Preoperative Nursing Education Interventions to Reduce Anxiety Level in Older Adults Undergoing Emergency Lower Limb Orthopaedic Surgery at a Tertiary Hospital

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Authors (including presenting author) :
Tsai MT
Affiliation :
Department of Orthopaedic and Traumatology, Prince of Wales Hospital
Introduction :
Prevalence of falls has become a growing health concern among older adults. Musculoskeletal limb fracture is a common serious condition resulting from fall. Emergency orthopaedic surgery is necessary for this group of patients in order to restore their premorbid function. However, anxiety and pain provoked by the injury and surgery are frequently unexpected and beyond patient’s control, which can cause sudden stress and influence the patient’s physical and psychological health. Reduction of anxiety can increase patient satisfaction which may enable the individual to undergo a successful surgery.
Objectives :
This study aimed to deliver a pre-operative education intervention and evaluate its effects on the outcomes of older adults undergoing emergency orthopaedic surgery. The effects of pre-operative education on patients’ level of anxiety, pain level, mental status, as well as the length of stay were studied.
Methodology :
A quasi-experimental study involving the effect on anxiety level through delivery of pre-operative education was conducted in comparison to the usual pre-operative care for older patients undergoing emergency lower limbs orthopaedic surgery. Outcome measures including anxiety level, pain score, length of stay and mental status were compared preoperatively and postoperatively in these two groups of older adults.
Result & Outcome :
Total of 57 participants consented and completed the study. There were 28 in experimental group and 29 in control group. The overall baseline anxiety level before operation was high for most of the participants, with a mean State-Trait Anxiety Inventory (STAI) of 49.21 ± 6.80 and 49.97 ± 6.07 for the experimental and control groups respectively. Even though the mean STAI after operation of experimental group (39.14 ± 5.14) was lower than that of control group (41.59 ± 4.72), Mann Whitney Test with p value = 0.08 indicated that the difference may not be statistically significant. Before operation, the mean pain score for the experimental group was 7.18 ± 1.66, whereas the mean pain score for the control group was 7.45 ± 1.35. After operation, the mean pain score of the experimental group was 3.82 ± 1.49, whereas the mean pain level of the control group was 5.31 ± 1.67. The difference of pain score in experimental group and control group after operation was significant (P = 0.001). The incidence of confusion noted in experimental group was 3 out of 28 participants. The incidence of confusion noted in control group was 7 out of 29 participants. However, the difference was not regarded as significant with Chi Square test (p = 0.183).The mean length of stay counted in term of days of the experimental group was 23.82 ± 11.64, whereas the mean length of stay in term of days of the control group was 30.76 ± 9.86. Although results of the current study did not reach significance level on reducing anxiety level, the potential benefits of providing patients with pre-operative education should be regarded. It was suggested that education should be initiated before assessing the patient’s cultural and social background in order to reach the best effect. Although STAI was a test most commonly used for anxiety detection, it may not suit the participants of older age with lower educational level. Additional education process applied to patients in the preoperative period should be regulated according to patients’ needs.
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