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Helping patients manage pre-surgery anxiety: Important strategies

Date: January 27, 2017

Nursing staff, particularly in hospitals, work closely with patients who are about to undergo surgery. For patients, preparing for surgery can elicit a range of emotions — most typically fear and anxiety — which usually is caused by worries of the unknown and general concern with the risks involved.

Given that nurses will spend a considerable amount of time working with preoperative patients, it is important that they become attuned to signs of patients’ anxiety. It is imperative, therefore, that nurse managers are able to educate nursing staff about the most effective strategies for helping patients manage pre-surgery anxiety. Below is a guide to some of the most useful approaches to this common issue.

How common is pre-surgery anxiety?
Pre-surgery anxiety is one of the most common emotional responses that a patient can experience prior to surgery. Even in cases where the risk of death is low and the chances of success are high, many patients will experience at least temporary emotional discomfort, an article from Informed Health Online, published by the U.S. National Library of Medicine, explained. The article further noted that the anxiety usually is compounded by the preparation process, particularly if patients have to check into the hospital to get ready for their procedure in the days leading up to the event.

Preoperative anxiety is so common, in fact, that research from Samara State University, published in BioMed Central, found that out of almost 300 surveyed patients, a wide majority — some 70 percent — experienced some degree of anxiety before their procedures.

Preoperative anxiety is obviously uncomfortable for patients, and as noted by Anxiety.org, reporting on the Samara State University study, it even can have an adverse effect on outcomes, actually increasing the risk of infection and leading to unwanted movement such as coughing during surgery. Patients with anxiety may experience more pain. That possibility is why it is so important for nurses to recognize the most common signs and symptoms associated with the problem, particularly if the patient in question does not disclose that he or she is in distress.

Helping patients manage pre-surgery anxiety: Important strategies

Common signs and symptoms of preoperative anxiety, as outlined by the Informed Health online article, include:

  • Nausea
  • Insomnia
  • Shortness of breath
  • Racing heart
  • Depression
  • Panic

Strategies to help patients cope
As explained above, nurses should play a critical role in identifying and managing patient preoperative anxiety. Nurse managers and nurse educators should ensure that all nursing staff on their teams have a clear understanding of the following anxiety management techniques:

1. Reiterate instructions
Prior to surgery, patients typically will receive a large number of instructions. As explained in the article “Preparing your patient for surgery,” by Linda M. DeLamar and published by Medscape, typical preoperative instructions include being asked not to eat in the hours leading up to the procedure, leaving jewelry at home, refraining from aspirin use seven days before and so on. For many patients, remembering all the instructions can be a challenge, particularly for those with lower health literacy. Without adequate understanding of what is expected and why, preoperative anxiety can be heightened, which, in turn, could negatively affect outcomes. Therefore, as the source advised, it’s crucial that nurses are able to explain all instructions and the reasons behind them to patients in a clear and concise manner and offer reminders when necessary.

The instructions should move beyond a simple statement of what is expected of the patient. They should contain a discussion of why the preoperative steps are necessary because, without an understanding of why something is expected, there is a greater chance that patients will ignore the instructions. DeLamar offered the example of fasting: Many patients are told not to eat without a comprehensive understanding of why it’s so important. Consequently, many individuals will ignore the request and eat regardless, which puts them at a heightened risk of certain complications. In essence, the more information that nurses are able to provide patients, the better, as patients will feel less anxiety and the chances of a positive outcome will improve.

2. Answer questions
Many patients are able to manage their preoperative anxiety if they have a clear understanding of not only their condition but also what will occur during surgery and the expected outcomes. While nurses shouldn’t be required to provide detailed answers to all questions, it’s important that they are able to answer general questions about the surgery and give clear explanations about each patient’s condition. For example, if a patient is having a tumor removed, a nurse should reasonably be expected to be able to outline how the procedure will take place, why it is necessary and what can be expected after in terms of further treatment, the Houston Chronicle explained. The source stressed that nurses also should be cognizant of when to stop giving advice and when to refer a patient’s questions to a physician or surgeon. Additionally, nurses should keep written information close by to pass on to patients when necessary.

3. Report signs of anxiety and depression
As referenced above, anxiety and depression pertaining to surgery actually can have a negative impact on outcomes. That’s why, as the Houston Chronicle detailed, it’s so important that nurses actively monitor patients exhibiting signs of mental discomfort and report what they see to a physician, surgeon or both.

4. Listen
Patients often need to articulate their anxiety to come to terms with it effectively. Given that nurses likely will spend more time than other members of the health care team with preoperative patients, it is important that they make an effort to listen to the patient’s concerns and act as a confidant, the Houston Chronicle argued. By serving as active listeners, nurses can help patients begin to feel better, especially if they are able to offer solutions and answer any questions. The source noted that it also is helpful if nurses are educated in demonstrating specific techniques that can be used by a patient to reduce stress, such as deep breathing.

5. Provide nonverbal comfort
The American Academy of Ophthalmology reported that studies have shown that nonverbal comfort, such as touching a patient’s shoulder or holding his or her hand, can reduce anxiety considerably. The source even noted a study that looked at a case wherein a nurse held a patient’s hand during the procedure itself. The method proved effective at helping manage the patient’s anxiety. While consent always should be given by the patient for this kind of approach, it is clear that it can help many people feel more cared for and, consequently, more relaxed.

Consider Bradley University’s MSN program
Nurse educators and nurse managers are charged with ensuring that all nursing staff are able to perform to the best of their ability and help patients in as many ways as possible, including managing preoperative anxiety. If you are considering studying for an advanced degree in the nursing profession, apply to Bradley University. With several Master of Science in Nursing program tracks to choose from, and the ease and flexibility of learning online, now is the time to take your nursing career to the next level. For more information, click here.

Sources

http://www.bradley.edu/academic/departments/nursing/online/

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072741/

http://work.chron.com/role-nurses-stress-anxiety-patients-7487.html

http://bmcsurg.biomedcentral.com/articles/10.1186/1471-2482-14-67

https://www.aao.org/eyenet/article/reducing-patient-anxiety-during-surgery

https://www.anxiety.org/preoperative-anxiety-before-surgery

http://www.medscape.com/viewarticle/500887_5

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