How to reduce patient anxiety before surgery
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HCA Virginia - January 19, 2018 Show
 What are you afraid of? Surgical fears rank high with adults—leading to stress and avoidance. Here are 5 things you need to know to deal with it. Being Nervous Is CommonMost people feel some uncertainty before surgery. That’s natural and even expected. When the feelings go beyond a simple case of nerves, it’s called surgical anxiety. There’s even a medical term for it: tomophobia. In extreme cases, medical fears prevent necessary or regular health care. Top Surgical FearsNot only do we all get nervous about surgery, but we’re nervous about the same things. The top fears include:
Symptoms of Surgical AnxietyWhile surgical anxiety is very common, the symptoms are unpleasant and can disrupt life before surgery, leaving you unable to relax and increasing stress. That level of anxiety can actually carry over, impacting your recovery and how you experience pain. Even if you don’t have one distinct fear, you may experience symptoms of surgical anxiety. Symptoms of surgical anxiety include:
Anxiety can be a vicious cycle as stress and physical symptoms cause sleeplessness, which in turn makes the anxiety worse. Keep reading for tips to manage anxiety—and when to get help. Calm ThyselfMany fears can be alleviated or lessened simply by seeking information. Learn about your illness, surgery, and expected recovery. Ask questions at appointments, pre-op testing, and registration. Your doctor and anesthesiologist are good sources for factual information. Tips to lessen anxiety include:
Share your FearWhen 45-year-old Kristin needed ACL reconstruction surgery, she worried about the pain involved. Watching a video of the procedure only increased her anxiety. She finally admitted her fears to her anesthesiologist, but only after he discovered her hyperventilating in a changing room. “He immediately reassured me that I would not wake up in pain,” said Kristin. “He also gave me medication right away that made me relax. Instead of fleeing, I felt like I could take a nap.” It’s essential to seek help for severe anxiety, particularly when fear causes you to consider canceling or postponing surgery, or when anxiety makes it impossible to carry on with your normal life. Talk to your surgeon, ask for support from family and friends, or find a support group for surgery or for your specific illness. Sharing your fear can be a relief and talking to others can be immensely beneficial. If your anxiety persists even after learning about your procedure and rallying support, your doctor may prescribe anti-anxiety medication and refer you to counseling. In cases where surgery can have a major impact, such as the removal of a breast or the potential loss of sight, counseling can help you cope with the changes. Most therapists can provide exercises that help control anxiety and the physical symptoms. No matter how you decide to manage, don't let stress or fear stop you from getting any necessary medical procedures. At Liverpool Heart and Chest Hospital, a few simple changes to perioperative processes have greatly enhanced the experience of patients and families. This initiative won the Surgical Nursing category in the 2018 Nursing Times Awards AbstractIn 2018, over 3,400 patients underwent cardiothoracic surgery at Liverpool Heart and Chest Hospital NHS Foundation Trust, with procedures such as coronary bypass grafts, aortic and mitral valve replacements, aneurysm repairs and lobectomies. These major interventions are daunting for patients and families but a lot can be done to reduce their stress and anxiety by making a few simple changes to perioperative processes. A project driven by the theatre matron and carried out by theatre department staff has vastly improved the experience of patients and relatives, at no extra cost and with no extra staff. Citation: Altintas F (2019) Reducing stress and anxiety in perioperative patients and families. Nursing Times [online]; 115: 8, 42-43. Author: Fiona Altintas is head of nursing for surgery and quality, Liverpool Heart and Chest Hospital NHS Foundation Trust.
IntroductionAdmission to hospital for cardiac or thoracic surgery can be daunting for patients and families, not only because of the nature of surgery but also because they are unfamiliar with theatre departments, which are sometimes perceived as functioning ‘behind closed doors’. At Liverpool Heart and Chest Hospital, by making a few changes to our perioperative processes, we have opened the doors of our theatres and, in so doing, improved the experience of patients and families, as well as the satisfaction of nursing staff. A daunting experienceLiverpool Heart and Chest Hospital NHS Foundation Trust provides specialist services in cardiothoracic surgery, cardiology, respiratory medicine and diagnostic imaging. Its catchment area of 2.8 million people spans Merseyside, Cheshire, North Wales and the Isle of Man. The communities it serves are marked by an increased prevalence of cardiovascular disease as well as higher levels of heart failure, hypertension and coronary artery disease. In 2018, more than 3,400 patients underwent cardiothoracic surgery at the hospital, involving procedures such as coronary bypass grafts, aortic and mitral valve replacements, aneurysm repairs, and lobectomies and wedge resections (most commonly for cancer). Traditionally, patients are admitted to a surgical ward at least 24 hours before surgery. They meet the surgeon and anaesthetist, who run through the procedure and tell them when they can expect to be called into theatre; patients then have to wait until the next day for the surgery to take place. If the theatre department is dealing with emergencies, the wait can be prolonged by several hours. When their turn comes, patients part from their relatives on the ward and walk into the theatre department without a familiar face at their side. Many have never been in such an environment before and perceive it as impersonal and cold. In the meantime, families face a long wait for news. They will have been given a rough idea of how long surgery will take, but if they have gone home they will have to telephone the hospital to find out whether their relative has left theatre and been transferred to the critical care unit (for cardiac surgery patients) or the ward or high-dependency unit (for patients undergoing thoracic surgery). What were our aims?Our trust’s mission is to provide excellent, compassionate and safe care for every patient, every day, and our strategic objectives include enhancing the quality of care, patient experience and staff motivation. We were aware that our traditional perioperative processes made for a poor patient experience but we also believed that, by making a few simple changes, we could hugely improve that experience and provide exemplary care that was centred around the patient and their family. Our primary aims were to:
