Psychological preparation for medical procedures Flashcards
stressful medical procedures, categories
uncomfortable
diagnostic
oncology
gynaecological
intensive
uncomfortable procedures
concern specific patient groups, cancer patients or children
large groups of patients, vaccinations, venepuncture, catheter insertion
diagnostic procedures
upper GI endoscopy
MRI
bone marrow aspiration
pelvic exam
smear test
mammography
oncology
cancer treatment
gynaecological procedures
IVF
C-section
laparoscopic/lapaotomy procedures
hysterectomy
intensive care
critical or life threatening conditions intubation
psychological preparation needed
surgery can be perceived as a potential threat
results in increased levels of anxiety
may lead to increased risk of complications, pain and longer recovery
preoperative anxiety
feeling exposed/loss of dignity
incision
losing consciousness
reliance on others
fear of not waking up
fear of being aware but not able to communicate
postoperative anxiety
diagnosis nd prognosis
pain/loss of sensation
loss of mobility/function
disfigurement
surgical/anaesthetic harm
postoperative infection
what is happening at home/wokr
what is anxiety
A sense of apprehension or doom,
accompanied by physiological reactions,
involving an uncertain or unspecified threat
increased level of pre op anxiety has been shown to be related to negative consequences, affecting
anaesthesia
postoperative care and treatment
rehabilitation
types of anxiety
cognitive
somatic
behaviour
state or trait
cognitive anxiety
negative thoughts
worry
rumination
somatic anxiety
autonomic arousal perception of physical symptoms of anxiety
increased HR,BP, muscle tension, sweating, nausea, trembling, dry mouth, dizziness
behaviour
adaptive
maladaptive
state or trait
some higher on trait anxiety
risk factors for preoperative state anxiety
history of:
cancer
smoking
psychiatric disorders
negative future perception
moderate to intense depressive symptoms
high-trait anxiety
moderate to intense pain
medium surgery
female gender
more than 12 years of education
previous surgery reduced the risk
more about cognitive anxiety
“what if?”
attentional bias towards threatening information
misinterpret benign physical sensations as evidence
biopsycho feedback loop that increases physical symptoms
worry about outcome and also everyday matters can be dispositional
consequences of high anxiety
phobias, panic attacks, maladaptive, inability to process information
positive correlation between preoperative anxiety and postoperative pain
high pre op anxiety predicts poorer recovery outcomes
pre op anxiety can influence the intensity of post op pain and anaesthesia and analgesia requirement
anxiety may even increase post op morbidity and mortality
how are patients helped to prepare
methods aim to increase feeling of control (informational, cognitive and behavioural) as well as reducing anxiety
information giving effectiveness depends on: type and level of information, anxiety level and coping style of patient
behavioural instruction
cognitive approaches
relaxation/imagery/hypnosis
focused discussion
modelling
4 general types of intervention
procedural information
sensory information
coping information
modelling
procedural information
giving objective information about the sequence of events, equipment used and timing of experiences
sensory information
describing sensations that precede, accompany and follow the procedure
coping infomration
teaching coping methods to minimise the experience of Naomi
modelling
showing other persons undergoing the procedure without complications
coping style and anxiety reduction
categorised into blunders and monitors
divided into high and low information groups
pulse rate measured pre and post information giving
monitors
seek information
less anxiety
high information
higher anxiety levels before information giving
blunters
avoid information
less anxiety
low information
lower anxiety levels before information giving
relaxation
involve training in transferable skills
reduce anxiety
counter physical consequences of anxiety
increase feeling of physical control
psychological and physical benefits
involving training in transferrable skills
progressive muscular relaxation
meditation
biofeedback
guided imagery
relaxation tapes
what does cognitive behaviorual interventions involve
identifying problem thoughts giving rise to anxiety
demonstrating link between thoughts and feelings
looking at evidence for problems mthoughts
replacing with more reality based thoughts
effectiveness of cognitive behavioural interventions
compared with routine care controls
no difference inc reported pain
faster mobility and reduced pain medicatio n
what is the most frequency used intervention in children n
modelling
delivers procedural and sensory information in a different way and is an underutilised/underexplored form of intervention
does psychological preparation work?
better prepared patients gave better post op outcomes
psychological preparation may be beneficial for
post op pain
behavioural recovery
negative affect
length of hospital stay
quicker resumption of activities
