Anxiety Management in Adult Day Surgery: A Nursing Perspective

246 Pages·2005·1.98 MB·English

by  Mark Mitchell

Anxiety Management in Adult Day Surgery
A Nursing Perspective

Anxiety Management in
Adult Day Surgery
A Nursing Perspective
Mark Mitchell
BA, MSc, PhD, RGN, NDNCert, RCNT, RNT
University of Salford, Greater Manchester, UK
W
W H U R R P U B L I S H E R S
LONDON AND PHILADELPHIA
© 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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British Library Cataloguing in Publication Data
A catalogue record for this book
is available from the British Library.
ISBN 1 86156 463 5
Typeset by Adrian McLaughlin, [email protected]
Printed and bound in the UK by Athenæum Press Limited, Gateshead, Tyne & Wear
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
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vi Anxiety Management in Adult Day Surgery: A Nursing Perspective
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 preop-
erative anxiety. The vast majority of patients experience varying degrees
of anxiety when entering hospital for surgery and yet little formal inter-
vention 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 suggest-
ed 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 psy-
choeducational aspects have largely remained informal, marginal issues.
Both surgery and anaesthesia have changed dramatically during this peri-
od 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, clini-
cally 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 nurs-
ing 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
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viii Anxiety Management in Adult Day Surgery: A Nursing Perspective
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 rel-
atives 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 profession-
al 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 interven-
tion, 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 knowl-
edge has much to offer the ambulatory surgery patient and we must
robustly demonstrate how our professional knowledge can make this con-
tribution. Professional knowledge and its application are powerful,
liberating and motivating forces. I hope that this book empowers, liber-
ates and motivates all who read it and that you find it as stimulating to
read as I have found it to write.
Mark Mitchell
Chapter 1
Twenty-first century: a time for
change
Growth of day surgery
The Department of Health (DoH 2000) has a clear vision for the future
level of day surgery activity. The NHS Planstates ‘Around three-quarters
of operations will be carried out on a day case basis with no overnight
stay required’ (DoH 2000, p. 19). In 1985 less than 15% of all elective
surgery was undertaken on a day-case basis (NHS Management Executive
Value for Money Unit 1991). A day surgery candidate is defined in the
UK as ‘a patient who is admitted for investigation or operation on a
planned non-resident basis and who nonetheless requires facilities for
recovery’ (Royal College of Surgeons of England 1992, p.3). More
recently, a day surgery candidate has been defined as ‘A patient admitted
electively during the course of a day with the intention of receiving care
who does not require the use of a hospital bed overnight and who returns
home as scheduled. If this original intention is not fulfilled and the patient
stays overnight, such a patient should be counted as an ordinary admis-
sion’ (Cook et al. 2004, p. 11).
Such a rapid change in surgical health-care delivery over the past 30
years has ensured a major shift in medical and nursing surgical interven-
tion. Intermediate elective surgical episodes once requiring lengthy
hospital admission are disappearing from the inpatient ward, never to
return, e.g. inguinal hernia repair, varicose vein stripping, cataract extrac-
tion and many more (Cahill 1999) (intermediate elective surgery is
defined here as planned uncomplicated surgery under general anaesthesia,
which can be undertaken in an operating theatre in less than an hour.)
Therefore, the extensive physical care and treatment once required by
patients undergoing cholecystectomy, for example, is now becoming
obsolete, as the British Association of Day Surgery has recommended that
at least 50% of all such surgery should now be possible in day-case facil-
ities (Cahill 1999). Patients undergoing cholecystectomy once remained in
hospital for approximately 3 weeks and required a considerable amount
of physical care, e.g. pain management, wound care, assistance with activ-
ities of living. Most adult elective surgery patients do not now require the
level of physical nursing intervention once demanded by more traditional
1