Comunication with the context fear reduction of patient with surgical therapy
Introduction
Every disease evokes a certain emotional response (Vágnerová, 2004). Surgical disease with an indication of surgical therapy also has its psychological consequences. A surgical procedure is usually associated with the experience of stress in patients. Stressful situations evoke emotional reactions ranging from cheerful mood (when a person evaluates the situation as challenging but manageable) to anxiety, fear, anger, dejection, and depression (Atkinson et al., 2003). It is generally known that hospitalization, especially in patients undergoing a surgical procedure, contributes to the development of anxiety based on fear of the unknown (Pritchard, 2009). Nurses can also contribute to reducing fear in surgical patients through quality and effective nursing care, which is unthinkable without mutual communication between the nurse and the patient. The nurse must have acquired specific communication practices and skills, including active listening, feedback, respect, empathy, explanation, expression of interest, support, silence, stillness, authenticity, understanding, and advice (Kristová, Tomašková, 2002). Communication between the nurse and the patient is often determined by the presence of instruments and technical devices during various diagnostic and therapeutic procedures. However, the development of technology must not lead to a restriction of personal contact between the patient and the doctor and other healthcare personnel (Čechová, Mellanová, 2008).
Through communication with the patient, the nurse can determine their psychological state, or detect the presence of fear or experience of stress. Communication under stress is often characterized by accelerated speech tempo, chaos, speed of judgment, and more pronounced emotional coloring. The patient's anxiety or fear can also be revealed, for example, by automatic nonverbal manifestations (covering the area most sensitive to pain, crossing arms, and the like) (Vybíral, 2005).
From the perspective of reducing fear in the patient before a surgical procedure, psychological preoperative preparation is important, which consists mainly of communication with the patient. It is necessary to specify it according to age and the urgency of the situation that leads to the necessity of the surgical procedure. The core of psychological preparation before surgery is an individual conversation between the nurse and the patient on the evening before the planned surgery. At this time, the patient already has certain information about their condition and its management from the doctor and is partially adapted to the hospital environment (Lepiešová et al., 2004).
Every conversation with a patient has a factual aspect (we obtain and provide information) and a socio-emotional aspect, which is determined by the healthcare worker's attitude toward the patient, the degree of their directiveness, and the ability to empathize with the patient's problems (Zacharová et al., 2007).
A nurse can also contribute significantly to reducing fear in a surgical patient through their psychotherapeutic approach. A psychotherapeutic approach is behavior by healthcare workers that contributes through psychological means to achieving the goals of treatment. It is an approach focused primarily on the relationship between the healthcare worker and the patient, based on interest, respect, and cooperation (Jobánková et al., 2002). "The therapeutic relationship of the professional to the patient is a special kind of interpersonal relationship. It arises in times of need in the artificial conditions of a healthcare or other institution" (Boledovičová, Drienovská, 2003, p. 12). The therapist's communication is subject to demands for empathy, authenticity, and sincerity (Vybíral, 2005).
The aim of the research was to determine the level of communication between nurses and patients during surgical therapy and its impact on reducing fear in patients.
Methodology and Sample
To obtain relevant data, a quantitative method of empirical research was used – a multi-item non-standardized questionnaire of our own design, which contained 32 items. Of the total number of items, 14 were closed, 12 were semi-open, and 6 were categorization items.
The sample of respondents consisted of 192 patients with surgical disease hospitalized at a surgical clinical department, who underwent a planned surgical procedure. The selection of respondents was intentional based on the following inclusion criteria: completed surgical procedure during the current hospitalization, postoperative period or time after surgery, cooperative patient (without cognitive impairment), ability and willingness to complete the questionnaire, age from 18 years without upper limit. Respondents were aged 18 to 84 years, with a mean age of 51.45 years. The research sample included 111 women and 81 men (see Table 1).
Results
50% of respondents confirmed that they experienced fear more before the surgical procedure than after it, 15.11% of respondents experienced fear equally before and after the surgical procedure, 4.17% of respondents more after surgery than before it. 26.55% of respondents did not experience fear in connection with the surgical procedure, and 4.17% of respondents could not assess this fact.
