ANXIETY OF PATIENTS IN THE PRE-OPERATIVE PERIOD

Rationale of the Study There are certain things that happen to specific people that are beyond ones control. These are experiences unique to individuals that others might not be able to relate on. Being afraid for instance is a subjective experience that only the person who feels it will get a story of the whole experience. Indeed, life is difficult to define just as how hard to explain some feelings of unknown causes like anxiety. There maybe several points of origin where anxiety could be derived from. In this era, several sources could make people anxious about whether it is psychological or physiological in nature. Disease is an example that creates human responses where stress could develop as a mean of adaptation to altered environmental condition and a prerequisite for responding to potential threat. Even at the earliest time men had lived, there had been chaos that occurred where health was at risk. Illnesses were everywhere where millions of lives have been inflicted with some of

the deadliest diseases. There was neither a single cure that had been made nor did medical science have done something to combat this fatal scenario. Today, in the light of global modernization comes hope through some of the greatest scientific innovations and

technological advancement. The science of medicine has been at the forefront to create remedy to several health problems of the people in such a way to lengthen or prolong their life. One of the most common procedures to date where sick people rely on is through surgery. Surgery is nonetheless the choice to get well and recovered from certain medical conditions. In fact, surgical care is an integral part of health care throughout the world, with an estimated 234 million operations performed annually. Surgery is performed in every community: wealthy and poor, rural and urban, and in all regions. The World Bank reported that in 2002, an estimated 164 million disability-adjusted life-years, representing 11% of the entire disease burden, were attributable to surgically treatable condition (Haynes et.al 2009).

In the Philippines, the need for surgery as a way to treat diseases is entirely the same. More and more people have been seeking medical treatment through surgical operation. However, some surgical procedures are done for different purposes whether be it diagnostic, curative, exploratory or palliative. In the light of the foregoing statements, curiosity seems to intervene into these situations as to what people might be thinking and feeling prior surgery. What seems to be boggling their minds knowing surgery is about to unfold. The researcher views the research topic to be very

interesting and informative because it is going to explore the level of anxiety experienced by patients who will undergo surgery in terms of knowing their temporary or current emotional state and to the long standing personality trait anxiety.

Theoretical Background/Review of Related Literature The health care team is in charge for the well-being being of the patient once admitted in the hospital. Members of the team assume many roles just to put the patient in the best condition possible.

According

to

the

nursing

theory

of

Parse

of

Human

Becoming, man is a combination of biological, psychological, sociological and spiritual factors. Every human being is unique in all aspects of life. That is why; each one has experiences that may have meanings that only the individuals would know. Anxiety is an example of an experience that a person perceives that others may not know. Anxiety is a response that prepares individuals to flee or fight danger by producing stress hormones such as cortisol and adrenaline. These hormones influence the bodies, emotions, attention and behavior (Heisler, 2011). Anxiety could take place anywhere at anytime. In this study, anxiety brought upon by the thought of surgery is a phenomenon in question. Anxiety to surgery is a psychological issue where a patients fear of surgery is so significant that they can begin to have physical symptoms such as racing heart, nausea and chest pain. This is when patient afraid of surgery dwells on their fear or begins the surgery process. Heisler added; that reasons for anxiety vary from fear of the unknown to having bad experience with previous surgeries.

However; when the source of anxiety is known like expecting surgery to happen, the patient may be feeling mixed emotions that normally do not happen. When this happens, the health care professionals have something to do also as part of the caring process. There is one theory in nursing that was developed where anxiety studies such as this can be anchored and it is called the Theory of Interpersonal Relations of Hildegard Peplau. It can be used as a guide in the plan of care to patients experiencing anxiety in the preoperative period. In her theory, she emphasized the importance to have a well established nurse-patient relationship in dealing with problems. The nurse and patient have to work collaboratively with the end purpose of meeting the patients needs. She also defined person as a developing organism that tries to reduce anxiety caused by patient need. Peplaus work has focused on other key concepts aside from anxiety such as tension, goals and frustration. In fact, her theory has been an inspiration of some researches conducted in the past. Hays D. in 1961; studied phases and steps of experimental teaching to patients of a concept of anxiety. Findings revealed that when taught by the experimental method, the patients were able

to apply the concept of anxiety. Burd. S.F on the other hand; developed and tested a nursing intervention framework for working with anxious patients. Preoperative anxiety and stress are common in patients awaiting surgical procedures. In particular, anxiety of post

operative pain, intra-operative awareness, waiting for operation is common anxieties in the preoperative period (Wetsch, et.al 2009). Patients may have various kinds of anxiety however; much of their psychological burdens are unknown. This has paved a way for researcher to investigate on patients anxiety prior surgery. Wetsch investigated anxiety with questionnaire prior to operation and analyzed them according to their anesthetic method, type of surgery and age. Findings of the study revealed that anxiety varied depending on the history of anesthesia, anesthetic method

previously received and age. The type of surgery and age of the patients have had significant difference too on the intensity of anxiety and preconceived pain of surgery causing patients to be anxious. There studies on the other hand where having the right information before the surgery could reduce anxiety. Researcher Kiyohara L.Y evaluated anxiety levels on the day before surgery as

