Effects of orientation information on spouses' anxieties and attitudes toward hospitalization and surgery

The effect of visiting surgical patients in the postanesthesia care unit on family members' anxiety: a prospective quasi-experimental study

PURPOSE

Surgical procedures pose stressful events for patients and their family members. The main purpose of this study was to determine if visiting patients in the postanesthesia care unit (PACU) would reduce the anxiety levels of Greek patients' family members.

DESIGN

A prospective study with a one-group quasi-experimental pretest/post-test design was used.

METHODS

Situational anxiety of surgical patients' relatives was assessed using the state subscale of the State-Trait Anxiety Inventory (STAI; Greek validation) at the beginning of the surgical procedure and again after their visitation of patients in the PACU.

FINDINGS

STAI scores were significantly higher preoperatively (57 [23-80]) than postoperatively (51 [21-77]; P=.000008). Clinically significant levels of anxiety were present in 76% and 58% of the participants, pre- and postoperatively, respectively.

CONCLUSIONS

Although postoperative STAI scores were reduced, family visitation in the PACU did not sufficiently reduce the anxiety of Greek family members to clinically acceptable levels.

Can providing paging devices relieve waiting room anxiety?

The purpose of this study was to evaluate the effect of providing individuals who are waiting for surgical patients with digital pagers. Twenty-eight subjects received routine waiting room procedures, and 29 subjects were given digital pagers during surgical procedures. Subjects completed questionnaires concerning activity, state anxiety, and their perceived threat while patients were undergoing surgical procedures. The group that received the paging devices reported significantly greater state anxiety (i.e., P < .03) and a greater percentage of time spent outside surgical waiting rooms (i.e., P < .00) than the group that did not receive paging devices.

Spousal coping during the surgical wait

The purpose of this study was to identify the coping strategies used by a patient's spouse and the perceived effectiveness of these coping strategies while waiting during a loved one's surgery. Forty spouses, male and female (age 25 to 65 years), waiting during a patient's surgery completed a demographic questionnaire and the Jalowiec Coping Scale. Mean scores of the styles and individual strategies were calculated and ranked in descending order. The optimistic coping strategy of "tried to think positively" was used most often by the subjects. The supportant coping strategy of "prayed or put trust in God" was ranked as the most effective strategy. The nurse who instructs the patient regarding their surgery should also prepare the spouse for the surgical wait. Recommending coping strategies to spouses may be a component of stress inoculation.

Preoperative patient education: evaluating postoperative patient outcomes

Preoperative teaching is an important part of patient care and can prevent complications, as well as promote patient fulfillment during hospitalization. A study was conducted at Alton Ochsner Medical Foundation in New Orleans, LA, in 1989, to determine the impact of a preoperative teaching program on the incidence of postoperative atelectasis and patient satisfaction. Results showed no significant difference of postoperative complications and patient gratification after participating in a structured preoperative teaching program. As part of this study, it was identified that a patient evaluation tool for a preoperative teaching class needed to be developed. The phases of this process are explained in the following article.

Pre-operative visits by ITU nurses: recommendations for practice

Pre-operative visiting by theatre nurses is now policy in many hospitals, following an explosion of research studies outlining the benefits to the patient. However, the author could find very little available literature on pre-operative visiting by intensive therapy unit (ITU) nurses, to patients electively admitted to ITU following surgery. The purpose of this project is to explore the need for patient information, outline the aims of an ITU nurse's pre-operative visit, and discuss the timing of the proposed visit, the information to give the patient, the inclusion of the patient's family and the provision of printed literature. Finally, recommendations are made for implementing a pre-operative visiting service by ITU nurses.

Anxiety of elective surgical patients' family members. Relationship between anxiety levels, family characteristics

Technological advances in the OR create new practices and procedures; however, humanistic and holistic approaches to nursing care remain the foundation of clinical practice. Perioperative nurses recognize that family members experience anxiety during surgery, especially during the time the patient is in the OR. Ironically, it is during this time period that little or no meaningful communication occurs between family members and health professionals. Patients continue to be discharged sooner, and in sicker condition, to be cared for by their family members. Families require information about how to provide postoperative care. Anxiety levels need to be decreased sufficiently to allow family members to use the information they are taught and ask appropriate questions. Interventions that reduce family members' anxiety need to be developed and tested so that family members can help patients after surgery. Using research findings as a basis for perioperative nursing practice may mean changing traditions and attitudes about family members of surgical patients. In the consumer-oriented climate of current health care, doing the "new" may make a difference in the market share. This "new" may be independent nursing interventions designed to reduce family members' anxiety during the intraoperative waiting period.

