Effects of pre-operative individualized education on anxiety and pain severity in patients following open-heart surgery

Elif Budak Ertürk, Hayriye Ünlü, Elif Budak Ertürk, Hayriye Ünlü

Abstract

Objectives: Individualized education is important for preparing patients for the operation both physically and psychologically. This study investigated the effects of pre-operative individualized education for open-heart surgery patients on post-operative anxiety and pain severity.

Methods: This quasi-experimental study was conducted in a university hospital between January and October 2014 and involved 109 patients. Data were collected through a form developed by the authors, the State-Trait Anxiety Inventory (STAI), and the visual analog scale (VAS). Patients underwent STAI 1 day before the operation to identify their sources of anxiety and educational needs, and then individualized education was given accordingly. 1 day after the operation, STAI was used to measure patients' state anxiety level, and VAS was used to measure their pain level. The effect of demographic variables on differences in anxiety and pain was investigated.

Results: The average age of the participants was 59.62; 69.7% were male, 92.7% were married, 49.5% graduated from primary school, and the majority (71.6%) had coronary heart disease. The most common sources of anxiety reported the participants included lack of knowledge, being away from family, risk of death, and pain. An analysis of the participants' pre-operative mean scores for state anxiety displayed statistically significant differences (P < 0.05) according to age groups and gender. No significant difference was detected between mean pre- and post-operative state anxiety scores. There was a statistically significant relationship between mean pre- and post-operative state anxiety scores and mean pain scores.

Conclusions: The individualized education is given to patients before surgery was found to have potential effects on their post-operative pain levels.

Keywords: Anxiety- pain; individualized patient education; nursing; open-heart surgery.

