Identification of the defining characteristics of fear and anxiety in patients scheduled for gynecological surgery

Abstracts

OBJETIVOS: Identificar a presença das características definidoras Medo e Ansiedade no pré-operatório imediato de 50 pacientes submetidas à cirurgia ginecológica, e verificar a Síndrome da Ansiedade Perioperatória. MÉTODOS: Estudo de coorte de caráter transversal teve como objetivo Realizado na Unidade de Ginecologia do Hospital São Paulo em maio de 2007. RESULTADOS: Confirmou-se a presença dos diagnósticos de interesse em 48 pacientes (96,0%) do total de 50 mulheres (100,0%). A Síndrome da Ansiedade Perioperatória foi identificada em 48 (96,0%) das pacientes. CONCLUSÃO: A pesquisa comprovou a presença dos diagnósticos Medo e Ansiedade, devido às manifestações clínicas, também contribuintes para evidenciar a Síndrome da Ansiedade Perioperatória

Diagnóstico de Enfermagem; Medo; Ansiedade; Procedimentos Cirúrgicos em Ginecologia; Período Intra-Operatório

ORIGINAL ARTICLE

Identification of the defining characteristics of fear and anxiety in patients scheduled for gynecological surgery^*

Identificación de las características definidoras de miedo y ansiedad en pacientes programadas para cirugía ginecológica

Maria Lucia Fernandez Suriano^I; Daniela Cristina da Fonte Lopes^II; Giselle Pinto de Oliveira Sá Macedo^III; Jeanne Liliane Marlene Michel^IV; Alba Lúcia Bottura Leite de Barros^V

^INurse. Professor Doctor at the Nursing Department of the Escola Paulista de Enfermagem, Universidade Federal de São Paulo/ UNIFESP. São Paulo (SP), Brazil

^IINurse.Graduated from the Universidade Federal de São Paulo/ UNIFESP - São Paulo (SP), Brasil

^IIIIntensive Care and Pediatric Emergencies Specialist from the Instituto da Criança - ICr/FMUSP. Nurse at the Hospital São Paulo- Universidade Federal de São Paulo/ UNIFESP - São Paulo (SP), Brazil

^IVPhD in Nursing. Professor at the Nursing Departament of the Universidade Federal de São Paulo; São Paulo (SP), Brazil

^VTitular Professor. Head of the Nursing Department of the Escola Paulista de Enfermagem of the Universidade Federal de São Paulo - UNIFESP, Titular Professor - São Paulo (SP), Brazil

Corresponding Author

ABSTRACT

OBJECTIVES: To identify defining characteristics of fear and anxiety during the immediate preoperative period in patient scheduled for gynecological surgery, and to diagnose preoperative anxiety syndrome.

METHODS: This was a cross-sectional study with 50 patients from the gynecological unit of the São Paulo hospital. Data was collected in May 2007.

RESULTS: Preoperative anxiety syndrome was diagnosed in 48 of the participants (96.0%).

CONCLUSION: Participants had clinical symptoms leading to the diagnosis of preoperative anxiety syndrome.

Keywords: Nursing Diagnosis; Fear; Anxiety; Gynecologic Surgical Procedures; Intraoperative Period

RESUMEN

OBJETIVOS: Identificar la presencia de las características definidoras de Miedo y Ansiedad en el pre-operatorio inmediato de 50 pacientes sometidas a cirugía ginecológica, y verificar el Síndrome de Ansiedad Perioperatoria.

MÉTODOS: Este estudio de cohorte de carácter transversal tuvo como objetivo fue realizado en la Unidad de Ginecología del Hospital Sao Paulo en mayo del 2007.

RESULTADOS: Se confirmó la presencia de los diagnósticos de interés en 48 pacientes (96,0%) de un total de 50 mujeres (100,0%). El Síndrome de Ansiedad Perioperatoria fue identificada en 48 (96,0%) de las pacientes.

CONCLUSIÓN: Con la investigación se comprobó la presencia de los diagnósticos Miedo y Ansiedad, debido a las manifestaciones clínicas, también contribuyentes para evidenciar el Síndrome de Ansiedad Perioperatoria.

Descriptores: Diagnóstico de Enfermería; Miedo; Ansiedad; Procedimientos Quirúrgicos Ginecológicos; Periodo Intraoperatorio

INTRODUCTION

While undergoing a surgical procedure, patients experience stressful situations, which can change the dynamics of life. The unknown can trigger negative reactions, such as non adherence to the treatment and therapy home care maintenance, changes of self-esteem and body image, psychological changes generated by fearing death and anxiety relating to not knowing on the anesthetic procedures and the surgery itself⁽¹⁾.

Studies suggest that patients while facing a frightening reality, such as a surgery, develop tension levels that compromises the emotional, physiological and cognitive abilities. The emotional states of fear and anxiety are often witnessed, important physiological and psychological changes can be noticed and detected in patients undergoing large surgical procedures, or related to sexual organs such as in urogynecology surgeries^(2-3).

