Rev. Latino-am. Enfermagem Artigo Original Level of Anxiety versus Self-care in the Preoperative and Postoperative Periods of Total Laryngectomy Patients 1

Level of anxiety versus self-care in the preoperative and postoperative periods of total laryngectomy patients. Objective: estimate the prevalence of anxiety in laryngectomy patients in the pre and postoperative periods and its relation with the self-care level. Method: observational research of 40 patients with stage IV laryngeal cancer. Three observations took place: in the preoperative phase, at seven and at 14 days after the surgery; between June 2010 and December 2012. Two self-care levels were defined: self-sufficient and needing help for activities of daily living and treatment-related activities. To assess the anxiety levels, Zigmond's hospital anxiety scale (1983) was used. Results: in the preoperative and postoperative phases, the patients presented high levels of anxiety. Concerning self-care, on average, self-sufficient patients presented lower levels of anxiety than patients who needed help to accomplish activities of daily living and activities deriving from the surgery, without significant differences. Conclusion: anxiety is present at all times in laryngectomy patients and the reduction of the self-care deficit seems to decrease it, without putting a permanent end to it. 1 Paper extrated from Doctoral Dissertation " Nivel de ansiedad versus nivel de autocuidados en el paciente laringectomizado " , presented to

The reference framework in the care for these patients was: Orem's general theory, which consists of the Self-Care Theory (SCT), Self-Care Deficit Theory (SCDT) and Nursing System Theory (NST) (12)(13) .
The development of Orem's Self-Care Theory is ordered and systematic, offering a global assessment of the patient. In addition, it can be used in any cancer stage and defines the activity range of the nurse, the patient and the caregivers, with a view to satisfying the patient's Self-Care Demands (12) .

Method
Observational study of patients medically and surgically judged with total laryngectomy, with a final To measure the anxiety, Zigmond's Hospital Anxiety and Depression Scale -HADS (14) was used, or higher as "defined cases". Nevertheless, various studies use different cut-off points, referring that a lower cut-off point provides excellent properties to detect psychological problems (15) . In this study, it was considered that, at cut-off point superior to 8, the patients suffered from anxiety (15) . The anxiety subscale (HADS-A) was validated in the Spanish population, with a sensitivity ratio of 78% and a specificity ratio of 74% (16) .
To value the support networks, the following were considered: whether the patient had a person for everything needed, occasionally, only for concrete things or no social networks.
For the self-care measure, Orem's theory was used.
Two self-care levels were defined: self-sufficient and need help to accomplish activities (self-care deficits), operationally defined as the performance of activities of daily living (ADLs), assessed using Barthel's index (17) , a questionnaire that measures the patient's ability for independent self-care, with a high reliability coefficient (Cronbachs alpha 0.86-0.92). Its replicability is excellent, with weighted kappa correlation coefficients of 0.98 intra-observers and over 0.88 inter-observers, and international consistency (Cronbach's alpha 0.86-0.92) (18) . The Barthel index assesses ten activities of daily living: feeding, bathing, dressing, grooming, toileting, bowel control, bladder control, chair transfer, ambulation and chair climbing. The total score ranges between 0 and 100. Dependence is mild when the score ranges between 91 and 99, moderate between 61 and 90, severe between 21 and 60 and total for scores inferior to 20 (17) . In this study, the patients

Results
Among the 40 total laryngectomy patients studied, 38 (95%) were men. The mean age of all patients was 61.73 (SD 11.08) years, with a maximum age of 82 and a minimum age of 42 years; in men, the mean age was 61.8 years (SD 11.2) and, in women, the mean age was 59.0 (SD 8.48). The mean length of the hospital stay was 18.5 (SD 4.8) days, with a minimum age of 14 and a maximum age of 38; 100% of the patients indicated they had been informed about the surgery and its consequences.
In Table 1, the socioeconomic and clinical characteristics and antecedents of the patients in the preoperative period are displayed.   (Table 2). post-surgery than between the seventh and 14 th day post-surgery (Table 3).  (Table 4).   Some studies (7)(8)(9) have demonstrated that the prevalence of anxiety in cancer patients in general is high.
Nevertheless, there are great prevalence differences, with figures ranging from 5% to 87%; this range can be due to methodological differences, such as the use of different tools, different cut-off points, cancer staging, different types of cancer diagnoses or the phase in which the assessment took place. Although apparently contradictory, some studies, including meta-analyses, have demonstrated that,