Carr Eloise, Brockbank Katrina, Allen Sandra, Strike Paul
Bournemouth University, Institute of Health and Community Studies, Bournemouth, Dorset, UK.
J Clin Nurs. 2006 Mar;15(3):341-52. doi: 10.1111/j.1365-2702.2006.01285.x.
Within a gynaecological surgical setting to identify the patterns and frequency of anxiety pre- and postoperatively; to identify any correlation between raised anxiety levels and postoperative pain; to identify events, from the patients' perspective, that may increase or decrease anxiety in the pre- and postoperative periods.
It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient outcomes. Few studies have been conducted to obtain the patient's perspective on the experience of anxiety and the events and situations that aggravate and ameliorate it.
The study used a mixed method approach. The sample consisted of women undergoing planned gynaecological surgery. Anxiety was assessed using the State Trait Anxiety Inventory. Trait anxiety was measured at the time of recruitment. State anxiety was then assessed at six time points during the pre- and postoperative periods. Postoperative pain was also measured using a 10 cm visual analogue scale. Taped semi-structured telephone interviews were conducted approximately a week after discharge.
State anxiety rose steadily from the night before surgery to the point of leaving the ward to go to theatre. Anxiety then increased sharply prior to the anaesthetic decreasing sharply afterwards. Patients with higher levels of trait anxiety were more likely to experience higher levels of anxiety throughout their admission. Elevated levels of pre- and postoperative anxiety were associated with increased levels of postoperative pain. Telephone interviews revealed a range of events/situations that patients recalled distressing them and many were related to inadequate information.
This study found higher rates of anxiety than previously reported and anxiety levels appeared raised before admission to hospital. This has important clinical and research implications.
Patients with high levels of anxiety may be identified preoperatively and interventions designed to reduce anxiety could be targeted to this vulnerable group. Patient experiences can inform the delivery of services to meet their health needs better.
在妇科手术环境中，确定术前和术后焦虑的模式及频率；确定焦虑水平升高与术后疼痛之间的任何相关性；从患者角度确定在术前和术后可能增加或减少焦虑的事件。
有充分文献记载，手术与焦虑增加有关，这对患者的预后有不利影响。很少有研究从患者角度探讨焦虑体验以及加剧和缓解焦虑的事件和情况。
本研究采用混合方法。样本包括接受计划性妇科手术的女性。使用状态-特质焦虑问卷评估焦虑。在招募时测量特质焦虑。然后在术前和术后的六个时间点评估状态焦虑。术后疼痛也使用10厘米视觉模拟量表进行测量。出院后约一周进行录音的半结构化电话访谈。
状态焦虑从手术前一晚到离开病房前往手术室时稳步上升。然后在麻醉前焦虑急剧增加，之后急剧下降。特质焦虑水平较高的患者在整个住院期间更有可能经历更高水平的焦虑。术前和术后焦虑水平升高与术后疼痛加剧有关。电话访谈揭示了一系列患者回忆起来令其痛苦的事件/情况，许多与信息不足有关。
本研究发现焦虑发生率高于先前报道，且在入院前焦虑水平似乎就已升高。这具有重要的临床和研究意义。
术前可识别出焦虑水平较高的患者，针对这一弱势群体设计旨在减轻焦虑的干预措施。患者体验可为提供更好满足其健康需求的服务提供参考。