Regarding the question concerning the intensity of experienced fear in connection with the surgical procedure, most – 39.07% of patients – reported experiencing moderate intensity fear, 25.52% of patients experienced mild intensity fear, 13.02% of patients experienced strong fear, and 0.52% of respondents even unbearable fear. 19.79% of patients did not experience fear before or after the surgical procedure, and 4 patients did not express their opinion on the intensity of fear. (An interesting finding is that in the first item of the questionnaire, 26.55% of respondents indicated no experience of fear, while in the second item, only 19.79% of respondents reported no intensity of fear.)
To alleviate fear, patients most often use prayer (34.90%), try not to think about what causes them fear (33.85%), and communicate with healthcare workers (30.73%). 25.52% of patients communicate with family members, and 22.92% of patients try to obtain information from healthcare workers. Other marked response options included seeking information from other patients (15.63%) and asking for a calming or sleeping pill (11.99%). 5.73% of patients added responses under "Other" such as running, meditation, reading appropriate literature, excessive food intake, communication with friends, walking, watching television, and performing routine daily activities.
We also investigated the respondents' opinion on the impact of nurse-patient communication on alleviating fear in patients undergoing surgical treatment. 92.71% of respondents hold the opinion that nurse-patient communication has an impact on alleviating fear in patients during surgical treatment; conversely, 2.60% of respondents think that communication has no impact on alleviating fear. 4.69% of respondents cannot assess the impact of communication on alleviating fear.
According to 50.51% of patients, nurses always had time and willingness to talk to them. 37.50% of patients report that nurses were mostly willing to listen to them. Nurses usually did not have time for a conversation with 4.69% of patients, and 3.65% of patients did not have the opportunity to express their feelings. 1 respondent (0.52%) stated that they felt a lack of time for communication due to the excessive workload of nurses, and 3.13% of respondents did not express their answer.
Communication in the nurse-patient relationship during the perioperative period is rated as excellent by most – 61.98% of patients. It was rated as average by 30.73% of patients, below average by 1.56% of patients, and insufficient by 0.52% of patients. 5.21% of patients did not express their opinion on the level of nurse communication.
We analyzed the obtained results and tested our assumption that surgical patients who positively evaluate communication in the nurse-patient relationship report experiencing fear of none or mild intensity.
Communication was rated as excellent by 119 respondents regardless of the intensity of experienced fear. This number represents 65.38% of respondents. A rating of grade 2 can also be considered positive, which was indicated by 59 respondents and represents 32.417% of respondents. Overall, we can summarize that on a scale of 1, 2, there were 178 ratings out of 182 respondents. Only four patients rated nurse-patient communication as below average or insufficient. Based on the evaluation of fear intensity and nurse communication, the results were similar. With increasing intensity of fear, the evaluation of communication also changed toward worse, but in all categories the evaluation was better than 2, i.e., average communication. For further statistical processing, the set of respondents was adjusted – intensity of fear 5 was reported by only one patient, therefore categories 4 and 5 were merged.
Patients with higher intensity of fear rate nurse-patient communication worse. The correlation coefficient value in this case is r = 0.91027.
Based on a more detailed evaluation, the group of patients with fear intensity 1 rates communication significantly better than patients with fear intensity 4 and 5, therefore we can state that our assumption was confirmed. Even though the mean values are at the borderline of excellent to better than average communication, there is room for improvement in the relationship especially with the category of patients with increased fear intensity.
Discussion
Surgical therapy represents a relatively common way of managing surgical diseases or injuries in patients. Every disease evokes a certain psychological response in the patient, a subjective experience and evaluation of the illness and its consequences. The individual patient's reaction to disease symptoms, their attitude toward illness and health, as well as all other psychological factors can influence treatment, the course of the disease, and the final outcome, therefore they must be taken into account in patient care (Tesařová, 2003 In: Collective of Authors, 2003). Morovicsová (2008) states that illness represents a challenging life situation for the patient, which they must cope with, often within a short period of time. It predominantly evokes unpleasant emotional states in the patient, such as fear, anxiety, and sadness. An important place among the psychological reactions of the patient during surgical therapy is occupied by the phenomenon of fear (Morovicsová, 2003). Preoperative or surgical fear is a well-recognizable emotional state in many patients awaiting surgery and is a risk factor for the development of serious personal and socioeconomic burden (Theunissen et al., 2014).
