Reducing Patient Anxiety Pre-cardiac Catheterization Through Education
- Posted on: 7/30/08
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What Does the Literature Tell Us About Anxiety?
Over the years there has been a great deal of research supporting the contention that the majority of patients suffer from anxiety prior to invasive procedures. Anxiety, as defined by Wilson-Barnett, is the fear of the unknown, disproportionate to the threat and related to the future.1 It is characterized by an individual’s inability to specify the source of the threat.2 Anxiety has been shown to lead to high levels of stress, creating delays in recovery and increased length of stay within the hospital.3 Historically, nurses have handled patient physiological needs with great confidence, but patient psychological needs, such as the manifestation of anxiety, have not received the same attention.4
One area in which evidence-based practice can offer great value is in addressing pre-cardiac catheterization anxiety. Evidence-based practice encompasses research, clinical expertise and patient preference.5 However, while searching the literature for data on pre-cardiac catheterization and patient anxiety, it became apparent that there is very little published on these topics. If we look at the data we do have, what can we learn about how cardiac cath lab staff can reduce patient anxiety pre-cardiac catheterization? It has been noted that pre-procedure psychological preparation reduces hospital-induced anxiety.6 Cupples and Martin both found that patients who received educational information pre-operatively were shown to have less nausea, vomiting, pain and post-op complications, and have deceased lengths of stay.7,8 In this article, we will review what current literature states as best practice for educating patients with the goal of anxiety reduction pre-cardiac catheterization.
Prior to educating patients, it is useful to have a baseline understanding of the cath lab patient population in order to appropriately tailor your cath lab’s pre-procedure educational approach. The age range for most patients in the relevant literature ranged from age 18 to 80-plus. The studies were composed of both men and women, with a diverse ethnic background of African-American, Caucasian, Asian, Hispanic, Native American, and other.9–12 Smith and Cason found that the majority of the patients, however, were Caucasian males.13
The Best Method of Education for Pre-Cath Anxiety Reduction
There are two different approaches taken by patients as they face the reality of an upcoming medical procedure. Studies have shown that patients are either “monitors” or “blunters.” Monitors are patients who truly desire educational materials. They specifically request educational literature and will ask several questions during the procedure. Blunters are patients who indicate, “I don’t want to know anything else about this procedure, I just want to get it done!”11,12,14
Patient education material is either sensory- or procedural-oriented. Procedural material describes the steps involved in the cardiac catheterization. Sensory information focuses on what the patient will see, hear, feel, smell or taste during the procedure. Sensory information helps the patient reduce anxiety by communicating a better understanding of what to expect during the procedure. It can take away the ambiguity regarding the event they are about to undergo.9
Current literature supports the delivery of both procedural and sensory information in order to reduce patient anxiety.9,11–13 Both procedural and sensory information can be presented through different medias. Many organizations allocate written pamphlets and/or videos that deliver both procedural and sensory information. It is important to note that when utilizing a pamphlet for catheterization education, it should include procedural and sensory information written at the fifth-grade reading level.13
If a video is used for education, it is better received if the presentation is from the patient’s perspective, thus permitting the patient to rehearse the procedure cognitively.11 Another valid method for delivering procedural and sensory information is in a face-to-face interaction between the patient and a cath lab staff member. One advantage to a face-to-face interaction is that cath lab staff have an opportunity to evaluate the patient’s comprehension of the information. Importantly, the interview also provides a social visit with the patient. In a 1991 study by Peterson, a social visit had the same impact in reducing anxiety for blunters as delivering procedural and sensory information.12
Simply put, the best time for patient education is as early as possible. Harkness et al found that 60% of patients felt their anxiety increased over time and that 68% of these patients preferred contact within the first two weeks of learning that they would need a heart catheterization.10 The reality in a cath lab setting, however, is that patients arrive through various pathways, meaning that the time available before the procedure for education varies substantially. Patients come as an outpatient admission from a cardiologist’s office days to weeks in advance, as a same-day admission from a family practice admit or as an emergency admit for acute myocardial infarction. Regardless of how patients arrive at the cath lab, the need for pre-cardiac catheterization education still exists. Delivery of the information as soon as possible is in the best interest of the patient, the patient’s family, the cardiologist and the support staff.
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