Nursing Responsibilities for Patient The preparation of patients for surgery is a significant area of research in clinical nursing. Effective preparation has been shown to reduce anxiety, enhance recovery, and improve overall patient outcomes. Since the 1960s, nursing and medical research have explored various methods for preparing patients physically and psychologically for surgical experiences. This article delves into different approaches to patient preparation, types of informational interventions, clinical outcomes, and the role of family in supporting patients undergoing surgery.
Preparing Patients for Surgery
The preparation of patients for surgery has been a focus of extensive research in nursing, medicine, and psychology for over two decades. The interest in this topic began in the 1960s when it was discovered that early ambulation (getting patients out of bed within hours after surgery rather than the traditional 7-10 days) significantly reduced morbidity and mortality rates. However, this practice was anxiety-provoking for both patients and healthcare providers, prompting research into how best to prepare patients for early ambulation and other postoperative activities.
Research during this period focused mainly on psychological preparation to help patients manage the anxiety associated with surgery and postoperative recovery. Early studies were often atheoretical, lacking a clear connection between clinical research and theoretical frameworks for coping with stressful events. However, the common goal across these studies was to identify effective strategies for minimizing postoperative complications and improving patient outcomes.
Nursing Research on Patient Preparation for Surgery
A wealth of research has examined the effects of various approaches to preparing patients for surgery. Both meta-analyses and narrative reviews have attempted to synthesize the findings of these studies. Although conducting tightly controlled studies in clinical settings has been challenging due to methodological flaws, there is a general consensus among reviewers that preoperative interventions aimed at preparing patients for their surgical experiences have a substantial positive effect on patient welfare.
Types of Informational Interventions
Informational interventions are among the most frequently tested strategies for preparing patients for surgery. These interventions typically fall into three categories: procedural information, sensory or concrete objective information, and individualized interactions.
- Procedural Information: This type of intervention provides patients with details about the routines of care they will experience. For example, patients may be informed that their skin will be prepared, that they will receive preoperative medication, and that they will go to the recovery room. However, the specifics of what they will experience during these procedures, such as the physical sensations they may feel, are not included. This type of intervention helps patients understand the sequence of events, reducing uncertainty and anxiety about the unknown.
- Sensory or Concrete Objective Information: These interventions focus on the patient’s perspective, emphasizing the physical sensations associated with surgical events, the timing of these events, and their duration. For instance, patients may be told how long they can expect to be in the recovery room, that their vital signs will be checked frequently, or that preoperative medication might cause a dry mouth and drowsiness. This type of information is meant to help patients anticipate and mentally prepare for the sensory experiences they will encounter.
- Individualized Interactions: Highly individualized nurse-patient interactions, hypnosis, relaxation techniques, and positive thinking are also used as interventions in some studies. These methods require special training for the healthcare provider and are less commonly applied. The impact of these studies on practice has been limited by inconsistent findings and the specialized training required to deliver the intervention effectively.
Clinical Experience and Outcomes
Clinical experience plays a crucial role in shaping the aspects of patient response, behaviors, and recovery chosen as outcome measures in research on patient preparation for surgery. Common outcomes include the length of postoperative stay, pain medication usage, complication rates, and ambulation behaviors. Additionally, some researchers have focused on psychological responses, such as mood, pain reports, satisfaction with care, and overall well-being.
Most studies have measured outcomes only during the hospital stay. However, a few researchers have extended their investigations to examine the impact of preoperative interventions on long-term recovery, such as the patient’s return to normal activities and psychological status after discharge from the hospital.
Interventions and Outcomes
Although over 100 studies have been included in various reviews, it is challenging to draw definitive conclusions about the relationship between specific types of interventions and their outcomes due to methodological variability. Many studies combined multiple types of content in their interventions, making it difficult to isolate the effects of individual components.
However, there is agreement among reviewers that combined interventions generally produce the most consistent positive outcomes. For example, a commonly used intervention combining instruction in postoperative exercises and behaviors with procedural information has been shown to have a positive effect on outcomes measured during hospitalization. Similarly, a combination of concrete objective information (from the patient’s perspective) and postoperative instruction has been associated with earlier returns to usual activities post-discharge.
Practice for Preparing Patients
The practice of preparing patients for surgery is widely disseminated and has become a standard part of care in most healthcare settings. Nursing textbooks and guidelines emphasize the importance of educating patients about what to expect before, during, and after surgery. The economic impact of effective patient preparation is considered self-evident due to the reduction in complications, shorter hospital stays, and quicker returns to productivity.
Moreover, preoperative interventions have positively affected patients’ subjective experiences, such as mood and satisfaction with care. The dual benefits of reducing healthcare costs and improving care quality make patient preparation practices a valuable and widely adopted component of surgical care.
Discharge after Ambulatory Surgery
The practice of ambulatory (outpatient) surgery, where patients are discharged shortly after waking from anesthesia, and admitting patients on the day of surgery with brief hospital stays have changed the nature of the surgical experience. Patients and their families are now responsible for much of the postoperative care, including monitoring for complications, making decisions about the patient’s status, managing the progression of physical activities, and caring for the surgical incision.
Despite these changes, there has been relatively little research on preparing patients for surgery in the context of ambulatory care. The shift towards shorter hospital stays and increased reliance on family care providers calls for new approaches and strategies to prepare patients and their families for surgery effectively.
Surgical Preparation and Family Role
Given the evolving needs of surgical patients and their families, new research on preparation for surgery is essential. This research should build on prior studies and incorporate advancements in theories about coping with healthcare experiences. Self-regulation theory, which relies on information processing to explain behavior, provides a framework for understanding why specific types of information about an experience, combined with instruction in self-care and coping activities, can help patients and families manage the surgical experience.
Healthcare cost containment pressures and insurance coverage decisions are primarily driven by cost-related data. There is a relative lack of data on how these coverage regulations impact patient welfare. Therefore, research on preparing surgical patients for their experience in the current healthcare environment has the potential to influence policies related to services covered by health insurance.
Conclusion
Patient preparation for surgery is a critical area of nursing practice that significantly impacts patient outcomes, healthcare costs, and overall satisfaction with care. Research has shown that various informational and psychological interventions can help reduce anxiety, improve postoperative recovery, and facilitate a smoother transition from hospital to home care. As the nature of surgical care evolves, with shorter hospital stays and more responsibility placed on patients and families, there is a growing need for innovative strategies and research to ensure that patients are adequately prepared for their surgical experiences. By integrating new theoretical approaches and focusing on the changing dynamics of healthcare delivery, nursing research can continue to play a vital role in improving patient care and outcomes.