General anesthesia and day-case patient anxiety by M.Mitchell - Essay Example

?Running Head: A critical appraisal of two primary studies on patients' anxiety in relation to anaesthesia and operating theatre Date: Mitchell, M. 2010. General anesthesia and day-case patient anxiety. Journal of Advanced Nursing 66(5), 1059–1071 Summary This research was carried out for purposes of uncovering aspects that provoke general anaesthesia as well as determine viable interventions that may be used to alleviate the condition. General anaesthesia has been cited as a condition that provokes anxiety. Indeed, with constrained formal anxiety management, brief hospital stays acute psychological consequences of day surgery, and inadequate contact with healthcare professionals the study indicates that anxiety may increase. During the study questionnaire were given to adult patients who were undergoing surgery. This study was done between the years 2005-2007. The questionnaire examined anxiety relating to general anaesthesia, hospital personnel, and the environment. The findings of the study indicate that 85% of the total respondents did in fact experience anxiety during the day of surgery. The aspects that highly provoked this anxiety as they indicated were concerns about unconsciousness and immediate preoperative experiences. The central features were identified using factor analysis such as Imminence of Surgery, Anaesthetic Catastrophising, Preoperative Anaesthetic Information, Final Support, Personal Support, Final Preoperative Experiences, and Possible Adverse Events (Stirling 2006). The study finally concludes that availing information about management of anaesthesia may help to dispel misconceptions about general anaesthesia and also assist in alleviating anxiety in patients. A Critical appraisal of the article The Introduction  In the research carried out about anaesthesis, by Mitchell (2010), and published in a journal of Advanced Nursing 66(5), 1059–1071. There is a clear statement about the topic being investigated. The research aims at investigating the ggeneral anesthesia and day-case patient anxiety. In a statement about the topic, the research espouses that general anesthesia has been shown to provoke high anxiety. Yet, with the increase in the elective day surgery, and brief hospital stay the patients do not get enough professional health care. Thus, in the absence of formal management of anxiety the patients develop psychological problems of the day surgery. The rational of the research is to uncover what it terms as the anxiety provoking characteristic of general anesthesia as well as evaluate the viable interventions that could be applied to take the edge off such anxiety (Mitchell 2010). The research indicates that from a theory test of descriptive statistics about 85 per cent of contributor indicated that the day surgery provoked anxiety. As such, it is the contention of the research that the existence of such an alarming percentage is a clear indication of the need for improved professional management of anxiety preceding day surgery. The general anaesthesia according to the research is the very vital apiece of knowledge to the patients even though it is only a about 33% of them who have faith that such information is adequate to prepare them for the day surgery. There are several limitations of the present study by Mitchell on the general anesthesia and day-case patient anxiety which are worth noting. According to the research there were limitations associated with the differing procedures of surgery carried out coupled with the use of patients self reported questionnaires. The research acknowledges the fact that one of the limitation of the research was that the participants went through a number of surgical procedures yet, only a few of those who underwent the surgical procedures went through a medical investigation. This kind of procedure could have influenced the data collected. Another imitation of the study was the use of self reported questionnaires which were answered by patients after they hand underwent surgery. Consequently, the perception of patients had the potential of being distorted. In addition, the use of set questions in the questionnaire restricted the participant to specific questions and obstructed an opportunity for them to express other aspects concerning individual anxiety. In the literature review of the research, most of the materials used are indeed contemporary and relevant to the topic in question. A case in mind in the present study is the use of contemporary materials such as the journal by Mitchell (2007a) on nursing research into modern day surgery: a literature review. This journal discusses the importance of addressing patients’ anxiety prior to day surgery. The research further uses the contemporary suggestions on day surgery outlined in a Journal by Stromberg et al (2008). This journal offers a review of clinical practice and routines for day surgery in Sweden the journal further outlines the implications for improvement in nursing interventions in the contemporary world. Thus, the references used by the researcher have indeed a clear link to the wider body of knowledge since the references cited have all been used in elaborating one or more concepts related to General anesthesia and day-case patient anxiety as the topic (Southern Health. 2009). The connection between the literature review and the formulation of the research question is quite clear in the research. Most of the literature reviewed in the research is directly related to the research question which is patient anxiety. The research has reviewed literature related to patient’s anxiety for instance Gardner et al. (2005) and Rose?n et al. (2008) literature has been reviewed to inform the research about the important concepts of patient’s anxiety that must be considered prior to the surgery. Literature review from Darzi (2007), Erkal (2007), and Gilmartin (2007) have been used to inform the research on the considerable changes that have been experienced in the field of surgery, these articles underscores the need to ensure that modern surgical techniques are suitable to ensure swift postoperative recovery as well as discharge of patients taking place as quickly as possible. The Methods Section  The research design involved a cross sectional questionnaire type of study. The research designs clearly described as the survey carried out was part of the wider research involving a big sample of patients of day surgery who were undergoing general as well as local