CONTINUING EDUCATION

Special Needs Populations:Alleviating Anxiety andPreventing Panic Attacks inthe Surgical Patient

CHASSIDY DAVIS-EVANS, MS, RN 1.5

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Purpose/GoalTo enable the learner to help alleviate anxiety and prevent

panic attacks in the surgical patient.

Objectives

1. Describe panic attacks.

2. Identify causes of panic attacks.

3. Discuss the etiology of panic attacks.

4. Explain how panic attacks may occur during the phases of

the surgical process.

5. Discuss interventions that can help relieve anxiety in the

surgical patient.

354 j AORN Journal � March 2013 Vol 97 No 3

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education by the American Nurses Credentialing Center’s

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your state board of nursing for acceptance of this activity for

relicensure.

Conflict of Interest DisclosuresMs Davis-Evans has no declared affiliation that could be

perceived as posing a potential conflict of interest in the

publication of this article.

The behavioral objectives for this program were created

by Rebecca Holm, MSN, RN, CNOR, clinical editor, with

consultation from Susan Bakewell, MS, RN-BC, director,

Perioperative Education. Ms Holm and Ms Bakewell have no

declared affiliations that could be perceived as posing potential

conflicts of interest in the publication of this article.

Sponsorship or Commercial SupportNo sponsorship or commercial support was received for this

article.

DisclaimerAORN recognizes these activities as continuing education for

registered nurses. This recognition does not imply that AORN

or the American Nurses Credentialing Center approves or

endorses products mentioned in the activity.

http://dx.doi.org/10.1016/j.aorn.2012.12.012

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SPECIAL NEEDS POPULATIONS

Alleviating Anxiety and PreventingPanic Attacks in the SurgicalPatient 1.5

www.aorn.org/CECHASSIDY DAVIS-EVANS, MS, RN

Surgery can be intimidating and can pro-

voke anxiety for any patient, but for the

patient who is prone to anxiety, surgery

can be the trigger for a panic attack. Thus, it is

crucial for health care providers to examine and

understand the mental health of patients who are

undergoing surgical procedures. Although it is

important to provide anxiety-decreasing interven-

tions for surgical patients solely for comfort,

decreasing anxiety during the perioperative

process also has been shown to produce better

patient outcomes. Hospital personnel, especially

nurses, should be aware of the anxiety-prone

patient population and take precautions to reduce

surgery-related anxiety. Pharmacological and

nonpharmacological interventions can be imple-

mented to help decrease anxiety and panic disor-

ders experienced by patients during the

perioperative process.

WHAT IS A PANIC ATTACK?

A panic attack is a sudden episode of intense fear

that triggers severe physical reactions when there is

no real danger or apparent cause.1 For a surgical

patient, surgery may present a real danger but the-

person may have a more severe reaction to that

fear of surgery than is warranted. “Panic attacks

are terrifying episodes during which the person is

convinced they are about to die or collapse. Without

warning, an individual is suddenly overwhelmed

by emotional and physical sensations that signal

imminent death.”2(p60)

http://dx.doi.org/10.1016/j.aorn.2012.12.012

� AORN, Inc, 2013

Panic attacks are a manifestation of the body’s

fundamental physiologic fight or flight response as

it prepares to defend itself against real or perceived

danger.3 Panic attacks can happen any time or any

place and may even wake the patient from sleep.

Some of the physiologic signs and symptoms of

panic attacks include rapid heart rate, chest tight-

ness, shortness of breath, hyperventilation, sweat-

ing, and trembling.1 Cognitively, panic attacks can

affect a person’s ability to concentrate and process

data.3 Emotionally, panic attacks can make the

person feel scared, anxious, worried, or sad. In-

dividuals may become tearful or cry during or

after a panic attack.

