The effects of pre-operative education on patients perception of anxiety before undergoing office-based anesthesia for urology procedures

Abstract

Physicians have performed surgeries for many decades in various settings, and these surgeries can offer different benefits to the patients and the providers. Conversely, anxiety has been a great concern due to the perception of the patients irrespective of the benefits gained from the office-based environment. This study has a crucial target for evaluating the impacts that the preoperative education can offer to the perception of the patients regarding the anxiety before they may undergo the office-based anesthesia for the urology procedures.
Introduction

Anxiety is among the comprehensive response to stress, which is present in the patients scheduled for the office-based anesthesia and surgery. The surgery is carried in the private office of the physician, which is never accredited by the state or the national organization as the ambulatory center for surgery or as the hospital. The practice is not a modern concept even if it has undergone the significant expansion (Parveen, 2016). The assessment of the presence of the anxiety as well as quantifying it becomes a challenge with pain.
Background

With the diminishing reimbursement of the healthcare and the growing demand of consumer, the significant portion of the healthcare delivery shifts from the in-patient environments to the outpatient facilities and to the offices of the physicians. The office-based procedures are also called the Wild West of the healthcare, and it continues to advance in high pace with around 12 million of the procedures carried annually (Yoo et al., 2015). The office-based environs provide the improved access together with the convenience of the providers and the patients. The office-based practices are also cost-effective as compared to various practice settings. Moreover, the office-based practices are never subjected to the similar state, local, and even the federal regulations in comparison to the hospitals or the centers of the ambulatory surgical.
Conceptual Framework

People still observe that procedures carried in the offices increase in variety as well as the complexity. In most cases, the patients have high comorbidities, and the office personnel is always unprepared of handling the complications (Taneja & Shah, 2017). Moreover, the office procedures catch the attention of the public due to the highly publicized malpractices fatalities and the claims.
Purpose of the Study

This project intends to discuss the effects of the pre-operative education on the perception of the patients concerning the anxiety before they undergo the office-based anesthesia for the urology procedures. Various literature has depicted that the office-based settings are suitable for the satisfaction of patients since they provide the same safety (Guo, 2015). In that case, such environment is highly convenient as well as advantageous to both the parties involved in performing the urology surgeries.
Research Questions

The researcher will seek to identify the following questions:

How pre-operative education compared with no pre-operative education affect patients’ perception of anxiety within 24 hours of surgery in adult patients undergoing office-based urology procedures?
What are the scholarly projects designed to investigate further the effects of the pre-operative education on patients’ perception of anxiety before undergoing office-based anesthesia for urology procedures?

Literature Review

The literature review was carried using the OVID, Cumulative Index to Nursing and Allied Health Literature (CINAHL), as well as the Public Medline (PubMed) along with the Centers for Disease Control (CDC) and Centers for Medicare and Medicaid Services (CMS) and Wilmington Library.

The increasing demand for cutting the expenses to the carriers of the health insurance resulted in the preferences of the affordable surgery for the elective procedures. The patients appreciate it since they can assist in cutting the health expenses that could have been incurred such as the use of the IT systems. In such situations, the most significant barrier in the study was the challenge of assessing the information of the patients due to lack of the IT System (Guo, 2015). The only facility that was available in the hospital was the charts that created the significant challenge in reaching the information of the patients, the pertinent labs, as well as the diagnostics. The STAI was used as the golden standard since it indicated the consistent results in various population as well as the ethnic groups when assessing the anxiety. It was also available in different languages. Most of the patients who await the office-based anesthesia and surgery could experience the high levels of the preoperative anxiety.

Offering the education to the patients together with the members of their families is among the critical aspects of the nursing care. The fundamental purpose of the preoperative education is to prepare the patient for the operation and prepare them for the expected results after the surgery. Thus, the preoperative knowledge may be extensive since it allows the patients to fell in control and even have an understanding of the surgery (Parveen, 2016). In that case, the preoperative education is essential in reducing the risk of the postoperative complications from taking place.