anesthesia for a number of surgical procedures. Personal involvement of the principle investigator in the research to collect data is in my view an appropriate method employed to investigate the research topic. The research indicates that the principle investigator (MJM) frequently contacted each DSU for purposes of supplying questionnaires. The advantages of such a design are that potential participants would be able to get first hand information related to the study, and also they could also be able to complete those questionnaires from home. In the selection of the participant, the research used the exclusion criteria to eliminate the patients who were undergoing ophthalmic surgery since they were likely to experience additional anxiety. There were 673 participants in the research. Data Collection and Analysis  The data collection in the research was carried out by the clinical staff over a period of 2 years in the DSU. The clinical staff distributed questionnaires to day surgery patients. The principal investigator also participated in the data collection by regularly contacting every DSU for purposes of supplying questionnaires. The questionnaire used has 59 items having a liker type response. Thus, the individuals who were collecting the research data could not have been more appropriate than the clinical staff that were handling the patients as well as observing them. Quantitative    The explanation of the sample size in the research is that the survey was part of a wider study comprising a sizable sample of patients who were going through surgery both general and local anaesthesia. The questionnaires had clear content validity as they were compiled on the basis of the available literature as well as previous field studies undertaken. The research used SPSS (Statistical Package for Service Solutions) as its statistical test. This type of test was appropriate for the sorts of data collected as it enabled the researcher to carry out effectively descriptive statistics, multiple regression, as well as factor analysis. The use of statistical analysis such as Statistical Package for Service Solutions is discussed in details. For example in factor analysis, the major component method of extraction is explained in details. In the research, there is evidence of a statistician's input to the analysis as it mentions the use of Bartlett’s test measures as well as tests were used to sample the adequacy. Qualitative  The research employed Statistical Package for Service Solutions for purposes of its descriptive statistics the study does not use any electronic analysis package. In an effort to validate the interpretation the researcher used the Bartlett’s test measures as well as tests were used to sample the adequacy. Ethics  Under the ethical considerations, the research was approved by the proper committee of research ethics. Nevertheless, there is no clear description about gaining consent, maintaining anonymity and or confidentiality stated in the research. The Results/ Findings  The result are related back to the literature review in that a total of 85 per cent of the respondents in the research were proved to have experienced some form of anxiety in the surgery day. The patients as indicated in the literature review experienced concerns and preoperative experiences in relation to unconsciousness which were provoking high anxiety. Using factor analysis Preoperative Anesthetic Information, Personal Support, Anesthetic Catastrophising, Final Support, Imminence of Surgery, Final Preoperative Experiences, and Possible Adverse Events were identified in the results as central features. These were the same features in the literature review as being associated with the general increase of anxiety levels. According to the research there were some design weaknesses associated with the differing procedures of surgery carried out coupled with the use of patients self reported questionnaires. The research acknowledges the fact that one of the weaknesses of the research was that the participants went through a number of surgical procedures yet, only a few of those who underwent the surgical procedures went through a medical investigation. In addition, the use of self-reported questionnaires by the patients could not be highly dependable as they were answered by the patients after the surgery which could be potentially distorted (Mitchell 2004). Quantitative   The results presented in the research very clear and unambiguous as there are tables’ percentages and fingers representing the results of the research. Thus, it is easy to tell that the results suggest anxiety related to misconceptions of information about anesthesia. All the results were presented in the research through the tables, percentages, and fingers. The tables give a clear picture of the sample data and results for instance Table 1 has a clear content of validity. This means that all the items connected to preoperative anxiety are recorded and confirmed by experts. Table 2 present a clear picture of the participants who underwent differing procedures with general surgery, gynecological surgery as well as orthopedic surgery. The tables are easy to use as they are explained in the research. A sample of 460 patients who underwent general anaesthesia and surgery were used in the study. Thus, the study had a response rate about 37%. From the 460 patients (271 females and 189 males) figure 1 of the research shows correctly that 85% of them stated that they were quite anxious on the surgery day Qualitative  The research uses questionnaire as evidence of data collection. The research clearly this evidence as part of the wider research involving a big sample of patients of day surgery who were undergoing general as well as local anesthesia for a number of surgical procedures. Personal involvement of the principle investigator in the research to collect data is in my view an appropriate method employed to investigate the research topic. The research indicates that the principle investigator (MJM) frequently contacted each DSU for purposes of supplying questionnaires. The advantages of such a design are that potential participants would be able to get first hand information related to the study, and also they could also be able to complete those questionnaires from home. The Conclusions  The study concludes that providing continuous information to the patients about management of anaesthesia may help to dispel misconceptions about general anaesthesia and also assist in alleviating anxiety in patients. The research