1. D'Alesandro, Mary Ann MSN, RN, CNOR, BC

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Anxiety is a normal response to an unknown situation or event.1 Although perioperative anxiety is common, it can trigger physiologic stress responses that can affect the patient's outlook, recovery process, and healing capabilities.


Many factors may lead to perioperative patient anxiety, including the reason for surgery, such as treatment of pathology, trauma, or unknown etiology requiring biopsy. In addition, some patients experience a perceived loss of control due to the need for sedation or the known recovery time that will require the patient to rely on others for basic needs. Other factors include fear of postoperative pain or an alteration of body image, separation from loved ones, and unknown surroundings.1



Several strategies have been evaluated in evidence-based practice that can reduce anxiety levels in surgical patients. These strategies include the use of music therapy, aromatherapy using essential oils, and relaxation techniques.1 Unfortunately, a fast-paced and high-turnover unit, such as the perioperative area, may not be the ideal place to employ these strategies. Alternatively, research has indicated that basic strategies, including effective communication and appropriate humor, can also reduce anxiety and can be used with patients having surgery-even those not exhibiting signs of anxiety.2


Surgical procedures also cause anxiety for the patient's family or significant others who are waiting for the patient. A nurse liaison can help facilitate communication between the surgical team members and the family or significant others waiting for the surgical patient.3 The nurse liaison provides information and helps those who are waiting for the patient to cope with feelings of uncertainty, emotional stress, and fear.3 The nurse liaison is responsible for ongoing communication with those who accompanied the patient and updates them on the surgery's progress.3


Back to basics

Perioperative nurses can use a variety of strategies to help reduce a surgical patient's anxiety, including:


* Effective communication: speaking clearly and in layman's terms, explaining the sequence of events that will occur during the perioperative stay. Considering implementing a perioperative nurse liaison role.2,3


* Humor: using appropriate, culturally-sensitive humor and encouraging laughter.2


* Music and aromatherapy: these are appropriate techniques, as long as they do not disturb other patients.


* Visitation: if possible, allowing family or significant others to visit with the patient while waiting for surgery. Conversely, being aware of the patient's anxiety level increasing with the presence of visitors.


* Anxiolytic medication: discussing the option of taking a preprocedure anxiety medication with the patient during the preoperative interview, and individualizing the medication plan.2



Surgery places a great deal of physical stress on the body and psychological stress on the patient's mental state. Patients with decreased perioperative anxiety have been shown to have improved outcomes.2 Keeping the basics in mind, perioperative nurses should implement all available, appropriate strategies, including communication, humor, visitation, and pharmacologic measures to decrease the surgical patient's anxiety and improve the patient's experience.




1. Bailey L. Strategies for decreasing patient anxiety in the perioperative setting. AORN J. 2010;92(4):445-457. [Context Link]


2. Davis-Evans C. Alleviating anxiety and preventing panic attacks in the surgical patient. AORN J. 2013;97(3):354-364. [Context Link]


3. Lerman Y, Kara I, Porat N. Nurse liaison: the bridge between the perioperative department and patient accompaniers. AORN J. 2011;94(4):385-392. [Context Link]