Effects of structured preoperative teaching upon postoperative physical recovery and psychological welfare : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
An experimental study to test the effects of structured pre-operative teaching on the physical recovery and psychological welfare of patients admitted for elective surgery was conducted in a 600 bed general hospital. The 30 experimental subjects, 16 women and 14 men, received pre-operative instruction by means of a booklet issued shortly after arrival in hospital, and a group teaching and discussion session conducted on the evening prior to surgery. A variety of general and specific information about surgery and hospitalization was provided, including instructions for self-assessment after discharge. Teaching in the group was by means of slide and tape presentation. An equal number of control patients received only the preparation routinely provided in the ward. Comparisons were made between the two groups of patients according to criterion measures in three categories: physical recovery, psychological welfare, and complex criteria. The latter used subjective evaluation by independent nurse observers of physical, sensory, cognitive, psycho-social and communication aspects of the patient's condition. Measures of physical recovery were complaint of pain, analgesic consumption, nausea and vomiting, post-operative complications, time to resumption of various normal body functions, sleep pattern and sedative consumption, and length of hospital stay. For psychological welfare criterion measures included scores on a specially constructed Surgical Patient Anxiety Scale; physiological indicators in the form of systolic blood pressure and pulse: patient postoperative psychological state as observed by independent nurse observers and patients' own assessment of their feelings after discharge. The overall results supported the general hypothesis that the structured pre-operative teaching reduced patient anxiety and aided recovery. Although few direct relationships were identified between level of pre-operative anxiety and specific aspects of post-operative recovery, there was evidence suggesting a more complex set of relationships. Analysis of group interaction in the teaching sessions showed that the teaching session had served its purpose well, and also that group composition, particularly in terms of sex, had influenced both the content and structure of patient interaction. Implications for nursing practice, derived from these findings have been suggested, and recommendations for further study are included.