The Effect of Hand Massage on Preoperative Anxiety in Ambulatory Surgery Patients

The Effect of Hand Reflexology Massage on Pain and Anxiety After Coronary Artery Bypass Graft Surgery: A Double-Blind, Randomized, Placebo-Controlled Trial

BACKGROUND

Pain and anxiety are common postoperative problems that impair recovery and quality of life in patients undergoing coronary artery bypass graft (CABG) surgery. Reflexology is a nonpharmacologic method used to control pain and anxiety.

OBJECTIVE

The aim of this study was to examine the effects of reflexology hand massage and stroking massage on pain and anxiety in patients in the immediate postoperative period after CABG.

METHODS

In this double-blind, randomized, placebo-controlled study, we compared the effects of a 20-minute hand-reflexology massage to placebo stroking massage on pain and anxiety in newly extubated patients in the intensive care unit who had undergone CABG surgery. Pain was measured by visual analog scale and anxiety by the State-Trait Anxiety Inventory before and at 5, 30, and 60 minutes post intervention.

RESULTS

A total of 48 patients were enrolled: 24 in the intervention group and 24 in the placebo. Mean pain scores were significantly reduced in the group who received reflexology compared with the placebo group (F = 36.569, P = .000). Mean anxiety scores were significantly reduced at 60 minutes for the reflexology group compared with the control group (P = .000).

CONCLUSIONS

We found that hand reflexology massage was effective in reducing pain and anxiety in patients during the immediate postoperative period after CABG.

Non-pharmacologic Approaches in Preoperative Anxiety, a Comprehensive Review

During the pre-operation period, surgical candidates experience situations that stimulate psychological anxiety leading to stress during and after surgery which is known as preoperative anxiety. This condition can cause psychological and physiological adverse effects on both children and adults. Due to the high prevalence and adverse effects of preoperative anxiety, different treatments have been evaluated including pharmacological and non-pharmacological approaches. As pharmacological treatments may cause adverse effects such as breathing problems, drowsiness, interfering with anesthetic drugs, and prolonged recovery, non-pharmacological interventions are becoming more popular. These methods include cognitive-behavioral therapy, music therapy, pre-op preparation video, aromatherapy, hypnosis, guided imagery relaxation therapy, and massage. In this study, the most popular non-pharmacological approaches to preoperative anxiety are reviewed focusing on more recent evidence provided by clinical studies. The reviewed clinical evidence on the mentioned methods shows the efficacy of non-pharmacological interventions for the treatment of preoperative anxiety, so they can be used in patients of different ages and types of disease and surgery.

Application of situational adaptation training combined with childlike nursing for children undergoing tonsillectomy or adenoidectomy

OBJECTIVE

This study aimed to investigate the clinical effect of situational adaptation training combined with child-friendly nursing in relieving the preoperative anxiety of children undergoing tonsillectomy or adenoidectomy.

METHODS

A total of 160 children undergoing tonsillectomy or adenoidectomy were randomly divided into two groups: a control group and a test group. In addition to the routine operating room nursing in the control group, children in the test group underwent situational adaptation training one day before surgery and child-friendly nursing on the day of surgery. The heart rates and differences in average dynamic pressure were compared between groups, both preoperatively and during anesthesia induction. The cooperativeness with anesthesia was also assessed. The anxiety states of children and their family members after the interventions were scored using the anxiety visual analog scale (VAS). The postoperative satisfaction with nursing was assessed and compared between groups.

RESULTS

The heart rates, differences in average dynamic pressure, cooperativeness with anesthesia, and VAS scores were significantly lower in the test group than in the control group. The VAS scores of family members were significantly lower in the test group than in the control group. The satisfaction degrees with nursing were significantly higher in the test group than in the control group.

CONCLUSION

Situational adaptation training combined with child-friendly nursing can significantly relieve the preoperative anxiety of children undergoing tonsillectomy or adenoidectomy and their family members. This treatment improves child cooperativeness during therapy, significantly reduces the amplitude of physiological stress response during surgery, and increases the satisfaction with nursing. Thus, situational adaptation training combined with child-friendly nursing is worthy of application in clinics.