About 20% of US adults will experience a panic

attack at some point in their lives.4 Panic attacks

were once dismissed as nerves or stress, but they

are now recognized as a real medical condition

that can lead to panic disorder.1 If a patient has

multiple panic attacks and spends long periods in

fear of another attack, the patient may have panic

disorder.1

CAUSES AND RISK FACTORS

The specific causes of panic attacks are still un-

known. Additionally, each panic attack a person

experiences can have a different cause. Genetics,

major stress, and individual temperament and brain

function may be some causes of panic attacks.1

Other risk factors include family history, death

or illness of a loved one, a major life change,

March 2013 Vol 97 No 3 � AORN Journal j 355

March 2013 Vol 97 No 3 DAVIS-EVANS

significant stress, a history of abuse, or a traumatic

event.1 Women and young adults are most prone to

panic attacks.1

Cultural Differences

Panic attacks, panic attack symptoms, and panic

disorder may vary according to patients’ culture

and ethnicity. According to Asnaani et al,5 ideas

about the meaning of anxiety-type psychological

and somatic sensations vary across cultures. There-

fore, feared sensations and the extent of fear would

be expected to vary. The symptoms that are most

prominent may depend on the cultural group of the

person experiencing the panic attack. The cultural

differences in panic attacks could be a result of

biological makeup, cultural metaphors used to ex-

press distress, or prominent cultural illnesses. Prom-

inent cultural illnesses in African Americans, for

example, are hypertension and diabetes, which could

lead to an amputation. Thus, African Americans may

view numbness, which could result from a panic

attack, as an indicator of a health problem that could

lead to amputation.5

Cultural variations also may result in different

rates of panic disorder and panic attacks. In an

explorative study by Asnaani et al, racial and ethnic

differences of panic attacks, panic disorder, and

certain panic attack symptoms were investigated by

jointly combining three epidemiological databases.

The compared groups were white Americans,

Hispanic Americans, Asian Americans, and black

Americans. Asnaani et al5 determined that white

Americans had a statistically higher rate of panic

attacks and panic disorder than the other groups.

Asian Americans reported the lowest rate of panic

attacks and panic disorders.

White Americans may experience higher rates

of panic attacks because of a greater fear of disease

and because panic attacks are becoming more

publicized in white American society. The group

of white Americans in the study experienced more

cardiac palpitations than people in the other groups,

in keeping with the white American population’s

fear of heart attacks.5 White Americans also expe-

356 j AORN Journal

rienced significant trembling or shaking, shortness

of breath, and nausea during panic attacks.5 Hispanic

Americans experienced nausea, choking sensations,

and shortness of breath during panic attacks, pos-

sibly because of Hispanic metaphors referencing

asphyxia.5 Black Americans reported racing hearts

and nausea during panic attacks. Although it was

not statistically significant in this study, Asian

Americans may experience more dizziness during

panic attacks because of a biologic predisposition

to dizziness and motion sickness, which was dis-

covered with use of an optokinetic drum.5

Perioperative nurses may be able to avoid

panic-provoking incidences during the surgical

procedure by helping the patient to express certain

cultural fears. For example, the nurse may help

a white American patient with deep breathing

exercises to decrease palpitations. To prepare a

patient for the possibility of experiencing throat

soreness after general anesthesia, the nurse may

need to explain the effects of intubation to a

Hispanic patient in a way that does not create

sensations of panic.

Preoperative Factors

A surgical procedure can be classified as a source

of significant stress, a major life change, or a trau-

matic event; therefore, anxiety-reducing measures

should be taken to help patients avoid panic attacks.

Typically, patients experience the most anxiety

during the preoperative period.6 While the patient

is waiting to be taken to surgery, he or she may

experience an unfamiliar environment, loss of

control, separation from friends and family, and

dependence on strangers. The patient has time to

think of actual or perceived risks, including death,

that may occur during surgery. Preoperative anxiety

has been found to correlate with high postoperative

anxiety, increased postoperative pain, increased

analgesic requirements, and prolonged hospital

stay.7 Excessive preoperative anxiety is associated

with unfavorable physiologic responses, such as

tachycardia, hypertension, cardiac arrhythmias,

hyperventilation, and postoperative pain.6

TABLE 1. Interventions to Reduce Anxiety

Intervention Strategies

Communication n Speak in layman’s terms.n Provide information in short sessions.n Obtain a complete medical history, including a history of psychiatric illness or previous panic attack.n Explain the sequence of surgical events.n Ensure that all health care providers (eg, surgeon, anesthesia professional, nurses) communicate with

the patient.

