Joumal of Advanced Nursmg, 1992,17,1050-1056
Reducing distress during abortion: a test of sensory information Nancy Wells DNSc RN Chmcal Nurse Researcher, Shong Memonal Hosptial, Umverstty of Rochester, Medtcal Center Box HWH, Rochester, New York 14642, USA
Accepted for publicafaon 27 January 1992
WELLS N (1992) Journal of Advanced Nursmg 17,1050-1056 Reducing distress during abortion: a test of sensory information The purpose of this study was to exarrune the efifect of providmg sensory information on distress dunng first-tnmester abortion using a 2 x 2 factonal desiga The fadors were type of mformation given and type of anaesthesia used Eighty-four women completed pre-abortion measures of state anxiety, and subjechve pam and distress Post-abortion measures mcluded behaviourai distress, subjective distress, pam and state anxiety No significant differences were found for type of information (sensory vs general) received on subjective or behaviourai distress measures Women receivmg intravenous sedation together with local cervical block reported less subjechve distress and pain than women receiving local anaesthesia alone Sensory information was not effective m reducmg distress dunng abortion
ABORTIONS IN THE USA Aborhon is a frequently performed medical procedure, the number of legal aborhons m the Umted States reached 1 6 million m 1988 (Henshaw & Van Vort 1990) While the psychological efifects of abortion have been mveshgated (Rogers ei al 1989), less attention has been placed on controllmg pam-related distress assoaated with the procedure itself The few mtervenhon studies conducted m this pKjpulahon found bttle effect on pam-related distress dunng abortion for women mstmcted m cogmhve distrachon techniques such as relaxahon and imagery (Wells 1989) The purpose of this study was to examme the effect on distress of providing sensory mformahon m women undergomg aborhon dunng thefirsttnmester of pregnancy Tlieoretica] frameworic Emohonal responses to pam do not vary directly with tfie level of pam intensity reported The conceptual distmchon between pam, as a physical sensahon, and distress, as the negahve, unpleasant emohonal state that often accompames pam, has been suggested (e g Beecher 1959) 1050
The perceptual-motor theory of emohon proposes parallel, mterdependent pathways of processmg sensory and emotional expenences (Leventhal 1984, Leventhal & Bverhart 1979) The schema, m this theory, is a cogmtive structure m which knowledge is stored and new mformation is integrated Informahon processed along the sensory (also called the objective) pathway leads to an objechve representation of the antiapated event, whereas mformahon processed along the emotional pathway leads to an emohonally laden representahon of the anhapated expenence (Figure I) The processmg of sensahon of pam is reflected m the subject's report of pam intensity, whereas the processmg of emotion is reflected m degree of distress Distress has mulhple modes of expression, ltKludmg behaviour mdicatmg distress, physiological arousal and report of distress The perceptual-motor theory of emotion suggests that the provision of sensory mformahon may have benefiaal effects on distress expenenced duni^ aversive procedures, workmg by promotmg an objective rqjresentahon of the anhapated event That is, by mcreasmg objechve or neuh'al, accurate expectahons at the schematic level discrepancy between expectahons and actual expenerKe
Reduang distress dunng aborhon Figure 1 Parallel response model VAS=Visual analogue scale, DCL = Distress Checklist
Information processing
i=ocusof attention
Objective/ 8en8ory
Ob)ective representation
Emotional
Emotionai representation
will be reduced Thus attention will be focused away from emotionai representation and toward objective representation of the expenence This cogmhve process will dampen negative emotiorud response
