Implementation of an integrated leaflet and video education program (LEAVIN): A quality improvement initiative in perioperative nursing
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Abstract
Background: Preoperative anxiety affects a substantial proportion of surgical patients and may compromise psychological readiness and physiological stability before anaesthesia. Pre-anaesthesia counselling at a Regional Public Hospital in East Jakarta was previously delivered verbally without structured visual or audiovisual educational media.
Purpose: This study describes the development of an integrated leaflet and video pre-anaesthesia education (LEAVIN), accessible via a quick-response (QR) code, and reports the preliminary effect of its implementation on preoperative anxiety.
Method: This was a quality-improvement initiative using a one-group pre-test–post-test design without a comparison group, conducted at the preoperative preparation unit of a Regional Public Hospital in East Jakarta, from February to April 2026. A needs assessment using items adapted from the Amsterdam Preoperative Anxiety and Information Scale (APAIS) was conducted among 21 patients. Educational content on anaesthesia procedures, pre-anaesthesia preparation, possible side effects, and a deep-breathing relaxation technique was developed, validated by an anaesthesiologist and peer nurses, and packaged as a leaflet and a QR-code-linked video. The intervention was delivered to 12 patients, whose anxiety was assessed before and after education using the Numeric Rating Scale for Anxiety (NRS-A).
Result: At baseline, 52.4% of patients feared anaesthesia, 61.9% reported persistent worry about anaesthesia, and 52.4% wanted more information. Following LEAVIN education, anxiety decreased in 7 of 12 patients (58.3%), while 5 patients (41.7%) reported no change.
Conclusion: Integrated leaflet and video education was feasible within routine perioperative nursing care and was associated with reduced preoperative anxiety in most evaluated patients. Larger controlled studies with validated instruments are needed to confirm its effectiveness.
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References
[1] M. A. Shebl et al., “Preoperative anxiety and its impact on surgical outcomes : A systematic review and meta-analysis”, doi: 10.1017/cts.2025.6.
[2] A. Bedaso, N. Mekonnen, and B. Duko, “Prevalence and factors associated with preoperative anxiety among patients undergoing surgery in low- income and income countries : a systematic review and meta- analysis,” pp. 1–10, 2022, doi: 10.1136/bmjopen-2021-058187.
[3] Utpala Kharod, N. N. Panchal, J. Varma, and K. Sutaria, “Effect of pre ‑ operative communication using anesthesia information sheet on pre ‑ operative anxiety of patients undergoing elective surgery — A randomised controlled study,” no. 21, pp. 559–572, 2022, doi: 10.4103/ija.ija.
[4] K. Anzalone, A. Ohliger, M. Tanios, N. M. Mas D Alessandro, H. Hill, and L. Tollinche, “Anxiety Assessment Education for Preoperative Nurses.,” J. perianesthesia Nurs. Off. J. Am. Soc. PeriAnesthesia Nurses, vol. 40, no. 5, pp. 1140-1146.e9, Oct. 2025, doi: 10.1016/j.jopan.2025.01.006.
[5] R. Wang, X. Huang, Y. Wang, M. Akbari, and Y. Wang, “Non-pharmacologic Approaches in Preoperative Anxiety , a Comprehensive Review,” vol. 10, no. April, 2022, doi: 10.3389/fpubh.2022.854673.
[6] Z. M. S. Ira Susilawati, Meynur Rohmah, “Pengaruh Pendidikan Kesehatan Terhadap Tingkat Kecemasan Pada Pasien Pre Operasi di RSUD Malingping,” vol. 5, no. April, 2023.
[7] S. H. Hatimah, R. Ningsih, R. Syahleman, S. Borneo, and C. Medika, “Hubungan Pengetahuan Dengan Kecemasan Pada Pasien Pre Operasi di Ruang Meranti RSUD Sultan Imanuddin Pangkalan Bun,” vol. 6, no. 1, 2022.
[8] Nabhani, Sulastri, and W. Setyorini, “Pengaruh Edukasi Anestesi Media Lembar Balik terhadap Kecemasan pada Pre Sectio Caesarea ITS PKU Muhammadiyah Surakarta , Indonesia ( SC ). Sectio Caesarea sebagai salah salah satu Tindakan operasi yang sudah sangat sering Pravelensi kelahiran dengan meto,” 2024.
