PREOPERATIVE TEACHING CLINIC

EFFECTS ON
SURGICAL ANXIETY REDUCTION:

TO ASSESS THE EFFICACY OF A

SURGICAL ORIENTATION
VIDEO IN DECREASING
PREOPERATIVE ANXIETY
Richard D. Kuylen, RN, BSN
Lallie Kemp Medical Center
Independence, Louisiana
 PREOPERATIVE ANXIETY
 Anxiety and pain – subjective elements of the patient
experience

 Can result in an increase in the levels of patients’

experience of pain, which usually requires management
through analgesia

 Can adversely influence anesthetic induction and patient

recovery

 Decrease patient satisfaction with the perioperative

experience
OPPORTUNITY STATEMENT

Participation in a Preoperative Teaching

Clinic, on a day prior to scheduled
surgery, will significantly decrease
preoperative anxiety and facilitate a
smooth transition through the surgical
process for patients, family members and
operating room staff.
 EXCESSIVE
PREOPERATIVE ANXIETY

 Can lead to pathopysiological responses:

* tachycardia
* hypertension
* arrhythmia
* higher levels of pain that may persist
into the postoperative period
PREOPERATIVE EDUCATION

 The process of informing clients about their

condition, surgery and postoperative care
 Prepare patients for surgery and help them to
manage their care postoperatively
 Key to decreased complications and readmission;
thus, improving cost effectiveness
 GOALS OF PREOPERATIVE
EDUCATION
 Provide the means for patients to participate in
treatment decisions with full understanding of factors
relevant to their proposed care
 Decrease potential complications through patient
education and family involvement
 Improve postoperative recovery
 Reduce surgical anxiety
 Mold attitudes regarding surgery, staff and the facility
 Clear up misconceptions and inaccurate information
 Address questions and concerns
 Provide emotional support
 Provide thorough and accurate information to patient
and family
 Facilitate smooth flow of surgery schedule
 METHODS/FORMAT OF
PREOPERATIVE EDUCATION

 One to one instruction

 Demonstrations

 Printed materials

 Videotapes
 STANDARD PREOPERATIVE
EDUCATION

 Involves the use of verbal instructions by

physicians and nurses

 Often delivered during a brief session prior to

the day of surgery

 Patient memory of instructions often

inadequate due to anxiety and feelings of
uncertainty
 PREOPERATIVE VIDEOTAPED
INSTRUCTION

 Enhances learning
in patients with low
literacy skills

 Beneficial for
elderly patients who
have difficulty reading
small printed
documents
 LITERATURE REVIEW
 Patients scheduled for surgery have increased
anxiety and fear of the unknown
 Preoperative period is the time when most
patients experience significant fear regarding
surgery, complications and level of recovery
 The more informed and better prepared patients
are about what to expect during the surgical
experience, the less anxious they tend to be
 Efficient organization and utilization of
resources available in a preoperative clinic results
in cost savings via reduction in operating room
delays
 LITERATURE REVIEW
(Cont’d)

 Preoperative teaching clinics improve efficiency

in admission and screening of patients
 Preoperative teaching programs foster :
decreased length of stay
* less demand for postoperative analgesic
* quicker recovery from surgery
* decreased infection rate
* decreased anxiety
 THEORY-PRACTICE GAP