Machine-Based Hand Massage Ameliorates Preoperative Anxiety in Patients Awaiting Ambulatory Surgery

BACKGROUND

Hand massage therapies have been used to relieve anxiety and pain in various clinical situations. The effects of machine-based hand massage on preoperative anxiety in ambulatory surgery settings have not been evaluated.

PURPOSE

This prospective study was designed to investigate the effect of machine-based hand massage on preoperative anxiety and vital signs in ambulatory surgery patients.

METHODS

One hundred ninety-nine patients aged 18 years and older who were scheduled to receive ambulatory surgery were recruited from the Taipei Municipal Wanfang Hospital in Taipei City, Taiwan. The patients were assigned randomly to the experimental group (n = 101), which received presurgical machine-based hand massage therapy, and the control group (n = 98), which received no intervention. The patients in both groups completed the Spielberger State-Trait Anxiety Inventory short form at preintervention (baseline) and postintervention.

RESULTS

Within-group comparisons of Spielberger State-Trait Anxiety Inventory short form scores showed significant decreases between preintervention and postintervention scores in the experimental group (44.3 ± 11.2 to 37.9 ± 8.7) and no significant change in the control group. Within-group comparisons of vital signs revealed a significant increase in mean respiration rate between baseline and postintervention in both groups (both ps < .05). Blood pressure was found to have decreased significantly only in the control group at postintervention (p < .05). No significant preintervention to postintervention change in pulse was observed in either group.

CONCLUSIONS

The findings of this study indicate that machine-based hand massage reduces anxiety significantly in patients awaiting ambulatory surgery while not significantly affecting their vital signs.

Effectiveness of nursing interventions for preoperative anxiety in adults: A systematic review with meta-analysis

AIMS

The aim of this review and meta-analysis is to analyse the effectiveness of nursing interventions for the management of preoperative anxiety in adults.

BACKGROUND

The perioperative process is a stressful situation for many people who are going to be operated and it can generate feelings of anxiety. Also, preoperative anxiety can appear in the perioperative period. Nursing management of preoperative anxiety through individualized interventions can be effective for reducing anxiety.

DESIGN

A systematic review with meta-analysis was performed.

DATA SOURCES

CINAHL, CUIDEN, Pubmed, ProQuest and Scopus databases were consulted without restriction per year of publication. The search was conducted in February 2020.

REVIEW METHODS

Experimental studies on nursing management in preoperative anxiety with adults sample (>18 years) published in English and/or Spanish were included. All types of surgery were included in the review. A random effects meta-analysis was performed to estimate the effect size for preoperative anxiety measured with STAI.

RESULTS

After the selection process n = 9 quantitative studies with nursing interventions for preoperative anxiety were included. A preoperative educational and informative interview was used in six studies, one study used empathic interview, one used motivational interview and one used hand massage. The meta-analysis, including four studies using nursing interviews, had a sample of n = 419 in the intervention group and n = 445 in the control group. The mean difference in preoperative state anxiety measured with the STAI was in favour of the nursing intervention.

CONCLUSION

Nursing interventions for patients who are going to be operated seems to have a positive impact in their preoperative anxiety. However, due to the low number of studies and the heterogeneity of the sample, more research is needed about the topic.

Effect of hand-holding and conversation alone or with midazolam premedication on preoperative anxiety in adult patients-A randomised controlled trial

Background and Aims:

Anxiety causing stress is most profound before surgery. Anxiolytics are used routinely to combat perioperative anxiety. Studies have shown that hand-holding and communication are useful in reducing anxiety levels intraoperatively. This study compares the effectiveness of the same with pharmacological interventions in allaying preoperative anxiety.

Material and Methods:

This is a three-arm parallel-group randomised controlled trial. A total of 90 adult patients aged <45 years and of American Society of Anesthesiologists (ASA) grade 1–2, undergoing laparoscopic surgery were enroled in this study. Patients received either intravenous (IV) midazolam (group M) or hand-holding and conversation (group HC), or a combination of IV midazolam and holding and conversation (group HCM) in the preoperative room. Anxiety, heart rate (HR) and mean blood pressure (MBP) were recorded before and 20 minutes after the intervention. Anxiety was measured using the Amsterdam preoperative anxiety and information scale. The analysis of covariance (ANCOVA) test was done to analyse the difference between the groups.

