Perioperative stress experiences of patients before surgical operation: A phenomenological study





Abstract


Aim


The aim of this study was to evaluate patients’ experiences of perioperative stress before surgery using a phenomenological approach.


Design


In the study, in which phenomenological research method was used, semi- structured in-depth interviews were conducted with 12 patients who were treated in the orthopedics clinic.


Method


Criterion sampling method, one of the purposive sampling methods, was used to reach the sample group. Interviews continued until data saturation was achieved. All interviews were recorded on a voice recorder after obtaining the necessary permissions and then transcribed. The data of the study were evaluated using thematic analysis. The study was conducted and reported according to the COREQ checklist.


Results


In the analysis of the data, three main themes (situations experienced before the surgical operation, feelings and thoughts about the operating room, and perioperative stress and thoughts about healthcare professionals) and seven sub-themes (mental, physical, social, emotions, thoughts, positive thoughts and negative thoughts) were identified.


Conclusion


It was found that patients experienced many psychosocial difficulties, especially fear and anxiety, in the preoperative period. It can be said that the difficulties experienced are related to both the surgical process and the operating room environment and the communication and interaction of healthcare professionals. In this context, determining the fear and anxiety levels of patients in the preoperative process, providing standardized comprehensive trainings to patients in order to prevent different practices related to the surgical process, organizing in-service trainings to strengthen the communication skills of healthcare professionals are very important for the healthy management of the process and providing holistic nursing care.


1


Introduction


Preoperative care is the preparations and practices made before surgery to make physical and psychological preparations, taking into account the special needs of the patient. This process starts with the patient’s admission to the surgical clinic and continues with physiological preparation. Hearing that surgery will be performed causes preoperative anxiety in individuals. The main causes of anxiety in surgical patients may be fear of the unknown, fear of death or inability to wake up after anesthesia, loss of control, pain, isolation, separation from loved ones and social withdrawal. For this reason, in addition to preoperative physical preparations, reducing the emotional stress experienced by surgical patients should also be included in nursing practices.


2


Background


The importance of preoperative psychological support or prehabilitation, a new concept, has attracted attention in recent years. Although the importance of prehabilitation was reported in the literature in the 1940s, the role of prehabilitation in improving postoperative outcomes has only been investigated since 2000. Several weeks may pass between the decision to operate and the actual surgery. This is a controllable process, referred to as a “teachable moment”. Various practices implemented during this period can psychologically relax patients by providing a distracting approach, thereby significantly contributing to early postoperative recovery. The term stress is sometimes used interchangeably with anxiety in the context of preoperative psychological health. However, stress refers to a different state that generates a physiological response that should not be confused with anxiety. During the preoperative stress period catecholamines released from the sympathetic nervous system, cortisol released from the adrenal cortex, suppressed immune system are expressed as a pathophysiological process with the stress response that occurs in the individual against the surgical situation. , In the literature, it has been reported that proper preoperative anxiety management has a positive effect on factors such as pain perception, analgesic use, sleep quality, and intestinal motility in postoperative patients.


Preoperative anxiety is not always systematically discussed with patients before surgery. It is therefore important to consider the phrases patients use to describe their preoperative thoughts. Patients may use different words or phrases to describe their anxiety, such as being worried, anxious, unable to sleep, or constantly thinking about surgery or anaesthesia. In the scientific literature, the word “anxiety” is used more frequently than “worry”; similarly, in Turkish, patients use the word “worry” to describe their preoperative anxiety. Ensuring patient comfort is one of the indicators of quality of care. Evaluation of perioperative experiences and implementation of appropriate practices for patient care thus affect the quality of care.


When the literature studies on the examination of preoperative experiences were examined, it was determined that there were a limited number of qualitative studies on the subject. For this reason, in this study, it is aimed to determine the anxieties of patients who will undergo orthopaedic surgery and what they are anxious about and their thoughts.


3


The study


3.1


Aim


The aim of this study was to evaluate patients’ experiences of perioperative stress before surgery using a phenomenological approach.


4


Methodology


Phenomenological (phenomenological) research design, one of the qualitative research methods, was used in the study. Throughout this study, the authors followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) ( Table 1 ).



