Preoperative Anxiety in Patients Undergoing Outpatient Cancer Surgery

Coping strategies and psychological distress in postoperative recovery: A repeated-measures study in women undergoing breast-conserving surgery

Objective

Breast-conserving surgery (BCS) is the standard treatment for early-stage breast cancer, yet patients often experience significant psychological distress and physical symptoms during recovery. This study aimed to explore the relationships between antecedents, physical symptoms (pain and nausea), psychological distress, and coping strategies utilized by women recovering from BCS to improve management of postoperative challenges.

Methods

This repeated-measures descriptive study involved 75 women who underwent BCS with sentinel lymph node biopsy at a National Cancer Institute-designated center. Participants completed the National Comprehensive Cancer Network (NCCN) Distress Thermometer and Ways of Coping Instrument on Postoperative Day 1 (POD1) and POD14. Bivariate analyses, multiple linear regression, and structural equation modeling were conducted to evaluate associations between antecedents, coping strategies, and distress. Open-ended responses were qualitatively analyzed for thematic content.

Results

Seeking social support (POD1 mean ​= ​1.25; POD14 mean ​= ​1.20) and planful problem-solving (POD1 mean ​= ​1.19; POD14 mean ​= ​1.04) were the most frequently used coping strategies, while accepting responsibility and confrontive coping were least utilized. Overall coping strategy use decreased between POD1 and POD14, likely reflecting recovery adaptation. Significant predictors of distress included escape-avoidance coping (β ​= ​0.415, P ​< ​0.001), social support (β ​= ​0.270, P ​= ​0.02), history of nausea (β ​= ​0.517, P ​< ​0.001), and age (β ​= ​0.293, P ​= ​0.007). Coping strategies did not mediate the relationship between antecedents and distress.

Conclusions

Adaptive coping strategies such as social support and planful problem-solving play a critical role in mitigating distress during BCS recovery. Interventions should emphasize fostering these strategies and addressing high-risk groups, such as younger patients and those with a history of nausea. Despite limitations, this study underscores the importance of supporting adaptive coping to improve postoperative outcomes and provides a basis for future research.

Emotional impact according to the way cancer patients are conducted to the surgical center: A randomized clinical trial comparing ambulation to the stretcher

This study aimed to evaluate anxiety, depression and satisfaction of cancer patients according to the type of conduction to the surgical center. A randomized clinical trial was carried out at Barretos Cancer Hospital from 2019 to 2021. One hundred seventy-six patients were enrolled: 94 in the control group (conduction to the surgical center on a stretcher and pajamas) and 82 in the experimental group (conduction to the surgical center by ambulation in one's own clothes). The Hospital Anxiety and Depression Scale (HADS) was used to assess the levels of anxiety and depression, and the Surgery Health Care Satisfaction Assessment Questionnaire (Sati-Cir) to assess the patient's satisfaction. There was no difference regarding anxiety and depression symptoms between groups, 15 (18.3%) and 20 (21.3%) patients had anxiety symptoms in the ambulation group and in the stretcher group, respectively (p =  0.621). Six (7.3%) patients in the ambulation group and 4 (4.3%) met the criteria for depression (p =  0.518). Compared to those who were referred to the surgical center on a stretcher, those in the ambulation group were more often satisfied or very satisfied according to the waiting time until surgery (91.5% vs 74.5%; p =  0.008) and type of clothing, own clothes compared to pajamas (100% vs 79%; p =  0.001). When all patients were asked about their preferred method of going to the surgical center, 70.5% chose to walk in their own clothes, 28.4% preferred a stretcher, and 1.1% opted for a wheelchair (p <  0.001). The transportation method to the surgical center did not affect anxiety and depression levels in cancer patients with no or low fall risk. However, patients in the ambulation group were more satisfied with the waiting time for surgery and the type of clothing. Clinical trial registration: clinicaltrials.gov, NCT03576482, https://clinicaltrials.gov/ct2/show/NCT03576482.

Effects of Virtual Reality on Preoperative Anxiety in Adult Patients: An Updated Meta-analysis

PURPOSE

To determine the effectiveness of virtual reality (VR) on preoperative anxiety in adult patients.

DESIGN

A systematic review and meta-analysis of randomized controlled trials.