Results:

The mean anxiety scores were significantly different in the three groups (p = 0.04) after intervention, with the lowest score in group HCM, followed by group HC and the highest score in group M. The mean heart rates were also significantly different in the three groups after intervention but MBP was not significantly different in the three groups.

Conclusion:

A combination of hand-holding and conversation and midazolam is best for allaying preoperative anxiety in patients undergoing laparoscopic surgeries than either method alone.

Emotional Changes and Functional Progressions during Post-Operative Rehabilitation in Collegiate Student-Athletes: A Preliminary Study

An interrelationship between psychological and physical health is generally accepted in the field of sports medicine. This preliminary study explored the association between emotional changes and functional outcomes and aimed to describe how each aspect progresses during postoperative rehabilitation. Four collegiate student-athletes (1 female and 3 males) who underwent supervised postoperative rehabilitation due to a lower-extremity injury volunteered for participation in the study. Emotion was quantified using a visual analogue scale prior to and after each session while self-reported function using the Lower-extremity Functional Scale was assessed every eight sessions throughout rehabilitation. There was a moderate correlation between emotional changes and functional outcomes (r = 0.58, p < 0.0001). After the first emotional improvement, patients experienced six emotional deteriorations (28% of the entire rehabilitation period; F49,297 = 2.25, p < 0.0001), while their function consistently increased (F49,147 = 17.39, p < 0.0001). Clinicians should be aware of the relationship between emotional changes and functional progression as well as the occurrence of emotional fluctuations when supervising and consulting patients during postoperative rehabilitation. A larger study is warranted to generalize the results.

Effect of foot reflexology on chest pain and anxiety in patients with acute myocardial infarction: A double blind randomized clinical trial

BACKGROUND AND PURPOSE

The aim of this study was to determine the effect of foot reflexology on chest pain and anxiety in patients with AMI.

MATERIALS AND METHODS

This study was a double blind randomized clinical trial. Stratified random sampling was carried out on 90 patients with AMI in the three groups of treatment, placebo and control. Foot reflexology was done for three consecutive days, each time for 20 min. Chest pain and anxiety were evaluated with Visual Analogue Scale before, immediately and 20 min later.

RESULTS

20 min after the intervention, severity of chest pain in treatment group was significantly lower than control group (p < 0.001) and placebo group (p = 0.002). Severity of anxiety between groups and at different times was not significant.

CONCLUSIONS

Foot reflexology was effective in attenuating chest pain, had the most effect in 20 min after intervention, and can be used to relieve chest pain in patients with AMI.

Effect of Hand Massage on Pain, Anxiety, and Vital Signs in Patients Before Venipuncture Procedure: A Randomized Controlled Trial

BACKGROUND

Massage is one of the relaxation techniques commonly used in recent years to control pain, stress, and anxiety.

AIMS

This study was conducted to evaluate the effect of hand massage application on pain, anxiety, and vital signs before venipuncture procedure.

METHODS

The sample of the study consisted of 97 individuals (48 experimental and 49 controls) who were admitted to a training and research hospital in Turkey between December 2018 and May 2019. Individuals assigned to the experimental group received hand massage. The data were obtained with an individual information form, a visual analog scale (VAS), and the State-Trait Anxiety Inventory (STAI).

RESULTS

The mean age of the participants was 49.52 ± 12.48 years. There was no significant difference between the pain levels of the experimental and control groups (p > .05), but the anxiety level of the experimental group was significantly less than that of the control group (p < .05). There was also a significant difference between the experimental and control groups in terms of systolic and diastolic blood pressure and heart rate. The blood pressure and heart rate of the experimental group decreased significantly (p < .05).

CONCLUSION

Hand massage was found to be a simple, non-pharmacologic, inexpensive, and independent nursing practice that could be used to reduce anxiety and positively affect vital signs in patients before venipuncture procedure.