REVIEW OF LITERATURE Sensory information Sensory mformahon provides the patient with concrete, objective (le non-emohonal) mformation about typical sensations (McHugh ei al 1982) This then promotes accurate expectations of the sensations that will be expenenced (Hartfield ei al 1982) Hence, sensory mformation minimizes the discrepancy between expected and exjjenenced physical sensations The theory does not predict a reduction m pam sensation with the provision of sensory mformation A meta-analysis by Suls & Wan (1989) indicates that sensory mformation is effective m reduang subjective distress, observer-rated distress and pam when compared to control mterventions The subjects m the studies used for this meta-analysis mcluded patients undergomg short diagnostic procedures, major surgery, and healthy mdividuals respondmg to expenmentally induced pam In studies of short diagnostic procedures, sensory mformation reduced subjechve reports of pam and/or distress (eg Hartfield ei al 1982, Watkms et al 1986), behavioural mdicators of distress (e g Johnson & Leventhal 1974, Fuller ei al 1978) and physiological mdicators of sympathetic arousal (Fuller et al 1978, Watkms ei al 1986) Sensory mformation has been found to reduce pam-related distress effectively in short medical procedures, where the duration of pam IS limited and full recovery is expected shortly after complehon of the procedure
State anxiety &tuahonal or state aruaety reflects an individual difference charactenstic (Spielberger 1972) that may mfluence
Outcome and measure
response to aversive medical procedures Anxiety has been related to surgical recovery (e g Auerbach 1973, Taenzer ei al 1986) and response to preparatory informahon Gohnson ei al 1978, Sime & Libera 1985) In the latter two studies, the patients with the highest levels of preoperahve anxiety or fear received the most benefit fi-om preparatory sensory information Abortion First-tnmester uncompbcated abortion is a short surgical procedure, lastmg 5 to 7 mmutes, associated with mild to moderate pam (Smith effl/ 1979, Wells 1991) Distress may cinse from the pam of the procedure, as hypothesized m the perceptual-motor theory, as well as from the abortion expenence itself In the bterature, distress assoaated with abortion has been op>erahonalized pnmanly as guilt, anxiety and depression (Rogers d al 1989) Despite the belief held by many health care professionals that abortion is psychologically dismphve (Baluk & O'Neill 1980), an extensive review of the bterature requested by then Surgeon General Koop (1989) revealed msuffiaent evidence to demonstrate that abortion was psychologically detnmental to women The few studies mcludmg prospective measurement of distress pre and post-aborhon mdicated a sigmficant reduchon m distress over time (Rogers ei al 1989) Thus, elevated distress (pnmanly depression) has been noted before aborhon, with substantial reductions withm the first few hours after the procedure Recently, Slomm-Nevo (I99I) reported on mterviews with 72 Israeb women just pnor to aborhon under general anaesthesia m a hospital settmg These women descnbed the difficulty m makmg the deasion to abort, once the decision had been made, the majonty (52%) felt the need for mformahon about the procedure The provision of concrete, objective mformation would fulfil this reported need 1051
N Welk The hypothesis, denved from the perceptual-motor theory of emohon (Leventhal 1984), was that the provision of sensory information would reduce distress m women undergomg first-tnmester abortion
responded to open-ended questions about their expenences dunng abortion and completed the McGill Pam Queshonnaire (Melzack 1975), which contams 78 verbal descnptors of pam, immediately after the procedure Nme sensations identified by over 50% of the subjects were METHOD mcorporated m a 3-mmute audio-taped message, which A 2 X 2 factonal design was used The first factor was the also included onentmg mformation For example, the sentype of information provided before the abortion The sations of pressure as the speculum was mserted, throbbmg expenmental subjects (M = 42) received sensory infor- dunng cervical dilation, and crampmg with suchon, were mation, and the control subjects (n = 42) received general mcluded in the sensory message The length of the interinformation The second factor was the type of anaesthesia vention tape was similar to preparatory messages given for used, local cervical block only (n = 41) administered to short dental and medical procedures (Mills & Krantz 1979, approximately half the women and intravenous (l v ) Auerbach ei al 1983), which were successful m reducing sedahon (diazepam and fentanyl) in addition to local cervi- procedural distress cal block (n = 43) to