Relieving Patient Anxiety Before Anesthesia
The most effective strategies to relieve a patient’s anxiety before anesthesia administration lie directly in the command of the nurse anesthetist — from preoperatively providing information to the patient, to diverting the patient’s attention, to thoughtfully administrating calming medication when deemed clinically appropriate.
These are among the best practices and insights gleaned from interviewing a small cohort of active nurse anesthetists with at least 5 years in the operating department at a medium-sized hospital in southern Sweden.
The study, recently published in the Journal of PeriAnesthesia Nursing, found a consistent thread in their counsel: holding the patient in primary/sole focus, attentive listening to the patient, and utilizing a wide variety of specific tactics to establish a sense of security for the patient.
The Swedish researchers hope that by nurse anesthetists incorporating or emphasizing more of these in their practice, adult patients will be provided a better overall operative experience.
The study participants relate that one critical baseline to create a sense of security for the patient begins with “Hello.” Introducing oneself to the patient establishes that the nurse anesthetist is there for the patient — regardless of the patient’s stress levels.
They further note that some patients appreciate if the nurse anesthetist adds humor, as long one senses that it is okay with the patient. Also, they advise, while candor is both essential and fundamental, one need not over disclose if the patient does not ask.
Eye contact, touch, and quiet talk can all be beneficial. A physical gesture as simple as a hand on the patient’s shoulder or holding the patient’s hand can aid nurse anesthetists’ efforts to instill calm in their patients.
Trying to meet the patient’s wishes as much as possible is desirable as well. Awareness of a patient’s previous anxiety issues can best inform the nurse anesthetist in advance of which specific aspects of the procedure might trigger fear. Study participants also noted that, for patients with anxiety, it is best to involve as few staff as necessary.
Patient over diagnosis
One pointer from the nurse anesthetist study participants’ experience was “Embrace the patient and not the diagnosis.”
In addition, the nurse anesthetist should consider preparing the patient as much as possible in the preoperative department as that location may be perceived as a calmer and more pleasant environment for the patient, with fewer staff.
Next, proactively providing information to the patient before the procedure that addresses such concerns as “Will I wake up again?” “Will I wake up during the operation?” and “Will I feel bad or have pain after surgery?” can relieve a patient’s anxiety.
Vigilance as balm
The nurse anesthetist study participants recommend that their peers attempt to assure patients that their fear of waking up during the operation is unfounded because he or she will be sitting at the patient’s side throughout the operation, watching the patient constantly.
The patient also may want to talk to the surgeon again before the operation as a further step in increasing his or her sense of security.
One tactic the study participants shared was to divert the attention of the patient by initiating conversation about where the patient lives or works, for instance. By concentrating on topics other than the surgery at hand and that are positive for the patient, like grandchildren, can help to reduce patient anxiety.
The nurse anesthetists also reported success in providing a calming effect by encouraging the patient to conjure a positive dream just before the patient falls asleep.
They further found that a focus on coaching patient breathing was helpful and especially resonated with many of their patients who practice yoga and mindfulness in their daily lives. Music was another effective diversionary tactic that can help achieve relaxation. The survey respondents also used heat as a dissipative method, such as provided via a heat cover that could be connected at an early stage for the patient to feel much better physically. One nurse anesthetist observed, “If you are nervous, are fasting, and then lie down and freeze on a cold bed, then anxiety increases.”
When medication has a role
While the nurse anesthetists surveyed used medication sparingly, most thought it was important to have it as an option if non-pharmacological calming tactics fell short — depending upon the patient and his or her clinical status.
If appropriate, patients can be offered some calming medication in small quantities, such as 10 mg to 20 mg of propofol or 100 mcg of fentanyl. The surveyed clinicians counseled that sedative medications should especially be considered for patients with dementia as these patients might be more prone to agitation. However, medications that induce amnesia should be avoided.
In sum, the nurse anesthetist most effectively alleviates fear by validating patient concerns, assuring him or her that it is normal to be afraid of anesthesia and surgery, and emphasizing that they will be fully present and focused solely on monitoring their care throughout.