The effect of education on nursing personnel's knowledge and attitudes regarding the use of integrative care techniques with hospice and palliative care patients

PURPOSE

To examine the effect of education on nursing personnel's knowledge and attitudes regarding the use of hand massage, breathing techniques, and essential oils with hospice and palliative care patients.

BACKGROUND

Unrelieved, end of life pain is common among hospitalized patients on hospice and palliative care units. Integrative care techniques such as hand massage, breathing techniques, and essential oils can be available to use with these individuals. Nursing personnel are often unaware of other techniques that are not a traditional pharmacology approach to pain.

METHODS

A quasi-experiment was conducted to evaluate the effect of an educational intervention on nursing personnel's knowledge and attitudes regarding the use of three integrative care techniques (hand massage, breathing techniques, and essential oils) with hospice and palliative care patients in an acute care setting. Data on knowledge and attitudes were collected pre- and postintervention.

RESULTS

Following the intervention, improvements in nursing personnel's attitudes and knowledge toward the use of the three techniques were found.

CONCLUSION

Results of this study suggest that education of nursing personnel may positively influence knowledge and attitudes toward providing hand massage, breathing techniques, and essential oil for end of life patients.

Calming Effects of Touch in Human, Animal, and Robotic Interaction-Scientific State-of-the-Art and Technical Advances

Small everyday gestures such as a tap on the shoulder can affect the way humans feel and act. Touch can have a calming effect and alter the way stress is handled, thereby promoting mental and physical health. Due to current technical advances and the growing role of intelligent robots in households and healthcare, recent research also addressed the potential of robotic touch for stress reduction. In addition, touch by non-human agents such as animals or inanimate objects may have a calming effect. This conceptual article will review a selection of the most relevant studies reporting the physiological, hormonal, neural, and subjective effects of touch on stress, arousal, and negative affect. Robotic systems capable of non-social touch will be assessed together with control strategies and sensor technologies. Parallels and differences of human-to-human touch and human-to-non-human touch will be discussed. We propose that, under appropriate conditions, touch can act as (social) signal for safety, even when the interaction partner is an animal or a machine. We will also outline potential directions for future research and clinical relevance. Thereby, this review can provide a foundation for further investigations into the beneficial contribution of touch by different agents to regulate negative affect and arousal in humans.

The effectiveness of massage on peri-operative anxiety in adults: A meta-analysis of randomized controlled trials and controlled clinical trials

BACKGROUND AND PURPOSE

and purpose: Massage has gained increasing attention for reducing peri-operative anxiety. We aimed to investigate the effectiveness of massage for peri-operative anxiety in adults.

METHODS

Six English electronic databases were comprehensively searched from their inception to February 2020. Subgroup analysis, quality assessment, sensitivity analysis, meta-regression and publication bias assessment were performed.

RESULTS

Twenty-five controlled trials comprising 2494 participants were included. The meta-analysis indicated that massage could significantly reduce peri-operative anxiety for most types of surgical patients. Specifically, it was effective for pre-, intra- and post-operative anxiety. Acupoint or specific body reflex area massage showed a larger effect than general massage did. Massage delivered by professionals and non-professionals were both effective. Massage lasting 10-20 min per session was the most worthy of recommendation. Massage was concomitant with the improvement of peri-operative vital signs and post-operative pain.

CONCLUSION

Massage is a promising complementary therapy for ameliorating peri-operative anxiety in adults.

Benefits of hand massage on anxiety in preoperative outpatient: A quasi-experimental study with pre- and post-tests

CONTEXT

Surgical patients experience procedure-related anxiety preoperatively. With delays and long waiting periods, surgical patients can experience increased anxiety and decreased satisfaction with their hospital visit.

MAIN OBJECTIVES

To evaluate whether a 15-minute non-therapeutic hand massage provided by the Caring Hands massage volunteers would reduce anxiety levels, increase satisfaction, and decrease physiological parameters among preoperative surgical patients.

DESIGN

This research study has a quasi-experimental design, with control and intervention groups, and pre and post-tests.

SETTING

This research study was conducted at Same Day Surgical Stations 53 and 63 at the Mayo Clinic Hospital, Methodist Campus, in Rochester Minnesota.