METHODS

A systematic search was carried out using PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, Scopus, PsycINFO, China National Knowledge Infrastructure (CNKI), WANFANG DATA, Chinese Science and Technology Periodical Database (VIP), and Sino-Med from inception to December 18, 2022. All eligible randomized controlled trials published were included (published in English and Chinese). The Cochrane Collaboration "Risk of Bias" tool was used to assess the methodological quality of the included studies. Review Manager software 5.4 was used for data analysis.

FINDINGS

Nine studies with sample sizes ranging from 72 to 255 and 1,046 participants were identified. The results of the meta-analysis showed that VR significantly reduced preoperative anxiety in adults (standardized mean difference = -0.48, 95% CI: -0.93 to -0.03, P = .04). Our results suggested that VR improved postoperative satisfaction scores more effectively compared with control care (mean difference = 15.29, 95% CI: 6.25 to 24.33, P = .0009).

CONCLUSIONS

Study results support that VR has a positive effect in reducing preoperative anxiety in adults. VR can also significantly improve patients' satisfaction after surgery. However, the results need to be further assessed due to the small sample sizes and high heterogeneity.

Assessment of perioperative anxiety levels at three time-points during hospital stay in patients undergoing elective surgery

BACKGROUND

Perioperative anxiety is associated with complications during and after surgery, resulting in prolonged hospital stays, and long-term physical and cognitive decline. A prospective observational study was conducted to assess anxiety levels at three time-points and identify sociodemographic factors influencing it.

METHODOLOGY

Three assessments were conducted on 105 patients (18-65 years) undergoing elective surgery after informed consent: A1 (day before surgery) using the State-Trait Anxiety Inventory (STAI-Trait) form, STAI-State form, and demographic data collection; A2 (on the day of surgery) with the STAI-S2 form; and A3 (24 h post-surgery) with the STAI-S3 form and a questionnaire on information requirements and pain.

RESULTS

Average state anxiety scores were S2 (18.06) > S1 (17.55) > S3 (16.38). The primary concerns were fear of feeling pain after surgery (41%), fear of the results of the surgery(33.3%), and concerns about family (32.40%). Unmarried individuals had significantly higher anxiety scores than married individuals in S1 (20.80 vs. 16.79, p - 0.009) and S2 (23.10 vs. 16.87, p - 0.001). Females consistently scored higher than males, with a significant difference in S2 (19.51 vs. 16.79, p - 0.05). Patients with a medical history showed the highest anxiety in S3 (18 vs. 15.67, p - 0.037). Skilled workers displayed the highest anxiety levels in S1 (20.20) and S2 (22.40, p - 0.044) as compared to other groups, while professionals showed the highest anxiety in S3 (18.05). Females (33%), rurals (29%), and ≤ 8th-grade education group (54.5%) were significantly more likely to report receiving inadequate information about surgery compared to males (12.5%, p - 0.018), urbans (13%, p - 0.036), and higher education group (18%, p - 0.022). Younger individuals of < 30 years (47%) were more likely to feel that more information about surgery would have relaxed them compared to 41-50 age group (7.14%, p - 0.016).

CONCLUSION

The anxiety levels fluctuated over three time-points and were influenced by demographic, cultural, and psychological factors. Therefore, anxiety should be identified both preoperatively and postoperatively through an individualized approach. Additionally, a significant proportion of the population still requires more information, and the diverse informational needs across the groups underscore the necessity for individualized interviews to ascertain specific information requirements, thereby preventing any paradoxical increase in anxiety due to inappropriate information delivery.

Relationship Between Preoperative Fasting Duration and Anxiety Levels With Postoperative Pain, Nausea-Vomiting, and Sleep Quality in Orthopedic Surgical Patients: A Cross-Sectional Study

This study is a cross-sectional study aimed to determine the association between preoperative fasting time and anxiety level and early postoperative pain intensity, nausea-vomiting severity, and sleep quality in patients undergoing orthopedic surgery. The study was conducted between March and June 2024 and completed with 188 patients. In the study, patient information form, Amsterdam Preoperative Anxiety and Information Scale, and Richards-Campbell Sleep Questionnaire were used. Correlation analysis indicated a significant negative correlation between postoperative sleep quality and pain intensity. There was a significant positive correlation between preoperative anxiety level and preoperative solid food fasting and fluid fasting times. According to the multiple linear regression model, preoperative anxiety level was found to have a significant effect on pain severity, and pain severity at the postoperative 24th hour significantly affected postoperative sleep quality. Adjusting patients' fasting durations prior to surgical interventions according to evidence-based guideline recommendations and monitoring anxiety closely are simple, practical, and safe measures that could alleviate postoperative pain and nausea-vomiting and improve sleep quality, potentially enhancing outcomes, comfort, and the quality of care.

