Prevalence and Predictors of Anxiety among Surgical Patients in the Preoperative Holding Area of National Orthopaedic Hospital, Enugu, Nigeria: A Cross-Sectional Study.

Background: High preoperative anxiety in surgical patients impacts anesthetic management, postoperative pain scores, patient satisfaction, and postoperative morbidity. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) offers an attractive option for the assessment of preoperative anxiety on account of its brevity and validity. Aim: Our aim was to determine the prevalence and predictors of preoperative anxiety in our surgical patients. Materials and Methods: We conducted a cross-sectional study among surgical patients by means of interviewer-administered structured questionnaire. The questionnaire incorporated both the APAIS and numeric rating scale for anxiety instruments, with the patients' demographic and clinical details. The data collection was carried out from January 2021 to October 2022. Data entry and analysis were done using IBM Statistical Product and Service Solutions, statistical software version 25. Continuous variables were summarized using mean and standard deviation, while categorical variables were presented using frequencies and proportions. Chi square test, Student t test, correlation analysis, and multivariate analysis using binary logistic regression were used in the analysis. Statistical significance was determined by a P value of <0.05. Results: A total of 451 patients participated in the study, with a mean age of 39.4 ± 14.4 years. The prevalence of clinically significant anxiety was 24.4% (110/451). The predictors of high preoperative anxiety in our cohort were female gender, tertiary education attainment, lack of previous surgical experience, ASA grade 3, and patients scheduled for major surgery. Conclusion: A substantial proportion of the surgical patients experienced clinically significant preoperative anxiety.

Patient safety culture in the operating room: a cross-sectional study using the Hospital Survey on Patient Safety Culture (HSOPSC) Instrument.

BACKGROUND: Credible evidence has established a link between the level of patient safety culture in healthcare environments and patient outcomes. Patient safety culture in the operating room has received scant attention despite the burden of adverse events among surgical patients. We aimed to evaluate the safety culture in our operating rooms and compare with existing data from other operating room settings. METHODS: We investigated the patient safety culture in the operating rooms of our hospital as perceived by the surgeons, nurse anaesthetists and perioperative nurses using the Hospital Survey on Patient Safety Culture (HSOPSC) instrument. IBM Statistical Package for Social Science software, version 25, was used for data entry and analysis. Differences were considered significant when p < 0.05. RESULTS: Only 122 completed surveys were returned out of a survey population of 132 frontline staff, yielding a response rate of 92.4%. The overall average composite score was 47%. The average composite scores ranged from 17-79.6% across the 12 dimensions of the HSOPSC, with teamwork within units being the only dimension with demonstrable strength. Non-punitive response to error, communication openness, feedback and communication about error", frequency of events reported", handoffs and transition and staffing need improvement. The perceived safety culture varied according to work areas and professional roles with nurse anaesthetists having the highest perception and the surgeons the least. CONCLUSION: Patient safety culture in our operating rooms is adjudged to be weak, with only one of the twelve dimensions of HSOPSC demonstrating strength. This is notwithstanding its comparative strengths relative to other operating room settings.

Burnout and presenteeism among healthcare workers in Nigeria: Implications for patient care, occupational health and workforce productivity.

Background: Burnout and presenteeism are two emerging occupational health challenges which share same locus among healthcare workers, and the trend is rising. We aim to define the magnitude of burnout and presenteeism among frontline members of the health workforce and explore any correlation between the two in order to provide empirical data from our socioeconomic and geographical background. Design and Methods: We used self-administered questionnaire to conduct a cross-sectional study among the physicians and nurses in a regional trauma centre in Enugu, Eastern Nigeria; with the respondents selected by stratified random sampling. The Oldenburg burnout inventory and Stanford presenteeism scale were used to measure burnout and presenteeism respectively, while the 2-item patient-health questionnaire (PHQ-2) was used to screen for depression. The level of statistical significance was determined by a p value of <0.05. Results: Among the healthcare workers surveyed (n=155); 34 (21.9%) were physicians, while 121 (78.1%) were nurses. Burnout prevalence was 69%. Burnout was associated with self-rated health status and length of years in professional service but not the occupation or depression screen status of the worker. Sixty-two healthcare workers (40%) screened positive for depression. A positive screen for depression was the only factor that had significant association with lower presenteeism scores (p=0.002). The mean presenteeism scores had strong negative correlation with both the exhaustion (p<0.001) and disengagement (p<0.001) domains of burnout. Conclusion: Burnout is high among the healthcare workers and correlates with presenteeism scores. The mental health of the workforce greatly impaired their productivity.

Physician burnout in Nigeria: a multicentre, cross-sectional study.

BACKGROUND: Healthcare workers are a burnout-prone occupational group and the prevalence is particularly high among physicians. With the prevailing low physician-patient ratio in Nigeria which has worsened with the recent wave of physician emigration, among other socio-economic constraints; a setting for high physician burnout may have been nurtured. Our survey set out to determine the prevalence of burnout among physicians practicing in Nigeria, ascertain the factors that were associated with the development of burnout and evaluate the respondents' perceived impact of physician burnout on patient safety. METHODS: We used the Oldenburg burnout inventory as the measurement tool for burnout in the cross-sectional study conducted between November and December, 2019 among physicians in five tertiary health institutions in Nigeria. A 5- point Likert-type scale was used to evaluate the participants rating of their perceived impact of physician burnout on patient safety. Data entry and analysis were done using IBM Statistical package for social sciences software version 25 and the level of statistical significance was determined by a p value < 0.05. RESULTS: The response rate was 61% (535/871), and burnout prevalence was 75.5% (404/535). Majority of the physicians (74.6%) perceive that physician burnout could impact patient safety. Physicians' professional grade, age and years in practice, but not specialty, gender or marital status were associated with the exhaustion domain, whereas only the physicians' age was associated with the disengagement domain of burnout. No socio-demographic or work-related characteristics determined overall burnout in our respondents. CONCLUSION: Physician burnout in Nigeria is high and pervasive, and this should alert physicians to be wary of their general and mental health status. Public health policy should address this development which has implications for patient safety, physician safety and healthcare system performance.