Anxiety of a Preoperative Patient - Essay Example

Anxiety of a Preoperative Patient Introduction It has been known that impending surgery is a stressful event for a patient who is waiting in the preoperative area in an emergency surgical unit. This has been evidenced to trigger specific emotional, cognitive, and physiological responses in such patients. The patient demonstrates anxiety both physiologically and verbally, and the patient reported anxiety is usually a good measure of the extent of stress suffered by these presurgical patients. The amount of reported anxiety usually depends on gender and age of the patient and the motives of the surgery. Extensive surgery or surgery with uncertain outcomes also generates more anxiety than any surgery with a predictable course of events. Ambiguity about the outcome and unpredictability about the course, although depend on the type of the surgery and the indication for which it is done. Therefore the nursing staff that is usually in contact with such patients in the immediate preoperative period in the preoperative area has a chance to intervene provided they can assess these patients in a systematic manner for the experienced perioperative stress leading to elevated anxiety scores of these patients. Perioperative nurses are specially trained to do so, and they must find out time to intervene in these patients even in the preoperative area to deal with these patients' emotional distress. If the positive outcome of the care is the goal of care delivery, these interventions can change the emotional status of these patients in such a manner that the relationship between preoperative psychological status and postoperative recovery of these patients is positively influenced (Stirling, 2006). The most common nursing diagnoses that require intervention from the nurses in this period are anxiety that may be partly related to knowledge deficit, but also partly contributed by the context and the environment. Therefore, the knowledge about the surgical procedure and the patient assessment findings can be combined to make an appropriate plan of care in such situations. It is to be remembered that every patient have their own perspectives of anxiety, and hence assessment and consequent plan of care should be individualized based on specific patient needs. A patient who needs surgery and is waiting for the in preoperative area may be surrounded by a sense of impending doom for the imminent surgery, and a nursing diagnosis of preoperative anxiety needs nursing intervention in that period only. Many of the incidents of anxiety result from patient knowledge deficits related to perioperative routine, surgical interventions, or outcome expectations (Stirling, 2006). Contextual assessment process would examine and assess the patient's knowledge about the surgery. Thus, the assessment must include the status and quality of communication the patient has already received, the patient's possible language barrier, assessment of sufficiency of the patient's mental capacity, extent of information received by the patient regarding the surgical procedure and why it is needed. Since most of the anxiety in this phase id related to the ignorance about the details of the surgical intervention and outcome expectations, the patient's level knowledge regarding those must be assessed in simple questions, so the nurse can design a customized intervention strategy and create the baseline communication link for future interventions before the surgery following this contextual assessment. This assessment should ultimately be able to determine the patient's learning needs and based on these needs, to design an intervention to fulfill the patient's knowledge deficits appropriate to the etiology of it (Mitchell, 2000). The environment plays a significant role in perioperative nursing, and the operating area environment has significant impact on all such patients. The perioperative nurse also is a part of the environment, and she can indeed catalyze a positive environment that can influence the patient's anxiety. While assessing anxiety, the nurse must remain aware that anxiety may be related to environment, and its grade varies depending on other variety of etiologies. Anxiety is usually assessed by patient self report. The nurse must assess by questioning what actually initiates the anxiety to disclose whether the patient's level of anxiety is more acute at some periods than at others. The nurse should know that in many patients the environment of the preoperative area initiates maximum anxiety just prior to surgery, and this would help her to intervene at the spot. Since this is an emergency case, this patient could be also vulnerable to anxiety when the decision of surgery was made, and these could be compounded. Asking a question about anxiety quite often relieves it, since quite often the anxiety is due to not being able to share the feelings, and many patients would not know the exact cause of anxiety. These patients may express an uneasiness or nervousness, and that may be manifested as palpitations, sweating, high blood pressure, and hurried breathing. The nurse must assess these. When the patient feels nervous, anxious, or tense, the patient may not be able to retain information. The nurse must enquire about all the factors related to anxiety, best by a rating scale that can pinpoint the source of anxiety. These may include surgical intervention, appearance and instrumentation in the operating room, surgical outcome, anesthesia, concern about impact of surgery on lifestyle, loss of control, pain, death, or any other issues (Mitchell, 2000). Nursing is caring, and all nursing knowledge resides within the nursing situation, which can serve as the context of knowing nursing. However, when the nurse actualizes a personal and professional commitment to the patient, the nurse actually knows the patient through a critical psychosocial assessment. These involve the nurse assessment of the patient's understanding and perception of the procedure, his coping abilities, ability to comprehend, readiness to learn, and anxiety related to surgical intervention or surgical outcome, perioperative routine, and cultural or spiritual beliefs relevant to surgical interventions. These can best be elicited