Documente Academic
Documente Profesional
Documente Cultură
Purpose
Quality improvement project
Mixed Methods
Assessed the effect of a NP/MD team approach
to Perioperative Care on Post-operative
Anxiety among neurosurgical patients.
Background
Donker et al. (2012) study in Netherlands
showed a preoperative NP had a significant
effect on alleviating anxiety of vascular surgery
patients
Background
Preoperative anxiety can influence
postoperative outcomes
Higher levels of immediate post-op pain
Predictor of chronic pain
Immune response and healing
(Vaughn, Wichowski, & Bosworth, 2007)
(Theunissen, Peters, Bruce, Gramke &
Marcus, 2012)
(Horowitz, Neeman, Sharon & Ben-Eliyahu,
2015).
Anxiety
DSM-V defined as anxiety as anticipation of
future threat
Trait anxiety
Characteristic of person
Anxiety
Presurgical Psychological Screening tools
MMPI
Used to identify ideal surgical candidates
Continuity of Care
Anxiety can be alleviated through continuity of
care
Evidence
Midwifery care
Couples undergoing fertility treatment to have
provider throughout the entire continuum of care
Methods
IRB
Submitted to Emory University IRB and
Piedmont IRB
Project
Aim
Sample
Size
Eligible
patients
26 enrolled
20 completed
Data Collected
Gender
Age
Self admitted past medical history of anxiety/depression
Antidepressant or anti-anxiolytic medication use
Tobacco use
Alcohol use
Preoperative time
Interactions with NP
Methods
Administer STAI
Pre-op appoint
Normal preoperative
appointment
Perioperative period
Intraoperative
Immediate post-op
Post-op
STAI
Post-operative Survey
Many people express anxiety or concern prior to
surgery. If you expressed anxiety or concern prior to
surgery, please describe the factors that may
contribute to your anxiety or concern.
Mixed Methods
Quantitative
Data
Qualitative
Data
STAI
Causes &
Relief of
Anxiety
Patient
Characteristic
s&
Satisfaction
Content
analysis
Time spent
with NP
Analyzed by
SPSS
Results
Enrolled
Private neurosurgical practice
Underwent cervical or lumbar surgery
26 enrolled
20 completed
Quantitative Findings
Patient Characteristics
55.5 years
70% female
No tobacco
45% average
ETOH
20% preexisting
dx of
anxiety/depressio
n
15% on
medication
STAI Results
Significance
Paired t-test
A p-value of < .05 statistically significant
STAI Y1
p-value .011
STAI Y2
p-value .028
Effect Size
Cohens D for effect size
STAI Y1
0.63 or moderate to large effect size
STAI Y2
0.53 or moderate effect size
NP Pre-Op Time
Pearson Correlation of >0.3 or positive
correlation of decrease in pre to postoperative
STAI scores and time spent in pre-operative
appointment with NP
Qualitative Findings
Qualitative Data
Cause of Anxiety
Fear of the unknown
Concerns regarding pain
Knowledge deficit
Others reaction to surgery
Causes of Anxiety
Interrelated
Pain
Knowledge
Deficit
Others
reaction
Relief of Anxiety
NP/MD team
Education
Faith
Education
Faith
getting as much information/details
about what to expect after surgery from
the NP, MD
While I was concerned about my
surgery I knew that I had the BEST
surgical team in the country. MD
reputationand the care and kindness I
received from him and NP diminished
my concerns
My conversations with NP helped to
calm my nerves and answer my
questions
Discussion
Summary of Findings
Statistically significant decrease in Post-op STAI
scores
Correlated with the time the NP spent in the
preoperative appointment.
Strengths
Provided evidence for quality improvement of
anxiety in this setting
Limitations
Small sample size
Not generalizable as expected with QI projects
Clinical significance
Continuity of care
Importance of provider providing the care
Back school through RN, PT should not be a
substitute for the provider
Further Implications
NP worth in a surgical setting to decrease
anxiety during the perioperative period and is
valuable member of the team
References
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References
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