Utilizing an Assessment Tool to Measure and Manage Preoperative Anxiety Among TURP Elective Patients Through Video Education and Quran Recitation: A quality improvement project
No Thumbnail Available
Date
2025
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Saudi Digital Library
Abstract
Abstract
Background: preoperative anxiety is increasingly recognised a significant challenge during the preoperative care journey with negative impacts on surgical outcomes. Literature has reported a high prevalence of his issues among Arab populations including Saudi Arabis, yet it remains under recognised and poorly managed.
Aim: this QI project aims to reduce preoperative anxiety among patients undergoing transurethral resection of prostate (TURP) by 30 % within six months.
Methods: This QI project proposes the use of a validated screening tool and evidence-based management guided by the Model for improvement and its iterative PDSA cycles. This QI project will begin with key preparatory steps such as staff training, stakeholders’ analysis, active stakeholders’ management, communication strategies and baseline data collection to initiate urgency for change and ensure shared ownership of change. Anticipated barriers include staff resistance to change which will be addressed by applying transformation leadership styles, Kotter's model and early stakeholders’ involvement.
Measurement: evaluation will follow Davidge’s Seven Steps incorporating process, outcomes and balancing measures. The primary outcome will be the change in APAIS scores which will be displayed in run charts to view the trends over time with potential use of SPC chart in later stage to evaluate sustainability. Process measure such as training and screening compliance rates will be tracked by using Bar chart, cumulative graphs. Patient experience will be assessed through a structured questionnaire and analysed descriptive statistics, while unintended consequences will be monitored by evaluating staff satisfaction through interviews analysed thematically.
Public and patient involvement (PPI): PPI is embedded in this QI project through an inclusion of a focused group of TURP patients as partners in semi structure interviews to ensure that the intervention reflects patient needs and preferences.
Ethical considerations: this project will adhere to ethical principles of autonomy, beneficence, non-maleficence and justice. Informed consent, confidentiality and cultural selectivity will remain central throughout implementation.
Description
Anxiety is a state of emotional distress or fear that may lead to autonomic and physical
symptoms affecting daily functioning (Bedaso, Mekonnen and Duko, 2022). While it
can be a normal response to serious situations (Bedaso et al., 2022; Gümüs, 2021),
surgery often triggers varying level of preoperative anxiety influenced by patients’ traits,
previous experiences, and medical history (Friedrich et al.,2022). Patients may fear
anaesthesia, complications, postoperative pain, or long-term disability (Gümüs, 2021).
An elevated level of preoperative anxiety (PA) can provoke stress responses,
potentially leading to adverse outcomes such as increased postoperative pain, poor
pain management, delayed recovery, impaired wound healing and autonomic
disturbances including tachycardia, hypertension and arrhythmias (Friedrich et
al.,2022; Bedaso et al., 2022). Consequently, assessing and managing PA is critical to
improve care quality (Bedaso et al., 2022; Gümüs, 2021). Transurethral resection of
the prostate (TURP) is common urological elective surgery that a gold surgical
intervention for treating benign prostate hyperplasia (BPH) (Rammah et al., 2023).
Although many studies have explored the PA among elective surgeries, there is a lack
of research specifically studying preoperative anxiety among Saudi patients scheduled
for TURP. In the urology department of a teaching hospital affiliated with a university
medical city, where this project will be conducted, PA is recognised as a concern.
However, no structure intervention currently exists to address it. This project focuses
on improving preoperative anxiety management for patients undergoing TURP.
Keywords
Preoperative anxiety', ‘Elective surgery’, ‘Adult’, ‘pharmacological and non-pharmacological interventions’, ‘perioperative anxiety management’, ‘Arab population Middle East