As a perioperative nurse in an ambulatory surgery center, what nonpharmacologic strategies can I use to minimize preoperative anxiety in my patients?-JBS, AURORA, COLO.

Christopher Stucky, PhD, RN, CNOR, CSSM, CNAMB, NEA-BC, and Rebecca Vortman, DNP, RN, CNOR, NEA-BC, respond-Most patients awaiting surgery experience differing levels of preoperative anxiety, as surgery is typically a stressful life event. Contributing to preoperative anxiety is a fear of anesthesia, particularly related to intraoperative awareness and delayed emergence from anesthesia, postoperative complications, pain, nausea, and an extended recovery.1 One of the greatest stressors for surgical patients is a fear of the unknown, potentially due to a loss of control.1 Furthermore, the unfamiliar noises, people, equipment, and surgical instruments in the surgical environment can also increase anxiety. Many factors affect preoperative anxiety experienced by surgical patients, including their age, gender, previous surgeries, marital status, and level of education.1

Preoperative anxiety manifests from the date of initial surgical planning and intensifies until the induction of anesthetics.2 High levels of anxiety are problematic for surgical patients as they may contribute to negative health outcomes such as increased pain, a prolonged hospital stay, delayed wound healing, and decreased satisfaction with care.1-4

Anesthesia providers effectively manage preoperative anxiety with pharmacotherapy; however, medications have the potential for harmful adverse reactions.5 Perioperative nurses can use several nonpharmacologic strategies to reduce preoperative anxiety and greatly improve nursing care.

Patient education

Patients may feel anxious because of a lack of information and fear of the unknown. Preoperative education and psychosocial support can allay fears or correct misconceptions, thus reducing anxiety. Perioperative nurses should engage patients early in the preoperative period to help them become collaborative care partners and to set realistic expectations. Preoperative education can include verbal, printed, and audio-visual strategies to teach patients basic details about their surgery, including preoperative instructions such as fasting, stopping certain medications, and herbal supplements; what to expect on the day of surgery; pain management; and postoperative recovery.

Research suggests that inviting patients to visit the center the day before surgery to increase familiarity and reduce anxiety.6 Some hospitals employ novel methods to educate patients and decrease anxiety, including OR orientation tours.7

Virtual reality

Virtual reality (VR) shows excellent promise as a method to reduce preoperative anxiety, as it is inexpensive, noninvasive, and typically easy to use for patients and nurses. With VR, patients are immersed in a 360-degree, three-dimensional video experience depicting nature scenes and playing relaxing music. The videos are typically administered via a phone using a VR headset. The VR videos can distract patients from stressful stimuli, which helps to reduce anxiety and enhance patient satisfaction.8

Open communication and empathy

Patient-centered care provides psychological support and empathy, and targets interventions to alleviate anxiety and stress by understanding the patient perspective. Empathetic patient-centered communication may reduce preoperative anxiety, improve surgical recovery and wound healing, and increase patient satisfaction.9 An empathetic patient-centered approach includes encouraging patient communication of feelings, concerns, and experiences within an atmosphere of privacy and answering questions with a nonjudgmental attitude in a calm, supportive, and confident manner.

Aromatherapy

Aromatherapy may be an effective strategy to alleviate preoperative patient anxiety and stress.10 In the healthcare environment, aromatherapy oils are administered topically, diffused, or inhaled from a cotton ball or piece of fabric.11 Common aromatherapy oils known to reduce anxiety are lavender, mandarin, rose, and bergamot orange citrus.11 In a randomized controlled study exploring how lavender influences anxiety levels, researchers found that patients who inhaled lavender had reduced preoperative anxiety.12

Nurses should be aware of safety considerations when administering aromatherapy oils, including the potential for contact dermatitis, chemical eye burns, and toxicity if swallowed. Healthcare facilities should establish policies for appropriate aromatherapy procedures and educate the nursing team on the safe and effective use of aromatherapy oils.11

Massage therapy

Preoperative massage therapy, such as hand massage, is becoming a popular and valuable intervention to decrease patient anxiety. Previous studies suggest that 10 to 15 minutes of a hand massage can reduce preoperative patient anxiety levels.13,14

Nurse educators can teach their teams to perform simple massage techniques using many reputable online sources and nursing manuals. Incorporating hand massage therapy into the preoperative routine is a feasible and cost-effective method to decrease anxiety and improve patient satisfaction. Such services may require specific training or licensing depending on the state in which the healthcare facility is located.14

Music therapy

Some investigators have found that music therapy reduced patient anxiety and pain while improving satisfaction and health outcomes.15,16 Patients receive music therapy via headphones and listen to preselected relaxing music or individually preferred selections such as classical, easy listening, new age, or inspirational. Music therapy can decrease anxiety and pain in surgical patients during and after surgery; however, it is most beneficial when administered preoperatively.15

Patients may express a desired preference for certain nonpharmacologic anxiety-reducing interventions over others. For example, a patient may prefer aromatherapy instead of massage therapy, or they may choose to have two interventions simultaneously. Offering a variety of options supports patient autonomy and allows the nurse to provide patient-centered care when collaborating with patients to reduce their anxiety.

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