Psychological preparation for surgery

Chapter 52 Psychological preparation for surgery


Psychological preparation for surgery is important because it has been shown to reduce patients’ anxiety and to improve recovery in the postoperative period.



Anxiety


Anxiety is an unpleasant emotion associated with threatening situations or thinking about threat. People differ in the degree to which they experience anxiety when facing challenges such as surgery. High anxiety makes it more difficult for the patient to understand information and to cooperate fully with instructions and can interfere with a psychological and physiological recovery processes, including wound healing (see pp. 126–127).



Anxiety in surgical patients


Patients are anxious before surgery for a number of reasons: they have an illness requiring surgery; they have to undergo the surgical procedure; and there may be uncertainty about the outcome and the likely speed of recovery. In addition, patients worry about being away from home and how their family is coping, as well as continuing to worry about their usual preoccupations, such as money and relationships.


Using standard measures of anxiety which have been developed to deal with the problems of subjective reporting, patients are found to have high levels of anxiety both before and after surgery. For example, Figure 1 shows daily anxiety levels from 4 days before to 14 days after major gynaecological surgery. Compared with normal levels of anxiety as measured 5 weeks after surgery, patients show high levels both before and after surgery. Anxiety before surgery has been found to relate to many postoperative outcomes, including: distress, pain, use of analgesics, and physiological functioning, return to normal activities and length of hospital stay.


image

Fig. 1 Anxiety levels before and after surgery


(from Johnston, 1980, with permission).


Therefore methods of reducing anxiety are likely to improve patient outcomes.



Methods of psychological preparation


A variety of methods of preparing people for surgery have been developed. They are typically administered on the day before surgery, although some have been used in outpatient visits prior to admission. Some of these methods can be delivered to groups of patients, and others incorporate the use of booklets, audio and video tapes. Methods used include:



Information-giving



Procedural information


Patients are informed about the procedures they will undergo, when they will happen and where they will be. E.g. they might be told about waking in the recovery room and the possibility of having a drip or catheter.



Sensation information


Patients are additionally informed about the sensations they are likely to experience. E.g. they might be told that premedication will not necessarily make them feel drowsy or that following major abdominal operations they may experience pain due to wind.



Behavioural instruction

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Jun 10, 2016 | Posted by in PSYCHOLOGY | Comments Off on Psychological preparation for surgery

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