Management of Depression and Anxiety in Perioperative Medicine

This Clinical Focus Review summarizes contemporary best practices, recent clinically relevant research, and pertinent unanswered questions related to perioperative screening and treatment of anxiety and depression.

Impact of Replacing Fentanyl With Hydromorphone as the First-Line Postoperative Opioid Among Patients Undergoing Outpatient Cancer Surgery

PURPOSE

In response to a nationwide fentanyl shortage, our institution assessed whether changing our first-line postoperative intravenous opioid from fentanyl to hydromorphone impacted patient outcomes. The primary research aim was to evaluate the association between first-line opioid and rapidity of recovery.

DESIGN

The study team retrospectively obtained data on all consecutive patients extracted from the electronic medical record. The rapidity of recovery was defined as the time from entry into the postanesthesia care unit to the transition to Phase 2 for ambulatory extended recovery patients and as the length of total postanesthesia care unit stay for outpatients.

METHODS

Following intent-to-treat-principles, we tested the association between study period and rapidity of recovery (a priori clinically meaningful difference: 20 minutes) using multivariable linear regression, adjusting for anesthesia type (general vs monitored anesthesia care), American Society of Anesthesiologst physical status (ASA) score (1-2 vs 3-4), age, service, robotic procedure, and surgery start time.

FINDINGS

Ambulatory extended recovery patients treated in the hydromorphone period had, on average, a 0.25 minute (95% confidence interval [CI] -6.5, 7.0), nonstatistically significant (P > .9) longer time to transition. For outpatient procedures, those who received hydromorphone had, on average, 8.5-minute longer stays (95% CI 3.7-13, P < .001). Although we saw statistical evidence of an increased risk of resurgery associated with receiving hydromorphone (0.5%; 95% CI -0.1%, 1.0%; P = .039 on univariate analysis), the size of the estimate is clinically and biologically implausible and is most likely a chance finding related either to multiple testing or confounding.

CONCLUSIONS

The multidisciplinary team concluded that the increase in postoperative length of stay associated with hydromorphone was not clinically significant and the decrease waste of prefilled syringes outweighed the small potential increased risk of resurgery compared to the shorter-acting fentanyl. We will therefore use hydromorphone moving forward.

Meditation for the reduction of perioperative anxiety in patients undergoing oncology surgery: A scoping review

Objective

Patients undergoing surgery, particularly patients undergoing surgery for oncology diagnoses, experience anxiety. Surgery remains the primary treatment for many common types of cancer. One promising potential intervention to alleviate anxiety in the preoperative and postoperative period is meditation, an integrative medicine intervention. However, there remains a gap in the literature regarding the effectiveness of meditation to alleviate anxiety during the perioperative time period.

Methods

The scoping review was conducted using the Arksey and O'Malley framework to synthesize the study findings and was reported with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The review included EMBASE, PubMed, Web of Science, CINAHL Plus, Scopus, and Cochrane Review databases from 2013 through 2024. All identified articles were exported to the online systematic review software, Covidence.

Results

A total of 538 initial citations were identified, 415 titles and abstracts were screened, and 83 full-text articles reviewed. Six studies were finally included. The data extracted from the literature included: study purpose, study design, sample size, preoperative or postoperative timeframe, instrument to evaluate anxiety, and conclusions.

Conclusions

For patients undergoing oncology surgery, the perioperative period can be filled with anxiety. Guided, mindfulness, and loving-kindness meditation may be helpful in reducing anxiety, particularly in patients undergoing surgery for breast cancer during the postoperative period. However, the current literature is extremely limited. Future research should expand on the preliminary effectiveness to broader populations and carefully target the highest-risk populations for the ideal time point for interventions.

