Patient and Family Member Needs During the Perioperative Period Yeta Davis, RN, CNOR, Marjorie Perham, Diploma, RN, Alicia M. Hurd, MSN, RN, Ronald Jagersky, BSN, RN, William J. Gorman, BSN, RN, Diane Lynch-Carlson, CST, Deborah Senseney, MSN, RN-BC Purpose: The purpose of this study was to determine the needs and
experiences of patients and family members throughout the entire perioperative experience. Design and Methods: Using a descriptive study design, a convenience sample of patients and family members were surveyed about their needs and how well those needs were met during the perioperative period. Survey questions were adapted from valid and reliable patient and family needs surveys. Rank order of patient and family needs were determined based on average item scores. Findings: A total of 68 patients and 63 family members were surveyed over an 8-month period. Patient needs with the highest scores were related to pain and/or nausea management, having information about the condition after surgery, and treatment with respect and dignity. Family member needs with the highest scores were related to communication with the surgeon after the procedure, opportunities to ask questions and address concerns with hospital staff, and receiving information about the surgical procedure itself before coming to the hospital. Patients and family members perceived that their needs were met most of the time. Conclusions: Results of this survey identify the needs of patients and family members throughout the perioperative time period. Keywords: descriptive study, survey, preoperative needs, intraoperative needs, PACU. Ó 2014 by American Society of PeriAnesthesia Nurses
CRITICAL TO DESIGNING new programs and interventions to improve patient quality and satisfaction is knowledge about how the health care experience is perceived and experienced by the patient and their family. Without this information, well-intentioned health care personnel can invest
precious resources and energies in making system or programmatic changes to improve care delivery, which could have little or no importance to patients or family members. Prior studies of family member needs have found that nurses’ and family members’ perceptions of important needs are not
Yeta Davis, RN, CNOR, is a Staff Nurse, Inpatient Operating Room, Exempla Lutheran Medical Center, Wheat Ridge, CO; Marjorie Perham, Diploma, RN, is a Staff Nurse, Inpatient Operating Room, Exempla Lutheran Medical Center, Wheat Ridge, CO; Alicia M. Hurd, MSN, RN, is a Staff Nurse, Inpatient Operating Room; Ronald Jagersky, BSN, RN, is a Staff Nurse, Inpatient Operating Room, Exempla Lutheran Medical Center, Wheat Ridge, CO; William J. Gorman, BSN, RN, is a Staff Nurse, Inpatient Operating Room, Exempla Lutheran Medical Center, Wheat Ridge, CO; Diane Lynch-Carlson, CST, is a Certified Surgical Technician, Inpatient Operating Room, Exempla
Lutheran Medical Center, Wheat Ridge, CO; and Deborah Senseney, MSN, RN-BC, is a Medical Surgical Clinical Practice Specialist, Exempla Lutheran Medical Center, Wheat Ridge, CO. Conflict of interest: None to report. Address correspondence to Deborah Senseney, Exempla Lutheran Medical Center, 8300 West 38th Avenue, Wheat Ridge, CO 80033; e-mail address: [email protected]. Ó 2014 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2013.05.013
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identical, particularly related to the visitation of critically ill1,2 or postanesthesia patients.3 Knowing the needs of patients and family members is particularly important when providing nursing care in the perioperative area because of the high patient acuity level, stress, anxiety, and uncertainty associated with the operative experience for patients and their family members.4-7 While many studies have been conducted on the needs of patients and/or family members in intensive care units,8-12 limited data are available on patients and/or family member needs immediately before and after the operative experience.3,13-17 Many of the studies focused on patient needs associated with educational preparation before hospital admission.13-15 Three studies focused on family member needs,3,16,17 with the majority of need items related to the postanesthesia care time period. In addition to the limited numbers of studies on patient and family needs throughout the perioperative period, most of the studies were done before the late 1990s. Given the tremendous changes in acute care surgical services in the past decade, resurveying patients and family members about their perceived needs during the entire perioperative period is needed to better guide future changes in perioperative and perianesthesia nursing. The purpose of this study was to determine the needs and experiences of patients and family members throughout the entire perioperative experience. The perioperative period was divided into three time periods: 1. preoperative—the time from before admission to the presurgical care unit (holding area) until transfer to the operating room (OR); 2. intraoperative— the time in the OR; and 3. postanesthesia—the time from admission to the postanesthesia care unit (PACU) until transfer to an inpatient care unit.
Materials and Methods This study was conducted in a 400-bed not-forprofit, community-hospital in the Rocky Mountain region of the United States with a perioperative area conducting 6,800 surgeries/year in 11 inpatient ORs and an 18-bed PACU. Study approval was obtained from the institution’s investigational review board before data collection. Data collection was completed over an 8-month period.
Study Design An exploratory, descriptive design was used to identify the needs and experiences of patients and family members during the perioperative period. Variables of interest were patient and family member needs and experiences. Instruments SURVEY OF PATIENT NEEDS AND EXPERIENCES DURING THE PERIOPERATIVE PERIOD. Patient needs and experiences before coming to the hospital and during the perioperative period were rated on a patient needs survey completed on the first postoperative day (Table 1). The patient needs survey was a 26-item listing of perioperative patient needs derived from previously validated surveys4,13,15 with statements focused on needs related to information, physical comfort, communication, psychosocial support, and hospital staff competence/professionalism. Each need was rated on a four-level Likert scale about the importance of the need (very important [3], important [2], not important [1], not important at all [0]), as well as the patient’s experience with how well that need was met during the perioperative period (met [3], partly met [2], not met [0], do not remember [not scored]). Space was provided for additional comments or suggestions by the patient about each need item. Content validity was determined by six experienced perioperative nurses. Survey questions were revised for clarity and relevance to the surgical experience based on pilot testing with postoperative patients before hospital discharge. Time for survey completion was approximately 4 minutes. SURVEY OF FAMILY MEMBER NEEDS AND EXPERIENCES DURING THE PERIOPERATIVE PERIOD. Family member needs and experiences before coming to the hospital and during the perioperative period were rated on a family member needs survey completed on the day of surgery (Table 2). For this study, ‘‘family member’’ was defined as an individual designated by the patient as a family member, significant other, and/or close friend or acquaintance. The family member survey was a 19-item listing of selected perioperative family member needs derived from previously validated surveys,2,3,8 with statements focused on
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Table 1. Patients’ Average (±SD) Scores* for Importance of Perioperative Needs and How Often Those Needs Were Perceived to Have Been Met (N 5 68) Patient Need (Item Number Refers to Order in Original Survey)
Importance of Need
Time period: Before coming to the hospital 3. Having information on how your pain will be 2.77 6 0.49 managed during and after the surgery. 2.71 6 0.57 1. Having information about the surgical procedure itself (eg, how the surgery is done, complications, expected hospitalization time). 4. Having someone answer your questions 2.58 6 0.60 before you come to the hospital. 2.55 6 0.65 2. Having information about what to do on the day of surgery (eg, time to arrive, where to park, where to go in the hospital, what to bring). Time period: Day of surgery in preoperative surgical care area 2.75 6 0.47 3. Being treated with respect and with dignity by hospital personnel (eg, personnel protected your privacy and modesty, addressed you in a courteous manner, took time to understand and answer your questions). 2.74 6 0.47 1. Having information about the procedures for getting you ready for surgery (eg, admission assessment, starting an IV infusion, getting medications before surgery, movement by cart to the operating room). 8. Having your family member or significant 2.69 6 0.64 other with you in the presurgical area. 2.67 6 0.56 2. Being physically comfortable (bed, room temperature, noise and activity level in the room, management of your pain or other symptoms). 4. Having important information about you 2.68 6 0.56 communicated to hospital personnel before your admission. 7. Having opportunities to ask questions and 2.66 6 0.58 address concerns with hospital staff. 2.61 6 0.64 6. Having hospital staff reassure you about any fears/anxieties you might have related to your surgical experience. 5. Being informed about delays in the operating 2.45 6 0.66 room schedule. Time period: Day of surgery in operative room area 2.73 6 0.45 4. Having important information about you communicated to hospital personnel before your arrival in the operating room. 2.70 6 0.49 3. Being treated with respect and with dignity by hospital personnel (eg, personnel protected your privacy and modesty, addressed you in a courteous manner, took time to understand and answer your questions).
