Can providing paging devices relieve waiting room anxiety?

AORN Journal, April, 1998 by Robert Topp, Eileen Walsh, Carol Sanford

Remaining in hospital surgical waiting rooms typically is a threatening and anxiety-provoking event for individuals who are waiting for patients undergoing surgical procedures.(1) In addition, individuals commonly report feelings of isolation and experience a sense of timelessness while waiting.(2) This anxiety is unrelated to the durations of the procedures.(3) These feelings may occur because individuals often do not leave surgical waiting rooms during the surgical procedures. Their hesitancy to venture out of waiting rooms is provoked by fears that they will be unavailable for important developments in patients' care or that they will miss opportunities to talk with attending surgeons. Consequently, individuals waiting for surgical patients typically spend entire surgical durations in hospital waiting rooms, producing a confinement that is associated with their fantasizing about undesirable surgical outcomes.(4) Lack of outside activity may contribute to anxiety among individuals who are waiting in surgical waiting rooms. This anxiety can have negative impacts on patients undergoing surgical procedures(5) and, thus, is of interest to nurses in the clinical area.

PILOT STUDY

Providing individuals who are waiting for surgical patients with digital pagers is one mechanism of communicating with them while allowing them to circulate outside the confinement of surgical waiting rooms. Digital pagers allow individuals to travel outside waiting rooms and to be contacted to return to surgical waiting rooms when needed. This paging system may allow individuals greater personal activity and reduce anxieties and feelings of threat during surgical periods. The purpose of this pilot project was to evaluate the effect of providing individuals waiting for surgical patients with digital pagers during surgical procedures. This purpose generated three hypotheses to be tested.

* Individuals who receive pagers report lower anxiety levels during surgical procedures than individuals who do not receive pagers.

* Individuals who receive pagers report reduced feelings of threat during surgical procedures than individuals who do not receive pagers.

* Individuals who receive pagers report greater activity levels during surgical procedures than individuals who do not receive pagers.

RELATED LITERATURE

These hypotheses are supported by previous research as well as by an evolving theoretical framework of the phenomena. Family members and significant others of hospitalized patients have reported significantly higher anxiety,(6) depression, and irritability when compared to matched controls.(7) This anxiety appears enhanced among family members and significant

others who are waiting during serious medical procedures such as surgery.(8) The anxiety these individuals experience has been attributed to their fantasies and fears of surgical patients' dying. This fearful fantasy about patients' deaths has been conceptualized as death threat.(9) Other investigators suggest that the feelings of death threat are heightened by a lack of information, poor understanding of the condition, and uncertainties regarding the patients' future health condition.(10) Previous studies have indicated that family members who are provided with timely information about their family members' progress report reduced anxiety during surgical procedures.(11) To date, no effective mechanisms exist to alert individuals of developments in patients' progress while allowing them to venture beyond surgical waiting rooms. Such mechanisms have the potential to reduce anxiety and feelings of threat and enhance activity levels of individuals who are waiting for patients undergoing surgical procedures. This improvement in waiting room experiences may positively affect individuals' perceptions of hospitals and, ultimately, improve customer satisfaction.

THEORETICAL FRAMEWORK

One theory that supports these hypotheses advocates that detrimental emotional states, such as worry, fear, or anxiety, are individual responses to perceived threats.(12) These emotional states are associated with increased sympathetic nervous discharge that contributes to subjective feelings of apprehension, stress, and tension. As individuals experience these threats and the resulting somatic and subjective responses, they attempt to deal with them by invoking various coping mechanisms that may deal directly with the sources of threats or with the emotional or physiological responses to threats. The experience of waiting in surgical waiting rooms is a threatening event that commonly results in complaints of anxiety and the accompanying increases in sympathetic nervous activity. Providing individuals in surgical waiting rooms with pagers may allow them to perceive less threat and more control over events. Pagers also may allow individuals to venture outside waiting rooms and may provide physical outlets for their increased sympathetic nervous activity. This "stress and coping" theory supports the utility of providing paging devices to individuals waiting in surgical waiting rooms to reduce their perceived threat and anxiety levels.