This book is centrally concerned with the formal management of preoperative anxiety. The vast majority of patients experience varying degrees of anxiety when entering hospital for surgery and yet little formal intervention is commonly provided. This is the first book of its kind to be written for nurses exclusively concerning the complete formal pre- and postoperative management of anxiety in relation to modern, elective, adult day surgery. During the early 1970s classic nursing studies suggested information provision to be crucial for effective inpatient preoperative anxiety management. However, following such early recommendations no other formal aspects of psychoeducational care have impacted on mainstream surgical nursing intervention. Physical aspects of care have dominated proceedings for the last three decades or more, whereas psychoeducational aspects have largely remained informal, marginal issues. Both surgery and anaesthesia have changed dramatically during this period and nursing intervention must now do likewise.
The domination of physical nursing intervention is, however, slowly changing as the continuous global rise in elective ambulatory surgery has highlighted the need for more structured psychoeducational approaches to patient care. The psychological theories to aid preoperative anxiety management have been available for many years. However, they have not succeeded in making an impact within the clinical surgical setting, because they have not previously been constructed into a coherent, clinically realistic plan of care. The purpose of this book is therefore (1) to consider the relevant psychological concepts that can inform and guide modern surgical nursing practices, (2) to provide a comprehensive map of the wider evidence available and (3) to introduce clinically realistic nursing interventions necessary for the complete psychoeducational management of adult patients undergoing elective, ambulatory surgery.
On a philosophical level, I hope to communicate with a wide audience of nurses working in the field of adult ambulatory surgery or studying modern surgical nursing practices. We need to re-evaluate nursing knowledge for this new surgical era so that compelling nursing evidence can help to guide practice and not remain in the shadows of medical advances. This book is intended to provoke debate within the profession, present the case for change and, above all, demonstrate the ability of nursing knowledge to make a significant contribution to the care required by patients experiencing modern ambulatory surgery. Much evidence, within the nursing domain, is widely available to help guide important global nursing issues in ambulatory surgery.
The political reforms currently running through the National Health Service in the UK have resulted in nursing knowledge largely becoming marginalized. The utilization of nurses and their skills features widely in these reforms, but not the utilization of nursing skills based on nursing knowledge. Surgical self-preparation and self-recovery are now implicit aspects of the modern surgical patients’ experience. Patients and their relatives did not request this new, essential role although most now welcome the social convenience and swift treatment that day surgery affords. Such advances have, however, guaranteed that many of yesterday’s professional nursing interventions have become today’s layperson interventions. Much physical surgical nursing is increasingly becoming obsolete because it can now be undertaken by laypeople. I am hopeful that this book will add to the debate about the future of modern surgical nursing intervention, because the trend of surrendering much pre- and postoperative care to relatives and replacing it with interventions that once were the domain of junior doctors must not remain unchallenged. ‘New’ nursing knowledge has much to offer the ambulatory surgery patient and we must robustly demonstrate how our professional knowledge can make this contribution. Professional knowledge and its application are powerful, liberating and motivating forces. I hope that this book empowers, liberates and motivates all who read it and that you find it as stimulating to read as I have found it to write.
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