The nurse performance is crucial in such important moments of a patient's life and should be able to evaluate the patient in immediate preoperative, in order to minimize possible behavioral complications, which can affect the post-surgical recovery⁽²⁾. A detailed examination of patient's emotional condition in such critical moment, in addition to physical examination, through nursing procedure, allows the nurse to establish an integral nursing diagnosis and trace possible interventions for the patient⁽⁴⁾.

"Fear" as a nursing diagnosis⁽⁵⁾ is defined as "Response to the threaten perceived, which is consciously recognized as danger". Anxiety is defined as a vague and discomforting feeling, or dread, followed by autonomic answer (the source is frequently not specified or unknown for the individual); apprehension feeling caused by the anticipation of danger. It is an alert that calls attention to an imminent hazard, which allows the individual to make decisions to lead with the threat.

Research shows that patients who had a high score of fear also had a high anxiety score⁽⁶⁾. That strong correlation constitutes a justification for defending the existence of a syndrome resulting from the set of manifestations of both fear and anxiety nursing diagnosis study⁽³⁾. Some authors^(7-8) have mentioned in their studies the presence of a possible anxious syndrome

The perioperative anxiety syndrome is defined as an emotional state with psychological and physiological elements⁽⁹⁾, with diffuse apprehension feelings, uncertainties, impotence, unpleasant and discomfort sensations, of a vague and unspecified nature associated to alienation and insecurity^(8-9).

OBJECTIVES

The study objectives are:

- Identify the presence of nursing diagnostics signs and symptoms for fear and anxiety in immediate preoperative patients undergoing gynecological elective surgeries.

- Identify the presence of signs and symptoms of the perioperative anxiety syndrome.

METHODS

The study has been developed within a prospective and descriptive character⁽¹⁰⁾. The research was executed after the project's approval from the Research Ethical Committee of the Universidade Federal de São Paulo and developed in the premises of the Gynecology Unit of the Hospital São Paulo, associated to UNIFESP university complex.

The study sample population was composed by 50 women undergoing gynecological elective surgeries, in immediate preoperative phase. The study included 48 patients who had at that stage the nursing diagnoses anxiety and fear proposed for this research.

Inclusion criteria were: patients over 18 years, undergoing elective gynecological surgeries, and aware that they were not under the effect of anesthetic premedication, who agreed to voluntarily participate in the study after signing the Term of Free and Cleared Consent.

An instrument elaborated and validated by previous study (^{Appendix 1})⁽³⁾ was used for data gathering.

A training program for the interviewers (two fourth-grade students in undergraduate nursing / UNIFESP) was executed by the counselor, to improve the interview techniques and optimize completion of the instrument, being pre-tested with five patients. With such training program, data gathering was made daily at the gynecology ward of the Hospital São Paulo.

After detailing the objectives of this research and after signing the referred Term, both the interview and the physical examination took place in immediate preoperative phase. If these defining characteristics (signs and symptoms) of fear and anxiety diagnoses were present, data were recorded on the instrument, as well as factors related to nursing diagnoses for study and "perioperative anxiety syndrome" developed in a previous study (^{Appendix 2})⁽³⁾.

Data: the data collected were tabulated and submitted to descriptive analysis, in absolute percentage.

RESULTS

Relating to the issue of having previously undergone a surgery, 65.5% of patients had had a previous surgery experience. The most frequent surgical specialties include 25.0% of total abdominal hysterectomy, 21.0% of vaginal hysterectomy, 16.7% of laparoscopic and hysteroscopic surgery 16.4%, 12.5% of exploratory laparotomy, and 4, surgical conization 2% and 4.2% salpingo-oophorectomy in 48 patients who had the nursing diagnoses in question.

It is verified in Figure 1 that from the total of 50 interviewed patients, the nursing diagnosis in question was present in 48 of them (96.0%).

Figure 2 shows that from the total of 48 patients showing the nursing diagnosis of Fear and Anxiety, the perioperative anxiety syndrome was observed in 46 of them (96.0%)

It is evident, in Fig.3 that the defining characteristics of perioperative anxiety syndrome present in 46 patients present high frequency rate (equals or above 70.0%) such as: apprehension and verbally reported anxiety at 95.8% respectively; verbalization and anguish at 93.7% respectively; excitement and restlessness at 91.6% respectively, dry mouth 87.5%, and respectively nervousness and fearing death at 70.0%.

In Figure 4, it is observed syndrome factors-related including: anesthetic at 93.7%, surgery at 62.5%; post-operative at 58.3% and hospitalization 35.4%.

DISCUSSION

While comparing nursing diagnosis clinical symptoms of fear and anxiety in the 48 patients selected for this study, with medical diagnostics of gynecological tumors and other gynecological problems (endometrial polyps and vaginal prolapse), we observed this population did not present qualitative or quantitative differences referring to the defining characteristics of the diagnoses being studied.

