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How can nurses reduce pre-operative anxiety?

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26 November, 2012

Article: Mitchell M (2012) Anxiety management in minimal stay surgery. Nursing Times; 108: 48, 14-16.

5 key points

  1. Pre-operative anxiety before general anaesthesia is common
  2. A planned programme of information provision before minimal-stay surgery is vital
  3. Offering choices (real or perceived) and positive encouragement will benefit patients
  4. Therapeutic use of the self by nurses in brief exchanges with patients can help to promote a therapeutic environment
  5. Minimising the impact of the environment can dispel anxiety

Let’s discuss

  1. How has the move to day case surgery changed the relationship between nurses and patients?
  2. List the common causes of anxiety for patients having a general anaesthetic.
  3. What specific concerns are identified by patients having local or regional anaesthesia?
  4. How can nurses help patients retain control during a day case procedure?
  5. How can nurses reduce pre-operative anxiety? Are there gender differences in the way men and women manage their anxiety?
  6. What role does the environment play in reducing anxiety?

Readers' comments (4)

  • I work in a small day surgery unit and although I work in theatre and recovery, most of the time I am in the pre-operative area. The most important thing to remember when fetching your patient from reception,(which is how we work) is to greet the patient by name and with a smile and introduce yourself. Reassure the relatives and give them an idea of how long the operation/procedure is likely to be.The receptionist will have already given the patient a small card to fill in which gives us up to date information as to who is taking the patient home and with their telephone numbers etc.(The notes will have this information but often the patients will have made other arrangements) We arrange to telephone them when the patient is ready for discharge. On arrival in the Pre-operatative area we reassure the patient,explain the changing procedure if this is neccessary. When the patient is ready (they are in a small cubicle) we sit and explain that what is going to happen before the procedure; who will be with them during the procedure and who they will be seen by before they go into theatre. Giving the patient time to ask questions is most important and this relieves a lot of their anxiety, especially for those having a GA which they may never have had before. We explain where they will be for their operation or procedure and following their procedure and who will be looking after them. Some patients are given a choice of whether to have a local anaesthetic or sedation( or they may need both)It is our job to explain these and enable the patient to make an informed choice without being persuaded to do something that they do not wish to have. The patients observations are taken and any other procedures are performed if necessary,eg Cannulation,enemas etc. The patient's pathway is completed and any observations noted.It is important to keep the patient informed at all times as to any delays or problems that may have occurred. A happy patient is an informed patient. Our area is quite pleasant with close access to toilets. We have a supply of magazines and we are always close by to continue the reassurance. Give the patients plenty of time and do not rush them even if you are rushed yourself. Our patients are usually very complimentary following their operations and we are rewarded by knowing that we have performed our duties to their satisfaction.
    This is a relatively shortened version of our routine so apologies if I have omitted anything.

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  • Anonymous | 27-Nov-2012 5:27 pm

    Nice one.

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  • As a nurse who has had 2 operations, one for impacted wisdom teeth and the other, emergency C section - I feel qualified to comment as a patient. The tooth op was pre-nursing and I recall being in a room on my own. I met another patient who was more scared than me so I spent most of the pre-op time talking to her and trying to ease her worries (the budding nurse in me!). I didn't get at all worried until it was time to go to theatre. When I arrived I suddenly had to pass urine which I did on the trolley in a bedpan. Although it was a long time ago, I don't remember anyone advising me about what the operation would entail. When I woke up after surgery I was in a lot of pain and dying of thirst so I got up and had a drink and promptly was sick. I was then given pethidine which worked a treat and I had a lovely sleep. Had I been told not to drink after surgery I would not have done so. Re the C Section. When I was being put through induced labour I don't recall being given much support either, even though it was obvious that I was going to need surgery. Perhaps the midwives thought that as I was a nurse I knew what was coming and didn't need any support or information. Having already spent many hours being induced, by the time I got to theatre I was physically a wreck. After delivery I recall someone trying to latch my baby on. This was after at least 24 hours without food or sleep. I had epidural, with 2 "top up". The first time I tried to use the toilet post surgery, 2 carers came in and knowing what was going to happen I said "stop" loudly, thanked then and said I would get up myself. I'm glad I had this experience because now I know how vulnerable people feel pre and post surgery. I was scared to walk! It felt as if my abdomen was going to fall down. I knew logically that it couldnt of course but I was still scared to walk from my room to the bathroom. The first time I had a bath, I was not offered any help and being me I didn't think to ask. When I first woke up my baby wasn't there and I spent a few tearful mins walking up and down the corridor looking for her. A passing midwife spotted me and told me she had been put in the nursery while I slept. Once she was in my room, I had to ring the bell for someone to pick her up and hand her to me. As you can imagine, I hardly slept at all because she was crying constantly for her milk, or so it seemed at the time... I wasn't prepared for any of this. I am not knocking the midwives, I could see how busy they were and being a nurse I knew that if they had had the time they would have spent more of it with me.

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  • I've been a nurse for 8 years in pre-and post-op areas. My favorite anxiety reducer is to say to the support person, "Together we will take better care of your loved one than either of us could alone." We practice the Joanne Duffy model at our hospital - we are in the patient's space, and be considerate when intruding upon them. They are not in OUR space. This year, I had day surgery and the OR team allowed me to have my favorite electronic music player in my ears the whole time, as long as I promised to keep the volume fairly low. I believe it increased my comfort, decreased anxiety and minimized requests for pain medication. As I awoke from GA, I'd hear a favorite tune, smile, take a deep breath, and nod back off. Maybe it helped that I gave myself a few pre-procedure suggestions to do just that!

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