Research Electronic Data Capture (REDCap) in an outpatient oncology surgery setting to securely email, collect, and manage survey data

BACKGROUND

Nursing interventions in the post-operative time period including psychological and emotional support, adverse event education, and instructions for follow-up care contribute patient satisfaction, safety, and quality of life. However, the time spent in the post-anesthesia care unit (PACU) and hospital continues to shorten around the world to reduce health care spending and improve patient outcomes. Nurses conducting research during the important post-operative recovery period need to utilize unique techniques and emerging technologies to contact, recruit and collect data outside of the hospital setting including the Research Electronic Data Capture (REDCap) platform.

AIMS

This paper describes the feasibility and acceptability, facilitators and barriers of the software application, REDCap, to complete a repeated-measures, descriptive correlational study in patients undergoing outpatient breast cancer surgeries.

METHODS & MATERIALS

The recruitment, data collection and storage were completed utilizing the secure REDCap Platform. The Institutional Research Board (IRB)-approved study was a repeated-measures, descriptive, correlational study with data collection at three time points. The data points aligned with important transitions and routine visits to improve data collection feasibility and increase relevance to clinical practice.

RESULTS

The sample consisted of women diagnosed with breast cancer undergoing breast conserving surgery between August 15 and October 15, 2020. There were 123 potential participants, of which 76 started the surveys and 75 participated (61%) responded and participated in the study on Post-operative Day 1. Fifty-nine participants (78%) completed the surveys on post-operative Day 14.

DISCUSSION

As the frequency of outpatient treatment increases, nurses conducting post-operative research will need to collect the data outside of the hospital setting.

CONCLUSION

Email provides a method of studying new phenomena by recruiting participants, providing information about the study, and collecting results in a non-traditional setting. REDCap provides a method to facilitate nursing research through a securely encrypted integrated process.

Incorporating the Distress Thermometer into preoperative vital signs in patients undergoing ambulatory oncology surgery: a pilot feasibility study

BACKGROUND

Despite the extensive literature supporting distress screening at relevant transitions of care, the implementation of distress screening remains limited in ambulatory surgery settings. Our multidisciplinary team completed a pilot study to assess the feasibility and acceptability of including a standardized psychosocial assessment, the Distress Thermometer (DT), with the collection of admission vital signs by Patient Care Technicians (PCTs) in patients undergoing oncology surgery.

METHODS

We assessed feasibility by the response rate and acceptability through discussions with the PCTs.

RESULTS

Of the 189 men who underwent radical prostatectomy at our center, 71 were approached with the DT scale, and all patients who were approached completed the DT with no missing data. The staff reported no issues with data collection. A total of 21/71 (30%; 95% CI 19%, 42%) reported a clinically relevant distress DT ≥ 4.

CONCLUSION

Our results demonstrated that incorporating the DT into vital sign collection was feasible, acceptable, and provided a valuable assessment.

Anxiety evaluated by the Hospital Anxiety and Depression Scale as a predictor of postoperative nausea and vomiting: a pilot study

The incidence of postoperative nausea and vomiting (PONV) remains high, and improving the accuracy of PONV prediction remains challenging. The primary aim of this study is to examine the impact of anxiety scores evaluated using the Hospital Anxiety and Depression Scale (HADS) on the PONV prediction model. We hypothesized that anxiety and depression, quantified using the HADS, could improve the accuracy of the PONV predictive model. This pilot study evaluated 100 patients. The HADS was conducted by a self-evaluation method before thoracoscopic surgery for lung tumors, and the anesthesia method was standardized. The criterion was whether the nurse in charge of the patient who complained of PONV assessed that drug administration was necessary. As the main analysis, the odds ratio of the HADS score for predicting PONV was evaluated using multivariable logistic regression models. Further, the receiver operating characteristic (ROC) curves of the model with the HADS score added to the variables of without-anxiety predictors and the model with the variables of without-anxiety predictors only were compared. The anxiety score was significantly higher in the PONV group than in the no PONV group (P = 0.021). For predictive accuracy, the model that included age, sex, smoking history, history of PONV, and anxiety score had a higher area under the ROC curve than did the model excluding the anxiety score (P = 0.021). In conclusion, the findings indicate that the HADS is worth investigating as a predictor of PONV.