There was no difference regarding the percentage of nursing diagnoses anxiety and fear among the 22 patients (46.0%) with a diagnosis of tumor, undergoing surgery to hysterectomy / vaginal hysterectomy, and the remaining 26 patients (54.0%) carriers of other gynecological problems. Therefore, the patients in question had similar incidence in the identification of nursing diagnoses in the study, regardless of medical diagnosis and surgical approach, in contrast to the findings of earlier research⁽³⁾.

The results in Figure 1 on the presence of fear and anxiety diagnoses show high percentages of frequency. Considering surgical procedure patients would undergo, also related to procreation or involving sexual organs procedures, it was confirmed such patients had high levels of fear and anxiety.

Confirmation of the existence of an anxiety syndrome, the syndrome of perioperative anxiety, observed in Figure 2 (96.0%) was identified by the high percentage indices of the defining characteristics of the two nursing diagnoses: fear and anxiety^{(3,7-8 )}.

It is interesting to note in Figures 3 and 4, respectively, that the high frequency rate of defining characteristics (found in more than 70.0% of patients) and associated factors confirm the presence of a possible syndrome involving the two nursing diagnoses in this study, i.e., the Perioperative Anxiety Syndrome^(3,8,11).

Nurse's abilities on propaedeutic techniques associated to the knowledge on physiology and physiopathology will contribute effectively to identify the clinical diagnoses mentioned and the attribution of the referred anxious syndrome^(3-4).

CONCLUSION

This research identified the presence of defining characteristics for the nursing diagnoses of Fear and Anxiety in immediate preoperative patients for gynecological elective surgeries, which are: apprehension and verbally reported anxiety respectively at 95.8%, verbalization and anguish at 93.7% respectively, excitement and restlessness at 91.6% respectively, dry mouth at 87.5%, nervousness and fearing death at 70.0% respectively.

The Perioperative Anxiety Syndrome was present in 96% of the interviewed patients, and key related facts are: anesthetic (93.7%); surgery (62.5%), post-operative (58.3%) and hospitalization (35.4%)

Data analyzed in the present study confirm the findings of other conducted surveys, being the diagnoses of Fear and Anxiety identified in patients given their exposure to stressful situations, such as surgical interventions to which they would undergo, and reinforce the importance of nurses performance while carrying out more systemized nursing care, in view of the patients necessity of attention and care in the moment before surgery.

REFERENCES

• 1. Gorestein C, Andrade LHSG, Zuardi AW, editores. Escalas de avaliação clínica em psiquiatria e psicofarmacologia. São Paulo: Lemos; 2000.
• 2. Suriano MLF. Diagnósticos e intervenções de enfermagem no período perioperatório dos pacientes submetidos a cirurgias cardiovasculares. [tese- mestrado]. São Paulo: Universidade Federal de São Paulo. Escola Paulista de Medicina; 1999.
• 3. Suriano MLF. Comportamento das características definidoras dos diagnósticos de enfermagem medo e ansiedade identificados no pré-operatório imediato de pacientes submetidos a cirurgias eletivas [tese-doutorado]. São Paulo: Universidade Federal de São Paulo. Escola Paulista de Medicina; 2005.
• 4. Barros ALBL, et al. Anamnese e exame físico: avaliação diagnóstica de enfermagem no adulto. Porto Alegre: Artmed; c2002.
• 5. North American Nursing Diagnosis Association - NANDA. Taxonomia I. Porto Alegre: Artmed; 2006.
• 6. Stuart GW, Laraia MT. Enfermagem psiquiátrica. 4a ed. Rio de Janeiro: Reichmann & Afonso Editores; 2002.
• 7. Adams P, Coler M, Collins J, Cotteta T, Delaney C, Miller BK, Levn R, Much J. Anxiety Fear Classification of Nursing Diagnoses. In: Proceedings of the Twelfth Conference. North American Nursing Diagnoses Association.1997; p.421- 25.
• ⁸
  Withley GGA Comparison of Two methods of Clinical Validation of Nursing Diagnoses. In: Proceedings of the Twelfth Conference. North American Nursing Diagnoses Association.1997. p.103-10.
• 9. Gentil VF, Lotufo FN. Transtornos de ansiedade (neuroses). Manual de psiquiatria. Rio de Janeiro: Guanabara Koogan; 1996.
• 10. Polit DF, Hungler BP. Fundamentos de pesquisa em enfermagem. 3a. ed. Porto Alegre: Artes Médicas; 1995.
• 11. Rothrock JC. Alexander cuidados de enfermagem ao paciente cirúrgico. 13a. ed. Rio de Janeiro: Elsevier; 2008.

Appendix 1

Appendix 2

*

Trabalho desenvolvida na Unidade de Ginecologia, do Hospital São Paulo, pertencente ao Complexo Universitário da Universidade Federal de São Paulo/ UNIFESP. São Paulo (SP), Brasil.

Publication Dates

• Publication in this collection
  10 Mar 2010
• Date of issue
  2009