy. Nurses need to assess the patients anxiety and able to interpret the anxiety score and take the clinical decision to conduct endoscopy or not. The nurse must know how to detect and prevent complications of this clinical procedure. One of the most important factor that impact patient complaints is the patient's anxiety level before procedure. Anxiety in patient results due to lack of awareness about the procedure and fear of discomfort or pain in procedure throughout. Prevention of anxiety during the examination is very much important, because of discomfort feeling, and due to which anxiety may increase the duration of the procedure and cause more side effects in patients. Anxiety in patient before endoscopy procedure may have more adverse consequences and can increase the need for sedation and analgesics. There is a need to provide information to the patient before GI endoscopy procedure. Proper assessment of anxiety and appropriate measures to relieve it will help to increase the rate of diagnostic accuracy and decrease complication. It will also increase the comfort of patient. To ensure the quality and safety of the procedure in upper GI endoscopy, it is important to know the patient anxiety level and the related factors. The nurses working in outpatient and inpatient department are responsible for the safety and security of the patient undergoing endoscopy.

Recommendations

The findings of the study will help future researcher to explore other aspects of anxiety before endoscopy, and the findings would help them in using interventions to improve the quality of diagnostic procedure and prevention of complications. Nursing research can focus on finding of strategies which will help in identification of specific group which experiences more anxiety and impart best patient teaching method to reduce complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Berzin TM, Blanco PG, Lamont JT, Sawhney MS. Persistent psychological or physical symptoms following endoscopic procedures: An unrecognized post-endoscopy adverse event. Dig Dis Sci 2010;55:2869-73.
2Flanagan SM, Wilson S, Luesley D, Damery SL, Greenfield SM. Adverse outcomes after colposcopy. BMC Womens Health 2011;11:2.
3Hamid AA, Mohamed AS. Effects of early preparation on anxiety level among patients undergoing upper gastrointestinal endoscopy. Am J Nurs Sci 2017;6:202-208.
4Hiremath P, Mohite VR, Narega P, Pawar S, Bhosae T. A study to assess the knowledge, attitude and pre-procedure anxiety level of patient undergoing upper GI endoscopy in Krishna hospital, Karad, India. Int J Innov Res Dev 2016;201-4.
5Luck A, Pearson S, Maddern G, Hewett P. Effects of video information on precolonoscopy anxiety and knowledge: A randomised trial. Lancet 1999;354:2032-5.
6Pearson S, Maddern GJ, Hewett P. Interacting effects of preoperative information and patient choice in adaptation to colonoscopy. Dis Colon Rectum 2005;48:2047-54.
7Sabzevari A, Kianifar H, Jafari SA, Saeidi M, Ahanchian H, Kiani MA, et al. The effect of music on pain and vital signs of children before and after endoscopy. Electron Physician 2017;9:4801-5.
8Ylinen ER, Vehviläinen-Julkunen K, Pietilä AM. Effects of patients' anxiety, previous pain experience and non-drug interventions on the pain experience during colonoscopy. J Clin Nurs 2009;18:1937-44.