Humor n Maintain cultural sensitivity.n Allow patients to joke because this may reveal unfounded anxiety and fear that the nurse can

help alleviate.n Promote laughter.

Music n Play soft, soothing music.n Have music in the waiting room, preoperative area, surgical suite, and postanesthesia care unit.n Allow the patient to bring a personal music player with headphones, if appropriate.

Medication n Explore a premedication option.n Individualize the medication plan.n Educate the patient about medications that may be an option to prevent or treat anxiety and panic

attacks.

SPECIAL NEEDS POPULATIONS www.aornjournal.org

Intraoperative Factors

Many surgical procedures are performed using

local or regional anesthesia.8 Although being

“awake” eliminates the patient’s anxiety about

undergoing anesthesia, other factors invoke anxiety

about conscious surgery. According to Mitchell,8

“some of the factors that created anxiety during

local and regional anesthetic procedures were

thoughts of

n being awake,

n experiencing more pain,

n feeling the surgery,

n having more than one injection,

n the numbness wearing off too soon, and

n seeing the body cut.”8(p266)

In the case of the conscious patient who is

prone to panic attacks, it is extremely important to

minimize anxiety so that the surgical procedure can

be completed successfully. A panic attack during

a conscious procedure might result in

n injury to the patient or to staff members,

n having to reschedule the procedure, or

n having to sedate the patient.

Postoperative Period

Factors that could induce postoperative anxiety

include pain, nausea, waking in an unfamiliar

environment, loss of control, the finality of surgery,

and fear of going home. The patient who has

undergone general anesthesia may awaken in a

state of panic. If the patient is calm upon waking,

he or she still risks entering a panicked state be-

cause of anxiety-inducing factors. It is important

for the nurse to recognize all of the postoperative

factors that can cause a patient to panic and work

with the patient to maintain a state of calm during

the recovery period.

INTERVENTIONS TO REDUCE ANXIETY

Perioperative nurses can use a variety of strategies

to help reduce a surgical patient’s anxiety. These

strategies include the nonpharmacological inter-

ventions of communication, humor, and music as

well as pharmacological interventions (Table 1).

Communication

Nurses should use effective communication

techniques when prepping a patient for surgery.

AORN Journal j 357

March 2013 Vol 97 No 3 DAVIS-EVANS

Patients receive an abundance of information

before a procedure. They may be unable to

process the majority of this information because

of increased anxiety and because many of the

medical terms used in communicating the

surgical procedure are unfamiliar to patients. The

nurse should attempt to explain procedures in

simple terms. The nurse may have to repeat

information several times so that the anxious

patient can process the information. For inpa-

tients, the nurse may decide to give the patient

information in small increments. According to

Haugen et al,9 patients have decreased anxiety

when they are allowed to ask questions before

a surgical procedure. Both inpatients and outpa-

tients need adequate time to process information

and formulate questions.

While communicating with the patient, the nurse

should assess and document whether the patient

has a history of panic attacks, panic disorder, or

other psychiatric issues. Haugen et al9 determined

that there is a significant positive relationship bet-

ween generalized anxiety and depression before

admission and anxiety experienced during the

intraoperative period. If the surgical team has

knowledge of an increasingly anxious patient,

Web Sites Related to Anxiety

n Anxiety. American Psychological Association. ht

.org/topics/anxiety/index.aspx.

n Anxiety disorders. American Psychiatric Associa

www.healthyminds.org/Main-Topic/Anxiety-Disor

n Generalized anxiety disorder. Anxiety and Depre

tion of America. http://www.adaa.org/understand

generalized-anxiety-disorder-gad.

n Generalized anxiety disorder. Freedom from Fea

.mhww.org/GAD%20Fact%20Sheet.pdf.

n Treatment works: get help for depression and an

for Disease Control and Prevention. http://www.c

s/Depression/index.html.

Web site accessed verified November 25, 2012.

358 j AORN Journal

preventive measures using effective communica-

tion can be taken to reduce the patient’s anxiety.

As in the preoperative period, communication

is a vital component in reducing anxiety in the

intraoperative period. Patients have fears that

are often unfounded or very unlikely to occur.

