Study area and periodThe study will beconducted in study period at St.
Luke’s Catholic hospital and Nurses College inWoliso town. The town is located 114 Kilometers South West of Addis Ababa witha total population of the town37,878, of whom 18,880 were men and 18,998 were women. The majority of theinhabitants 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 centralstatistical agency (CSA) report).
St. Luke’s Catholic hospital and Nursescollage(SLCHNC) is built and opened in 2000 by the Italian NGO “Doctors with AfricaCUAMM”, which works in the building to give support to healthcare managementand 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 servicesthrough bed capacity of 390 and a total of more than 500 staffs. Currently, thehospital has more than 310 health professionals of different categories (8specialists, 6 anaesthetic nurses and 236 all other nurses) and 264 supportingstaffs. Out of these health professionals, 231 Diploma, 5 BSc nurse, 6 arephysicians, 15 are medical laboratory and laboratory technicians,7 are pharmacistand pharmacy technicians, 3 are radiographers, 4 Health assistant, 2 Sanitarianand 15 are patient registration clerks and others like physical therapists.Operation room (OR) unit is one of the units of SLCHCN.
In the hospitaldifferent surgery were performed such as thyroidectomy, mastectomy, colostomy,hemoriedectomy, laparatomy, and etc.Study design:- A facility based cross-sectional study design will be used toassess the preoperative anxiety level and determinant factors among patients waitingsurgery in SLCHCN.Population:- All adult patients will be all selectedclients/patients who will be diagnosed and scheduled for surgery in SLCHCNduring the study period. Inclusion criteria:-The study will be includedall patients 15 and above years and those patients able to comprehend and cancommunicate ASA (American Society of Anaesthesiologists) I and II. Exclusion criteria: – will be excludedpatient diagnosed with any types of anxiety disorder such as phobic, panic,generalized, obsessive compulsive etc.
and patients taking anti-anxiety oranti-depressant medications such as benzodiazepines, tricyclic antidepressants,selective serotonin inhibitors, monoamine oxidase inhibitors and lithium. Patientwho undergoes the emergency surgery and who will understand neither Afan Oromonor Amharic languageSamplingmethodA formula for estimation of single population proportion will beused to calculate the sample size. Since there was previous study done on preoperativeanxiety at Jimma University Specializedand Teaching Hospital (JUSTH) (2014), South West Ethiopia, reported that theprevalence of preoperative anxiety was 70.3%, calculation will be doneusing the assumption of proportion (p) of surgical patients facinganxiety 70.3%, with 95% CI, 5% marginal error (where n isminimum sample size, Z is value of standard normal variable at95% confidence interval, p is maximum expected proportionwhich is 70.
3% and d is marginal error which is 5%). = (1.96)2 *0.73(0.27) = 303 (0.05)2Then correctionformula will be used as the number of patients scheduled for surgeryis?10, 000 nf =n/1+(n/N) Where N?=?(Patients???15 yearsfor whom surgery will be performed in data collection period 2018 in SLCHCN).Then considering 10% for non-response rate (individuals), the final sample sizewill be calculated.Sampling procedures: - Anon-probability sampling technique using a convenience sampling technique willbe used.
The patients who will available during data collection period and willbe accepted to participate in research will be selected from the study(2, 5). The operating theater list will be used tolocalize the patient in hospitalization ward the sampling will be concerned onthe patients who will be operated on next day of data collection.Datacollection instrument: – Data collection tools onpreoperative anxiety will be adapted and modified from validated questionnaireused on other study ruwada, 28, 29, 30. The questionsand statements will be grouped and arranged according to the particularobjectives that it can address.
Level of anxiety and information about surgeryand anaesthesia will be assessed with PITI measurement Scale 31. This tool wasdeveloped by Crockett,Gumley Longmate and the tool is Likertscale with composed of 20 questions(22). The questionnaire was madeof three sections. Section A asks about participant’s demographic data and itis made of five questions, section B asks about information related to healthof the participant and it is composed of seven questions and Section C:consists of PITI 20 items which together self-assess preoperative anxiety.
PITIis 20 item questionnaires, The PITI was made ofsix themes that are pre-occupation, outcome concerns, being unconscious, lossof control, dependence on others and pain/discomfort which reflect thepreoperative situation. With 4 points Likert scale ranging through “notat all” with 0 points, “some of the time” with 1 point, “often” with 2 pointsand “most of the time” with 3 point. The highest score ofthe scale is 60 points and the lowest score is 0, the author of the toolreported that 15 or more score on PITI-20 scale reliably detects the patientswith significant anxiety. The sum of points of an each individual PITI itemwill be made to obtain total preoperative anxiety score of each participant inorder to detect participants who reached cut- off score of ? 15 that is thebaseline of detecting clinically significant anxiety.
