Document Type : Original Article

Authors

1 Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Golestan, Iran

2 Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

3 Gorgan, Golestan, Iran, 1 Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Golestan, Iran

Abstract

BACKGROUND: Anxiety is the most common health problem and the second leading cause of
disability worldwide. Patients undergoing surgery often experience anxiety. It is necessary to use
appropriate interventions to achieve the best results. The aim of this study is to develop, implement,
and evaluate of anxiety management program for gynecological surgery patients under spinal
anesthesia.
MATERIALS AND METHODS: This participatory action research will be conducted through four
phases; problem identification, planning, action, and evaluation phases in the Gonbad‑e‑Kavous
Shahada, hospital in northeastern of Iran. These phases will be guided based on the Promoting
Action on Research Implementation in Health Services framework. Participants will be included using
purposive sampling method. We will use both of qualitative (semi‑structured interview, observation)
and quantitative (questionnaire) approaches for data collection through the study.
CONCLUSION: For anxiety management of patients, context‑based interventions should be
performed. Combination of multidimension approach based on health‑care providers, patients, and
environment will have an effect to solve the problem in the clinical setting.

Keywords

  1. Eberhart L, Aust H, Schuster M, Sturm T, Gehling M, Euteneuer F,
    et al. Preoperative anxiety in adults – A cross‑sectional study on
    specific fears and risk factors. BMC Psychiatry 2020;20:140.
    2. Laufenberg‑Feldmann R, Kappis B. Assessing preoperative
    anxiety using a questionnaire and clinical rating: A prospective
    observational study. Eur J Anaesthesiol 2013;30:758‑63.
    3. Celik F, Edipoglu IS. Evaluation of preoperative anxiety and fear
    of anesthesia using APAIS score. Eur J Med Res 2018;23:41.
    4. Hobson JA, Slade P, Wrench IJ, Power L. Preoperative anxiety
    and postoperative satisfaction in women undergoing elective
    caesarean section. Int J Obstet Anesth 2006;15:18‑23.
  2. 5. Labrague LJ, McEnroe‑Petitte DM. Influence of music on
    preoperative anxiety and physiologic parameters in women
    undergoing gynecologic surgery. Clin Nurs Res 2016;25:157‑73.
    6. Pokharel K, Bhattarai B, Tripathi M, Khatiwada S, Subedi A.
    Nepalese patients’ anxiety and concerns before surgery. J Clin
    Anesth 2011;23:372‑8.
    7. Webster F, Bremner S, McCartney CJ. Patient experiences as
    knowledge for the evidence base: A qualitative approach to
    understanding patient experiences regarding the use of regional
    anesthesia for hip and knee arthroplasty. Reg Anesth Pain Med
    2011;36:461‑5.
    8. Bae I, Lim HM, HurMH, LeeM. Intra‑operative music listening for
    anxiety, the BIS index, and the vital signs of patients undergoing
    regional anesthesia. Complement Ther Med 2014;22:251‑7.
    9. Hu P, Harmon D, Frizelle H. Patient comfort during regional
    anesthesia. J Clin Anesth 2007;19:67‑74.
    10. Arakelian E, Laurssen E, Öster C. Older patients’ worries in
    connection with general anesthesia and surgery – A qualitative
    study. J Perianesth Nurs 2018;33:822‑33.
    11. Ortiz J, Wang S, Elayda MA, Tolpin DA. Preoperative patient
    education: Can we improve satisfaction and reduce anxiety?. Rev
    Bras Anestesiol 2015;65:7‑13.
    12. Lee WP, Wu PY, Lee MY, Ho LH, Shih WM. Music listening
    alleviates anxiety and physiological responses in patients
    receiving spinal anesthesia. Complement Ther Med 2017;31:8‑13.
    13. Ilkkaya N, Ustun F, Sener E, Kaya C, Ustun Y, Koksal E, et al.
    The effects of music, white noise, and ambient noise on sedation
    and anxiety in patients under spinal anesthesia during surgery.