Nevertheless, patients are often unaware that their

apprehensions are groundless, either because they

have not been informed of the effect of the surgical

environment, have forgotten such details, or did not

know what to anticipate during the intraoperative

period. The effect of the surgical environment

refers to the anxiety that patients feel when

entering the unfamiliar environment of the OR.

The sight and sounds of unfamiliar surgical

equipment and tools and the introduction of

multiple health care providers often cause patients

to lose their preoperative reasoning abilities.8

Patients may experience decreased anxiety if the

anesthesia professional explains the anticipated

sequence of events before surgery and the circu-

lating nurse reinforces this information immediately

before the administration of anesthetics.8 Under-

standing the sequence of events helps the patient

establish realistic expectations of the surgical

experience.8 The anesthesia professional should

tp://www.apa

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ders.aspx.

ssion Associa-

ing-anxiety/

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xiety. Centers

dc.gov/feature

inform the patient about how

long the anesthetics will last.

This information may resolve

apprehension regarding the

anesthetic wearing off

too soon.

Finally, the circulating

nurse or anesthesia profes-

sional may be able to distract

the conscious patient from

the procedure by conversing

with the patient. If the pa-

tient is engaged in conver-

sation, he or she may be less

likely to notice the effects

of the anesthesia and the

ongoing procedure. The

anesthesia screen blocks the

SPECIAL NEEDS POPULATIONS www.aornjournal.org

patient’s view of the surgical site, which helps the

patient focus on the conversation and not on the

procedure and eliminates the possibility that the

patient will see needles, scalpels, or other instru-

ments or the manipulation of body parts.

Humor

According to Buxman, one definition of humor is

“that which lends itself to laughing, smiling, or

amusement. It is considered a positive emotion

and may be used synonymously with a sense of joy.

It has characteristics that make it a viable coping

mechanism.”10(p67) In the perioperative setting,

humor can be used to establish relationships,

relieve anxiety, release anger in a socially accept-

able way, avoid or deny painful feelings, and

facilitate learning.10 A nurse can use humor to

create a therapeutic atmosphere, which increases

the likelihood of a more positive surgical

experience.

There are also numerous physiologic and

psychological benefits of humor, including

reducing stress, anxiety, and tension; decreasing

depression, loneliness, and anger; improving mood;

increasing self-esteem; and enhancing a sense of

empowerment.10 Specifically regarding anxiety,

nurses can assess the patient’s humor to identify

underlying messages. For example, a patient may

be too embarrassed to state plainly that he or

she is scared to undergo a procedure. However,

the patient may joke about being scared. If the

nurse recognizes the patient’s underlying anxiety,

the nurse can help the patient acknowledge his or

her fears and help relieve these fears through

education and communication. Research regarding

physiologic benefits specific to laughter suggests

that laughter increases pain tolerance; improves

respiration and breathing; improves mental

functioning, including alertness, creativity, and

memory; and decreases muscle tension.10

When using humor as an anxiety-reducing

strategy, it is important for the nurse to use

cultural sensitivity. “Humor is one of those com-

mon denominators in the human equationdlike

aggression, love, fear, sadness”11(p237); however,

humorous interventions should not be used indis-

criminately.11 There are intercultural differences in

the realm of what content is considered humorous.

However, humor is an appropriate intervention for

ethnically diverse clients when used sensitively in

the counseling process.11

Music

Another potential way to reduce anxiety during

all phases of the surgical experience is allowing

patients to listen to music. Music has a stress-

relieving effect because it acts as a distractor.12,13

Music is familiar and soothing and allows the

patient an alternative stimulus on which to focus.14

According to the study by Lee et al,14 music should

have a low pitch, slow tempo, regular rhythm, and

pleasing harmonics and should have selections of

piano, string, or flute medleys. Genre and duration

did not have an influence on the music interven-

tion.14 Although the study was conducted on

ambulatory patients, music intervention could also

be used for inpatients awaiting surgery. Music

could be played in the inpatient’s room before the

patient is taken to surgery. This inpatient inter-

vention might involve coordination between the

perioperative nurse and the nurse caring for the

patient on the postoperative nursing care unit.