Effects of intraoperative progress reports on anxiety of elective surgical patients' family members

The purpose of this experimental study was to examine the effects of intraoperative progress reports on family members' state anxiety level (STAI S-Anxiety), mean arterial pressure (MAP), and heart rate during elective surgical procedures. Family members of randomly selected surgical patients were eligible to participate. Control group family members (n = 50) received usual care. Family members in the experimental group (n = 50) received a 5- to 10-minute progress report protocol about halfway through a surgical procedure. Families' STAI S-Anxiety scores, MAP, and heart rates were compared between the control and experimental groups using multivariate analysis of variance (MANOVA). Family members in the experimental group reported lower STAI S-Anxiety scores (p < .001), and had significantly lower MAP and heart rates than did the control group (p < .001). Progress reports appear to be a beneficial nursing intervention for reducing anxiety in family members during the intraoperative period.

Significant others benefit from preoperative information

Little attention has been given to the preparation of the patient's family prior to surgery, even though nurses' clinical experience suggests that family members are often more anxious than the patient. This study explored the knowledge and anxiety of spouses and significant others of patients preparing for cardiac surgery. The subjects were selected by convenience from a preoperative class offered at the hospital where surgery was to occur. Before and after the class, the subjects completed a cardiac-surgery knowledge test and an anxiety test. The significant others were significantly more anxious than the patients prior to the class. The anxiety level of significant others was significantly reduced after the class. There were no statistically significant differences between patients and significant others on the cardiac-surgery knowledge test. These results suggest that significant others may benefit from preoperative instruction.

Improving recovery following cardiac surgery: a randomized clinical trial

To enhance individual and family health during recovery from heart surgery, this study employed nursing interventions based on self-efficacy and family stress theory during the hospitalization period and for 3 months thereafter. The effectiveness of the interventions were assessed through a randomized trial in which 67 prospective bypass and valve surgery patients, aged 30-77 years, and their spouses, were allocated either the experimental interventions or usual care and followed for 6 months. At 3 months post-surgery, the only statistically significant differences between the experimentals and controls were on perceived self-efficacy for lifting and tolerating emotional distress. At 6 months no significant differences were found on individual or family measures. Analyses revealed that age, gender and preoperative cardiac status significantly affected individual recovery. The study is continuing with a larger sample in order to explicate the recovery process and to better determine whether a low intensity nursing intervention can effect changes in individual and family recovery.

Sex differences in the psychological reactions of medical and surgical patients to crisis intervention counseling: sauce for the goose may not be sauce for the gander

The psychological reactions of 259 female and 130 male medical and surgical patients were examined. Both when they were discharged and when they were followed up 12 months later, women who received crisis intervention counseling during their hospitalisation showed the predicted psychological gains when compared with non-counseled women. They expressed fewer feelings of helplessness and more of competence in the short term and fewer feelings of anxiety and helplessness in the long term. Men showed some improvements in the short term but fewer in the long term when, although they later expressed more feelings of competence, there were also more of helplessness. Women and men also showed the predicted benefits of counseling similarly in fewer indirect expressions of anger on both occasions. They also showed less anxiety on discharge and fewer depressive feelings on follow-up. Explanations of the sex differences in terms of sex role stereotypes, the extent of each patient's crisis and possible methodological artefacts were considered.

Anxiety in Surgical Patients' Families

The purpose of this field experimental study was to test these hypotheses. Videotaped preoperative information directed specifically toward surgical patients' families would reduce their state anxiety during the patients' hospitalization. Informative and supportive staff interaction with family members would increase their perception of support from the nursing staff. A combination of the above would reduce the family members' state anxiety and increase perceived support from the nurse more effectively than either of the above actions would singly. The subjects were 67 family members of 60 patients scheduled for major elective surgery. Anxiety was measured by the Spielberger State Anxiety Inventory, and perceived social support was measured by a modified version of Caplan's Social Support Index. The two experimental treatments were fully crossed in a 2 x 2 factorial design. Correlational methods were also used for data analysis. Findings in this study showed that videotaped preoperative information decreased state anxiety in family members of surgical patients, staff-family interaction had a positive effect on the family's perceived support from the nurse, and family member state anxiety scores were higher during the intraoperative period than during the postoperative period.