Stress prior to surgery: a concept analysis

Stress prior to surgery: A Concept Analysis

Identity goals as they relate to nursing practice

Nursing goals related to the concept "stress prior to surgery" should ultimately be associated with alleviating as much of such stress as possible. The elimination of stress could be done through offering the patient more time and calm education regarding the procedure. Answering any questions that have not been answered by the patient's surgeon or other health care providers, or asking the surgeon to see the patient to clarify fears and needs associated with their care. The nurse might intervene additionally by walking the patient through a mental checklist of the procedure, they are about to have, as well as offering additional sedation options, allowing them to meet and possibly spend time with any other individuals who might be involved in their care before, during and after the procedure. The nurse might also do a mental double check of the preparations for the procedure, ensuring the patient that all the preparations have been done for their safety and a positive outcome. (Bradley, 1994, p. 22) (King, 1991, p. 129) Lastly, it is the responsibility of the nurse to identify when stress prior to surgery becomes abnormal and will therefore increase risk during and after the procedure.

2. Assumptions: Identify assumptions about the concept

Assumptions regarding the concept "stress prior to surgery" are associated with the fact that stress is a psychological and physical response to fear that can alter the patient's physical well being with regard to outcomes of the surgery, including but not limited to vital sign alterations, i.e. increased pulse rate, increased blood pressure both of which can interfere with bleeding and other physical outcomes of the procedure. (Thomas, 1985, p. 30) Additionally, undue, abnormal stress, pre-surgically can effect post surgical pain and therefore recovery time. (King, 1991, p. 127) Finally, when a patient enters a procedure, i.e. anesthesia in a state of increased stress they will be more likely to awake, post-op in a state of increased stress, which can interfere with immediate and long-term post-op recovery. (Lewis, 1998, p. 26)

3. Definitions: Define the concept using a variety of sources

Stress prior to surgery comes with a long list of possible known and unknown side effects, yet it is commonly known that such stress is both normal and problematic, as it could have an adverse outcome with regard to patient recovery but is also a normal aspect of someone facing the unknown. (Lewis, 1998, p. 26) "The body responds to stress through a hormone system called the hypothalamic-pituitary-adrenal (HPA) axis. Stimulation of this system results in the secretion of stress hormones (i.e., glucocorticoids). Chronic excessive glucocorticoid secretion can have adverse health effects..." (Spencer & Hutchison, 1999, p. 272) Stress or anxiety alleviation through greater investment in education and self-efficacy support is a great predictor of rapid recovery of patient from surgery. (Mahler, Kulik & Hill, 1993, p. 437) Eliminating pre-surgical anxiety through psychological techniques, such as guided imagery also seems to assist patients with alleviation of anxiety as well as reduced recovery time. ("Guided Imagery Speeds Surgical," 1996, p. 8)

4. Related Concepts: Define those concepts that may be used interchangeably with the title of this concept (stress prior to surgery), or that are closely related

Anxiety is a concept that closely relates to stress, and could be utilized as an interchangeable term.

It is important to note that the relationship between pain and anxiety is reciprocal. Painful experiences may lead to anxiety (e.g., "Something must be wrong... Increased anxiety will lead to accentuated perception of pain, which further increases the anxiety level. Obviously, potentially traumatic experiences may result unless there is some intervention in this pain-anxiety cycle. Narcotics may be helpful, but psychological interventions are quite appropriate in this regard. (King, 1991, p. 129)

5. Defining Criteria: Describe how you would know if the concept were present in a situation.

Listening to the patient and watching physical cues, such as increases pulse of BP, increased pallor, as well as listening to the patient when he or she has concerns about procedural or context questions.

6. Antecedents: Identify antecedents that you would expect to find in biological, psychological and/or social systems

Precious personal or secondary bad experiences with surgical procedures, recovery times or even fatal events are all antecedents to "stress prior to surgery," though these issues are not absolutely self-evident and no prior experience with surgery in a primary or secondary sense may be just as likely to be antecedent to "stress prior to surgery."