Distress, Pain, and Coping Strategies in Patients Undergoing Breast-Conserving Surgery: A Scoping Literature Review

PROBLEM IDENTIFICATION

Most patients with breast cancer are diagnosed at an early stage, when surgery remains the primary treatment. This scoping literature review explores the frequency and severity of symptoms; which patients are at the highest risk for pain, nausea, and distress; and the relationships between coping strategies and these symptoms.

LITERATURE REVIEW

This review included articles found in the MEDLINE®, CINAHL®, PubMed®, PsycINFO®, APA PsycArticles®, and Cochrane Library databases and published from 2010 through 2022, using combinations of the following keywords: coping, cancer, distress, surgery, and breast.

DATA EVALUATION

Initial search results yielded 111 research articles, and 13 were included in the review. Extracted data included the purpose, study design, sample size, time point, instrument, and conclusion.

SYNTHESIS

Nausea, pain, and distress are substantial problems for women following breast cancer surgery. The relationships among predictors, pain, nausea, and distress are clear, but the direction and strength of these relationships remain unknown. A better understanding of the relationships among these factors is important to improve the experience of women with breast cancer.

IMPLICATIONS FOR RESEARCH

Nursing research should focus on developing targeted interventions to reduce these symptoms.

Acupressure can reduce preoperative anxiety in adults with elective surgery: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Preoperative anxiety is prevalent amongst adults with elective surgery and is associated with multiple detrimental perioperative physiological effects. Increasing studies support the effectiveness of acupressure in managing preoperative anxiety. However, the magnitude of acupressure's positive association with preoperative anxiety is still unclear due to a lack of rigorous evidence synthesis.

OBJECTIVE

To estimate the efficacy of acupressure on preoperative anxiety and physiological parameters amongst adults scheduled for elective surgery.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Search terms were combined for acupressure and preoperative anxiety in PubMed, Cochrane Library, EMBASE, CINAHL, China National Knowledge Infrastructure, and WanFang Data Knowledge Service Platform to search for eligible randomised controlled trials from the inception of each database through September 2022.

METHODS

Pairs of researchers independently screened and extracted data from included studies. The risk of bias was assessed using the Cochrane risk of bias tool Version 2.0. Meanwhile, random-effects meta-analysis of overall effects and prespecified subgroup (i.e., surgery types, intervention providers, and acupressure stimulation tools) was conducted using Review Manager Software 5.4.1. Meta-regression was performed to explore study-level variables that may contribute to heterogeneity using STATA 16.

RESULTS

Of 24 eligible randomised controlled trials, there were a total of 2537 participants from 5 countries contributed to this synthesis. When comparing acupressure with usual care or placebo, acupressure showed a large effect size for preoperative anxiety (SMD = -1.30; 95%CI = -1.54 to -1.06; p < 0.001; I2 = 86%). The significant mean reduction of heart rate, and systolic and diastolic blood pressure was -4.58 BPM (95%CI = -6.70 to -2.46; I2 = 89%), -6.05 mmHg (95%CI = -8.73 to -3.37; p < 0.001; I2 = 88%), and -3.18 mmHg (95%CI = -5.09 to -1.27; p = 0.001; I2 = 78%), respectively. Exploratory subgroup analyses showed significant differences in surgery types and acupressure stimulation tools, whilst the intervention providers (i.e., healthcare professionals and self-administered) showed no statistically significant difference for acupressure therapy. None of the predefined participants and study-level characteristics moderated preoperative anxiety through meta-regression.

CONCLUSION

Acupressure appears efficacious as a therapy for improving preoperative anxiety and physiological parameters amongst adults with elective surgery. Self-administered acupressure, which is effective with a large effect, may be considered as an evidence-based approach to managing preoperative anxiety. Hence, this review aids in the development of acupressure in different types of elective surgeries and the improvement of the rigour of acupressure therapy.