References

    1. Republic of Turkey Ministry of Health. Turkey Cardiovascular Disease Prevention and Control Program. 2010. [[Last cited on 2011 Nov 20]]. p. 13. Available from: .
    1. World Health Organization Cardiovascular disease fact sheets, 2015. Updated January. 2015. [[Last cited on 2015 Feb 03]]. Available From: .
    1. Erdil F, Elbaş NÖ. Surgical Nursing. 6th ed. Ankara: Tasarım Offset; 2012. pp. 322–8.
    1. Rymaszewska J, Kiejna A, Hadryś T. Depression and anxiety in coronary artery bypass grafting patients. Eur Psychiatry. 2003;18:155–60.
    1. Gallagher R, McKinley S. Stressors and anxiety in patients undergoing coronary artery bypass surgery. Am J Crit Care. 2007;16:248–57.
    1. Guo P, East L, Arthur A. A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients:A randomized controlled trial. Int J Nurs Stud. 2012;49:129–37.
    1. Guo P. Preoperative education interventions to reduce anxiety and improve recovery among cardiac surgery patients:A review of randomised controlled trials. J Clin Nurs. 2015;24:34–46.
    1. Krannich JH, Weyers P, Lueger S, Herzog M, Bohrer T, Elert O, et al. Presence of depression and anxiety before and after coronary artery bypass graft surgery and their relationship to age. BMC Psychiatry. 2007;7:47.
    1. Akbarzadeh F, Kouchaksaraei FR, Bagheri Z, Ghezel M. Effect of preoperative information and reassurance in decreasing anxiety of patients who are candidate for coronary artery bypass graft surgery. J Cardiovasc Thorac Res. 2009;1:25–8.
    1. Demir A, Akyurt D, Ergün B, Haytural C, Yiğit T, Taşoğlu İ. Anxiety therapy in cardiac surgery patients. Turk Gogus Kalp Dama. 2010;18:177–82.
    1. Deyirmenjian M, Karam N, Salameh P. Preoperative patient education for open-heart patients:A source of anxiety? Patient Educ Couns. 2006;62:111–7.
    1. Douki ZE, Vaezzadeh N, Shahmohammadi S, Shahhosseini Z, Tabary SZ, Mohammadpour RA, et al. Anxiety before and after coronary artery bypass grafting surgery:Relationship to QOL. Middle East J Sci Res. 2011;7:103–8.
    1. Ivarsson B, Larsson S, Lührs C, Sjöberg T. Extended written pre-operative information about possible complications at cardiac surgery - Do the patients want to know? Eur J Cardiothorac Surg. 2005;28:407–14.
    1. Jlala HA, French JL, Foxall GL, Hardman JG, Bedforth NM. Effect of preoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesia. Br J Anaesth. 2010;104:369–74.
    1. Navarro-García MA, Marín-Fernández B, de Carlos-Alegre V, Martínez-Oroz A, Martorell-Gurucharri A, Ordoñez-Ortigosa E, et al. Preoperative mood disorders in patients undergoing cardiac surgery:Risk factors and postoperative morbidity in the intensive care unit] Rev Esp Cardiol. 2011;64:1005–10.
    1. Taşdemir A, Erakgün A, Deniz AN, Çertuğ A. Comparison of preoperative and postoperative anxiety levels with state-trait anxiety inventory test in preoperatively informed patients. Turk J Anaesthesiol Reanim. 2013;41:44–9.
    1. Bahar A, Taşdemir HS. Anxiety and depression in hospitalized patients at clinics medical and surgical. J Anatolia Nurs Health Sci. 2008;11:9–17.
    1. Tel H, Sabancıoğulları S. Sleep Anxiety and Depression in Hospitalized Patients. İzmir: Presented at the 3rd International-10th National Nursing Congress Abstract Book; 2005.
    1. Sadati L, Pazouki A, Mehdizadeh A, Shoar S, Tamannaie Z, Chaichian S, et al. Effect of preoperative nursing visit on preoperative anxiety and postoperative complications in candidates for laparoscopic cholecystectomy:A randomized clinical trial. Scand J Caring Sci. 2013;27:994–8.
    1. Foss M. Enhanced recovery after surgery and implications for nurse education. Nurs Stand. 2011;25:35–9.
    1. Doğu Ö. Meeting the needs of education and training in patients with planned surgery preparation psychological effects of individual patient-Sakarya sample. J DU Health Sci Inst. 2013;3:10–3.
    1. Gurdogan EP, Findik UY, Arslan BK. Patients'perception of individualized care and satisfaction with nursing care levels in Turkey. Int J Comput Sci. 2011;8:369–75.
    1. Suhonen R, Leino-Kilpi H, Välimäki M. Development and psychometric properties of the individualized care scale. J Eval Clin Pract. 2005;11:7–20.
    1. Özcan H. The Use Rates of Patient Discharge Education Given by the Nurse after Open Heart Surgery. Master's Thesis. Edirne: Trakya University Health Sciences Institute, Department of Nursing; 2008.