Rank Order of Need Importance in Each Time Period
Was Need Met?
1
2.94 6 0.39
2
2.89 6 0.40
3
2.94 6 0.25
4
2.90 6 0.17
1
3.00 6 0.0
2
3.00 6 0.0
3
3.00 6 0.00
4
2.99 6 0.12
5
2.90 6 0.43
6
2.98 6 0.13
7
2.98 6 0.13
8
2.85 6 0.64
1
2.93 6 0.40
2
2.93 6 0.53
(Continued )
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Table 1. Continued Patient Need (Item Number Refers to Order in Original Survey)
Importance of Need
Rank Order of Need Importance in Each Time Period
Was Need Met?
5. Having hospital staff reassure you about any fears/anxieties you might have related to your surgical experience. 6. Having opportunities to ask questions and address concerns with hospital staff. 2. Being physically comfortable (on bed, room temperature, noise and activity level around you). 1. Having information about the role of operating room staff (nurse, technician, anesthesiologist). Time period: Postanesthesia care unit area 3. Having your pain, nausea, and/or vomiting adequately managed by the recovery room staff. 1. Having information about your condition. 4. Being treated with respect and with dignity by hospital personnel (eg, personnel protected your privacy and modesty, addressed you in a courteous manner, took time to understand and answer your questions). 5. Having important information about you communicated to hospital personnel before your arrival in the recovery room. 2. Being physically comfortable (bed, room temperature, noise and activity level in the room). 7. Having opportunities to ask questions and address concerns with hospital staff. 6. Reassurance from hospital staff about fears/ anxieties related to the surgical experience. 8. Having your family member or significant other visit you in recovery room.
2.69 6 0.55
3
2.94 6 0.40
2.68 6 0.56
4
2.84 6 0.66
2.58 6 0.58
5
2.90 6 0.56
2.54 6 0.70
6
2.92 6 0.45
2.82 6 0.39
1
2.88 6 0.51
2.76 6 0.43 2.71 6 0.46
2 3 (tie)
2.90 6 0.49 2.95 6 0.39
2.71 6 0.49
3 (tie)
2.88 6 0.56
2.70 6 0.49
5 (tie)
2.85 6 0.58
2.70 6 0.55
5 (tie)
2.95 6 0.39
2.58 6 0.60
7
2.90 6 0.39
2.56 6 0.76
8
2.94 6 0.3
IV, intravenous; SD, standard deviation. *Range of importance scores were from 3 (very important) to 0 (not important at all); range for need met scores were from 3 (met) to 1 (not met).
needs related to information, physical comfort, communication, psychosocial support, and hospital staff competence/professionalism. Ratings of needs were done in the same format as the patient needs survey described previously. Space was provided for additional comments or suggestions by the family member about each need item. Content validity was determined by six experienced perioperative nurses. Survey questions were revised for clarity and relevance to the surgical experience based on pilot tested with family
members of postoperative patients. Time for survey completion was approximately 4 minutes. Sample Selection Two independent convenience samples of patients and family members were studied. Patient inclusion criteria included ability to speak and understand English, age $21 years, mentally competent and alert, postoperative patient on a surgical inpatient unit following an elective operative procedure, pain level , 5 on the numeric pain scale
PERIOP PATIENT AND FAMILY NEEDS
(0 5 no pain, 10 5 worst pain), and no postoperative stay in the intensive care unit. Family member inclusion criteria included family member, significant other, and/or close friend of the patient who was scheduled for elective surgery; ability to speak and understand English; age $21 years; mentally competent; and present in the hospital during the patient’s perioperative stay. Sample size was determined by review of prior patient and family needs surveys and a desire to survey at least as many individuals or more than prior studies.1,3,11,17 A minimum sample of 60 patients and 60 family members was determined in advance of data collection.
Study Procedure The following procedures were performed in this study: FAMILY MEMBER PARTICIPANTS. Potential participants for the family member needs survey were identified in the Surgical Family Room during the time the family member was in the OR and PACU. Family members who met the eligibility criteria had the study explained by one of the investigators and were given a written survey to complete. An investigator was present to answer any questions about the study or how to complete the survey. Completed surveys were placed in a sealed envelope by the participant before return to the investigator. Only one individual from each family was allowed to complete a family member survey. PATIENT PARTICIPANTS. Potential participants for the patient needs survey were identified from the list of surgical patients transferred from PACU to an inpatient surgical unit. On the day after surgery, patients who meet the eligibility criteria had the study explained by one of the investigators and asked if he/she wanted to participate in the study. Each consenting participant was given a survey to complete. The study investigator remained with the participant while he/ she completed the survey to answer questions and/or assist with survey completion if requested. Completed surveys were placed in a sealed envelope by the participant before being returned to the investigator.
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Data Analysis Descriptive statistics were used to summarize patients and family member needs. A rank order listing of patient and family member needs and how well those needs were met before hospital admission and during the perioperative period was based on the average score for each item and was determined for subjects in each category (patients, family member/significant others).