Ultrasound Guided Intraoperative Wire Localization Under General Anesthesia in Breast-Conserving Surgery

Breast-conserving surgery (BCS) is becoming an increasingly preferred surgical technique for treating breast cancer. For the last several decades, using a preoperative wire placed by a radiologist has been the gold standard to help guide surgeons to excise a suspicious mass. In recent years, there has been an increasing focus on using surgeon-performed intraoperative ultrasound (IOUS) during breast-conserving therapy, suggesting improved cosmetic outcomes and a decreased need for re-excision. However, studies have also highlighted that ultrasound may be uncomfortable for surgeons who have become most familiar with a wire-localization technique. Wire localization and intraoperative ultrasound are valuable tools that can improve the accuracy of tumor localization and reduce the need for re-excision. We present a 45-year-old female with a right breast mass, measuring breast imaging reporting and data system (BIRADS) 4A on preoperative ultrasound. Intraoperative wire-localization was performed by the surgeon utilizing ultrasound guidance. The right breast lesion was successfully excised with negative margins. The patient was discharged home and recovered well. Surgeon-performed intraoperative ultrasound can be combined with surgeon-performed wire localization to reduce the need for re-excision surgery and allow the surgeon to retain the familiarity of utilizing a gold-standard technique. Further research is needed to determine the optimal use of surgeon-performed IOUS and wire-localization, and its impact on long-term outcomes.

The Effect of a Simple Perioperative Video on Maternal Anxiety and Satisfaction Before Regional Anesthesia in a Caribbean Setting: A Randomized Controlled Trial

BACKGROUND

Anxiety before regional anesthesia and surgery is common among women undergoing cesarean section. Although perioperative education has been shown to reduce this level of anxiety, the optimal form and timing of this intervention are not known. The goal of this study was to evaluate the efficacy of an educational anesthetic video on reducing anxiety and improving maternal satisfaction in patients scheduled for elective cesarean section under regional anesthesia.

METHODS

Eighty patients scheduled for cesarean section at a tertiary-level obstetric center were randomized to either an interventional group (viewed an educational video on the evening before surgery) or the control group (no educational video). Both groups received a standard preoperative assessment on the morning of surgery. Anxiety was assessed using the Spielberger State-Trait Anxiety Inventory (STAI) and the visual analog scale for anxiety (VAS-A). Maternal satisfaction was assessed using the Maternal Satisfaction Scale Score for Cesarean Section (MSSSCS). Anxiety was assessed at baseline (the evening before surgery) and immediately before surgery. Maternal satisfaction was assessed on the first postoperative day. Patients in the intervention group also had their state anxiety measured immediately after viewing the educational anesthetic video using the VAS-A.

RESULTS

Both groups were equally matched at baseline, and a statistically significant reduction in anxiety measured using VAS-A was seen in the intervention group vs. the control group (6 vs. 4.6, p = 0.018). State-trait anxiety measured using STAI, however, was not significantly lower in the intervention vs. control group (44 vs. 46, p = 0.99). VAS-A immediately after looking at the video was also not significantly different (5 vs. 4, p = 0.323) from the control group. Maternal satisfaction was also higher in the intervention group (113 vs. 104.5, p = 0.015).

CONCLUSION

The use of a simple educational anesthetic video may be associated with reduced anxiety and improved maternal satisfaction in patients scheduled for elective cesarean section under regional anesthesia.

Nurse-led web-based patient education reduces anxiety in thyroidectomy patients: A randomized controlled study

AIM

The aim of this study was to determine the effect of web-based patient education on anxiety in patients scheduled for thyroid surgery. A secondary aim was to evaluate the patients' postoperative recovery outcomes.

DESIGN

This study is a randomized controlled trial.

METHOD

The study was conducted at a university hospital in Turkey between September 2018 and May 2019 with 76 patients scheduled for thyroidectomy surgery and randomly assigned into two groups. Patients in the intervention group received web-based education, while those in the control group were given only routine care. Measurements were performed before surgery, on the day of surgery, and 1 week after discharge.

RESULTS

On the day of surgery, intervention group anxiety levels were lower than those of the control group, and the majority of early recovery parameters were significantly better in the intervention group than in the control group. One week after discharge, the intervention group patients' anxiety levels were significantly lower. Web-based education had no impact on pain, time in the operating room, readmission to the hospital after discharge, or length of hospitalization.

CONCLUSIONS

Nurse-led web-based education reduced patients' anxiety regarding surgery. The results also show that it may improve postoperative early recovery.