In a study by Ikonomidou et al,15 researchers

discovered that allowing a period of peaceful,

undisturbed rest immediately before surgery had

a positive effect on patients’ feelings of well-being

and was appreciated by the majority of patients.

The period of rest also had a positive influence

on postoperative pain and vital signs.15 It could

be beneficial to have music playing in the post-

anesthesia care unit to allow the patient to recover

in a calm, relaxing environment.

With panic attacks, patients usually have an

increase in blood pressure, pulse, and respirations.

A calm postoperative environment could help

normalize a patient’s vital signs. If music could

help stabilize vital signs and minimize pain in

the immediate postoperative period, the patient

AORN Journal j 359

March 2013 Vol 97 No 3 DAVIS-EVANS

would be less likely to enter a state of extreme

anxiety. Conversely, panic may be induced if the

patient wakes up to extreme pain in a chaotic

environment.

Pharmacology

Using a researcher-designed questionnaire,

Mitchell12 identified patient preferences and de-

termined that 54.1% of patients preferred light

sedation in the preoperative period over reading,

listening to music, or watching a movie. Conse-

quently, pharmacology may be the anxiety-reducing

method of choice for many patients. In a study in

which midazolam was used for premedication, pa-

tients reported decreased levels of anxiety.12 This

same study showed that postoperatively, all patients

rated their satisfaction with the care provided as

either good (30%) or excellent (70%).12 When pre-

operatively administered, both diazepam and pro-

pranolol demonstrated a decrease in mean arterial

blood pressure when measured against placebos.12

Preoperative anxiolytic medication, as with

a low-dose benzodiazepine, has been an underused

resource to prevent or limit anxiety. In the study by

Carroll et al,6 only 4% of patients were offered

and prescribed premedication preoperatively. The

limited amount of premedications prescribed may

be a result of decreased preoperative visits by the

anesthesia professional, because many surgeries are

completed on an outpatient basis and the anesthesia

professional meets the patient only minutes before

surgery. In addition, time constraints in high-

pressure surgical situations may hinder the anes-

thesia professional from accurately assessing the

patient’s psychological status and lead to the

omission of appropriate anxiolytic premed-

ications. There is also a lack of premedication

prescribing standards for anesthesia professionals;

therefore, the patient is unable to independently

premedicate before arriving to an outpatient

surgery.6,12 Premedications are not widely ad-

ministered in outpatient surgeries because of

fear of

n slow onset and delay of discharge,

360 j AORN Journal

n the patient’s inability to remember important

discharge information, and

n the patient’s inability to walk after surgery.12

A comparison of ambulatory surgery patients

who were premedicated with benzodiazepines,

beta-adrenoceptor blockers, or opioids with non-

premedicated patients revealed no difference

in time of discharge.12 As with any medication

prescription, it is important for nurses to educate

patients about the effects of the prescribed medi-

cation before administration.

CONCLUSION AND RECOMMENDATIONS

Surgery places a great deal of physical stress on the

body and psychological stress on the patient’s

mental state. Increased patient anxiety in the peri-

operative period has the potential to initiate panic

attacks. Patients with decreased preoperative

anxiety have been shown to have improved post-

operative outcomes. Thus, perioperative nurses

should implement all available strategies to de-

crease the surgical patient’s anxiety. Potential

nonpharmacological methods to reduce patient

anxiety include communication, humor, and music,

all of which are simple and economical strategies.

Pharmacological methods, such as administration

of preoperative medications, are popular among

patients. Chosen anxiety-reducing strategies should

be individualized based on each

patient’s needs.

References1. Panic attacks and panic disorder. Mayo Clinic. http://

www.mayoclinic.com/health/panic-attacks/DS00338.

Accessed October 27, 2012.

2. Patterson C. High anxiety: managing panic attacks.

Alive: Canada’s Natural Health & Wellness Magazine.

2011;343:59-63. http://www.alive.com/articles/view/

23128/high_anxiety. Accessed December 11, 2012.

3. Tompkins O. Panic attacks. AAOHN J. 2010;58(6):268.

4. Panic attacks (panic disorder). MedicineNet. http://

www.medicinenet.com/panic_disorder/article.htm.