Results A total of 68 patients and 63 family members were surveyed over an 8-month period (Table 3). The average age of patients and family members was 62.3 (SD 5 616.8) and 52.9 (SD 614.7) years, respectively. The majority of participants were Caucasian, who had completed at least a community college or trade school educational program. Family member participants were most commonly the spouse or child of a surgical patient. The vast majority of patients and family members reported that they had received information before coming to the hospital about the time to arrive, where to park, and where the admissions area was located (Table 3). More than 85% of patients reported receiving information preoperatively about the types of items they should bring to the hospital as well as information on whether they should take their usual medications before coming to the hospital. Patients’ average scores for responses to the importance of each need statement and how well the need was met during the prehospital and perioperative period are summarized in Table 1. The top rated needs in each time period were the following: 1. before hospital admission: having information on how pain will be managed and about the surgical procedure itself; 2. presurgical care period: being treated with respect and dignity by hospital personnel and having information about procedures for operative preparation; 3. operative period: having important information communicated to OR staff before patient’s arrival in OR and being treated with respect and dignity by hospital personnel; and 4. postanesthesia care period: having pain, nausea, and vomiting adequately managed and having information about their condition. The lowest rated needs in each time period
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Table 2. Family Members’ Average (±SD) Scores* for Importance of Perioperative Needs and How Often Those Needs Were Perceived to Have Been Met (N 5 63) Family Member Need (Item Number Refers to Order in Original Survey)
Importance of Need
Rank Order of Need Importance in Each Time Period
Time period: Before coming to the hospital 1. Having information about the surgical procedure 2.81 6 0.39 itself (eg, how the surgery is done, complications, expected hospitalization time). 2. Having information about what to do on the day 2.60 6 0.52 of surgery (eg, time to arrive, where to park, where to go in the hospital, what to bring). 3. Having someone answer your questions before 2.59 6 0.52 you come to the hospital. Time period: Day of surgery in the preoperative area and during the operation 5. Having communication with the surgeon after 2.84 6 0.37 the procedure with consideration for privacy. 8. Having opportunities to ask questions and 2.83 6 0.38 address concerns with hospital staff. 2. Being with your family member/significant other 2.77 6 0.49 while they were in the preoperative surgical care area. 2.75 6 0.43 6. Being treated with respect and with dignity by hospital personnel (eg, personnel protected your privacy, addressed you in a courteous manner, took time to understand and answer your questions). 2.69 6 0.53 4. Having communication with operating room nurses about the patient’s condition during the surgical procedure. 7. Being informed about delays in the operating 2.67 6 0.54 room schedule. 2.57 6 0.56 1. Having information about the presurgical care procedures for getting the patient ready for surgery (eg, admission assessment, starting an intravenous infusion, getting medications before surgery, movement by cart to the operating room). 3. Being physically comfortable in the OR family 2.38 6 0.59 room area. Time period: Day of surgery in the postanesthesia care unit area 4. Having communication with the surgeon or other 2.82 6 0.39 physicians after the procedure with consideration for privacy. 7. Having opportunities to ask questions and 2.79 6 0.41 address concerns with hospital staff. 2.77 6 0.46 3. Having communication with recovery room nurses about the patient’s condition during the surgical procedure. 2.76 6 0.43 5. Being treated with respect and with dignity by hospital personnel (eg, personnel protected your privacy, addressed you in a courteous manner, took time to understand and answer your questions).
Was Need Met?
1
2.76 6 0.61
2
2.87 6 0.34
3
2.79 6 0.41
1
2.97 6 0.26
2
2.89 6 0.36
3
2.99 6 0.12
4
3.00 6 0.00
5
2.87 6 0.46
6
2.93 6 0.26
7
2.97 6 0.18
8
2.93 6 0.26
1
2.96 6 0.21
2
2.99 6 0.12
3
2.88 6 0.45
4
2.99 6 0.12
(Continued )
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Table 2. Continued Family Member Need (Item Number Refers to Order in Original Survey) 1. Visiting or being with your family member/ significant other while they were in the recovery room. 6. Being informed about when transfer to a regular hospital room would take place. 2. Being physically comfortable in the OR family room area.
Importance of Need
Rank Order of Need Importance in Each Time Period
Was Need Met?
2.69 6 0.47
5
2.84 6 0.52
2.61 6 0.58
6
2.94 6 0.31
2.49 6 0.58
7
2.91 6 0.33
OR, operating room; SD, standard deviation. *Range of importance scores were from 3 (very important) to 0 (not important at all); range for need met scores were from 3 (met) to 1 (not met).
were the following: 1. before hospital admission: having information about arrival time/where to park/what to bring; 2. presurgical care period: in-
formation about delays in OR schedule; 3. operative period: having information about the role of OR staff; and 4. postanesthesia care period: having
Table 3. Demographic Data and Characteristics of Patient and Family Member Participants Characteristics Age (y) Mean 6 (SD) Gender Female Male Ethnicity Caucasian Hispanic African-American Other Highest educational level completed Grade school High school Community college or trade school College Graduate school Received information before coming to the hospital on Time to arrive Where to park Location for admission Items to bring to hospital Information on taking your usual medications before coming to the hospital Location of OR family area Relationship to patient Parent Spouse Significant other Sibling Child Friend Other OR, operating room.
Patients (N 5 68)
Family Members (N 5 63)
62.3 6 16.8
52.9 6 14.7
39 30
29 34
60 7 1 1
52 9
5 16 16 22 9
1 22 11 18 11
64 47 (N 5 47) 58 (N 5 63) 54 (N 5 61) 54 (N 5 62)
2
61 61
62 3 28 1 7 17 2 5
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Table 4. Select Verbatim Comments Recorded by Patient or Family Members at the End of the Needs Survey Patients 1. The pre-op and OR staff was exceptional. Very personable and great sense of humor. Made me feel less anxious. 2. Wanted a more detailed diagram/picture of the procedure and materials of artificial components. 3. Level of education has nothing to do with wisdom or intelligence. 4. Needed extra blood, was done fast and thorough, made me feel at ease. 5. My nurse made me feel like I was her only patient, she attended to all my needs—I had a lot of pain. 6. I like the new policy of letting family or significant other into recovery as they can only sit and stew until they actually see the patient. Family members 1. I am so stressed out being a caregiver and also have my own health problems that the littlest thing seems like a mountain. 2. When I arrived in the waiting area a nurse liaison introduced herself and asked if we had any questions. That was greatly appreciated. 3. There was no sense of rush or bustle anywhere. This creates a sense of calm and reduces anxiety. This is the only hospital in my experience to convey this (both the patient and family were considered). 4. I was told it would be done at 11:00 (am) and she did not go in until 11:00 (am). Just a phone call would have been good because I had to run an errand while down here. 5. Patient is handled with dignity . instead of a part of a procedure. Very important to family that family room is kept well, good light, very clean. 6. Wish other family members would be allowed in PACU. 7. Your patient liaison is incredible. She is so caring, polite. 8. Each staff member has been professional as well as being friendly and supportive. I have been impressed with the procedure. 9. I was very pleased at the level of family centered care I received as the daughter of the patient. I expected excellent surgical and nursing care for her consistent with the previous care she has had at this facility, but I was very happy with the added services I received as a family member. Supporting the family helps us all to care for the patient. 10. Having to be in the hospital is traumatizing. It interrupts your routine. You’re unsure or maybe scared of the outcome of your visit or procedure and you’re exposed to language and terms you don’t understand. You feel a loss of control. Hospital staff can go a long way for alleviating these fears by being informative, interested in your concerns, answering questions so you understand what’s going on and in general showing that you understand it’s not easy. In a sense during the patients stay, you’re seen as somewhat of a hero. 11. The pre surgery treatment and info (information) on procedure was very comforting and helped to know what to expect. It followed thru (through) and made it easy to await reunion with friend. Thanks so much to all. OR, operating room; PACU, postanesthesia care unit.