Magnitude of Preoperative Anxiety and Associated Factors Among Adult Surgical Patients in Debre Berhan Comprehensive Specialized Hospital

Background

Anxiety is an un-pleasurable emotional state associated with psychophysiological changes in response to an intra-psychic conflict. The perioperative period is one of the worrying events for most surgical patients. Despite preoperative anxiety having many negative consequences on post-operative physical and mental health, no adequate information on the degree to which the preoperative period exposed clients to preoperative anxiety and its associated factors.

Objective

To assess the prevalence of preoperative anxiety and associated factors among adult surgical patients in Debre Berhan Comprehensive Specialized Hospital, Ethiopia.

Methods

Institution-based cross-sectional study was conducted from June 1, 2020, to August 30, 2020. State-Trait Anxiety Inventory Scale (S-STAI) was used to measure the level of pre-operative anxiety. A systematic random sampling technique was employed to collect the data. The data were entered to Epi-Data version 4.6 and exported to SPSS version 25 for data analysis. A statistically significant association was declared at a p-value less than 0.05.

Results

A total of 330 patients were enrolled in the study with a response rate of 93.2%. The prevalence of a high level of preoperative anxiety was 53.6% (95% CI (49.6-58.7)). Being female 3.2 (2.19, 3.71) illiterate 4.1 (2.01, 15.39), fear of death 2.12 (1.30, 3.44), results of operation 2.60 (1.75, 4.18), postoperative pain 2.35 (1.37, 4.02), and surgical complication 1.9 (1.03, 12.13) were statistically significant factors.

Conclusion

Preoperative anxiety affects more than half of surgical patients which is a high and serious health burden. Additionally, this study revealed that being female, illiterate, fear of death, having a history of surgical complications and fear of complications, and fear of postoperative pain were significantly associated with preoperative anxiety. Assessing during the preoperative period helps to detect and ameliorate the problem. Preoperative counseling and informed consent taken as a prerequisite for surgery will help in reducing preoperative anxiety.

The Influence of Online Cognitive Behavior Therapy Applications on Nurse’s Anxiety during the COVID-19

BACKGROUND: Coronavirus disease 2019 (COVID-19) has an impact on all aspects of human life. The rapid spread of COVID-19 has resulted in many infected patients and deaths. The rapid increase in cases affects the physical and psychological health of health workers who work in hospitals. Health workers, especially nurses, are at the forefront of treating COVID-19 patients. The most common psychological impact is anxiety. AIM: This study aims to determine the effect of the cognitive behavior therapy online application on nurses during the COVID-19 pandemic at the USU Teaching Hospital. METHODS: The research design is a quasi-experimental study. The research procedure was carried out by developing an online CBT application for nurses. The research respondents were 60 nurses in the COVID-19 inpatient room which were divided into an intervention group and a control group. The implementation of CBT will be carried out in five sessions. The research process in the intervention group begins with conducting a pre-test, then intervention, and post-test. Meanwhile, in the control group, only pre- and post-tests were performed. Data analysis was performed using bivariate analysis, namely, t test. RESULTS: The results of the study can be concluded that the majority of nurses are Muslim (46%), educated nurses (66.7%), female (75%) and working 0–6 months (31.7%), aged 34, 32 years with age a minimum of 26 years, and a maximum age of 45 years, and the average anxiety experienced by nurses was 61 and 73 (medium category). The results showed that there was a significant effect of giving CBT with nurses’ anxiety (p = 0.001). The difference in anxiety scores before and after the CBT intervention in the intervention group was greater than that in the control group. CONCLUSION: Recommendations to hospitals apply CBT to reduce nurse anxiety.

Effects of aromatherapy on sleep disorders: A protocol for systematic review and meta-analysis

BACKGROUND

The progress of modern society and changes in lifestyle have not only increased the proportion of sub-healthy people, but also caused many people to suffer from sleep disorders and mental anxiety. Long-term lack of high-quality sleep will not only cause psychological problems such as anxiety and fatigue, but also cause physical abnormalities, such as abnormal hormone secretion, weakened immunity, neuroendocrine disorders, and high blood pressure. Therefore, the purpose of this study is to systematically evaluate the effectiveness of aromatherapy in improving sleep quality in people with sleep disorders.

