TABLE OF CONTENTS
Content Page
Title Page i
Certification ii
Dedication iii
Acknowledgements vi
Abstract v
Table of Contents vi
List of Tables viii
List of Figures ix
Appendices x
Abbreviations xi
CHAPTER ONE: INTRODUCTION
CHAPTER TWO: REVIEW OF LITERATURE
2.0. Introduction 8
2.1. Concept
of Pain 8
2.2. Effects
of Pain 10
2.3. Expressions of Pain 11
2.4. Types of
Pain 12
2.5. Physiology of Pain 13
2.6.
Nociception 13
2.7. Pain after Surgery 15
2.8. Pain Assessment 16
2.8.1. Central Principles of Pain Assessment 17
2.8.2. Roles of Nurses in Pain Assessment 18
2.8.3. Standard Tools for Pain Assessment 19
2.8.4. Patient Self-reporting Pain Scales 21
2.9. Methods of Pain Management 24
2.9.1. Non-Drug Techniques to Manage Pain 24
2.9.2. Pharmacological Methods of Pain Management 29
2.10. Anxiety 31
2.11. Types of Anxiety 32
Content Page
2.12. Causes
of Anxiety 32
2.13. Effects
of Anxiety 33
2.14. Prevalence of Anxiety 34
2.15. Levels
of Anxiety 35
2.16. Assessment of Anxiety in Surgical Patients 36
2.17. Management of Anxiety in Surgical Patients 38
2.18. Empirical Reviews of Surgical Patients’ Anxiety 42
2.19. Theoretical Model and Framework 45
2.19.1. Theory of Health as Expanding Consciousness 45
2.19.2.
Application of the Theory to the Study 46
CHAPTER THREE: METHODOLOGY
3.0. Introduction 48
3.1. Research Design 52
3.2. Population 52
3.3. Sample
size and samplingTechnique 52
3.4. Instrumentation 53
3.5. Validity and Reliability of Instrument 54
3.6. Method of Data Collection 55
3.7. Method of Data Analysis 55
3.8. Ethical Consideration 56
CHAPTER FOUR: DATA ANALYSIS, RESULTS
AND DISCUSSION OF FINDINGS
4.0.
Introduction 58
4.1. Data
Analysis and Result Presentations 58
4.8. Discussion
of Findings 67
CHAPTER FIVE: SUMMARY,
CONCLUSION, AND
RECOMMENDATIONS
5.0.
Introduction 73
5.1. Summary 73
5.2. Conclusion 73
5.3.
Recommendations
74
5.4.
Limitation of the Study 75
5.5.
Suggestion for Further Studies 75
REFERENCES 76
APPENDICES 108
LIST OF TABLES
Table Page
4.1.Socio-Demographic
Data of Study Participants 53
4.2. Assessment of Anxiety States and Pain Intensity using a Tool/ instrument by nurses 55
4.3.Distribution
of Study Participants and their Perception of their Anxiety in the Pre-Operative Periods (a
& b) 56
4.4.Distribution of Study Participants and their Perception of their Anxiety in the Post-Operative Periods (a & b) 58
4.5. Baseline and Post-Operative Anxiety and Pain intensity among surgical patients 60
4.6. Relationship between nursing intervention for the relief of Pre-Operative anxiety and control of post-operative
pain 62
4.7. Relief
of anxiety state levels in response to nursing intervention on the basis of gender and educational
levels 64
4.8. Relief of post-operative pain intensity in response to nursing intervention on the basis of gender and educational levels 65
4.9. Hypothesis testing of the relationship between nursing intervention for the relief of anxiety levels and post-operative pain 66
4.10.Hypothesis testing of relationship of the relief of Anxiety levels in response to nursing intervention on the basis of Gender and Educational levels 66
4.11.Hypothesis testing of relationship of the relief of Post-Operative pain in response to nursing intervention on the basis of Gender and Educational levels 67
LIST OF FIGURES
Figure Page
Conceptual Framework of Margaret Newman 47
APPENDICES
Appendix Page
Informed
Consent 108
Questionnaire 110
Planned
Preoperative Teaching Module 113
Ethical
Approval 115
ABBREVIATIONS
AIDS Acquired Immune Deficiency
Syndrome
ANOVA Analysis of Variance
CNS Central Nervous System
DSM IV-TR Diagnostic and Statistical Manual of Mental
Disorders (4th edition,Text Revision)
HEC Health as Expanded Consciousness
HIV Human Immuno-deficiency Virus
HND Higher National Diploma
