Study area and period
The study will be
conducted in study period at St. Luke’s Catholic hospital and Nurses College in
Woliso town. The town is located 114 Kilometers South West of Addis Ababa with
a total population of the town
37,878, of whom 18,880 were men and 18,998 were women. The majority of the
inhabitants religion Ethiopian Orthodox Christianity with 63.29% of the population report,
while 19.06% of the population were Protestant and 16.36% were Muslim (2007 central
statistical agency (CSA) report). St. Luke’s Catholic hospital and Nurses
collage(SLCHNC) is built and opened in 2000 by the Italian NGO “Doctors with Africa
CUAMM”, which works in the building to give support to healthcare management
and clinical activities of the staff, serving about 430,000 people. Each year,
there are about 93,000 outpatient visits and 11,500 admissions.
It provides compressive health services
through bed capacity of 390 and a total of more than 500 staffs. Currently, the
hospital has more than 310 health professionals of different categories (8
specialists, 6 anaesthetic nurses and 236 all other nurses) and 264 supporting
staffs. Out of these health professionals, 231 Diploma, 5 BSc nurse, 6 are
physicians, 15 are medical laboratory and laboratory technicians,7 are pharmacist
and pharmacy technicians, 3 are radiographers, 4 Health assistant, 2 Sanitarian
and 15 are patient registration clerks and others like physical therapists.
Operation room (OR) unit is one of the units of SLCHCN. In the hospital
different surgery were performed such as thyroidectomy, mastectomy, colostomy,
hemoriedectomy, laparatomy, and etc.
– A facility based cross-sectional study design will be used to
assess the preoperative anxiety level and determinant factors among patients waiting
surgery in SLCHCN.
– All adult patients will be all selected
clients/patients who will be diagnosed and scheduled for surgery in SLCHCN
during the study period.
Inclusion criteria:-The study will be included
all patients 15 and above years and those patients able to comprehend and can
communicate ASA (American Society of Anaesthesiologists) I and II.
Exclusion criteria: – will be excluded
patient diagnosed with any types of anxiety disorder such as phobic, panic,
generalized, obsessive compulsive etc. and patients taking anti-anxiety or
anti-depressant medications such as benzodiazepines, tricyclic antidepressants,
selective serotonin inhibitors, monoamine oxidase inhibitors and lithium. Patient
who undergoes the emergency surgery and who will understand neither Afan Oromo
nor Amharic language
A formula for estimation of single population proportion will be
used to calculate the sample size. Since there was previous study done on preoperative
anxiety at Jimma University Specialized
and Teaching Hospital (JUSTH) (2014), South West Ethiopia, reported that the
prevalence of preoperative anxiety was 70.3%, calculation will be done
using the assumption of proportion (p) of surgical patients facing
anxiety 70.3%, with 95% CI, 5% marginal error (where n is
minimum sample size, Z is value of standard normal variable at
95% confidence interval, p is maximum expected proportion
which is 70.3% and d is marginal error which is 5%).
= (1.96)2 *0.73(0.27) = 303
formula will be used as the number of patients scheduled for surgery
is?10, 000 nf =n/1+(n/N) Where N?=?(Patients???15 years for whom surgery will be performed in data collection period 2018 in SLCHCN). Then considering 10% for non-response rate (individuals), the final sample size will be calculated. Sampling procedures: - A non-probability sampling technique using a convenience sampling technique will be used. The patients who will available during data collection period and will be accepted to participate in research will be selected from the study(2, 5). The operating theater list will be used to localize the patient in hospitalization ward the sampling will be concerned on the patients who will be operated on next day of data collection. Data collection instrument: - Data collection tools on preoperative anxiety will be adapted and modified from validated questionnaire used on other study ruwada, 28, 29, 30. The questions and statements will be grouped and arranged according to the particular objectives that it can address. Level of anxiety and information about surgery and anaesthesia will be assessed with PITI measurement Scale 31. This tool was developed by Crockett, Gumley Longmate and the tool is Likert scale with composed of 20 questions(22). The questionnaire was made of three sections. Section A asks about participant's demographic data and it is made of five questions, section B asks about information related to health of the participant and it is composed of seven questions and Section C: consists of PITI 20 items which together self-assess preoperative anxiety. PITI is 20 item questionnaires, The PITI was made of six themes that are pre-occupation, outcome concerns, being unconscious, loss of control, dependence on others and pain/discomfort which reflect the preoperative situation. With 4 points Likert scale ranging through "not at all" with 0 points, "some of the time" with 1 point, "often" with 2 points and "most of the time" with 3 point. The highest score of the scale is 60 points and the lowest score is 0, the author of the tool reported that 15 or more score on PITI-20 scale reliably detects the patients with significant anxiety. The sum of points of an each individual PITI item will be made to obtain total preoperative anxiety score of each participant in order to detect participants who reached cut- off score of ? 