acknowledges the implications of further studies which are necessary for purposes of developing the themes related to the evaluation and professional presentation of information to dismiss the misconceptions associated with evaluating intervention and general anesthesia especially on the day of surgery for purposes of managing anxiety in patients. Arvid et al (2009) Anxiety in the operating theatre: a study of frequency and environmental impact in patients having local, plexus, or regional anaesthesia. Journal of Clinical Nursing 18(16), 2301-2310 Summary The study was carried out to estimate the environmental factors that influence intraoperative anxiety, study the relationship between generalized anxiety, intraoperative anxiety, and depression (Haugen et al. 2009). The study was also carried out to estimate the frequency of intraoperative anxiety. The study also aims at addressing the lacuna left by previous studied which have indicated surgery is linked with anxiety and stress yet few of these studies have been conducted to obtain the perspectives of patients about theater environment and its influence on anxiety. Questionnaires were used as the survey design of the study. Clinical variables were used from medical records of anaesthesia. The assessment of anxiety was carried out using the Depression scale, the Hospital Anxiety, and Jakobsen’s questionnaire. The findings of the study indicated that 23 % of the respondents experienced some form of anxiety in the operating theatre; at indication of anaesthesia, thirty-five per cent were anxious, while about 12% experienced anxiety after indication. When the surgery began, fifteen per cent felt anxious and nine percent experienced anxiety during surgery. The study shows that giving information to patients reduced anxiety in forty nine per cent of the participants while asking questions during the period of intraoperative alleviated anxiety feeling in 55% of the patients. The study concludes that the level of patient’s anxiety is increased at indication of anaesthetics, further, the hearing and sight of technical equipments as well as the environment of the theater has a less influence on patient anxiety. In addition, giving the patients an opportunity to ask questions as well as giving them continuous information reduces the level of anxiety in patients. Finally, the study indicate that there exists a surmountable positive link between depression and general anxiety before admission as well as the experience of anxiety throughout the period of intraoperative. A Critical appraisal of the article The Introduction  The research has a clear statement about Anxiety in the operating theatre: a study of frequency and environmental impact in patients having local, plexus, or regional anaesthesia the topic being investigated. The research espouses that previous studies has only documented that surgery is linked with increases anxiety and stress. Nevertheless, few studies have been undertaken to obtain the perspectives of patients in relation to the influence of the operating theater setting on anxiety. The rational of the research is to address the issue of depression as well as generalized anxiety prior to surgery and to implement the intervention of nursing for purposes of reducing anxiety in the theatre during an operation (Solutions for Public Health 2006). The limitations of the study include the use of convenient sample involving an assortment of dissimilar surgical population in an effort to evaluate the perspective of patients about anxiety experienced in the intra-operative setting. The research acknowledges that the problem of such a sample selection is that it reduces the possibility of generalizing the research findings (Polit & Beck 2004; Aalen et al. 2006; and Hobson et al 2006). The research also has used a heterogeneous sample thus, the findings of the research is further limited to the internal validity. The Literature Review  The research has employed a variety of contemporary materials related to the anxiety which is the topic of investigation. For instance, the research used the work by Gillies & Baldwin (2001) about the information distributed before admission of a patient and the role that such information play in reduction of preoperative anxiety. The research has further used contemporary materials on anxiety such as the work of Leinonen et al. (2003), on the need for educational programs as well as disseminating standardized information to patient for purposes of reducing anxiety. This is a clear indication that the researcher has linked his work to the wider body of knowledge through the references cited. There is also a link between the literature about anxiety and the research question on how to deal with anxiety. The Methods Section  The research employed a survey design together with questionnaires. The evaluation of clinical data was carried out from medical records related to anaesthesia. The study was retrospective since the patients who had undergone surgery from 0­-7 day have to remember the intensity of anxiety they experienced during the operation period. This method or research was quite appropriate for the topic being investigated as the researcher could get first hand information from the individuals who experienced anxiety during the surgery in the theater which is the center of investigation. The advantage of the research design is that the researcher was able to obtain firsthand information from the patient’s experience of anxiety during surgery (Caumo et al. 2001). However, the biggest disadvantage of the design is that patients could not remember all the information due to post operation weaknesses. The number of who participated in the research is clearly stated as a convenience sample of 119 patients who had underwent surgery with regional, local, or plexus anesthetics. Data Collection and Analysis  The researcher recruited patients from 0_3 days after they underwent surgery for purposes of getting the data needed. The patients returned the questionnaires handed to them before they were discharged from the hospital. Potential participants were chosen from a list of surgical patients by coworker with the help of computerized programs of assessment. There were also three nurses from the hospital who assisted in asking the patients who had underwent surgery to take part in the research. Quantitative  The sample used in the study comprised of 119 patients. The explanation of the sample size used in the research is clearly explained. The research states that the selection of the sample was done from patients who had been admitted for surgery between September and December 2006. From these patients 868 underwent surgery but only 178 patients met the criteria for inclusion. 