related to the information known by the patient regarding the diagnosis, surgical procedure and anesthesia. It was found out that unfamiliarity with the surgical procedure raised state-anxiety levels and conclusion was made that increased knowledge of patients regarding the surgery that are about to undergo may reduce their state-anxiety levels. As previously stated, two of the objectives of the study are to determine the state and trait anxiety of patients. The concepts of these anxieties were first introduced by Cattell and have been elaborated by Spielberger. Anxiety states are characterized by subjective feelings of tension, apprehension, nervousness and by the arousal of the autonomic nervous system. Anxiety states are often transitory and can recur when evoked by appropriate stimuli; however, anxiety may be prolonged if the evoking conditions persist (JCZ Lui, 1999). In contrast, a personality trait is a relatively enduring characteristic that relates to an individuals perception of the world and disposition to react or behave in a certain manner with predictable regularity. Having an anxious personality trait can be considered a consistent feature of a person. According to Lui study in 1999, such

a person will likely become anxious easily and to experience an anxiety state when faced with ordinary difficulties. An individual who is not usually anxious, however, may experience only transient episodes of anxiety whenever a stressful situation has to be faced, he added. Hence, he concluded that the level of anxiety one feels at a given moment (anxiety state) is determined both by an individuals personality (anxiety trait) and by how stressful the situation is. It has been further implied that the important role of anxiety in disrupting the well being of an individual is demonstrated by its relationship with both physical and psychological health. The conventional view of the stress-illness relationship is that extensive bodily changes can result from stress-generated emotions such as anxiety.

Statement of the Problem This study is going to explore the preoperative levels of anxiety of patients. It seeks to answer the following questions: 1. What are the socio-demographic characteristics of the patients?

2. What is the level of anxiety of patients before surgery (state anxiety) and their level of personality trait anxiety? 3. What is the overall anxiety of patients?

Hypothesis There is no significant difference between state anxiety and personality anxiety.

Significance of the Study Although there have been numerous studies about anxiety in various settings, few have been conducted in the clinical setting especially using this tool to measure anxiety. In addition, the exploration of the levels of anxiety to pre-operative patients has never been that much too to somehow establish baseline data about this matter. Furthermore, there is currently no report on this subject in Kabacan, where this study will be conducted. This study would be beneficial to the following: Patients: the results of this study could become baseline

information to them that there are certain levels of anxiety which can be beneficial while some are no longer good. At times the anxiety that people experience can be so overwhelming and

disabling that they can no longer lead normal lives. Although in this case, it is normal for patients to feel anxious prior to surgery but when anxiety becomes too severe, lasts too long or is triggered easily, then there might be other underlying conditions that may be needing attention instead. Health Care Professionals- the results of this study could help surgeons, nurses, and other members of the health team to initiate relaxation measures in order to relieve the anxiety of patients. The findings of the State-Trait Anxiety Inventory in particular has been very useful for the health professionals as a tool for clinical diagnosis, to help differentiate anxiety from depression, for psychological and health research; and for the assessment of clinical anxiety in clients in medical, surgical and psychiatric patients ( Mindgarden, 2008 ).

Methodology Research Design

Research Environment The University of Southern Hospital is

Research Subjects The respondents of the study will be patients of the University Hospital preparing for surgery regardless of sex, race and religion. To be participants in this study; patients will be 18 in age at least and must have secured informed consent. Those with previous surgeries are still eligible to be part of the study. Research Instrument This study will be using the State Trait Anxiety Inventory (STAI) as a survey tool to measure anxiety of patients in the preoperative period. The STAI was developed by Spielberger in 1970 and its present version was revised in 1983. This version is used to measure anxiety in adults. The STAI has two parts: the State Anxiety Inventory (SAI) and the Trait Anxiety Inventory (TAI). The former part measures situational anxiety while the latter measures baseline anxiety; each part consists of 20 items using a four-point scale (1, not at all/almost never; 2,

somewhat/sometimes; 3, moderately so/often; 4, very much so/almost always). Before patients are going to answer the STAI, part of the survey tool will also be asking for the socio-demographic

characteristics of the patients such as age, gender, type of surgery, previous surgery; if applicable and anesthetic method.

Research Procedure The questionnaire will be given to the patients not less than 3 hours but not more than 24 hours before the surgery. The researcher is therefore would have already checked by then on who will be scheduled for surgery within the inclusion criteria on the time frame given. At least 20 patients shall be used as respondents from the months slated for this study; starting May until July 2011. The researcher should also check that upon return of the questionnaire, all items have been answered by the

respondents. Statistical analysis will be performed for the STAI. The Pearson correlation coefficient (r) will be administered to explore the relationship of the SAI and TAI for the respondents.

Definition of Terms

Anxiety: an unpleasant emotional

arousal in anticipation of

threatening situations, demands, or dangers, not including anxiety as a mental disorder or illness. Preoperative: the period of which patient has been admitted in the hospital for at least 3 hours before the surgery but not more than 24 hours. State anxiety: current emotion, dependent on the individual experience of a dreadful situation. Trait anxiety: the baseline tendency to respond to anxiety related to the individual personality. It refers to individual differences in reactions.