 A Theory-Practice gap identified

 Preoperative education benefits along with cost
effectiveness to institutions and patients are well
documented through years of research
 Many facilities have no formal policy or program
for providing structured education
 Thus, many patients arrive the morning of surgery
very anxious and poorly informed
 Organizational Framework
 Patient presents to Medicine Clinic or Emergency
Room with a complaint/symptom
 Patient referred to Surgery Clinic for surgical
evaluation if clinically indicated
 Surgery scheduled with OR staff based on
surgeon’s evaluation/recommendation
 Patient provided appointment to Preoperative
Teaching Clinic on a day prior to scheduled
surgery
 Family and friends involved in postoperative care
encouraged to attend preoperative education
 Aim/Purpose of Project
 Aim of project:
* Promote awareness of benefits and effectiveness of a
Preoperative Teaching Clinic
* Encourage development of a Surgical Orientation
Video in other LSU Hospitals
 Purpose of study:
* To evaluate the effectiveness of a preoperative surgical
orientation video in decreasing anxiety in patients
scheduled for surgery with general anesthesia
 Surgical Orientation Video, developed at Lallie Kemp
Medical Center, walks a patient through the surgical
process from admit through discharge.
 By viewing video, patient sees many nurses and
anesthesia personnel that will provide care morning of
surgery, along with some monitoring equipment used
PREOPERATIVE TEACHING
CLINIC VISIT
 Intervention group (n=13) – views a
preoperative surgical orientation video and
receives surgery-specific preoperative education
 Control group (n=17)– receives standard
preoperative education without viewing the
orientation video
 Surgery and anesthesia-related anxiety
evaluated by using a quantitative scale of
preoperative anxiety before and after
implementing preoperative education and viewing
the preoperative video
 RESEARCH DESIGN
 Two - group, pretest / posttest research design
 Determine significant difference in anxiety
levels between:
* group that received standard preoperative
education (control group)
* group that received standard preoperative
education, along with viewing the surgical
orientation video (intervention group)
 Sample size : 30 patients (n=30) *
randomly assigned to either *
intervention or control group
 HYPOTHESIS
 The intervention group that also views the video
will have less preoperative anxiety than the control
group that does not view the video

 The intervention group will have decreased anxiety

after preoperative teaching is implemented

 The control group will also have decreased anxiety

after preoperative teaching is implemented

 There will be no difference in anxiety between the

two groups prior to preoperative teaching
 METHODOLOGY
 Principal Investigator (PI) obtained approval to conduct
study from the following authorities:
* Institution Compliance liaison and privacy officer
* LSU HCSD Office of Research and Development
* Institution Medical Executive Committee
 Institutional Review Board of Southeastern Louisiana
University (SLU) also granted permission
 Population consisted of patients seen in the surgery clinic
at a LSU HSC Lallie Kemp Medical Center
 METHODOLOGY
(Cont’d)
 Patients evaluated in the surgery clinic and
scheduled for surgery

 Patients scheduled for preoperative teaching

clinic visit for surgery and anesthesia education,
on a day prior to surgery

 Family members involved in postoperative care

encouraged to attend preoperative education
CRITERIA FOR INCLUSION
IN STUDY

English - speaking patient

Between the ages of 21 and 65
Basic Literacy (able to read and understand)

First 30 that met criteria were randomly assigned to:

** intervention group -13 **
** control group - 17 **
 SETTING
 Preoperative Teaching Clinic at Lallie Kemp Medical
Center in Independence, Louisiana

 Patients provided scheduled appointment to see the

preoperative teaching nurse when discharged from the
surgery clinic

 Focus on anxiety reduction through surgery - specific

preoperative education

 Preoperative Surgical Orientation Video viewed after

preoperative education implemented

 Krames color illustrated surgical literature used to

facilitate preoperative education
 INSTRUMENTATION
 Amsterdam Preoperative Anxiety and Information Scale
(APAIS)
 Anxiety Scale *
consists of 4 questions (1, 2, 4, 5) * each
question scores from 1 to 5 * score is the
sum of the four questions, ranging from 4 to 20
 Subscales *
anesthesia-related anxiety (Sum A=1+2) * surgery-
related anxiety (Sum S=4+5) * combined
anxiety component Sum C=Sum A +Sum
S=1+2+4+5
 Scale also includes an information desire component (3+6)
 AMSTERDAM PREOPERATIVE ANXIETY &
INFORMATION SCALE
CRONBACH’S CALCULATED ALPHA ESTIMATES
FOR ANXIETY COMPONENTS

 For Anesthesia - Related Anxiety (Alpha.779)

 For Surgery - Related Anxiety (Alpha .848)
 For Combined -Anesthesia Component (Alpha .810)
 For Information - Desire Component (Alpha .730)

 * Findings confirm the internal consistency and reliability of the

measurements
 * Results also confirm the scales validity for use in preoperative
anxiety assessment
 DATA ANALYSIS & CALCULATIONS
SPSS PROGRAM
 Demographic data
* Gender
* Age
* Educational level
* Frequencies and percentages of responses

