Principal Investigator: Merrie Watters, M.S., R.N., CNOR
Co-investigators: Judith Feldman, M.D., David Schoetz, M.D., F.A.C.S., Mary Abrams, R.N., Cynthia Goy, R.N., Marie Catman, M.S., R.N., Peggy Huddleston, M.T.S.
The Lahey Clinic, Burlington, MA
Purpose of the Study
The psychological, spiritual and physiological effects of stress on surgical patients are well documented in nursing and medical literature. Most preoperative education programs focus on cognitive and psychomotor content, overlooking the affective domain of learning. The purpose of this study was to evaluate outcomes for patients using a preoperative stress reduction program,
“Prepare for Surgery, Heal Faster” in conjunction with standard preoperative education, compared to patients using only standard preoperative education. Outcomes measured included:
- Pre-operative calmness
- Post-operative calmness
- Postoperative irritability
- Postoperative headache
- Postoperative insomnia
- Postoperative nightmares
- Postoperative appetite
- Postoperative pain
- Use of pain medication
- Length of stay
Description and Methodology
Using an experimental design, a systematic random sample of 56 adult patients scheduled for major colon-rectal surgery was studied. Patients were enrolled at least one week before surgery. Experimental patients used, “Prepare for Surgery, Heal Faster,” TM a program developed by Peggy Huddleston, which included a book, Relaxation audiotape and a 1-hour telephone workshop. Data collection included three scripted telephone interviews, and retrospective chart reviews. Postoperative stress related symptoms were measured using a Likert type self-reporting scale. Descriptive statistics were used for demographic data. The Mann-Whitney U test and a 1-tailed T-test were used for length of stay and use of pain medication. ANCOVA was used to determine if differences between the two groups was due to age, which was not statistically significant.
Clinically significant differences were found in all outcomes measured. Several statistically significant differences between the two groups were also found. Experimental patients were significantly calmer preoperatively and discharged 1.6 days sooner than the control group. This resulted in a savings of approximately $3,200 per patient. Two days after discharge they had significantly less postoperative irritability, insomnia, nightmares and loss of appetite, and were using 60% less pain medication.
Perioperative Nursing Implications
“Prepare for Surgery, Heal Faster” TM is a cost-effective and therapeutic approach to preoperative patient education that facilitates recovery and empowers the patient as a full partner in the healing process. It has direct applications as a quality improvement initiative for both patient safety and pain management.