Moreover, it allows individual to have the active role in the process of their recovery. For that matter, the preoperative teaching needs to take place over the prolonged period to give the patient opportunity of asking the questions and even ensuring the assimilation of the information (Simeone et al., 2017).
Methods

The researcher will identify the research population during the first interview with the urologist. The eligibility criteria will involve all healthy adult patients with two groups of eighty patients. The first group will receive the preoperative instructions in the morning of surgery, while the second group will receive the preoperative education given by nurse anesthetist at night and in the morning before the surgery using The Amsterdam Preoperative Anxiety and Information Scale (APAIS). The scholar will conduct the measurements of the anxiety before the surgery and before the discharge for both the groups.
Results

Amusingly, the most significant concern of these patients awaiting the urology procedures was fear of the end followed by the fear of the unknown. It was clear that the patients suffered needlessly because of the insufficient preoperative preparation as well as the lack of the information concerning the postoperative course (Taneja & Shah, 2017). The office-based providers of the anesthesia should analyze nature of procedure along with its appropriateness for the ambulatory environment. It calls for consideration the anticipated duration of the procedures as well as the complexity. Thus, the preoperative education on the perception of the patients concerning the anxiety before they undergo the office-based anesthesia for the urology procedures will assist them to be courageous.
Interpretation of Findings

The study on the preoperative teaching offered a surgical patient with the pertinent information regarding the surgical process. It also offered the expected sensations and the probable results (Bettelli & Solca, 2017). Moreover, the preoperative education served as the way of providing the appropriate reassurances to the patient through the therapeutic communication. In such situations, the nurse could respond to the patients in the manner favorable to the mental and the physical health of the patient. This kind of approach could assist in calming the patient and facing the situation positively.

The study limitations were that the time allocated for the research was not sufficient with the patients postoperatively. The limitations also emerged from the restrictions in the organizational routine, which were never feasible for carrying out the study. It was also never possible to apply the control group with the pre-anesthetic visit in current research for the ethical reasons related to the safety of the patient. Nevertheless, one investigator was tasked with the collection of the information about the patient to limit the bias.
The implication for Further Research

Thus, the impact for the advanced practice is that the preoperative education provides some potential in decreasing the anxiety of the patients. The patients called the night before the surgery were thankful and were at ease during their operation (Simeone et al., 2017). The office-based providers of the anesthesia should analyze nature of procedure along with its appropriateness for the ambulatory environment. It also involves considering the anticipated duration of the procedures as well as the complexity. Thus, the preoperative education on the perception of the patients concerning the anxiety before they undergo the office-based anesthesia for the urology procedures will assist them to be courageous.
References

Bettelli, G., & Solca, M. (2017). Surgery and Office-based Procedures. Perioperative Care of the Elderly: Clinical and Organizational Aspects, 182.

Guo, P. (2015). Preoperative education interventions to reduce anxiety and improve recovery among cardiac surgery patients: a review of randomized controlled trials. Journal of clinical nursing, 24(1-2), 34-46.

Parveen, A. (2016). Effect of Pre-Operative Education on Level of Anxiety in Patients Undergoing Cataract Surgery. Journal of Islamabad Medical & Dental College, 5(4), 192-194.

Simeone, S., Pucciarelli, G., Perrone, M., Rea, T., Gargiulo, G., Dell’Angelo, G., … & Vosa, C. (2017). Comparative analysis: Implementation of a pre-operative educational intervention to decrease anxiety among parents of children with congenital heart disease. Journal of Pediatric Nursing: Nursing Care of Children and Families, 35, 144-148.

Taneja, S. S., & Shah, O. (2017). Complications of Urologic Surgery E-Book: Prevention and Management. Elsevier Health Sciences.

Yoo, E., Crawley, B., Kwon, D., & Hata, J. (2015). Pain Control during Office-Based Procedures in Unsedated Patients: A Cross-Specialty Review of the Literature. Critical Reviews™ in Physical and Rehabilitation Medicine, 27(2-4).

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