The Effect of Preoperative Instruction and Unit Orientation on Selected Postoperative Factors of Nonemergency Critical Care Surgical Patients

The intensive care unit\u27s effect on the patient has become a subject discussed often by nurses and other health team members. One of the nursing interventions that has been implemented to attempt to de crease the potentially harmful environmental effects of the ICU on the patient is orienting the patient about what to expect prior to the ICU admittance. A major problem is that most intensive care unit (ICU) patients are admitted to the unit on an emergency basis. Few studies, therefore, have focused on the effects of preoperative instruction of ICU patients. The studies that have been done were on cardiotomy patients and most hospitals doing open-heart procedures now have preoperative patient teaching programs in action. There is a need to expand this teaching to include other surgical patients who will be cared for in an ICU. The purpose of the present study was to investigate whether or not planned preoperative instruction and unit orientation would affect the postoperative anxiety levels, positive perception levels, number of pain medications received during the first 48 hours postoperatively, and length of postoperative hospital stay. Patients undergoing nonemergency carotid endartarectomy surgery from two hospitals were included in the study. The quasi-experimental method of research was used with patients divided into a control group (N=6) and an experimental group (N=6). The individuals selected for the study were assigned alternately to the experimental and control groups. The control group received routine preoperative nursing care as usually done on the hospital units. The experimental group received planned preoperative instruction and a preoperative intensive care unit orientation visit conducted by the re searcher in addition to the routine care. The independent variables measured were anxiety levels determined by use of Speilberger\u27s State-Trait Anxiety Inventory (STAI), perception levels as determined by the ICU Perception Questionnaire developed by the researcher, and number of doses of pain medication received within 48 hours postoperatively, and the length of the postoperative hospital stay. The data were analyzed using the Mann Whitney U test at p=.05. Four null hypotheses were researched. In all of the areas investigated there were only slight differences between the control and experimental group. None of these results were statistically significant at p=.05. Therefore, the following null hypotheses were retained; Planned preoperative instruction and unit orientation had no effect on the postoperative anxiety levels of nonemergency critical care surgical patients. Planned preoperative instruction and unit orientation had no effect on the postoperative perception levels of nonemergency critical care surgical patients. Planned preoperative instruction and unit orientation had no effect on the postoperative length of hospital stay of nonemergency critical care surgical patients. Planned preoperative instruction and unit orientation had no effect on the number of pain medication doses received in the first 48 hours postoperatively of nonemergency critical care surgical patients. Patients were evenly divided in the control and experimental groups from each hospital. Using two hospitals did not seem to affect the results. The results may have been affected by the fact that the control group was composed primarily of women and had a higher anxiety score (STAI) median preoperatively (40.5) and postoperatively (33.5) and the experimental group was composed primarily of men and had a lower anxiety score (STAI) median preoperatively (31) and postoperatively (26.5). Recommendations for related studies included conducting a similar study matching the control and experimental groups and including a larger sample of ICU patients. The effects of preoperative instruction and unit orientation of ICU patients on other independent variables such as compliance with coughing, deep breathing and leg exercises, mood scales, and objective bodily responses need to be investigated. It is also recommended that the ICU Perception Questionnaire be tested further to determine its reliability and validity. The implications for nursing were based on the fact that there were no harmful results of planned preoperative instruction and unit orientation noted in this study. This was in contrast to the opinions of some that preoperative instruction may do harm to the patient by increasing anxiety. Subjective appreciation was expressed by the experimental patients after receiving the preoperative instruction and unit orientation. This finding still convinces some nurses that despite no significant findings as in the present study and inconsistent findings in the literature reviewed, some patients obtain positive benefits from preoperative instruction and unit orientation. An additional implication for nurses is the need to conduct further research in new areas related to preoperative instruction of surgical ICU patients with emphasis on differences in individual anxiety or depression levels and types of data collection instruments used to measure them. Different types of critical care surgical patients may also be studied since no effect was found when patients spent only one day in the ICU