Although the number of patients undergoing intermediate elective in-patient surgery is diminishing rapidly, such patients have an increased amount of time (relative to day surgery patients) in which to gain information and glean answers to questions to allay fears. Prior to a decrease in the amount of time patients now spend in hospital, timing of information provision did not therefore necessarily present as a problematic issue i.e. the days spent in hospital during the pre-operative phase were frequently utilised to educate the patient. However, as the length of hospital stay has fallen and the amount of elective day surgery has risen, the issue of timing of information provision has gained momentum.
According to Johnston (1980), following her study of 136 patients undergoing various types of surgery, increased anxiety is experienced many days and/ or weeks prior to surgery and for at least five to six days following surgery. On an
individual basis the exact time when anxiety begins and when it eventually falls has not been clearly established. Pre-operative anxiety is therefore not a minor, short-term emotional disturbance. It results from the rational fear of a serious life-threatening event and can last for many days/ weeks before and after surgery (Johnston 1980). Wallace (1987) interviewed 118 surgical patients who were requested to complete the State-Trait Anxiety Inventory (Spielberger et al 1983) during an out-patient visit and also prior to hospitalisation. An analysis of the results revealed elevated state anxiety scores six to eight weeks prior to surgery regarding their planned hospitalisation. If pre-operative anxiety does indeed begin in some patients many days/ weeks in advance of surgery and continue for many days afterwards, timing of information provision must be viewed as a challenging issue for day surgery. It must be regarded as a challenging issue for day surgery for two main reasons i) little time is available on the day of surgery for educational clarification, and ii) nurse/ patient and doctor/ patient contact in the pre and post-operative stages is very brief.
Christopherson and Pfeiffer (1980) conducted a study in which 41 patients undergoing cardiac surgery were either sent no information (group 1), an informational booklet 1 to 2 days prior to surgery (group 2) or an informational booklet 3 to 35 days prior to surgery (group 3). The level of patient anxiety and knowledge concerning surgery was measured using a self-rated questionnaire. Group 3 experienced the lowest anxiety pre-operatively and group 2 experienced the lowest anxiety post-operatively. However, this paradox may have arisen as a result of two design issues. Firstly, the exact time each
member of the two groups read the information can only be assumed. Many participants in group 3 could have received the information 3, 4 or 5 days prior to surgery and read it immediately. Many in group 2 who received the information booklet 2 days prior to surgery could have also read it immediately. The difference between receiving and reading information 3, 4, or 5 days prior to surgery and receiving and reading information 2 days prior to surgery may be indistinguishable. Secondly, the information booklet sent to participants in groups two and three was 16 pages long. From a practical viewpoint, patients in group 2 may not have had sufficient time to read the entire 16-page booklet 48 hours prior to surgery.
Schoessler (1989) conducted one of the earliest studies on preference for timing of information provision with regard to modern surgical practices i.e. patients admitted to hospital on the morning of surgery. Data were collected from 116 patients undergoing various surgical procedures and general anaesthesia. It was discovered that 50% of participants required information on admission, 41% wanted the information prior to admission and some merely wanted the information immediately prior to surgery. Furthermore, the information most requested prior to admission was psycho-social support i.e. how to cope on the day of surgery and afterwards at home. Yount and Schoessler (1991) compared the information from the above study (Schoessler 1989) with a survey employing 159 surgical nurses. The nurses agreed information should be provided prior to admission.
O'Hara et al (1989) following a comprehensive study of 1,420 undergoing various surgical procedures concluded anxiety was greatest the day of surgery and post-operatively had no sudden end. Indeed, 14% of participants reported high levels of psychological distress up to three months after surgery. Cupples (1991) studied patients undergoing cardiac surgery and compared one group provided with information 5 - 14 days prior to admission (experimental group) with a control group who received routine teaching on admission. In the post- operative period the experimental group had a greater level of knowledge, more positive self-reported mood states and increased physiological recovery. However, no differences were observed in anxiety levels even though, in comparison, the experimental group spent a far greater amount of time with the nursing staff.
Oberle et al (1994) surveyed 294 patients undergoing various surgical procedures. A large number of patients were dissatisfied with the timing of information provision as the bulk of it occurred on the ward immediately prior to surgery. It was concluded the majority of patients would have preferred to receive information prior to admission. Scriven and Tucker (1997) evaluated 184 leaflets collected from 97 hospitals, concerning one particular surgical technique - hysterectomy. Only 35% of the hospitals gave their available hospital leaflets at the optimum time i.e. prior to admission. Mitchell (1997) surveyed 150 patients undergoing minor gynaecological day surgery and general anaesthesia. Six percent stated they would have preferred to receive
the information a few months prior to surgery, 24% a few weeks prior to surgery, 48% a few days before surgery and 20% a few hours before surgery.