through an intersubjective encounter between the nurse and the patient in which she knows the patient from the patient's perspectives. The very concept of being with the patient implies the intention to experience the patient's experience with a conscious intention to appreciate the connection of the moment and it involves communicating the caring within the nursing situation. These can be achieved in practice through attentive and involved listening, provision of information as needed, solicitation of patient's expression of anxiety or fear, and provision of emotional support and reassurance (Stirling, 2006). The perioperative nurse is the patient's advocate during the surgery. Surgery is a unique condition where patient's protective reflexes are compromised by preanesthetic medications, anesthesia, or other requirements for surgery, and for these the patient is invariably dependent on the nurse. The nurses' knowledge from the patient assessment provides important information that is necessary for advocacy responsibilities. For example, when a patient with knee osteoarthritis is undergoing an emergency surgery for intestinal perforation, the nurse may advocate proper positioning of the patient with support underneath the affected knee in such a manner that any further trauma to that area can be avoided. Assessment parameters such diagnosis, chronic diseases and the treatments, medications, planned surgery and the surgical site, previous surgeries and anesthesia and possible complications, abnormal laboratory data, age, substance abuse, skin condition, allergies, nutritional status, sensory impairments, and mobility impairments, prosthetic devices, anthropometric parameters, vital signs may all help to be a better advocate (Vermette, EM., 1997). Watson's theory of caring speaks about themes of dignity, love, security, presence, respect, and sensitivity in human caring as applicable to nursing. While speaking about emergency surgery, the patient or the family hardly anticipate surgery as the primary modality of the management, and therefore, they have very less time to get mentally prepared. In such situation the intensity of such anxiety may assume inappropriate proportions, and the sense of helplessness that the subject experiences in such episodes of anxiety will need care, intervention, and support. The nursing interventions are not only through pharmacological means, this needs recognition of the importance of the subjective experience and would need understanding of the other through listening to their stories with a focus to the wholeness of the person, and should be in pursuit of meaning in the uncertainty of these experiences. Caring is a way of being in which the nurse attends a person in those ways necessary to support health, healing, and quality of life. Supporting a person in anxiety does not always need a high degree of technical skills. Quinn et al. has highlighted the importance of multiple ways of knowing that explore the full range facets involved in any relationship that heals. In this context, the perioperative nurse can incorporate a holistic concept in her practice where care can be combined with knowing. In this position the perioperative nurse is in a strategic position to know her patients, care for them with empathy, and support them throughout the entire surgical procedure. The nurses' reaction to the patient's stress thus would depend on knowing the perspectives of the patient from both the contextual and environmental factors of the impending surgery. Knowing allows the mind, spirit, and emotions to focus on one activity, and ability to focus ultimately quietens the mind and brings about the sense of well being (Junttila, Salantera, and Hupli, 2005). The perioperative nurse while delivering care remains committed to the patient. To alleviate anxiety, she solicits the patient perception about the surgery and his questions related to the surgery. Assessment of the teaching needs would guide the nurse to explain the surgical routines and to provide appropriate information with consideration of the patient's level of ability to understand. In addition to providing information, the perioperative nurse provides emotional support and reassurance to the patient through solicitation of patient's expression of feelings and concerns regarding surgery. In this regard is nurse is committed to the patient in terms of attentive listening and provision of reassurance as well as for provision of information delivered calmly and candidly. An attentive and caring attitude developed through knowing combined with appropriate touch can comfort and reassure the patient. Reduction of anxiety and fear is necessary so necessary teaching can be provided to alleviate anxiety further before the surgery (Lindwall, von Post, and Bergbom, 2003). Criteria that may be utilized to evaluate these interventions would include fulfillment of certain outcomes. These involve confirmation of the consent, description of expected sequence of events, expression of feelings about the surgical experience by the patient. The patient would be able to indicate knowledge of expected surgical outcomes and to confirm procedures to be followed upon discharge. To be able to achieve these outcomes, the nurse may need collaboration from other senior nurses, anesthesiologists, and even members of the surgical team to boost confidence and reassurance. This can be successfully implemented through application of a holistic nursing paradigm and a thorough evaluation of anxiety through a rating scale and its documentation (Vermette, EM., 1997). Reference List Junttila, K., Salantera, S., and Hupli, M., (2005). Perioperative nurses' attitudes toward the use of nursing diagnoses in documentation. Journal of Advanced Nursing; 52(3): 271-80 Lindwall, L., von Post I., and Bergbom, I., (2003). Patients' and nurses' experiences of perioperative dialogues. Journal of Advanced Nursing; 43(3): 246-53 Mitchell, M., (2000). Nursing intervention for pre-operative anxiety. Nursing Standard; 14(37): 40-3. Stirling, L., (2006). Reduction and management of perioperative anxiety. British Journal of Nursing; 15(7): 359-61. Vermette, EM., (1997). Holistic practice is a tradition of excellence in perioperative nursing. AORN J; 66(5): 913. Read More