PATIENTS

One hundred and thirty-eight surgical outpatients were recruited preoperatively, with 31 participants in the control group and 107 in the intervention group.

INTERVENTIONS

Patients in the control group were asked to rest for 15 min. Patients in the intervention group received a 15-minute non-therapeutic hand massage administered by the Caring Hands massage volunteers from the Mayo Clinic Volunteer Program.

MAIN OUTCOME MEASURES

Patient anxiety level and physiological parameters were measured and recorded before and after a resting session (control group) or a 15-minute non-therapeutic hand massage session (intervention group). Patients in the intervention group were also surveyed for satisfaction. The feasibility of incorporating a 15-minute non-therapeutic hand massage into the preoperative routine was also analyzed.

RESULTS

After receiving a 15-minute non-therapeutic hand massage, patients experienced reduced anxiety levels and increased satisfaction. It was also found that it is feasible to add a 15-minute non-therapeutic hand massage to the routine of a same-day surgical station.

The effect of bergamot orange essence on anxiety, salivary cortisol, and alpha amylase in patients prior to laparoscopic cholecystectomy: A controlled trial study

BACKGROUND AND PURPOSE

This study aimed to determine the effect of bergamot orange essence on anxiety, salivary cortisol, and alpha amylase in patients prior to laparoscopic cholecystectomy.

MATERIAL AND METHODS

This clinical trial with pre-post design was conducted on 60 candidates for cholecystectomy. The participants were randomly divided into an intervention and a control group. The intervention group participants underwent aromatherapy using two drops of 3% bergamot orange essence, while the control group ones inhaled two drops of odourless grape seed oil. Anxiety mean score and salivary cortisol and alpha amylase levels were measured before and after the intervention.

RESULTS

A significant difference was found between the groups regarding anxiety (F = 9.00, p = 0.004) and alpha amylase level (F = 9.46, p = 0.003) after the intervention.

CONCLUSION

Bergamot orange essence decreased anxiety and salivary alpha amylase level. Therefore, this method can be used as a complementary technique to reduce patients' anxiety prior to laparoscopic cholecystectomy surgery.

IRCT REGISTRATION NUMBER

IRCT20171113037428N2. It is available in following website: https://www.irct.ir/trial/27696 REGISTRATION DATE: 03/25/2018.

Effects of Extremity Massage on Preoperative Anxiety: A Three-Arm Randomized Controlled Clinical Trial on Phacoemulsification Candidates

PURPOSE

The present study aimed to compare the effects of foot and hand massage on preoperative anxiety.

DESIGN

Three-arm randomized, nonblinded, placebo-controlled, parallel group trial.

METHODS

This study was conducted on 90 female candidates waiting for phacoemulsification cataract surgery in Arak Amirkabir Hospital, Iran. Patients were consecutively selected and randomly divided into three groups of hand (n = 30), foot (n = 30), and placebo (n = 30), using a random number generator software program. In each group, massage was performed 5 minutes for each hand or foot in the surgical waiting room about 10 minutes before surgery. Anxiety was measured before and after the intervention by visual analog scale and also assessing physiological indicators (heart rate, respiratory rate, systolic and diastolic blood pressures).

FINDINGS

All the 90 patients completed the study and were included in the final analysis. Both hand and foot massage resulted in a significant decrease compared with placebo massage in anxiety and heart rate. However, no significant difference was found between hand and foot massage in any of the measured parameters. In the foot group and hand group, a significant reduction was observed in heart rate and anxiety after the intervention, whereas the anxiety increased significantly in the placebo group after the intervention. Moreover, systolic blood pressure in the foot group and the respiratory rate in the hand group significantly decreased after the intervention.

CONCLUSIONS

Application of hand or foot massage seems to be effective in managing anxiety in patients waiting for phacoemulsification cataract surgery.