a family member visit. Average scores for how well patient needs were met during the perioperative experience were high (.2.8) for all surveyed needs. Family members’ average scores for responses to the importance of each need statement and how well the need was met during the prehospital and perioperative period are summarized in Table 2. The top rated needs in each time period were the following: 1. before hospital admission: having information about the surgical procedure
itself; 2. presurgical care and operative period: having communication with the surgeon after the procedure and having opportunities to ask questions and address concerns with hospital staff; and 3. postanesthesia care period: having communication with the surgeon after the procedure with consideration for privacy and having opportunities to ask questions and address concerns with hospital staff. The lowest rated needs in each time period were the following: 1. before hospital admission: having someone to answer questions before coming to the hospital; 2. presurgical care
PERIOP PATIENT AND FAMILY NEEDS
and operative period: being physically comfortable in the operative family room; and 3. postanesthesia care period: being physically comfortable in the operative family room. Average scores for how well family member needs were met for the perioperative experience were high (.2.75) for all surveyed needs. Many patients and family members wrote in personal comments at the end of the survey tool. Selected comments are summarized in Table 4.
Discussion For both patients and family members, many of the highest rated needs during the perioperative period were related to information and communication. In addition, patients also highly rated needs relating to pain and/or nausea management and being treated with respect and dignity. Anecdotal comments by patients and family members further emphasized the importance of the highly ranked items on the survey. The need for information and communication with health care providers throughout the perioperative period is consistent with prior operative studies3,17 and parallels findings in the family members of critically ill patients.1,8-12 Since this is one of the first surveys to determine needs at various time periods throughout the perioperative experience, several findings are worthy of emphasis. In the period before coming to the hospital, patients’ highest rated needs were to have information about how their pain would be managed after surgery and how the surgical procedure itself would be done. Their lowest rated need was for information about logistics about arriving at the hospital. Family members’ ratings of information about the surgical procedure and hospital logistics were similar to patients’ ratings. When designing preoperative educational classes or written materials, providing content on pain management should be a priority, along with information about the surgical procedure itself. During the time the patient is in the preoperative area on the day of surgery, both patients and family members rated highly the need to be present with each other. This finding emphasizes the need to organize care routines and the physical environment in the presurgical preparation area to accom-
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modate family presence as much as possible. In our facility, family members were encouraged to remain with the patient until just before transfer to the OR. Another interesting finding of this study is related to PACU family visitation. During the time of the study, our PACU policy on family visitation was changed to allow one family member to visit stable patients for a short period of time. Based on extremely positive and enthusiastic feedback from family members after the policy change, we were surprised at the lower ratings both patients and family members gave to the item related to the importance of visiting in PACU. A prior study conducted in our unit on PACU visitation found significant reductions in family member anxiety after visitation, with very supportive anecdotal comments about the importance of PACU visitation by both experimental and control group members.18 The high ratings given by both patients and family members to be together during the time immediately before surgery is in contrast to their rating of this same need in PACU time period. From an organizational perspective, we were very pleased to find that the vast majority of patients and family members rated their needs as having been met. Average scores for whether a need was met were .2.9 on a three-point maximum scale for most of the needs in the survey. This survey provided much more specific information to the perioperative staff about customer satisfaction with care than had previously been available from the post discharge patient satisfaction survey used by the hospital. Study Limitations Findings of this study are limited by the demographics of the study sample, reflecting an educated sample of middle-aged Caucasian adults. While these demographics are reflective of the patient population in our facility in the Rocky Mountain region, patient and family needs may differ in younger and older populations, those with lower educational levels, and/or from different regions. Another limitation is that the patient and family participants were not necessarily related to each other. We did not attempt to have family member surveys completed for each patient survey completed. Since patients were not surveyed until
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the day after surgery, a final limitation is that patient recall of preoperative needs may not have been the same if we had surveyed them on the day of surgery. Recommendations for Clinical Practice, Education, and Research
presence of a family member in the PACU unit should be explored for units with and without a family visitation program to determine if our findings of lower priority scores were related to having that need met at a high level.
Conclusions
Highly rated needs in each of the perioperative phases should be taken into account when organizing and planning care delivery. For example, care routines and the physical environment in the presurgical preparation area should be organized to accommodate family presence as much as possible since this was a need rated highly by both patients and family members. Future research should examine patient and family needs in the discrete phases of the perioperative experience in a variety of different demographic groups. Determining the priority of the need for
This study ranked the priority of needs for patients and family members during each of the phases of the perioperative experience. Findings from this study will provide guidance for designing new programs and interventions to improve patient quality and satisfaction during the perioperative experience.
Acknowledgments Special thanks to Marianne Chulay, RN, PhD, FAAN, for assistance with study design, data analysis, and manuscript preparation.
References 1. Lynn-McHale D, Bellinger A. Needs satisfaction levels of family members of critical care patients and accuracy of nurses’ perception. Heart Lung. 1988;17:447-453. 2. O’Malley P, Anderson B, Sieve S. Critical care nurse perceptions of family needs. Heart Lung. 1991;20:189-201. 3. Cormier S, Pickett S, Gallagher J. Comparison of nurses’ and family members’ perceived needs during postanesthesia care unit visits. J Post Anesth Nurs. 1992;7:387-391. 4. Rhodes L, Miles G, Pearson A. Patient subjective experience and satisfaction during the perioperative period in day surgery setting: A systematic review. Int J Nurs Pract. 2006;12: 178-192. 5. Leske JS. Intraoperative progress reports decrease family members’ anxiety. AORN J. 1996;64:424-425. 428-436. 6. Leske JS. Effects of intraoperative progress reports on anxiety levels of surgical patients’ family members. Appl Nurs Res. 1995;8:169-173. 7. Leske JS. Anxiety of elective surgical patients’ family members. Relationship between anxiety levels, family characteristics. AORN J. 1993;57:1091-1092. 1096-1103. 8. Leske J. Overview of family needs after critical illness: From needs assessment to intervention. AACN Clin Issues Crit Care Nurs. 1991;2:220-226. 9. Paul F, Rattray J. Short- and long-term impact of critical illness on relatives: Literature review. J Adv Nurs. 2008;62:276-292.