[9] F. P. Santoso and T. Hardiyani, “Pengaruh Video Edukasi Terhadap Tingkat Kecemasan Pasien Pre Operasi Sectio Caesarea dengan Teknik Spinal Anestesi,” vol. 02, no. 02, pp. 1452–1461, 2025.
[10] F. A. M. K. Sari and F. A. M. Mendrofa, “Pemberian edukasi tindakan operasi untuk menurunkan kecemasan pasien pre operasi,” 2025.
[11] N. Sadeghi, N. Salari, and R. Jalali, “Effect of multimedia education on anxiety and pain in patients undergoing laparoscopic cholecystectomy : a Solomon four- group randomized controlled trial,” pp. 1–12, 2025.
[12] N. Mustika, A. Nugroho, and A. S. Prayogi, “The Effect Of Android Audio Visual Health Education On Anxiety Pre Spinal Anesthesia Patients in PKU Muhammadiyah Bantul Hospital Pengaruh Pendidikan Kesehatan Audio Visual Android Terhadap Kecemasan Pasien Pre Operasi Spinal Anestesi di RSU PKU Muhammadiyah Bantul,” vol. 16, no. 1, pp. 8–15, 2020.
[13] A. Asyrofi et al., “MEDIA AUDIOVISUAL DAN KECEMASAN PASIEN PRE OPERASI :,” vol. 2, pp. 31–39, 2025.
[14] L. Fatmawati and P. Pawestri, “Penurunan Tingkat Kecemasan pada Pasien Pre Operasi Sectio Caesarea dengan Terapi Murotal dan Edukasi Pre Operasi,” 2021.
[15] M. Karalar, A. Demirbas, O. Gercek, I. Keles, and K. Topal, “Impact of Preoperative Video-Based Education on Anxiety Levels in Patients with Renal Stones Scheduled for Flexible Ureteroscopic Lithotripsy : A Comparative Study Using APAIS and STAI,” pp. 1–6, 2023, doi: 10.12659/MSM.941351.
[16] S. Mathari et al., “Evaluating Virtual Reality Patient Education in Cardiac Surgery : Impact on Preoperative Anxiety and Postoperative Patient Satisfaction,” pp. 1–15, 2024.
[17] Kementerian Kesehatan Republik Indonesia, “Survei Kesehatan Indonesia Tahun 2023,” 2023.
[18] G. Ogrinc, L. Davies, D. Goodman, P. Batalden, F. Davidoff, and D. Stevens, “Research And Reporting Methodology Squire 2 . 0 ( Standards for QUality Improvement Reporting Excellence ) : revised publication guidelines from a detailed consensus process,” vol. 0, no. table 1, pp. 986–992, 2016, doi: 10.1136/bmjqs-2015-004411.
[19] G. A. Lancaster, S. Dodd, and P. R. Williamson, “Design and analysis of pilot studies: recommendations for good practice,” J. Eval. Clin. Pract., vol. 10, no. 2, pp. 307–312, 2004, doi: 10.1111/j.1365-2753.2002.384.doc.x
[20] S. M. Eldridge, C. L. Chan, M. J. Campbell, C. M. Bond, and S. Hopewell, “CONSORT 2010 statement : extension to randomised pilot and feasibility trials The Consolidated Standards of Reporting Trials ( CONSORT ) statement reporting of randomised controlled an extension to that statement for,” 2016, doi: 10.1136/bmj.i5239.
[21] S. S. Dagona, U. Archibong, and G. T. McClelland, “Translation and validation of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) into Hausa language,” 2026.
[22] A. Perdana, M. F. Firdaus, and C. Kapuangan, “Uji Validasi Konstruksi dan Reliabilitas Instrumen The Amsterdam Preoperative Anxiety and Information Scale ( APAIS ) Versi Indonesia Construct Validity and Reliability of The Amsterdam Preoperative Anxiety and Information Scale ( APAIS ) Indonesian Version,” pp. 279–286.
[23] A. Prokopowicz, B. Stanczykiewicz, and I. Uchmanowicz, “Validation of the Numerical Anxiety Rating Scale in postpartum females: a prospective observational study.,” Ginekol. Pol., vol. 93, no. 9, pp. 686–694, 2022, doi: 10.5603/GP.a2021.0197.