Preoperative Anxiety and Self-Efficacy to Postoperative Exercise in
Women undergoing Elective Caesarean Section
Sofiana Salim
1
, Elyana Asnar
2
and Erna Dwi Wahyuni
1
1
Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
2
Faculty of Medicine, Airlangga University, Surabaya, Indonesia
Keywords: Anxiety, Self-efficacy, Exercise, Preoperative, Postoperative, Caesarean section.
Abstract: Caesarean section both elective and emergency are complex and stressful experience. Anxiety is closely
related to self-efficacy to postoperative exercise. The study aims to describe anxiety and self-efficacy to
postoperative exercise in women undergoing elective caesarean section. This study used an descriptive
quantitative design and 70 patients collected as respondents by using consecutive sampling. Data collection
using questionnaires. This study showed that woman’s age mostly between 26-30 years old (55,7%). Most
of the respondents had elementary school education (47.1%) and most of them did not work (81.4%). The
majority of respondents had given birth 1-2 times (54.3%) and most had never undergone cesarean section
surgery (84.3%). Most of the indications of cesarean section were placenta previa (18.6%). Most of the
respondents had moderate anxiety and moderate self-efficacy to postoperative exercise. Preoperative
anxiety may be occur at all ages, levels of education, occupation, and history of operation. Self-efficacy
relates to personal factors. The women should be able to manage emotions by reducing stress and increasing
positive feelings, so it can be a way to increase a person's self-efficacy into a good practice
1 BACKGROUND
Surgery, both elective and emergency treatment is
complex and stressful events. Sectio caesarea (SC) is
surgery to delivery of a fetus through an incision in
the abdominal wall and the uterine wall, SC is an
action that is quick and easy, but SC also has some
danger of complications, such as wound infections,
thrombophlebitis, bleeding and pain after surgery if
not given proper care when preoperative (O'Neill et
al., 2013). Mothers who will undergo sectio caesarea
are concerned with the impacts of operations that
will result after the anesthetic effect is lost
(Dempsey et al., 2017).
Anxiety in general surgery patients occur due to
conditions perceived regarded as a threat to its role
in life, integration of body, or even life itself
(Smeltzer, 2002). If anxiety is not treated properly, it
can give an adverse effect on physiological
parameters in anesthesia, both during surgery and
postoperative (Guo, P., et al, 2012).
According to WHO sectio caesarea increase in
deliveries across the country during the years 2007 -
2008 is 110,000 per delivery across Asia (Leveno,
2009). Based on research Nigussie et al., (2014)
patients undergoing preoperative anxiety was
significantly seen in 70.3% of 239 patients.
According to Carpenito (2002), stated that 90% of
patients may experience preoperative anxiety.
Based on the results Riskesdas 2013, in
Indonesia shows birth with sectio caesarea
operations amounted to 9.8% of the total of 49.603
births throughout the 2010-2013 (Sihombing et al.,
2017). The results of preliminary studies were
carried out on December 21, 2017 in Bangil
Hospital, Pasuruan, East Java, starting in January -
September 2017 the average number of patients who
undergo SC was 187 patients per month.
Patients who undergo surgery often doubt their
ability to perform activities of rehabilitation due to
increased levels of stress and anxiety of patients
with severe postoperative pain (Barlow, 2010).
When someone is experiencing strong anxiety and
stress is high, then that person has the expectation of
a low self-efficacy (Bandura, A., 1977). Self-
efficacy is the confidence in its capacity to do
specific task (Bandura, A., 1977). If self-efficacy is
low then the individual will avoid the behavior that
is difficult, because such behavior is seen as a threat
to her (Bandura, A., 1977). The purpose of this study
314
Salim, S., Asnar, E. and Wahyuni, E.
Preoperative Anxiety and Self-Efficacy to Postoperative Exercise in Women undergoing Elective Caesarean Section.
DOI: 10.5220/0008324503140318
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 314-318
ISBN: 978-989-758-336-0
Copyright
c
2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
is to describe the anxiety and self-efficacy to
postoperative exercise in women undergoing
elective caesarean section in Bangil Hospital,
Pasuruan, East Java.