the remainder Based upon previous research (Wells 1990), women were expected to differ on General informatton reported pam intensity by type of anaesthesia State The general informahon message, of equal length, was anxiety was mduded as a moderahng vanable Subjects mduded to control for expenmenter attenhon It mcluded were randomly assigned to treatment condihon by type of information on the dime and mformation on the procedure This message provided some onentmg infonnahon, such as anaesthesia the similarity of the procedure room to an examinmg room, and reassurance that a medical tedimaan would be available Sample to assist them dunng the procedure No sensory mfonnahon Subjects were recmited from a free-standing pnvate was mduded m the general informahon message reproductive health dime m a metropobtan area of New England, USA Women were mcluded if they were (a) over the age of 18, and (b) able to read and understand Instruments Engbsh There was a high refusal rate amongst those asked Subjective dtsiress to parhapate Of the 94 women who agreed to parhapate, Subjective distress was measured on a visual analogue scale representmg a 25% acceptance rate, 84 had complete data (VAS) The VAS is a standard length bne, typically 10 cm, Subjects with mcomplete data mduded women who could with anchors at the extremes The anchors for subjective not undergo the procedure because of gestational age of distress were 'not bad at all' and 'most intense bad feelmg the fetus (« = 3), and lack of an observer dunng the pro- possible for me' Distress was defmed as the amount of cedure who was Ignorant of the type of mformahon bother or unpleasantness caused by the sensahons of pam received by the pahent (n = 7) A radio was used to explam how volume (l e mtensity) and The women ranged m age from 18 to 44 years, with a unpleasantness or distress may vary mdependently (Pnce mean of 26 4 years The majonty of women were smgle ei al 1983) Validity of the distress VAS as a measure of (60-7%), with 16 7% mamed, arnl the remamder either emotionai response was supported by significant correseparated or divorced Most of the women (53%) had at lahons with state anxiety and depression (Taenzer 1983) m least 1 year of college educahon Of the women reportmg a post-operahve samples religious affibahon (M = 69), the majonty were Catholic (48 8%) This was the first abortion for 32 (38 1%) of the Dtsiress Checklisi women, the remamder had had fi-om one to four previous The Distress Checklist (DCL) is a seven-item observahonal abortions One half of the sample had had no children checkbst tapping four categones of behavour — faaal or miscamages the other half reported havmg had one to expression, posture, vocalizahon and verbalization — SIX child births/miscamages There were 19 (22 6%) which are bebeved to be expressions of the expenence of distress (Wells 1990) Each behaviour is scored as present pnmiparas and 65 (77 4%) mulhparas m this sample or absent, with the sum of behaviours present producmg a InlervenUom DCL score Sensory mformaiion In pilot teshng, interrater rebabibty over five subjects The typical sertsaticms expenaiced durmg ^Torhon were reached 95% agreemoit, which is consistent with rqx>rts ldenhfied dunng a pilot study of 31 women These wonwn of hig^ mterrator rebabibty for similar observahonal
1052
Reducing distress dunng aborhon
measures (Fuller effl/ 1978) In a senes of 31 women undergomg first-tnmester abortion, mtemal consistency was 0-71 Validity was supported by the moderate to high correlations with self-reported and observer-rated distress m this pilot sample The DCL adequately discnmmated between women who received l v sedahon and those who received local anaesthesia (Wells 1990) Fain miensity The intensity of painful sensations was assessed using a 10cm VAS The anchors for pam mtensity were 'no sensation' and 'the most mtense sensation unaginable' Pam mtensity was descnbed as the intensity of the pamful sensations expenenced, using the volume of a radio as an example Clinically, the stability of successive measures is low because of the vanable nature of pain (Ziemer 1983) Vabdity of the intensity VAS has been supported by substantial correlahon with other measures of pam intensity (Scott & Huskisson 1976) Siaie anxieiy State ortion methodoiogicai and outcome