Effects of couples positive massage programme on wellbeing, perceived stress and coping, and relation satisfaction

Objectives: Although supporting preventative self-regulation and self-care activity for daily stress is important as dyadic coping, there seems a paucity of exploration of non-verbal interventions such as tactile communication. This preliminary experimental study assessed the efficacy of a short educational massage programme for healthy but stressed couples. The study aimed to investigate if the educational mutual massage (Positive Massage) programme has any acute and sustained effects on wellbeing, perceived stress and coping, and relationship satisfaction among couples. Design: A pseudo randomised two group design employing a delayed treatment element assessed the effects of the Positive Massage programme and subsequent at-home application. Thirty-eight participants completed a three-week massage course. Main Outcome Measures: Measurements of the Warwick-Edinburgh Mental Well-being Scale, the Rhode Island Stress and Coping Inventory, and the Positive Feelings Questionnaire were collected online using Qualtrics at three time points (the start, the end, and three weeks after the course). Data were analysed with mixed ANOVAs. Results: Mental wellbeing, and perceived stress and coping significantly improved from before to after the Positive Massage programme. There was no significant decline after the cessation of the massage programme. Relationship satisfaction did not show significant changes from the initial assessment. Conclusions: The overall effects of the Positive Massage programme indicate the importance of developing further large scale studies of mutual massage as a safe and beneficial self-care activity. This innovative study has laid the groundwork for future studies into the possibility of mutual massage as a self-regulation dyadic coping strategy for home use to improve overall wellbeing.

The Effect of Hand Massage Before Cataract Surgery on Patient Anxiety and Comfort: A Randomized Controlled Study

PURPOSE

This study aimed to determine the effectiveness of hand massage on patient anxiety and comfort before cataract surgery.

DESIGN

A randomized controlled trial.

METHODS

The 140 patients in this study were assigned to the intervention group (n = 70), which received a 10-minute hand massage before cataract surgery, and to the control group (n = 70), which received routine nursing care. The visual analog scale (VAS) and Spielberger State-Trait Anxiety Inventory (STAI) were used to collect data.

FINDINGS

The median STAI state scores of the intervention and control groups were found to be 46.0 (44.7 to 48.0) and 57.0 (55.75 to 59.00), respectively. The VAS comfort score of the intervention group after hand massage (4.0 [1.7-5.0]) was lower than that of the control group immediately before surgery (8.0 [6.0-10.0]) (P < .05). In addition, except oxygen saturation, the remaining vital signs were lower in the intervention group.

CONCLUSIONS

Hand massage reduced the anxiety of patients, positively affected their vital signs, and increased their comfort.

Evaluating the Effect of Slow-Stroke Back Massage on the Anxiety of Candidates for Cataract Surgery

BACKGROUND

The patients under cataract surgery often experience anxiety not only during the surgery, but also prior to the surgery.

PURPOSE

We sought to determine the effects of slow-stroke back massage on anxiety in patients undergoing cataract surgery.

SETTING

The study was conducted in the Amiral-momenin Hospital of Zabol city, south-east of Iran.

PARTICIPANTS

A total of 60 candidates of cataract surgery participated in the study.

RESEARCH DESIGN

The participants were randomly allocated to either control or intervention groups. The intervention group received slow-stroke back massages, while patients in control group received routine interventions.

INTERVENTION

The slow-stroke back massage was performed on the patients assigned to the intervention group. The intervention was performed in the morning of the surgery day at 30 minutes before the surgery. The researcher performed each massage session in a sitting position. The duration of each massage session was 15 minutes.

MAIN OUTCOME MEASURES

Anxiety was assessed in the both groups in the morning of the surgery, before and immediately after the intervention. Independent samples Student's t test, paired samples Student's t test, and chi-squared test were used to analyze the data.

RESULTS

Anxiety was not significantly different between the two groups before and after the massage (p = .816). On the other hand, paired samples Student's t test showed a significant difference comparing the anxiety scores before (49.7±5.43) and after (45.16±3.89) the massage in the intervention group (p < .001).

CONCLUSIONS

Based on our results, slow-stroke back massage, which is a low-cost and safe method, reduced anxiety in patients who were candidates for cataract surgery.

Attitudes of Spine Surgeons Regarding Management of Preoperative Anxiety: A Cross-sectional Study

STUDY DESIGN

This is a cross-sectional study.

OBJECTIVE

To investigate spine surgeons' attitudes regarding preoperative anxiety measurement, management, and responsibility.