    1. Turhan Y. The Relationship between Patient Satisfaction, with Preoperative and Postoperative Anxiety and who is Undergoing Elective Surgery. TC. Cukurova University Faculty of Medicine Department of Anesthesiology and Reanimation, Dissertation Adana. 2007
    1. Republic of Turkey Ministry of Health Nursing Regulations. 2010. [[Last cited on 2013 Dec 05]]. Available from: .
    1. Cebeci F, Çelik SŞ. Effects of discharge teaching and counseling on anxiety and depression level of CABG patients. Turk Gogus Kalp Dama. 2011;19:170–6.
    1. Guidelines for Implementation of Enhanced Recovery Protocols. 2009. [[Last cited on 2013 Dec 05]]. Available from .
    1. Zhang CY, Jiang Y, Yin QY, Chen FJ, Ma LL, Wang LX, et al. Impact of nurse-initiated preoperative education on postoperative anxiety symptoms and complications after coronary artery bypass grafting. J Cardiovasc Nurs. 2012;27:84–8.
    1. Öner N, Le Compte A. State-Trait Anxiety Inventory Hand Book. İstanbul: Boğaziçi Üniversitesi Publishers; 1998. pp. 1–26.
    1. Çöçelli PL, Bacaksız B, Ovayolu N. The nurse factor in pain therapy. Gaziantep Tıp Derg. 2008;14:53–8.
    1. Arslan FE. Pain assessment methods. Cumhuriyet Nurse J. 2002;6:9–14.
    1. Hoyer J, Eifert GH, Einsle F, Zimmermann K, Krauss S, Knaut M, et al. Heart-focused anxiety before and after cardiac surgery. J Psychosom Res. 2008;64:291–7.
    1. Tully PJ, Baker RA. Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery:A contemporary and practical review. J Geriatr Cardiol. 2012;9:197–208.
    1. Feuchtinger J, Burbaum C, Heilmann C, Imbery C, Siepe M, Stotz U, et al. Anxiety and fear in patients with short waiting times before coronary artery bypass surgery –A qualitative study. J Clin Nurs. 2013;23:1900–7.
    1. Scott A. Managing anxiety in ICU patients:The role of pre-operative information provision. Nurs Crit Care. 2004;9:72–9.
    1. Nayir HU. Master's Thesis. Afyonkarahisar: TC Afyon Kocatepe University Health Sciences Institute, Surgical Nursing Program; 2012. The Relationship between Preoperative Anxiety and Postoperative Complications of Open Heart Surgery.
    1. Yıldız D. Identifying the Anxiety Level of Patients before and after an Operation. Near East University Health Sciences Institute, Nursing Programme, Master's Thesis, Nicosia. 2011
    1. Karabulut N, Aktaş YY, Gürçayır D, Yılmaz D, Gökmen V. Patient satisfaction with their pain management and comfort level after open heart surgery. Aust J Adv Nurs. 2015;32:16–24.
    1. Asilioglu K, Celik SS. The effect of preoperative education on anxiety of open cardiac surgery patients. Patient Educ Couns. 2004;53:65–70.
    1. Shuldham CM, Fleming S, Goodman H. The impact of pre-operative education on recovery following coronary artery bypass surgery. A randomized controlled clinical trial. Eur Heart J. 2002;23:666–74.
    1. Sidar A, Dedeli Ö, İşkesen Aİ. The relationship between anxiety, pain distress and pain severity before and after open heart surgery in patients. J Turk Soc Intens Care. 2013;4:1–8.
    1. Ozalp G, Sarioglu R, Tuncel G, Aslan K, Kadiogullari N. Preoperative emotional states in patients with breast cancer and postoperative pain. Acta Anaesthesiol Scand. 2003;47:26–9.
    1. Karaca F. Outlook on life and future expectations of elderly people living in nursing home. Aile Toplum. 2010;6:50–72.
    1. Şanli T, Saraçli S. Analysis of the factors affecting the university students'future expectations. J KAU IIBF. 2015;6:25–36.
    1. Bekker MH, van Mens-Verhulst J. Anxiety disorders:Sex differences in prevalence, degree, and background, but gender-neutral treatment. Gend Med. 2007;(Suppl B):S178–93.
    1. Edéll-Gustafsson UM, Hetta JE. Anxiety, depression and sleep in male patients undergoing coronary artery bypass surgery. Scand J Caring Sci. 1999;13:137–43.
    1. GüneşÜ Y, Eşer İ, Khorshid L. The beliefs of nurses and physicians'about patients'responses to pain related to their age and gender. Ege Üniversitesi Hemşirelik Yüksek Dergisi. 2005;21:145–56.
    1. Çevik K, Zaybak A. The effect of exercises on pain after open heart surgery. J Anatol Nurs Health Sci. 2011;14:54–9.
    1. Leegaard M, Nåden D, Fagermoen MS. Postoperative pain and self-management:Women's experiences after cardiac surgery. J Adv Nurs. 2008;63:476–85.

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