2 METHODS
This study was a descriptive quantitative aims to
describe the behavior of postoperative exercise in
patients sectio caesarea in Bangil Hospital,
Pasuruan, East Java. The study population was the
entire study population was sectio caesarea patient in
Bangil Hospital, Pasuruan, East Java. Sample in this
study a total of 70 people, selected using consecutive
sampling. Inclusion criteria for this study, namely
sectio caesarea elective patients, aged 20-35 years
old, patients with subaracnoid block anesthesia,
consciousness composmentis, not impaired senses of
sight and hearing based on medical records. The
exclusion criteria of this study, in which patients are
unable to communicate, sectio caesarea at the
request of the patient. The instrument used was the
Amsterdam Preoperative Anxiety Information Scale
(APAIS) to assess anxiety and Preoperative Self-
efficacy Scale (PSES) to assess self-efficacy.
3 RESULTS
3.1 Characteristics of Respondents
3.1.1 Age
The following table describes the description of the
respondent's age, namely:
3.1.2 Education
The following table describes the description of the
last education of respondents, namely:
3.1.3 Number of Children
The following table describes the description of the
number of children before surgery, namely:
3.1.4 Indication of Sectio Caesarea
The following table describes the operating
indication description sectio caesarea namely:
Table 3: Description of the number of child patients in
hospital Bangil Hospital, Pasuruan, East Java sectio
caesarea January 2018.
Characteristics of
Respondents
Frequency
(person)
Percentage
(%)
Number of children
Have not had
1-2
3-4
> 4
20
38
8
4
28.6
54.3
11.4
5.7
Total
70
100%
Table 2: Description of recent education sectio caesarea
patient in Bangil Hospital, Pasuruan, January 2018.
Characteristics of
Respondents
Frequency
(person)
Recently Pendidkan
Elementary School
Junior High School
Senior High School
College
33
12
23
2
Total
70
Table 4: Description of the operation indication sectio
caesarea in Bangil Hospital, Pasuruan, East Java in
January 2018.
Characteristics of
Respondents
Frequency
(person)
Percentag
e (%)
placenta previa
Location of latitude
breech
CPD
Gemelli
Preeklampsi
Oligohidroamnion
miopi
Anemia
Grande multipara
floating head
Asthma
PROM
hemorrhoids
33
7
6
11
1
8
5
2
3
1
2
1
9
1
18.6
10
8.6
15.7
1.4
11.4
7.1
2.9
4.3
1.4
2.9
1.4
12.9
1.4
Total
70
100
Table 1: Description of the patient's age sectio
caesarea in Bangil Hospital, Pasuruan, East Java
Month January 2018.
characteristics of
Respondents
Frequency
Percentage
(%)
Age 20-25
Age 26-30
Age 31-35
14
39
17
20
55.7
24.3
Total
70
100
Preoperative Anxiety and Self-Efficacy to Postoperative Exercise in Women undergoing Elective Caesarean Section
315
3.1.5 Operation History
The following table describes the description of
operating history, namely:
3.1.6 Self-Efficacy
The following table describes the description of self-
efficacy, namely:
Table 6: Description of the patient's self-efficacy
sectio caesarea in Bangil Hospital, Pasuruan, East Java
in January 2018.
characteristics of
Respondents
mean
SD
Minimal-
maximal
Self-Efficacy
102.43
22.6
35-131
On average respondents' self-efficacy is 102.43
with a minimum score of 35 and a maximum of 131
3.1.7 Anxiety
The following table describes the description of
anxiety, namely:
Table 7: Description of sectio caesarea patient anxiety
in the Bangil Hospital, Pasuruan, East Java in January
2018.
Characteristics of
Respondents
mean
SD
Minimal-
maximal
anxiety
21.71
3.371
13-30
The average anxiety respondents is 21.71 with a
minimum score of 13 and a maximum of 30
4 DISCUSSION
4.1 Anxiety in Patients Sectio Caesarea
Age is closely related to the condition of the
mother's pregnancy. The infant mortality rate were
born to mothers aged under 20 years is almost
double that of those born to mothers aged 30-34
years. Babies born to teenage mothers are also more
likely to be born prematurely and twice long term to
be hospitalized due to accidents or gastroenteritis
(Whitworth et al., 2017). The results showed that
most of the respondents aged between 26-30 years
as many as 33 people (55.7%). This age is
considered safe for pregnancy and childbirth. Age
could also be one of the factors of anxiety
preoperatively. Maternal death in pregnancy and
childbirth at the age below 20 years, it was 2 to 5
times higher than in maternal deaths occur at ages 20
to 29 years.
The education level of respondents in this study
are mostly elementary school. Respondents with
lower education levels have high levels of anxiety
than patients who are highly educated. Less
educated patient anxiety is unwarranted because of
their ignorance about the operation sectio caesarea
(Frost et al., 2009). Respondent's type of work may
affect his anxiety in having surgery, because
respondent who is not working feels the burden of
family support, and feels anxious because she can
not directly perform her work activities.