summary of empinAuerijach SJvf (1973) Trait-state anxiety and adjustment to surcai research iwtween 1966 and 1988 Health Care for Women gery Joumal of Consultir^ and Clmical Psychology 40,264-2 71 Intematwnal 10, 347-376 Atterbach S M , Marteih M F & Mercun LG (1983) Anxiety, informahon, interpersonai impacts, and adjustment to a stress- Scott J & Huskisson E C (1976) Grapiuc representation of pain. Pam 2,175-184 fui iieaith care situation Joumal of Personality and Sociai Sime A M & Libiera M B (1985) Sensation informatioa seifPsychology 44,1284-1296 mstruction, and response to dentai surgery Research in Nursing Baiuk U & O'Nedi P (1980) Health professionals' percephon of and Health 6,41-47 tiie psychoiogicai consequences of ai>ortion Amencan Joumal Sionim-Nevo V (1991) The experience of women who face of Communtty F'sychtatry 8,67-75 aljortion Health Care for Women Intemattortal 12,283—292 BeecherHK {1959) Measurement of Subjective Responses Oxford Smith G M , Shibblefieid P G, Chirchiniio L & McCarthy M J Uruversity Press, New York. (1979) Pam of first-tnmester abortion its quantificahon and Fuiier S S , Endress M P & Johnson JE (1978) The efifects of reiahons with other vanabies Amencan Joumal of Obstetncs cognitive and isetiaviorai controi on coping with an aversive and Gynecology 133,489-498 heaith examination Joumal of Human Stress 4(4), 18-25 Hartfieid M T, Cason C L & Cason G L (1982) Effects of infor- SpieibergerCD (1972) Anxiety as an onohonai state In Anxiety Current Trends m Theory and Research voi I (Spieiberger C D mation aix}ut a tiireatening procedure on pahents' expeced), Academic Press, New Yoric pp 23—49 tahons and emohonai distress Nursing Research 31,202—206 Haishaw SK & Van Vort J (1990) Aborhon services in the Spieiberger C D , Gorsuch R.L, Lushene R E, Vagg P R & Jacobs G A (1983) Manual for the State-Tratt Anxiety Ini>entory (Form United States, 1987 and 1988 Family Planning Perspechves 22, Y) Consuitmg Psychoiogists Press, Paio Aito, Caiifomia 102-108 Suis J & Wan C K (1989) Effects of sensory and procedurai Hensiiaw SJC & Sdvennan J (1988) The charactenshcs and pnor information on coping with stressfid medicai procedures a contracephve use of VS aborhon pahei^s Family Planning meta-anaiysis Joumal of Consulting and Clinical Psychology 5 7, Perspectives 20,158-168 371-379 Jotinson J E & Leventiiai H (1974) Efifects of accurate expectahons and lT^iavioral mstruchon on reactions dunng a Taenzer P (1983) Postof>erahve pam relationsiiip among measures of pain, mood, and narcohc requir^ient In Pain noxious medicai exanunation. Joumal of Personality and Soaal Measurement and /Asessment (Meizack R ed), Raven, New Psychology 29, 710-718 Yoric pp 111-118 JoimsonJE &RiceVH (1974) Sensory and distress components of pain unphcations for tiie study of duucai pain Nurstng Taenzer P , Meizack R & Jeans M E (1956) Influence of psychoiogicai factors on postoperative pain, mood, and anaigesic Research 2 3 , 203-209 requirements Pam 24,331—342 Johnson J E, Fuiiar S 5 , Endress M P & Rice V H (1978) Aitermg Watkms L O , Weaver L & Odegaard V (1986) Preparation for patients' resjjonses to surgery an extension and rephcation cardiac cathetenzahon tadormg the content of instruction to Research tn Nursmg and Health 1,111-121 copmg styie Heart and Lung 15,382-389 KoopCE (1989) A measured response-Koop on aijorhon Family Weiis N (1989) Management of pam dunng abortion Joumal of Planmng Perspectives 2 1 , 31-32 Advanced Nursing 14,56—62 Leventhai H (1984) A perceptuai-motor theory of emohon In Advances in Expenmental Psychology voi 17 (Berkowitz L ed), Weiis N (1990) Beiiaviorai measurement of distress dunng pamfiii medical procedures In Measurement of Nurstng Outcomes, Academic Press, New Yoric, pp 117-182
vol 4 Measunng Client Self-Care cmd Copmg Shlls (Waltz C & Leventhal H & Everhart D (1979) Emotion, pain and physical Shiddand O eds), Spnnger, New Yoric, pp 250-266 lihiess In Emottom m Personality and Psychopathobgy (Izard C Weiis N (1991) Pain and Astress dunng aborhcHi HeidthCanfor ed). Plenum, New Ywk, pp 263-299 Women bitemattonel 12,293-302 McHugh N G , Chnstman N J & Johnson J E (1982) Pr^aratory mform^KMi. vAak iieips and M^y American Jmtmal of Nursmg Zietner M M (1983) ^fects of infcmnatKMi on postsurgicai 82,7S&-782. Nurang Research 32,282-287 W96