SUMMARY OF BACKGROUND DATA

The vast majority of patients scheduled for spine surgery experience preoperative anxiety. However, there are currently no consensus guidelines for measure or management of preoperative anxiety in spinal operations.

MATERIALS AND METHODS

An anonymous questionnaire was sent online to spine surgeons of AO Spine North America to capture their views regarding preoperative anxiety.

RESULTS

Of 69 complete responses, most respondents were male (n=66, 95.7%), orthopedic surgeons (n=52, 75.4%), and practicing at an academic setting (n=39, 56.5%). Most spine surgeons practiced for at least 20 years (n=52, 75.4%), operated on 100-300 patients per year (n=48, 69.6%), and were attending physicians (n=61, 88.4%). Most did not measure preoperative anxiety (n=46, 66.7%) and would not use a rating scale to measure it (n=38, 55.1%). However, most would discuss it if mentioned by the patient (n=40, 58.0%). Other spine surgeons measured anxiety verbally (n=22, 31.9%) or with a rating scale or survey (n=6, 8.7%). Although preferences for preoperative anxiety management varied, most respondents used patient education (n=54, 78.3%) and permitting family members' presence (n=36, 52.2%) to reduce patient anxieties. Spine surgeons held themselves, anesthesiologists, and patients most responsible to manage preoperative anxiety.

CONCLUSIONS

The majority of spine surgeons surveyed did not regularly measure preoperative anxiety, but would discuss its management if the subject was broached by the patient. Spine surgeons relied on a variety of methods to manage a patient's anxiety, but most preferred preoperative education and permitting the presence of family members. Responsibility for controlling preoperative anxiety was chiefly allocated to surgeons, anesthesiologists, and patients. Future avenues for research may include developing a preoperative anxiety measurement scale and management protocol specific to spine surgery.

LEVEL OF EVIDENCE

Level IV.

Proposal of nursing diagnoses, outcomes and interventions for postoperative patients of orthognathic surgery

OBJECTIVE

To propose nursing diagnoses, outcomes and interventions for patients in the postoperative period of orthognathic surgery.

METHOD

Secondary analysis of an information bank of a focal group with five patients submitted to orthognathic surgery. The classifications of the North American Nursing Diagnosis Association International, Nursing Outcomes Classification and Nursing Interventions Classification were used for elaborating nursing diagnoses, outcomes and interventions. Nursing diagnoses were identified based on the transcription of the focus group and the expected outcomes and interventions were proposed. In the second stage, the material was submitted to an analysis by judges for validating the previous stage.

RESULTS

After careful analysis of the retrieved information, nine nursing diagnoses that relate to both the difficulties already installed and to potential patient difficulties were identified. After this phase, the expected outcomes for nursing care and the appropriate interventions for the postoperative period at home were identified.

CONCLUSION

Given the short hospital stay and the long postoperative period, the established actions have a strong educational focus.

Effects of Nurse-Led Intervention on Patients' Anxiety and Sleep Before Coronary Artery Bypass Grafting

The aim of this study to examine the effects of supportive-educational nurse-led intervention on the patients' anxiety and sleep before the coronary artery bypass grafting.The current clinical trial recruited 160 patients (N = 160) waiting for the coronary artery bypass grafting by random block sampling and divided them into two 80-people experimental and control groups. Spielberger's State Anxiety Inventory was completed on the first day. The Groningen's Sleep Quality Index was also completed by the patients on the day of surgery. Data were analyzed in SPSS software version 16, using descriptive and inferential statistics tests.The mean anxiety score in the experimental group decreased to 48.39, whereas in the control group, the mean anxiety score saw a rise after the intervention (61.09). The comparison of the mean quality of sleep the night before the surgery for both groups showed that sleep in the control group compared with sleep in the experimental group had a lower quality, and statistically, it was significant (P < .001).Results showed that nonpharmacological and supportive interventions can reduce patients' anxiety and sleep disturbance before the coronary artery bypass grafting. According to the results, nonpharmacological therapies should be placed at the top of nurses' tasks.

