Effectiveness Of Intra Operative Hand Holding On Anxiety And Physiological Parameters Among Patients Undergoing Cataract Surgery

Introduction :

Cataract is a public health problem in many developing countries including India. In India cataract has been reported to be responsible for 50-80% of the bilaterally blind in the country. Cataract surgery in India has seen exponential growth in the past decade.

Most cataract surgery is now performed under local anaesthesia on a day care basis. As patients are fully conscious during the procedure, it is important that they remain still and have their faces and upper body covered. Many have coexisting health complaints. Patients with cardio respiratory disease, those with continence problems, those with generalised arthritis, and those who are anxious may find it difficult to relax and remains still during the operation. Cataract surgery patients who have severe anxiety might move during the operation, and might lose vision due to complications such as haemorrhage, or glaucoma after surgery. Therefore, psychological comfort in the preoperative phase and compliance during operation are very important for postoperative prognosis. It is important to take into account patient preference, anxiety, and ability to cooperate, and to assure patients that they will be carefully monitored.

The results of a cross sectional study carried out by Marback et al., to identify the emotional factors among patients prior to the cataract surgery at the ophthalmology clinic of Paulo University Hospital concluded that doubt as to the outcome (32.7%), distress/anxiety (26.4%), sadness (25.5%), happiness (10.9%), and anger (4.5%) were the predominant feelings prior to the surgery.⁴ Another study conducted by Chaudhury et al., found that the main anxiety provoking factors were concerns about the success of surgery and the requirement of lying immobile during surgery covered with surgical drapes.⁵ An experimental study conducted in Korea by Moon and Cho to assess the effectiveness of handholding on the anxiety of patients undergoing planned cataract surgery under local anaesthesia was found to be effective in reducing anxiety. The results of another study conducted in Korea by Jung and Sook to assess the effect of hand massage and hand holding on the anxiety in patients with local infiltration anaesthesia was found to be effective in reducing anxiety and the physiological parameters.⁶

The purpose of the study was to find the effectiveness of intra operative hand holding as a non pharmacological measure in relieving anxiety among patients undergoing cataract surgery. It will also allow for the better patient compliance during the procedure and optimal post operative patient outcomes.

Materials and methods:

The administrative permission and ethical clearance from the concerned authority was obtained. The consent was taken from participants of the study. The present study adopted an evaluative approach with quasi experimental design and was conducted in the ophthalmology ward and OT of Kasturba Hospital, Manipal. A total of 54 patients who fulfilled the inclusion criteria such as age > 55 years, who knew to read Kannada and with no known/documented mental illnesses, anxiety disorders, hypotension and thyroid disorders were selected to experimental and control groups. Tools developed by the researcher were validated and tested for its reliability. Tools utilized were, Tool 1: Demographic proforma, Tool 2: Early pre operative anxiety assessment scale, Tool 3: Numerical Visual Analog Scale to measure immediate pre

operative and post operative anxiety, Tool 4: Proforma for measuring physiological parameters and Tool 5: Opinionnaire on intra operative i and holding. Cronbach's alpha coefficient for tool 2 was 0.72 and test retest reliability for tool 3 was 0.99. Tool 5 had 9 questions with no scoring as it was analysed descriptively using frequency and percentage. Tool 2 had 20 items in which the positively worded statements were scored with a range of five for strongly agree and one for strongly disagree. Negatively worded statements were scored reverse to this. The scale had a score range of 20-100. The early pre operative anxiety was categorised as 20- 46 (mild anxiety), 47-73 (moderate anxiety) and 74-100 (severe anxiety). The pilot study conducted among 20 patients revealed that, the study design was feasible and practicable. Both descriptive and inferential statistics were used to analyse data using SPSS windows 16 version.

On the previous day of surgery, the researcher visited the admitted patients to assess their eligibility to include as samples in the study. After selecting the patients for the study, they were told about the details of the study and their participation role as either in experimental or control group and informed consent was taken. On the same day itself, the researcher administered the demographic proforma to obtain the baseline data and rating scale on early pre operative anxiety to assess their early pre operative anxiety.

On the day of surgery, the immediate pre operative anxiety score was measured with numerical VAS scale in the operation theatre before commencement of the surgery. The physiological parameters such as heart rate, systolic and diastolic blood pressure were monitored using an automated blood pressure monitor. The respiratory rate was measured by observing the chest movements per minute in the operation theatre before the surgery.

Intra operative hand holding was done by the researcher starting from the time the local anesthesia was being administered. The researcher sat at the side opposite to the eye being operated and gently held the patient's hand in a reassuring manner. Both the patient's and researcher's

hands were resting at the patient's side. Hand holding was continued till the operated eye got bandaged at the end of the surgery. During intra operative period, the heart rate, blood pressure and respiratory rate were recorded at different intervals of time, such as at 10 minutes, 20 minutes and at the end of the surgery by using the automated blood pressure monitor. Meanwhile the respiratory rate was recorded by the researcher by observing the chest movements following the same time interval; the timing ofwhich was done using a stop watch.

The immediate post operative anxiety was measured using numerical VAS scale at the end of the surgery in the operation theatre. Patient's opinion with regard to hand holding during surgery was rated by using an opinionnaire. It was administered after the patient got shifted from the operation theatre to the ward. Descriptive statistics (frequency and percentage) and inferential statistics (Mann Whitney U test and RMANOVA) were used for the analysis.

Results:

Section 2: Description of early preoperative anxiety level of patients

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Fig 1

Bar diagram representing the percentage distribution of early pre operative anxiety

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Discussion :

Conclusion :

In summary, the present study findings showed that majority of the patients, 24 (88.9%) in the experimental group and 25(92.6%) in the control group had moderate level of early pre operative anxiety. It was also found that intra operative hand holding was effective in reducing systolic blood pressure and diastolic blood pressure and heart rate of patients undergoing cataract surgery except heart rate which showed no significant difference. Most of the patients in the experimental group perceived hand holding as beneficial in reducing their anxiety during the operation even though there was no significant difference between the groups. Nurses strive to enhance well-being for patients and their families through implementation of non-pharmacologic interventions such as intra operative hand holding which is type of touch therapy which will help in relieving anxiety among patients undergoing cataract surgery. It will also allow for the better patient compliance during the procedure and optimal post operative patient outcomes. The intra operative hand holding can be incorporated as a part of an effective alternative to medications.