Preoperative Care - Reducing Pre-Surgery Anxiety


Published: 26 November 2017

Day surgery nurses have an important role in preparing the client for their surgery and coordinating the care required for the individual client’s needs.

Turunen et al.’s (2017) integrative review found that preoperative nursing, when performed effectively (as per the authors’ ‘seven-task structure’), can result in satisfaction, client safety, quality healthcare and cost-effectiveness.

Preoperative Patient Anxiety

Alanazi’s (2014) systematic review demonstrated that preoperative education can decrease the pre-surgery anxiety of clients.

Nurse managers and educators may need to increase guidance for preoperative nurses involved in direct-care, such as the implementation of a formal plan for preoperative education requirements for clients (Mitchell 2016). Mitchell suggests that interventions such as this may help to ‘ease nurses’ cognitive workload and enhance patient satisfaction.’

Messina et al. (2014) express that studies indicate ‘play, learning and entertainment’ during the preparation for surgery can prevent preoperative anxiety for clients that are children. A specific piece of evidence indicating the success of preoperative play in reducing anxiety for children aged 4-12 years, is that of McLaughlin (2016). McLaughlin (2016) reviewed ‘Three single, blind, randomized controlled trials that were published between 2008 and 2010 and published in the English language.’

Preoperative Care - Reducing Pre-Surgery Anxiety - Ausmed Child Patient

Branchs and Lerman (2013) acknowledge that there are other non-pharmacological ways to minimise anxiety.

For children, parental presence during anaesthesia induction is promoted for anxiolysis (Branchs & Lerman 2013). Ghabeli, Moheb and Hosseini Nasab (2014) found in their study that the provision of toys to children pre-surgery, and educating the child’s parents about the medical information, significantly decreased the anxiety of the child and others, and improved the mothers’ satisfaction with treatment.

It is crucial that person-centred care takes place, as anxiety can be dependent on a range of factors unique to the individual, such as their: age, prior hospitalisations, socioeconomic status, ethnicity and temperament (Branchs & Lerman 2013). Clearly, preoperative nurses need to be aware of the causes or triggers of anxiety in order to prevent and manage this situation effectively.

King et al.’s (2017) qualitative study showed that preoperative anxiety stemmed from:

  • The surgery
  • Complications
  • Symptoms
  • Recovery
  • Organisation and provision of care

Gursoy et al. (2016) found in their quasi-experimental study, that preoperative stress was due to:

  • ‘Fear of the unknown’
  • Fear of the anaesthesia
  • Fear of the operating room environment
  • Fear of complications during the operation

Interestingly, Gursoy et al. (2016) concluded that operating room nurses can reduce the preoperative stress of clients by visiting them prior to surgery.

Day-of-Surgery Cancellations

A different issue that preoperative nurses face, can include day-of-surgery cancellations (Ming Teh et al. 2016). Dimitriadis, Iyer and Evgeniou (2013) state that day-of-surgery cancellations are a global issue that lead to: decreased revenue, wasted resources, decreased training opportunities for staff, and effects on the clients’ psychology, finances and social life.

Ming Teh et al. (2016) found that ‘a good history obtained by a trained and experienced advanced practice nurse or registered nurse can reduce day-of-surgery cancellations’. Ming Teh et al. (2016) describe that nurses can perform telephone assessments to establish whether clients are at risk of complications and can refer at-risk clients to relevant health professionals for further evaluation prior to surgery.

This finding aligns with that of Malley et al. (2015) that convey the preoperative nursing assessment can reveal clients’ risk factors for surgery and the overall ‘perioperative care trajectory’.

Malley et al. (2015) also outline that the preoperative nurse’s role is focused on advocating for, and detecting, clients’ individual needs and potential risks in relation to surgery and the perioperative journey.

From the literature, it is apparent that preoperative nursing is a speciality that can promote clinical safety, client satisfaction, and cost-efficiency for health organisations, emphasising the need for adequate staffing, skills mix, competence and continuous development in preoperative nursing.

It is important that preoperative nurses have an understanding of and competence in delivering evidence-based health education, and other anxiety-relieving interventions relevant to their client’s specific needs and age. This highlights the need for nurse managers and educators to support direct-care nurses’ continuous professional development, performance evaluations and competency assessments.