Reducing distress during abortion: a test of sensory information Nancy Wells DNSc RN Chmcal Nurse Researcher, Shong Memonal Hosptial, Umverstty of Rochester, Medtcal Center Box HWH, Rochester, New York 14642, USA
Accepted for publicafaon 27 January 1992
WELLS N (1992) Journal of Advanced Nursmg 17,1050-1056 Reducing distress during abortion: a test of sensory information The purpose of this study was to exarrune the efifect of providmg sensory information on distress dunng first-tnmester abortion using a 2 x 2 factonal desiga The fadors were type of mformation given and type of anaesthesia used Eighty-four women completed pre-abortion measures of state anxiety, and subjechve pam and distress Post-abortion measures mcluded behaviourai distress, subjective distress, pam and state anxiety No significant differences were found for type of information (sensory vs general) received on subjective or behaviourai distress measures Women receivmg intravenous sedation together with local cervical block reported less subjechve distress and pain than women receiving local anaesthesia alone Sensory information was not effective m reducmg distress dunng abortion
ABORTIONS IN THE USA Aborhon is a frequently performed medical procedure, the number of legal aborhons m the Umted States reached 1 6 million m 1988 (Henshaw & Van Vort 1990) While the psychological efifects of abortion have been mveshgated (Rogers ei al 1989), less attention has been placed on controllmg pam-related distress assoaated with the procedure itself The few mtervenhon studies conducted m this pKjpulahon found bttle effect on pam-related distress dunng abortion for women mstmcted m cogmhve distrachon techniques such as relaxahon and imagery (Wells 1989) The purpose of this study was to examme the effect on distress of providing sensory mformahon m women undergomg aborhon dunng thefirsttnmester of pregnancy Tlieoretica] frameworic Emohonal responses to pam do not vary directly with tfie level of pam intensity reported The conceptual distmchon between pam, as a physical sensahon, and distress, as the negahve, unpleasant emohonal state that often accompames pam, has been suggested (e g Beecher 1959) 1050
The perceptual-motor theory of emohon proposes parallel, mterdependent pathways of processmg sensory and emotional expenences (Leventhal 1984, Leventhal & Bverhart 1979) The schema, m this theory, is a cogmtive structure m which knowledge is stored and new mformation is integrated Informahon processed along the sensory (also called the objective) pathway leads to an objechve representation of the antiapated event, whereas mformahon processed along the emotional pathway leads to an emohonally laden representahon of the anhapated expenence (Figure I) The processmg of sensahon of pam is reflected m the subject's report of pam intensity, whereas the processmg of emotion is reflected m degree of distress Distress has mulhple modes of expression, ltKludmg behaviour mdicatmg distress, physiological arousal and report of distress The perceptual-motor theory of emotion suggests that the provision of sensory mformahon may have benefiaal effects on distress expenenced duni^ aversive procedures, workmg by promotmg an objective rqjresentahon of the anhapated event That is, by mcreasmg objechve or neuh'al, accurate expectahons at the schematic level discrepancy between expectahons and actual expenerKe
Reduang distress dunng aborhon Figure 1 Parallel response model VAS=Visual analogue scale, DCL = Distress Checklist
Information processing
i=ocusof attention
Objective/ 8en8ory
Ob)ective representation
Emotional
Emotionai representation
will be reduced Thus attention will be focused away from emotionai representation and toward objective representation of the expenence This cogmhve process will dampen negative emotiorud response
