Extensive surgery or surgery with uncertain outcomes also generates more anxiety than any surgery with a predictable course of events. Ambiguity about the outcome and unpredictability about the course, although depend on the type of the surgery and the indication for which it is done. Therefore the nursing staff that is usually in contact with such patients in the immediate preoperative period in the preoperative area has a chance to intervene provided they can assess these patients in a systematic manner for the experienced perioperative stress leading to elevated anxiety scores of these patients. Perioperative nurses are specially trained to do so, and they must find out time to intervene in these patients even in the preoperative area to deal with these patients' emotional distress. If the positive outcome of the care is the goal of care delivery, these interventions can change the emotional status of these patients in such a manner that the relationship between preoperative psychological status and postoperative recovery of these patients is positively influenced (Stirling, 2006).
The most common nursing diagnoses that require intervention from the nurses in this period are anxiety that may be partly related to knowledge deficit, but also partly contributed by the context and the environment. Therefore, the knowledge about the surgical procedure and the patient assessment findings can be combined to make an appropriate plan of care in such situations. It is to be remembered that every patient have their own perspectives of anxiety, and hence assessment and consequent plan of care should be individualized based on specific patient needs. A patient who needs surgery and is waiting for the in preoperative area may be surrounded by a sense of impending doom for the imminent surgery, and a nursing diagnosis of preoperative anxiety needs nursing intervention in that period only. Many of the incidents of anxiety result from patient knowledge deficits related to perioperative routine, surgical interventions, or outcome expectations (Stirling, 2006).
Contextual assessment process would examine and assess the patient's knowledge about the surgery. Thus, the assessment must include the status and quality of communication the patient has already received, the patient's possible language barrier, assessment of sufficiency of the patient's mental capacity, extent of information received by the patient regarding the surgical procedure and why it is needed. Since most of the anxiety in this phase id related to the ignorance about the details of the surgical intervention and outcome expectations, the patient's level knowledge regarding those must be assessed in simple questions, so the nurse can design a customized intervention strategy and create the baseline communication link for future interventions before the surgery following this contextual assessment. This assessment should ultimately be able to determine the patient's learning needs and based on these needs, to design an intervention to fulfill the patient's knowledge deficits appropriate to the etiology of it (Mitchell, 2000).
The environment plays a significant role in perioperative nursing, and the operating area environment has significant impact on all such patients. The perioperative nurse also is a part of the environment, and she can indeed catalyze a positive environment that can influence the patient's anxiety. While assessing anxiety,