The surgeon's 'gut feeling' as a predictor of post-operative outcome

The aim of this study was to identify the accuracy of prediction of the 'gut feeling' of the surgeon immediately upon completion of an operation in the prediction of subsequent outcome. A consecutive series of 120 patients, each of whom underwent gastrointestinal surgery, were studied. The two operating surgeons scored each patient on a scale of 1-3 which related to his expectations of the outcome. This prediction was compared with the prediction generated by the POSSUM scoring system. The surgeon's 'gut feeling' upon completion of a major procedure was a good indicator of the post-operative course of the patient.

Preparing children for the operating room: psychological issues

Children respond psychologically to the prospect of surgery in a variable and age-dependent manner. This review summarizes the psychoanalytic, cognitive, behavioural and family system models of child development. It then reviews studies of hospitalization and anaesthesia in children. These studies suggest that younger children, children previously anaesthetized, and children who experience turbulent anaesthetic inductions are at particular risk for postoperative behavioural disturbances. Strategies of dealing with children and their parents during the perioperative period are discussed. Such strategies include: allowing a parent to be present during induction of anaesthesia, administering sedative premedication, creating a supportive environment, educating children and parents (verbal descriptions, tours, books, videos), and establishing rapport with children and their parents. Age-specific techniques of establishing rapport with children are discussed. If children are less anxious during the perioperative period, not only will they often exhibit less behavioural disturbances postoperatively, but they may face subsequent medical care more easily.

Use of the Threat Index with family members waiting during surgery

We describe the use of the 40-item Threat Index (TI) with family members (N = 206) of surgical patients who also completed Templer's (1970) Death Anxiety Scale, the Death-of-Self and Dying-of-Self subscales of the Collett-Lester (1969) Fear of Death Scale, and the Death Acceptance subscale of Reker and Peacock's (1992) Life Attitude Profile-Revised. Word sets from the 40-item TI that are part of the 25- and 7-item versions of the TI produced strong alphas and correlations to their parent instrument. Regression analyses indicated that self/ideal-self scores and previous experience as a hospital patient were significantly associated with TI scores. We conclude that if the time available for completion and scoring of the TI is limited, the shorter versions can be used, although their alpha strengths are slightly lower than that of the full TI and the respondent's age influences the scores.

[Surgical patients' attitude towards anesthesia]

There are few studies assessing the degree of understanding of anesthesia among surgical patients in Taiwan. So we designed a questionnaire to explore patients' attitude toward anesthesia. 505 patients scheduled for routine surgery were included in this study. We found there were great differences between the patients in their attitude toward and understanding of anesthesia. It is clear that we must give much more attention to communicating clearly with our patients in this regard. Further detailed studies may be useful in revealing particular area of misunderstanding.

Psychological factors influencing the surgical patients' consent to regional anaesthesia

To investigate the preoperative attitude of surgical patients to regional anaesthesia, 162 subjects scheduled for elective surgery were studied. On the day before operation, patients were interviewed by an anaesthesiologist, using a semi-structured schedule. Topics investigated were sociodemographic variables and clinical correlates, such as past anaesthetic experience, information about anaesthesia and surgery, as well as questions and fears related to anaesthesia. Subjects were assessed for personality characteristics and emotional symptoms by Eysenck's Personality Questionnaire (EPQ), Zung's Self-rating Anxiety and Depression Rating Scales, Schalling-Sifneos' Personality Scale and the 43-item Life Events Inventory of Holmes and Rahe. Seventy-one patients (44%) consented to regional anaesthesia. Consent to regional anaesthesia was associated with advanced age, low neuroticism and high extroversion score in the EPQ, as well as longer duration of illness. The deniers of consent asked more questions and expressed more fears about anaesthesia. It is suggested that the patients' characteristics influence their preference, acceptance or refusal of regional anaesthesia.

It only hurts when I don't laugh

For this nurse, hospitalization was a study in the therapeutic power of humor. Laugh--and learn--along with her.

