w3 Physiological preparation for medical procedures

Question 1

What are the trends in medical procedures that are considered stressful?

Answer 1

Uncomfortable procedures
Involve children
Affect large groups of people such as vaccinations
Diagnostic procedures - fear of outcome
Oncology - fear of survival and sideffects
Gynaecology - invasive, social construct is negative
Intensive care - fear death.

Question 2

What are some consequences of anxiety on health procedures?

Answer 2

More likely to fear pain or upset
Increased risk of complications
Longer recovery time
Poorer uptake of anaesthetic
Increased risk or mortality and morbidity.
Linked to the effects of stress on the body and mind.
Longer hospitalisation after visiting the surgery.

Question 3

What are patients often anxious about in preoperative conditions?

Answer 3

Pain
Survival rates
Complications
Feeling exposed or embarrassed
Incisions or needles
Losing control
Not waking up
Not being able to communicate but being aware (fault in anaesthetic).

Question 4

What are patients often anxious about in the post-operative state?

Answer 4

Diagnosis or prognosis
Loss of sensation
Coping with recovery at home/work etc
Disfigurement
Post-operative infection

Question 5

What is anxiety?

Answer 5

A sense of apprehension or doom, with physiological symptoms due to an uncertain or unspecific threat.

Question 6

How common is anxiety in surgical patients?

Answer 6

80% of patients scheduled for high risk surgical procedures suffer from anxiety.

Question 7

What are the different types of anxiety?

Answer 7

Cognitive - negative thoughts and feelings
Somatic - physical symptoms
Behavioural - adaptive or maladaptive

Question 8

What are some physical symptoms of anxiety?

Answer 8

Increased heart rate
Increased blood pressure
Muscle tension
Sweating
Nausea
Trembling

Question 9

What is meant by anxiety as a trait or state?

Answer 9

State - finite event of anxiety emotions, with a cause
Trait - personality more likely to suffer anxiety.

Question 10

How might we measure anxiety?

Answer 10

The self report scale such as the State Trait Anxiety Inventory.
HADS - hospital anxiety and depression scale
-*Both the above use statements then a scale of strong agree or disagree to calculate a score e.g I feel safe.
Physiological measure such as pulse rate or Gulvanic Skin Response. (symptom associated with the illness)

Question 11

What makes some patients more likley to have pre-operative anxiety?

Answer 11

Withdrawl of coping mechanims - smoking, family etc
Psychiatric disorders
Personality trait - negative thought tendency or anxious nature
Internal working mechanism of hospitals and surgical procedures.
More than 12 years in education
Female

Question 12

How might gender effect the risk of pre-operative anxiety?

Answer 12

Cultural differences in willingness to express anxiety
Stigma around sex related procedures, unable to explain worries to support network
Results are mixed and inconsistent on if women show higher levels of pre-operative anxiety than men.

Question 13

What are some thoughts of preopertative cognitive anxiety?

Answer 13

Attention bias towards negative information.
Misinterpret or exaggerate symptoms as more dangerous events
Evaluation of situation creates feedback that portrays the event as more negative than it actually is. Or tensing as expecting pain can increase the level of pain
Blame surgery for everyday inconveniences.
Characterised by intrusive thoughts and disorganised thinking.

Question 14

How does trait anxiety affect per-operative anxiety?

Answer 14

Evidence shows both trait anxious and not anxious individuals have higher anxiety before surgery.
Do not necessarily response worse to medical procedures.

Question 15

How can anxiety affect the consent process?

Answer 15

Undermine the capacity to give consent as give undue influence to phobias.
Anxiety reduced memory recall so do not understand information, so can not give informed consent.

Question 16

What are the different ways to prepare a patient for surgery?

Answer 16

Increase feelings of control by
Information giving
Cognitive therapy
Relaxation
Focused discussions
Modelling.

Question 17

What are the four types of general intervention types to help patients prepare for surgery?

Answer 17

1) giving objective procedural information, what will happen when and how.
2) giving sensory information about what the patient should expect to feel before, during and after the surgery.
3) teaching coping methods to minimise the pain, stress and side effects
4) modelling, giving examples of patient whose surgeries have been successful and managed to cope afterwards. video of procedure etc.

Question 18

What is important to remember when giving information about surgery to patients?

Answer 18

Must have enough info to give informed consent.
Some patients are information seekers others are information avoiders.
Level of anxiety and type of information desired will vary from patient to patient.

Question 19

What is the cognitive appraisal behind sensory information?

Answer 19

Patient begins to think about their emotions and consider how they will feel.
By being aware of the threat, the stress appraisal is reduced and better coping mechanisms can be thought of in advance.
By understanding how they will feel afterwards it reduced the number of visits to GP about surgery symptoms.

Question 20

Why is information on information giving about surgeries controversial?

Answer 20

Different patients react in different ways.
Difficult to investigate.
Sensory information - patients expects to feel a certain negative way so does, placebo effect, even if they don’t. Increase fear of side effects that they didn’t know about before.

Question 21

What are coping instructions?

Answer 21

When a doctor tells a patient specific behaviour patterns to follow in order to recover from surgery or minimise potential complications, such as breathing or limb exercises.

Question 22

How does being a ‘sensitiser’ effect patients who are preparing for hospital?

Answer 22

Patients are more likely to be stressed or experience high levels of anxiety.
Are more easily overwhelmed by the hospital environment and change in routine.
Often experience more pain and have worse outcomes after surgery.

Question 23

What are the different coping strategies of patients according to Miller and Mangan in 1983?
How does this relate to levels of anxiety?

Answer 23

Blunters - avoid information and pretend things will not and have not happened.
Monitors - seek high levels of information, over analyse situations and seek help for small unexpected changes.
Monitors often have higher levels of anxiety and are more costly before information is given.

Question 24

What is involved in relaxation to reduce anxiety?

Answer 24

Training in skills such a muscular relaxation, biofeedback, meditation and guided imagery.
Helps to reduce the feelings and physical symptoms of anxiety, and increase feelings of control.
Has physiological and psychological benefits.

Question 25

What are the two most common anxiety subtypes regarding operations?

Answer 25

Fear of what will happen during the surgery.
Fear of te consequences of the surgery.
These are both types of anticipatory anxiety.

Question 26

What is the relationship between anxiety and stress?

Answer 26

Anxiety is an emotional response to stress.

Question 27

What are cognitive-behavioural interventions?
Is it effective?

Answer 27

Changes the patients thought process, identifies the negative thoughts that cause anxiety and reappraises these based on evidence to help the patient focus on the positives.
Demonstrates the link between thoughts and feelings
Compared to a control group there was no difference in pain but patients did reduce pain medication and become mobile faster after surgery.

Question 28

What is the difference between a sensitiser and a repressor?

Answer 28

Repression - motivated forgetting by the ego, hides disturbing or upsetting thoughts, not successful long term as though can rearise from the unconscious resulting in panic attacks, sudden break down or nightmaters
Sensitiser - seeks out threatening information, feel higher levels of anxiety, feel emotions in the moment.