REVIEW OF LITERATURE Sensory information Sensory mformahon provides the patient with concrete, objective (le non-emohonal) mformation about typical sensations (McHugh ei al 1982) This then promotes accurate expectations of the sensations that will be expenenced (Hartfield ei al 1982) Hence, sensory mformation minimizes the discrepancy between expected and exjjenenced physical sensations The theory does not predict a reduction m pam sensation with the provision of sensory mformation A meta-analysis by Suls & Wan (1989) indicates that sensory mformation is effective m reduang subjective distress, observer-rated distress and pam when compared to control mterventions The subjects m the studies used for this meta-analysis mcluded patients undergomg short diagnostic procedures, major surgery, and healthy mdividuals respondmg to expenmentally induced pam In studies of short diagnostic procedures, sensory mformation reduced subjechve reports of pam and/or distress (eg Hartfield ei al 1982, Watkms et al 1986), behavioural mdicators of distress (e g Johnson & Leventhal 1974, Fuller ei al 1978) and physiological mdicators of sympathetic arousal (Fuller et al 1978, Watkms ei al 1986) Sensory mformation has been found to reduce pam-related distress effectively in short medical procedures, where the duration of pam IS limited and full recovery is expected shortly after complehon of the procedure
State anxiety &tuahonal or state aruaety reflects an individual difference charactenstic (Spielberger 1972) that may mfluence
Outcome and measure
response to aversive medical procedures Anxiety has been related to surgical recovery (e g Auerbach 1973, Taenzer ei al 1986) and response to preparatory informahon Gohnson ei al 1978, Sime & Libera 1985) In the latter two studies, the patients with the highest levels of preoperahve anxiety or fear received the most benefit fi-om preparatory sensory information Abortion First-tnmester uncompbcated abortion is a short surgical procedure, lastmg 5 to 7 mmutes, associated with mild to moderate pam (Smith effl/ 1979, Wells 1991) Distress may cinse from the pam of the procedure, as hypothesized m the perceptual-motor theory, as well as from the abortion expenence itself In the bterature, distress assoaated with abortion has been op>erahonalized pnmanly as guilt, anxiety and depression (Rogers d al 1989) Despite the belief held by many health care professionals that abortion is psychologically dismphve (Baluk & O'Neill 1980), an extensive review of the bterature requested by then Surgeon General Koop (1989) revealed msuffiaent evidence to demonstrate that abortion was psychologically detnmental to women The few studies mcludmg prospective measurement of distress pre and post-aborhon mdicated a sigmficant reduchon m distress over time (Rogers ei al 1989) Thus, elevated distress (pnmanly depression) has been noted before aborhon, with substantial reductions withm the first few hours after the procedure Recently, Slomm-Nevo (I99I) reported on mterviews with 72 Israeb women just pnor to aborhon under general anaesthesia m a hospital settmg These women descnbed the difficulty m makmg the deasion to abort, once the decision had been made, the majonty (52%) felt the need for mformahon about the procedure The provision of concrete, objective mformation would fulfil this reported need 1051
N Welk The hypothesis, denved from the perceptual-motor theory of emohon (Leventhal 1984), was that the provision of sensory information would reduce distress m women undergomg first-tnmester abortion
responded to open-ended questions about their expenences dunng abortion and completed the McGill Pam Queshonnaire (Melzack 1975), which contams 78 verbal descnptors of pam, immediately after the procedure Nme sensations identified by over 50% of the subjects were METHOD mcorporated m a 3-mmute audio-taped message, which A 2 X 2 factonal design was used The first factor was the also included onentmg mformation For example, the sentype of information provided before the abortion The sations of pressure as the speculum was mserted, throbbmg expenmental subjects (M = 42) received sensory infor- dunng cervical dilation, and crampmg with suchon, were mation, and the control subjects (n = 42) received general mcluded in the sensory message The length of the interinformation The second factor was the type of anaesthesia vention tape was similar to preparatory messages given for used, local cervical block only (n = 41) administered to short dental and medical procedures (Mills & Krantz 1979, approximately half the women and intravenous (l v ) Auerbach ei al 1983), which were successful m reducing sedahon (diazepam and fentanyl) in addition to local cervi- procedural distress cal block (n = 43) to the remainder Based