Evaluation of a self-efficacy scale for preoperative patients

Self-efficacy has been validated as a predictor of an individual's behavior in aversive situations. Traditionally, nurses have conducted preoperative instruction to help patients cope with the adversities of surgery. Assessing patients' self-efficacy is an additional way to assist them through the experience of surgery and plan their care. This study developed and tested an instrument to measure self-efficacy in adult preoperative patients. The instrument consists of two subscales: a 16-item efficacy expectation subscale and a 16-item outcome expectation subscale. The instrument was administered to 200 surgical patients to obtain descriptions of item characteristics, internal consistency reliability, and beginning construct validity. Evidence supports the validity and reliability of both self-efficacy subscales. The revised instrument can assist perioperative nurses in assessing preoperative patients' self-efficacy.

Patient information provision: its effect on patient anxiety and the role of health information services and libraries

This article is concerned with the importance of communicating information to patients as an aid to recovery by decreasing anxiety. Recent research suggests that pre-operative information helps to decrease post-operative stress and leads to a quicker recovery. The health belief model has proven to be an effective predictor of individuals' responses towards health-related matters. It is described as a useful theoretical framework for medical professionals in deciding the content and quantity of information that each patient should receive. A study for further research is suggested, exploring the hypothesis that reading about illness significantly helps to reduce anxiety when the patient has added emotional support from a health professional. The existing problem of who is ultimately responsible for giving information to patients is highlighted in the general practice, hospital and public settings. Recommendations are made for the improvement of patient information provision in these three areas. Librarians are seen as being in a good position to liaise with medical professionals to provide the most effective health information service possible for patients and the consumer in general.

Who is in control? An investigation of nurse and patient beliefs relating to control of their health care

This study compares nurse and patient beliefs regarding control of health and perceptions of the amount of patient control. Data were collected from 21 nurses and 32 patients on a mixed surgical ward, using a series of self-report questionnaires. No difference was found between nurse and patient perceptions of patient control. However, nurses were found to have a significantly greater desire for control over their own health care and a significantly weaker belief in the influence of powerful others (i.e. doctors and nurses) than did patients. It is suggested that such differences in nurse and patient beliefs will have significant effects on how nurses and patients feel about the care patients receive. Implications of the findings for nursing theory and nurse education are also considered. In the light of previous research showing the stress-reducing effects of giving control to patients who want and expect it, the study calls for the development of a tool to assess the amount of control desired by each patient. This should help to ensure that nursing care is congruent with the control beliefs of the patient, rather than those of the nurse.

Psychosocial aspects of surgical care in the elderly patient

Delirium, dementia, and depression often complicate the care of elderly surgical patients. Simple screening procedures performed preoperatively and postoperatively facilitate the early detection of these conditions and enable the physician to promptly institute appropriate treatment. Although the evaluation and management of these disorders are often within the range of the surgical treatment team, psychiatric consultation should be obtained when uncertainty exists about diagnosis or therapy.

Hypnosis with the surgical patient

Since World War I, hypnosis has been used by U.S. military medical personnel to treat shell shock, battle fatigue, and traumatic neurosis. Most recently, hypnosis has also been effective in the treatment of Vietnam combat veterans with post-traumatic stress disorder. Additionally, over 30 years ago, the American Medical Association endorsed the use of hypnosis by physicians and the teaching of hypnosis in medical schools. However, even with this rich tradition, there remains an underutilization of hypnosis within medical and surgical settings. To encourage the use of hypnosis, this paper reviews current literature concerning the benefits of employing hypnosis and positive outcome suggestions with surgery patients in a military hospital. Case studies are also included that describe the applications of hypnosis as an adjunct to successful surgical procedures. Practitioners are encouraged to learn more about hypnosis so as to determine the efficacy of this therapeutic modality as an appropriate addition to their treatment armamentarium. A protocol for hypnotic induction and positive suggestions with surgery patients is also included.