 T- test for differences between control and

intervention groups on anxiety
* Independent t-test - compares across group
means
* Paired t-test – compares pre- and posttest
scores across each group
 RESULT
EXPERIMENTAL 2-GROUP PRETEST-
/POSTTEST DESIGN

 PURPOSE – to determine if significant anxiety exists

between the control and intervention groups
 SAMPLE – 30 patients (n=30) scheduled for elective
surgery with general anesthesia
> Randomly assigned to either :
* control group (n=17)
* intervention group (n=13)
> Gender Frequency
* Males (n=11) 36.7%
* Females (n=19) 63.3%
* Age range: 21 – 62 years (m=44.4years)
> Educational level
* Less than high school – 23 % (n=7)
* High school graduate - 70 % (n=21)
* Post high school - 7% (n=2)
 HYPOTHESIS I
 Intervention group will have less preoperative anxiety than
the control group after preoperative teaching is
implemented
* Independent sample t- test – conducted to evaluate
hypothesis
* Post t- test – all p- values greater than .05

 Not enough evidence to say that the means are different at

the 95% confidence level

 However, pre-test means in the Intervention group were

higher in all categories than pre-test means in Control
group

 Hypothesis I is not supported

 HYPOTHESIS II
 Intervention group will have decreased anxiety after
preoperative teaching is implemented

 Paired t- test analysis results (p-value)

* anesthesia related anxiety - 0.006
* surgery related anxiety - 0.002
* information desire component - 0.001
* combined anxiety component - 0.003
 P- values less than 0.05 – There is enough evidence to say
that the means are different at 95% confidence

 Hypothesis II is supported
 HYPOTHESIS III
 The control group will have decreased anxiety after
implementation of preoperative teaching

 Control group t- test results (p- value)

* anesthesia related anxiety - 0.227 ( > .05)
* surgery related anxiety - 0.039 ( < .05)
* information desire component - 0.005 ( < .05)
* combined anxiety component - 0.037 ( < .05)
 Not enough evidence to say that means are different at
95% confidence for anesthesia related anxiety
 With 95% confidence, there is not enough evidence to say
that the means are equal in all other anxiety components

 Hypothesis III is partially supported

 HYPOTHESIS IV
 There will be no difference in anxiety between the two
groups prior to preoperative teaching

 Independent sample t-test results (p-value)

 * anesthesia-related anxiety - 0.014 ( < .05 )
* combined anxiety component - 0.024 ( < .05 )
* surgery-related anxiety - 0.320 ( > .05)

 T-test at pre-measure significantly higher in one out of

three measures

 Pre-test means higher in all components in the intervention

group than in the control group

 Hypothesis IV is not supported

 DISCUSSION/CONCLUSION
 Participation in a Preoperative Teaching Clinic prior to
surgery can significantly decrease preoperative anxiety as
evident in this small pilot study

 Intervention group: significant decrease in mean anxiety

between pre and post test analysis for :
* anesthesia-related anxiety (p= 0.006)
* surgery-related anxiety (p= 0.002)
* information desire component (p= 0.001)
* combined anxiety component (p= 0.003)
 DISCUSSION
(Cont’d)
 Control group: significant decrease with preoperative
education for :
 * surgery-related anxiety (p= 0.039)
* information desire component (p= 0.005)
* combined anxiety component (p= 0.037)
 No significant reduction in mean anesthesia-related anxiety
(p=0.227) shown in the control group compared to
intervention group (p=0.006) with preoperative education.
Video includes section where Anesthesiologist speaks with
patient prior to surgery
 Perhaps this decreased anxiety in this group!
 Pilot study showed no significant difference in
preoperative education with addition of surgical orientation
video as evidenced by independent samples t-test for post
test between groups (Table 2).
 Systems Impacted
 The LSU HCSD system could benefit from
results of this pilot study by improving
preoperative education or developing
preoperative teaching clinics
 Preoperative Surgical Orientation Videos
specific to each hospital could also facilitate
preoperative education
Since this was a small pilot study
conducted in a rural hospital that
caters to a mostly indigent
population, future research is
indicated to assess the
Preoperative Surgical Orientation
Video’s effects on anxiety
reduction. Larger studies in
multiple, non-profit and private
hospitals would increase the
validity of the findings.