    J Perianesth Nurs 2014;29:418‑26.
    14. Lee CH, Liu JT, Lin SC, Hsu TY, Lin CY, Lin LY. Effects of
    educational intervention on state anxiety and pain in people
    undergoing spinal surgery: A randomized controlled trial. Pain
    Manag Nurs 2018;19:163‑71.
    15. Waterman H, Tillen D, Dickson R, De Koning K. Action research:
    A systematic review and guidance for assessment. Health Technol
    Assess (Winchester, England) 2001;5:3.
    16. Battistella G, Berto G, Bazzo S. Developing professional habits
    of hand hygiene in intensive care settings: An action‑research
    intervention. Intensive Crit Care Nurs 2017;38:53‑9.
    17. McNiff J. Action Research: Principles and Practice. London:
    Routledge; 2013.
    18. Wimpenny K. Using participatory action research to support
    knowledge translation in practice settings. Int J Pract Based Learn
    Health Soc Care 2013;1:3‑14.
    19. Harvey G, Kitson A. Implementing Evidence‑Based Practice in
    Healthcare: A Facilitation Guide. London: Routledge; 2015.
    20. Seers K, Rycroft‑Malone J, Cox K, Crichton N, Edwards RT,
    Eldh AC, et al. Facilitating Implementation of Research
    Evidence (FIRE): An international cluster randomised controlled
    trial to evaluate two models of facilitation informed by the
    Promoting Action on Research Implementation in Health
    Services (PARIHS) framework. Implement Sci 2018;13:137.
    21. Skene C, Gerrish K, Price F, Pilling E, Bayliss P. Developing
    family-centred care in a neonatal intensive care unit: An action
    research study protocol. J Adv Nurs 2016;72:658‑68.
    22. Abad - Corpa E, Meseguer - Liza C ,
    Martínez - Corbalán JT, Zárate - Riscal L ,
    Caravaca-Hernández A, Paredes-Sidrach de Cardona A, et al.
    Effectiveness of the implementation of an evidence-based nursing
    model using participatory action research in oncohematology:
    Research protocol. J Adv Nurs 2010;66:1845‑51.
    23. Moreno‑Poyato AR, Delgado‑Hito P, Suárez‑Pérez R,
    Leyva‑Moral JM, Aceña‑Domínguez R, Carreras‑Salvador R,
    et al. Implementation of evidence on the nurse‑patient relationship
    in psychiatric wards through a mixed method design: Study
    protocol. BMC Nurs 2017;16:1.
    24. Spradley JP. Participant Observation. USA. Waveland Press; 2016.
    25. Poland F, Spalding N, Gregory S, McCulloch J, Sargen K, Vicary P.
    Developing patient education to enhance recovery after colorectal
    surgery through action research: A qualitative study. BMJ Open
    2017;7:e013498.
    26. Valiee S, Bassampoor S, Nikbakht Nasrabadi AR, Mehran A,
    Poresmaei Z. Assessment the synergism effect of acupoints on
    preoperative anxiety. Payesh (Health Monitor) 2010;9:279‑88.
    27. Lopes D, Baena M, Rosângela H. The role of the clinical nurse
    specialist in caring for patients with prostate cancer: A narrative
    review. Nurs Res Rev 2014;4:77‑89.
    28. Onwuegbuzie AJ, Leech NL, Collins KM. Qualitative analysis
    techniques for the review of the literature. Qual Rep 2012;17:56.
    29. Uysal Aİ, Altıparmak B, Güner Ö. The effect of an informative
    leaflet on preoperative anxiety and patient’s knowledge of
    anesthesia and anxiety. J Clin Anal Med 2017;8:370‑4.
    30. Fitzgerald BM, Elder J. Will a 1‑page informational handout
    decrease patients’ most common fears of anesthesia and surgery?
    J Surg Educ 2008;65:359‑63.
    31. Lemos MF, Lemos‑Neto SV, Barrucand L, Vercosa N, Tibirica E.
    Preoperative education reduces preoperative anxiety in cancer
    patients undergoing surgery: Usefulness of the self‑reported beck
    anxiety inventory. Rev Bras Anestesiol 2019;69:1‑6.
    32. Cakmak M, Kose I, Zinzircioglu C, Karaman Y, Tekgul ZT,
    Pektas S, et al. Effect of video‑based education on anxiety and
    satisfaction of patients undergoing spinal anesthesia. Rev Bras
    Anestesiol 2018;68:274‑9.