  • Alanazi, AA 2014, ‘Reducing anxiety in preoperative patients: a systematic review’, British Journal of Nursing, vol. 23, no. 7, pp. 387-393, viewed 20 November 2017,…4245
  • Branchs, RJ & Lerman, J 2013, ‘Preoperative Anxiety Management, Emergence Delirium, and Postoperative Behavior’, Anesthesiology clinics, vol. 32, no. 1, pp. 1-23, viewed 20 November 2017,
  • Dimitriadis, PA, Iyer, S & Evgeniou, E 2013, ‘The challenge of cancellations on the day of surgery’, International Journal of Surgery, vol. 11, iss. 10, pp. 1126-30, viewed 20 November 2017,
  • Ghabeli, F, Moheb, N & Hosseini Nasab, SD 2014, ‘Effect of Toys and Preoperative Visit on Reducing Children’s Anxiety and their Parents before Surgery and Satisfaction with the Treatment Process’, Journal of Caring Sciences, vol. 3, no. 1, pp. 21–8, 20 November 2017,
  • Gürsoy, A, Candaş, B, Güner, S & Yılmaz, S 2016, ‘Preoperative Stress: An Operating Room Nurse Intervention Assessment’, Journal of PeriAnesthesia Nursing, vol. 31, no. 6, pp. 495-503, viewed 20 November 2017,
  • King, A, Bartley, J, Johanson, DL, Broadbent, E 2017, ‘Components of preoperative anxiety: A qualitative study’, Journal of Health Psychology, viewed 20 November 2017,
  • Malley, A, Kenner, C, Kim, T & Blakeney, B 2015, ‘The Role of the Nurse and the Preoperative Assessment in Patient Transitions’, AORN Journal, vol. 102, no. 2, p. 181, viewed 20 November 2017,
  • McLaughlin, SL 2016, ‘Is Therapeutic Play Effective at Reducing Preoperative Anxiety In Children Age 4 Through 12?’, PCOM Physician Assistant Studies Student Scholarship, viewed 20 November 2017,
  • Messina, M, Molinaro, F, Meucci, D, Angotti, R, Giuntini, L, Cerchia, E, Bulotta, AL & Brandigi, E 2014, ‘Preoperative distraction in children: hand-held videogames vs clown therapy’, La Pediatria Medica e Chirurgica, vol. 36, no, 5-6,
  • Ming Teh, AH, Turner, BS, Tan, SB & Tham, CS 2016, ‘Effectiveness of an Advanced Practice Nurse–Led Preoperative Telephone Assessment’, Journal of Nursing Care Quality, vol. 31, no. 2, pp. 191–6, viewed 20 November 2017,
  • Mitchell, M 2017, ‘Day surgery nurses’ selection of patient preoperative information’, Journal of Clinical Nursing, vol. 26, iss. 1-2, pp. 225–37, viewed 20 November 2017,
  • Turunen, E, Miettinen, M, Setälä, L and Vehviläinen-Julkunen, K 2017, ‘An integrative review of a preoperative nursing care structure’, Journal of Clinical Nursing, vol. 26, no. 7-8, pp. 915-30, viewed 20 November 2017,


Portrait of Madeline Gilkes
Madeline Gilkes

Madeline Gilkes, CNS, RN, is a Fellow of the Australasian Society of Lifestyle Medicine. She focused her master of healthcare leadership research project on health coaching for long-term weight loss in obese adults. In recent years, Madeline has found a passion for preventative nursing, transitioning from leadership roles (CNS Gerontology & Education, Clinical Facilitator) in hospital settings to primary healthcare nursing. Madeline’s vision is to implement lifestyle medicine to prevent and treat chronic conditions. Her brief research proposal for her PhD application involves Lifestyle Medicine for Type 2 Diabetes Mellitus. Madeline is working towards Credentialled Diabetes Educator (CDE) status and primarily works in the role of Head of Nursing. Madeline’s philosophy focuses on using humanistic management, adult learning theories/evidence and self-efficacy theories and interventions to promote positive learning environments. In addition to her Master of Healthcare Leadership, Madeline has a Graduate Certificate in Diabetes Education & Management, Graduate Certificate in Adult & Vocational Education, Graduate Certificate of Aged Care Nursing, and a Bachelor of Nursing. See Educator Profile

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