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Mahkooyeh SA. et al., 2024: The effect of education on pre-operative anxiety in patients undergoing extracorporeal shock wave lithotripsy.

Wednesday, 14 May 2025

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Saeideh Azizi Mahkooyeh 1, Masoomeh Zakerimoghadam 2, Shima Haghani 3, Mojdeh Navidhamidi 4
1PhD Student in Nursing, Department of Medical-Surgical, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
2Associate Professor, Medical-Surgical Group, Faculty of Nursing and Midwifery, Tehran University of Medical sciences, Tehran, Iran.
3MSc in Biostatistics, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran.
4Department of Medical-Surgical Nursing and Basic Sciences, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Background: The period before diagnostic and therapeutic procedures is associated with increased anxiety levels in patients due to a lack of sufficient information. This study aimed to determine the effect of education on physiological and psychological anxiety levels in patients before extracorporeal shock wave lithotripsy (ESWL).

Materials and methods: This randomized clinical trial was conducted at Baharloo Hospital in Tehran on 122 patients, and the samples were selected in two stages. In the first stage, the samples were selected using convenience sampling. In the second stage, they were randomly assigned to the intervention and control groups. The data were collected using demographic information and Spielberger's State-Trait Anxiety Inventory to measure psychological anxiety. Salivary cortisol was measured to evaluate physiological anxiety by both groups before the intervention and entering the room. The intervention group received the information before ESWL via face-to-face lectures and the broadcast of pre-recorded lecture videos. The control group received only the usual care in the ward. The data analysis was performed by SPSS version 25 using descriptive statistics that included the calculation of mean, standard deviation, and frequency distribution and inferential statistics (independent t-test, paired t-test ANOVA, and Chi-square test).

Results: There was no significant difference in demographic characteristics between the intervention and control groups (P > 0.05). A significant decrease in the mean salivary cortisol level was found in the intervention group compared with the control group (P < 0.001). The anxiety level was markedly decreased in the intervention group compared with the control group (P < 0.001).

Conclusion: Adequately informing patients before ESWL could decrease patients' physiological and psychological anxiety levels. So, people in the field of nursing education can take an important step towards using this method and reducing the anxiety of patients. The existence of such videos and holding training sessions can be a suitable solution for educating the patient.

J 4 Educ Health Promot. 2024 Nov 29;13:445. doi: 10.4103/jehp.jehp_1111_23. eCollection 2024. PMID: 39811847 FREE PMC ARTICLE

Comments 1

Peter Alken on Wednesday, 14 May 2025 11:00

Hopefully my comment will not be misinterpreted as a chauvinistic act if I start by saying that this research was carried out by 4 women. But emphasising this might also draw the attention of male readers to this work, who are traditionally more fascinated by machines than by nursing interventions. And it could contribute to a better understanding of the socio-cultural situation in Iran by Westerners. This is the affiliation of the authors:
1PhD Student in Nursing, Department of Medical-Surgical, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran,
2Associate Professor, Medical-Surgical Group, Faculty of Nursing and Midwifery, Tehran University of Medical sciences,
3MSc in Biostatistics, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran,
4Department of Medical‑Surgical Nursing and Basic Sciences, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

Some of the reasons to do this research were: “Anxiety is an important nursing diagnosis.” “Since nurses are the largest members of the healthcare team who are in direct and continuous contact with patients, and considering that the healthcare system in Iran is facing a lack of nurses, the existence of such videos and holding training sessions can be a suitable solution for educating the patient and reducing anxiety in patients who are candidates for ESWL.”
The study provides exactly what is too often missing in the myriads of uniform ‘we also have ESWL experience’ publications: the focus on the patients and their well-being.
It is a perfectly done study and the little comment from a male machinist is just:
Yes, right, "Previous studies have shown that the level of anxiety in pre‑ESWL patients is very high and occurs in nearly all patients. The patients’ tolerance and the effectiveness of this method appear to be highly influenced by ESWL‑related anxiety. This can limit the maximum amount of shockwave energy from reaching the stone, which in turn may reduce the overall success rate of ESWL and increase the number of ESWL sessions, which the patient may refuse to do again due to pain and anxiety."
It would have been very informative and compelling to see how the one-hour pre-procedure information would have improved patient tolerance to the procedure and success as measured by objective data. Hopefully, a second study on ESWL protocols and follow-up data of these patient groups will follow in conjunction with a urologist.

Peter Alken

Some of the reasons to do this research were: “Anxiety is an important nursing diagnosis.”  “Since nurses are the largest members of the healthcare team who are in direct and continuous contact with patients, and considering that the healthcare system in Iran is facing a lack of nurses, the existence of such videos and holding training sessions can be a suitable solution for educating the patient and reducing anxiety in patients who are candidates for ESWL.”
The study provides exactly what is too often missing in the myriads of uniform ‘we also have ESWL experience’ publications: the focus on the patients and their well-being.
It is a perfectly done study and the little comment from a male machinist is just:
Yes, right, "Previous studies have shown that the level of anxiety in pre‑ESWL patients is very high and occurs in nearly all patients. The patients’ tolerance and the effectiveness of this method appear to be highly influenced by ESWL‑related anxiety. This can limit the maximum amount of shockwave energy from reaching the stone, which in turn may reduce the overall success rate of ESWL and increase the number of ESWL sessions, which the patient may refuse to do again due to pain and anxiety." 
It would have been very informative and compelling to see how the one-hour pre-procedure information would have improved patient tolerance to the procedure and success as measured by objective data. Hopefully, a second study on ESWL protocols and follow-up data of these patient groups will follow in conjunction with a urologist.

Peter Alken

Hopefully my comment will not be misinterpreted as a chauvinistic act if I start by saying that this research was carried out by 4 women. But emphasising this might also draw the attention of male readers to this work, who are traditionally more fascinated by machines than by nursing interventions. And it could contribute to a better understanding of the socio-cultural situation in Iran by Westerners. This is the affiliation of the authors: 1PhD Student in Nursing, Department of Medical-Surgical, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran, 2Associate Professor, Medical-Surgical Group, Faculty of Nursing and Midwifery, Tehran University of Medical sciences, 3MSc in Biostatistics, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran, 4Department of Medical‑Surgical Nursing and Basic Sciences, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran Some of the reasons to do this research were: “Anxiety is an important nursing diagnosis.” “Since nurses are the largest members of the healthcare team who are in direct and continuous contact with patients, and considering that the healthcare system in Iran is facing a lack of nurses, the existence of such videos and holding training sessions can be a suitable solution for educating the patient and reducing anxiety in patients who are candidates for ESWL.” The study provides exactly what is too often missing in the myriads of uniform ‘we also have ESWL experience’ publications: the focus on the patients and their well-being. It is a perfectly done study and the little comment from a male machinist is just: Yes, right, "Previous studies have shown that the level of anxiety in pre‑ESWL patients is very high and occurs in nearly all patients. The patients’ tolerance and the effectiveness of this method appear to be highly influenced by ESWL‑related anxiety. This can limit the maximum amount of shockwave energy from reaching the stone, which in turn may reduce the overall success rate of ESWL and increase the number of ESWL sessions, which the patient may refuse to do again due to pain and anxiety." It would have been very informative and compelling to see how the one-hour pre-procedure information would have improved patient tolerance to the procedure and success as measured by objective data. Hopefully, a second study on ESWL protocols and follow-up data of these patient groups will follow in conjunction with a urologist. Peter Alken

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