IASP International Association for the
Study of Pain
IBM International Business Machines
JCAHO Joint Commission on Accreditation of
Healthcare Organizations
NRS Numeric Rating Scale
NSAIDs Non-Steroidal Anti-Inflammatory Drugs
OND Ordinary National Diploma
PCA Patient-Controlled Analgesia
STAI State-Trait Anxiety Inventory
VAS Visual Analogue Scale
VDS Verbal Descriptor Scale
WHO World Health Organization
CHAPTER ONE
INTRODUCTION
Health
has been described as the nonexistence of disease and impairment, as well as a
condition of complete wellness in the mental, physical, and social realms. The
persistence of the internal environment of any human system is dependent on
their physiological, sociological and psychological equilibrium. Nursing care
has the primary objective to render service for maintenance of health through
the preservation of a stable internal environment, and assisting to ensure the
restoration of equilibrium in the condition of illness (Birol, 2005; Şanli, 1991).
There are three phases in the nursing care a surgical patient passes through in the health care services called perioperative nursing. These phases include: pre-operative, intra-operative and post-operative. The pre-operative phase involves the administration of nursing care to the clients who are planned to undergo surgical procedures (Phillips, 2013; Spry, 2005). The primary responsibility of the health care providers as reported in literatures is to assess and educate the patient during this phase, to minimize the dangers during the surgery and have better outcomes of the patients. The main rationale for preoperative phase of care is linked to reduction of defects operative morbidities and decrease stay of patients at hospital (Association of Anesthetists of Great Britain, and Ireland (AABI) safety guidelines, 2010).
Surgery
is one of the major life changes that cause anxiety. Hospitalization provokes anxiety
in the patient admitted for surgery, even in the absence of disease. Stress resulting
from protracted anxiety may eventually endanger the client if not discovered
early and slow-down recovery(Goebel, Kaup, & Mehdorn, 2011; Jafar & Khan, 2009;
Swindale, 2004; Yilmaz, Sezer, Gurler, & Beker, 2011). Surgery
can trigger a panic attack in a patient who is prone to anxiety. The
preparative care of surgical patients becomes very challenging with the
increasing existence of anxiety before surgery.
Anxiety
experience is common to most patients awaiting elective surgery and generally
seen as normal response(Jawaid, Mushtaq, Mukhtar, & Khan, 2007).
Surgical patients perceived the day of surgery as highly terrifying in their
lives. Patients manifest anxiety with varying degrees in relation to what is
expected in future and these are associated with many factors which may be type
and extent of the proposed surgery, gender, age, previous surgical experiences, and personal
tendency for unpleasant events(Ping, Linda, & Antony, 2012).
The intervention for employed by the healthcare providers has been found to
promote, comfort, and favorable surgical outcomes. Nurses and other healthcare
givers needs to know patients who are prone to anxiety in the population in
order to reduce the occurrence of anxiety resulting from surgery.
The
Babylonian clay tablets revealed the evidence of thephenomenon of pain as
referenced in achieves. The Greek philosopher, Aristotle, in the 4th century
B.C., identified pain as an emotion, and a reciprocal of pleasure. Although
emotions certainly play an important role in pain perception, there is much
more to the experience than the feelings involved. In the Middle Ages, pain had
religious interpretations, in which pain was seen as God’s punishment for sins
or as evidence that an individual was possessed b
