Effects Of Aromatherapy And Therapeutic Touch On Preoperative Anxiety Of Patients Undergoing Gynaecological Surgery

BackgroundsSurgery represents a major stressor that provokes strong psychological responses in patients, of which anxiety is the most common reaction. The incidence of preoperative anxiety has been reported to range from 11% to 80% among adult patients. Gynaecological surgery mostly involves generative organs, i.e. uterus, ovary, leading to patients' great fear of endocrine dyscrasia, alteration in body image, premature senility, sexual hypofunction as well as the disease, having an anaesthetic, surgery and pain. It has also been demonstrated that women undergoing gynaecological surgery, who expressed more worry before their surgery, displayed greater heart rate and blood pressure changes before and during surgery were more difficult to anaesthetize and were more likely to experience headache, vomiting and pain afterwards.As to anxiety assessment, the vast majority of studies employ subjective Measurement tools, i.e. State-Trait Anxiety Inventory (STAI), Visual Analog scale(VAS), Self—Rating Anxiety Scale (SAS), Symptom Checklist-90 (SCL-90) or Amsterdam Pre-operative Anxiety and Information Scale. These paper-and-pencil anxiety rating scales and questionnaires, however, are sometimes cumbersome and difficult to use in the surgical setting. The Numeric Visual Analog Anxiety Scale(NVAAS), which is considered convenient and easy to use at bedside, has been reported to assess presurgery anxiety among patients undergoing colorectal surgery. Although the NVAAS scores were significantly correlated with scores on the SAI, the degree of agreement between the instruments was not assessed.The management of preoperative anxiety was investigated in two main areas, i.e. anxiolytic premedication and alternative therapies. The three main drugs employed were benzodiazepines, beta-adrenoceptor blockers and opioids. Alternative therapies, which are based on the philosophy and science of caring developed by Jean Watson, concern the employment of distracting interventions, i.e. hypnosis, music, therapeutic touch, guided imagery, aromatherapy, to minimize the preoperative anxiety. The majority of anxiety interventions were adopted at a few hours prior to the surgery. Research, however, has shown that the state anxiety in women undergoing gynaecological surgery rise steadily from the night before surgery, and is significantly higher than normal criterion. It has also been demonstrated that there is a correlation between anxiety the night before surgery and that existing immediately preoperatively. Nevertheless there are few studies focused on anxiety the night before surgery.Aromatherapy is one of the most actively growing forms of alternative medicine. Studies have shown that certain essential oils have an effect on brainwaves, resulting in changes in emotions and behavior, such as reduction of stress and anxiety, promotion of physiological relaxation. Therapeutic touch, a noninvasive nursing intervention, has been practiced in individuals with various clinical conditions, including cardiac disease, breast cancer, emergency nurses and so on. Researches indicated that TT had a positive effect on stress and anxiety. And it has been demonstrated that women are more sensitive to odors and touch than men. Despite these findings, it has not ever been reported that the effect of aromatherapy with therapeutic touch on preoperative anxiety of patients undergoing gynaecological surgery.ObjectivesThe primary objectives of this study were to explore the effect of aromatherapy with therapeutic touch on preoperative anxiety and blood pressure, pulse rate of patients undergoing gynaecological surgery. Secondary objective was to evaluate the utility of NVAAS as a potentially accurate and efficient way to determine preoperative anxiety among patients undergoing gynaecological surgery. Third objective was to investigate the perceptions of patients to aromatherapy plus therapeutic touch applying self-designed questionnaire. Forth objectives were to analyze the impact of patient's demographic data, clinical characteristics in-hospital on the anxiety and the intervention outcome.Methods90 patients undergoing planned gynaecological surgery, with SAI scores ≥40 the night before surgery, were randomly allocated to three groups of equal size (n=30). Treatment was applied for 20min with (1) aromatherapy and therapeutic touch; (2) therapeutic touch; (3) lay in bed with eyes closed. Anxiety levels were measured pre and post intervention using SAI and NVAAS. Blood pressure, pulse rate and perception to AT and TT in experiment groups were also investigated. Compare the effect on anxiety of three groups after intervention to find differences. Compare the impact on blood pressure, pulse rate and subjective perception between the two experiment groups. Analyze the correlation and agreement between SAI and NVAAS using Pearson correlation and Kappa test. Analyze the relationship between some demographic data or clinical characteristics in-hospital and anxiety or intervention outcomes through regression analysis.ResultsThere was little observed difference about pre intervention SAI scores among AT with TT group (51.27± 8.08), TT group(50.97± 7.57), control group (50.50 ± 7.80) ,and both were significantly higher than normal criterion of Chinese. In the AT with TT group and TT group, the postintervention SAI scores decreased to 32.87±6.18 and 37.33 ±7.26, respectively. In the control group, there was no statistically change. The anxiety level in AT with TT group was lower in comparison to the TT group (P<0. 05) .While blood pressure and pulse rate in AT with TT group were statistically decreased (P<0. 05), there was no significant difference in TT group. The score of questionnaire in AT with TT group was higher than TT group (P<0.01). NVAAS and SAI had significantly relationship. Correlation coefficient were 0.75, 0.78 (P< 0.01).The Kappa value were 0.632, 0.619, indicating moderate agreement between the two instruments. The result of regression analysis showed that the type of surgery and cost were important impact factors on anxiety, whereas the anxiety level before the treatment and the type of surgery were relate to intervention outcome.Conclusions1. The anxiety level of subjects at the night before surgery were significantly higher than normal criterion of Chinese, indicating that anxiety were still present in a lot of patients even after routine psychological nursing.2. Both AT with TT group and TT group significantly alleviated preoperative anxiety of patients undergoing gynaecological surgery, and AT with TT was more effective thanTT.3. While blood pressure and pulse rate in AT with TT group were statistically decreased, there was no significant difference in TT group. It showed that AT with TT had a positive effect on physiological outcomes.4. The score of subjective perception in AT with TT group was higher than that in TT group, demonstrating that patients were more likely to accept AT with TT.5. There was a significant, positive correlation and moderate agreement between NVAAS and SAI. And NVAAS appear to be a valid and sensitive measure of preoperative anxiety among patients undergoing gynaecological surgery.6. Patients with personal cost or undergoing hysterectomy had negative impact on preoperative anxiety level. The findings reminded that nurses should pay more attention to these patients. Preintervention anxiety level and hysterectomy were positively related to intervention outcome.