Accessed October 27, 2012.

5. Asnaani A, Gutner CA, Hinton DE, Hofmann SG. Panic

disorder, panic attacks and panic attack symptoms across

race-ethnic groups: results of the collaborative psychi-

atric epidemiology studies. CNS Neurosci Ther. 2009;

15(3):249-254.

SPECIAL NEEDS POPULATIONS www.aornjournal.org

6. Carroll JK, Cullinan E, Clarke L, Davis NF. The role

of anxiolytic premedication in reducing preoperative

anxiety. Br J Nurs. 2012;21(8):479-483.

7. Caumo W, Schmidt AP, Schneider CN, et al. Risk factors

for postoperative anxiety in adults. Anaesthesia. 2001;

56(8):720-728.

8. Mitchell M. Conscious surgery: influence of the environ-

ment on patient anxiety. J Adv Surg. 2008;64(3):261-271.

9. Haugen AS, Eide GE, Olsen MV, Haukeland B,

Remme AR, Wahl AK. Anxiety in the operating theatre:

a study of frequency and environmental impact in

patients having local, plexus or regional anaesthesia.

J Clin Nurs. 2009;18(16):2301-2310.

10. Buxman K. Humor in the OR: a stitch in time? AORN J.

2008;88(1):67-77.

11. Kruger A. The nature of humor in human nature: cross-

cultural commonalities. Couns Psychol Q. 1996;9(3):

235-241.

12. Mitchell M. Patient anxiety and modern elective surgery:

a literature review. J Clin Nurs. 2003;12(6):806-815.

13. Nilsson U. The anxiety and pain reducing effects of

music interventions: a systematic review. AORN J. 2008;

87(4):780-807.

14. Lee KC, Chao YH, Yiin JJ, Chiang PY, Chao YF.

Effectiveness of different music-playing devices for

reducing preoperative anxiety: a clinical control study.

Int J Nurs Stud. 2011;48(10):1180-1187.

15. Ikonomidou E, Rehnstr€om A, Naesh O. Effect of music

on vital signs and postoperative pain. AORN J. 2004;

80(2):269-278.

Chassidy Davis-Evans, MS, RN, is a staff nurse

at Murray Medical Center, Chatsworth, GA. Ms

Davis-Evans has no declared affiliation that

could be perceived as posing a potential conflict

of interest in the publication of this article.

AORN Journal j 361

EXAMINATION

CONTINUING EDUCATION PROGRAM

1.5

www.aorn.org/CESpecial Needs Populations:

Alleviating Anxiety and PreventingPanic Attacks in the Surgical Patient

PURPOSE/GOAL

36

To enable the learner to help alleviate anxiety and prevent panic attacks in the

surgical patient.

OBJECTIVES

1. Describe panic attacks.

2. Identify causes of panic attacks.

3. Discuss the etiology of panic attacks.

4. Explain how panic attacks may occur during the phases of the surgical process.

5. Discuss interventions that can help relieve anxiety in the surgical patient.

The Examination and Learner Evaluation are printed here for your conven-

ience. To receive continuing education credit, you must complete the Exami-

nation and Learner Evaluation online at http://www.aorn.org/CE.

QUESTIONS

1. Signs and symptoms of panic attacks include

1. chest tightness.

2. feeling scared, anxious, or worried.

3. inability to concentrate and process data.

4. rapid heart rate.

5. shortness of breath and hyperventilation.

6. sweating and trembling.

a. 1, 3, and 5 b. 2, 4, and 6

2 j AORN Journal

c. 2, 3, 5, and 6 d. 1, 2, 3, 4, 5, and 6

2. Panic attacks may be caused by

1. a traumatic event or a major life change.

2. brain function.

3. genetics or a family history of panic attacks.

� March 2013 Vol 97 No 3

4. a history of abuse.

5. individual temperament.

6. a major stressor, such as death or illness of

a loved one.

a. 1, 3, and 5 b. 2, 4, and 6

c. 2, 3, 5, and 6 d. 1, 2, 3, 4, 5, and 6

3. ___________________ are most prone to panic

attacks.

