Relaciones interpersonales y rendimiento académico

Sedation. Seven (64%) patients received intravenous sedation for UGI endoscopy and two of these thought that the amount of sedation was just right, whereas one said that he would have referred more sedation. The remaining four (36%) patients had undergone this procedure with only a throat spray and were satisfied with this. Of those who received sedation five (71%) had no recollection of the procedure, whereas two (29%) patients were aware of the endoscopy tube in their throat or stomach.

Tw o (29%) patients of the seven who had received intravenous sedation said that they preferred to be sedated for future endoscopy procedures and would not consider only a throat spray. One (25%) of the patients who received a throat spray said that he may consider having an sedative injection on the next occasion, despite saying that he was satisfied with the throat spray on this occasion. The remaining eight (73%) of the eleven patients did not comment on future endoscopy examinations.

Patients' descriptions of the procedure. When asked how they would describe the procedure responses included: 'not painful' (1 patient, 9%), 'fairly uncomfortable, but not painful' (2 patients, 18%), 'unpleasant, but not sore' (1 patient, 9%) and 'uncomfortable' (1

patient, 9%) regardless of whether sedation was received. Only one (9%) patient described the procedure as 'painful', this patient also expressed a preference for more sedation. Three (27%) patients said that they were aware of the tube in their throat before the sedation took effect. Two (18%) patients has no recollection of endoscopy. No other procedural descriptions were given.

Patients' thoughts or feelings before or during the procedure. Seven (64%) patients undergoing a UGI endoscopy mentioned feeling 'nervous' or 'worried' about the procedure. Of these seven, three patients were worried about vomiting or gagging, and one added that he was worried that he "might push the camera up or something”. Four of the seven patients said that they were anxious before the procedure. One of these four compared it to waiting at the dentist and another added that she had a "fear o f not swallowing the tube"’, a third who was anxious before the procedure was concerned that she would have no choice regarding sedation, as she preferred not to be sedated, [expressed fear of swallowing the tube.] A further patient (9%) said that although he "felt panicky when the tube was being put down, it go t better and better and I wasn't worried at all". One (9%) patient was aware of the endoscopy tube, but was not bothered by it and another (9%) said that he felt as if he was choking when the tube was in his throat, but added that he was not worried. Only one (9%) patient, who had no recollection of the procedure, claimed not to be worried beforehand.

Patients' understanding of UGI endoscopy. Five (62.5%) out of eight patients who were asked about the information they received said that they were satisfied with it. One (12.5%) patient stated that the letter informing patients about the procedure indicated that the duration was 20 minutes, but in fact the procedure only lasted 2 or 3 minutes and another (12.5% ) suggested that people should be explicitly informed that it wasn't a large camera which was to be pushed into the stomach. One (12.5%) patient received no explanation before but would have liked some. Three patients were asked how others might be prepared for an UGI endoscopy. One stated, " ...you cannot really prepare someone fo r what's going to happen." Another patient suggested providing an information leaflet for those who want to read it, especially if they are having the procedure for the first time and the third said, "knowing that everyone is helpful and nice is a great help."

or 'relieved' that the procedure was over. A further three (27%) reported feeling 'drowsy' or 'drunk' immediately after the procedure and the rest said (46%) that they were 'fine'. On the whole patients were pleased with the staff, describing them as 'helpful' (4 patients, 36%), 'competent' (1 patient, 9%), 'pleasant' (1 patient, 9%), 'nice' (3 patients, 27%), 'great' (1 patient, 9%) or 'efficient and understanding' (1 patient, 9%).

Relaxation as psychological preparation. When the eleven patients were asked for their views about the use of a relaxation procedure four (36%) thought that it would help, although one of these wanted to confirm whether a painkiller would also be given; two (18%) said that a relaxation tape may act as distraction or a form of personal interaction and that it would be beneficial especially if patients had to wait for their medical procedure; three (27%) said that a relaxation tape would help those who are tense, although one of these said that she preferred sedation; and one (9%) patient thought that it was up to each person to relax in their own way and suggested that it would help if the waiting area was much quieter, although he added that the busy unit had provided him with distractions which he found helpful. One (9%) patient did not answer the question, but rather talked about other medical problems.

ERCP

Sedation. All patients received relatively high doses of sedation and consequently their recollection of the experience of ERCP was minimal.

Descriptions of ERCP experience. When the ten ERCP patients were asked what they could describe about their experience four (40%) said that they had no recollection and the remainder described at least one of the following events^: entering the room (2 patients), being instructed to adopt the particular position for the procedure (1 patient), the insertion of a mouth-piece (2 patients), oxygen being administered (1 patient) and, for three patients, the endoscopy tube being put in.

Patients' thoughts or feelings before or during the procedure. When asked about their

thoughts and feelings before the procedure three (30%) described themselves as feeling 'apprehensive', one (10%) as 'a little anxious' and another (10%) as 'worried beforehand'; one (10% ) said that she didn't like the thought of coming in to have this procedure; another (10% ) said that she did not have good thoughts before, because of a previous 'bad experience' and two (20%) said that they were not worried on this occasion, one of these added that he had been anxious before previous procedures. One (10%) patient who was extremely tired after the procedure asked for the interview to be brief and therefore was not asked this question. No patient described any thoughts or feelings experienced during the procedure, probably due to the higher dose of sedation and its amnesic properties.

Patients' understanding of ERCP. Four (40%) patients appeared to be satisfied with the explanations they received. Another (10%) patient said that a number of things were explained to him, and although he didn't hear a lot of what was said he was satisfied with amount of information he received. Two (20%) patients said they were happy with the information, although when shown the ERCP leaflet (supplied by Keymed; "Having an ERCP - a guide to the test") one said that she would have liked to have seen it before and the other, who was attending as a day case, said, "7 don't worry, I've had it done now. They explained everything to me at my own hospital." One (10%) patient wasn't sure that the provision of information would help her because she had previous experience of ERCP and had received the corresponding leaflet in the past. Another (10%) said that he trusted the doctors to do their best. Finally, one (10%) patient said that everyone explained it all so that he knew what to expect.

Patients' thoughts or feelings following ERCP. Five patients were asked about their thoughts/feelings after ERCP. Two (40%) were anxious to be informed of the outcome of the procedure or treatment. One (20%) patient who had been told the results of his ERCP was very happy with the results and two (40%) patients said that they were pleased that it was over. Four patients commented on the staff, all of which were favourable descriptions including 'helpful', 'competent' and 'very nice'.

Relaxation as psvchological preparation. Nine patients were asked whether a relaxation tape would help them or other patients to prepare for an ERCP. Two (22%) responded that a relaxation tape would help others, especially those undergoing the procedure for the first

time or if they are particularly anxious. Four (44%) patients said that a relaxation tape was a good idea, one in particular thought that some kind of distraction would be beneficial. Another (11%) thought that relaxation was a good idea, but wasn't particularly interested in listening to a tape. One (11%) patient wasn't sure about such tapes and added that she didn't want to criticise staff in any way. Finally, one (11%) patient replied that she didn't worry.

8.2.4 Discussion