ANXIETY MANAGEMENT IN ADULT DAY SURGERY A NURSING PERSPECTIVE

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Anxiety Management in
Adult Day Surgery
A Nursing Perspective
Mark Mitchell BA, MSc, PhD, RGN, NDNCert, RCNT, RNT
University of Salford, Greater Manchester, UK

© 2005 Whurr Publishers Ltd
First published 2005
by Whurr Publishers Ltd
19b Compton Terrace
London N1 2UN England and
325 Chestnut Street, Philadelphia PA 19106 USA
All rights reserved. No part of this publication may be
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or by any means, electronic, mechanical, photocopying, recording or
otherwise, without the prior permission of Whurr Publishers Limited.
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without a similar condition including this condition being imposed
upon any subsequent purchaser.
British Library Cataloguing in Publication Data
A catalogue record for this book
is available from the British Library.
ISBN 1 86156 463 5

Contents
Preface vii
Chapter 1 Twenty-first century: a time for change 1
Growth of day surgery 1
Psychoeducational management 5
Summary 10
Chapter 2 Day surgery: patients’ perceptions 12
Advancements in surgical practice 12
Preassessment and patient teaching 13
Information provision 15
Patient experiences on the day of surgery 23
Patient recovery 28
Conclusion 46
Summary 48
Chapter 3 Patient anxiety and elective surgery 50
Patient anxiety 50
Conclusion 73
Summary 73
Chapter 4 Psychological approaches to coping 75
Broad psychological approaches 75
Specific psychological approaches 80
Conclusion 95
Summary 96
Chapter 5 Information selection 98
Information categories 98
Conclusion 115
Summary 115
Chapter 6 Information Delivery 117
Information provision and elective surgery 117
Conclusion 141
Summary 142
Chapter 7 Anxiety management in day surgery 144
Preoperative psychoeducational care 144
Implementation 156
Conclusion 169
Summary 171
Chapter 8 Twenty-first century elective surgical nursing 173
Day-surgery innovation 173
Conclusion 191
Summary 192
Glossary 194
References 205
Index 235


Preface
This book is centrally concerned with the formal management of preoperative
anxiety.
The vast majority of patients experience varying degrees
of
anxiety when entering hospital for surgery and yet little formal intervention
is commonly provided. This is the first book of its kind to be
written
for nurses exclusively concerning the complete formal pre- and
postoperative
management of anxiety in relation to modern, elective,
adult
day surgery.
During the early 1970s
classic nursing studies suggested
information provision to be crucial for effective inpatient preoperative
anxiety
management. However,
following such early recommendations
no
other formal aspects of psychoeducational care have impacted on
mainstream
surgical nursing intervention. Physical aspects of care have
dominated
proceedings for the last three decades or more, whereas psychoeducational
aspects have largely remained informal, marginal issues.
Both
surgery and anaesthesia have changed dramatically during this period
and nursing intervention must now do likewise.
The domination of physical nursing intervention is, however, slowly
changing as the continuous global rise in elective ambulatory surgery has
highlighted the need for more structured psychoeducational approaches
to patient care. The psychological theories to aid preoperative anxiety
management have been available for many years. However, they have not
succeeded in making an impact within the clinical surgical setting,
because they have not previously been constructed into a coherent, clinically
realistic plan of care. The purpose of this book is therefore (1)
to
consider
the relevant psychological concepts that can inform and guide
modern
surgical nursing practices, (2)
to provide a comprehensive map of
the
wider evidence available and (3)
to introduce clinically realistic nursing
interventions necessary for the complete psychoeducational
management of adult patients undergoing elective, ambulatory surgery.
On a philosophical level, I hope to communicate with a wide audience
of nurses working in the field of adult ambulatory surgery or studying
modern surgical nursing practices. We need to re-evaluate nursing
knowledge for this new surgical era so that compelling nursing evidence
can help to guide practice and not remain in the shadows of medical
advances. This book is intended to provoke debate within the profession,
present the case for change and, above all, demonstrate the ability of
nursing knowledge to make a significant contribution to the care required
by patients experiencing modern ambulatory surgery. Much evidence,
within the nursing domain, is widely available to help guide important
global nursing issues in ambulatory surgery.
The political reforms currently running through the National Health
Service in the UK have resulted in nursing knowledge largely becoming
marginalized. The utilization of nurses and their skills features widely in
these reforms, but not the utilization of nursing skills based on nursing
knowledge. Surgical self-preparation and self-recovery are now implicit
aspects of the modern surgical patients’ experience. Patients and their relatives
did not request this new,
essential role although most now welcome
the
social convenience and swift treatment that day surgery affords. Such
advances
have, however,
guaranteed that many of yesterday’s
professional
nursing interventions have become today’s
layperson interventions.
Much
physical surgical nursing is increasingly becoming obsolete because
it
can now be undertaken by laypeople. I am hopeful that this book will
add
to the debate about the future of modern surgical nursing intervention,
because the trend of surrendering much pre- and postoperative care
to
relatives and replacing it with interventions that once were the domain
of
junior doctors must not remain unchallenged. ‘New’ nursing knowledge
has much to offer the ambulatory surgery patient and we must
robustly
demonstrate how our professional knowledge can make this contribution.
Professional knowledge and its application are powerful,
liberating
and motivating forces. I hope that this book empowers, liberates
and motivates all who read it and that you find it as stimulating to
read
as I have found it to write.
Mark Mitchell