Anxiety and knowledge of patients before being subjected to orthognathic surgery

ABSTRACT Objective: to verify the correlation between anxiety level and degree of knowledge in patients before they are subjected to orthognathic surgery. Method: Descriptive cross-sectional study with 40 patients in the preoperative period before orthognathic surgery of a private clinic in the city of São Paulo. Results: IDATE-trait anxiety levels feature prevalence of medium-level anxiety with 72.5% (n=29), followed by low-level anxiety with 72.5% (n=29) and high-level level anxiety with 10% (n=4). In the pre-operative period, transitory IDATE-state anxiety levels feature medium-level anxiety with 65% (n=26), followed by high-level anxiety with 22.5% (n=9) and low-level anxiety with 10% (n=4). Pearson’s correlation coefficient resulted in negative r (−0.2) for anxiety-trait (p 0.197) and in negative r (−0.1) for anxiety-state (p 0.417). Conclusion: The data shows a weak correlation in which greater knowledge about the surgical procedure reduces levels of anxiety that may be related to the absence of appropriate guidance about the surgical procedure.

Comparison of the effectiveness of two different interventions to reduce preoperative anxiety: A randomized controlled study

This study was conducted to determine and compare the effectiveness of nature sounds and relaxation exercises for reducing preoperative anxiety. A repeated measures randomized controlled trial design was used. We divided 159 preoperative patients into three groups: nature sounds (n = 53), relaxation exercises (n = 53), and control groups (n = 53). We evaluated anxiety using the visual analog scale and state anxiety inventory scores immediately before, immediately after, and 30 min after interventions in nature sounds and relaxation exercises groups, and silent rest in the control. We found no differences between the measurement values in the intervention groups, but we did observe a difference between the intervention and control groups. The two interventions were similarly effective in reducing preoperative anxiety. These simple and low-cost interventions can be used to reduce preoperative anxiety in surgical clinics.

The impact of hand reflexology on pain, anxiety and satisfaction during minimally invasive surgery under local anaesthetic: a randomised controlled trial

BACKGROUND

Elevated patient anxiety during surgery is linked to a range of suboptimal treatment outcomes. Reflexology has been reported to be effective in reducing pre and post-operative anxiety and post-operative pain.

OBJECTIVES

To explore whether the addition of hand reflexology to treatment as usual during minimally invasive varicose vein surgery under local anaesthetic impacted upon patient reported anxiety and pain during surgery, and patient satisfaction with treatment.

DESIGN

Randomised controlled trial.

SETTING

Private outpatient clinic specialising in venous conditions.

PARTICIPANTS

137 participants were assessed for eligibility. One hundred patients were recruited (mean age 47.8 years, 83% female). Participants received endovenous thermal ablation and/or phlebectomy for the treatment of varicose veins. Inclusion criteria included age (between 18 and 80) and receiving endovenous thermal ablation and/or phlebectomy for the treatment of varicose veins under local anaesthetic. Exclusion criteria included the presence of leg ulcers and receiving microsclerotherapy or foam sclerotherapy treatments, being unwilling to enter into the randomisation process and arriving late at the clinic.

METHODS

Participants were randomly allocated to either treatment as usual (control group) or intra-operative hand reflexology during minimally invasive varicose vein surgery under local anaesthetic. Participants in the reflexology group received a session of intra-operative hand reflexology which began in the operating theatre, prior to analgesic injections and continued until surgery was complete. It was not possible to blind the participants, researchers or theatre staff to group allocation due to the modifications required to the operating theatre for participants in the reflexology group. The researcher could not be blinded due to the role they played in the trial organisation.

RESULTS

Of the 137 participants screened for eligibility, 7 participants declined to participate and a further 30 did not meet the inclusion criteria, giving a recruitment rate of 93%. Fifty participants were randomised to the reflexology group and fifty participants were randomised to the control group. Intra-operative anxiety was significantly lower in the reflexology group (mean score of 3.24 on an 11-point rating scale) than the control group (mean score of 5.0, p<.001).

CONCLUSIONS

Intra-operative hand reflexology is a useful adjunct to local anaesthetic varicose vein surgery, with participants in the reflexology group reporting significantly lower intra-operative anxiety and shorter pain duration than participants receiving treatment as usual.