INTRODUCTION:

The anticipation of surgery and its experience is well known stressor to the patients. The unfamiliar, sterile and cold environment of the operation theatre makes surgery a potentially unpleasant and uncomfortable experience.

Anxiety experienced by patients undergoing hospitalization for surgery has been viewed as a normal human response to a stressful event.

In the present scenario surgeries are found to be the treatment modality for many disease conditions. In India spinal anesthesia is one of the common regional anesthesia and it is used among 40-45% of surgery cases.

Spinal anesthesia is one of the mostly performed regional anesthesia for the following surgeries which are done below the level of umbilicus such as operations in the lower gastro intestinal tract, gynecological operations, urological operations, perineum and genitalia operations and all operation on the leg. The patients contraindicated for spinal anesthesia include clotting disorders, hypovolaemia, patient refusal for the administration, either due to lack of knowledge or preference for genera./l anesthesia, unco-operative patients, such as children, mentally challenged individuals, patients with psychiatric disorder, anatomical difficulties to administer the spinal anesthesia, and patients are suffered by sepsis, septicaemia and neurological disease.

Xie and Liu (2004), reported about the practice of spinal anesthesia in China. Questionnaires were sent to 237 hospitals over six geographic areas, including some military hospitals. The response rate was 38% (90 hospitals). There were 1,304,214 documented spinal blocks in these hospitals. This survey revealed that spinal anesthesia was used extensively in China for various types of surgery, ranging from lower abdominal to the lower extremities. The incidence of total spinal anesthesia as a complication was reported to be only 0.013%, and about half of these cases required intubation and ventilation.

Safe anaesthesia is of vital importance with any surgery. Perioperative anxiety is a great concern that has the potential effect to influence the smooth induction, maintenance and recovery from anaesthesia. Unlike general anesthesia, the awareness of the surroundings in the operating theatre during spinal anesthesia may potentially increase patient anxiety level.

Different methods have been used to alleviate anxiety and fear during the peri-operative period. Some of these methods include a warm and friendly hospital and operating theatre environment, appropriate information and explanations regarding the anesthesia, surgery and perioperative course, pharmacological methods such as premedication and intra-operative sedation and complementary therapies such as music therapy, hypnosis, acupressure and guided imagery have also been shown to decrease patient anxiety during the perioperative period.

A study on influence of the environment on anxiety during surgery under local/regional anaesthesia. 214 patients were provided with a questionnaire on the day of surgery for return by mail 24-48 hours following surgery. The number of patients experiencing a degree of anxiety on the day of surgery was 77%. Many patients experienced anxiety resulting from the thought of being awake (60%), possibly feeling the surgeon (60%), potentially seeing their body cut open (47%), the thought of the numbness wearing off too quickly (53%) or the thought of local/ regional anaesthesia being more painful (61%).

A randomized controlled study to evaluate whether watching video compact discs intra-operatively using a liquid crystal display (LCD) unit decreased anxiety. Forty-four patients undergoing elective surgery under regional anaesthesia were assigned to either the LCD or control group. Anxiety was measured using the Chinese version of the State-Trait Anxiety Inventory (STAI) and visual analogue score (VAS). The mean (SD) anxiety trait scores were 46.15 (6.28) and 46.40 (7.32) in the control and LCD groups, respectively. The state anxiety of the LCD group [35.50 (7.96)] measured immediately postoperatively was significantly lower than the control group [41.50 (9.02); p = 0.03]. The median (range) reduction in VAS anxiety score was not significantly greater in the LCD group [20 (20 to 80) mm] compared with the control group [12.5 (70 to 60) mm]. Watching video intra-operatively reduces patient anxiety as measured by the STAI.

STATEMENT OF PROBLEM:

Effectiveness of intraoperative video therapy on anxiety among patients under spinal anesthesia at Valli hospital, Erode

OBJECTIVES:

1) To assess the level of anxiety among patients under spinal anesthesia in control and experimental group before and after intraoperative video therapy.

2) To determine the effectiveness of intraoperative video therapy on anxiety among patients under spinal anesthesia in control and experimental group.

3) To find out the association between post test scores of anxiety among control and experimental group of patients under spinal anesthesia with their demographic variables.

RESEARCH METHODOLOGY:

Research Approach:

Evaluation approach was used to test the effectiveness of intraoperative video therapy on anxiety among patients under spinal anesthesia.

Research Design:

Quasi-experimental design, where Pretest Posttest Nonequivalent Group design

Research Settings:

The study was conducted in Valli hospital, Erode.

Variables:

Independent variable is intraoperative video therapy.

Dependent variable is anxiety

Sample:

The sample consisted of 30 patients under spinal anesthesia out of which 15 patients were control group and 15 patients were experimental group.

Sampling technique:

Non probability convenience sampling technique was used to select the sample

Development of the tool:

Section A: Demographic variables of patients under spinal anesthesia, i.e., Age in years, Gender, Name of surgery, Duration of surgery, Previous history of surgery, Trait anxiety (STAI-T) and Occupation

Section B: It consists of Spielberger State Anxiety Inventory (STAI-S) which consists of 20 self reporting statements (9 positive statements and 11 negative statements). Each statement in the STAI-S is rated on a four-point scale (not at all-1, a little-2, somewhat-3 and very much so-4). The overall (total) score for STAI ranges from a minimum of 20 to a maximum of 80; STAI scores are commonly classified as ‘no or low anxiety’ (20–37), ‘moderate anxiety’ (38–44), and ‘high anxiety’ (45–80).

