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THEORETICAL
LITERATURE ON PREOPERATIVE ANXIETY

Preoperative
anxiety is a challenging in preoperative care of patients awaiting elective surgery
and it is widely accepted as an expected response. Anxiety
can be explained as a reaction to stress or fear and elicits the autonomic
physiological response that helps a person to fight or flight the danger(2).

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Studies
have shown that people react differently to anxiety-provoking situations and
related this difference to trait anxiety that described as an established
individual difference in anxiety proneness and how stressful situations are
perceived have described trait anxiety as a relatively permanent personality
characteristic that is not influenced by a stressful situation(17). This implies that surgery does not affect trait
anxiety of the patient. However, state anxiety that has been described as an
unpleasant emotional response while coping with threatening or dangerous
situations (18). State anxiety level varies depending on how
the situation is judged by an individual to be high or low threatening. State
anxiety level is high in a dangerous situation and low in the safe or less
dangerous situation(17).
 

According
to study done by Strongman the anxiety is
different from fear in sense that fear is caused by tangible object with known
expected outcome and it can be escaped while anxiety happens when the danger is
not palpable and it cannot be avoided, the author continued showing that
anxiety is characterized by being unsure of the future and how to behave once a
person meets the danger(19). It has been reported that the main purpose of
anxiety is to detect the danger or threat in a potentially harmful environment,
so that a person reacts effectively to escape the danger(20).

2.2
LEVELS OF PREOPERATIVE ANXIETY

Levels of preoperative anxiety are categorized in either high or
low levels of preoperative anxiety, clinically significant or not clinically
significant. However, clinically significant preoperative anxiety and high
preoperative anxiety level are used interchangeably and not clinical
significant and low preoperative anxiety level is used interchangeably. Some
authors classify the levels of preoperative anxiety in no, mild, moderate or
severe preoperative anxiety(17).

The categorization levels of preoperative anxiety depend on the
used preoperative anxiety assessment tool based on its cut-off score. The
studies using Hospital Anxiety and Depression Scale (HADS) consider the sum
score ?11 as high preoperative anxiety level and the sum score 44 score as significant anxiety or high
anxiety level and the sum score ?44 as low anxiety level or not significant
anxiety(4, 21) and for the studies using the
Pre-operative Intrusive Thoughts Inventory (‘The PITI’ or ‘PITI-20’) consider the sum score ?15 as clinically significant preoperative
anxiety level and the sum score

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