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
- 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. - 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.