15 that is the baseline of detecting clinically significant anxiety. The participants scored fifteen (15) or more will be ranked as having clinically significant preoperative anxiety while participants scored less than fifteen (15) will be ranked as not having clinically significant anxiety(22). Data collection methods and procedures: - Data will be collected by five trained diploma nurses recruited from outside SLCHCN staffs who are fluent speaker of Afan Oromo and Amharic through face to face interview method/self-administering. The period of data collection will be for two month and data will be collected the night before the day of surgery and informed consents will be filled. The data collectors will be trained and collected the data using a structured interviewer administered Afan Oromo version questionnaire. Supervisor and principal investigator will be closely supervised the process of data collection and verifies. Data processing and analysis:-The completed questionnaires will be checked for inconsistencies and missed values. Incomplete questionnaires will be excluded from the analysis. Before data entry, appropriate coding and editing will be performed. After data entries checking of already entered data will be performed and the analysis will be performed using SPSS for windows version software package 20.0. Simple and multiple linear regression analysis will be used and assumptions such as linearity, normality, homoscedasticity and independence will be considered. Common descriptive statistics will be considered as per variables of interest. Statistical tests will be performed at the level of significance of 5%. The results will be summarized using tables and figures and will be presented with narrative descriptions. Data Quality Control:- To ensure the quality of data training will be given to data collectors and supervisor on the content, objective, relevance of the study, confidentiality of information, respondent right, about pre-test and informed consent. The formulated questionnaire will be pre tested to check for validity using 5% of the total sample size in Tullu Bollo Hospital which is outside of the study populations a week prior to the actual data collection to assess the validity of the questionnaire by trained data collector to check for clarity of questions, ambiguity, arrangement of questions order & options for the questions and skipping pattern accordingly. All questioners will be checked during the data collection period by the supervisor and principal investigator on daily basis to see its completeness. Before analysis the data will be cleaned thoroughly to check for errors during entry and the use of Epi info software can also minimize error during entry. Variables of the study Dependent variable • Pre-operative anxiety Independent variable Socio demographic variables Age, Sex, Residence, Marital status, Religion, Ethnicity, Level of education, Monthly income, Occupation, family condition Medical conditions of the patient Pain, Type of anaesthesia, Type of current surgery, Information provision about surgery, Postponement of surgery, Previous history of surgery, Outcome of the of the surgery, Medical / surgical diagnosis Previous medical condition Cancer and chronic illness, previous hospital admission, previous anaesthesia, previous surgery Patients related behavioral of Substance abuse (Smoking, Alcoholism, Chat ), antidepressant medications Health care providers related Therapeutic communication, preoperative education, empathic patient-centered, nonjudgmental and respectful attitude, privacy care concern hospital set up Postoperative out come Surgical recovery, wound healing, Satisfaction of the patient . Operational definitions Assessment: in this study assessment refers to the screening of patients for anxiety and finding out the factors associated with the anxiety. Preoperative: This is a period that starts from the time the patient is informed that s/he will be surgically operated and ends at the time the intraoperative preparation of the patient starts. Preoperative anxiety in this study refers to the anxiety a patient may develop as result of waiting for a surgical operation. Anxiety: In this study, anxiety means apprehensive tension or uneasiness that may result from the anticipation of having a surgical operation in future that is considered by a patient as a threat. Patient awaiting surgery: this refers to a person who has been informed to undergo surgery but who is not yet surgically operated. PITI: State anxiety: Threat anxiety: Fear: Level of anxiety: The State Anxiety Scale (STAI) The Trait Anxiety scale (STAI Form Y-2) Ethical considerations:-Ethical clearance letter will be initially obtained from University of Gondar College of Public Health and Medical Sciences Ethical Committee. Then written letter will be submitted to SLCHCN chief executive organization (CEO), hospital clinical and nursing director to get permission. For participants greater than 18 years, written informed consent for participation in the study will be obtained from participants and for participants in between 15–18 years consent will be obtained from the parent or legal guardian of the patient. Further, study participants will be briefed about the study by stating the main objective and any unclear points related to the study before the interview begun. In addition, confidentiality of the information will be assured and privacy of the study population will be respected and kept as well. Moreover, to ensure confidentiality the name of respondents will be not written on the consent form. Telling that his/her participation in the study is very important, every client to be interviewed will be informed that he/she has a full right to discontinue the interview. Dissemination of Findings:-The findings of the research will be submitted and presented to school of nursing as part of the study fulfillment and Submitted to SLCHCN. Finally findings will be presented in different seminars; meetings and peer reviewed journal publications will also be considered.