10. Takman C, Severinsson E. Comparing Norwegian nurses’ and physicians’ perceptions of the needs of significant others in intensive care units. J Clin Nurs. 2005;14:621-631. 11. Obringer K, Hilgenberg C, Booker K. Needs of adult family members of intensive care unit patients. J Clin Nurs. 2012; 21:1651-1658. 12. Khalaila R. Patients’ family satisfaction with needs met at the medical intensive care unit. J Adv Nurs. 2013;69:1172-1182. http://dx.doi.org/10.1111/j.1365-2648.2012.06109.x. 13. Yount M, Schoessler M. A description of patient and nurse perceptions of preoperative teaching. J Post Anesth Nurs. 1991;6:17-26. 14. Mitchell M. Patients’ perception of pre-operative preparation for day surgery. J Adv Nurs. 1997;26:356-363. 15. Bernier M, Sanares D, Owen S, Newhouse P. Preoperative teaching received and valued in a day surgery setting. AORN J. 2003;77:563-582. 16. Tuller S, McCabe L, Cronenwett L, et al. Patient, visitor, and nurse evaluations of visitation for adult postanesthesia care unit patients. J Postanesth Nurs. 1997;12:401-412. 17. Carmody S, Hickey P, Bookbinder M. Perioperative needs of families. AORN J. 1991;54:561-567. 18. Carter A, Deselms J, Ruyle S, et al. PACU visitation decreases family member anxiety. J Perianesth Nurs. 2012;27: 3-9.
experiences of patients and family members throughout the entire perioperative experience. Design and Methods: Using a descriptive study design, a convenience sample of patients and family members were surveyed about their needs and how well those needs were met during the perioperative period. Survey questions were adapted from valid and reliable patient and family needs surveys. Rank order of patient and family needs were determined based on average item scores. Findings: A total of 68 patients and 63 family members were surveyed over an 8-month period. Patient needs with the highest scores were related to pain and/or nausea management, having information about the condition after surgery, and treatment with respect and dignity. Family member needs with the highest scores were related to communication with the surgeon after the procedure, opportunities to ask questions and address concerns with hospital staff, and receiving information about the surgical procedure itself before coming to the hospital. Patients and family members perceived that their needs were met most of the time. Conclusions: Results of this survey identify the needs of patients and family members throughout the perioperative time period. Keywords: descriptive study, survey, preoperative needs, intraoperative needs, PACU. Ó 2014 by American Society of PeriAnesthesia Nurses
CRITICAL TO DESIGNING new programs and interventions to improve patient quality and satisfaction is knowledge about how the health care experience is perceived and experienced by the patient and their family. Without this information, well-intentioned health care personnel can invest
precious resources and energies in making system or programmatic changes to improve care delivery, which could have little or no importance to patients or family members. Prior studies of family member needs have found that nurses’ and family members’ perceptions of important needs are not
Yeta Davis, RN, CNOR, is a Staff Nurse, Inpatient Operating Room, Exempla Lutheran Medical Center, Wheat Ridge, CO; Marjorie Perham, Diploma, RN, is a Staff Nurse, Inpatient Operating Room, Exempla Lutheran Medical Center, Wheat Ridge, CO; Alicia M. Hurd, MSN, RN, is a Staff Nurse, Inpatient Operating Room; Ronald Jagersky, BSN, RN, is a Staff Nurse, Inpatient Operating Room, Exempla Lutheran Medical Center, Wheat Ridge, CO; William J. Gorman, BSN, RN, is a Staff Nurse, Inpatient Operating Room, Exempla Lutheran Medical Center, Wheat Ridge, CO; Diane Lynch-Carlson, CST, is a Certified Surgical Technician, Inpatient Operating Room, Exempla
Lutheran Medical Center, Wheat Ridge, CO; and Deborah Senseney, MSN, RN-BC, is a Medical Surgical Clinical Practice Specialist, Exempla Lutheran Medical Center, Wheat Ridge, CO. Conflict of interest: None to report. Address correspondence to Deborah Senseney, Exempla Lutheran Medical Center, 8300 West 38th Avenue, Wheat Ridge, CO 80033; e-mail address: [email protected]. Ó 2014 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2013.05.013
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identical, particularly related to the visitation of critically ill1,2 or postanesthesia patients.3 Knowing the needs of patients and family members is particularly important when providing nursing care in the perioperative area because of the high patient acuity level, stress, anxiety, and uncertainty associated with the operative experience for patients and their family members.4-7 While many studies have been conducted on the needs of patients and/or family members in intensive care units,8-12 limited data are available on patients and/or family member needs immediately before and after the operative experience.3,13-17 Many of the studies focused on patient needs associated with educational preparation before hospital admission.13-15 Three studies focused on family member needs,3,16,17 with the majority of need items related to the postanesthesia care time period. In addition to the limited numbers of studies on patient and family needs throughout the perioperative period, most of the studies were done before the late 1990s. Given the tremendous changes in acute care surgical services in the past decade, resurveying patients and family members about their perceived needs during the entire perioperative period is needed to better guide future changes in perioperative and perianesthesia nursing. The purpose of this study was to determine the needs and experiences of patients and family members throughout the entire perioperative experience. The perioperative period was divided into three time periods: 1. preoperative—the time from before admission to the presurgical care unit (holding area) until transfer to the operating room (OR); 2. intraoperative— the time in the OR; and 3. postanesthesia—the time from admission to the postanesthesia care unit (PACU) until transfer to an inpatient care unit.
Materials and Methods This study was conducted in a 400-bed not-forprofit, community-hospital in the Rocky Mountain region of the United States with a perioperative area conducting 6,800 surgeries/year in 11 inpatient ORs and an 18-bed PACU. Study approval was obtained from the institution’s investigational review board before data collection. Data collection was completed over an 8-month period.
