Effectiveness of Preoperative Nursing Visits in Reducing Preoperative Anxiety Among Surgical Patients in Kaduna State, Nigeria
Abstract
A quasi-experimental evaluation of structured preoperative nursing visits and their association with preoperative anxiety among elective surgical patients in two tertiary hospitals in Kaduna State, Nigeria.
Preoperative anxiety is a common challenge among surgical patients and is associated with poorer perioperative outcomes. Preoperative nursing visits have been associated with reduced anxiety, but evidence from Nigerian tertiary hospitals, particularly in northern states, remains limited.
A post-test-only non-equivalent control-group quasi-experimental design was used to recruit 204 adults scheduled for elective surgery in two tertiary hospitals in Kaduna State. Participants were allocated by facility to an intervention group (n = 102) receiving structured preoperative nursing visits and a control group (n = 102) receiving routine nursing care. Anxiety was categorised as mild, moderate or severe. Chi-square and independent t-tests were used in the analysis.
Patients in the intervention group had a lower mean anxiety score than those receiving routine care (2.82 versus 3.11; t = −2.90883, p = 0.00981). Chi-square analysis also identified a statistically significant association between preoperative nursing visits and anxiety categories (χ² = 12.026, df = 2, p = 0.002).
Patients receiving preoperative nursing visits showed greater information-seeking behaviour, particularly regarding anaesthesia and the surgical procedure. The authors interpret this as greater engagement and preparedness rather than simply increased anxiety.
Patients receiving structured preoperative nursing visits reported lower anxiety scores than those receiving routine nursing care. Because of the non-equivalent post-test-only design, the findings do not establish causality, but they suggest that structured nursing visits may support reduced preoperative anxiety and greater patient preparedness in Nigerian tertiary hospitals.
Adults undergoing elective surgery across two tertiary hospitals.
Patients receiving structured preoperative nursing visits.
Patients receiving routine preoperative nursing care.
Structured visit conducted at least 24 hours before surgery.
2.82 vs 3.11
The intervention group recorded a mean anxiety score of 2.82 compared with 3.11 in the control group. The difference was statistically significant (t = −2.90883, p = 0.00981).
χ² = 12.026
The distribution of mild, moderate and severe anxiety differed significantly between groups (df = 2, p = 0.002), supporting an association between preoperative nursing visits and anxiety level.
63% vs 41%
Approximately 63% of patients receiving the nursing visit were classified within the mild anxiety category, compared with approximately 41% of the control group.
26% vs 48%
Moderate anxiety occurred less frequently in the intervention group, with approximately 26% compared with 48% among patients receiving routine care.
Individualised Nursing Visit
The structured 20–30-minute visit included information about surgery, anaesthesia, expected recovery, pain management and postoperative care together with emotional reassurance and opportunities for patients to ask questions.
At Least 24 Hours Before Surgery
The intervention was delivered by trained perioperative nurses at least 24 hours before surgery using a validated checklist to promote consistency.
APAIS
The Amsterdam Preoperative Anxiety and Information Scale was adapted by collapsing responses into mild, moderate and severe categories while retaining the original item scoring structure. Reported internal consistency was Cronbach’s α = 0.84.
Greater Patient Engagement
Patients receiving structured visits demonstrated a stronger desire for information about anaesthesia and surgical procedures, which the article interprets as increased preparedness and engagement.
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Post-Test-Only Non-Equivalent Control Group
The study used a quasi-experimental design because randomisation and within-hospital controls were considered impractical. Separate hospitals were used for intervention and control groups to reduce treatment contamination.
Two Tertiary Hospitals in Kaduna State
Patients receiving the structured nursing intervention were recruited at Ahmadu Bello University Teaching Hospital, Zaria. Patients receiving routine nursing care were recruited at Barau Dikko Teaching Hospital, Kaduna.
Adults Aged 18–60 Years
Eligible participants were adults scheduled for elective surgery. The published criteria excluded emergency surgery, day-case procedures, previous surgery and several defined clinical or cognitive conditions.
204 Surgical Patients
The Cochran-Armitage formula for comparing two proportions was used. The final sample comprised 102 participants per group after allowing for 10% attrition.
Convenience Sampling
Participants were recruited using convenience sampling within the two selected tertiary hospitals.
Structured Preoperative Nursing Visit
The intervention consisted of a structured 20–30-minute session delivered at least 24 hours before surgery by trained perioperative nurses using a validated checklist.
Education, Reassurance & Preparation
The nursing visit covered the surgical procedure, anaesthesia, expected recovery, pain-management strategies and postoperative care. Nurses also provided emotional reassurance and encouraged patients to ask questions.
Amsterdam Preoperative Anxiety and Information Scale
The APAIS instrument was adapted by categorising post-scoring responses into mild, moderate and severe anxiety. The original items and scoring structure were retained. Internal consistency in this study was Cronbach’s α = 0.84.
SPSS Version 27.0
Clinical and sociodemographic characteristics were summarised descriptively. Independent t-tests and chi-square tests were used, with statistical significance defined at p ≤ 0.05.
Two Research Ethics Approvals
Approval was reported from the Kaduna State Ministry
of Health Research and Ethics Committee and the
Ahmadu Bello University Teaching Hospital Research
and Ethics Committee.
Kaduna State:
NHRE/17/03/2018
ABUTH:
NHREC/ABUTH-HREC/29/08/23
Written Informed Consent
Written informed consent was obtained from participants. Confidentiality and anonymity were maintained and participants were free to withdraw at any time.
Standardised Intervention
The authors identify strengths including standardised intervention delivery, adequate sample size and use of a validated anxiety measurement instrument.
No Baseline Anxiety Measurement
The intervention and control groups came from different hospitals and baseline anxiety was not assessed. Hospital culture, routine nursing practice, demographic differences and surgical-team factors may therefore have contributed to observed differences.
Association, Not Proven Causation
Because the design was post-test-only and non-equivalent, the authors explicitly caution that the findings cannot establish causality. A randomised controlled study within the same hospital would provide stronger causal evidence.
Equal Contributions
The published article records equal contributions among the authors.
Conflict of Interest & Funding
Conflict of Interest:
No conflict of interest was declared.
Funding:
No financial support was received from any organisation
for the submitted work.
Editorial Timeline
CC BY 4.0
This article is published by The Operating Room Global
Journal under the Creative Commons Attribution 4.0
International licence.
DOI: 10.64573/torgj2512006
Volume 2 · Issue 1 · 2026
The Operating Room Global Journal (TORGJ).
ISSN 3105-3262.
Article DOI: 10.64573/torgj2512006.
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