upon previous research (Wells 1990), women were expected to differ on General informatton reported pam intensity by type of anaesthesia State The general informahon message, of equal length, was anxiety was mduded as a moderahng vanable Subjects mduded to control for expenmenter attenhon It mcluded were randomly assigned to treatment condihon by type of information on the dime and mformation on the procedure This message provided some onentmg infonnahon, such as anaesthesia the similarity of the procedure room to an examinmg room, and reassurance that a medical tedimaan would be available Sample to assist them dunng the procedure No sensory mfonnahon Subjects were recmited from a free-standing pnvate was mduded m the general informahon message reproductive health dime m a metropobtan area of New England, USA Women were mcluded if they were (a) over the age of 18, and (b) able to read and understand Instruments Engbsh There was a high refusal rate amongst those asked Subjective dtsiress to parhapate Of the 94 women who agreed to parhapate, Subjective distress was measured on a visual analogue scale representmg a 25% acceptance rate, 84 had complete data (VAS) The VAS is a standard length bne, typically 10 cm, Subjects with mcomplete data mduded women who could with anchors at the extremes The anchors for subjective not undergo the procedure because of gestational age of distress were 'not bad at all' and 'most intense bad feelmg the fetus (« = 3), and lack of an observer dunng the pro- possible for me' Distress was defmed as the amount of cedure who was Ignorant of the type of mformahon bother or unpleasantness caused by the sensahons of pam received by the pahent (n = 7) A radio was used to explam how volume (l e mtensity) and The women ranged m age from 18 to 44 years, with a unpleasantness or distress may vary mdependently (Pnce mean of 26 4 years The majonty of women were smgle ei al 1983) Validity of the distress VAS as a measure of (60-7%), with 16 7% mamed, arnl the remamder either emotionai response was supported by significant correseparated or divorced Most of the women (53%) had at lahons with state anxiety and depression (Taenzer 1983) m least 1 year of college educahon Of the women reportmg a post-operahve samples religious affibahon (M = 69), the majonty were Catholic (48 8%) This was the first abortion for 32 (38 1%) of the Dtsiress Checklisi women, the remamder had had fi-om one to four previous The Distress Checklist (DCL) is a seven-item observahonal abortions One half of the sample had had no children checkbst tapping four categones of behavour — faaal or miscamages the other half reported havmg had one to expression, posture, vocalizahon and verbalization — SIX child births/miscamages There were 19 (22 6%) which are bebeved to be expressions of the expenence of distress (Wells 1990) Each behaviour is scored as present pnmiparas and 65 (77 4%) mulhparas m this sample or absent, with the sum of behaviours present producmg a InlervenUom DCL score Sensory mformaiion In pilot teshng, interrater rebabibty over five subjects The typical sertsaticms expenaiced durmg ^Torhon were reached 95% agreemoit, which is consistent with rqx>rts ldenhfied dunng a pilot study of 31 women These wonwn of hig^ mterrator rebabibty for similar observahonal
1052
Reducing distress dunng aborhon
measures (Fuller effl/ 1978) In a senes of 31 women undergomg first-tnmester abortion, mtemal consistency was 0-71 Validity was supported by the moderate to high correlations with self-reported and observer-rated distress m this pilot sample The DCL adequately discnmmated between women who received l v sedahon and those who received local anaesthesia (Wells 1990) Fain miensity The intensity of painful sensations was assessed using a 10cm VAS The anchors for pam mtensity were 'no sensation' and 'the most mtense sensation unaginable' Pam mtensity was descnbed as the intensity of the pamful sensations expenenced, using the volume of a radio as an example Clinically, the stability of successive measures is low because of the vanable nature of pain (Ziemer 1983) Vabdity of the intensity VAS has been supported by substantial correlahon with other measures of pam intensity (Scott & Huskisson 1976) Siaie anxieiy State ortion methodoiogicai and outcome summary of empinAuerijach