Plan for data analysis:

The data were analysed by using both descriptive and inferential statistics

· Back ground information of the subject were described by percentage distribution

· Mean, standard deviation, paired ‘t’ test and Unpaired ‘t’ was used to find the relationship between pre-test and post test scores on anxiety among patients under spinal anesthesia.

· Chi square test was used to find out the relationship between selected variables of patients under spinal anesthesia with their post test scores.

RESULTS:

Section A:

In control group, most (66%) of the patients were in the age group of 31 -50 years, 67% of them were males, half of them were underwent hemorrhoidectomy and fissurectomy, 80% of them duration of surgery was less than 1 hour, 60% of the patients had no previous history of surgery, most of them have low and moderate trait anxiety and 94% of them were in non medical occupation.

In experimental group, most (60%) of the patients were in the age group of 41 – 60 years, 53% of them were males, half of them were underwent fistulectomy and fissurectomy, 87% of them duration of surgery was less than 1 hour, 60% of the patients had previous history of surgery, most of them had low and moderate trait anxiety and all of them were in non medical occupation.

Section B: Frequency and percentage distribution of the control group and experimental group post test scores of level of anxiety among patients under spinal anesthesia.

Level of anxiety	Post test scores
	Control group		Experimental group
	Frequency (N₁)	Percentage %	Frequency (N₂)	Percentage %
No/Low anxiety	10	67	13	87
Moderate anxiety	4	27	2	13
High anxiety	1	06	0	0

Section C :Paired ‘t’ test value of pre and post test scores of level of anxiety in control and experimental group

Patients under spinal anesthesia	Paired ‘t’ value	Table value	Level of significant (P)
Control group	6.83	2.15	P < 0.05 significant
Experimental group	10.43	2.15	P < 0.05 significant

The paired ‘t’ test value was 6.83 and 10.43 in control group and experimental group, when compared to table value (2.15) both are high. This shows that even though there was a significant effectiveness between pre and post test scores of level of anxiety among both control and experimental group, intraoperative video therapy was more effective on anxiety among patients under spinal anesthesia

80

Unpaired ‘t’ test value of post test scores of anxiety in control group and experimental group

Level of anxiety	Unpaired ‘t’ value	Table value	Level of significant (P)
Post test scores of anxiety in experimental and control group	2.42	2.05	P<0.05 Significant

The unpaired ‘t’ test value was 2.42, when compared to table value (2.05, p<0.05), it is high. It seems that there was a significant effectiveness of intraoperative video therapy on anxiety among patients under spinal anesthesia.

Section D:

Chi square test showed only trait anxiety in control group and duration of surgery and trait anxiety in experimental group have significant association with their post test scores of level of anxiety and other demographic variables have no significant association with the post test score of level of anxiety in both control and experimental group.

DISCUSSION:

· There was a significant effectiveness of Intraoperative video therapy on anxiety among patients under spinal anesthesia.

· There was a significant association between the post test scores of anxiety when compared with trait anxiety

· There was a significant association between the post test scores of anxiety when compared with duration of surgery in control group

· There was no significant association between post test scores of anxiety when compared with age, gender, name of surgeries, previous history of surgery and occupation.

· There was no significant association between post test scores of anxiety when compared with duration of surgery in experimental group.

RECOMMENDATIONS:

Based on the findings of the study the following recommendations have been made for further study.

· A study can be conducted with large samples to generalize the findings.

· A similar study can be conducted in various regional anesthesia patients like epidural anesthesia, plexus block and single nerve block.

· A similar study can be conducted on various physiological problems among intraoperative patients like increased heart rate and blood pressure, physical discomfort and pain.

· A similar study can be conducted on various psychological problems among intraoperative patients like anxiety, depression, post traumatic stress symptoms and cognitive impairment

· A comparative study can be conducted to compare the effectiveness of various complementary therapies like music, hypnosis, acupressure, guided imagery, massage therapy, hand holding and video therapy on intraoperative anxiety among patients under local/regional anesthesia

· A comparative study can be conducted to assess the effectiveness of video therapy among children vs adult patients under local/regional anethesia.

· A comparative study can conducted to assess the effectiveness of intraoperative video therapy among various types of regional anesthesia like spinal anesthesia, epidural anesthesia, plexus block and single nerve block.

REFERENCE:

1. Long Phipps and Cassvever, (1993), ‘‘Medical Surgical Nursing-A Nursing Process Approach’’ (3^rd edition), Mosby Publication, Missouri.

2. Mark Mitchel, (2005). Anxiety Management In Adult Day Surgery: A Nursing Perspectives. Whurr Publisher Ltd, Philadelphia.

3. A.K.Y. Man, (2003). The effect of intraoperative video on anxiety. Anesthesia- Journal of the association of Great Britain and Ireland, volume-58, Issue-1. P_p: 64-68.

4. Augustin P, Hains AA, (1996). Effect of music on ambulatory surgery patients' pre-operative anxiety. AORN Journal-63. P_p:750–8.

5. Bailey L, (2010). Strategies for decreasing patient anxiety in the Perioperative setting. AORN J- 92(6). P_p-708.

6. Cruise CJ, Chung F, Yogendran S et al (1997). Music increases satisfaction in elderly outpatients undergoing cataract surgery. Canadian Journal of Anaesthesia -44. P_p :43–8.

7. Jlala H, French J, Foxall G, Hardman J, Bedforth N, (2010). Effect of pre-operative multimedia information on Perioperative anxiety in patients undergoing procedures under regional anaesthesia. British Journal of Anaesthesia- 104. P_p:369–374.

Received on 24.02.2014 Modified on 15.04.2014

Int. J. Nur. Edu. and Research 2(3): July- Sept. 2014; Page 192-195