The majority of respondents had never
undergone surgery before sectio caesarea. The
experience can be a source of knowledge for the
patient to face the psychological discomfort in the
face of something, especially surgery. Previous
operating experience can impact on preoperative
anxiety so it needs the support of the service
providers to continue to support women emotionally,
beyond the stage of decision making and the whole
process of birth is selected. (Torigoe and Shorten,
2017)
Salmon (2000), describes three primary ways in
which anxiety may influence a patient’s perception
of a medical procedure. Firstly, there may be
increased vigilance for negative sensations;
secondly, anxious patients may make more negative
interpretations of ambiguous stimuli and if one
assumes some continuity between preand
postoperative states, anxious patients may recall
memories consistent with their mood (Hobson et al.,
2006)
Operating indication sectio caesarea most of this
research is placenta previa. Complications of
pregnancy is detected long before the time of
delivery with routine antenatal care to obstetricians
and midwives. So that patients can be better
prepared for delivery to the operation. The provision
of pre-operative information that can effectively
reduce maternal anxiety prior to surgery. Research
from Hobson, et al, (2006) showed that lower
preoperative anxiety was associated with greater
maternal satisfaction with elective caesarean section.
Higher satisfaction with preoperative information
from the anesthesiologist and the perceived
Table 5: Description of operating history sectio
caesarea patient in the Bangil Hospital, Pasuruan, East
Java in January 2018.
Characteristics of
Respondents
Frequency
(person)
Percentage
(%)
Yes
No
11
59
15.7
84.3
Total
70
100
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
316
emotional support larger of the pair is very
predictive of postoperative maternal satisfaction by
cesarean section (Hobson et al., 2006)
4.2 Self-Efficacy in Patients Sectio
Caesarea
The results showed that self-efficacy among
respondents classified as medium category, with a
mean value of 102.43. This could be of respondents
age factor, where the age of mothers classified as
ready for delivery. While the education level of
respondents are mostly elementary school and they
had never had surgery before. It could the
respondents have a low self-efficacy due to lack of
experience and knowledge, but in fact the mother's
self-efficacy in a medium category.
According to Bandura (1997), education is one
of the factors that affect a person's self-efficacy. A
high level of education a person more formal
education than someone with a lower education
level, this was due to the higher formal education a
person would more have the opportunity to deal with
issues that require cognitive aspects in the solution.
Self-efficacy is a formation that is through cognitive
processes in a person.
Bandura (1997) says there are some important
factors that affect self-efficacy that mastery
experience, the experience of others (vicarious
experience or modeling), verbal persuasion, and
physiological and affective state.
According to Bandura A (1997) vicarious
experience to be an indicator forming a source of
self-efficacy, the results showed that it can
strengthen the belief that the mother is the
experience of other women who have the same
problem. Vicarious experience is the experience
gained from other people who have the same
characteristics, can pass through or perform
successfully (Bandura A 1994). According to
(Peterson, S, J., Bredow, T 2004) that if an
individual does not have to experience it yourself
then the individual will learn from the successful
experience of others.
Stressor can also affect self-efficacy mothers in
postoperative, one stressornya is anxious. According
to Bandura A (1997) a person to be confident in its
ability one of which is that a person's coping to
stressors encountered. Emotion management by
reducing stress and positive feelings will change the
perception and interpretation of one's ability that had
also positive that a good coping can be a way to
change someone into a good self efficacy (Bandura
A 1994). Coping can be an indicator and how to
establish self-efficacy.
Self-efficacy is the most important thing in a
person to form a strong motivation, according to the
expectancy value theory states that motivation is
formed through hope, effort someone based on how
much hope to be achieved (Bandura A 1997). The
research results of Rachmawati PD, et al, (2016),
showed that the source of self-efficacy effect on
self-efficacy, self-efficacy and maternal
characteristics direct effect on maternal behavior.
5 CONCLUSIONS
Preoperative anxiety can occur at any age, education
level, occupation, and history of the mother's own
operations. Self-efficacy is the most important thing
in a person to form a strong motivation. Self-
efficacy is related to one's personal factors, to be
confident in its ability mother should be able to
manage emotions to reduce stress and increase
positive feelings, so good coping can be a way to
change a person's self-efficacy to be good in the
exercise of postoperative sectio caesarea
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