1.1. environment and the patients may also worry about


Preoperative anxiety is described
as an unpleasant state of uneasiness or tension that is secondary to a patient
being concerned about a disease, hospitalization, anaesthesia, surgery or the
unknown reason(1).

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The majority of patients awaiting
surgery experience anxiety and perceive the day of surgery as life threatening
event that has never happened. According to study from Rwanda the incidence of
preoperative anxiety was 72.8% in surgical patients(2). In Nigeria, the preoperative
anxiety in adult patients varies between11 % to 80% (1). It has been documented that in hospitalized patients with
nonsurgical reasons 10% to 30% may present anxiety, this incidence of anxiety
may rise up to 60%-80% in patients waiting for surgery and 5% of the anxious
patients may refuse surgery (3). According to study in Jimma university specialized hospital the
prevalence preoperative anxiety was 70.3(4) and study conducted in Gondar university compressive
specialized shown that 59.6% of preoperative anxiety prevalence(5).

The preoperative anxiety may be
caused by medical diagnosis, physical separation from family, hospitalization,
preoperative instructions including fasting period and other physical
preoperative preparation, no or little knowledge about diagnosis, surgical
interventions or therapeutic methods, operating room environment and the
patients may also worry about anaesthesia, success of surgery, post-operative
pain management and high costs of operation (6). The anxiety starts at the time of being scheduled for surgery
and increases to a peak level at the time of admission for surgery (7). But the surgical team takes
little consideration of preoperative anxiety while it predicts the difficult
surgical process and outcomes(8).

Preoperative anxiety may result
in slower and more complicated recovery with affects the path of surgery
associated with vasoconstriction, hypertension and increased heart rate, may
lead to bleeding, postoperative mortality or major morbidity and poor health outcome(1, 6, 9, 10).


In addition, preoperative anxiety
is associated with an increase in pain perception, nausea, and vomiting after
surgery, it also correlates with long hospital stay, high health care cost and
decrease patient satisfaction (3, 4, 11).

Therefore anxiety as nursing
diagnosis in patient awaiting surgery may investigated and managed by nurses
before the surgery(12, 13). Preoperative education and psychological support to patients by
nurses have been mentioned to be among the most effective interventions to
decrease the anxiety level. When a perioperative nurse is providing an
education and psychological support, the patient gets an opportunity to express
his/her thoughts, feelings and their expectations which increase the patient’s
confidence in the surgical team(3).

The preoperative detection of the
level of anxiety and identification of associated factors are crucial for
better preoperative anxiety management that results in a better surgical
outcome, patient satisfaction and low health care cost with increased












anxiety is a common component of the surgical experience and increased levels
of anxiety may alter a patient’s surgical course and cause increased
postoperative complication(14).

study conducted by Tanaka in 2015 found that heart rate and systolic blood
pressure have risen higher in patients with anxiety than in patients without
anxiety after entering operating room. In addition
in his study found that patients with a high anxiety level have a 2.17
fold higher risk of hypothermia during the first hour and a 1.77-fold higher
risk of hypothermia during the first 2 hours than patients with a low/moderate
anxiety level(15). The study conducted by showed that patients with preoperative
anxiety or depression had more than 6 times higher risk to be dissatisfied
compared with patients with no anxiety or depression and dissatisfied patients
were hospitalized 1 day more than satisfied patients(16).

preoperative anxiety also associated with an increase in health care cost. In a
study conducted in patients with preoperative anxiety and depression who
undergone total joint arthroplasty found that the hospitalization charges were
significantly higher for patients with preoperative anxiety $55,670 compared to
the hospitalization charges with median of $52,270. For patients without
anxiety and patients with anxiety who were undergone total knee replacement
were significantly hospitalized more days compared to patients without anxiety
or depression with median length of hospital stay of 3.5 days and 3.4 days
respectively, the authors also showed that the rate of complications was higher
in patients with preoperative anxiety at 29% than in patients without those
disorders at 15.5%,(16).

the negative effects of preoperative anxiety on the surgical process, the
preoperative anxiety level of patients waiting for surgery in Ethiopia is not
adequately assessed(4).
Therefore for the purpose study is smoothly running the surgical process which
results in positive surgical outcomes, the nurse needs to assess preoperative
anxiety level and associated factors in order to intervene effectively for
patients awaiting surgery.







purpose of this study is to assess the preoperative anxiety levels and
determinant factors for patients awaiting surgery. The study findings will be
provided a body of knowledge on preoperative anxiety and associated factors
that may contribute to nursing education and teaching the nursing students or
professional nurses in preoperative preparation of patients.

 Furthermore, the findings will be used for
further preoperative patient preparation or anxiety related researches. The
hospitals administration may use the results of this study in planning the
package of nursing interventions patients have to receive preoperatively, develop
policy and procedure related to preoperative anxiety. Moreover, in nursing
practice, the nurses may use the findings for early identification of anxious
patients and patients needing more nursing interventions before they undergo
the surgery.

results will be finally contribute to the quality of care and once the anxious
patients are screened at early and individualized interventions are implemented
on time, it results in low anxiety that leads to quick recovery and better
patient outcome and increases the productivity of people. The productive people
contribute to country development.