1. Self-Directed Audio Relaxation in Surgical Patients: A Pilot Study
Tanya G. Island, CRNA, MS, BSN, BS
March 13, 2015

2. Introduction Preoperative preparation of patients
Preoperative preparation of patients often focuses on hospital requirements and medico-legal considerations. Patients are subjected to testing, treatments, and focused assessments based on the scheduled surgical procedure. The presentation will describe the various aspects of a proposal describing the planned pilot study.
Preoperative preparation of patients
Emphasis on hospital requirements
Process revolves around documentation and medico-legal considerations
Minimal emphasis on mind-body preparation leads to anxiety
Preoperative area  high traffic, ambient noise, lack of privacy, variable duration of wait time

3. Purpose
The purpose of this capstone project is to evaluate the efficacy of a self-directed audio
relaxation intervention for pain, anxiety, and patient satisfaction outcomes measures for the
outpatient surgical population at Memorial Hermann Surgical Hospital – First Colony.
The project aims are to translate evidence regarding effectiveness of self-directed audio relaxation
interventions to the practice setting of a community hospital in Sugar Land, Texas.
Evaluated efficacy of a self-directed audio relaxation intervention
Aimed to translate evidence regarding effectiveness of self-directed audio relaxation intervention to community hospital practice setting

4. Problem Statement Surgical patients experience wide array of emotions
Inadequate mind-body preparation
Heightened emotional distress
Lack of privacy
Unfamiliar surroundings
Fear of anesthesia vs surgery
Need for additional information & education

5. Research Questions & Hypotheses
Hypotheses and Null Hypotheses
The self-directed audio intervention will decrease anxiety and pain scores experienced by
surgical patients.
The self-directed audio intervention will improve patient satisfaction scores
after surgery.
The self-directed audio intervention was successfully piloted at a community
hospital, demonstrating translation of evidence-based practice into clinical practice.
The null hypothesis stated that the self-directed audio intervention will not improve pain,
anxiety, and patient satisfaction outcomes in surgical patients at a community hospital.
This conclusion would indicate that no statistically significant benefit was derived from using the self
directed audio intervention in surgical patients at a community hospital.
Will a self-directed audio relaxation intervention:
Reduce VAS anxiety scores?
Reduce VAS pain scores?
Increase patient satisfaction scores?
Can an evidence-based relaxation intervention be successfully implemented in a community hospital surgical population?

6. PICOT Statement
In surgical patients scheduled for outpatient surgery at a community hospital in a southern Texas city, how did a self-directed audio relaxation guided imagery intervention compare to pharmacological anxiolytic and narcotic medication administration in the outcome measures of pain, anxiety, and patient satisfaction during the 2-month pilot study investigation window of January to February 2015?

7. STETLER MODEL OF RESEARCH UTILIZATION
DEFINE – ASSESS – PLAN – IMPLEMENT – EVALUATE
STETLER MODEL OF RESEARCH UTILIZATION
(Reprinted from Nursing Outlook, Vol. 49, Stetler, C. B., Updating the Stetler model of research utilization to facilitate evidence-based practice, pg. 272–279, copyright © 2001, see Appendix A for reprint license from Elsevier)

8. Literature Review
Assessment of anxiety with valid and reliable tools (APAIS, VAS anxiety)
Effects of anxiety on anesthesia requirements
Therapeutic interventions shown to help reduce preoperative anxiety

9. Population, Sample & Instrumentation
Surgical patients scheduled for outpatient procedures at a community hospital
Ages 18-65, no regional anesthesia blocks, no comorbid psychiatric or pain disorders
Outcomes evaluated:
APAIS
VAS pain
VAS anxiety
Patient satisfaction