SJvf (1973) Trait-state anxiety and adjustment to surcai research iwtween 1966 and 1988 Health Care for Women gery Joumal of Consultir^ and Clmical Psychology 40,264-2 71 Intematwnal 10, 347-376 Atterbach S M , Marteih M F & Mercun LG (1983) Anxiety, informahon, interpersonai impacts, and adjustment to a stress- Scott J & Huskisson E C (1976) Grapiuc representation of pain. Pam 2,175-184 fui iieaith care situation Joumal of Personality and Sociai Sime A M & Libiera M B (1985) Sensation informatioa seifPsychology 44,1284-1296 mstruction, and response to dentai surgery Research in Nursing Baiuk U & O'Nedi P (1980) Health professionals' percephon of and Health 6,41-47 tiie psychoiogicai consequences of ai>ortion Amencan Joumal Sionim-Nevo V (1991) The experience of women who face of Communtty F'sychtatry 8,67-75 aljortion Health Care for Women Intemattortal 12,283—292 BeecherHK {1959) Measurement of Subjective Responses Oxford Smith G M , Shibblefieid P G, Chirchiniio L & McCarthy M J Uruversity Press, New York. (1979) Pam of first-tnmester abortion its quantificahon and Fuiier S S , Endress M P & Johnson JE (1978) The efifects of reiahons with other vanabies Amencan Joumal of Obstetncs cognitive and isetiaviorai controi on coping with an aversive and Gynecology 133,489-498 heaith examination Joumal of Human Stress 4(4), 18-25 Hartfieid M T, Cason C L & Cason G L (1982) Effects of infor- SpieibergerCD (1972) Anxiety as an onohonai state In Anxiety Current Trends m Theory and Research voi I (Spieiberger C D mation aix}ut a tiireatening procedure on pahents' expeced), Academic Press, New Yoric pp 23—49 tahons and emohonai distress Nursing Research 31,202—206 Haishaw SK & Van Vort J (1990) Aborhon services in the Spieiberger C D , Gorsuch R.L, Lushene R E, Vagg P R & Jacobs G A (1983) Manual for the State-Tratt Anxiety Ini>entory (Form United States, 1987 and 1988 Family Planning Perspechves 22, Y) Consuitmg Psychoiogists Press, Paio Aito, Caiifomia 102-108 Suis J & Wan C K (1989) Effects of sensory and procedurai Hensiiaw SJC & Sdvennan J (1988) The charactenshcs and pnor information on coping with stressfid medicai procedures a contracephve use of VS aborhon pahei^s Family Planning meta-anaiysis Joumal of Consulting and Clinical Psychology 5 7, Perspectives 20,158-168 371-379 Jotinson J E & Leventiiai H (1974) Efifects of accurate expectahons and lT^iavioral mstruchon on reactions dunng a Taenzer P (1983) Postof>erahve pam relationsiiip among measures of pain, mood, and narcohc requir^ient In Pain noxious medicai exanunation. Joumal of Personality and Soaal Measurement and /Asessment (Meizack R ed), Raven, New Psychology 29, 710-718 Yoric pp 111-118 JoimsonJE &RiceVH (1974) Sensory and distress components of pain unphcations for tiie study of duucai pain Nurstng Taenzer P , Meizack R & Jeans M E (1956) Influence of psychoiogicai factors on postoperative pain, mood, and anaigesic Research 2 3 , 203-209 requirements Pam 24,331—342 Johnson J E, Fuiiar S 5 , Endress M P & Rice V H (1978) Aitermg Watkms L O , Weaver L & Odegaard V (1986) Preparation for patients' resjjonses to surgery an extension and rephcation cardiac cathetenzahon tadormg the content of instruction to Research tn Nursmg and Health 1,111-121 copmg styie Heart and Lung 15,382-389 KoopCE (1989) A measured response-Koop on aijorhon Family Weiis N (1989) Management of pam dunng abortion Joumal of Planmng Perspectives 2 1 , 31-32 Advanced Nursing 14,56—62 Leventhai H (1984) A perceptuai-motor theory of emohon In Advances in Expenmental Psychology voi 17 (Berkowitz L ed), Weiis N (1990) Beiiaviorai measurement of distress dunng pamfiii medical procedures In Measurement of Nurstng Outcomes, Academic Press, New Yoric, pp 117-182
vol 4 Measunng Client Self-Care cmd Copmg Shlls (Waltz C & Leventhal H & Everhart D (1979) Emotion, pain and physical Shiddand O eds), Spnnger, New Yoric, pp 250-266 lihiess In Emottom m Personality and Psychopathobgy (Izard C Weiis N (1991) Pain and Astress dunng aborhcHi HeidthCanfor ed). Plenum, New Ywk, pp 263-299 Women bitemattonel 12,293-302 McHugh N G , Chnstman N J & Johnson J E (1982) Pr^aratory mform^KMi. vAak iieips and M^y American Jmtmal of Nursmg Zietner M M (1983) ^fects of infcmnatKMi on postsurgicai 82,7S&-782. Nurang Research 32,282-287 W96