35 patients were requested to participate because they were discharged soon after the surgery. In total 143 surgery patients were requested to take part in the study, however, 11 of them declined. After the inclusion process 13 more patients were excluded due to general anaesthesia at some point in surgery, cognitive impairment, or , insufficient language knowledge. The study used descriptive statistics to evaluate the anxiety frequency experienced during the period a patient was in the operating theater. Following the fact that single responses were absent in the five HAD questionnaires, the study calculated the means of the answers that were remaining for purposes of replacing the scores that were missing. The study also used the SPSS General Linear Model procedure to analyze the possibility of any form of gender influence on anxiety (Kim 2000). In a bid to identify any influence of clinical variables and socio demographic on anxiety measures, the study used Pearson’s chisquare test. Since the valuables were generally at ordinary level, the research used non-parametric statistic method. The statistical tests used were appropriate for the data collected since the computation of spearman was carried out to assess the link between depression and HAD anxiety scores as well as anxiety scorers measured retrospectively at five stages during the duration in the operating theatre. Qualitative   The researcher participated in the analysis performed in relation to social demographic sample as well as the sample of clinical characteristics. There was also the use of electronic analysis package discussed in the study. Potential participants were chosen from a list of surgical patients by coworker with the help of computerized programs of assessment. Ethics  The research was carried out in accordance with the ethical perspectives under the Helsinki declaration. Written consent was obtained from the patients; they patients answered the questionnaires and returned them. The study was reviewed and approved by the Committee for Medical Research Ethics of the Western Health Region of Norway. Further, there was express consent to the survey project by the Norwegian Social Science Data Services. The anaesthesia department of the university hospital as well as the surgical department involved also gave permission for the researchers to carry out the project. The Results/ Findings  The findings of the study are indeed consistent with findings of Jakobsen (2004), work in the literature review in which work a number of patients were influenced by the period spent while waiting for the surgery. Reducing this duration to be as short as possible seems to be as vital in the findings of this study as other research cited in the literature review. For example, McCleane & Cooper (1990) indicate that the waiting period is an important factor that determines a patient’s preoperative anxiety. One of the weaknesses acknowledged by the research is that the study was retrospective since the patients who had undergone surgery from 0­_7 day have to remember the intensity of anxiety they experienced during the operation period. Quantitative  The findings of the study are indeed clear and unambiguous since they are in conformity with literature review of the research and they are also presented tables, charts numbers, as well as percentages for clarifications. The tables are very clear in the study for instance Tables 1 and 2 of the study present basic clinical and demographic characteristics of the data sample (Ingham-Broomfield 2008). This makes it easy for the reader to use the tables the tables also uses percentages for instance gender percentages of 59% and 41% to represent 70 male and 49 females respectively as the study sample of 119 participants. These percentages and numbers are indeed accurate and clear. Qualitative  The evidence of data collected is presented in the research through the use of questionnaires. The researcher recruited patients from 0-3 days after they underwent surgery for purposes of getting the data needed. The patients returned the questionnaires handed to them before they were discharged from the hospital. Potential participants were chosen from a list of surgical patients by coworker with the help of computerized programs of assessment. There were also three nurses from the hospital who assisted in asking the patients who had underwent surgery to take part in the research. The data collected is presented as part of the theme to support the analysis in that it included records of previous surgery in the socio-demographic data. Conclusions  The study concludes that the level of patient’s anxiety is increased at indication of anaesthetics, further, the hearing and sight of technical equipments as well as the environment of the theater has a less influence on patient anxiety. In addition, giving the patients an opportunity to ask questions as well as giving them continuous information reduces the level of anxiety in patients. Finally, the study indicate that there exists a surmountable positive link between depression and general anxiety before admission as well as the experience of anxiety throughout the period of intraoperative (Carnwell & Daly 2001). The research acknowledges the need for further research for purposes of comprehending the mechanism influencing the frequency of intra-operative anxiety. The research further acknowledges the need for further research for purposes of developing the best ways in which hospital may offer quality care among patients going through both major and minor surgery (Teasdale et al. 2000). The importance of professionals working in the surgical department to understand the concept of anxiety during surgery is also emphasized by the research as a section that also need further research. It worth noting that, the study found an occurrence of anxiety in patients following the operation in the theater. This finding according to the research has not been present by other studies. References Arvid et al. 2009. Anxiety in the operating theatre: a study of frequency and environmental impact in patients having local, plexus, or regional anaesthesia. Journal of Clinical Nursing 18(16), 2301-2310 Cardiff University. 2011. Harvard Referencing Tutorial [Online]. United Kingdom: Information Services. 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