10. Implementation
Phase
Dates
Tasks I
1 Sep 14 to 18 Dec 14
Evaluation of clinical problem of interest
Input and meetings from facility staff
SWOT analysis
Proposal preparation
Coordination with facility exec leadership
Capstone Proposal Defense & IRB approval II
18 Dec 14 to 22 Dec 14
Equipment selection, trials, and acquisition
Preparation and approval of cost estimate
III
3 Jan 15 to 13 Feb 15
Pilot study implementation
Data collection IV
16 Feb 15 to 28 Feb 15
Statistical analysis of data
Summarize conclusions
Answer research questions V
1 Mar 15 to 13 Mar 15
Presentation to stakeholders
Capstone Project Paper
Capstone Poster Presentation
Capstone Podium Presentation
Phase I – project proposal and preparation of pilot study, evaluation of problem
Phase II – equipment selection, acquisition and cost proposal
Phase III – project implementation
Phase IV – statistical analysis
Phase V – dissemination of findings to stakeholders

11. Equipment

12. Results
The project sought to improve mind-body preparation of surgical patients
scheduled for outpatient surgery – IT DID (DECREASED ANXIETY AND INCREASED PT SAT)
 The project sought to alleviate emotional distress and reduce anxiety associated
with waiting for scheduled surgical procedures – IT DID (DECREASED ANXIETY)
 The project sought to overcome physical and structural limitations of the facility
in which the investigation was conducted by providing a distraction in a curtained
holding area with high ambient noise and limited privacy – IT DID (HIGH PATIENT SAT)
Statistical significance for anxiety reduction and patient satisfaction improvement
No significant relationship between audio intervention and VAS pain

13. Results Frequency Cumulative Percent Male 34 45.9 Female 40 54.1
Frequency
Cumulative Percent
Male
Female
Study results for pain and anxiety were not normally distributed, and statistical analysis was conducted using Wilcoxon Signed Rank Test (Pallant, 2010).
Patient satisfaction was analyzed using Mann Whitney U Test because no pre-intervention data points existed, due to nature of the analysis (Pallant, 2010). The analysis of pain and anxiety focused on comparisons between two related groups with pre-intervention and post-intervention reference points.
Mean preoperative pain score was with a standard deviation of 21.46, indicating a non-normal distribution (see Appendix H). Mean postoperative pain score was with a standard deviation of Mean preoperative anxiety score was with a standard deviation of 31.3, also indicating a non-normal distribution (see Appendix H). Mean postoperative anxiety score was with a standard deviation of (see Appendix H). Both pain and anxiety scores were significantly skewed leftward (see Figure 6).
Patient satisfaction score indicated a mean score of 4.45 and a standard deviation of 0.8 (see Appendix H). This variable had significant rightward skewness and a non-normal distribution.
Wilcoxon Signed Rank Test failed to reveal a statistically significant reduction in pain following use of the self-directed audio relaxation intervention, z = , asymptotic significance .133, p < .001.
Alternatively, Wilcoxon Signed Rank Test revealed a statistically significant reduction in anxiety following use of the self-directed audio relaxation intervention, z = , p < .001, with a medium effect size (r = .39). The median score on the VAS anxiety decreased from pre-intervention (Md = 20) to post-intervention (Md = 0) (see Table 3).
Mann-Whitney U tests were conducted on the patient satisfaction study variable using postoperative survey results. The relationship between audio intervention and patient satisfaction (Md = 5, n = 74) was found to be statistically significant with moderate effect, U = 335, z = , p = .053, r = .22 (see Table 4).

14. Photos taken with express written consent of patients
Photos taken with express written consent of patients. Patients also consented to reproduction in written and visual modalities for purposes of education, publication, and research.

15. Recommendations
Perform a cost-benefit analysis to determine if additional audio units can be made available in preoperative holding area
Conduct further analysis on a screening mechanism to rapidly identify who is most in need of a relaxation intervention
Conduct inservices with staff to educate about non-pharmacological relaxation interventions

16. Conclusions
Self-directed audio relaxation intervention improved patient perception of anxiety and improved patient satisfaction
Currently under consideration by executive leadership team for expansion of pilot study

17. May be viewed in capstone document below
References
May be viewed in capstone document below