1. Men

2. Women

3. Children

4. Older adults

5. Young adults

a. 2 and 5 b. 1, 3, and 4

c. 1, 2, 3, and 5 d. 1, 2, 3, 4, and 5

� AORN, Inc, 2013

CE EXAMINATION www.aornjournal.org

4. According to one study, _________________ had

a statistically higher rate of panic attacks and

panic disorder.

a. Asian Americans b. white Americans

c. Hispanic Americans d. black Americans

5. According to that same study, _______________

experienced nausea, choking sensations, and

shortness of breath during panic attacks, possibly

because of their culture’s many metaphors

relating to asphyxia.

a. white Americans b. Asian Americans

c. Hispanic Americans d. black Americans

6. Typically, patients experience the most anxiety

during the _________________ period.

a. preoperative b. intraoperative

c. postoperative

7. There is no risk of the patient entering a panicked

state in the postoperative period if he or she is

calm upon waking from anesthesia.

a. true b. false

8. Strategies that perioperative nurses can use to

help decrease a surgical patient’s anxiety include

1. communication.

2. electroconvulsive therapy.

3. humor.

4. music.

5. pharmacological interventions.

6. physical therapy.

a. 1, 3, and 5 b. 2, 4, and 6

c. 1, 3, 4, and 5 d. 1, 2, 3, 4, 5, and 6

9. Physiologic benefits of laughter include that

laughter

1. increases pain tolerance.

2. improves respiration and breathing.

3. improves mental functioning.

4. decreases muscle tension.

a. 1 and 3 b. 2 and 4

c. 1, 2, and 4 d. 1, 2, 3, and 4

10. According to one study, music used to soothe to

surgical patients should have

1. a low pitch, slow tempo, and regular

rhythm.

2. an underlying deep bass cadence.

3. high decibel and prolonged trill.

4. selections of piano, string, or flute medleys.

5. pleasing harmonics.

a. 3 and 5 b. 1, 4, and 5

c. 2, 3, and 4 d. 1, 2, 3, 4, and 5

AORN Journal j 363

LEARNER EVALUATION

CONTINUING EDUCATION PROGRAM

1.5

www.aorn.org/CESpecial Needs Populations:

Alleviating Anxiety and PreventingPanic Attacks in the Surgical Patient

This evaluation is used to determine the extent

to which this continuing education program

met your learning needs. Rate the items as

described below.

OBJECTIVES

To what extent were the following objectives of this

continuing education program achieved?

1. Describe panic attacks.

Low 1. 2. 3. 4. 5. High

2. Identify causes of panic attacks.

Low 1. 2. 3. 4. 5. High

3. Discuss the etiology of panic attacks.

Low 1. 2. 3. 4. 5. High

4. Explain how panic attacks may occur during the

phases of the surgical process.

Low 1. 2. 3. 4. 5. High

5. Discuss interventions that can help relieve anxiety in

the surgical patient.

Low 1. 2. 3. 4. 5. High

CONTENT

6. To what extent did this article increase your

knowledge of the subject matter?

Low 1. 2. 3. 4. 5. High

7. To what extent were your individual objectives met?

Low 1. 2. 3. 4. 5. High

8. Will you be able to use the information from this

article in your work setting? 1. Yes 2. No

364 j AORN Journal � March 2013 Vol 97 No 3

9. Will you change your practice as a result of reading

this article? (If yes, answer question #9A. If no,

answer question #9B.)

9A. How will you change your practice? (Select all that

apply)

1. I will provide education to my team regarding

why change is needed.

2. I will work with management to change/

implement a policy and procedure.

3. I will plan an informational meeting with

physicians to seek their input and acceptance

of the need for change.

4. I will implement change and evaluate the

effect of the change at regular intervals until

the change is incorporated as best practice.

5. Other: _______________________________

9B. If you will not change your practice as a result of

reading this article, why? (Select all that apply)

1. The content of the article is not relevant to my

practice.

2. I do not have enough time to teach others

about the purpose of the needed change.

3. I do not have management support to make

a change.

4. Other: _______________________________

10. Our accrediting body requires that we verify

the time you needed to complete the 1.5 con-

tinuing education contact hour (90-minute)

program: ________________________________

� AORN, Inc, 2013