Fear and anxiety disrupt the patient's psychological balance and are often accompanied by autonomic disorders (tachycardia, hypertension). At the same time, they adversely affect the induction of anesthesia, its management, and the postoperative course (Spurná, 2001). The experience of fear in connection with surgical therapy was also confirmed by patients in our research. A total of 69.28% of patients confirmed that they experienced or are experiencing fear in connection with the surgical procedure they underwent, both before surgery and after surgery (15.11%), more before surgery than after surgery (50%), or more after surgery than before surgery (4.17%), with the most frequently reported intensity of fear being moderate (39.07%).
Within the research, we also investigated the level of nurse communication with patients at surgical departments and its impact on reducing fear in patients. "Communication in the doctor-nurse-patient relationship is of great importance. The psychological influence of the doctor's and nurse's personality on the patient significantly affects their experience throughout the entire hospitalization" (Gulášová, 2006, p. 302). Communication skills contribute to establishing and expanding better quality contact with the patient and have a favorable effect on interpersonal communication (Beran et al., 2010). According to 92.71% of respondents, nurse communication with patients has an impact on alleviating fear in patients during surgical therapy, with 61.98% of respondents rating it as excellent and 30.73% of respondents as average. "The basic pillar of 'psychological' care for the patient is, on the one hand, understanding their situation, and on the other hand, applying interactive and communicative elements aimed at their evaluation" (Kristová, Miklovičová, 2008, p. 93). Janíček (2008) states regarding healthcare workers' communication with the patient: In an acute condition or in moments when we are consumed by anxiety, the worst thing is when doctors and other healthcare personnel do not talk to us. It can quite justifiably seem to us that the human being has disappeared from the healthcare system. Not in the form of matter, however, but as a being that thinks, feels, and speaks.
Within the research, we confirmed the assumption that surgical patients who positively evaluate communication in the nurse-patient relationship report experiencing fear of none or mild intensity. At the same time, however, it is essential to consider improving the communication relationship especially with the category of patients with increased fear intensity. It is precisely through communication – especially its therapeutic component – that it is possible to effectively contribute to the reduction of fear. Also, patients who experience more intense fear may not objectively evaluate communication in the nurse-patient relationship.
Conclusion
Surgical therapy, which is indicated for various diseases and post-traumatic conditions, significantly affects the patient's psychological experience. The continuous modernization of diagnostic and therapeutic procedures leads to the performance of increasingly complex, but also less invasive surgical procedures than in the past. However, state-of-the-art instrumental and material-technical equipment of surgical departments may not guarantee optimal care for the patient's psyche, for whom surgery is often associated with the experience of fear and anxiety. Nurses at their workplaces can also contribute significantly to reducing or even eliminating these negative emotions in patients during surgical therapy, through effective communication, as confirmed by patients in our research. Therefore, effective communication including a psychotherapeutic approach should be an integral part of nursing care for the surgical patient, both on the inpatient ward and in the outpatient clinic. Supportive conversation is essential especially with the patient before and during various painful procedures (e.g., wound dressings, examinations), before and after a surgical procedure, particularly in radical and mutilating surgeries. Thorough and effective psychological preoperative preparation is not possible without optimal communication with the patient. In addition to the patient, the nurse must also apply proper communication skills in relation to their support persons.
Authors: PhDr. Iveta Kurová Chirurgická klinika, Ústredná vojenská nemocnica SNP Ružomberok – FN PhDr. Mgr. Mariana Magerčiaková, PhD. Katedra ošetrovateľstva, Fakulta zdravotníctva, Katolícka univerzita v Ružomberku Literature
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