METHODS

Computer search CNKI, SinoMed, Wanfang, PubMed, Web of science, and EMbase collect randomized controlled trials on aromatherapy to improve sleep quality of people with sleep disorders. The search time limit is to build the database until April 5, 2021. RevMan5.3 software is used for meta-analysis.

RESULTS

This systematic review will provide an assessment of the current state of sleep disorders, aiming to assess the efficacy of aromatherapy for patients with sleep disorders.

CONCLUSION

This systematic review will provide a credible evidence-based for the clinical treatment of sleep disorders with aromatherapy.

The Effects of Preoperative and Postoperative Anxiety on the Quality of Recovery in Patients Undergoing Abdominal Surgery

PURPOSE

The aim of this study was to investigate the effect of preoperative and postoperative anxiety on the state of recovery in patients undergoing abdominal surgery.

DESIGN

This research is a descriptive and cross-sectional study.

METHODS

The study included a total of 82 patients undergoing elective abdominal surgery. Demographic data were collected. State-Trait Anxiety Inventory was the measure for anxiety. The quality of recovery (QoR) was assessed using Quality of Recovery Scale (QoR-40). Both have known validity and reliability and valid translations into Turkish. After obtaining consent from patients, 82 patients completed their demographic profile and State-Trait Anxiety Inventory before surgery, and after 24 hours of surgery completed the state anxiety and QoR.

FINDINGS

Patients who received general anesthesia had higher anxiety before and after surgery (P = .004 and P = .022). Patients who were not informed about the surgery had higher preoperative trait anxiety (P = .01). The QoR scores of the patients were negatively related to preoperative and postoperative state anxiety (P = .01 and P = .000). Preoperative state anxiety was positively related to preoperative trait and postoperative state anxiety (P = .000 and P = .000).

CONCLUSIONS

The results provided more evidence that patients need education before surgery as to what to expect both in the surgical suite and immediately after surgery to alleviate anxiety. This should also improve QoR.

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.

Options to manage postcraniotomy acute pain in neurosurgery: no protocol available

The physical processes of incision, traction and hemostasis used for craniotomy, stimulate nerve fibers and specific nociceptors, resulting in postoperative pain. During the first 24 h after craniotomy, 87% of patients have postoperatory pain. The rate of suffering pain after craniotomy falls 3% for every year of life. The objective of this study is to review the available therapeutic options to help physicians treating this pain, and discuss pain mechanisms, pathophysiology, plasticity, risk factors and psychological factors. This is a narrative review of the literature from 1970 to June 2019. Data were collected by doing a search in PubMed, EMBASE, Cochrane Reviews and a manual search of all relevant literature references. The literature includes some drugs treatment: Opioids, codeine, morphine, and tramadol, anti-inflammatory non-steroids such as cyclooxygenase-2 inhibitors, gabapentin. It discusses: side effects, pharmacodynamics and indications of each drug, anatomy and Inervation of Skull and its Linigs, pathogenesis of pain Post-craniotomy, scalp nerve block, surgical nerve injury, neuronal plasticity, surgical factors and chronic post-surgical pain.

Evaluation of the joint nurse scientist role across academia and practice

BACKGROUND

Mapped with the guiding principles of academic-practice partnerships (APPs) outlined by the American Association of Colleges of Nursing and the American Organization for Nursing Leadership, a joint nurse scientist role between a nursing school and acute care facility at a large academic health center was developed and characterized by a PhD-prepared nurse appointed in a research role across organizations. To date, eight faculty are now appointed across the School and four health systems.

PURPOSE

Describe outcomes, facilitators and vulnerabilities of the joint nurse scientist role.

METHODS

Review of administrative records.

DISCUSSION

Outcomes include the 1) conduct and dissemination of joint research, 2) translation of evidence into practice, 3) development of educational programs for health system nurses, 4) scholarly activities among health system nurses, and 5) improved visibility and valuation of the PhD-prepared nurse. Role facilitators include those previously reported for APPs, the joint nurse scientists' ability to broker opportunities across settings, and the evolving nature of the role. Role vulnerabilities pertain to the negotiation of workload, promotion, and institutional priorities.

CONCLUSION

The joint nurse scientist role fosters shared scholarly successes across academia and service.