    33. Dias R, Baliarsing L, Barnwal NK, Mogal S, Gujjar P. Role of
    pre‑operative multimedia video information in allaying anxiety
    related to spinal anaesthesia: A randomised controlled trial.
    Indian J Anaesth 2016;60:843‑7.
    34. Jlala HA, French JL, Foxall GL, Hardman JG, Bedforth NM. Effect
    of preoperative multimedia information on perioperative anxiety
    in patients undergoing procedures under regional anaesthesia.
    Br J Anaesth 2010;104:369‑74.
    35. Akhlaghi F, Azizi S, Malek B, Mahboubi F, Shams S,
    Karimizadeh M. Effect of preoperative anesthesia consultation on
    decreasing anxiety in patients undergoing oral and maxillofacial
    surgery. J Dent (Shiraz) 2020;21:102‑5.
    36. Sadati L, Pazouki A, Mehdizadeh A, Shoar S, Tamannaie Z,
    Chaichian S. Effect of preoperative nursing visit on preoperative
    anxiety and postoperative complications in candidates for
    laparoscopic cholecystectomy: A randomized clinical trial. Scand
    J Caring Sci 2013;27:994‑8.
    37. Medina‑Garzón M. Effectiveness of a nursing intervention to
    diminish preoperative anxiety in patients programmed for knee
    replacement surgery: Preventive controlled and randomized
    clinical trial. Invest Educ Enferm 2019;37:e07.
    38. Acar K, Aygin D. Efficacy of guided imagery for postoperative
    symptoms, sleep quality, anxiety, and satisfaction regarding
    nursing care: A randomized controlled study. J Perianesth Nurs
    2019;34:1241‑9.
    39. Choubsaz M, Rezavand N, Bayat A, Farhadi K, Amirifard N.
    Comparison between the effect of ear plug and music in reducing
    anxiety in patients undergoing elective cesarean section under
    spinal anesthesia. Kuwait Med J 2018;50:37‑42.
    40. Kukreja P, Talbott K, MacBeth L, Ghanem E, Sturdivant AB,
    Woods A, et al. Effects of music therapy during total knee
    arthroplasty under spinal anesthesia: A prospective randomized
    controlled study. Cureus 2020;12:e7396.
    41. Hepp P, Hagenbeck C, Gilles J, Wolf OT, Goertz W, Janni W,
    et al. Effects of music intervention during caesarean delivery on
    anxiety and stress of the mother a controlled, randomised study.
    BMC Pregnancy Childbirth 2018;18:435.
    42. Moon JS, Cho KS. The effects of handholding on anxiety in
    cataract surgery patients under local anaesthesia. J Adv Nurs
    2001;35:407‑15.
    43. Anuja B, Devi ES, Sequira L, Rao L, Pai VH. Effectiveness of intra operative hand holding on anxiety and physiological parameters
    among patients undergoing cataract surgery. Nitte Univ J Health
    Sci 2014;4:27‑32.
    44. Kim BH, Kang HY, Choi EY. Effects of handholding and providing
    information on anxiety in patients undergoing percutaneous
    vertebroplasty. J Clin Nurs 2015;24:3459‑68.
    45. Abadi F, Abadi F, Fereidouni Z, Amirkhani M, Karimi S,
    Najafi Kalyani M. Effect of acupressure on preoperative cesarean
    section anxiety. J Acupunct Meridian Stud 2018;11:361‑6.
    46. Dagli R, Avcu M, Metin M, Kiyma S, Ciftci H. The effects of
    aromatherapy using rose oil(Rosa damascena Mill.) on preoperative
    anxiety: A prospective randomized clinical trial. Eur J Integr Med
    2019;26:37‑42.
    47. Fayazi S, Babashahi M, Rezaei M. The effect of inhalation
    aromatherapy on anxiety level of the patients in preoperative
    period. Iran J Nurs Midwifery Res 2011;16:278‑83.
    48. HurY, WooJJ, AhnH. Anxiety relief effects of non‑pharmacological
    intervention on patients under local anesthesia. Int J Biosci
    Biotechnol 2016;8:323‑36.
    49. Sahin G, Basak T. The effects of intraoperative progressive muscle
    relaxation and virtual reality application on anxiety, vital signs,
    and satisfaction: A randomized controlled trial. J Perianesth Nurs
    2020;35:269‑76.
    50. Yamashita Y, Shimohira D, Aijima R, Mori K, Danjo A. Clinical
    application of virtual reality to alleviate anxiety during oral
