From English Oxford dictionary(Stevenson, 2015) anxiety is defined as a feeling of worry, nervousness, or unease about something with an uncertain outcome. The American Psychology Association defines anxiety based on Encyclopaedia of Psychology (Kazdin, 2019) as an emotion characterized by feelings of tension, worried thoughts and physical changes. Anxiety can be a normal and expected feeling in life. However, when it causes the disproportions and interferences to the daily activities, job performance and relationship of the individual, it is called as Anxiety Disorder. According to the latest DSM-5 (Grohol, 2013) criteria for Anxiety Disorder, it is divided into seven categories such as Separation Anxiety Disorder, Selective Mutism, Specific Phobia, Social Anxiety Disorder (Social Phobia), Panic Disorder, Panic Attack (Specifier), Agoraphobia and Generalized Anxiety Disorder. Generally, an anxiety reaction may be developed due to an acute pain (Woo, 2010). The example of acute pain that is going to be explored in relation to anxiety in this study will be venipuncture.
Venipuncture is one of the commonest medical procedure whereby the vein is punctured with the needle to withdraw the blood or for intravenous medication purposes. Despite of it common, there is approximately 10% of individuals in medical settings report an excessive fear of the needle which subsequently may lead to significant avoidance, distress and problems in managing and treating the patients (Buowari, 2013; Hamilton, 1995). There are number of studies that investigated the anxiety and pain on venipuncture and cannulations procedures in the recent years. However, the studies focused on the children and young adult populations (Humphrey, Boon, van Linden van den Heuvell, & van de Wiel, 1992; Inan & Inal, 2019; McLenon & Rogers, 2019; Shave, Ali, Scott, & Hartling, 2018). Mc Lenon et. al. (2019) found the prevalence for needle fear ranged from 20-50% in adolescents and 20-30% in young adults. Another study done by Humphrey et al. (1992) also found that high level of distress for venipuncture is common and the prevalence of young adults aged 12 years old and above experienced it was 28%. Nevertheless, very limited source of studies and available data that looked into the fear and anxiety of venipuncture among the adult populations (Deacon & Abramowitz, 2006; Kivrak, Kose-Ozlece, Ustundag, & Asoglu, 2016).
There are several factors that may be associated with anxiety among patients with an invasive procedure particularly venipuncture. A study done by Bisogoni et al (2014) looking at the association in children who are repeatedly exposed to the painful procedures especially those with the chronic diseases with their level of perception to pain. He compared with those who has no previous health problem nor experience with venipuncture. Initially it was thought that chronic disease children patient will have higher threshold to pain and therefore lesser anxiousness. Oppositely, the findings has contradict to the common belief. Besides, there were other studies looking at the association between age and gender versus pain and distress level where it demonstrated the inverse correlation between the variables during an invasive procedure (Fowler-Kerry & Lander, 1991; Goodenough, Champion, Laubreaux, Tabah, & Kampel, 1998). However, Bisogoni et. al (2014) found in his study that there was no statistical significance that can support the older children will have lower pain and distress level (p>0.05).
Other factor that may be associated with the level of anxiety of patient with venipuncture procedure is the presence of accompany together with the patient during the procedure. Alireza et.al(2019) was comparing the effect of the trained versus untrained family presence on their anxiety during invasive procedures in emergency department using Spielberger State-Trait Anxiety Inventory (STAI). She found that the presence of untrained family members during the invasive procedures has reduce the level of anxiety significantly compared to the presence of trained family with p=0.011.
Celikol et. al(2019) studied on the effect of different means of games used during pediatric blood flow on the levels of procedure-induced fear and anxiety. The study found that music or watch a video during venipuncture has decreased the level of anxiety significantly with reported p-value of
Apart from concerning on the level of anxiety of the patients who are waiting for the venipuncture procedure, there are other aspect that we shall look through which affect the venipuncture services itself as well as patient’s satisfaction. Several studies found in relation to healthcare services provided in venipuncture. (Kantartjis et al., 2017; Mijailovic et al., 2014; Oatey & Stiller, 2009; Saunsbury & Howarth, 2016; Yip, Pang, Chan, Chan, & Lee, 2016). However, no similar study found from Malaysian setting. Most of the factor that to be associated with the venipuncture services provided were patient waiting time, difficulties of venipuncture procedures per patient, interpersonal skills of phlebotomist and excellent venipuncture skills in first pass. (Oatey & Stiller, 2009; Piredda et al., 2017)
From the literatures, we can see that the pattern of previous studies on anxiety versus venipuncture or other invasive procedures were mainly conducted in children and young population. The topic of venipuncture services in our local also yet still under study. Since there are very limited studies done on this area especially among the adult population in Malaysian setting, it opens an area for the researcher to explore further the level of anxiety and factors that may be associated with among our patients with venipuncture.
I would like to explore the experience of the adult patients dealing with blood taking procedures in (UiTMSCSB) and to determine factors that may associate with their level of anxiety while waiting for the procedure. In addition, I would like to access the perception of the venipuncture services from patient perspective in UiTMSCSB. The findings from the study will give some ideas and insight to the medical professional personnel especially to the phlebotomist and clinician into this problem. Hence, a specific measure can be introduced and applied in the future especially to this group of patients who are having anxiety to venipuncture