From there we derived two secondary goals:
What changes have we made?Today, all patients receive a visit from the theatre team – comprising nurses, operating department practitioners and healthcare assistants – on the ward on the day before their surgery is due to take place. Staff explain to patients and families what they can expect in the theatre department, answer their questions, address their concerns and talk about recovery. Rotas are planned so there is a named member of staff who undertakes the pre-operative visit and is also on duty at the theatre the next day, so patients will see at least one familiar face. On the day of surgery, patients are given the opportunity to have up to two relatives (or carers or friends) accompanying them to the area where they wait before anaesthesia, so they do not have to be alone in unfamiliar surroundings. They can stay together until the last minute before the patient goes into the anaesthetic room. Immediately after the operation, theatre staff call the relatives, having previously ensured that they have a direct contact number. This means families do not have to repeatedly call the hospital, wondering how their relative is; instead, they know they will receive an update from the hospital as soon as the surgery is over. We also made changes to the pathway for vulnerable patients, such as people with learning disabilities. After having been identified at the pre-operative assessment clinic, these patients are offered a home visit by the safeguarding nurse. An individual care plan is put in place, which may involve a single room or having relatives present in the anaesthetic room. Another option is to schedule the patient’s arrival to the theatre department when all other patients are already in theatre, thereby ensuring the environment is calmer and quieter. How did we go about it?The idea originally came from the theatre matron, who also led the project. She had had a negative experience at another trust, which led her to think about how we could reduce the stress and anxiety patients and families go through. The changes involved no extra cost, no extra staff, no modifications in working patterns and no negotiations with management. We started introducing the new processes in December 2017. Staff engagement was crucial and forthcoming. Pre-operative visits started with a handful of volunteers recruited among the theatre department team. As the project grew, more staff wanted to be involved and the new processes gradually became a normal part of their roles. Today 30 members of the team are involved.
What are the next steps?The project is continually evolving as new ideas emerge. To reduce the wait before surgery, we have started offering same-day admission to patients where feasible. A member of the theatre team – usually a nurse or operating department practitioner – comes to meet the patient and their relatives in our ‘day-of-surgery admission lounge’, before taking them to the theatre department. They then accompany the patient into the anaesthetic room. We aim to have the same member of staff telephone the family once surgery is finished. Cardiothoracic surgery can be time consuming. Some operations, such as aneurysm repairs and valve replacements, can take 12 hours or more. We plan to call relatives several times during lengthy procedures to prevent them having to wait anxiously for news for hours on end. We will start to do this for procedures that last longer than six hours. The calls will be coordinated by the team member who oversees all theatres. What have we achieved?Our achievements include a better understanding, on the part of patients and families, of the journey ahead of them, including the surgical procedure. This, combined with improved support, means they are less anxious. Collaboration between theatre, wards and critical care has greatly improved and there has been a culture shift within the theatre department. Staff at the department recognise the importance of enhancing the experience of patients and families, and support them throughout their journey, making it less daunting. Staff members’ job satisfaction has increased. Verbal feedback and staff survey results show their engagement and pride in continually improving the service. Pre-operative visits are something they look forward to doing. The changes have been met with extremely positive feedback from patients and families. Often, in hospitals, wards hear back from grateful patients but theatre departments do not. At Liverpool Heart and Chest Hospital, this is no longer the case: theatre staff receive thank you cards and letters, just like ward staff. Advice for setting up similar projects
Key points
What do they give you to calm you down before surgery?Midazolam injection is used to produce sleepiness or drowsiness and relieve anxiety before surgery or certain procedures. When midazolam is used before surgery, the patient will not remember some of the details about the procedure.
How do you reassure someone before surgery?You can use these phrases to reassure your loved ones who are about to enter the operating room.. “We're in this together, I'm with you.” ... . “Take your time to rest and recover.” ... . “I'm here to help.” ... . “You're in great hands.” ... . “You're so strong, you're doing an amazing job.” ... . “My thoughts and prayers are with you.”. How do you calm down an anxiety patient?Ease patients' anxiety with a calming office environment. Offer a warm reception. When patients come in, greet them warmly with a smile. ... . Make the waiting room welcoming and comfortable. ... . Offer productive distractions. ... . Manage timeline expectations. ... . Consider a concierge. ... . Engage earnestly. ... . Preview the appointment. ... . Keep it simple.. What can help reduce a patient anxiety and post surgical pain?The results of previous studies revealed that physical therapy, music (Binns-Turner et al., 2011), psychological intervention (Scheel et al., 2014; Hansen et al., 2015), and melatonin could reduce preoperative anxiety and play a role in reducing postoperative pain.
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