Mark Mitchell

Psychological preparation for patients undergoing day surgery

The aim of the study was to discover the most suitable methods of psychologically preparing patients for modern day surgery and to formulate a pre-operative nursing plan which embraces such methods. Contemporary evidence suggests the level of information provided, individual coping style, anxiety and social cognitions may strongly influence the psychological status of patients undergoing surgery. However, the most crucial aspect within day surgery may concern the degree to which the level of information provided meets with individual requirements i.e. information matched with maximum (vigilant coper) and minimum (avoidant coper) levels of requirement. A convenience sample of 120 patients undergoing intermediate, non-life threatening, gynaecological laparoscopic day surgery were contacted prior to admission and randomly assigned into two groups. Group I received an extended information booklet and Group II a simple information booklet. All participants received a questionnaire pack pre-operatively which was utilised to determine coping style, anxiety, health locus of control and self-efficacy. Initially, the nurses rated participants in receipt of the extended information as less anxious, irrespective of coping style (F (1, 47) = 4.257, p = 0.45). However, irrespective of the information booklet received, participants with a vigilant coping style encountered greater external health locus of control (F (1, 47) = 4.249, p = 0.045). Again, irrespective of the information booklet received, participants with a vigilant coping style also experienced lower self-efficacy (F (1, 47) = 6.173, p = 0.017). As participants in receipt of the extended information booklet were observed to be less anxious, the ability of the booklet to alleviate anxiety is discussed. Additionally, regardless of information received, vigilant coping behaviour was associated with diminished health locus of control and lower self-efficacy. Such sub-optimal appraisals are equally explored. An innovative plan is proposed providing explicit psycho-educational guidance for intervention throughout modern elective day surgery. Incorporation of this strategy into nursing practice is outlined and techniques for implementation recommended.

Patients' perceptions of day surgery: A literature review

Medical and pharmacological advances in surgery have contributed to the current and continued growth of day surgery. As the majority of adult UK elective surgery now takes place within day surgery facilities, these changes will inevitably have an impact upon nursing intervention. Past nursing practices may have to undergo a period of redevelopment in order to meet these changes and the logical first step towards any innovative change must involve acquiring the views of patients. The main themes to emerge related to nursing practice, information provision, experiences within day surgery and recovery at home. The overwhelming principle challenge was that of information provision followed closely by postoperative pain management.

Anxiety management: a distinct nursing role in day surgery

Improved anaesthetic techniques and the increase in minimal access surgery over the past 20 years has had a considerable impact upon the pattern of nursing care required by the surgical patient. In order to adapt to these changes some day surgery nurses have opted for an extension to their role while the majority have expanded their remit and perform nursing interventions within a multi-skilled role. Amid these changing patterns, the nursing profession has been active in conducting research into best practice concerning day surgery. Consequently, a great deal of information is available regarding areas for possible growth. One possible growth area which is also a vitally important issue for patients prior to day surgery is anxiety management. A future nursing role could involve formal anxiety management implicit within a multi-skilled role and as part of an expanded role. The role possibilities are discussed together with an information provision plan as both are central to the effective handling of pre-operative fears.

Patient anxiety and conscious surgery.

The amount of surgery undertaken on the conscious patient is increasing. However, many patients are anxious and resistant to such surgery. Patients (n=214) were surveyed to determine their related apprehensions. Being awake, feeling or seeing the body cut open and experiencing pain all increased anxiety. The potential for insufficient information provision was also a source of concern. Formal management of intraoperative apprehension may help limit anxiety and expel apparent misapprehensions.

Anaesthesia type, gender and anxiety

The number of patients treated by elective day-case surgery in the UK is growing. Patient preoperative anxiety can be considerable, although the opportunity to help to reduce fears is minimal. Day surgery patients (n=674) were surveyed and 82% were found to be anxious. General anaesthesia patients were more anxious than local anaesthesia patients and females more anxious than males. The results indicate that general anaesthesia patients may require more preoperative information, and gender differences associated with waiting may need to be given greater consideration.

Constructing information booklets for day-case patients

As modern surgical and anaesthetic techniques develop even greater capabilities, the time in which to adequately undertake such nurse/patient discussions has past and will never return. Information provision is thus a challenge for day surgery. Many studies have suggested patients require differing levels of information i.e. full, partial and minimal disclosure. Future information booklets may need to be constructed in a more patient centred manner. This article attempts to provide a methodical approach to the required level of information, a guide to the construction of information booklets and suggestions for their application in day surgery.