Can stress experienced by patients who are about to undergo surgery be reduced by specific types of nurse intervention *?

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Volume 11, Issue 2, 1975, Pages 155-165

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Bob Price Independent health services training consultant, Surrey

Patients are often anxious about planned medical interventions, and those experiencing anxiety are less likely to have the confidence to collaborate with healthcare professionals on their plan of care, and make decisions about consent. They may also find it challenging to follow rehabilitation guidelines, which can affect their long-term recovery. As part of their professional duty, nurses are required to recognise when people are anxious or in distress and respond compassionately, and while acquiring valid consent for any planned medical intervention requires the nurse to explain any risks, they should also attempt to reassure patients. The anxiety that precedes a planned medical intervention has been described as state anxiety; this refers to feelings of discomfort and uncertainty that accompany a situation such as an operation or a diagnostic procedure. Nurses can attempt to reduce any anxiety that patients experience by explaining the planned medical intervention and providing accurate information at the optimum time. This article outlines some of the coping theories that nurses can use to support patients in managing their anxiety about planned medical interventions.

Nursing Standard. 31, 47, 53-63. doi: 10.7748/ns.2017.e10544

Correspondence

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Conflict of interest

None declared

Received: 26 April 2017

Accepted: 12 June 2017

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Arpino L, Iavarone A, Parlato C, Moraci A. Prognostic role of depression after lumbar disc surgery. Neurol. Sci. 2004;3:145–7.
Google Scholar
Broadbent E, Kahokehr A, Booth RJ, Thomas J, Windsor JA, Buchanan CM, et al. A brief relaxation intervention reduces stress and improves surgical wound healing response: A randomised trial. Brain Behav Immun. 2012;26(2):212–7. Available from:. https://doi.org/10.1016/j.bbi.2011.06.014.
PubMed Article Google Scholar
Broadbent E, Petrie K, Alley P, Booth R. Psychological Stress Impairs Early Wound Repair Following Surgery. Psychosom. Med. 2003;65(5):865–9.
PubMed Google Scholar
Ellis HB, Howard KJ, Khaleel MA, Bucholz R. Effect of psychopathology on patient-perceived outcomes of total knee arthroplasty within an indigent population. J Bone Joint Surg Am. 2012;94(12):e84 Available from: http://jbjs.org/data/Journals/JBJS/24169/e84.pdf.
PubMed Google Scholar
Glaser R, Kiecolt-Glaser JK, Marucha PT, MacCallum RC, Laskowski BF, Malarkey WB. Stress-related changes in proinflammatory cytokine production in wounds. Arch Gen Psychiatry. 1999;56(5):450–6.
CAS PubMed Google Scholar
Good M, Albert JM, Anderson GC, Wotman S, Cong X, Lane D, et al. Supplementing relaxation and music for pain after surgery. Nurs Res. 2010;59(4):259–69.
PubMed Google Scholar
Granot M, Ferber SG. The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity: A prospective study. Clin J Pain. 2005;21(5):439–45.
PubMed Google Scholar
Hansen MM. A feasibility pilot study on the use of complementary therapies delivered via mobile technologies on Icelandic surgical patients’ reports of anxiety, pain, and self-efficacy in healing. BMC Complement Altern Med. 2015;15(1):1–12.
Google Scholar
Hızlı F, Özcan O, Selvi İ, Eraslan P, Köşüş A, Baş O, et al. The effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety. Int Urol Nephrol. 2015;47(11):1773–7.
PubMed Google Scholar
Jindal V, Gupta S, Das R. Molecular Mechanisms of Meditation. Mol Neurobiol. 2013;48(3):808–11.
CAS PubMed Google Scholar
Johnston M, Vögele C. Benefits of psychological preparation for surgery: A meta-analysis. Ann Publ Soc Behav Med. 1993;15(4):245–56.
Google Scholar
Kaplan KH, Goldenberg DL, Galvin-Nadeau M. The impact of a meditation-based stress reduction program on fibromyalgia. Gen Hosp Psychiatry. 1993;15:284–9.
CAS PubMed Google Scholar
Kehlet H, Ph D. Manipulation of the Metabolic Response in Clinical Practice. World J Surg. 2000;24:690–5.
CAS PubMed Google Scholar
LaMontagne LL, Hepworth JT, Cohen F, Salisbury MH. Cognitive-behavioral intervention effects on adolescents’ anxiety and pain following spinal fusion surgery. Nurs Res. 2003;52:183–90.
PubMed Google Scholar
Lin LY, Wang RH. Abdominal surgery, pain and anxiety: Preoperative nursing intervention. J Adv Nurs. 2005;51(3):252–60.
PubMed Google Scholar
Maduka IC, Neboh EE, Ufelle SA. The relationship between serum cortisol , adrenaline , blood glucose and lipid profile of undergraduate students under examination stress. Afr Heal Sci. 2015;15(1):1–4.
Google Scholar
Manyande A, Berg S, Gettins D, Stanford SC, Mazhero S, Marks DF, et al. Preoperative rehearsal of active coping imagery influences subjective and hormonal responses to abdominal surgery. Psychosom Med. 1995;57(2):177–82.
CAS PubMed Google Scholar
Mavros MN, Athanasiou S, Gkegkes ID, Polyzos KA, Peppas G, Falagas ME. Do psychological variables affect early surgical recovery? PLoS One. 2011;6(5):e20306 Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3102096&tool=pmcentrez&rendertype=abstract.

