1.1. BACKGROUND OF THESTUDY Preoperative anxiety is describedas an unpleasant state of uneasiness or tension that is secondary to a patientbeing concerned about a disease, hospitalization, anaesthesia, surgery or theunknown reason(1). The majority of patients awaitingsurgery experience anxiety and perceive the day of surgery as life threateningevent that has never happened. According to study from Rwanda the incidence ofpreoperative anxiety was 72.8% in surgical patients(2). In Nigeria, the preoperativeanxiety in adult patients varies between11 % to 80% (1).
It has been documented that in hospitalized patients withnonsurgical reasons 10% to 30% may present anxiety, this incidence of anxietymay rise up to 60%-80% in patients waiting for surgery and 5% of the anxiouspatients may refuse surgery (3). According to study in Jimma university specialized hospital theprevalence preoperative anxiety was 70.3(4) and study conducted in Gondar university compressivespecialized shown that 59.6% of preoperative anxiety prevalence(5).The preoperative anxiety may becaused by medical diagnosis, physical separation from family, hospitalization,preoperative instructions including fasting period and other physicalpreoperative preparation, no or little knowledge about diagnosis, surgicalinterventions or therapeutic methods, operating room environment and thepatients may also worry about anaesthesia, success of surgery, post-operativepain management and high costs of operation (6). The anxiety starts at the time of being scheduled for surgeryand increases to a peak level at the time of admission for surgery (7).
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But the surgical team takeslittle consideration of preoperative anxiety while it predicts the difficultsurgical process and outcomes(8).Preoperative anxiety may resultin slower and more complicated recovery with affects the path of surgeryassociated with vasoconstriction, hypertension and increased heart rate, maylead to bleeding, postoperative mortality or major morbidity and poor health outcome(1, 6, 9, 10). In addition, preoperative anxietyis associated with an increase in pain perception, nausea, and vomiting aftersurgery, it also correlates with long hospital stay, high health care cost anddecrease patient satisfaction (3, 4, 11).Therefore anxiety as nursingdiagnosis in patient awaiting surgery may investigated and managed by nursesbefore the surgery(12, 13). Preoperative education and psychological support to patients bynurses have been mentioned to be among the most effective interventions todecrease the anxiety level. When a perioperative nurse is providing aneducation and psychological support, the patient gets an opportunity to expresshis/her thoughts, feelings and their expectations which increase the patient’sconfidence in the surgical team(3).
The preoperative detection of thelevel of anxiety and identification of associated factors are crucial forbetter preoperative anxiety management that results in a better surgicaloutcome, patient satisfaction and low health care cost with increasedproductivity. 1.2. PROBLEMT STATEMENTPreoperativeanxiety is a common component of the surgical experience and increased levelsof anxiety may alter a patient’s surgical course and cause increasedpostoperative complication(14). Astudy conducted by Tanaka in 2015 found that heart rate and systolic bloodpressure have risen higher in patients with anxiety than in patients withoutanxiety after entering operating room. In additionin his study found that patients with a high anxiety level have a 2.
17fold higher risk of hypothermia during the first hour and a 1.77-fold higherrisk of hypothermia during the first 2 hours than patients with a low/moderateanxiety level(15). The study conducted by showed that patients with preoperativeanxiety or depression had more than 6 times higher risk to be dissatisfiedcompared with patients with no anxiety or depression and dissatisfied patientswere hospitalized 1 day more than satisfied patients(16). Furthermore,preoperative anxiety also associated with an increase in health care cost. In astudy conducted in patients with preoperative anxiety and depression whoundergone total joint arthroplasty found that the hospitalization charges weresignificantly higher for patients with preoperative anxiety $55,670 compared tothe hospitalization charges with median of $52,270. For patients withoutanxiety and patients with anxiety who were undergone total knee replacementwere significantly hospitalized more days compared to patients without anxietyor depression with median length of hospital stay of 3.5 days and 3.
4 daysrespectively, the authors also showed that the rate of complications was higherin patients with preoperative anxiety at 29% than in patients without thosedisorders at 15.5%,(16).Althoughthe negative effects of preoperative anxiety on the surgical process, thepreoperative anxiety level of patients waiting for surgery in Ethiopia is notadequately assessed(4).
Therefore for the purpose study is smoothly running the surgical process whichresults in positive surgical outcomes, the nurse needs to assess preoperativeanxiety level and associated factors in order to intervene effectively forpatients awaiting surgery. 1.3.JUSTIFICATION OF THE STUDY Thepurpose of this study is to assess the preoperative anxiety levels anddeterminant factors for patients awaiting surgery. The study findings will beprovided a body of knowledge on preoperative anxiety and associated factorsthat may contribute to nursing education and teaching the nursing students orprofessional nurses in preoperative preparation of patients.
Furthermore, the findings will be used forfurther preoperative patient preparation or anxiety related researches. Thehospitals administration may use the results of this study in planning thepackage of nursing interventions patients have to receive preoperatively, developpolicy and procedure related to preoperative anxiety. Moreover, in nursingpractice, the nurses may use the findings for early identification of anxiouspatients and patients needing more nursing interventions before they undergothe surgery. Theresults will be finally contribute to the quality of care and once the anxiouspatients are screened at early and individualized interventions are implementedon time, it results in low anxiety that leads to quick recovery and betterpatient outcome and increases the productivity of people.
The productive peoplecontribute to country development.