Study Design An exploratory, descriptive design was used to identify the needs and experiences of patients and family members during the perioperative period. Variables of interest were patient and family member needs and experiences. Instruments SURVEY OF PATIENT NEEDS AND EXPERIENCES DURING THE PERIOPERATIVE PERIOD. Patient needs and experiences before coming to the hospital and during the perioperative period were rated on a patient needs survey completed on the first postoperative day (Table 1). The patient needs survey was a 26-item listing of perioperative patient needs derived from previously validated surveys4,13,15 with statements focused on needs related to information, physical comfort, communication, psychosocial support, and hospital staff competence/professionalism. Each need was rated on a four-level Likert scale about the importance of the need (very important [3], important [2], not important [1], not important at all [0]), as well as the patient’s experience with how well that need was met during the perioperative period (met [3], partly met [2], not met [0], do not remember [not scored]). Space was provided for additional comments or suggestions by the patient about each need item. Content validity was determined by six experienced perioperative nurses. Survey questions were revised for clarity and relevance to the surgical experience based on pilot testing with postoperative patients before hospital discharge. Time for survey completion was approximately 4 minutes. SURVEY OF FAMILY MEMBER NEEDS AND EXPERIENCES DURING THE PERIOPERATIVE PERIOD. Family member needs and experiences before coming to the hospital and during the perioperative period were rated on a family member needs survey completed on the day of surgery (Table 2). For this study, ‘‘family member’’ was defined as an individual designated by the patient as a family member, significant other, and/or close friend or acquaintance. The family member survey was a 19-item listing of selected perioperative family member needs derived from previously validated surveys,2,3,8 with statements focused on
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Table 1. Patients’ Average (±SD) Scores* for Importance of Perioperative Needs and How Often Those Needs Were Perceived to Have Been Met (N 5 68) Patient Need (Item Number Refers to Order in Original Survey)
Importance of Need
Time period: Before coming to the hospital 3. Having information on how your pain will be 2.77 6 0.49 managed during and after the surgery. 2.71 6 0.57 1. Having information about the surgical procedure itself (eg, how the surgery is done, complications, expected hospitalization time). 4. Having someone answer your questions 2.58 6 0.60 before you come to the hospital. 2.55 6 0.65 2. Having information about what to do on the day of surgery (eg, time to arrive, where to park, where to go in the hospital, what to bring). Time period: Day of surgery in preoperative surgical care area 2.75 6 0.47 3. Being treated with respect and with dignity by hospital personnel (eg, personnel protected your privacy and modesty, addressed you in a courteous manner, took time to understand and answer your questions). 2.74 6 0.47 1. Having information about the procedures for getting you ready for surgery (eg, admission assessment, starting an IV infusion, getting medications before surgery, movement by cart to the operating room). 8. Having your family member or significant 2.69 6 0.64 other with you in the presurgical area. 2.67 6 0.56 2. Being physically comfortable (bed, room temperature, noise and activity level in the room, management of your pain or other symptoms). 4. Having important information about you 2.68 6 0.56 communicated to hospital personnel before your admission. 7. Having opportunities to ask questions and 2.66 6 0.58 address concerns with hospital staff. 2.61 6 0.64 6. Having hospital staff reassure you about any fears/anxieties you might have related to your surgical experience. 5. Being informed about delays in the operating 2.45 6 0.66 room schedule. Time period: Day of surgery in operative room area 2.73 6 0.45 4. Having important information about you communicated to hospital personnel before your arrival in the operating room. 2.70 6 0.49 3. Being treated with respect and with dignity by hospital personnel (eg, personnel protected your privacy and modesty, addressed you in a courteous manner, took time to understand and answer your questions).
Rank Order of Need Importance in Each Time Period
Was Need Met?
1
2.94 6 0.39
2
2.89 6 0.40
3
2.94 6 0.25
4
2.90 6 0.17
1
3.00 6 0.0
2
3.00 6 0.0
3
3.00 6 0.00
4
2.99 6 0.12
5
2.90 6 0.43
6
2.98 6 0.13
7
2.98 6 0.13
8
2.85 6 0.64
1
2.93 6 0.40
2
2.93 6 0.53
(Continued )
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Table 1. Continued Patient Need (Item Number Refers to Order in Original Survey)
Importance of Need
Rank Order of Need Importance in Each Time Period
Was Need Met?
5. Having hospital staff reassure you about any fears/anxieties you might have related to your surgical experience. 6. Having opportunities to ask questions and address concerns with hospital staff. 2. Being physically comfortable (on bed, room temperature, noise and activity level around you). 1. Having information about the role of operating room staff (nurse, technician, anesthesiologist). Time period: Postanesthesia care unit area 3. Having your pain, nausea, and/or vomiting adequately managed by the recovery room staff. 1. Having information about your condition. 4. Being treated with respect and with dignity by hospital personnel (eg, personnel protected your privacy and modesty, addressed you in a courteous manner, took time to understand and answer your questions). 5. Having important information about you communicated to hospital personnel before your arrival in the recovery room. 2. Being physically comfortable (bed, room temperature, noise and activity level in the room). 7. Having opportunities to ask questions and address concerns with hospital staff. 6. Reassurance from hospital staff about fears/ anxieties related to the surgical experience. 8. Having your family member or significant other visit you in recovery room.
2.69 6 0.55
3
2.94 6 0.40
2.68 6 0.56
4
2.84 6 0.66
2.58 6 0.58
5
2.90 6 0.56
2.54 6 0.70
6
2.92 6 0.45
2.82 6 0.39
1
2.88 6 0.51
2.76 6 0.43 2.71 6 0.46
2 3 (tie)
2.90 6 0.49 2.95 6 0.39
2.71 6 0.49
3 (tie)
2.88 6 0.56
2.70 6 0.49
5 (tie)
2.85 6 0.58
2.70 6 0.55
5 (tie)
2.95 6 0.39
2.58 6 0.60
7
2.90 6 0.39
2.56 6 0.76
8
2.94 6 0.3
IV, intravenous; SD, standard deviation. *Range of importance scores were from 3 (very important) to 0 (not important at all); range for need met scores were from 3 (met) to 1 (not met).
needs related to information, physical comfort, communication, psychosocial support, and hospital staff competence/professionalism. Ratings of needs were done in the same format as the patient needs survey described previously. Space was provided for additional comments or suggestions by the family member about each need item. Content validity was determined by six experienced perioperative nurses. Survey questions were revised for clarity and relevance to the surgical experience based on pilot tested with family
members of postoperative patients. Time for survey completion was approximately 4 minutes. Sample Selection Two independent convenience samples of patients and family members were studied. Patient inclusion criteria included ability to speak and understand English, age $21 years, mentally competent and alert, postoperative patient on a surgical inpatient unit following an elective operative procedure, pain level , 5 on the numeric pain scale
PERIOP PATIENT AND FAMILY NEEDS
(0 5 no pain, 10 5 worst pain), and no postoperative stay in the intensive care unit. Family member inclusion criteria included family member, significant other, and/or close friend of the patient who was scheduled for elective surgery; ability to speak and understand English; age $21 years; mentally competent; and present in the hospital during the patient’s perioperative stay. Sample size was determined by review of prior patient and family needs surveys and a desire to survey at least as many individuals or more than prior studies.1,3,11,17 A minimum sample of 60 patients and 60 family members was determined in advance of data collection.
