The Effect of Pre-Operative Distress on the Perioperative Period-Juniper Publishers
Juniper Publishers-Journal of Anesthesia
Abstract
Distress is defined as feelings and ideas that lead
to unpleasant problems in diseases and treatments. Distress has meanings
such as sadness, hopelessness, weakness, fear, excitement, anxiety,
panic, depression, indecision and burnout. Pre-operative patients
undergo distress at different levels and different reasons.
The main cause of distress for surgery patients is
fear. Death, fear that body will be damaged and pain will occur, loss of
identity and control under anesthesia, mysteries about surgery and
dependency in the post-operative period are the most common causes of
fear. Pre-operative distress levels vary by diagnosis, type of surgery,
organ or system involved and patients' prejudgments about these issues.
Distress effects the individual negatively in every
sense leads to various complications during perioperative period
negative effects. Patients suffer from such problems as pain, increased
risk of infection, nausea and vomiting, delayed wound healing, longer
hospital stays during the postoperative period due to pre-operative
distress.
As a biopsycho social being, the patient should be
evaluated and supported in terms of preoperative distress to help them
cope with preoperative distress. This article deals with the effect of
pre-operative distress on the post-operative period.
Keywords: Peri-operative; Surgery; Patients; Psychosocial supportIntroduction
Distress is defined as feelings and ideas that lead
to unpleasant problems in diseases and treatments. Distress has meanings
such as sadness, hopelessness, weakness, fear, excitement, anxiety,
panic, depression, indecision and burnout. The pre-operative period is a
crisis period for many people. During this period individuals may
experience many of the feelings, emotions and ideas that cause distress [1,2].
Fear is the most common cause of distress about surgery. Death, fear
that body will be damaged, waking and suffering during surgery, pain,
loss of identity and control under anesthesia and loss of organs and
tissues are the most common causes of fear. Hospitalization and waiting
for surgery, the meaning of the surgery for the patient and lack of
knowledge about surgery also cause distress. Being unfamiliar with
operating rooms, the idea that attention is not paid to privacy during
surgery, postoperative pain and being dependent on others, life
conditions being negatively affected, being away from family and
friends, inability to provide care to dependents and fear of job loss
are other causes of distress [3,4].
The stressful period that starts with telling patients that they will
be operated on can negatively affect their disease, care, compliance
with treatment, treatment duration, treatment costs and quality of life [1].
Akbulut reported that patients had pre-operative
anxiety due to causes such as lack of knowledge and experience of
anesthesia, failure to wake up after anesthesia, absence of the
anesthesiologist in the operating room, altered awareness under
anesthesia, post-operative nausea and vomiting, attitudes of the
anesthesiologist, staying in intensive care, long postoperative sleep,
fear of injections and fear that medical personnel may cause problems [5].
As a result of pre-operative distress, many
physiological and psychological changes occur in individuals. Due to the
autonomic nervous system affected by distress, anxiety and fear, the
sympathetic and parasympathetic nervous systems are affected, and
adrenalin increases blood pressure by causing dilatation in the
bronchus. Tachycardia, tachypnea, changes in body temperature, cold
skin, sweating and dryness of the mouth may occur. Gastrointestinal
system functions and secretion reduce. Nervousness, trembling
extremities, lack of appetite, speaking quickly, uneasiness, flushed
skin, sweating palms, urinary incontinence and hypersensitivity may
occur [6].
With the stimulation of autonomic nervous system, blood pressure, heart
rate, respiration rate increase. Stomach and bowel movements increase.
Saliva decreases, dry mouth occurs and blood glucose levels increase [2,6].
Reactions to distress may include the mobilization of
energy stores used for sustaining life, hypermetabolism, activation of
the cardiovascular system and increase in blood volume to vital organs.
These reactions can be dangerous during surgery and anesthesia because
they increase energy consumption and myocardial load [7].
Intraoperative excessive distress leads to
hemodynamic changes and thus excessive use of anesthetics may be
required during surgery, hypothermia and intraoperative bleeding [8].
The type of anesthetics administered to patients during surgery should
not be ignored. The type and amount of the anesthesia and sedative drugs
administered can change the mean arterial pressure, heart rate,
arterial oxygen saturation, cortisol, insulin and blood glucose levels
of patients who have undergone surgical distress.These changes can
affect individuals negatively during the post-operative period. In the
meantime, patients' recovery is prolonged, their pain threshold falls,
and their need for analgesics increases.
Postoperative pain and associated physiological changes increase stress more and thus put patients in a vicious cycle [9,10].
These conditions increase infection risk, nausea and vomiting,
immobilization and respiratory difficulty. Eating disorders caused by
stress during preoperative period retard surgical recovery, too and thus
hospital stay gets prolonged, quality of life deteriorates and various
problems are experienced. Studies emphasize that stress augments
mortality and morbidity risk in the post-operative period [1,9].
The psychological problems caused by surgical
distress include inability to communicate, insomnia, inability to eat,
dissatisfaction with activities, psychological tiredness, insensitivity
to environment, burnout and feelings of inadequacy towards family
members [11].
The psychological preparation of surgery patients is
as important as physiological preparation. In the peri-operative period,
all members of the surgical team should consider patients holistically
when they assess their distress. Because the patient is afraid to know
that he will have surgery, but he is also afraid that he does not know
what to do and that he is strangers to the people around him. Patients
feel fear not only because they know they will have surgery, but also
because they do not know what will happen in the postoperative period
and they are unfamiliar with people around them. In the pre-operative
period, that anesthesiologists and nurses meet patients and introduce
them operating room may reduce their operative fears and distress and
thus patients feel more secure in a safe and familiar environment in the
future period and comfort themselves by sharing negative opinions and
emotions with others easily [12]. Kiyohara et al. [13] reported that preoperative visits paid by anesthesiologists and patient training reduced patients' anxiety. Karayurt [14]
reported that patients to whom routine preoperative patient training
was provided by operating nurses had lower levels of anxiety. Similarly,
a study by Sadati et al. [15] found that pre-operative nurse visits decreased pre-operative anxiety and post-operative complications.
It is highly important to provide patient training
and psychological support to reduce surgical distress. Surgical team
members should assess patients not only physiologically, but also
psychologically and socially. All members of health care teams should
keep in mind that pre-operative psychological preparation is as
important as physiological preparation. Patient-centered and holistic
care should be used so that surgeons, anesthesiologists and nurses can
manage patients' distress. Patients should be allowed to express their
opinions and emotions, and their fears should be understood. Correct,
clear and sufficient clarifications should be given at the right time,
and patients should be encouraged in all phases of their treatment. The
team should not forget that results of a surgery that is technically the
most successful will not be a success for a patient who is not ready
and prepared.
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