Preparing patients for invasive medical and surgical procedures. 1: Adding behavioral and cognitive interventions

The authors of three related articles look at various aspects of preparing adult and child patients psychologically for invasive surgical procedures. The first article is a review of the literature in the field, primarily from the last 30 years. Researchers have examined anxiety and coping mechanisms, patient-practitioner relationships, medical phobias, and the effectiveness of different types of psychological intervention. In the second article, the authors offer practical suggestions for implementing preparatory psychological interventions, describing effective communication techniques such as active listening, role plays, imaging, modeling, and progressive relaxation. In the final article in the series, the author considers policy, practice, and educational implications of the use of behavioral and cognitive interventions for patients, medical practitioners, and healthcare planners.

Access to the coping strategies. Managing anxiety in elective surgical patients

1. The prospect of surgery increases anxiety and reduces cognitive thinking, reducing the ability to cope. 2. Patients use information to reduce their anxiety. 3. Preoperative information has been shown to be effective in improving patient outcomes after surgery. 4. Theatre nurses must base their practice on research, and embrace a perioperative role, using such interventions as preoperative teaching, preparatory sensory information and active listening.

A procedure for developing a quality-of-life measure for epilepsy surgery patients

In 1990, the NIH Consensus Conference Panel on epilepsy surgery called for the development and use of reliable and valid health-related quality-of-life (HRQOL) measures in epilepsy surgery studies. A HRQOL measure for epilepsy surgery patients has been developed and evaluated. The procedure, which could also be used to develop HRQOL measures for other neurological diseases, entails the following steps: (a) specify desired characteristics of the measure; (b) identify relevant HRQOL areas by reviewing the literature; (c) assemble generic core items and disease-specific supplementary items; (d) pilot test and revise the measure; (e) administer revised measure items to a large sample of epilepsy surgery patients; (f) perform item analysis to evaluate hypothesized item placement within scales; and (g) assess the reliability and validity of the scales. The product of this process, the Epilepsy Surgery Inventory (ESI)-55, is a self-report measure of 11 dimensions of HRQOL. It is brief, comprehensive, and reliable; preliminary evidence supports its validity.

Patient satisfaction with communication in general surgery: problems of measurement and improvement

The research reported here is taken from a pilot inquiry into patient experiences of general surgery provided in National Health Service hospitals. This study sought to identify how the cross section of patients facing general surgery experienced communication and information problems particular to their surgical 'settings', how such discontent is understood or rationalised by them, and consequently how it would be reported to relatives or researchers. Drawing on interviews with patients and surgical staff, the paper explores the range of communication difficulties facing certain types of patient which arise from the hospital setting and the routines and rituals of service providers. While it is concluded that communication should be explored with some reference to disease classification, this should not divert attention from the general context of care to the unique circumstances of patient or surgeon. It is questioned whether patients are always disposed to rationalise their difficulties in terms of 'dissatisfaction' in the way required by survey research. Drawing on interview-generated comments by patients and staff, the paper illustrates less obvious validity problems for patient satisfaction studies, and addresses briefly questionnaire design which may account for them.

[Patient information in surgery]

In a prospective study 50 patients undergoing a hernia repair were asked their opinion about an information sheet which was given to them preoperatively. For 94% this paper is of help; for 82% the written information has to be clarified by an additional personal talk with the doctor. Another possibility, especially good for visualisation, is the video. At the hospital of Davos there are at the moment 7 clips available to explain the treatment and the aftercare after an operation or conservative therapy in traumatology.

Healing from surgery: a phenomenological study

A phenomenological study explored the experience of healing in nine post-surgical patients. Extensive interviews were conducted at one and four weeks after hospital discharge. A follow-up interview was conducted after participants reviewed descriptions of the experience. Healing included four overlapping themes: Active Participation (personal responsibility to assist in the healing process); Achieving Balance (reintegration of the whole system); Evolving Beyond (examination of goals, values and priorities); and Healing Process (change over time and connections between themes).