Table 1

Combined criteria for reporting qualitative research (COREQ).







































Area 1: Research team and reflexivity
Personal Characteristics
Number Item Guiding questions Explanations
1 Interviewer/facilitator Which author/authors conducted the interview or focus group? The first author conducted the interview .
2 Identity information What were the credentials of the researcher? First author PhD Second author PhD
Third author PhD
3 Profession What was their occupation at the time of the study? First author Dr. Surgical Nursing
Second author Dr. Psychiatric Nursing
Third author Dr. Psychiatric Nursing
4 Gender Was the researcher a man or a woman? Three researchers Women
5 Experience and training What experience or Training did the researcher have? The first author has taken courses on qualitative research. Second author: has taken qualitative courses, The third author has taken qualitative courses, has experience in qualitative research and has published qualitative studies in international journals.






















Relationship with participants
6 Relationship status Was a relationship established before the training started? No relationship was established before the start of the study.
7 Interviewer’s participant knowledge What did participants know about the researcher? Individuals knew that the researcher had a doctorate in surgical diseases nursing
8 Interviewer characteristics What characteristics were reported about the interviewer/facilitator? At the beginning of each interview, participants were informed about the purpose and
objectives of the study.














Area 2. Study design
Theoretical framework
9 Methodological orientation and Theory Which methodological orientation was specified to support the study, e.g. discourse analysis, ethnography, phenomenology, content analysis? This is a qualitative study.



























Participant selection
10 Sampling How were the participants selected? Criterion sampling method, one of the purposive sampling methods, was used.
11 Approach method How were the participants approached? The timing of the interviews was determined by the individuals who voluntarily agreed to participate in the study.
12 Sample size How many participants were there in the study? A total of 12 individuals were included in the study.
13 Disagree How many people refused to participate or dropped out?
Reasons?		 There were no individuals who refused to participate in the study.






















Setting
14 The setting of data collection Where was the data collected? Detailed information is provided in the data collection section of the study.
15 Presence of non- participants Was there anyone else present apart from the participants and the researchers? There were no observers.
16 Description of the sample What are the important characteristics of the sample? Individuals who agreed to participate in the study were included in the study.










































Data collection
17 Interview guide Were questions, prompts and guidelines provided by the authors? Has it been pilot tested? Detailed information is given in the Methods section.
18 Repeat interviews Have there been re-interviews? If yes, how many? No.
19 Audio/visual recording Was audio or visual recording used to collect data in the study? The interviews were recorded with a voice recorder.
20 Field notes Were field notes taken during and/or after the interview or focus group? The responses of all individuals and the researcher’s observations were recorded.
21 Duration How long were the interviews or focus groups? Each interview lasted between 30 and 40 min.
22 Data saturation Has data saturation been discussed? Data saturation is discussed.
23 Transcripts returned Have transcripts been returned to participants for comments and/or corrections? No.
































Area 3: Analysis and findings
24 Number of data coders How many data coders coded the data? Three researchers coded the data.
25 Identification of data Did the authors define coding? The headings and subheadings in the results section represent the final coding.
26 Derivation of themes Were the themes predetermined or derived from the data? Themes were derived from the data.
27 Software What software, if any, was used to manage the data? Data were analyzed manually.
28 Participant control Did participants provide feedback on the findings? No.



























Reporting
29 Quotes provided Are participant quotes presented to illustrate themes/findings? Is each quote identified, e.g. participant number Conclusion. Participant quotes are provided to illustrate themes/findings. For example, participant number.
30 Data and findings consistent Was there consistency between the data presented and the findings? Yes
31 Clarity of main themes Are the main themes clearly presented in the findings? Yes
32 Clarity of small themes Is there an explanation of the different cases or a discussion of minor issues? Yes


4.1


Study design


This study was conducted between May 2024 and June 2024 using an inductive qualitative design. Semi-structured in-depth interviews were conducted with 12 patients treated in the orthopedic clinic of a public hospital in a province in northern Türkiye.


4.2


Research team and reflexivity


All three members of the research team are active faculty members in nursing schools. Two of the researchers have a doctorate in psychiatric nursing and one in surgical nursing. All three had experience working as clinical nurses in hospitals and all three were trained in qualitative research methods.


4.3


Study group


Criterion sampling method, which is one of the purposeful sampling methods, was used to determine the study group of the research. Criterion sampling is the sampling of people, events, objects or situations that have the qualities determined for the problem. , Semi-structured in-depth interviews were conducted with 12 patients receiving treatment in the orthopedics clinic of a state hospital in a province in northern Türkiye. The interviews continued until the data were repeated and were terminated when data saturation was reached by interviewing 12 individuals.