Study Procedure The following procedures were performed in this study: FAMILY MEMBER PARTICIPANTS. Potential participants for the family member needs survey were identified in the Surgical Family Room during the time the family member was in the OR and PACU. Family members who met the eligibility criteria had the study explained by one of the investigators and were given a written survey to complete. An investigator was present to answer any questions about the study or how to complete the survey. Completed surveys were placed in a sealed envelope by the participant before return to the investigator. Only one individual from each family was allowed to complete a family member survey. PATIENT PARTICIPANTS. Potential participants for the patient needs survey were identified from the list of surgical patients transferred from PACU to an inpatient surgical unit. On the day after surgery, patients who meet the eligibility criteria had the study explained by one of the investigators and asked if he/she wanted to participate in the study. Each consenting participant was given a survey to complete. The study investigator remained with the participant while he/ she completed the survey to answer questions and/or assist with survey completion if requested. Completed surveys were placed in a sealed envelope by the participant before being returned to the investigator.
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Data Analysis Descriptive statistics were used to summarize patients and family member needs. A rank order listing of patient and family member needs and how well those needs were met before hospital admission and during the perioperative period was based on the average score for each item and was determined for subjects in each category (patients, family member/significant others).
Results A total of 68 patients and 63 family members were surveyed over an 8-month period (Table 3). The average age of patients and family members was 62.3 (SD 5 616.8) and 52.9 (SD 614.7) years, respectively. The majority of participants were Caucasian, who had completed at least a community college or trade school educational program. Family member participants were most commonly the spouse or child of a surgical patient. The vast majority of patients and family members reported that they had received information before coming to the hospital about the time to arrive, where to park, and where the admissions area was located (Table 3). More than 85% of patients reported receiving information preoperatively about the types of items they should bring to the hospital as well as information on whether they should take their usual medications before coming to the hospital. Patients’ average scores for responses to the importance of each need statement and how well the need was met during the prehospital and perioperative period are summarized in Table 1. The top rated needs in each time period were the following: 1. before hospital admission: having information on how pain will be managed and about the surgical procedure itself; 2. presurgical care period: being treated with respect and dignity by hospital personnel and having information about procedures for operative preparation; 3. operative period: having important information communicated to OR staff before patient’s arrival in OR and being treated with respect and dignity by hospital personnel; and 4. postanesthesia care period: having pain, nausea, and vomiting adequately managed and having information about their condition. The lowest rated needs in each time period
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Table 2. Family Members’ Average (±SD) Scores* for Importance of Perioperative Needs and How Often Those Needs Were Perceived to Have Been Met (N 5 63) Family Member Need (Item Number Refers to Order in Original Survey)
Importance of Need
Rank Order of Need Importance in Each Time Period
Time period: Before coming to the hospital 1. Having information about the surgical procedure 2.81 6 0.39 itself (eg, how the surgery is done, complications, expected hospitalization time). 2. Having information about what to do on the day 2.60 6 0.52 of surgery (eg, time to arrive, where to park, where to go in the hospital, what to bring). 3. Having someone answer your questions before 2.59 6 0.52 you come to the hospital. Time period: Day of surgery in the preoperative area and during the operation 5. Having communication with the surgeon after 2.84 6 0.37 the procedure with consideration for privacy. 8. Having opportunities to ask questions and 2.83 6 0.38 address concerns with hospital staff. 2. Being with your family member/significant other 2.77 6 0.49 while they were in the preoperative surgical care area. 2.75 6 0.43 6. Being treated with respect and with dignity by hospital personnel (eg, personnel protected your privacy, addressed you in a courteous manner, took time to understand and answer your questions). 2.69 6 0.53 4. Having communication with operating room nurses about the patient’s condition during the surgical procedure. 7. Being informed about delays in the operating 2.67 6 0.54 room schedule. 2.57 6 0.56 1. Having information about the presurgical care procedures for getting the patient ready for surgery (eg, admission assessment, starting an intravenous infusion, getting medications before surgery, movement by cart to the operating room). 3. Being physically comfortable in the OR family 2.38 6 0.59 room area. Time period: Day of surgery in the postanesthesia care unit area 4. Having communication with the surgeon or other 2.82 6 0.39 physicians after the procedure with consideration for privacy. 7. Having opportunities to ask questions and 2.79 6 0.41 address concerns with hospital staff. 2.77 6 0.46 3. Having communication with recovery room nurses about the patient’s condition during the surgical procedure. 2.76 6 0.43 5. Being treated with respect and with dignity by hospital personnel (eg, personnel protected your privacy, addressed you in a courteous manner, took time to understand and answer your questions).
Was Need Met?
1
2.76 6 0.61
2
2.87 6 0.34
3
2.79 6 0.41
1
2.97 6 0.26
2
2.89 6 0.36
3
2.99 6 0.12
4
3.00 6 0.00
5
2.87 6 0.46
6
2.93 6 0.26
7
2.97 6 0.18
8
2.93 6 0.26
1
2.96 6 0.21
2
2.99 6 0.12
3
2.88 6 0.45
4
2.99 6 0.12
(Continued )
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Table 2. Continued Family Member Need (Item Number Refers to Order in Original Survey) 1. Visiting or being with your family member/ significant other while they were in the recovery room. 6. Being informed about when transfer to a regular hospital room would take place. 2. Being physically comfortable in the OR family room area.
Importance of Need
Rank Order of Need Importance in Each Time Period
Was Need Met?
2.69 6 0.47
5
2.84 6 0.52
2.61 6 0.58
6
2.94 6 0.31
2.49 6 0.58
7
2.91 6 0.33
OR, operating room; SD, standard deviation. *Range of importance scores were from 3 (very important) to 0 (not important at all); range for need met scores were from 3 (met) to 1 (not met).
were the following: 1. before hospital admission: having information about arrival time/where to park/what to bring; 2. presurgical care period: in-
formation about delays in OR schedule; 3. operative period: having information about the role of OR staff; and 4. postanesthesia care period: having
Table 3. Demographic Data and Characteristics of Patient and Family Member Participants Characteristics Age (y) Mean 6 (SD) Gender Female Male Ethnicity Caucasian Hispanic African-American Other Highest educational level completed Grade school High school Community college or trade school College Graduate school Received information before coming to the hospital on Time to arrive Where to park Location for admission Items to bring to hospital Information on taking your usual medications before coming to the hospital Location of OR family area Relationship to patient Parent Spouse Significant other Sibling Child Friend Other OR, operating room.