    surgery under local anesthesia. J Oral Maxillofac Surg Med Pathol
    2020;32:441‑4.
    51. Hamester L, Souza EN, Cielo C, Moraes MA, Pellanda LC.
    Effectiveness of a nursing intervention in decreasing the anxiety
    levels of family members of patients undergoing cardiac
    surgery: A randomized clinical trial. Rev Lat Am Enfermagem
    2016;24:e2729.
    52. Niknejad R, Mirmohammad‑Sadeghi M, Akbari M, Ghadami A.
    Effects of an orientation tour on preoperative anxiety in candidates
    for coronary artery bypass grafting: A randomized clinical trial.
    ARYA Atheroscler 2019;15:154‑60.
    53. Yuzkat N, Soyalp C, Turk O, Keskin S, Gulhas N. Effects of
    showing the operating room on preoperative anxiety and
    hemodynamics among patients with hypertension: A randomized
    controlled trial. Clin Exp Hypertens 2020;42:553‑8.
    54. Kacem I, Kahloul M, El Arem S, Ayachi S, Hafsia M, Maoua M,
    et al. Effects of music therapy on occupational stress and burn‑out
    risk of operating room staff. Libyan J Med 2020;15:e1768024.
    55. Jenkins BN, Fortier MA, Stevenson R, Makhlouf M, Lim P,
    Converse R, et al. Changing healthcare provider and parent
    behaviors in the pediatric post-anesthesia-care-unit to reduce
    child pain: Nurse and parent training in postoperative stress.
    Pediatr Anesth 2019;29:730‑7.
    56. Martin SR, Chorney JM, Tan ET, Fortier MA, Blount RL, Wald SH,
    et al. Changing healthcare providers’ behavior during pediatric
    inductions with an empirically based intervention. J Am Soc
    Anesthesiol 2011;115:18‑27.
    57. Park SH, MattsonRH. Ornamental indoor plants in hospital rooms
    enhanced health outcomes of patients recovering from surgery.
    J Altern Complement Med 2009;15:975‑80.
    58. Eminovic S, Vincze G, Fink A, Fischerauer SF, Sadoghi P,
    Leithner A, et al. Positive effect of colors and art in patient
    rooms on patient recovery after total hip or knee arthroplasty:
    A randomized controlled trial. Wien Klin Wochenschr
    2021;134(5):221-6. [doi: 10.1007/s00508‑021‑01936‑6].
    59. AtashzadehShourideh F, Hassani P. Action research: A way to
    improving quality nursing practice. Iran J Nurs Res 2009;6:48‑56.
    60. Kemmis S, McTaggart R, Nixon R. The Action Research Planner:
    Doing Critical Participatory Action Research. Singapore: Springer
    Science & Business Media; 2013.
    61. Kwong EW, Hung MS, Woo K. Improvement of pressure ulcer
    prevention care in private for‑profit residential care homes: An
    action research study. BMC Geriatr 2016;16:192.
    62. Assarroudi A, Heshmati Nabavi F, Armat MR, Ebadi A,
    Vaismoradi M. Directed qualitative content analysis: The
    description and elaboration of its underpinning methods and
    data analysis process. J Res Nurs 2018;23:42‑55.
    63. Graneheim UH, Lundman B. Qualitative content analysis in
    nursing research: Concepts, procedures and measures to achieve
    trustworthiness. Nurse Educ Today 2004;24:105‑12.
    64. Polit DF, Beck CT. Essentials of Nursing Research: Appraising
    Evidence for Nursing Practice. USA: Lippincott Williams &
    Wilkins; 2017.
    65. Jaruzel CB, Gregoski M, Mueller M, Faircloth A, Kelechi T.
    Aromatherapy for preoperative anxiety: A pilot study.
    J Perianesth Nurs 2019;34:259‑64.
    66. Heshmatifar N, Mohebbi M, Borzoee F, Rakhhani M. The effect
    of mental imagery on preoperative anxiety of elective hernia.
    Complement Med J 2020;9:3930‑9.
    67. Jlala HA, Bedforth NM, Hardman JG. Anesthesiologists’
    perception of patients’ anxiety under regional anesthesia. Local
    Reg Anesth 2010;3:65‑71.
    68. Cueva‑Ariza D, Delgado‑Hito P, Martínez‑Estalella G,
    Lluch‑Canut T, Romero‑García M. Implementation of the
    evidence for the improvement of nursing care to the critical
    patient’s family: A participatory action research. BMC Health
    Serv Res 2018;18:357.