The participants scoredfifteen (15) or more will be ranked as having clinically significantpreoperative anxiety while participants scored less than fifteen (15) will beranked as not having clinically significant anxiety(22). Data collection methods and procedures: – Data will becollected by five trained diploma nurses recruited from outside SLCHCN staffswho are fluent speaker of Afan Oromo and Amharic through face to face interviewmethod/self-administering. The period of data collection will be for two monthand data will be collected the night before the day of surgery and informedconsents will be filled. The data collectors will be trained and collected thedata using a structured interviewer administered Afan Oromo versionquestionnaire. Supervisor and principal investigator will be closely supervisedthe process of data collection and verifies. Data processing and analysis:-The completedquestionnaires will be checked for inconsistencies and missed values.
Incomplete questionnaires will be excluded from the analysis. Before dataentry, appropriate coding and editing will be performed. After data entrieschecking of already entered data will be performed and the analysis will be performedusing SPSS for windows version software package 20.0.Simpleand multiple linear regression analysis will be used and assumptions such aslinearity, normality, homoscedasticity and independence will be considered. Commondescriptive statistics will be considered as per variables of interest.Statistical tests will be performed at the level of significance of 5%.
Theresults will be summarized using tables and figures and will be presented withnarrative descriptions.Data QualityControl:- To ensure the quality of datatraining will be given to data collectors and supervisor on the content,objective, relevance of the study, confidentiality of information, respondentright, about pre-test and informed consent. The formulated questionnaire willbe pre tested to check for validity using 5% of the total sample size in TulluBollo Hospital which is outside of the study populations a week prior to theactual data collection to assess the validity of the questionnaire by traineddata collector to check for clarity of questions, ambiguity, arrangement ofquestions order & options for the questions and skipping patternaccordingly.
All questioners will be checked during the data collection periodby the supervisor and principal investigator on daily basis to see itscompleteness. Before analysis the data will be cleaned thoroughly to check forerrors during entry and the use of Epi info software can also minimize errorduring entry. Variables of the studyDependent variable • Pre-operative anxietyIndependent variableSocio demographic variables Age, Sex, Residence, Maritalstatus, Religion, Ethnicity, Level of education, Monthlyincome, Occupation, family conditionMedical conditions ofthe patient Pain, Type of anaesthesia, Type of currentsurgery, Information provision about surgery, Postponement ofsurgery, Previous history ofsurgery, Outcome of the of thesurgery, Medical / surgical diagnosisPrevious medical condition Cancer and chronic illness, previous hospitaladmission, previous anaesthesia, previous surgeryPatients relatedbehavioral of Substanceabuse (Smoking, Alcoholism, Chat ), antidepressant medicationsHealth care providers relatedTherapeuticcommunication, preoperative education, empathic patient-centered, nonjudgmentaland respectful attitude, privacy care concern hospital set upPostoperative outcomeSurgicalrecovery, wound healing, Satisfaction of the patient .
Operational definitionsAssessment: in this study assessment refers to the screening of patients foranxiety and finding out the factors associated with the anxiety.Preoperative: This is aperiod that starts from the time the patient is informed that s/he will besurgically operated and ends at the time the intraoperative preparation of the patientstarts. Preoperative anxiety in this study refers to the anxiety a patient may developas result of waiting for a surgical operation.Anxiety: In this study, anxiety means apprehensive tension or uneasinessthat may result from the anticipation of having a surgical operation in futurethat is considered by a patient as a threat.Patientawaiting surgery: this refers toa person who has been informed to undergo surgery but who is not yet surgicallyoperated.PITI:State anxiety:Threat anxiety:Fear:Level of anxiety:The State AnxietyScale (STAI)The Trait Anxietyscale (STAI Form Y-2) Ethical considerations:-Ethical clearanceletter will be initially obtained from University of Gondar College of PublicHealth and Medical Sciences Ethical Committee.
Then written letter will besubmitted to SLCHCN chief executive organization (CEO), hospital clinical andnursing director to get permission. For participants greater than18 years, written informed consent for participation in the study will beobtained from participants and for participants in between 15–18 years consentwill be obtained from the parent or legal guardian of the patient. Further,study participants will be briefed about the study by stating the mainobjective and any unclear points related to the study before the interviewbegun.Inaddition, confidentiality of the information will be assured and privacy of thestudy population will be respected and kept as well.
Moreover, to ensureconfidentiality the name of respondents will be not written on the consentform. Telling that his/her participation in the study is very important, everyclient to be interviewed will be informed that he/she has a full right todiscontinue the interview.Dissemination of Findings:-The findings of the research will be submitted and presented toschool of nursing as part of the study fulfillment and Submitted to SLCHCN.Finally findings will be presented in different seminars; meetings and peerreviewed journal publications will also be considered.