Ideas That Work: Lost (Anxiety) at Sea

Practical pearls from your colleagues

Two perioperative nurses noted stress and anxiety among many patients who were about to undergo local anesthesia cases at the surgery center at Penn Presbyterian Medical Center in Philadelphia. Seeking a vehicle to help these patients relax, the nurses’ compassion and empathy led them (to quote a song from the film “The Little Mermaid”) “under the sea.”

The nurses — Holly Gindhart, ASN, RN, CNOR, and Sheri Levin, RN, MSN, CNOR, CPSN — investigated the value of animal-assisted therapy in calming patients, but bringing live animals into the ORs was not an option. They instead honed in on an unofficial concept they dubbed “aquarium therapy” after reading studies that found viewing an aquarium reduces stress and anxiety, increases feelings of relaxation and decreases heart rate and muscle tension.

A real-life aquarium for each of the center’s ORs was out of the question, so the nurses leveraged technology already present in the ORs to bring their aquarium therapy concept to life.

“All six of our ORs have internet access and articulating monitors,” they say. “While we were not able to have a live fish tank, we chose to use a live underwater video feed of fish because of ease of use in the OR. Patients undergoing procedures with straight local anesthesia were able to view these monitors during their surgeries.”

The live feed, broadcast from a reef off the Caribbean island of Bonaire, enabled nurses to engage with patients during their procedures about sights they had seen from previous viewings, including the many colorful fish, the active divers and even a large brain coral that an octopus used as a den. The patients enjoyed the conversations and the captivating live views.

To evaluate the strategy’s effectiveness, Ms. Gindhart and Ms. Levin provided 72 patients with a simple yes/no questionnaire in pre-op that asked if they felt nervous or anxious. The 55 who responded “yes” watched the live feed during their procedures. Postoperatively, 49 of the 55 patients reported feeling more relaxed and less anxious while viewing the coral reef during their procedures. OSM