Patients (N 5 68)
Family Members (N 5 63)
62.3 6 16.8
52.9 6 14.7
39 30
29 34
60 7 1 1
52 9
5 16 16 22 9
1 22 11 18 11
64 47 (N 5 47) 58 (N 5 63) 54 (N 5 61) 54 (N 5 62)
2
61 61
62 3 28 1 7 17 2 5
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Table 4. Select Verbatim Comments Recorded by Patient or Family Members at the End of the Needs Survey Patients 1. The pre-op and OR staff was exceptional. Very personable and great sense of humor. Made me feel less anxious. 2. Wanted a more detailed diagram/picture of the procedure and materials of artificial components. 3. Level of education has nothing to do with wisdom or intelligence. 4. Needed extra blood, was done fast and thorough, made me feel at ease. 5. My nurse made me feel like I was her only patient, she attended to all my needs—I had a lot of pain. 6. I like the new policy of letting family or significant other into recovery as they can only sit and stew until they actually see the patient. Family members 1. I am so stressed out being a caregiver and also have my own health problems that the littlest thing seems like a mountain. 2. When I arrived in the waiting area a nurse liaison introduced herself and asked if we had any questions. That was greatly appreciated. 3. There was no sense of rush or bustle anywhere. This creates a sense of calm and reduces anxiety. This is the only hospital in my experience to convey this (both the patient and family were considered). 4. I was told it would be done at 11:00 (am) and she did not go in until 11:00 (am). Just a phone call would have been good because I had to run an errand while down here. 5. Patient is handled with dignity . instead of a part of a procedure. Very important to family that family room is kept well, good light, very clean. 6. Wish other family members would be allowed in PACU. 7. Your patient liaison is incredible. She is so caring, polite. 8. Each staff member has been professional as well as being friendly and supportive. I have been impressed with the procedure. 9. I was very pleased at the level of family centered care I received as the daughter of the patient. I expected excellent surgical and nursing care for her consistent with the previous care she has had at this facility, but I was very happy with the added services I received as a family member. Supporting the family helps us all to care for the patient. 10. Having to be in the hospital is traumatizing. It interrupts your routine. You’re unsure or maybe scared of the outcome of your visit or procedure and you’re exposed to language and terms you don’t understand. You feel a loss of control. Hospital staff can go a long way for alleviating these fears by being informative, interested in your concerns, answering questions so you understand what’s going on and in general showing that you understand it’s not easy. In a sense during the patients stay, you’re seen as somewhat of a hero. 11. The pre surgery treatment and info (information) on procedure was very comforting and helped to know what to expect. It followed thru (through) and made it easy to await reunion with friend. Thanks so much to all. OR, operating room; PACU, postanesthesia care unit.
a family member visit. Average scores for how well patient needs were met during the perioperative experience were high (.2.8) for all surveyed needs. Family members’ average scores for responses to the importance of each need statement and how well the need was met during the prehospital and perioperative period are summarized in Table 2. The top rated needs in each time period were the following: 1. before hospital admission: having information about the surgical procedure
itself; 2. presurgical care and operative period: having communication with the surgeon after the procedure and having opportunities to ask questions and address concerns with hospital staff; and 3. postanesthesia care period: having communication with the surgeon after the procedure with consideration for privacy and having opportunities to ask questions and address concerns with hospital staff. The lowest rated needs in each time period were the following: 1. before hospital admission: having someone to answer questions before coming to the hospital; 2. presurgical care
PERIOP PATIENT AND FAMILY NEEDS
and operative period: being physically comfortable in the operative family room; and 3. postanesthesia care period: being physically comfortable in the operative family room. Average scores for how well family member needs were met for the perioperative experience were high (.2.75) for all surveyed needs. Many patients and family members wrote in personal comments at the end of the survey tool. Selected comments are summarized in Table 4.
Discussion For both patients and family members, many of the highest rated needs during the perioperative period were related to information and communication. In addition, patients also highly rated needs relating to pain and/or nausea management and being treated with respect and dignity. Anecdotal comments by patients and family members further emphasized the importance of the highly ranked items on the survey. The need for information and communication with health care providers throughout the perioperative period is consistent with prior operative studies3,17 and parallels findings in the family members of critically ill patients.1,8-12 Since this is one of the first surveys to determine needs at various time periods throughout the perioperative experience, several findings are worthy of emphasis. In the period before coming to the hospital, patients’ highest rated needs were to have information about how their pain would be managed after surgery and how the surgical procedure itself would be done. Their lowest rated need was for information about logistics about arriving at the hospital. Family members’ ratings of information about the surgical procedure and hospital logistics were similar to patients’ ratings. When designing preoperative educational classes or written materials, providing content on pain management should be a priority, along with information about the surgical procedure itself. During the time the patient is in the preoperative area on the day of surgery, both patients and family members rated highly the need to be present with each other. This finding emphasizes the need to organize care routines and the physical environment in the presurgical preparation area to accom-
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modate family presence as much as possible. In our facility, family members were encouraged to remain with the patient until just before transfer to the OR. Another interesting finding of this study is related to PACU family visitation. During the time of the study, our PACU policy on family visitation was changed to allow one family member to visit stable patients for a short period of time. Based on extremely positive and enthusiastic feedback from family members after the policy change, we were surprised at the lower ratings both patients and family members gave to the item related to the importance of visiting in PACU. A prior study conducted in our unit on PACU visitation found significant reductions in family member anxiety after visitation, with very supportive anecdotal comments about the importance of PACU visitation by both experimental and control group members.18 The high ratings given by both patients and family members to be together during the time immediately before surgery is in contrast to their rating of this same need in PACU time period. From an organizational perspective, we were very pleased to find that the vast majority of patients and family members rated their needs as having been met. Average scores for whether a need was met were .2.9 on a three-point maximum scale for most of the needs in the survey. This survey provided much more specific information to the perioperative staff about customer satisfaction with care than had previously been available from the post discharge patient satisfaction survey used by the hospital. Study Limitations Findings of this study are limited by the demographics of the study sample, reflecting an educated sample of middle-aged Caucasian adults. While these demographics are reflective of the patient population in our facility in the Rocky Mountain region, patient and family needs may differ in younger and older populations, those with lower educational levels, and/or from different regions. Another limitation is that the patient and family participants were not necessarily related to each other. We did not attempt to have family member surveys completed for each patient survey completed. Since patients were not surveyed until
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the day after surgery, a final limitation is that patient recall of preoperative needs may not have been the same if we had surveyed them on the day of surgery. Recommendations for Clinical Practice, Education, and Research
presence of a family member in the PACU unit should be explored for units with and without a family visitation program to determine if our findings of lower priority scores were related to having that need met at a high level.
Conclusions
Highly rated needs in each of the perioperative phases should be taken into account when organizing and planning care delivery. For example, care routines and the physical environment in the presurgical preparation area should be organized to accommodate family presence as much as possible since this was a need rated highly by both patients and family members. Future research should examine patient and family needs in the discrete phases of the perioperative experience in a variety of different demographic groups. Determining the priority of the need for
This study ranked the priority of needs for patients and family members during each of the phases of the perioperative experience. Findings from this study will provide guidance for designing new programs and interventions to improve patient quality and satisfaction during the perioperative experience.
Acknowledgments Special thanks to Marianne Chulay, RN, PhD, FAAN, for assistance with study design, data analysis, and manuscript preparation.
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