CAS PubMed PubMed Central Google Scholar
Michie S, Johnston M, Francis JJ, Hardeman W, Eccles M. From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol An Int Rev. 2008;57:660–80.
Google Scholar
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
PubMed PubMed Central Google Scholar
Munafò MR, Stevenson J. Anxiety and surgical recovery: Reinterpreting the literature. J. Psychosom Res. 2001;51(4):589–96.
PubMed Google Scholar
Nelson EA, Dowsey MM, Knowles SR, Castle DJ, Salzberg MR, Monshat K, et al. Systematic review of the efficacy of pre-surgical mind-body based therapies on post-operative outcome measures. Complement Ther Med. 2013;21(6):697–711. Available from:. https://doi.org/10.1016/j.ctim.2013.08.020.
PubMed Article Google Scholar
Powell R, Scott N, Manyande A, Bruce J, Vögele C, Byrne-Davis L, et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev. 2016;26(5):CD008646. PMID: 27228096.
Rainville P, Bao QVH, Chrétien P. Pain-related emotions modulate experimental pain perception and autonomic responses. Pain. 2005;118(3):306–18.
PubMed Google Scholar
Rejeh N, Heravi-Karimooi M, Vaismoradi M, Jasper M. Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing abdominal surgery. Int J Nurs Pract. 2013;19(5):462–70.
PubMed Google Scholar
Richards SH, Anderson L, Jenkinson CE, Whalley B, Rees K, Davies P, et al. Psychological interventions for coronary heart disease. Cochrane database Syst Rev. 2017;4(4):CD002902.
PubMed Google Scholar
Rolving N, Oestergaard LG, Willert MV, Christensen FB, Blumensaat F, Bünger C, et al. Description and design considerations of a randomized clinical trial investigating the effect of a multidisciplinary cognitive-behavioural intervention for patients undergoing lumbar spinal fusion surgery. BMC Musculoskelet Disord. 2014;15:62.
PubMed PubMed Central Google Scholar
Rosenberger P, Jokl P, Ickovics J. Psychosocial factors and surgical outcomes: An evidence-based literature review. J Am Acad Orthop Surg. 2006;14(7):397–405 Available from: http://www.jaaos.org/content/14/7/397.short.
PubMed Google Scholar
Roykulcharoen V, Good M, Bolton FP. Sytematic relaxation to relieve postoperative pain. J Adv Nurs. 2004;48(2):140–8.

PubMed Google Scholar
Sockalingam S, Leung SE, Hawa R, Wnuk S, Parikh SV, Jackson T, et al. Telephone-based cognitive behavioural therapy for female patients 1-year post-bariatric surgery: A pilot study. Obes Res Clin Pract. 2019;13(5):499–504. Available from. https://doi.org/10.1016/j.orcp.2019.07.003.
PubMed Article Google Scholar
Szeverenyi C, Kekecs Z, Johnson A, Elkins G, Csernatony Z, Varga K. The Use of Adjunct Psychosocial Interventions Can Decrease Postoperative Pain and Improve the Quality of Clinical Care in Orthopedic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Pain United States. 2018;19(11):1231–52.
Google Scholar
Theunissen M, Peters ML, Bruce J, Gramke H-F, Marcus MA. Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clin J Pain. 2012;28(9):819–41 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22760489.
PubMed Google Scholar
Visioni A, Shah R, Gabriel E, Attwood K, Kukar M, Nurkin S. Enhanced Recovery After Surgery for Noncolorectal Surgery?: A Systematic Review and Meta-analysis of Major Abdominal Surgery. Ann Surg United States. 2018;267(1):57–65.
Google Scholar
Walburn J, Vedhara K, Hankins M. Psychological stress and wound healing in humans: a systematic review and meta-analysis. J Psychosom Res. 2009;67(3):253–71.
PubMed Google Scholar
Walton KG, Pugh ND, Gelderloos P, Macrae P. Stress reduction and preventing hypertension: preliminary support for a psychoneuroendocrine mechanism. J Altern Complement Med. 1995;1(3):263–83 Available from: http://www.ncbi.nlm.nih.gov/pubmed/9395623.
CAS PubMed Google Scholar
Wolsko PM, Eisenberg DM, Davis RB, Phillips RS. Use of mind-body medical therapies. J Gen Intern Med. 2004;19(1):43–50 Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1494676&tool=pmcentrez&rendertype=abstract.
PubMed PubMed Central Google Scholar
Zhang XD, Zhao QY, Fang Y, Chen GX, Zhang HF, Zhang WX, et al. Perioperative comprehensive supportive care interventions for Chinese patients with esophageal carcinoma: A prospective study. Asian Pacific J Cancer Prev. 2013;14(12):7359–66.
Google Scholar

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From: Effects of psychological interventions on anxiety and pain in patients undergoing major elective abdominal surgery: a systematic review

Psychological perioperative treatments
Cognitive-behavioural therapies Psychosocial interventions aimed at identifying and challenging maladaptive thoughts, positively modifying feelings and behaviours, and thereby experiences; interventions may focus on the cognitive component or directly influence behavioural responses (Rolving et al. 2014).
Relaxation techniques Physical and cognitive treatments (such as progressive muscle relaxation, simple relaxation, breathing practices, music relaxation) aimed at reducing sympathetic arousal, increasing the feeling of calm, and improving self-control (LaMontagne et al. 2003; Michie et al. 2008).
Mindfulness-based interventions Psychological interventions inspired by religion-based practices of meditation and contemplation; these presuppose patient engagement in the relevant aspects of the present experience in a non-judgmental manner (Kaplan et al. 1993).
Coping strategies Behavioural and psychological strategies employed to master, tolerate, reduce, or minimise stressful events.
Hypnosis Cognitive-behavioural technique with no specific side effects used to encourage and evaluate responses to suggestions (Hızlı et al. 2015).
Narrative medicine Medical approach that acknowledges the value of people’s narratives and individual stories, focusing on the relational and psychological dimensions that are implied in physical illness.