4.4


Participants


4.4.1


Inclusion criteria




  • •

    Being an in patient in orthopedics service


  • •

    To undergo surgical intervention,


  • •

    Being open to communication,


  • •

    Voluntary participation in the research



4.4.2


Exclusion criteria


Having a language, speech or hearing impairment that prevents communication


4.5


Data collection tools


In the study, a “Descriptive Information Form” consisting of questions about the demographic characteristics of the patients and a “Semi-structured Interview Form” including interview questions to determine patient experiences were used.


The interviews were conducted in an environment where only the participant and the researcher were present after the written and verbal consent of the people participating in the research was obtained, with a seating arrangement at a ninety-degree angle, with the help of a semi-structured interview form in the form of active listening, using the rapid note-taking technique. During the interview, the interview was recorded using a voice recorder with the knowledge, verbal and written consent of the participant.


4.5.1


Introductory information form


Introductory information form was developed by the researcher from the literature It was prepared in line with the knowledge and consists of 5 questions.


4.5.2


Semi-structured interview form


In line with the aim of the research, the form is based on the relevant literature information was utilized in this study. The semi-structured interview form consists of supportive subsidiary questions to examine the main topics to be used when necessary (participant keeping silent, going off topic, etc.) about the perioperative stress experiences of the patients before the surgical operation. The questions in the form are presented below;



  • 1-

    What does worry mean to you? How do you define it? How do you react when you worry and what do you do to reduce your worry? What are your experiences in this regard?


  • 2-

    Did you have any concerns when the decision for surgery was made, did any individual or healthcare professionals talk to you to reduce your concerns, if so, who was it and what did they say?


  • 3-

    Can you tell us if you were worried when you came to the surgical ward for hospitalization? Can you describe what the operating room is like? What are your experiences in this regard?


  • 4-

    What is the biggest thing that scares you during the surgical procedure and can you express the severity of the fear with a number?



4.6


Validity and reliability of the study


Lincon and Guba’s (1985) four basic criteria were taken into consideration in order to try to keep the credibility level of the research high. In order to see whether the research meets the criteria of credibility (creadibility), the results obtained as a result of the analysis of the interviews will be shared with two of the participants with a high level of education and participant approval was obtained. In order to achieve the transferability criterion to ensure that the findings can be used in other contexts, detailed information about the characteristics of the participants and the place where the research was conducted was provided. In this respect, it is thought that other researchers can reach similar results with similar participants in similar environments. In order to reach the dependability criterion, detailed information about the research process was provided. In line with the confirmability criteria, quotations from the participants’ own statements were given in the study results before the analysis. In order to increase internal reliability, especially the codes were given independently by three researchers. In order to increase internal validity, opinions were obtained from 4 experts in the field for the research questions


4.7


Data analysis


In the analysis of the qualitative data obtained from the interviews, the 7-step analysis method developed by Colaizzi (1978) for phenomenological studies was used. In this context, the interview texts were first read independently and repeatedly by three researchers. Thus, it was tried to understand what was explained in the data. Important statements in the interview texts were selected, reorganized and expressed in general terms. Then, the data that were tried to be explained in the statements were identified and analyzed.


The researchers formulated and validated the meanings by discussing them until they reached a consensus. The researchers then identified and organized the themes into main and sub-themes. The themes and sub-themes of the study were developed through clear articulation. In addition, participants’ statements were included so that the reader could verify the interpretation and analysis of the data.


4.8


Ethical statement


This research was approved by XXX University Scientific Research and Publication Ethics Committee (Date:22/04/2024, No:2024/4, E-95674917–108.99–248167). Informed consent was obtained from the participants before starting the interview. Recordings and transcripts were stored on a password- protected device. The study was conducted in accordance with the Declaration of Helsinki and the ethical standards of the National Research Committee.


5


Results


Six of the individuals included in the study were women. In addition, eight of the participants were married. Demographic characteristics of the individuals participating in the study are presented in Table 2 . As a result of the analysis of the data obtained from the semi-structured interviews, themes, sub-themes and codes were identified ( Table 3 ).


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May 22, 2025 | Posted by in ANESTHESIA | Comments Off on Perioperative stress experiences of patients before surgical operation: A phenomenological study

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