Postoperative Nursing Care Contributions To Symptom Distress And Functional Status After Ambulatory Surgery

AORN Journal, March, 1999 by Amy L. Reichert

POSTOPERATIVE NURSING CARE CONTRIBUTIONS TO SYMPTOM DISTRESS AND FUNCTIONAL STATUS AFTER AMBULATORY SURGERY B Swan Medsurg Nursing Vol 7 (June 1998) 148-158

Ambulatory surgery continues to grow in response to economic and regulatory pressures. Increases in the number of patients undergoing ambulatory surgery have an effect on the process of nursing care, the way in which nurses provide care, and the manner in which patients perceive care. This researcher identified the need to study the relationship of shortened stays on ambulatory patient outcomes related to symptom distress and functional status.

The purpose of this study was to examine the relationship of preoperative and postoperative patient-perceived nursing caring behaviors to symptom distress and functional status 24 hours, four days, and seven days after surgery.

There has been minimal study of the relationship between patient-perceived nurse caring behaviors and patient outcomes in the ambulatory setting. Nursing interventions are designed to minimize symptom distress and optimize functional status through caring behaviors. Only one study has examined the effect of nurses' caring behavior on the health status of the hospitalized patient.

The methodology was a prospective, single cohort design used to examine the relationship of patient-perceived nurse caring behaviors and patient outcomes in adults undergoing surgery in an ambulatory setting. A consecutive sample of 100 consenting adults who had undergone surgical procedures in an urban academic medical center, a suburban community hospital, and a suburban teaching hospital was used. These patients had undergone either a laparoscopy or an incisional inguinal hernia repair.

The mean age of the patients was 42.6. Sixty-two percent were female, 72% were white, 75% were married, and 63% had at least a high school education. Forty-one percent of the procedures were hernia repairs, and 59% were laparoscopies. Using the American Society of Anesthesiologists' (ASA) Physical Status Classification system, 21 patients were categorized ASA I, 66 were categorized ASA II, and 13 were categorized ASA III. Seventy-nine percent of the patients had at least one comorbidity (ie, hypertension, diabetes, asthma).

The general symptom distress scale (GSDS) was used to measure preoperative and postoperative symptom distress, with 11 symptoms being rated. The functional status questionnaire (FSQ) was used to measure preoperative and postoperative functional status. The FSQ uses 34 questions to assess the patient's physical, psychological, and social state and role function.

The caring behavior inventory (CBI) was used to measure preoperative and postoperative caring behaviors. The CBI was designed to assess the nursing care process. The ASA classification system was used to categorize preoperative comorbidities.

After approval by the university's institutional review board, each subject gave written, informed consent. The principal investigator contacted all subjects one to five days preoperatively to administer the questionnaires. The GSD and FSQ were used preoperatively and on postoperative days one, four, and seven. The preoperative data was collected in person. The CBI was used postoperatively on days one, four, and seven.

Multiple linear regression analysis was used to assess the preoperative and postoperative relationship. The only correlation found 24 hours after surgery was between social interaction and positive connectedness. A significant correlation was found four days postoperatively between symptom distress and respective deference to others, assurance of human presence, and positive connectedness. Seven days postoperatively, symptom distress and mental health were significantly correlated to respectful deference to others, assurance of human presence, positive connectedness, professional knowledge and skill, and attentiveness to others' experience.

Findings from this study indicate that patient outcomes after ambulatory surgery are influenced by postoperative patients, perceived nurse caring behaviors, and ASA classification. Preoperative comorbidity did not play a role in patient-perceived nurse caring behavior.

Patients who reported a greater awareness of nurse caring behaviors in the postanesthesia care unit had less symptom distress in the postoperative period. These patients experienced a quicker return to activities of daily living.

The findings from this study add to the body of knowledge concerning the outcomes of ambulatory surgery patients. There remains many important areas to be studied--clinical problems related to streamlining patient care and the patient/nurse relationship are only two of the areas to be studied that would benefit patient care and outcomes.

AMY L. REICHERT RN, MSN, CNOR NURSING RESEARCH COMMITTEE